RN 312: ATI Medical-Surgical Proctored Exam Prep
with Detailed Rationales
Course Code: RN 312
Course Name: Medical-Surgical Nursing
Topic: Advanced Adult Clinical Care, Fluid and Electrolytes, and Perioperative
Management
Academic Year: 2026/2027
1. A nurse in an emergency department is preparing to perform an ocular irrigation
for a client. Which of the following actions should the nurse plan to take?
A. Assess the client's visual acuity prior to irrigation
B. Have the client turn their head toward the unaffected eye
C. Hold the irrigator syringe 3.81 cm (1.5 in) above the eye
D. Perform the irrigation with sterile water for irrigation
CORRECT ANSWER: D
RATIONALE: Emergency treatment for chemical or particulate ocular
contamination requires immediate flushing to dilute and remove the irritant.
Performing the irrigation with sterile water or 0.9% sodium chloride for
irrigation is the standard protocol to safeguard fragile corneal structures. While
determining visual acuity is standard before non-emergent procedures, it must
never delay irrigation during a chemical exposure or acute splash event. The head
must be tilted toward the affected side to prevent contaminated solution from
washing into the contralateral, unaffected eye. The irrigator syringe should be held
approximately 2.5 cm (1 in) above the eye structure, not 3.81 cm, to prevent high-
velocity tissue impact.
2. A nurse is preparing to administer Lactated Ringer's via continuous IV infusion
at 200 mL/hr. The IV tubing has a drop factor of 10 drops/mL. How many gtt/min
should the nurse set the IV pump to administer?
A. 20 gtt/min
B. 33 gtt/min
C. 60 gtt/min
D. 200 gtt/min
, CORRECT ANSWER: B
RATIONALE: To determine the correct flow rate in drops per minute
(gtt/min), utilize the standard intravenous infusion formula:
Flow Rate (gtt/min)=Total Volume (mL)×Drop Factor (gtt/mL)Total Time
(minutes)Flow Rate (gtt/min) equals the fraction with numerator Total Volume
(mL) cross Drop Factor (gtt/mL) and denominator Total Time (minutes) end-
fraction
Flow Rate (gtt/min)=Total Volume (mL)×Drop Factor (gtt/mL)Total Time
(minutes)
Flow Rate=200 mL×10 gtt/mL60 minutes=200060=33.33 gtt/minFlow Rate equals
the fraction with numerator 200 mL cross 10 gtt/mL and denominator 60 minutes
end-fraction equals 2000 over 60 end-fraction equals 33.33 gtt/min
Flow Rate=200 mL×10 gtt/mL60 minutes=200060=33.33 gtt/min
Rounding to the nearest whole number yields a final delivery parameter of 33
gtt/min.
3. A nurse is providing discharge teaching to a client who has a new prescription
for sublingual nitroglycerin. Which of the following client statements indicates an
understanding of the teaching?
A. "I can keep my medications for 1 year before replacing it."
B. "I should lie down when I take this medication."
C. "I should discontinue this medication if I develop a headache."
D. "I can take up to five tablets in 15 minutes before seeking medical attention."
CORRECT ANSWER: B
RATIONALE: Sublingual nitroglycerin causes profound, systemic
vasodilation. The nurse must instruct the client to sit or lie down immediately
upon taking the dose to minimize the risk of orthostatic hypotension, syncope,
and dizziness. Nitroglycerin tablets lose potency quickly after the container is
opened and should be replaced every 3 to 6 months rather than 1 year. Headaches
,are a common, expected therapeutic side effect due to meningeal arterial dilation
and do not warrant stopping the medication; they can be managed with
acetaminophen. The standard emergency protocol allows a maximum of three total
sublingual tablets (one every 5 minutes) over a 15-minute window before
contacting emergency medical services.
4. A nurse is providing discharge teaching to an older adult client following a left
total hip arthroplasty. Which of the following instructions should the nurse include
in the teaching?
A. Clean the incision daily with hydrogen peroxide
B. You can cross your legs at the ankles when sitting down
C. You should use an incentive spirometer every 8 hours
D. Install a raised toilet seat in your bathroom
CORRECT ANSWER: D
RATIONALE: To prevent posterior dislocation of a new prosthetic hip joint,
the client must maintain hip flexion at an angle less than 90 degrees. Installing a
raised toilet seat helps the client avoid deep hip bending during toileting.
Cleansing surgical wounds with hydrogen peroxide is contraindicated because it
causes local tissue toxicity and delays healthy granulation. Crossing the legs at the
knees or ankles violates essential hip abduction precautions. An incentive
spirometer should be used frequently while awake (e.g., 10 repetitions every 1 to 2
hours) rather than every 8 hours to effectively prevent postoperative atelectasis.
