RN ATI Adult Medical Surgical Med-Surg 2023 Proctored Exam
with NGN | 300 High-Yield Question Bank & Level 3
Remediation Guide (Updated 2026) Chamberlain University
This premium 300-question practice bank provides verified, high-yield Next-Generation NCLEX (NGN)
and standard multiple-choice questions explicitly designed for the 2023 ATI Adult Medical Surgical
Proctored Exam. Every item features a bolded correct answer and a highly detailed, italicized rationale
based on the official ATI active learning templates to ensure a Level 3 score performance. Perfect for
nursing students seeking comprehensive, scan-ready remediation material, this guide optimizes study
time and guarantees high marketplace review ratings.
Question 1
A nurse is preparing a client for an esophagogastroduodenoscopy (EGD). Which of the
following nursing interventions is the priority?
A. Assess the client's post-procedure gag reflex.
B. Ensure the client has been NPO for at least 6 to 8 hours prior.
C. Administer a continuous maintenance infusion of normal saline.
D. Position the client in a high-Fowler's position during the exam.
ANSWER: B. Ensure the client has been NPO for at least 6 to 8 hours prior.
RATIONALE: Prevention of aspiration is the priority safety goal for a client
undergoing an upper endoscopy. Keeping the client strictly NPO for 6 to 8 hours
ensures the stomach is empty, minimizing the risk of vomiting and subsequent
airway compromise under conscious sedation. While assessing the gag reflex
(Choice A) is a critical nursing action, it is a post-procedure intervention
performed before reintroducing oral fluids. The client is typically placed in a left
side-lying position (Choice D) during the procedure, not high-Fowler's, to
facilitate clearance of secretions and scope advancement.
Question 2
A nurse is caring for a client admitted with Diabetic Ketoacidosis (DKA). The nurse
notes a current blood glucose level of 240 mg/dL, an intravenous regular insulin infusion
running, and a prescription to change the IV fluids to include 5% Dextrose. Which of the
,following explanations best describes the physiological purpose of adding dextrose to
the IV solution?
A. To prevent a rapid drop in blood glucose that can induce cerebral edema.
B. To reverse metabolic alkalosis by providing excess carbohydrates.
C. To treat hypokalemia by drawing potassium out of the cells.
D. To accelerate the clearance of ketones via the urinary tract.
ANSWER: A. To prevent a rapid drop in blood glucose that can induce cerebral
edema.
RATIONALE: During the management of DKA, when the blood glucose level
decreases to approximately 250 mg/dL, the intravenous fluid solution should be
switched to include 5% dextrose (such as 5% dextrose in 0.45% normal saline).
This intervention prevents a rapid drop in blood glucose, which can induce
severe cerebral edema. It also allows the regular insulin infusion to continue
safely so that circulating insulin can resolve the underlying ketosis and metabolic
acidosis. A pH of 7.35 indicates resolution of acidosis but is not the primary
trigger for adding dextrose. Hypokalemia require potassium replacement, not
dextrose.
Question 3
A nurse is setting up a sterile field to perform a central venous catheter dressing
change. Which of the following actions should the nurse perform first when opening the
sterile package wrapper?
A. Open the right side flap of the package wrapper.
B. Open the left side flap of the package wrapper.
C. Open the flap furthest away from the nurse's body.
D. Open the closest flap toward the nurse's body.
ANSWER: C. Open the flap furthest away from the nurse's body.
RATIONALE: When establishing a sterile field, the nurse must always open the
top flap furthest away from their body first. This prevents the nurse's unsterile
arm from crossing directly over the exposed sterile field during the subsequent
opening of the side and front flaps, thereby maintaining strict surgical asepsis.
Opening the closest flap first (Choice D) or side flaps first (Choices A and B)
would force the nurse to reach over the sterile contents to open the remaining
flaps, contaminating the environment.
,Question 4
A nurse is monitoring a client who is receiving a unit of packed red blood cells (PRBCs).
Ten minutes into the transfusion, the client reports lower back pain, chills, and
shortness of breath. Which of the following actions should the nurse take first?
A. Notify the healthcare provider and the blood bank.
B. Discontinue the blood transfusion completely.
C. Infuse normal saline through the blood tubing.
D. Administer prescribed diphenhydramine intravenously.
ANSWER: B. Discontinue the blood transfusion completely.
RATIONALE: Low back pain, chills, and dyspnea are classic manifestations of an
acute hemolytic transfusion reaction, which is a life-threatening emergency. The
immediate priority intervention is to stop the transfusion to prevent further
exposure to incompatible blood cells. Normal saline should be infused to
maintain intravenous access, but it must be administered through entirely new IV
tubing (Choice C), not the existing blood tubing, to prevent flushing remaining
blood into the client's circulation. Notifying the provider (Choice A) and
administering medications (Choice D) are done immediately after stopping the
infusion and securing the airway.
Question 5
A nurse is preparing an educational plan for a client diagnosed with acute
gastroenteritis. Which of the following dietary guidelines should the nurse include in the
teaching?
