NGN ATI Medical-Surgical Proctored Exam 2
Study Guide 2024
Versions A and B: 220 Questions with Detailed Answers and Rationales
For Nursing Students Preparing for Medical-Surgical Nursing Excellence
Aligned with ATI Guidelines and NGN Formats
June 19, 2025
,Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Version A: Questions 1110 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 Cardiovascular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.2 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.3 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.4 Endocrine Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.5 Neurological Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.6 Musculoskeletal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.7 Case Study 1: Heart Failure (Questions 6165) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.8 Case Study 2: Gastrointestinal Bleeding (Questions 6670) . . . . . . . . . . . . . . . . . . . . . . 10
2.9 Case Study 3: Diabetic Ketoacidosis (Questions 7175) . . . . . . . . . . . . . . . . . . . . . . . . 10
2.10 Bow-Tie Question: Sepsis Management (Questions 7681) . . . . . . . . . . . . . . . . . . . . . . . 11
2.11 Matrix Question: Postoperative Care (Questions 8286) . . . . . . . . . . . . . . . . . . . . . . . . 12
2.12 Additional Questions (87110) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 Version B: Questions 111220 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.1 Cardiovascular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.2 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.3 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4 Study Tips and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1
, NGN ATI Med Surg Proctored Exam 2 Study Guide 2024 2
1 Introduction
This study guide prepares nursing students for the NGN ATI Medical-Surgical Proctored Exam 2, 2024, covering
Versions A and B. It includes 220 questions (110 per version) in NGN formats (multiple-choice, case studies,
bow-tie, matrix) across cardiovascular, respiratory, gastrointestinal, endocrine, neurological, and musculoskeletal
systems. Each question includes a detailed answer and rationale to enhance clinical judgment, aligned with ATI
guidelines and the NCSBN Clinical Judgment Measurement Model.
2 Version A: Questions 1110
2.1 Cardiovascular Disorders
1. A client with angina uses sublingual nitroglycerin. Which statement indicates correct understanding?
A) "Ill take up to five tablets every 5 minutes."
B) "I should lie down when taking it to avoid dizziness."
C) "Ill store it in a warm, humid place."
D) "Ill replace it every 12 months."
Answer: B) "I should lie down when taking it to avoid dizziness."
Rationale: Lying down prevents falls due to hypotension, a common side effect. The maximum dose is
three tablets, 5 minutes apart. Nitroglycerin should be stored at room temperature and replaced every 6
months.
2. A client arrives at the ED with chest pain. What is the nurses first action?
A) Administer aspirin 325 mg orally
B) Obtain vital signs
C) Perform a 12-lead ECG
D) Administer sublingual nitroglycerin
Answer: B) Obtain vital signs
Rationale: Assessing vital signs establishes the clients stability and guides further interventions.
3. A client with heart failure reports dyspnea and a 4 kg weight gain in 48 hours. What is the priority action?
A) Notify the healthcare provider
B) Administer furosemide IV
C) Encourage fluid intake
D) Increase oxygen flow rate
Answer: A) Notify the healthcare provider
Rationale: Rapid weight gain and dyspnea suggest worsening heart failure, requiring provider intervention.
4. A client post-myocardial infarction develops atrial fibrillation. What is the priority assessment?
A) Risk for thromboembolism
B) Blood pressure stability
C) Respiratory rate
D) Pain level
Answer: A) Risk for thromboembolism
Rationale: Atrial fibrillation increases thromboembolism risk due to blood pooling in the atria.
5. A client on lisinopril reports a persistent dry cough. What should the nurse advise?
A) "This may require switching to a different medication."
B) "Increase fluid intake to reduce the cough."
C) "Use cough drops to manage it."
D) "The cough will resolve with continued use."
Answer: A) "This may require switching to a different medication."
Rationale: A dry cough is a common side effect of ACE inhibitors, often requiring a switch to an ARB.
6. A client with hypertension on metoprolol has a heart rate of 45 bpm. What should the nurse do?
A) Withhold the dose and notify the provider
B) Administer the dose as prescribed
C) Monitor for 1 hour
D) Encourage ambulation
Answer: A) Withhold the dose and notify the provider
Rationale: Bradycardia (HR < 50 bpm) is a concerning side effect of beta-blockers.
