ATI PN Adult Medical Surgical (Med-Surg)
2023 Proctored Exam with NGN 100
Questions and Answers Latest Update 2026
1. 1. NGN Priority — Sepsis
A client with pneumonia received IV fluids and antibiotics 2 hr ago. The
client is now restless. Findings: T 39.1°C, HR 132/min, RR 32/min, BP
84/48 mmHg, urine output 15 mL/hr, lactate 4.8 mmol/L. Which finding
most strongly indicates progression to shock?
A. Temperature 39.1°C
B. Heart rate 132/min
C. Blood pressure 84/48 mmHg with oliguria
D. Respiratory rate 32/min
Answer: C
Rationale: Hypotension with oliguria indicates inadequate organ perfusion
and is more concerning for shock than fever or tachycardia alone.
2. 2. SATA — Sepsis
Which actions should the nurse anticipate for this client? Select all that
apply.
A. Obtain cultures as ordered without unnecessarily delaying antibiotics
B. Administer prescribed broad-spectrum antibiotics
C. Monitor urine output closely
D. Restrict all IV fluids
E. Trend lactate and hemodynamic status
Answer: A, B, C, E
,Rationale: Sepsis management emphasizes timely antimicrobials, cultures
when indicated, perfusion assessment, fluid resuscitation as prescribed,
and trending markers such as lactate.
3. 3. Trend — COPD
A client with COPD has ABGs trending from pH 7.36/PaCO2 52 to pH
7.29/PaCO2 64 mmHg. The client becomes drowsy. Which interpretation is
best?
A. Improving compensated respiratory acidosis
B. Worsening ventilatory failure
C. Metabolic alkalosis
D. Normal chronic COPD finding
Answer: B
Rationale: Falling pH with rising PaCO2 indicates acute worsening
respiratory acidosis and hypoventilation; drowsiness is a dangerous
clinical change.
4. 4. Priority — COPD
Which prescription should the nurse question for a drowsy client with
COPD and worsening hypercapnia?
A. Continuous pulse oximetry
B. Repeat ABG
C. Sedative medication without additional respiratory assessment
D. Respiratory therapy evaluation
Answer: C
Rationale: Sedatives can worsen respiratory depression and carbon-
dioxide retention in a client already showing ventilatory failure.
5. 5. NGN Bow-Tie — Pulmonary Embolism
,A postoperative client suddenly develops pleuritic chest pain, dyspnea, HR
128/min, RR 30/min, and SpO2 82%. Identify the most likely condition, the
priority action, and two parameters to monitor.
Condition: Pulmonary embolism
Action: Support oxygenation and urgently notify/activate the appropriate
response
Monitor: oxygen saturation and hemodynamic status
Answer: Pulmonary embolism; support oxygenation/urgent
escalation; monitor oxygenation and hemodynamics
Rationale: The abrupt postoperative presentation is highly concerning for
PE. Immediate stabilization and escalation are priorities.
6. 6. SATA — Heart Failure
A client with HFrEF has a 2.5-kg gain in 3 days, orthopnea, crackles, and
potassium 3.0 mEq/L while taking a loop diuretic. Which findings/actions
require attention? Select all that apply.
A. Assess response to prescribed diuretic therapy
B. Monitor potassium
C. Place the client flat
D. Assess oxygenation and respiratory effort
E. Review intake and output
Answer: A, B, D, E
Rationale: Rapid weight gain and pulmonary findings indicate fluid
congestion. Loop diuretics can worsen hypokalemia, while positioning flat
can increase dyspnea.
7. 7. Pharmacology — Furosemide
, Which finding in a client receiving IV furosemide requires the most
immediate follow-up?
A. Potassium 2.7 mEq/L with ventricular ectopy
B. Urine output 900 mL/8 hr
C. Decreased ankle edema
D. Weight loss of 0.5 kg
Answer: A
Rationale: Severe hypokalemia with ventricular ectopy creates an
immediate dysrhythmia risk.
8. 8. ACS
A client with suspected acute coronary syndrome reports crushing
substernal pressure and diaphoresis. Which finding would make the nurse
most concerned about cardiogenic shock?
A. BP 78/46 mmHg with cool clammy skin
B. Pain rated 8/10
C. HR 104/min
D. Mild nausea
Answer: A
Rationale: Severe hypotension with cool clammy skin indicates impaired
cardiac output and systemic perfusion.
9. 9. ECG
A client has potassium 6.8 mEq/L. Which ECG change should the nurse
recognize as an early warning of hyperkalemia?
