ATI RN ADULT MEDICAL SURGICAL
PROCTORED EXAM PREP 2023–2026 HIGH-
YIELD NGN MASTER QUESTIONS &
RATIONALES FOR LEVEL 3 SUCCESS
Unlock Level 3 mastery on your upcoming nursing exam with this
comprehensive study bundle featuring premium, high-yield practice
questions with detailed clinical rationales. Explicitly engineered to mirror the
Next Generation NCLEX (NGN) format and ATI proctored standards, this
guide covers essential medical-surgical domains including advanced
cardiovascular, respiratory, and endocrine emergencies. Perfect for last-
minute cramming or structured self-assessment, this document provides
the exact test-taking frameworks and priority rationales needed to
confidently pass on your first attempt.
Part 1: Fluid, Electrolytes, and Acid-Base
Balance
1. A nurse is caring for a client with a serum
sodium level of 122 mEq/L. Which of the
following interventions should the nurse
anticipate?
A) Administration of hypotonic intravenous
fluids.
B) Restricting fluid intake to 1,000 mL/day.
C) Encouraging increased oral water intake.
D) Administering a loop diuretic continuously.
Answer: B
Rationale: A serum sodium level of 122
mEq/L indicates severe hyponatremia. Fluid
, restriction is a primary intervention for
dilutional hyponatremia to prevent further
dilution of serum sodium. Hypotonic fluids
or increased water intake would worsen the
condition. Loop diuretics may cause further
sodium loss unless hypervolemic
hyponatremia is specified.
2. A client is admitted with a serum potassium level
of 6.2 mEq/L. Which of the following provider
orders should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate.
B) Obtain a 12-lead electrocardiogram (ECG).
C) Initiate a continuous infusion of regular insulin
and dextrose.
D) Inform the dietary department to restrict
potassium.
Answer: B
Rationale: Hyperkalemia (potassium > 5.0
mEq/L) can cause lethal cardiac
dysrhythmias. Obtaining an ECG to check for
tall, peaked T waves or widened QRS
complexes is the absolute priority to assess
cardiac stability before or simultaneously
with lowering therapies.
,3. A nurse reviews the arterial blood gas (ABG)
results for a client with severe respiratory
distress: pH 7.28, PaCO2 55 mmHg, HCO3 24
mEq/L. How should the nurse interpret these
findings?
A) Uncompensated respiratory acidosis
B) Compensated metabolic acidosis
C) Uncompensated respiratory alkalosis
D) Fully compensated respiratory acidosis
Answer: A
Rationale: The pH is below 7.35, indicating
acidosis. The PaCO2 is elevated above 45
mmHg, which matches the acidic direction
(respiratory). The HCO3 is within the normal
range (22–26 mEq/L), meaning the metabolic
system has not yet compensated.
4. A client with an prolonged history of nasogastric
(NG) tube suctioning is at risk for which acid-
base imbalance?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: D
Rationale: Nasogastric suctioning removes
, highly acidic gastric secretions (hydrochloric
acid), leading to a loss of hydrogen ions and
an excess of base, resulting in metabolic
alkalosis.
5. A nurse is assessing a client with hypocalcemia.
Which of the following findings should the nurse
expect?
A) Flaccid paralysis and hyporeflexia
B) Positive Trousseau's sign
C) Constipation and abdominal distension
D) Shortened QT interval on ECG
Answer: B
Rationale: Hypocalcemia increases
neuromuscular excitability. A positive
Trousseau's sign (carpal spasm induced by
inflating a blood pressure cuff) and
Chvostek's sign are classic clinical
manifestations. Hypocalcemia causes
prolonged QT intervals and hyperreflexia.
Part 2: Perioperative Care and Shock
6. A nurse is reviewing the preoperative checklist
for a client scheduled for surgery in one hour.
Which of the following actions is the priority?
PROCTORED EXAM PREP 2023–2026 HIGH-
YIELD NGN MASTER QUESTIONS &
RATIONALES FOR LEVEL 3 SUCCESS
Unlock Level 3 mastery on your upcoming nursing exam with this
comprehensive study bundle featuring premium, high-yield practice
questions with detailed clinical rationales. Explicitly engineered to mirror the
Next Generation NCLEX (NGN) format and ATI proctored standards, this
guide covers essential medical-surgical domains including advanced
cardiovascular, respiratory, and endocrine emergencies. Perfect for last-
minute cramming or structured self-assessment, this document provides
the exact test-taking frameworks and priority rationales needed to
confidently pass on your first attempt.
Part 1: Fluid, Electrolytes, and Acid-Base
Balance
1. A nurse is caring for a client with a serum
sodium level of 122 mEq/L. Which of the
following interventions should the nurse
anticipate?
A) Administration of hypotonic intravenous
fluids.
B) Restricting fluid intake to 1,000 mL/day.
C) Encouraging increased oral water intake.
D) Administering a loop diuretic continuously.
Answer: B
Rationale: A serum sodium level of 122
mEq/L indicates severe hyponatremia. Fluid
, restriction is a primary intervention for
dilutional hyponatremia to prevent further
dilution of serum sodium. Hypotonic fluids
or increased water intake would worsen the
condition. Loop diuretics may cause further
sodium loss unless hypervolemic
hyponatremia is specified.
2. A client is admitted with a serum potassium level
of 6.2 mEq/L. Which of the following provider
orders should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate.
B) Obtain a 12-lead electrocardiogram (ECG).
C) Initiate a continuous infusion of regular insulin
and dextrose.
D) Inform the dietary department to restrict
potassium.
Answer: B
Rationale: Hyperkalemia (potassium > 5.0
mEq/L) can cause lethal cardiac
dysrhythmias. Obtaining an ECG to check for
tall, peaked T waves or widened QRS
complexes is the absolute priority to assess
cardiac stability before or simultaneously
with lowering therapies.
,3. A nurse reviews the arterial blood gas (ABG)
results for a client with severe respiratory
distress: pH 7.28, PaCO2 55 mmHg, HCO3 24
mEq/L. How should the nurse interpret these
findings?
A) Uncompensated respiratory acidosis
B) Compensated metabolic acidosis
C) Uncompensated respiratory alkalosis
D) Fully compensated respiratory acidosis
Answer: A
Rationale: The pH is below 7.35, indicating
acidosis. The PaCO2 is elevated above 45
mmHg, which matches the acidic direction
(respiratory). The HCO3 is within the normal
range (22–26 mEq/L), meaning the metabolic
system has not yet compensated.
4. A client with an prolonged history of nasogastric
(NG) tube suctioning is at risk for which acid-
base imbalance?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: D
Rationale: Nasogastric suctioning removes
, highly acidic gastric secretions (hydrochloric
acid), leading to a loss of hydrogen ions and
an excess of base, resulting in metabolic
alkalosis.
5. A nurse is assessing a client with hypocalcemia.
Which of the following findings should the nurse
expect?
A) Flaccid paralysis and hyporeflexia
B) Positive Trousseau's sign
C) Constipation and abdominal distension
D) Shortened QT interval on ECG
Answer: B
Rationale: Hypocalcemia increases
neuromuscular excitability. A positive
Trousseau's sign (carpal spasm induced by
inflating a blood pressure cuff) and
Chvostek's sign are classic clinical
manifestations. Hypocalcemia causes
prolonged QT intervals and hyperreflexia.
Part 2: Perioperative Care and Shock
6. A nurse is reviewing the preoperative checklist
for a client scheduled for surgery in one hour.
Which of the following actions is the priority?
