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ATI Advanced Med Surg Proctored
2019 NGN Exam – Updated Questions,
Correct Answers & Rationales
Question 1
A nurse is assessing a client with septic shock. Which finding requires immediate intervention?
A. Heart rate 88 bpm
B. Mean arterial pressure (MAP) 58 mmHg
C. Oxygen saturation 92%
D. Temperature 100.4°F
Correct Answer: B. Mean arterial pressure (MAP) 58 mmHg
Rationale: A MAP below 60 mmHg indicates inadequate organ perfusion in septic shock,
requiring immediate intervention (e.g., fluid bolus, vasopressors) to prevent multi-organ failure,
per Surviving Sepsis Campaign guidelines. Other findings are concerning but less urgent.
Question 2
A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation. Which
ventilator setting should the nurse prioritize to prevent lung injury?
A. High tidal volume
B. Low positive end-expiratory pressure (PEEP)
C. Tidal volume 6 mL/kg ideal body weight
D. High fraction of inspired oxygen (FiO2)
Correct Answer: C. Tidal volume 6 mL/kg ideal body weight
Rationale: Low tidal volume ventilation (6 mL/kg ideal body weight) is the standard for ARDS
to prevent ventilator-induced lung injury (VILI), per ARDSNet protocol. High tidal volume
increases barotrauma risk, and high FiO2 can cause oxygen toxicity.
Question 3
A nurse is caring for a client post-myocardial infarction (MI) with a new left bundle branch
block. Which action is the priority?
A. Administer aspirin 325 mg
B. Prepare for cardiac catheterization
C. Monitor oxygen saturation
D. Obtain a 12-lead ECG
, 2
Correct Answer: B. Prepare for cardiac catheterization
Rationale: A new left bundle branch block post-MI suggests acute coronary occlusion, requiring
urgent cardiac catheterization for revascularization, per AHA/ACC guidelines. Aspirin and ECG
are important but not the immediate priority.
Question 4
A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL and potassium of
3.2 mEq/L. What is the nurse’s first action?
A. Administer insulin bolus
B. Initiate potassium replacement
C. Increase IV fluid rate
D. Check arterial blood gas (ABG)
Correct Answer: B. Initiate potassium replacement
Rationale: Hypokalemia (3.2 mEq/L) in DKA is life-threatening due to the risk of arrhythmias.
Potassium replacement must precede insulin administration to prevent further potassium
depletion, per ADA guidelines.
Question 5
A client with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mmHg.
Which intervention should the nurse implement first?
A. Administer mannitol IV
B. Elevate the head of the bed to 30 degrees
C. Increase sedation
D. Hyperventilate the client
Correct Answer: B. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage and reduces
ICP in TBI, a non-invasive first-line intervention, per Brain Trauma Foundation guidelines.
Mannitol and hyperventilation are secondary measures.
Question 6
A client with pneumonia develops a fever of 102.2°F and hypotension. Which action should the
nurse prioritize?
A. Administer antipyretics
B. Obtain blood cultures
C. Increase oxygen flow rate
D. Encourage oral fluids
Correct Answer: B. Obtain blood cultures
Rationale: Fever and hypotension suggest possible sepsis. Obtaining blood cultures before
antibiotics is critical to identify the causative organism, per Surviving Sepsis Campaign
guidelines.
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Question 7
A nurse is caring for a client with a pulmonary embolism (PE). Which finding indicates
worsening condition?
A. Respiratory rate 18 breaths/min
B. Oxygen saturation 88%
C. Blood pressure 120/80 mmHg
D. Heart rate 90 bpm
Correct Answer: B. Oxygen saturation 88%
Rationale: Hypoxemia (O2 sat 88%) indicates worsening gas exchange in PE, requiring
immediate intervention (e.g., oxygen, anticoagulation), per AHA guidelines. Other findings are
within normal limits.
Question 8
A client post-coronary artery bypass graft (CABG) reports chest pain. Which action should the
nurse take first?
A. Administer morphine IV
B. Notify the provider
C. Obtain a 12-lead ECG
D. Increase oxygen flow
Correct Answer: C. Obtain a 12-lead ECG
Rationale: Chest pain post-CABG may indicate graft occlusion or ischemia. A 12-lead ECG is
the priority to assess for acute changes, per AHA/ACC guidelines, before administering
medications or notifying the provider.
Question 9
A client with heart failure is prescribed furosemide 40 mg IV. Which electrolyte should the nurse
monitor closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale: Furosemide, a loop diuretic, causes potassium loss, increasing the risk of
hypokalemia and arrhythmias, requiring close monitoring, per AHA heart failure guidelines.
Question 10
A client with a gastrointestinal bleed is receiving a blood transfusion. Which finding indicates a
transfusion reaction?
