ATI RN Adult Medical Surgical Proctored Exam with NGN – 2023/2024 Edition: Comprehensive
Question Bank with Detailed Rationales
📋 COMPLETE 150+ QUESTION BANK WITH ANSWERS &
RATIONALES
(Organized by Clinical Topic Area)
🩸 CARDIovascular & Hematologic Disorders (Questions 1-22)
Q1. A nurse is assessing a client who is 12 hr postoperative following a colon resection. Which of the
following findings should the nurse report to the surgeon?
a. Heart rate 90/min
b. Absent bowel sounds
c. Hgb 8.2 g/dL
d. Gastric pH of 3.0
Correct Answer: c. Hgb 8.2 g/dL
Rationale: Normal hemoglobin is 13-18 g/dL for males and 12-16 g/dL for females. A level of 8.2 g/dL
is significantly low and indicates possible postoperative hemorrhage, which requires immediate
reporting to the surgeon. Absent bowel sounds are expected after major bowel surgery and can take
several days to return.
Q2. A nurse is caring for a client receiving a blood transfusion. The nurse observes bounding
peripheral pulses, hypertension, and distended jugular veins. Which medication should the nurse
anticipate administering?
a. Diphenhydramine
b. Acetaminophen
c. Pantoprazole
d. Furosemide
Correct Answer: d. Furosemide
Rationale: These signs indicate circulatory overload (fluid volume excess). Furosemide is a loop diuretic
that reduces fluid volume by promoting diuresis. Diphenhydramine is for allergic reactions;
,acetaminophen for fever; pantoprazole for GI prophylaxis.
Q3. A nurse is reviewing a client's ABG results: pH 7.42, PaCO2 30 mm Hg, and HCO3 21 mEq/L. The
nurse should recognize these findings as indication of which condition?
a. Metabolic acidosis
b. Metabolic alkalosis
-- d. Uncompensated respiratory acidosis
Correct Answer: c. Compensated respiratory alkalosis
Rationale: The pH is within normal range (7.35-7.45), indicating compensation. PaCO2 is low (normal
35-45 mm Hg), indicating respiratory alkalosis. The HCO3 is slightly low (normal 22-26 mEq/L),
showing the kidneys are attempting to compensate by excreting bicarbonate.
Q4. A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor.
Which of the following should the nurse analyze to determine whether the client is experiencing a
myocardial infarction?
a. PR interval
b. QRS duration
c. T wave
d. ST segment
Correct Answer: d. ST segment
Rationale: ST segment elevation or depression is the key ECG indicator of myocardial ischemia or
infarction. PR interval relates to AV conduction; QRS duration to ventricular depolarization; T wave
changes are less specific for acute MI.
Q5. A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of
hypomagnesemia. Which finding indicates effectiveness of the medication?
a. Lungs clear
b. Apical pulse 82/min
c. Hyperactive bowel sounds
d. Blood pressure 90/50 mm Hg
Correct Answer: b. Apical pulse 82/min
,Rationale: Hypomagnesemia often causes cardiac dysrhythmias and tachycardia. A normal apical pulse
(60-100/min) indicates therapeutic effect and resolution of dysrhythmias.
Q6. A nurse is caring for a client with a new prescription for warfarin. Which statement by the client
indicates understanding of the teaching?
a. "I will take ibuprofen if I have a headache."
b. "I should avoid eating leafy green vegetables."
c. "I will have my blood tested regularly while taking this medication."
d. "I can stop taking this medication if I notice bruising."
Correct Answer: c. "I will have my blood tested regularly while taking this medication."
Rationale: Clients taking warfarin require regular monitoring of INR to ensure therapeutic levels and
prevent bleeding complications. Ibuprofen increases bleeding risk; vitamin K-rich foods should be
consistent rather than avoided; medication should never be stopped without provider instruction.
Q7. NGN Case Study – Digoxin Toxicity: A client on digoxin reports nausea, vomiting, and has an apical
heart rate of 45 bpm. What should the nurse do first?
a. Administer the digoxin as ordered
b. Hold the medication and notify the provider
c. Encourage fluids and monitor
d. Check potassium level and give supplement
Correct Answer: b. Hold the medication and notify the provider
Rationale: Nausea, vomiting, and bradycardia (HR <60 bpm) are classic signs of digoxin toxicity. The
nurse should hold the dose and notify the provider for further orders, which may include checking
digoxin and potassium levels.