5. A nurse is planning care for a client following a cardiac catheterization. Which
of the following actions should the nurse take?
A. Keep the client on bed rest for 24 hours
B. Limit the client's fluid intake to 1 L per day
C. Maintain the client's affected extremity in extension
D. Change the client's dressing every 8 hours
CORRECT ANSWER: C
RATIONALE: Following an arterial puncture during a cardiac
catheterization, the client is at high risk for hematoma formation, pseudoaneurysm,
or severe retroperitoneal hemorrhage. The nurse must keep the affected extremity
completely extended for a prescribed window (typically 4 to 6 hours) to maintain
mechanical compression at the arteriotomy site. Standard post-catheterization bed
, rest lasts between 4 to 6 hours rather than a full 24 hours. Fluid intake should be
increased, not restricted, to help the kidneys excrete the nephrotoxic intravenous
contrast dye. The original pressure dressing is typically left intact for the first 24
hours unless it becomes saturated or compromised.
6. A nurse is caring for a client who has a lower extremity fracture and a
prescription for crutches. Which of the following client statements indicates that
the client is adapting to their role change?
A. "I will need to have my partner take over shopping for groceries and
cooking the meals for us."
B. "These crutches will make it impossible to care for my child."
C. "I feel bad that I have to ask my partner to keep the house clean."
D. "It's going to be difficult to tell my parents I can't take them to their
appointments anymore."
CORRECT ANSWER: A
RATIONALE: Psychosocial adaptation to a sudden illness or physical
limitation involves acknowledging the realistic limits of one's current state and
actively restructuring daily responsibilities. Stating that the partner will take over
shopping and cooking shows functional problem-solving and role adaptation.
Statements expressing absolute impossibility or excessive guilt (options B, C, and
D) reflect maladaptive coping strategies, situational distress, and role conflict that
may require further supportive care.
7. A nurse is caring for a client who has gastroenteritis. Which of the following
assessment findings should the nurse recognize as an indication that the client is
experiencing dehydration?
A. Pitting, dependent edema
B. Distended jugular veins
C. Increased blood pressure
D. Decreased blood pressure
CORRECT ANSWER: D
RATIONALE: Gastroenteritis with severe vomiting or diarrhea leads to a
substantial loss of extracellular fluid, causing hypovolemia. A decrease in blood
pressure (hypotension), accompanied by compensatory tachycardia, flattened
neck veins, and poor skin turgor, indicates significant volume depletion. Pitting
with Detailed Rationales
Course Code: RN 312
Course Name: Medical-Surgical Nursing
Topic: Advanced Adult Clinical Care, Fluid and Electrolytes, and Perioperative
Management
Academic Year: 2026/2027
1. A nurse in an emergency department is preparing to perform an ocular irrigation
for a client. Which of the following actions should the nurse plan to take?
A. Assess the client's visual acuity prior to irrigation
B. Have the client turn their head toward the unaffected eye
C. Hold the irrigator syringe 3.81 cm (1.5 in) above the eye
D. Perform the irrigation with sterile water for irrigation
CORRECT ANSWER: D
RATIONALE: Emergency treatment for chemical or particulate ocular
contamination requires immediate flushing to dilute and remove the irritant.
Performing the irrigation with sterile water or 0.9% sodium chloride for
irrigation is the standard protocol to safeguard fragile corneal structures. While
determining visual acuity is standard before non-emergent procedures, it must
never delay irrigation during a chemical exposure or acute splash event. The head
must be tilted toward the affected side to prevent contaminated solution from
washing into the contralateral, unaffected eye. The irrigator syringe should be held
approximately 2.5 cm (1 in) above the eye structure, not 3.81 cm, to prevent high-
velocity tissue impact.
2. A nurse is preparing to administer Lactated Ringer's via continuous IV infusion
at 200 mL/hr. The IV tubing has a drop factor of 10 drops/mL. How many gtt/min
should the nurse set the IV pump to administer?
A. 20 gtt/min
B. 33 gtt/min
C. 60 gtt/min
D. 200 gtt/min
, CORRECT ANSWER: B
RATIONALE: To determine the correct flow rate in drops per minute
(gtt/min), utilize the standard intravenous infusion formula:
Flow Rate (gtt/min)=Total Volume (mL)×Drop Factor (gtt/mL)Total Time
(minutes)Flow Rate (gtt/min) equals the fraction with numerator Total Volume
(mL) cross Drop Factor (gtt/mL) and denominator Total Time (minutes) end-
fraction
Flow Rate (gtt/min)=Total Volume (mL)×Drop Factor (gtt/mL)Total Time
(minutes)
Flow Rate=200 mL×10 gtt/mL60 minutes=200060=33.33 gtt/minFlow Rate equals
the fraction with numerator 200 mL cross 10 gtt/mL and denominator 60 minutes
end-fraction equals 2000 over 60 end-fraction equals 33.33 gtt/min
Flow Rate=200 mL×10 gtt/mL60 minutes=200060=33.33 gtt/min
Rounding to the nearest whole number yields a final delivery parameter of 33
gtt/min.