A. Peaked T waves
B. Prominent U waves
C. Prolonged QT only
2023 Proctored Exam with NGN 100
Questions and Answers Latest Update 2026
1. 1. NGN Priority — Sepsis
A client with pneumonia received IV fluids and antibiotics 2 hr ago. The
client is now restless. Findings: T 39.1°C, HR 132/min, RR 32/min, BP
84/48 mmHg, urine output 15 mL/hr, lactate 4.8 mmol/L. Which finding
most strongly indicates progression to shock?
A. Temperature 39.1°C
B. Heart rate 132/min
C. Blood pressure 84/48 mmHg with oliguria
D. Respiratory rate 32/min
Answer: C
Rationale: Hypotension with oliguria indicates inadequate organ perfusion
and is more concerning for shock than fever or tachycardia alone.
2. 2. SATA — Sepsis
Which actions should the nurse anticipate for this client? Select all that
apply.
A. Obtain cultures as ordered without unnecessarily delaying antibiotics
B. Administer prescribed broad-spectrum antibiotics
C. Monitor urine output closely
D. Restrict all IV fluids
E. Trend lactate and hemodynamic status
Answer: A, B, C, E
,Rationale: Sepsis management emphasizes timely antimicrobials, cultures
when indicated, perfusion assessment, fluid resuscitation as prescribed,
and trending markers such as lactate.
3. 3. Trend — COPD
A client with COPD has ABGs trending from pH 7.36/PaCO2 52 to pH
7.29/PaCO2 64 mmHg. The client becomes drowsy. Which interpretation is
best?
A. Improving compensated respiratory acidosis
B. Worsening ventilatory failure
C. Metabolic alkalosis
D. Normal chronic COPD finding
Answer: B
Rationale: Falling pH with rising PaCO2 indicates acute worsening
respiratory acidosis and hypoventilation; drowsiness is a dangerous
clinical change.
4. 4. Priority — COPD
Which prescription should the nurse question for a drowsy client with
COPD and worsening hypercapnia?
A. Continuous pulse oximetry
B. Repeat ABG
C. Sedative medication without additional respiratory assessment
D. Respiratory therapy evaluation
Answer: C
Rationale: Sedatives can worsen respiratory depression and carbon-
dioxide retention in a client already showing ventilatory failure.
5. 5. NGN Bow-Tie — Pulmonary Embolism
,A postoperative client suddenly develops pleuritic chest pain, dyspnea, HR
128/min, RR 30/min, and SpO2 82%. Identify the most likely condition, the
priority action, and two parameters to monitor.
Condition: Pulmonary embolism
Action: Support oxygenation and urgently notify/activate the appropriate
response
Monitor: oxygen saturation and hemodynamic status
Answer: Pulmonary embolism; support oxygenation/urgent
escalation; monitor oxygenation and hemodynamics
Rationale: The abrupt postoperative presentation is highly concerning for
PE. Immediate stabilization and escalation are priorities.
6. 6. SATA — Heart Failure
A client with HFrEF has a 2.5-kg gain in 3 days, orthopnea, crackles, and
potassium 3.0 mEq/L while taking a loop diuretic. Which findings/actions
require attention? Select all that apply.
A. Assess response to prescribed diuretic therapy
B. Monitor potassium
C. Place the client flat
D. Assess oxygenation and respiratory effort
E. Review intake and output
Answer: A, B, D, E
Rationale: Rapid weight gain and pulmonary findings indicate fluid
congestion. Loop diuretics can worsen hypokalemia, while positioning flat
can increase dyspnea.
7. 7. Pharmacology — Furosemide
, Which finding in a client receiving IV furosemide requires the most
immediate follow-up?
A. Potassium 2.7 mEq/L with ventricular ectopy
B. Urine output 900 mL/8 hr
C. Decreased ankle edema
D. Weight loss of 0.5 kg
Answer: A
Rationale: Severe hypokalemia with ventricular ectopy creates an
immediate dysrhythmia risk.
8. 8. ACS
A client with suspected acute coronary syndrome reports crushing
substernal pressure and diaphoresis. Which finding would make the nurse
most concerned about cardiogenic shock?
A. BP 78/46 mmHg with cool clammy skin
B. Pain rated 8/10
C. HR 104/min
D. Mild nausea
Answer: A
Rationale: Severe hypotension with cool clammy skin indicates impaired
cardiac output and systemic perfusion.
9. 9. ECG
A client has potassium 6.8 mEq/L. Which ECG change should the nurse
recognize as an early warning of hyperkalemia?
A. Peaked T waves
B. Prominent U waves
C. Prolonged QT only