A. Temperature 99.8°F
ATI Advanced Med Surg Proctored
2019 NGN Exam – Updated Questions,
Correct Answers & Rationales
Question 1
A nurse is assessing a client with septic shock. Which finding requires immediate intervention?
A. Heart rate 88 bpm
B. Mean arterial pressure (MAP) 58 mmHg
C. Oxygen saturation 92%
D. Temperature 100.4°F
Correct Answer: B. Mean arterial pressure (MAP) 58 mmHg
Rationale: A MAP below 60 mmHg indicates inadequate organ perfusion in septic shock,
requiring immediate intervention (e.g., fluid bolus, vasopressors) to prevent multi-organ failure,
per Surviving Sepsis Campaign guidelines. Other findings are concerning but less urgent.
Question 2
A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation. Which
ventilator setting should the nurse prioritize to prevent lung injury?
A. High tidal volume
B. Low positive end-expiratory pressure (PEEP)
C. Tidal volume 6 mL/kg ideal body weight
D. High fraction of inspired oxygen (FiO2)
Correct Answer: C. Tidal volume 6 mL/kg ideal body weight
Rationale: Low tidal volume ventilation (6 mL/kg ideal body weight) is the standard for ARDS
to prevent ventilator-induced lung injury (VILI), per ARDSNet protocol. High tidal volume
increases barotrauma risk, and high FiO2 can cause oxygen toxicity.
Question 3
A nurse is caring for a client post-myocardial infarction (MI) with a new left bundle branch
block. Which action is the priority?
A. Administer aspirin 325 mg
B. Prepare for cardiac catheterization
C. Monitor oxygen saturation
D. Obtain a 12-lead ECG
, 2
Correct Answer: B. Prepare for cardiac catheterization
Rationale: A new left bundle branch block post-MI suggests acute coronary occlusion, requiring
urgent cardiac catheterization for revascularization, per AHA/ACC guidelines. Aspirin and ECG
are important but not the immediate priority.
Question 4
A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL and potassium of
3.2 mEq/L. What is the nurse’s first action?
A. Administer insulin bolus
B. Initiate potassium replacement
C. Increase IV fluid rate
D. Check arterial blood gas (ABG)
Correct Answer: B. Initiate potassium replacement
Rationale: Hypokalemia (3.2 mEq/L) in DKA is life-threatening due to the risk of arrhythmias.
Potassium replacement must precede insulin administration to prevent further potassium
depletion, per ADA guidelines.
Question 5
A client with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mmHg.
Which intervention should the nurse implement first?
A. Administer mannitol IV
B. Elevate the head of the bed to 30 degrees
C. Increase sedation
D. Hyperventilate the client
Correct Answer: B. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage and reduces
ICP in TBI, a non-invasive first-line intervention, per Brain Trauma Foundation guidelines.
Mannitol and hyperventilation are secondary measures.
Question 6
A client with pneumonia develops a fever of 102.2°F and hypotension. Which action should the
nurse prioritize?
A. Administer antipyretics
B. Obtain blood cultures
C. Increase oxygen flow rate
D. Encourage oral fluids
Correct Answer: B. Obtain blood cultures
Rationale: Fever and hypotension suggest possible sepsis. Obtaining blood cultures before
antibiotics is critical to identify the causative organism, per Surviving Sepsis Campaign
guidelines.
, 3
Question 7
A nurse is caring for a client with a pulmonary embolism (PE). Which finding indicates
worsening condition?
A. Respiratory rate 18 breaths/min
B. Oxygen saturation 88%
C. Blood pressure 120/80 mmHg
D. Heart rate 90 bpm
Correct Answer: B. Oxygen saturation 88%
Rationale: Hypoxemia (O2 sat 88%) indicates worsening gas exchange in PE, requiring
immediate intervention (e.g., oxygen, anticoagulation), per AHA guidelines. Other findings are
within normal limits.
Question 8
A client post-coronary artery bypass graft (CABG) reports chest pain. Which action should the
nurse take first?
A. Administer morphine IV
B. Notify the provider
C. Obtain a 12-lead ECG
D. Increase oxygen flow
Correct Answer: C. Obtain a 12-lead ECG
Rationale: Chest pain post-CABG may indicate graft occlusion or ischemia. A 12-lead ECG is
the priority to assess for acute changes, per AHA/ACC guidelines, before administering
medications or notifying the provider.
Question 9
A client with heart failure is prescribed furosemide 40 mg IV. Which electrolyte should the nurse
monitor closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale: Furosemide, a loop diuretic, causes potassium loss, increasing the risk of
hypokalemia and arrhythmias, requiring close monitoring, per AHA heart failure guidelines.
Question 10
A client with a gastrointestinal bleed is receiving a blood transfusion. Which finding indicates a
transfusion reaction?
A. Temperature 99.8°F
