ATI Med-Surg Proctored Exam 2024 – 100% Verified
Questions & In-Depth Study Guide with Latest NGN
Updates
Instructions
The following 80 multiple-choice questions are designed for the ATI Medical-Surgical
Proctored Exam 2024, incorporating Next Generation NCLEX (NGN) clinical content
and current nursing best practices. Each question includes four answer options, with one
correct answer marked and a detailed rationale. Select the best answer (A–D) to prepare
for a 100
Question 1: A nurse is caring for a client with acute myocardial infarction (MI) who reports
chest pain rated 6/10. The client is receiving nitroglycerin sublingually. What is
the nurse’s priority action?
A. Administer a second dose of nitroglycerin immediately.
B. Increase the oxygen flow rate to 4 L/min.
C. Assess the client’s vital signs and pain characteristics. (Correct)
D. Notify the healthcare provider of the pain.
Rationale: Assessing vital signs and pain characteristics determines the effectiveness
of nitroglycerin and guides further intervention. Nitroglycerin doses are given 5
minutes apart (A), oxygen adjustment (B) requires assessment, and notification
(D) is secondary to assessment.
Question 2: A client with chronic obstructive pulmonary disease (COPD) has an oxygen satu-
ration of 88A. Increase oxygen to 4 L/min.
B. Assess respiratory rate and lung sounds. (Correct)
C. Administer a bronchodilator nebulizer.
D. Place the client in a supine position.
Rationale: Dyspnea and low saturation suggest worsening respiratory status. As-
sessing rate and lung sounds identifies the cause (e.g., exacerbation). Increasing
oxygen (A) risks CO2 retention, C requires an order, and D worsens dyspnea.
Question 3: A nurse is caring for a client with a suspected stroke who presents with slurred
speech and right-sided weakness. What is the nurse’s priority action?
A. Administer aspirin 325 mg orally.
B. Prepare the client for a CT scan.
C. Notify the stroke team immediately. (Correct)
D. Monitor the client’s blood pressure every 15 minutes.
Rationale: Stroke symptoms require urgent intervention (e.g., thrombolytics). No-
tifying the stroke team ensures rapid evaluation. Aspirin (A) is contraindicated
before ruling out hemorrhagic stroke, B and D are secondary to team activation.
Question 4: A client with peptic ulcer disease reports sudden, severe abdominal pain and a rigid
abdomen. What should the nurse do first?
1
, A. Administer an antacid.
B. Encourage the client to lie flat.
C. Notify the healthcare provider. (Correct)
D. Insert a nasogastric tube.
Rationale: Severe pain and a rigid abdomen suggest perforation, a surgical emer-
gency. Notifying the provider ensures rapid intervention. Options A, B, and D are
inappropriate or delay care.
Question 5: A nurse is caring for a client with diabetic ketoacidosis (DKA) whose blood glucose
is 600 mg/dL and potassium is 3.2 mEq/L. What is the nurse’s priority action?
A. Administer insulin as prescribed.
B. Notify the provider of the potassium level. (Correct)
C. Encourage oral fluid intake.
D. Monitor urine output hourly.
Rationale: Hypokalemia (3.2 mEq/L) in DKA risks arrhythmias, especially with
insulin administration, which lowers potassium further. Notifying the provider for
supplementation is critical. Options A, C, and D are secondary or risky without
correction.
Question 6: A client with chronic kidney disease reports nausea and muscle cramps. The nurse
notes a potassium level of 6.5 mEq/L. What should the nurse do first?
A. Administer a diuretic.
B. Encourage a low-potassium diet.
C. Prepare to administer calcium gluconate. (Correct)
D. Increase fluid intake.
Rationale: Hyperkalemia (6.5 mEq/L) risks cardiac arrhythmias. Calcium glu-
conate stabilizes cardiac membranes, a priority intervention. Options A, B, and D
are inappropriate or long-term.
Question 7: A client with heart failure is receiving furosemide. The nurse notes a weight gain
of 3 pounds in 24 hours and bilateral crackles. What should the nurse do first?
A. Administer an additional dose of furosemide.
B. Encourage a low-sodium diet.
C. Notify the healthcare provider. (Correct)
D. Increase the client’s fluid restriction.
Rationale: Weight gain and crackles indicate fluid overload, requiring medical eval-
uation for medication adjustment. Options A, B, and D are secondary or require
orders.
Question 8: A nurse is caring for a client with a chest tube for a pneumothorax. The drainage
system is accidentally disconnected. What is the nurse’s immediate action?
A. Reconnect the system quickly.
B. Notify the healthcare provider.
C. Clamp the chest tube temporarily. (Correct)
D. Place the client in a Trendelenburg position.
Rationale: Clamping prevents air entry, reducing pneumothorax risk. Reconnecting
(A) requires sterility, B delays action, and D is irrelevant.
Question 9: A client with a traumatic brain injury has an intracranial pressure (ICP) of 18
mmHg. What is the nurse’s priority intervention?
2
, A. Administer a sedative.