A. Consume low-fat milk products to maintain calcium intake.
B. Increase caffeine consumption to promote intestinal motility.
C. Avoid dairy, caffeine, and highly seasoned foods during acute episodes.
D. Transition immediately to a high-fiber diet to solidify stools.
ANSWER: C. Avoid dairy, caffeine, and highly seasoned foods during acute
episodes.
RATIONALE: Managing acute gastroenteritis requires resting the gastrointestinal
tract and preventing hypermotility. Dairy products contain lactose, which can
exacerbate diarrhea due to temporary lactose intolerance during gut
inflammation. Caffeine stimulates gastric secretions and increases peristalsis,
worsening cramping and fluid loss. Highly seasoned foods irritate the mucosal
lining. High-fiber items (Choice D) should be avoided initially as they stimulate
the bowel; instead, a bland, low-residue diet should be introduced gradually.
, Question 6
A nurse is assessing a client with a history of left-sided heart failure. Which of the
following clinical manifestations should the nurse expect to find?
A. Jugular venous distention and peripheral edema.
B. Splenomegaly and ascites.
C. Bilateral lung crackles and orthopnea.
D. Weight gain and hepatomegaly.
ANSWER: C. Bilateral lung crackles and orthopnea.
RATIONALE: Left-sided heart failure causes backward failure of the left ventricle,
leading to pulmonary congestion and increased hydrostatic pressure in the
pulmonary vasculature. Fluid shifts into the alveoli, presenting as crackles,
dyspnea, cough, and orthopnea (difficulty breathing while lying flat). Jugular
venous distention (Choice A), splenomegaly/ascites (Choice B), and
hepatomegaly (Choice D) are classic manifestations of right-sided heart failure,
which results in systemic venous congestion.
Question 7
A nurse is caring for a client who is 2 hours postoperative following a total
thyroidectomy. Which of the following pieces of equipment is the priority to maintain at
the client's bedside?
A. An incentive spirometer.
B. A tracheostomy tray.
C. An electronic blood pressure cuff.
D. A PCA pump with opioid analgesics.
ANSWER: B. A tracheostomy tray.
RATIONALE: Following a thyroidectomy, the client is at high risk for acute airway
obstruction due to post-operative complications such as laryngeal edema,
hemorrhage, or bilateral recurrent laryngeal nerve damage. Keeping an
emergency tracheostomy tray at the bedside is the priority safety intervention to
secure an immediate airway if sudden respiratory distress occurs. While
incentive spirometry (Choice A) supports lung expansion and blood pressure
monitoring (Choice C) checks hemodynamic stability, they do not take
precedence over life-saving airway management equipment.
with NGN | 300 High-Yield Question Bank & Level 3
Remediation Guide (Updated 2026) Chamberlain University
This premium 300-question practice bank provides verified, high-yield Next-Generation NCLEX (NGN)
and standard multiple-choice questions explicitly designed for the 2023 ATI Adult Medical Surgical
Proctored Exam. Every item features a bolded correct answer and a highly detailed, italicized rationale
based on the official ATI active learning templates to ensure a Level 3 score performance. Perfect for
nursing students seeking comprehensive, scan-ready remediation material, this guide optimizes study
time and guarantees high marketplace review ratings.
Question 1
A nurse is preparing a client for an esophagogastroduodenoscopy (EGD). Which of the
following nursing interventions is the priority?
A. Assess the client's post-procedure gag reflex.
B. Ensure the client has been NPO for at least 6 to 8 hours prior.
C. Administer a continuous maintenance infusion of normal saline.
D. Position the client in a high-Fowler's position during the exam.
ANSWER: B. Ensure the client has been NPO for at least 6 to 8 hours prior.
RATIONALE: Prevention of aspiration is the priority safety goal for a client
undergoing an upper endoscopy. Keeping the client strictly NPO for 6 to 8 hours
ensures the stomach is empty, minimizing the risk of vomiting and subsequent
airway compromise under conscious sedation. While assessing the gag reflex
(Choice A) is a critical nursing action, it is a post-procedure intervention
performed before reintroducing oral fluids. The client is typically placed in a left
side-lying position (Choice D) during the procedure, not high-Fowler's, to
facilitate clearance of secretions and scope advancement.
Question 2
A nurse is caring for a client admitted with Diabetic Ketoacidosis (DKA). The nurse
notes a current blood glucose level of 240 mg/dL, an intravenous regular insulin infusion
running, and a prescription to change the IV fluids to include 5% Dextrose. Which of the
,following explanations best describes the physiological purpose of adding dextrose to
the IV solution?
A. To prevent a rapid drop in blood glucose that can induce cerebral edema.
B. To reverse metabolic alkalosis by providing excess carbohydrates.
C. To treat hypokalemia by drawing potassium out of the cells.
D. To accelerate the clearance of ketones via the urinary tract.
ANSWER: A. To prevent a rapid drop in blood glucose that can induce cerebral
edema.
RATIONALE: During the management of DKA, when the blood glucose level
decreases to approximately 250 mg/dL, the intravenous fluid solution should be
switched to include 5% dextrose (such as 5% dextrose in 0.45% normal saline).
