ATI RN Adult Medical-Surgical (NGN) – ATI Adult
Medical-Surgical Proctored Exam Study Guide,
Original NGN-Style Practice Questions & Answers,
Comprehensive Med-Surg Review, Cardiovascular,
Respiratory, Gastrointestinal, Hepatic, Renal,
Genitourinary, Endocrine, Metabolic, Neurological,
Musculoskeletal, Immune & Infectious Disorders,
Perioperative Care, Pharmacology, Laboratory
Values, Prioritization, Patient Safety & Clinical
Judgment
Question 1: A nurse is caring for a client who is 24 hours post-operative
following a total hip arthroplasty. Which of the following actions should the
nurse implement to prevent dislocation of the new joint?
A. Position the client with the affected hip in adduction.
B. Maintain the client's hips in a position of flexion greater than 90 degrees.
C. Keep a pillow between the client's legs when turning.
D. Encourage the client to cross their legs at the ankles while sitting.
CORRECT ANSWER: C. Keep a pillow between the client's legs when turning.
Rationale: Maintaining abduction of the affected hip by keeping a pillow between the
legs prevents adduction, which can cause dislocation. Flexion should not exceed 90
degrees, and crossing legs is strictly contraindicated.
Question 2: A nurse is assessing a client with chronic obstructive pulmonary
disease (COPD). Which of the following findings indicates that the client is
experiencing right-sided heart failure?
A. Jugular venous distention
B. Bibasilar crackles
C. Orthopnea
D. Paroxysmal nocturnal dyspnea
CORRECT ANSWER: A. Jugular venous distention
Rationale: Right-sided heart failure, often caused by chronic pulmonary hypertension in
COPD, leads to systemic venous congestion, manifesting as jugular venous distention,
peripheral edema, and hepatomegaly. Bibasilar crackles, orthopnea, and PND are signs
of left-sided failure.
Question 3: A nurse is preparing to administer a blood transfusion of packed
red blood cells (PRBCs) to a client with anemia. Which of the following IV
solutions is compatible with PRBCs for priming the blood tubing?
,A. Lactated Ringer's
B. 5% Dextrose in Water (D5W)
C. 0.9% Sodium Chloride
D. 0.45% Sodium Chloride
CORRECT ANSWER: C. 0.9% Sodium Chloride
Rationale: Only 0.9% sodium chloride (normal saline) is isotonic and compatible with
PRBCs. Lactated Ringer's contains calcium, which can cause clotting in the tubing, and
dextrose solutions can cause hemolysis.
Question 4: A nurse is providing discharge teaching to a client who has a new
diagnosis of heart failure. Which of the following statements by the client
indicates a need for further teaching?
A. "I will weigh myself every morning before breakfast."
B. "I will take an extra diuretic pill if I gain more than 2 pounds in a day."
C. "I should limit my daily sodium intake to less than 2,000 mg."
D. "I should eat fresh fruits and vegetables rather than canned ones."
CORRECT ANSWER: B. "I will take an extra diuretic pill if I gain more than 2
pounds in a day."
Rationale: Clients should notify the provider if they gain 2-3 pounds in a day or 5
pounds in a week, but they should never adjust their own medication dosages without
consulting the provider.
Question 5: A nurse is caring for a client who has an acute exacerbation of
asthma. Which of the following medications should the nurse administer first
to relieve bronchospasm?
A. Fluticasone
B. Montelukast
C. Albuterol
D. Theophylline
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) used as a rescue inhaler for
acute bronchospasm. Fluticasone is a corticosteroid for long-term control, montelukast
is a leukotriene modifier, and theophylline is a bronchodilator used for maintenance.
Question 6: A nurse is assessing a client with diabetic ketoacidosis (DKA).
Which of the following clinical manifestations is expected?
,A. Serum pH of 7.35
B. Deep, rapid respirations
C. Serum bicarbonate level of 24 mEq/L
D. Hypoglycemia
CORRECT ANSWER: B. Deep, rapid respirations
Rationale: Kussmaul respirations (deep, rapid) are a compensatory mechanism to blow
off carbon dioxide and decrease the acidosis. DKA presents with a low pH (<7.3), low
bicarbonate (<15 mEq/L), and hyperglycemia.
Question 7: A nurse is inserting a nasogastric (NG) tube for a client with a
small bowel obstruction. Which of the following actions best verifies correct
placement before the initial feeding?
A. Aspirating gastric contents with a pH of 5.
B. Auscultating a gurgling sound over the epigastric area while injecting air.
C. Placing the end of the tube in water and observing for bubbles.
D. Obtaining an abdominal X-ray.
CORRECT ANSWER: D. Obtaining an abdominal X-ray.
Rationale: An X-ray is the only definitive method to confirm NG tube placement. pH
testing can be helpful but is not definitive; auscultation is unreliable and the "bubbling"
test is for checking pneumothorax, not gastric placement.
