ATI RN Medical Surgical Proctored Exam 2026 with NGN
Complete 300 Q&A Master Bank Chamberlain University
This premium 300-question study guide provides a comprehensive, high-yield review specifically tailored
for the ATI RN Medical Surgical Proctored Exam with Next Generation NCLEX (NGN) clinical judgment
items. Each verified question features the updated correct answer and a detailed, evidence-based
rationale positioned immediately after the item to maximize active recall and study efficiency. Perfect
for achieving a Level 2 or Level 3 proficiency rating, this master bank covers core concepts across all
major adult body systems, acute care management, and pharmacology.
Question 1
A nurse is assessing a client who is 4 hours postoperative following a subtotal
thyroidectomy. Which of the following findings is the priority for the nurse to report to the
provider?
A. Mild hoarseness when speaking
B. Client reports a pain level of 4 on a 0-to-10 scale
C. Laryngeal stridor on inspiration
D. 15 mL of serosanguineous drainage on the dressing
VERIFIED UPDATED ANSWER: C
RATIONALE: Laryngeal stridor is a harsh, high-pitched sound heard on
inspiration that indicates an acute upper airway obstruction. Following a
thyroidectomy, this is a life-threatening emergency caused by laryngeal nerve
damage, tetany from hypocalcemia, or a compressing neck hematoma. Mild
hoarseness, localized moderate pain, and minimal drainage are expected early
postoperative findings.
Question 2
A nurse is preparing to administer blood to a client who has a prescription for 1 unit of
packed red blood cells. Which of the following actions should the nurse take first?
A. Verify the client's identity and blood product details with a second nurse.
B. Prime the blood administration tubing with a container of Lactated Ringer's.
C. Ensure the blood infuses completely within 6 hours of arrival from the lab.
D. Warm the blood container in a microwave oven for 30 seconds.
VERIFIED UPDATED ANSWER: A
RATIONALE: Verifying the client's identity and matching the blood product
compatibility specifications with a second licensed nurse at the bedside is the
absolute priority safety action to prevent a fatal acute hemolytic transfusion
reaction. Blood must be co-infused only with 0.9% normal saline, must be
completed within 4 hours, and should never be warmed in a microwave.
,Question 3
A nurse is reviewing the arterial blood gas (ABG) results of a client with an acute
exacerbation of chronic obstructive pulmonary disease (COPD): pH 7.32, PaCO₂ 54
mmHg, HCO₃⁻ 25 mEq/L. Which of the following acid-base imbalances is this client
experiencing?
A. Uncompensated respiratory acidosis
B. Fully compensated metabolic acidosis
C. Partially compensated respiratory alkalosis
D. Uncompensated metabolic alkalosis
VERIFIED UPDATED ANSWER: A
RATIONALE: The pH is below 7.35, establishing acidosis. The PaCO₂ is elevated
above 45 mmHg, indicating a respiratory cause due to alveolar hypovellatory
carbon dioxide retention. Because the bicarbonate (HCO₃⁻) is within the normal
reference range (22–26 mEq/L), the kidneys have not yet compensated for the
respiratory imbalance.
Question 4
A nurse is assessing a client with primary open-angle glaucoma (POAG). Which of the
following clinical findings should the nurse expect?
A. Sudden onset of severe ocular pain accompanied by colored halos around lights
B. Gradual, painless loss of peripheral vision resulting in tunnel vision
C. Multiple floating spots and sudden flashes of light across the visual field
D. Complete, irreversible opacification of the lens of the eye
VERIFIED UPDATED ANSWER: B
RATIONALE: POAG is a chronic condition characterized by a slow, progressive
increase in intraocular pressure that causes painless, gradual atrophy of the
optic nerve. This results in a loss of peripheral vision while central vision remains
intact initially. Sudden severe pain indicates acute angle-closure glaucoma,
flashes indicate retinal detachment, and lens opacification indicates a cataract.
Question 5
A nurse is caring for a client who is in the oliguric phase of acute kidney injury (AKI).
Which of the following assessment findings should the nurse expect?
A. Hypokalemia and a urinary output greater than 2,000 mL per day
B. Hyperkalemia, fluid volume excess, and elevated serum creatinine
C. Metabolic alkalosis due to excessive renal bicarbonate retention
D. Profound hypophosphatemia combined with hypercalcemia
VERIFIED UPDATED ANSWER: B
RATIONALE: During the oliguric phase of AKI, glomerular filtration falls
dramatically. The kidneys cannot excrete metabolic wastes or excess fluids,
leading to elevated blood urea nitrogen (BUN) and creatinine, hyperkalemia, and
fluid retention. Metabolic acidosis, rather than alkalosis, occurs due to the failure
to excrete hydrogen ions.