B. Lower the head of the bed.
C. Maintain the head in a neutral position. (Correct)
D. Encourage deep breathing exercises.
Rationale: Elevated ICP requires maintaining a neutral head position to promote
venous drainage. Sedation (A) requires an order, lowering the bed (B) increases
ICP, and D is irrelevant.
Question 10: A client with cirrhosis reports increased abdominal swelling and shortness of breath.
The nurse notes ascites. What should the nurse do first?
A. Administer a diuretic.
B. Encourage a high-protein diet.
C. Notify the healthcare provider. (Correct)
D. Restrict fluid intake.
Rationale: Ascites and dyspnea suggest worsening liver failure, possibly requiring
paracentesis. Notifying the provider is critical. Options A, B, and D require orders
or are inappropriate.
Question 11: A nurse is caring for a client with hypothyroidism who reports fatigue and weight
gain. The client’s TSH is 7 mU/L (normal: 0.4–4.0). What should the nurse do?
A. Encourage increased physical activity.
B. Notify the healthcare provider. (Correct)
C. Administer levothyroxine as prescribed.
D. Monitor the client’s weight daily.
Rationale: Elevated TSH indicates inadequate thyroid hormone, requiring medica-
tion adjustment. Notifying the provider ensures proper management. Options A,
C, and D are secondary or premature.
Question 12: A client with acute kidney injury has a urine output of 20 mL/hour and a creatinine
of 3.5 mg/dL. What is the nurse’s priority action?
A. Encourage oral fluid intake.
B. Administer a loop diuretic.
C. Monitor fluid and electrolyte balance. (Correct)
D. Prepare for dialysis.
Rationale: Oliguria and elevated creatinine indicate worsening kidney function, re-
quiring close monitoring of fluids and electrolytes to prevent overload or imbalances.
Options A, B, and D are premature or require orders.
Question 13: A client with atrial fibrillation is prescribed warfarin. The nurse notes an INR of
4.8 (therapeutic: 2–3). What should the nurse do first?
A. Administer the next dose of warfarin.
B. Notify the healthcare provider. (Correct)
C. Encourage a high-vitamin K diet.
D. Monitor for bruising.
Rationale: An INR of 4.8 indicates excessive anticoagulation, increasing bleeding
risk. Notifying the provider allows dose adjustment or reversal. Options A, C, and
D worsen the risk or are secondary.
Question 14: A client with pneumonia reports increased shortness of breath. The nurse notes a
respiratory rate of 32 breaths/min and crackles. What should the nurse do first?
3
Questions & In-Depth Study Guide with Latest NGN
Updates
Instructions
The following 80 multiple-choice questions are designed for the ATI Medical-Surgical
Proctored Exam 2024, incorporating Next Generation NCLEX (NGN) clinical content
and current nursing best practices. Each question includes four answer options, with one
correct answer marked and a detailed rationale. Select the best answer (A–D) to prepare
for a 100
Question 1: A nurse is caring for a client with acute myocardial infarction (MI) who reports
chest pain rated 6/10. The client is receiving nitroglycerin sublingually. What is
the nurse’s priority action?
A. Administer a second dose of nitroglycerin immediately.
B. Increase the oxygen flow rate to 4 L/min.
C. Assess the client’s vital signs and pain characteristics. (Correct)
D. Notify the healthcare provider of the pain.
Rationale: Assessing vital signs and pain characteristics determines the effectiveness
of nitroglycerin and guides further intervention. Nitroglycerin doses are given 5
minutes apart (A), oxygen adjustment (B) requires assessment, and notification
(D) is secondary to assessment.
Question 2: A client with chronic obstructive pulmonary disease (COPD) has an oxygen satu-
ration of 88A. Increase oxygen to 4 L/min.
B. Assess respiratory rate and lung sounds. (Correct)
C. Administer a bronchodilator nebulizer.
D. Place the client in a supine position.
Rationale: Dyspnea and low saturation suggest worsening respiratory status. As-
sessing rate and lung sounds identifies the cause (e.g., exacerbation). Increasing
oxygen (A) risks CO2 retention, C requires an order, and D worsens dyspnea.
Question 3: A nurse is caring for a client with a suspected stroke who presents with slurred
speech and right-sided weakness. What is the nurse’s priority action?
A. Administer aspirin 325 mg orally.
B. Prepare the client for a CT scan.
C. Notify the stroke team immediately. (Correct)
D. Monitor the client’s blood pressure every 15 minutes.
Rationale: Stroke symptoms require urgent intervention (e.g., thrombolytics). No-
tifying the stroke team ensures rapid evaluation. Aspirin (A) is contraindicated
before ruling out hemorrhagic stroke, B and D are secondary to team activation.
Question 4: A client with peptic ulcer disease reports sudden, severe abdominal pain and a rigid
abdomen. What should the nurse do first?
1
, A. Administer an antacid.