Question 8: A nurse is providing care to a client who has a new colostomy.
Which of the following foods should the nurse recommend to help prevent a
blockage?
A. Popcorn
B. Nuts
C. Applesauce
D. Dried fruit
CORRECT ANSWER: C. Applesauce
Rationale: Applesauce is a low-fiber, easily digestible food that is safe for clients with a
new colostomy. Popcorn, nuts, and dried fruit are high in insoluble fiber and can cause
obstruction.
Question 9: A nurse is monitoring a client who is receiving a transfusion of
packed red blood cells. The client develops chills, fever, and a headache 30
minutes after the transfusion starts. What is the priority nursing action?
, A. Administer an antipyretic.
B. Stop the blood transfusion.
C. Increase the infusion rate of normal saline.
D. Notify the provider.
CORRECT ANSWER: B. Stop the blood transfusion.
Rationale: These are signs of a febrile non-hemolytic or hemolytic transfusion reaction.
The priority is to stop the transfusion immediately to prevent further complications, then
notify the provider.
Question 10: A nurse is teaching a client with peripheral arterial disease (PAD)
about foot care. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I should use a heating pad to warm my feet."
B. "I will wear tight-fitting shoes to prevent rubbing."
C. "I will soak my feet in hot water daily."
D. "I should apply lotion to my feet to prevent cracking."
CORRECT ANSWER: D. "I should apply lotion to my feet to prevent cracking."
Rationale: Clients with PAD have poor circulation and are at high risk for skin
breakdown. Lotion keeps the skin moisturized, preventing cracking and infection.
Heating pads and hot water can cause burns, and tight shoes restrict circulation.
Question 11: A nurse is assessing a client who has a head injury and notes a
clear drainage from the client's nose. Which of the following actions should the
nurse take first?
A. Suction the nares.
B. Test the drainage for glucose.
C. Ask the client to blow their nose.
D. Place a nasal cannula for oxygen.
CORRECT ANSWER: B. Test the drainage for glucose.
Rationale: Clear drainage from the nose after a head injury may indicate a
cerebrospinal fluid (CSF) leak. CSF contains glucose, while normal nasal mucus does
not. Testing for glucose helps differentiate it. Suctioning and blowing the nose are
contraindicated as they can increase intracranial pressure.
Question 12: A nurse is caring for a client with a myocardial infarction who is
receiving alteplase (t-PA). Which of the following findings is the highest
priority to report to the healthcare provider?
Medical-Surgical Proctored Exam Study Guide,
Original NGN-Style Practice Questions & Answers,
Comprehensive Med-Surg Review, Cardiovascular,
Respiratory, Gastrointestinal, Hepatic, Renal,
Genitourinary, Endocrine, Metabolic, Neurological,
Musculoskeletal, Immune & Infectious Disorders,
Perioperative Care, Pharmacology, Laboratory
Values, Prioritization, Patient Safety & Clinical
Judgment
Question 1: A nurse is caring for a client who is 24 hours post-operative
following a total hip arthroplasty. Which of the following actions should the
nurse implement to prevent dislocation of the new joint?
A. Position the client with the affected hip in adduction.
B. Maintain the client's hips in a position of flexion greater than 90 degrees.
C. Keep a pillow between the client's legs when turning.
D. Encourage the client to cross their legs at the ankles while sitting.
CORRECT ANSWER: C. Keep a pillow between the client's legs when turning.
Rationale: Maintaining abduction of the affected hip by keeping a pillow between the
legs prevents adduction, which can cause dislocation. Flexion should not exceed 90
degrees, and crossing legs is strictly contraindicated.
Question 2: A nurse is assessing a client with chronic obstructive pulmonary
disease (COPD). Which of the following findings indicates that the client is
experiencing right-sided heart failure?
A. Jugular venous distention
B. Bibasilar crackles
C. Orthopnea
D. Paroxysmal nocturnal dyspnea
CORRECT ANSWER: A. Jugular venous distention
Rationale: Right-sided heart failure, often caused by chronic pulmonary hypertension in
COPD, leads to systemic venous congestion, manifesting as jugular venous distention,
peripheral edema, and hepatomegaly. Bibasilar crackles, orthopnea, and PND are signs
of left-sided failure.
Question 3: A nurse is preparing to administer a blood transfusion of packed
red blood cells (PRBCs) to a client with anemia. Which of the following IV
solutions is compatible with PRBCs for priming the blood tubing?
,A. Lactated Ringer's
B. 5% Dextrose in Water (D5W)
C. 0.9% Sodium Chloride
D. 0.45% Sodium Chloride
CORRECT ANSWER: C. 0.9% Sodium Chloride
Rationale: Only 0.9% sodium chloride (normal saline) is isotonic and compatible with
PRBCs. Lactated Ringer's contains calcium, which can cause clotting in the tubing, and
dextrose solutions can cause hemolysis.