,Question 6
A nurse is assessing a client who has a suspected deep vein thrombosis (DVT) in the
right lower extremity. Which of the following manifestations should the nurse expect to
find?
A. Well-demarcated pale skin that is exceptionally cool to the touch
B. Unilateral calf edema, localized warmth, and erythema
C. Bilateral pitting pedal edema with a dark brownish skin discoloration
D. Absence of a palpable right dorsalis pedis artery pulse
VERIFIED UPDATED ANSWER: B
RATIONALE: Unilateral swelling, localized warmth, erythema, and tenderness of
the calf muscle are classic diagnostic indicators of an acute deep vein
thrombosis due to venous vascular congestion and localized inflammation. Cold,
pale skin and absent pulses point to peripheral arterial occlusion, whereas
bilateral brownish discoloration is a hallmark of chronic venous insufficiency.
Question 7
A nurse is caring for a client with a history of heart failure who is taking digoxin and
furosemide daily. The client reports experiencing persistent anorexia, nausea, and
seeing yellow-green halos around objects. Which of the following actions should the
nurse perform first?
A. Administer the prescribed oral antiemetic medication.
B. Check the client's apical pulse rate and withhold the next dose of digoxin.
C. Request an emergency prescription for an increased dose of furosemide.
D. Draw a blood sample for arterial blood gas analysis.
VERIFIED UPDATED ANSWER: B
RATIONALE: Gastrointestinal symptoms (anorexia, nausea, vomiting) and
neurological visual disturbances (yellow-green halos) are early and classic
indicators of digoxin toxicity. Loop diuretics like furosemide can cause
hypokalemia, which heavily sensitizes the myocardium to digoxin toxicity. The
nurse must check the apical pulse, hold the dose, and obtain a serum digoxin
level.
Question 8
A nurse is planning care for a client who has advanced cirrhosis and a significantly
elevated serum ammonia level. Which of the following interventions should the nurse
include?
A. Administer lactulose orally or rectally as prescribed.
B. Encourage the client to consume a high-protein, high-fat diet.
C. Maintain the client on a strict fluid restriction of 500 mL per day.
D. Perform vigorous abdominal deep palpation to monitor ascites.
VERIFIED UPDATED ANSWER: A
RATIONALE: Lactulose is osmotic laxative that promotes the excretion of
ammonia through the gastrointestinal tract. In the bowel, it converts ammonia
into ammonium, which is trapped in the stool and excreted, directly treating or
, preventing hepatic encephalopathy. Clients with high ammonia levels require
protein restriction, not a high-protein diet.
Question 9
A nurse is assessing a client who has a continuous chest tube drainage system
connected to water seal suction. The nurse notes constant, rapid bubbling in the water
seal chamber. how should the nurse interpret this finding?
A. The client's collapsed lung has completely re-expanded.
B. There is an active air leak somewhere within the drainage system.
C. This is a normal, expected finding during high-pressure suctioning.
D. The external suction regulator setting has been turned off.
VERIFIED UPDATED ANSWER: B
RATIONALE: Continuous, rapid bubbling in the water seal chamber points toward
an unintended air leak within the chest tube drainage system or at the insertion
site. Intermittent bubbling during expiration, coughing, or sneezing is expected
as air leaves the pleural space, but constant bubbling requires immediate tracing
and clamping to locate the leak.
Question 10
A nurse is caring for a client who is recovering from an emergency total laryngectomy.
Which of the following nursing interventions is the highest priority?
A. Providing alternative communication tools like a picture board or tablet.
B. Monitoring and maintaining a clear, patent airway via suctioning and humidification.
C. Administering enteral tube feedings to meet caloric needs.
D. Providing comprehensive education regarding permanent stoma care.
VERIFIED UPDATED ANSWER: B
RATIONALE: Airway patency is always the highest priority in nursing care.
Following a total laryngectomy, the trachea is brought to the skin surface to form
a permanent stoma. Copious, thick mucus secretions are produced initially,
which can easily cause airway plugging and asphyxiation if the airway is not kept
clear with suction and humidification.
Question 11
A nurse is caring for a client who is 12 hours postoperative following an abdominal
hysterectomy. The nurse notes that the client's urinary output has dropped to 20 mL/hr
over the past 2 hours. Which of the following actions should the nurse take first?
A. Administer a prescribed oral analgesic to manage incisional pain.
B. Assess the client's vital signs and check the urinary catheter for kinks or obstructions.
C. Encourage the client to increase oral fluid intake immediately.
D. Notify the surgeon to request an emergency dose of an intravenous diuretic.
VERIFIED UPDATED ANSWER: B
RATIONALE: A urinary output less than 30 mL/hr is an abnormal finding that can
signify acute kidney injury, hypovolemic shock, or mechanical urinary retention.