B. Encourage the client to lie flat.
C. Notify the healthcare provider. (Correct)
D. Insert a nasogastric tube.
Rationale: Severe pain and a rigid abdomen suggest perforation, a surgical emer-
gency. Notifying the provider ensures rapid intervention. Options A, B, and D are
inappropriate or delay care.
Question 5: A nurse is caring for a client with diabetic ketoacidosis (DKA) whose blood glucose
is 600 mg/dL and potassium is 3.2 mEq/L. What is the nurse’s priority action?
A. Administer insulin as prescribed.
B. Notify the provider of the potassium level. (Correct)
C. Encourage oral fluid intake.
D. Monitor urine output hourly.
Rationale: Hypokalemia (3.2 mEq/L) in DKA risks arrhythmias, especially with
insulin administration, which lowers potassium further. Notifying the provider for
supplementation is critical. Options A, C, and D are secondary or risky without
correction.
Question 6: A client with chronic kidney disease reports nausea and muscle cramps. The nurse
notes a potassium level of 6.5 mEq/L. What should the nurse do first?
A. Administer a diuretic.
B. Encourage a low-potassium diet.
C. Prepare to administer calcium gluconate. (Correct)
D. Increase fluid intake.
Rationale: Hyperkalemia (6.5 mEq/L) risks cardiac arrhythmias. Calcium glu-
conate stabilizes cardiac membranes, a priority intervention. Options A, B, and D
are inappropriate or long-term.
Question 7: A client with heart failure is receiving furosemide. The nurse notes a weight gain
of 3 pounds in 24 hours and bilateral crackles. What should the nurse do first?
A. Administer an additional dose of furosemide.
B. Encourage a low-sodium diet.
C. Notify the healthcare provider. (Correct)
D. Increase the client’s fluid restriction.
Rationale: Weight gain and crackles indicate fluid overload, requiring medical eval-
uation for medication adjustment. Options A, B, and D are secondary or require
orders.
Question 8: A nurse is caring for a client with a chest tube for a pneumothorax. The drainage
system is accidentally disconnected. What is the nurse’s immediate action?
A. Reconnect the system quickly.
B. Notify the healthcare provider.
C. Clamp the chest tube temporarily. (Correct)
D. Place the client in a Trendelenburg position.
Rationale: Clamping prevents air entry, reducing pneumothorax risk. Reconnecting
(A) requires sterility, B delays action, and D is irrelevant.
Question 9: A client with a traumatic brain injury has an intracranial pressure (ICP) of 18
mmHg. What is the nurse’s priority intervention?
2
, A. Administer a sedative.
B. Lower the head of the bed.
C. Maintain the head in a neutral position. (Correct)
D. Encourage deep breathing exercises.
Rationale: Elevated ICP requires maintaining a neutral head position to promote
venous drainage. Sedation (A) requires an order, lowering the bed (B) increases
ICP, and D is irrelevant.
Question 10: A client with cirrhosis reports increased abdominal swelling and shortness of breath.
The nurse notes ascites. What should the nurse do first?
A. Administer a diuretic.
B. Encourage a high-protein diet.
C. Notify the healthcare provider. (Correct)
D. Restrict fluid intake.
Rationale: Ascites and dyspnea suggest worsening liver failure, possibly requiring
paracentesis. Notifying the provider is critical. Options A, B, and D require orders
or are inappropriate.
Question 11: A nurse is caring for a client with hypothyroidism who reports fatigue and weight
gain. The client’s TSH is 7 mU/L (normal: 0.4–4.0). What should the nurse do?
A. Encourage increased physical activity.
B. Notify the healthcare provider. (Correct)
C. Administer levothyroxine as prescribed.
D. Monitor the client’s weight daily.
Rationale: Elevated TSH indicates inadequate thyroid hormone, requiring medica-
tion adjustment. Notifying the provider ensures proper management. Options A,
C, and D are secondary or premature.
Question 12: A client with acute kidney injury has a urine output of 20 mL/hour and a creatinine
of 3.5 mg/dL. What is the nurse’s priority action?
A. Encourage oral fluid intake.
B. Administer a loop diuretic.
C. Monitor fluid and electrolyte balance. (Correct)
D. Prepare for dialysis.
Rationale: Oliguria and elevated creatinine indicate worsening kidney function, re-
quiring close monitoring of fluids and electrolytes to prevent overload or imbalances.
Options A, B, and D are premature or require orders.
Question 13: A client with atrial fibrillation is prescribed warfarin. The nurse notes an INR of
4.8 (therapeutic: 2–3). What should the nurse do first?
A. Administer the next dose of warfarin.
B. Notify the healthcare provider. (Correct)
C. Encourage a high-vitamin K diet.
D. Monitor for bruising.
Rationale: An INR of 4.8 indicates excessive anticoagulation, increasing bleeding
risk. Notifying the provider allows dose adjustment or reversal. Options A, C, and
D worsen the risk or are secondary.
Question 14: A client with pneumonia reports increased shortness of breath. The nurse notes a
respiratory rate of 32 breaths/min and crackles. What should the nurse do first?
3
