ATI Med-Surg Proctored Exam 2026: NGN
Practice Questions
Part 1: NGN Case Studies (Clinical Judgment)
Scenario: A 72-year-old client is 2 days post-operative
following an open reduction internal fixation (ORIF) of a
fractured right hip. History: hypertension and type 2
diabetes. Vital signs: BP 148/88, HR 98, RR 20, Temp 38.3°C
(101.0°F), SpO2 94% on room air. The nurse enters the room
to find the client reporting sudden shortness of breath and
sharp chest pain that increases with inspiration. The client
appears anxious and diaphoretic.
1. As the nurse, what is your priority action?
A. Notify the healthcare provider immediately.
B. Reassure the client and administer prescribed pain medication.
, C. Administer oxygen at 2-4 L/min via nasal cannula.
D. Elevate the head of the bed and take a full set of vital signs.
o Correct Answer💜💜: C. Administer oxygen at 2-4 L/min via nasal
cannula.
o Rationale: Airway and breathing are the priority. The client's
symptoms (sudden dyspnea, chest pain, tachycardia) are highly
suggestive of a pulmonary embolism (PE), a life-threatening
complication after orthopedic surgery . The first action is to
administer oxygen to correct or prevent hypoxemia.
2. The healthcare provider suspects a pulmonary embolism. Which of the
following assessment findings would the nurse expect? (Select all that
apply.)
A. Bradycardia
B. Pleuritic chest pain
C. Crackles in the lung bases bilaterally
D. Tachypnea
E. Productive cough with purulent sputum
F. Low-grade fever
, o Correct Answer💜💜s: B, D, F
o Rationale: Classic signs of a PE include pleuritic chest pain (sharp,
worsens on inspiration), tachypnea, and a low-grade fever from
inflammation . Tachycardia, not bradycardia, is typical. Purulent
sputum suggests infection.
3. The provider orders a stat CT pulmonary angiogram, which confirms a
pulmonary embolism. Which of the following orders should the nurse
anticipate and prepare to administer?
A. Tissue plasminogen activator (tPA)
B. Intravenous heparin infusion
C. Warfarin (Coumadin) 5 mg orally
D. Alteplase (Activase) bolus
o Correct Answer💜💜: B. Intravenous heparin infusion
o Rationale: The initial anticoagulation for a PE is a fast-acting
parenteral anticoagulant like IV heparin to prevent further clot
formation . tPA (A, D) is a thrombolytic reserved for massive,
hemodynamically unstable PEs. Warfarin is a long-term oral
anticoagulant started later, overlapping with heparin.
, Case Study 2: Fluid and Electrolyte Imbalance
Scenario: A 65-year-old client is admitted with nausea, vomiting, and diarrhea for
3 days. History of heart failure, takes furosemide (Lasix) and digoxin (Lanoxin)
daily. Vital signs: BP 100/58, HR 110 (irregular), RR 22, Temp 37.2°C (99.0°F). The
client is lethargic and complains of severe muscle weakness and cramping.
4. The nurse reviews the client's admission lab results. Which of the
following findings is of most concern and should be reported to the
provider immediately?
A. Serum sodium 150 mEq/L
B. Serum potassium 2.9 mEq/L
C. Serum creatinine 1.1 mg/dL
D. Blood glucose 140 mg/dL
o Correct Answer💜💜: B. Serum potassium 2.9 mEq/L
o Rationale: This client is at high risk for hypokalemia due to GI losses
and furosemide use. A potassium of 2.9 mEq/L indicates severe
hypokalemia. When combined with digoxin therapy, hypokalemia
dramatically increases the risk of digoxin toxicity and life-threatening
cardiac dysrhythmias (evidenced by the irregular HR) .
Practice Questions
Part 1: NGN Case Studies (Clinical Judgment)
Scenario: A 72-year-old client is 2 days post-operative
following an open reduction internal fixation (ORIF) of a
fractured right hip. History: hypertension and type 2
diabetes. Vital signs: BP 148/88, HR 98, RR 20, Temp 38.3°C
(101.0°F), SpO2 94% on room air. The nurse enters the room
to find the client reporting sudden shortness of breath and
sharp chest pain that increases with inspiration. The client
appears anxious and diaphoretic.
1. As the nurse, what is your priority action?
A. Notify the healthcare provider immediately.
B. Reassure the client and administer prescribed pain medication.
, C. Administer oxygen at 2-4 L/min via nasal cannula.
D. Elevate the head of the bed and take a full set of vital signs.
o Correct Answer💜💜: C. Administer oxygen at 2-4 L/min via nasal
cannula.
o Rationale: Airway and breathing are the priority. The client's
symptoms (sudden dyspnea, chest pain, tachycardia) are highly
suggestive of a pulmonary embolism (PE), a life-threatening
complication after orthopedic surgery . The first action is to
administer oxygen to correct or prevent hypoxemia.
2. The healthcare provider suspects a pulmonary embolism. Which of the
following assessment findings would the nurse expect? (Select all that
apply.)
A. Bradycardia
B. Pleuritic chest pain
C. Crackles in the lung bases bilaterally
D. Tachypnea
E. Productive cough with purulent sputum
F. Low-grade fever
, o Correct Answer💜💜s: B, D, F
o Rationale: Classic signs of a PE include pleuritic chest pain (sharp,
worsens on inspiration), tachypnea, and a low-grade fever from
inflammation . Tachycardia, not bradycardia, is typical. Purulent
sputum suggests infection.
3. The provider orders a stat CT pulmonary angiogram, which confirms a
pulmonary embolism. Which of the following orders should the nurse
anticipate and prepare to administer?
A. Tissue plasminogen activator (tPA)
B. Intravenous heparin infusion
C. Warfarin (Coumadin) 5 mg orally
D. Alteplase (Activase) bolus
o Correct Answer💜💜: B. Intravenous heparin infusion
o Rationale: The initial anticoagulation for a PE is a fast-acting
parenteral anticoagulant like IV heparin to prevent further clot
formation . tPA (A, D) is a thrombolytic reserved for massive,
hemodynamically unstable PEs. Warfarin is a long-term oral
anticoagulant started later, overlapping with heparin.
, Case Study 2: Fluid and Electrolyte Imbalance
Scenario: A 65-year-old client is admitted with nausea, vomiting, and diarrhea for
3 days. History of heart failure, takes furosemide (Lasix) and digoxin (Lanoxin)
daily. Vital signs: BP 100/58, HR 110 (irregular), RR 22, Temp 37.2°C (99.0°F). The
client is lethargic and complains of severe muscle weakness and cramping.
4. The nurse reviews the client's admission lab results. Which of the
following findings is of most concern and should be reported to the
provider immediately?
A. Serum sodium 150 mEq/L
B. Serum potassium 2.9 mEq/L
C. Serum creatinine 1.1 mg/dL
D. Blood glucose 140 mg/dL
o Correct Answer💜💜: B. Serum potassium 2.9 mEq/L
o Rationale: This client is at high risk for hypokalemia due to GI losses
and furosemide use. A potassium of 2.9 mEq/L indicates severe
hypokalemia. When combined with digoxin therapy, hypokalemia
dramatically increases the risk of digoxin toxicity and life-threatening
cardiac dysrhythmias (evidenced by the irregular HR) .