Complete 300 Q&A Master Bank Chamberlain University
This premium 300-question study guide provides a comprehensive, high-yield review specifically tailored
for the ATI RN Medical Surgical Proctored Exam with Next Generation NCLEX (NGN) clinical judgment
items. Each verified question features the updated correct answer and a detailed, evidence-based
rationale positioned immediately after the item to maximize active recall and study efficiency. Perfect
for achieving a Level 2 or Level 3 proficiency rating, this master bank covers core concepts across all
major adult body systems, acute care management, and pharmacology.
Question 1
A nurse is assessing a client who is 4 hours postoperative following a subtotal
thyroidectomy. Which of the following findings is the priority for the nurse to report to the
provider?
A. Mild hoarseness when speaking
B. Client reports a pain level of 4 on a 0-to-10 scale
C. Laryngeal stridor on inspiration
D. 15 mL of serosanguineous drainage on the dressing
VERIFIED UPDATED ANSWER: C
RATIONALE: Laryngeal stridor is a harsh, high-pitched sound heard on
inspiration that indicates an acute upper airway obstruction. Following a
thyroidectomy, this is a life-threatening emergency caused by laryngeal nerve
damage, tetany from hypocalcemia, or a compressing neck hematoma. Mild
hoarseness, localized moderate pain, and minimal drainage are expected early
postoperative findings.
Question 2
A nurse is preparing to administer blood to a client who has a prescription for 1 unit of
packed red blood cells. Which of the following actions should the nurse take first?
A. Verify the client's identity and blood product details with a second nurse.
B. Prime the blood administration tubing with a container of Lactated Ringer's.
C. Ensure the blood infuses completely within 6 hours of arrival from the lab.
D. Warm the blood container in a microwave oven for 30 seconds.
VERIFIED UPDATED ANSWER: A
RATIONALE: Verifying the client's identity and matching the blood product
compatibility specifications with a second licensed nurse at the bedside is the
absolute priority safety action to prevent a fatal acute hemolytic transfusion
reaction. Blood must be co-infused only with 0.9% normal saline, must be
completed within 4 hours, and should never be warmed in a microwave.
,Question 3
A nurse is reviewing the arterial blood gas (ABG) results of a client with an acute
exacerbation of chronic obstructive pulmonary disease (COPD): pH 7.32, PaCO₂ 54
mmHg, HCO₃⁻ 25 mEq/L. Which of the following acid-base imbalances is this client
experiencing?
A. Uncompensated respiratory acidosis
B. Fully compensated metabolic acidosis
C. Partially compensated respiratory alkalosis
D. Uncompensated metabolic alkalosis
VERIFIED UPDATED ANSWER: A
RATIONALE: The pH is below 7.35, establishing acidosis. The PaCO₂ is elevated
above 45 mmHg, indicating a respiratory cause due to alveolar hypovellatory
carbon dioxide retention. Because the bicarbonate (HCO₃⁻) is within the normal
reference range (22–26 mEq/L), the kidneys have not yet compensated for the
respiratory imbalance.
Question 4
A nurse is assessing a client with primary open-angle glaucoma (POAG). Which of the
following clinical findings should the nurse expect?
A. Sudden onset of severe ocular pain accompanied by colored halos around lights
B. Gradual, painless loss of peripheral vision resulting in tunnel vision
C. Multiple floating spots and sudden flashes of light across the visual field
D. Complete, irreversible opacification of the lens of the eye
VERIFIED UPDATED ANSWER: B
RATIONALE: POAG is a chronic condition characterized by a slow, progressive
increase in intraocular pressure that causes painless, gradual atrophy of the
optic nerve. This results in a loss of peripheral vision while central vision remains
intact initially. Sudden severe pain indicates acute angle-closure glaucoma,
flashes indicate retinal detachment, and lens opacification indicates a cataract.
Question 5
A nurse is caring for a client who is in the oliguric phase of acute kidney injury (AKI).
Which of the following assessment findings should the nurse expect?
A. Hypokalemia and a urinary output greater than 2,000 mL per day
B. Hyperkalemia, fluid volume excess, and elevated serum creatinine
C. Metabolic alkalosis due to excessive renal bicarbonate retention
D. Profound hypophosphatemia combined with hypercalcemia
VERIFIED UPDATED ANSWER: B
RATIONALE: During the oliguric phase of AKI, glomerular filtration falls
dramatically. The kidneys cannot excrete metabolic wastes or excess fluids,
leading to elevated blood urea nitrogen (BUN) and creatinine, hyperkalemia, and
fluid retention. Metabolic acidosis, rather than alkalosis, occurs due to the failure
to excrete hydrogen ions.
