Latest ATI Adult Medical-Surgical NGN-Style Practice Exam with case
study plus rationales and verified answers
1. A client with heart failure reports increasing shortness of breath and has crackles
throughout both lung fields. The oxygen saturation is 86% on room air. What is the nurse’s
priority action?
A. Encourage oral fluids
B. Place the client in high-Fowler’s position
C. Obtain the client’s daily weight
D. Administer a prescribed potassium supplement
Answer: B. Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning promotes lung expansion and decreases venous return,
helping improve oxygenation in acute pulmonary congestion.
2. A client receiving IV furosemide has a potassium level of 2.9 mEq/L. Which finding
should the nurse recognize as most concerning?
A. Increased urinary frequency
B. Muscle weakness
C. Mild thirst
D. Blood pressure of 118/72 mm Hg
Answer: B. Muscle weakness
Rationale: Hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias. The nurse should promptly report significant hypokalemia.
Case Study 1 — Acute Respiratory Deterioration
A 68-year-old client with COPD is admitted with worsening dyspnea. The client is restless and
anxious. Assessment reveals:
• Respiratory rate: 30/min
• Oxygen saturation: 84%
• Heart rate: 112/min
• Temperature: 37.8°C (100°F)
• Diminished breath sounds bilaterally
• Increasing use of accessory muscles
,3. Which findings require immediate nursing intervention? Select all that apply.
A. Oxygen saturation of 84%
B. Respiratory rate of 30/min
C. Use of accessory muscles
D. Temperature of 37.8°C
E. Restlessness and anxiety
Answer: A, B, C, E
Rationale: Severe hypoxemia, tachypnea, accessory-muscle use, and altered behavior can
indicate worsening respiratory failure. These findings require prompt intervention.
4. Which action should the nurse take first?
A. Encourage the client to increase oral fluids
B. Position the client upright
C. Obtain a sputum culture
D. Place the client supine
Answer: B. Position the client upright
Rationale: Upright positioning maximizes diaphragmatic expansion and improves ventilation.
Airway and breathing take priority.
5. The provider prescribes oxygen therapy. Which nursing action is appropriate for a client
with COPD?
A. Administer oxygen as prescribed and monitor response
B. Withhold oxygen because it suppresses respiratory drive in all COPD clients
C. Administer oxygen at the highest possible flow rate
D. Place the client on room air every 15 minutes
Answer: A. Administer oxygen as prescribed and monitor response
Rationale: Oxygen should not be withheld from a hypoxemic client with COPD. The nurse
administers the prescribed oxygen and closely monitors respiratory status.
6. Which finding best indicates that the intervention is effective?
,A. Oxygen saturation increases to the prescribed target
B. Respiratory rate increases to 38/min
C. The client becomes increasingly confused
D. Accessory-muscle use increases
Answer: A. Oxygen saturation increases to the prescribed target
Rationale: Improved oxygenation and reduced respiratory distress indicate a positive response.
Case Study 2 — Diabetic Ketoacidosis
A client with type 1 diabetes presents with vomiting, abdominal pain, and deep, rapid
respirations. Laboratory results include:
• Glucose: 520 mg/dL
• pH: 7.19
• HCO₃⁻: 12 mEq/L
• Potassium: 5.4 mEq/L
• Positive serum ketones
7. Which condition is most consistent with these findings?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Metabolic alkalosis
D. Hypoglycemia
Answer: B. Diabetic ketoacidosis
Rationale: Hyperglycemia, metabolic acidosis, ketones, and Kussmaul respirations are classic
findings of diabetic ketoacidosis.
8. Which prescribed intervention should the nurse anticipate first?
A. IV isotonic fluid replacement
B. Oral potassium replacement
C. Sodium bicarbonate for every client
D. Immediate subcutaneous long-acting insulin only
Answer: A. IV isotonic fluid replacement
, Rationale: Significant dehydration is a major component of DKA. Initial treatment generally
focuses on restoring circulating volume with isotonic IV fluids.
9. The client begins receiving IV regular insulin. Which laboratory value requires
especially close monitoring?
A. Potassium
B. Calcium
C. Hemoglobin
D. Platelets
Answer: A. Potassium
Rationale: Insulin drives potassium into cells and can cause serum potassium to fall rapidly.
Severe hypokalemia can produce dangerous dysrhythmias.
Case Study 3 — Acute Kidney Injury
A hospitalized client develops oliguria after several days of hypotension. The client has:
• Urine output: 15 mL/hr
• BUN: 68 mg/dL
• Creatinine: 3.4 mg/dL
• Potassium: 6.1 mEq/L
• ECG: peaked T waves
10. Which finding is the highest priority?
A. Elevated BUN
B. Elevated creatinine
C. Urine output of 15 mL/hr
D. Potassium of 6.1 mEq/L with peaked T waves
Answer: D. Potassium of 6.1 mEq/L with peaked T waves
Rationale: Severe hyperkalemia with ECG changes can rapidly cause fatal cardiac dysrhythmias
and requires immediate intervention.