7. A client post-cardiac catheterization reports groin pain. Which finding requires immediate action?
A) Hard, tender swelling at the site
B) Mild bruising around the site
C) Warm distal extremity
D) Strong pedal pulse
Study Guide 2024
Versions A and B: 220 Questions with Detailed Answers and Rationales
For Nursing Students Preparing for Medical-Surgical Nursing Excellence
Aligned with ATI Guidelines and NGN Formats
June 19, 2025
,Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Version A: Questions 1110 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.1 Cardiovascular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.2 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.3 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.4 Endocrine Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.5 Neurological Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.6 Musculoskeletal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.7 Case Study 1: Heart Failure (Questions 6165) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.8 Case Study 2: Gastrointestinal Bleeding (Questions 6670) . . . . . . . . . . . . . . . . . . . . . . 10
2.9 Case Study 3: Diabetic Ketoacidosis (Questions 7175) . . . . . . . . . . . . . . . . . . . . . . . . 10
2.10 Bow-Tie Question: Sepsis Management (Questions 7681) . . . . . . . . . . . . . . . . . . . . . . . 11
2.11 Matrix Question: Postoperative Care (Questions 8286) . . . . . . . . . . . . . . . . . . . . . . . . 12
2.12 Additional Questions (87110) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 Version B: Questions 111220 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.1 Cardiovascular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.2 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.3 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4 Study Tips and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1
, NGN ATI Med Surg Proctored Exam 2 Study Guide 2024 2
1 Introduction
This study guide prepares nursing students for the NGN ATI Medical-Surgical Proctored Exam 2, 2024, covering
Versions A and B. It includes 220 questions (110 per version) in NGN formats (multiple-choice, case studies,
bow-tie, matrix) across cardiovascular, respiratory, gastrointestinal, endocrine, neurological, and musculoskeletal
systems. Each question includes a detailed answer and rationale to enhance clinical judgment, aligned with ATI
guidelines and the NCSBN Clinical Judgment Measurement Model.
2 Version A: Questions 1110
2.1 Cardiovascular Disorders
1. A client with angina uses sublingual nitroglycerin. Which statement indicates correct understanding?
A) "Ill take up to five tablets every 5 minutes."
B) "I should lie down when taking it to avoid dizziness."
C) "Ill store it in a warm, humid place."
D) "Ill replace it every 12 months."
Answer: B) "I should lie down when taking it to avoid dizziness."
Rationale: Lying down prevents falls due to hypotension, a common side effect. The maximum dose is
three tablets, 5 minutes apart. Nitroglycerin should be stored at room temperature and replaced every 6
months.
2. A client arrives at the ED with chest pain. What is the nurses first action?
A) Administer aspirin 325 mg orally
B) Obtain vital signs
C) Perform a 12-lead ECG
D) Administer sublingual nitroglycerin
Answer: B) Obtain vital signs
Rationale: Assessing vital signs establishes the clients stability and guides further interventions.
3. A client with heart failure reports dyspnea and a 4 kg weight gain in 48 hours. What is the priority action?
A) Notify the healthcare provider
B) Administer furosemide IV
C) Encourage fluid intake
D) Increase oxygen flow rate
Answer: A) Notify the healthcare provider
Rationale: Rapid weight gain and dyspnea suggest worsening heart failure, requiring provider intervention.
4. A client post-myocardial infarction develops atrial fibrillation. What is the priority assessment?
A) Risk for thromboembolism
B) Blood pressure stability
C) Respiratory rate
D) Pain level
Answer: A) Risk for thromboembolism
Rationale: Atrial fibrillation increases thromboembolism risk due to blood pooling in the atria.
5. A client on lisinopril reports a persistent dry cough. What should the nurse advise?
A) "This may require switching to a different medication."
B) "Increase fluid intake to reduce the cough."
C) "Use cough drops to manage it."
D) "The cough will resolve with continued use."
Answer: A) "This may require switching to a different medication."
Rationale: A dry cough is a common side effect of ACE inhibitors, often requiring a switch to an ARB.
6. A client with hypertension on metoprolol has a heart rate of 45 bpm. What should the nurse do?
A) Withhold the dose and notify the provider
B) Administer the dose as prescribed
C) Monitor for 1 hour
D) Encourage ambulation
Answer: A) Withhold the dose and notify the provider
Rationale: Bradycardia (HR < 50 bpm) is a concerning side effect of beta-blockers.
7. A client post-cardiac catheterization reports groin pain. Which finding requires immediate action?
A) Hard, tender swelling at the site
B) Mild bruising around the site
C) Warm distal extremity
D) Strong pedal pulse