Question 4: A nurse is providing discharge teaching to a client who has a new
diagnosis of heart failure. Which of the following statements by the client
indicates a need for further teaching?
A. "I will weigh myself every morning before breakfast."
B. "I will take an extra diuretic pill if I gain more than 2 pounds in a day."
C. "I should limit my daily sodium intake to less than 2,000 mg."
D. "I should eat fresh fruits and vegetables rather than canned ones."
CORRECT ANSWER: B. "I will take an extra diuretic pill if I gain more than 2
pounds in a day."
Rationale: Clients should notify the provider if they gain 2-3 pounds in a day or 5
pounds in a week, but they should never adjust their own medication dosages without
consulting the provider.
Question 5: A nurse is caring for a client who has an acute exacerbation of
asthma. Which of the following medications should the nurse administer first
to relieve bronchospasm?
A. Fluticasone
B. Montelukast
C. Albuterol
D. Theophylline
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) used as a rescue inhaler for
acute bronchospasm. Fluticasone is a corticosteroid for long-term control, montelukast
is a leukotriene modifier, and theophylline is a bronchodilator used for maintenance.
Question 6: A nurse is assessing a client with diabetic ketoacidosis (DKA).
Which of the following clinical manifestations is expected?
,A. Serum pH of 7.35
B. Deep, rapid respirations
C. Serum bicarbonate level of 24 mEq/L
D. Hypoglycemia
CORRECT ANSWER: B. Deep, rapid respirations
Rationale: Kussmaul respirations (deep, rapid) are a compensatory mechanism to blow
off carbon dioxide and decrease the acidosis. DKA presents with a low pH (<7.3), low
bicarbonate (<15 mEq/L), and hyperglycemia.
Question 7: A nurse is inserting a nasogastric (NG) tube for a client with a
small bowel obstruction. Which of the following actions best verifies correct
placement before the initial feeding?
A. Aspirating gastric contents with a pH of 5.
B. Auscultating a gurgling sound over the epigastric area while injecting air.
C. Placing the end of the tube in water and observing for bubbles.
D. Obtaining an abdominal X-ray.
CORRECT ANSWER: D. Obtaining an abdominal X-ray.
Rationale: An X-ray is the only definitive method to confirm NG tube placement. pH
testing can be helpful but is not definitive; auscultation is unreliable and the "bubbling"
test is for checking pneumothorax, not gastric placement.
Question 8: A nurse is providing care to a client who has a new colostomy.
Which of the following foods should the nurse recommend to help prevent a
blockage?
A. Popcorn
B. Nuts
C. Applesauce
D. Dried fruit
CORRECT ANSWER: C. Applesauce
Rationale: Applesauce is a low-fiber, easily digestible food that is safe for clients with a
new colostomy. Popcorn, nuts, and dried fruit are high in insoluble fiber and can cause
obstruction.
Question 9: A nurse is monitoring a client who is receiving a transfusion of
packed red blood cells. The client develops chills, fever, and a headache 30
minutes after the transfusion starts. What is the priority nursing action?
, A. Administer an antipyretic.
B. Stop the blood transfusion.
C. Increase the infusion rate of normal saline.
D. Notify the provider.
CORRECT ANSWER: B. Stop the blood transfusion.
Rationale: These are signs of a febrile non-hemolytic or hemolytic transfusion reaction.
The priority is to stop the transfusion immediately to prevent further complications, then
notify the provider.
Question 10: A nurse is teaching a client with peripheral arterial disease (PAD)
about foot care. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I should use a heating pad to warm my feet."
B. "I will wear tight-fitting shoes to prevent rubbing."
C. "I will soak my feet in hot water daily."
D. "I should apply lotion to my feet to prevent cracking."
CORRECT ANSWER: D. "I should apply lotion to my feet to prevent cracking."
Rationale: Clients with PAD have poor circulation and are at high risk for skin
breakdown. Lotion keeps the skin moisturized, preventing cracking and infection.
Heating pads and hot water can cause burns, and tight shoes restrict circulation.
Question 11: A nurse is assessing a client who has a head injury and notes a
clear drainage from the client's nose. Which of the following actions should the
nurse take first?
A. Suction the nares.
B. Test the drainage for glucose.
C. Ask the client to blow their nose.
D. Place a nasal cannula for oxygen.
CORRECT ANSWER: B. Test the drainage for glucose.
Rationale: Clear drainage from the nose after a head injury may indicate a
cerebrospinal fluid (CSF) leak. CSF contains glucose, while normal nasal mucus does
not. Testing for glucose helps differentiate it. Suctioning and blowing the nose are
contraindicated as they can increase intracranial pressure.
Question 12: A nurse is caring for a client with a myocardial infarction who is
receiving alteplase (t-PA). Which of the following findings is the highest
priority to report to the healthcare provider?