,Question 6
A nurse is assessing a client who has a suspected deep vein thrombosis (DVT) in the
right lower extremity. Which of the following manifestations should the nurse expect to
find?
A. Well-demarcated pale skin that is exceptionally cool to the touch
B. Unilateral calf edema, localized warmth, and erythema
C. Bilateral pitting pedal edema with a dark brownish skin discoloration
D. Absence of a palpable right dorsalis pedis artery pulse
VERIFIED UPDATED ANSWER: B
RATIONALE: Unilateral swelling, localized warmth, erythema, and tenderness of
the calf muscle are classic diagnostic indicators of an acute deep vein
thrombosis due to venous vascular congestion and localized inflammation. Cold,
pale skin and absent pulses point to peripheral arterial occlusion, whereas
bilateral brownish discoloration is a hallmark of chronic venous insufficiency.
Question 7
A nurse is caring for a client with a history of heart failure who is taking digoxin and
furosemide daily. The client reports experiencing persistent anorexia, nausea, and
seeing yellow-green halos around objects. Which of the following actions should the
nurse perform first?
A. Administer the prescribed oral antiemetic medication.
B. Check the client's apical pulse rate and withhold the next dose of digoxin.
C. Request an emergency prescription for an increased dose of furosemide.
D. Draw a blood sample for arterial blood gas analysis.
VERIFIED UPDATED ANSWER: B
RATIONALE: Gastrointestinal symptoms (anorexia, nausea, vomiting) and
neurological visual disturbances (yellow-green halos) are early and classic
indicators of digoxin toxicity. Loop diuretics like furosemide can cause
hypokalemia, which heavily sensitizes the myocardium to digoxin toxicity. The
nurse must check the apical pulse, hold the dose, and obtain a serum digoxin
level.
Question 8
A nurse is planning care for a client who has advanced cirrhosis and a significantly
elevated serum ammonia level. Which of the following interventions should the nurse
include?
A. Administer lactulose orally or rectally as prescribed.
B. Encourage the client to consume a high-protein, high-fat diet.
C. Maintain the client on a strict fluid restriction of 500 mL per day.
D. Perform vigorous abdominal deep palpation to monitor ascites.
VERIFIED UPDATED ANSWER: A
RATIONALE: Lactulose is osmotic laxative that promotes the excretion of
ammonia through the gastrointestinal tract. In the bowel, it converts ammonia
into ammonium, which is trapped in the stool and excreted, directly treating or
, preventing hepatic encephalopathy. Clients with high ammonia levels require
protein restriction, not a high-protein diet.
Question 9
A nurse is assessing a client who has a continuous chest tube drainage system
connected to water seal suction. The nurse notes constant, rapid bubbling in the water
seal chamber. how should the nurse interpret this finding?
A. The client's collapsed lung has completely re-expanded.
B. There is an active air leak somewhere within the drainage system.
C. This is a normal, expected finding during high-pressure suctioning.
D. The external suction regulator setting has been turned off.
VERIFIED UPDATED ANSWER: B
RATIONALE: Continuous, rapid bubbling in the water seal chamber points toward
an unintended air leak within the chest tube drainage system or at the insertion
site. Intermittent bubbling during expiration, coughing, or sneezing is expected
as air leaves the pleural space, but constant bubbling requires immediate tracing
and clamping to locate the leak.
Question 10
A nurse is caring for a client who is recovering from an emergency total laryngectomy.
Which of the following nursing interventions is the highest priority?
A. Providing alternative communication tools like a picture board or tablet.
B. Monitoring and maintaining a clear, patent airway via suctioning and humidification.
C. Administering enteral tube feedings to meet caloric needs.
D. Providing comprehensive education regarding permanent stoma care.
VERIFIED UPDATED ANSWER: B
RATIONALE: Airway patency is always the highest priority in nursing care.
Following a total laryngectomy, the trachea is brought to the skin surface to form
a permanent stoma. Copious, thick mucus secretions are produced initially,
which can easily cause airway plugging and asphyxiation if the airway is not kept
clear with suction and humidification.
Question 11
A nurse is caring for a client who is 12 hours postoperative following an abdominal
hysterectomy. The nurse notes that the client's urinary output has dropped to 20 mL/hr
over the past 2 hours. Which of the following actions should the nurse take first?
A. Administer a prescribed oral analgesic to manage incisional pain.
B. Assess the client's vital signs and check the urinary catheter for kinks or obstructions.
C. Encourage the client to increase oral fluid intake immediately.
D. Notify the surgeon to request an emergency dose of an intravenous diuretic.
VERIFIED UPDATED ANSWER: B
RATIONALE: A urinary output less than 30 mL/hr is an abnormal finding that can
signify acute kidney injury, hypovolemic shock, or mechanical urinary retention.