Q8. Multiple-Select NGN – Heparin Adverse Effects: Which adverse effects should the nurse monitor for
in a client receiving heparin? (Select all that apply.)
a. Bleeding gums
b. Bruising
c. Hypertension
d. Thrombocytopenia
e. Hyperkalemia
, Correct Answers: a, b, d
Rationale: Heparin can cause bleeding (bleeding gums, bruising) and heparin-induced
thrombocytopenia (HIT). It does not typically cause hypertension or hyperkalemia.
Q9. NGN Case Study – Blood Transfusion Reaction: A nurse is preparing to administer a blood
transfusion to a client. Which action should the nurse take first?
a. Obtain the client's vital signs
b. Verify the client's identity with another nurse
c. Prime the blood tubing with 0.9% sodium chloride
d. Educate the client about signs of a transfusion reaction
Correct Answer: b. Verify the client's identity with another nurse
Rationale: Patient safety during blood transfusion begins with two-nurse verification of client identity,
blood product, and compatibility. Vital signs are obtained second, then tubing primed, then education
provided.
Q10. A client is receiving IV heparin. The nurse notes a platelet count of 80,000/mm³. What should the
nurse do?
a. Continue therapy and monitor labs
b. Hold heparin and notify the provider
c. Increase heparin dose
d. Administer vitamin K
Correct Answer: b. Hold heparin and notify the provider
Rationale: Thrombocytopenia (platelets <100,000/mm³) may indicate heparin-induced
thrombocytopenia (HIT), a life-threatening complication. Heparin must be stopped immediately and
the provider notified.
Q11. Multiple-Select NGN – Beta-Blocker Adverse Effects: Which adverse effects should the nurse
monitor in a client taking metoprolol? (Select all that apply.)
a. Bradycardia
b. Bronchospasm
c. Hypoglycemia
Question Bank with Detailed Rationales
📋 COMPLETE 150+ QUESTION BANK WITH ANSWERS &
RATIONALES
(Organized by Clinical Topic Area)
🩸 CARDIovascular & Hematologic Disorders (Questions 1-22)
Q1. A nurse is assessing a client who is 12 hr postoperative following a colon resection. Which of the
following findings should the nurse report to the surgeon?
a. Heart rate 90/min
b. Absent bowel sounds
c. Hgb 8.2 g/dL
d. Gastric pH of 3.0
Correct Answer: c. Hgb 8.2 g/dL
Rationale: Normal hemoglobin is 13-18 g/dL for males and 12-16 g/dL for females. A level of 8.2 g/dL
is significantly low and indicates possible postoperative hemorrhage, which requires immediate
reporting to the surgeon. Absent bowel sounds are expected after major bowel surgery and can take
several days to return.
Q2. A nurse is caring for a client receiving a blood transfusion. The nurse observes bounding
peripheral pulses, hypertension, and distended jugular veins. Which medication should the nurse
anticipate administering?
a. Diphenhydramine
b. Acetaminophen
c. Pantoprazole
d. Furosemide
Correct Answer: d. Furosemide
Rationale: These signs indicate circulatory overload (fluid volume excess). Furosemide is a loop diuretic
that reduces fluid volume by promoting diuresis. Diphenhydramine is for allergic reactions;
,acetaminophen for fever; pantoprazole for GI prophylaxis.
Q3. A nurse is reviewing a client's ABG results: pH 7.42, PaCO2 30 mm Hg, and HCO3 21 mEq/L. The
nurse should recognize these findings as indication of which condition?
a. Metabolic acidosis
b. Metabolic alkalosis
-- d. Uncompensated respiratory acidosis
Correct Answer: c. Compensated respiratory alkalosis
Rationale: The pH is within normal range (7.35-7.45), indicating compensation. PaCO2 is low (normal
35-45 mm Hg), indicating respiratory alkalosis. The HCO3 is slightly low (normal 22-26 mEq/L),
showing the kidneys are attempting to compensate by excreting bicarbonate.