11. Which prescription should the nurse question?
study plus rationales and verified answers
1. A client with heart failure reports increasing shortness of breath and has crackles
throughout both lung fields. The oxygen saturation is 86% on room air. What is the nurse’s
priority action?
A. Encourage oral fluids
B. Place the client in high-Fowler’s position
C. Obtain the client’s daily weight
D. Administer a prescribed potassium supplement
Answer: B. Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning promotes lung expansion and decreases venous return,
helping improve oxygenation in acute pulmonary congestion.
2. A client receiving IV furosemide has a potassium level of 2.9 mEq/L. Which finding
should the nurse recognize as most concerning?
A. Increased urinary frequency
B. Muscle weakness
C. Mild thirst
D. Blood pressure of 118/72 mm Hg
Answer: B. Muscle weakness
Rationale: Hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias. The nurse should promptly report significant hypokalemia.
Case Study 1 — Acute Respiratory Deterioration
A 68-year-old client with COPD is admitted with worsening dyspnea. The client is restless and
anxious. Assessment reveals:
• Respiratory rate: 30/min
• Oxygen saturation: 84%
• Heart rate: 112/min
• Temperature: 37.8°C (100°F)
• Diminished breath sounds bilaterally
• Increasing use of accessory muscles
,3. Which findings require immediate nursing intervention? Select all that apply.
A. Oxygen saturation of 84%
B. Respiratory rate of 30/min
C. Use of accessory muscles
D. Temperature of 37.8°C
E. Restlessness and anxiety
Answer: A, B, C, E
Rationale: Severe hypoxemia, tachypnea, accessory-muscle use, and altered behavior can
indicate worsening respiratory failure. These findings require prompt intervention.
4. Which action should the nurse take first?
A. Encourage the client to increase oral fluids
B. Position the client upright
C. Obtain a sputum culture
D. Place the client supine
Answer: B. Position the client upright
Rationale: Upright positioning maximizes diaphragmatic expansion and improves ventilation.
Airway and breathing take priority.
5. The provider prescribes oxygen therapy. Which nursing action is appropriate for a client
with COPD?
A. Administer oxygen as prescribed and monitor response
B. Withhold oxygen because it suppresses respiratory drive in all COPD clients
C. Administer oxygen at the highest possible flow rate
D. Place the client on room air every 15 minutes
Answer: A. Administer oxygen as prescribed and monitor response
Rationale: Oxygen should not be withheld from a hypoxemic client with COPD. The nurse
administers the prescribed oxygen and closely monitors respiratory status.
6. Which finding best indicates that the intervention is effective?
,A. Oxygen saturation increases to the prescribed target
B. Respiratory rate increases to 38/min
C. The client becomes increasingly confused
D. Accessory-muscle use increases
Answer: A. Oxygen saturation increases to the prescribed target
Rationale: Improved oxygenation and reduced respiratory distress indicate a positive response.
Case Study 2 — Diabetic Ketoacidosis
A client with type 1 diabetes presents with vomiting, abdominal pain, and deep, rapid
respirations. Laboratory results include:
• Glucose: 520 mg/dL
• pH: 7.19
• HCO₃⁻: 12 mEq/L
• Potassium: 5.4 mEq/L
• Positive serum ketones
7. Which condition is most consistent with these findings?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Metabolic alkalosis
D. Hypoglycemia
Answer: B. Diabetic ketoacidosis
Rationale: Hyperglycemia, metabolic acidosis, ketones, and Kussmaul respirations are classic
findings of diabetic ketoacidosis.
8. Which prescribed intervention should the nurse anticipate first?
A. IV isotonic fluid replacement
B. Oral potassium replacement
C. Sodium bicarbonate for every client
D. Immediate subcutaneous long-acting insulin only
Answer: A. IV isotonic fluid replacement
, Rationale: Significant dehydration is a major component of DKA. Initial treatment generally
focuses on restoring circulating volume with isotonic IV fluids.
9. The client begins receiving IV regular insulin. Which laboratory value requires
especially close monitoring?
A. Potassium
B. Calcium
C. Hemoglobin
D. Platelets
Answer: A. Potassium
Rationale: Insulin drives potassium into cells and can cause serum potassium to fall rapidly.
Severe hypokalemia can produce dangerous dysrhythmias.
Case Study 3 — Acute Kidney Injury
A hospitalized client develops oliguria after several days of hypotension. The client has:
• Urine output: 15 mL/hr
• BUN: 68 mg/dL
• Creatinine: 3.4 mg/dL
• Potassium: 6.1 mEq/L
• ECG: peaked T waves
10. Which finding is the highest priority?
A. Elevated BUN
B. Elevated creatinine
C. Urine output of 15 mL/hr
D. Potassium of 6.1 mEq/L with peaked T waves
Answer: D. Potassium of 6.1 mEq/L with peaked T waves
Rationale: Severe hyperkalemia with ECG changes can rapidly cause fatal cardiac dysrhythmias
and requires immediate intervention.
11. Which prescription should the nurse question?