This intervention prevents a rapid drop in blood glucose, which can induce
severe cerebral edema. It also allows the regular insulin infusion to continue
safely so that circulating insulin can resolve the underlying ketosis and metabolic
acidosis. A pH of 7.35 indicates resolution of acidosis but is not the primary
trigger for adding dextrose. Hypokalemia require potassium replacement, not
dextrose.
Question 3
A nurse is setting up a sterile field to perform a central venous catheter dressing
change. Which of the following actions should the nurse perform first when opening the
sterile package wrapper?
A. Open the right side flap of the package wrapper.
B. Open the left side flap of the package wrapper.
C. Open the flap furthest away from the nurse's body.
D. Open the closest flap toward the nurse's body.
ANSWER: C. Open the flap furthest away from the nurse's body.
RATIONALE: When establishing a sterile field, the nurse must always open the
top flap furthest away from their body first. This prevents the nurse's unsterile
arm from crossing directly over the exposed sterile field during the subsequent
opening of the side and front flaps, thereby maintaining strict surgical asepsis.
Opening the closest flap first (Choice D) or side flaps first (Choices A and B)
would force the nurse to reach over the sterile contents to open the remaining
flaps, contaminating the environment.
,Question 4
A nurse is monitoring a client who is receiving a unit of packed red blood cells (PRBCs).
Ten minutes into the transfusion, the client reports lower back pain, chills, and
shortness of breath. Which of the following actions should the nurse take first?
A. Notify the healthcare provider and the blood bank.
B. Discontinue the blood transfusion completely.
C. Infuse normal saline through the blood tubing.
D. Administer prescribed diphenhydramine intravenously.
ANSWER: B. Discontinue the blood transfusion completely.
RATIONALE: Low back pain, chills, and dyspnea are classic manifestations of an
acute hemolytic transfusion reaction, which is a life-threatening emergency. The
immediate priority intervention is to stop the transfusion to prevent further
exposure to incompatible blood cells. Normal saline should be infused to
maintain intravenous access, but it must be administered through entirely new IV
tubing (Choice C), not the existing blood tubing, to prevent flushing remaining
blood into the client's circulation. Notifying the provider (Choice A) and
administering medications (Choice D) are done immediately after stopping the
infusion and securing the airway.
Question 5
A nurse is preparing an educational plan for a client diagnosed with acute
gastroenteritis. Which of the following dietary guidelines should the nurse include in the
teaching?
A. Consume low-fat milk products to maintain calcium intake.
B. Increase caffeine consumption to promote intestinal motility.
C. Avoid dairy, caffeine, and highly seasoned foods during acute episodes.
D. Transition immediately to a high-fiber diet to solidify stools.
ANSWER: C. Avoid dairy, caffeine, and highly seasoned foods during acute
episodes.
RATIONALE: Managing acute gastroenteritis requires resting the gastrointestinal
tract and preventing hypermotility. Dairy products contain lactose, which can
exacerbate diarrhea due to temporary lactose intolerance during gut
inflammation. Caffeine stimulates gastric secretions and increases peristalsis,
worsening cramping and fluid loss. Highly seasoned foods irritate the mucosal
lining. High-fiber items (Choice D) should be avoided initially as they stimulate
the bowel; instead, a bland, low-residue diet should be introduced gradually.
, Question 6
A nurse is assessing a client with a history of left-sided heart failure. Which of the
following clinical manifestations should the nurse expect to find?
A. Jugular venous distention and peripheral edema.
B. Splenomegaly and ascites.
C. Bilateral lung crackles and orthopnea.
D. Weight gain and hepatomegaly.
ANSWER: C. Bilateral lung crackles and orthopnea.
RATIONALE: Left-sided heart failure causes backward failure of the left ventricle,
leading to pulmonary congestion and increased hydrostatic pressure in the
pulmonary vasculature. Fluid shifts into the alveoli, presenting as crackles,
dyspnea, cough, and orthopnea (difficulty breathing while lying flat). Jugular
venous distention (Choice A), splenomegaly/ascites (Choice B), and
hepatomegaly (Choice D) are classic manifestations of right-sided heart failure,
which results in systemic venous congestion.
Question 7
A nurse is caring for a client who is 2 hours postoperative following a total
thyroidectomy. Which of the following pieces of equipment is the priority to maintain at
the client's bedside?
A. An incentive spirometer.
B. A tracheostomy tray.
C. An electronic blood pressure cuff.
D. A PCA pump with opioid analgesics.
ANSWER: B. A tracheostomy tray.
RATIONALE: Following a thyroidectomy, the client is at high risk for acute airway
obstruction due to post-operative complications such as laryngeal edema,
hemorrhage, or bilateral recurrent laryngeal nerve damage. Keeping an
emergency tracheostomy tray at the bedside is the priority safety intervention to
secure an immediate airway if sudden respiratory distress occurs. While
incentive spirometry (Choice A) supports lung expansion and blood pressure
monitoring (Choice C) checks hemodynamic stability, they do not take
precedence over life-saving airway management equipment.