Q4. A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor.
Which of the following should the nurse analyze to determine whether the client is experiencing a
myocardial infarction?
a. PR interval
b. QRS duration
c. T wave
d. ST segment
Correct Answer: d. ST segment
Rationale: ST segment elevation or depression is the key ECG indicator of myocardial ischemia or
infarction. PR interval relates to AV conduction; QRS duration to ventricular depolarization; T wave
changes are less specific for acute MI.
Q5. A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of
hypomagnesemia. Which finding indicates effectiveness of the medication?
a. Lungs clear
b. Apical pulse 82/min
c. Hyperactive bowel sounds
d. Blood pressure 90/50 mm Hg
Correct Answer: b. Apical pulse 82/min
,Rationale: Hypomagnesemia often causes cardiac dysrhythmias and tachycardia. A normal apical pulse
(60-100/min) indicates therapeutic effect and resolution of dysrhythmias.
Q6. A nurse is caring for a client with a new prescription for warfarin. Which statement by the client
indicates understanding of the teaching?
a. "I will take ibuprofen if I have a headache."
b. "I should avoid eating leafy green vegetables."
c. "I will have my blood tested regularly while taking this medication."
d. "I can stop taking this medication if I notice bruising."
Correct Answer: c. "I will have my blood tested regularly while taking this medication."
Rationale: Clients taking warfarin require regular monitoring of INR to ensure therapeutic levels and
prevent bleeding complications. Ibuprofen increases bleeding risk; vitamin K-rich foods should be
consistent rather than avoided; medication should never be stopped without provider instruction.
Q7. NGN Case Study – Digoxin Toxicity: A client on digoxin reports nausea, vomiting, and has an apical
heart rate of 45 bpm. What should the nurse do first?
a. Administer the digoxin as ordered
b. Hold the medication and notify the provider
c. Encourage fluids and monitor
d. Check potassium level and give supplement
Correct Answer: b. Hold the medication and notify the provider
Rationale: Nausea, vomiting, and bradycardia (HR <60 bpm) are classic signs of digoxin toxicity. The
nurse should hold the dose and notify the provider for further orders, which may include checking
digoxin and potassium levels.
Q8. Multiple-Select NGN – Heparin Adverse Effects: Which adverse effects should the nurse monitor for
in a client receiving heparin? (Select all that apply.)
a. Bleeding gums
b. Bruising
c. Hypertension
d. Thrombocytopenia
e. Hyperkalemia
, Correct Answers: a, b, d
Rationale: Heparin can cause bleeding (bleeding gums, bruising) and heparin-induced
thrombocytopenia (HIT). It does not typically cause hypertension or hyperkalemia.
Q9. NGN Case Study – Blood Transfusion Reaction: A nurse is preparing to administer a blood
transfusion to a client. Which action should the nurse take first?
a. Obtain the client's vital signs
b. Verify the client's identity with another nurse
c. Prime the blood tubing with 0.9% sodium chloride
d. Educate the client about signs of a transfusion reaction
Correct Answer: b. Verify the client's identity with another nurse
Rationale: Patient safety during blood transfusion begins with two-nurse verification of client identity,
blood product, and compatibility. Vital signs are obtained second, then tubing primed, then education
provided.
Q10. A client is receiving IV heparin. The nurse notes a platelet count of 80,000/mm³. What should the
nurse do?
a. Continue therapy and monitor labs
b. Hold heparin and notify the provider
c. Increase heparin dose
d. Administer vitamin K
Correct Answer: b. Hold heparin and notify the provider
Rationale: Thrombocytopenia (platelets <100,000/mm³) may indicate heparin-induced
thrombocytopenia (HIT), a life-threatening complication. Heparin must be stopped immediately and
the provider notified.
Q11. Multiple-Select NGN – Beta-Blocker Adverse Effects: Which adverse effects should the nurse
monitor in a client taking metoprolol? (Select all that apply.)
a. Bradycardia
b. Bronchospasm
c. Hypoglycemia