3. A nurse is providing discharge teaching to a client who has a new prescription
for sublingual nitroglycerin. Which of the following client statements indicates an
understanding of the teaching?
A. "I can keep my medications for 1 year before replacing it."
B. "I should lie down when I take this medication."
C. "I should discontinue this medication if I develop a headache."
D. "I can take up to five tablets in 15 minutes before seeking medical attention."
CORRECT ANSWER: B
RATIONALE: Sublingual nitroglycerin causes profound, systemic
vasodilation. The nurse must instruct the client to sit or lie down immediately
upon taking the dose to minimize the risk of orthostatic hypotension, syncope,
and dizziness. Nitroglycerin tablets lose potency quickly after the container is
opened and should be replaced every 3 to 6 months rather than 1 year. Headaches
,are a common, expected therapeutic side effect due to meningeal arterial dilation
and do not warrant stopping the medication; they can be managed with
acetaminophen. The standard emergency protocol allows a maximum of three total
sublingual tablets (one every 5 minutes) over a 15-minute window before
contacting emergency medical services.
4. A nurse is providing discharge teaching to an older adult client following a left
total hip arthroplasty. Which of the following instructions should the nurse include
in the teaching?
A. Clean the incision daily with hydrogen peroxide
B. You can cross your legs at the ankles when sitting down
C. You should use an incentive spirometer every 8 hours
D. Install a raised toilet seat in your bathroom
CORRECT ANSWER: D
RATIONALE: To prevent posterior dislocation of a new prosthetic hip joint,
the client must maintain hip flexion at an angle less than 90 degrees. Installing a
raised toilet seat helps the client avoid deep hip bending during toileting.
Cleansing surgical wounds with hydrogen peroxide is contraindicated because it
causes local tissue toxicity and delays healthy granulation. Crossing the legs at the
knees or ankles violates essential hip abduction precautions. An incentive
spirometer should be used frequently while awake (e.g., 10 repetitions every 1 to 2
hours) rather than every 8 hours to effectively prevent postoperative atelectasis.
5. A nurse is planning care for a client following a cardiac catheterization. Which
of the following actions should the nurse take?
A. Keep the client on bed rest for 24 hours
B. Limit the client's fluid intake to 1 L per day
C. Maintain the client's affected extremity in extension
D. Change the client's dressing every 8 hours
CORRECT ANSWER: C
RATIONALE: Following an arterial puncture during a cardiac
catheterization, the client is at high risk for hematoma formation, pseudoaneurysm,
or severe retroperitoneal hemorrhage. The nurse must keep the affected extremity
completely extended for a prescribed window (typically 4 to 6 hours) to maintain
mechanical compression at the arteriotomy site. Standard post-catheterization bed
, rest lasts between 4 to 6 hours rather than a full 24 hours. Fluid intake should be
increased, not restricted, to help the kidneys excrete the nephrotoxic intravenous
contrast dye. The original pressure dressing is typically left intact for the first 24
hours unless it becomes saturated or compromised.
6. A nurse is caring for a client who has a lower extremity fracture and a
prescription for crutches. Which of the following client statements indicates that
the client is adapting to their role change?
A. "I will need to have my partner take over shopping for groceries and
cooking the meals for us."
B. "These crutches will make it impossible to care for my child."
C. "I feel bad that I have to ask my partner to keep the house clean."
D. "It's going to be difficult to tell my parents I can't take them to their
appointments anymore."
CORRECT ANSWER: A
RATIONALE: Psychosocial adaptation to a sudden illness or physical
limitation involves acknowledging the realistic limits of one's current state and
actively restructuring daily responsibilities. Stating that the partner will take over
shopping and cooking shows functional problem-solving and role adaptation.
Statements expressing absolute impossibility or excessive guilt (options B, C, and
D) reflect maladaptive coping strategies, situational distress, and role conflict that
may require further supportive care.
7. A nurse is caring for a client who has gastroenteritis. Which of the following
assessment findings should the nurse recognize as an indication that the client is
experiencing dehydration?
A. Pitting, dependent edema
B. Distended jugular veins
C. Increased blood pressure
D. Decreased blood pressure
CORRECT ANSWER: D
RATIONALE: Gastroenteritis with severe vomiting or diarrhea leads to a
substantial loss of extracellular fluid, causing hypovolemia. A decrease in blood
pressure (hypotension), accompanied by compensatory tachycardia, flattened
neck veins, and poor skin turgor, indicates significant volume depletion. Pitting
