ATI RN Adult Medical-Surgical Proctored Exam 2026/2027 –
NGN Questions and Answers with Detailed Rationales
SECTION I — RESPIRATORY DISORDERS
1. NGN — Recognize Cues
A client with pneumonia has RR 30/min, SpO₂ 84%, HR 116/min, and new
confusion. Which finding requires the most immediate intervention?
A. HR 116/min
B. RR 30/min
C. SpO₂ 84%
D. Temperature 38.2°C
Answer: C
Rationale: An SpO₂ of 84% indicates significant hypoxemia and threatens oxygen
delivery to vital organs. The nurse should immediately assess airway and
breathing and initiate prescribed/emergency oxygen support.
2. Clinical Judgment
A client with COPD becomes increasingly dyspneic. Which action should the nurse
take first?
A. Place the client in high-Fowler's position
B. Encourage oral fluids
C. Obtain a weight
D. Assist the client to ambulate
Answer: A
Rationale: Upright positioning maximizes diaphragmatic expansion and
ventilation. The immediate priority is improving breathing while further
assessment occurs.
,3. Multiple Response
Which findings are consistent with respiratory distress?
A. Nasal flaring
B. Accessory-muscle use
C. Cyanosis
D. Severe dyspnea
E. Relaxed breathing
Answer: A, B, C, D
Rationale: Nasal flaring, accessory-muscle use, cyanosis, and severe dyspnea are
signs of impaired oxygenation or increased work of breathing.
4. A client with asthma has wheezing and difficulty speaking. Which medication
is typically used for rapid bronchodilation?
A. Albuterol
B. Montelukast
C. Fluticasone
D. Salmeterol
Answer: A
Rationale: Albuterol is a short-acting beta₂ agonist used for rapid relief of acute
bronchospasm.
5. Which finding indicates worsening asthma?
A. Ability to speak in full sentences
B. Decreased wheezing with improved airflow
C. Silent chest with severe respiratory distress
D. SpO₂ 97%
Answer: C
,Rationale: A silent chest in a severely distressed client can indicate minimal air
movement and impending respiratory failure. It is more concerning than audible
wheezing.
6. NGN — Multiple Response
Which interventions are appropriate for a client with COPD?
A. Encourage pursed-lip breathing
B. Position upright
C. Encourage smoking cessation
D. Administer oxygen as prescribed
E. Encourage prolonged bed rest
Answer: A, B, C, D
Rationale: Pursed-lip breathing improves expiratory airflow, upright positioning
promotes ventilation, smoking cessation reduces further lung injury, and
prescribed oxygen supports oxygenation.
7. A client with pulmonary embolism suddenly develops dyspnea and chest
pain. What is the priority?
A. Encourage ambulation
B. Apply oxygen and assess respiratory status
C. Offer food
D. Place the client flat
Answer: B
Rationale: Pulmonary embolism can cause life-threatening hypoxemia.
Oxygenation and respiratory assessment are immediate priorities.
8. Which finding is most consistent with pulmonary embolism?
A. Sudden dyspnea
B. Gradual weight gain
, C. Bradycardia
D. Increased appetite
Answer: A
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are
common manifestations of pulmonary embolism.
9. Which intervention helps prevent postoperative atelectasis?
A. Incentive spirometry
B. Bed rest
C. Fluid restriction for all clients
D. Avoiding coughing
Answer: A
Rationale: Incentive spirometry promotes alveolar expansion and reduces
atelectasis.
10. Which instruction is appropriate for incentive spirometry?
A. Inhale slowly and deeply
B. Exhale forcefully into the device
C. Use once per day
D. Use only when severe dyspnea occurs
Answer: A
Rationale: Slow, sustained inhalation expands the alveoli and helps prevent
atelectasis.
11. A client with pneumonia has thick respiratory secretions. Which
intervention is generally appropriate if not contraindicated?
A. Encourage fluids
B. Restrict fluids
NGN Questions and Answers with Detailed Rationales
SECTION I — RESPIRATORY DISORDERS
1. NGN — Recognize Cues
A client with pneumonia has RR 30/min, SpO₂ 84%, HR 116/min, and new
confusion. Which finding requires the most immediate intervention?
A. HR 116/min
B. RR 30/min
C. SpO₂ 84%
D. Temperature 38.2°C
Answer: C
Rationale: An SpO₂ of 84% indicates significant hypoxemia and threatens oxygen
delivery to vital organs. The nurse should immediately assess airway and
breathing and initiate prescribed/emergency oxygen support.
2. Clinical Judgment
A client with COPD becomes increasingly dyspneic. Which action should the nurse
take first?
A. Place the client in high-Fowler's position
B. Encourage oral fluids
C. Obtain a weight
D. Assist the client to ambulate
Answer: A
Rationale: Upright positioning maximizes diaphragmatic expansion and
ventilation. The immediate priority is improving breathing while further
assessment occurs.
,3. Multiple Response
Which findings are consistent with respiratory distress?
A. Nasal flaring
B. Accessory-muscle use
C. Cyanosis
D. Severe dyspnea
E. Relaxed breathing
Answer: A, B, C, D
Rationale: Nasal flaring, accessory-muscle use, cyanosis, and severe dyspnea are
signs of impaired oxygenation or increased work of breathing.
4. A client with asthma has wheezing and difficulty speaking. Which medication
is typically used for rapid bronchodilation?
A. Albuterol
B. Montelukast
C. Fluticasone
D. Salmeterol
Answer: A
Rationale: Albuterol is a short-acting beta₂ agonist used for rapid relief of acute
bronchospasm.
5. Which finding indicates worsening asthma?
A. Ability to speak in full sentences
B. Decreased wheezing with improved airflow
C. Silent chest with severe respiratory distress
D. SpO₂ 97%
Answer: C
,Rationale: A silent chest in a severely distressed client can indicate minimal air
movement and impending respiratory failure. It is more concerning than audible
wheezing.
6. NGN — Multiple Response
Which interventions are appropriate for a client with COPD?
A. Encourage pursed-lip breathing
B. Position upright
C. Encourage smoking cessation
D. Administer oxygen as prescribed
E. Encourage prolonged bed rest
Answer: A, B, C, D
Rationale: Pursed-lip breathing improves expiratory airflow, upright positioning
promotes ventilation, smoking cessation reduces further lung injury, and
prescribed oxygen supports oxygenation.
7. A client with pulmonary embolism suddenly develops dyspnea and chest
pain. What is the priority?
A. Encourage ambulation
B. Apply oxygen and assess respiratory status
C. Offer food
D. Place the client flat
Answer: B
Rationale: Pulmonary embolism can cause life-threatening hypoxemia.
Oxygenation and respiratory assessment are immediate priorities.
8. Which finding is most consistent with pulmonary embolism?
A. Sudden dyspnea
B. Gradual weight gain
, C. Bradycardia
D. Increased appetite
Answer: A
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are
common manifestations of pulmonary embolism.
9. Which intervention helps prevent postoperative atelectasis?
A. Incentive spirometry
B. Bed rest
C. Fluid restriction for all clients
D. Avoiding coughing
Answer: A
Rationale: Incentive spirometry promotes alveolar expansion and reduces
atelectasis.
10. Which instruction is appropriate for incentive spirometry?
A. Inhale slowly and deeply
B. Exhale forcefully into the device
C. Use once per day
D. Use only when severe dyspnea occurs
Answer: A
Rationale: Slow, sustained inhalation expands the alveoli and helps prevent
atelectasis.
11. A client with pneumonia has thick respiratory secretions. Which
intervention is generally appropriate if not contraindicated?
A. Encourage fluids
B. Restrict fluids
