ATI Medical-Surgical Proctored Exam Prep
Document 2026/2027 | Adult Health Nursing, Clinical
Judgment & NGN Medical-Surgical Review | 100
Verified Questions with Detailed Rationales
NGN Clinical Judgment & Prioritization (Questions 1–20)
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient requires the nurse's
immediate attention?
A. A patient with stable atrial fibrillation whose heart rate is 88 and who is watching television
B. A patient 2 hours post-op appendectomy with a blood pressure of 110/72 and pain rated 3/10
C. A patient with COPD whose respiratory rate has increased from 18 to 32, who is using accessory
muscles, and whose SpO2 has dropped from 94% to 86% on 2L NC [CORRECT]
D. A patient with type 2 diabetes whose blood glucose is 142 mg/dL before lunch
Correct Answer: C
Rationale: The best answer is C. This patient shows classic signs of acute respiratory failure—tachypnea,
accessory muscle use, and significant desaturation—which threatens airway, breathing, and circulation
and requires immediate intervention.
Q2: A patient post-op day 3 after abdominal surgery reports sudden onset of dyspnea and pleuritic chest
pain. Vital signs: HR 118, RR 28, BP 92/58, SpO2 89% on room air. What is the nurse's priority action?
A. Administer morphine for pain relief
B. Apply supplemental oxygen, call for help, and prepare for possible pulmonary embolism workup and
stabilization [CORRECT]
C. Encourage deep breathing and coughing exercises
D. Reposition the patient on the left side
Correct Answer: B
Rationale: The best answer is B. Sudden dyspnea, pleuritic pain, tachycardia, hypotension, and
hypoxemia in a postoperative patient are classic for pulmonary embolism—a life-threatening event
requiring immediate oxygen, stabilization, and rapid diagnostic and therapeutic intervention.
,Q3: A nurse receives report on four patients. Which patient should be assessed first?
A. A patient with heart failure whose weight increased 1 pound since yesterday
B. A patient with a new ileostomy whose stoma is pink and moist with active output
C. A patient with sepsis whose temperature is 39.2°C, HR 128, RR 32, and BP 82/48 despite 2L fluid
resuscitation [CORRECT]
D. A patient with osteoarthritis requesting their scheduled acetaminophen
Correct Answer: C
Rationale: The best answer is C. This patient meets criteria for septic shock with persistent hypotension
despite fluid resuscitation, representing a medical emergency that will rapidly progress to multi-organ
failure without immediate vasopressor support and source control.
Q4: A patient with a chest tube for pneumothorax accidentally dislodges the tube while turning in bed.
What is the nurse's first action?
A. Call the provider immediately
B. Cover the insertion site with a sterile petroleum gauze and tape on three sides, leaving one side open
to prevent tension pneumothorax [CORRECT]
C. Reinsert the chest tube using sterile technique
D. Place the patient in Trendelenburg position
Correct Answer: B
Rationale: The best answer is B. An occlusive three-sided dressing allows air to escape during exhalation
while preventing air entry during inhalation, avoiding a life-threatening tension pneumothorax until a
new tube can be placed.
Q5: A nurse is reviewing morning labs. Which result requires immediate notification of the provider?
A. Potassium 4.2 mEq/L
B. Hemoglobin 11.8 g/dL in a patient with CKD
C. Sodium 118 mEq/L [CORRECT]
D. INR 2.5 in a patient on warfarin
Correct Answer: C
Rationale: The best answer is C. Severe hyponatremia (118 mEq/L) can cause cerebral edema, seizures,
and death; it requires immediate provider notification and careful correction to avoid osmotic
demyelination syndrome.
,Q6: A patient with DKA has the following ABG: pH 7.22, PaCO2 28, HCO3 12, PaO2 88. The nurse
recognizes this as:
A. Respiratory acidosis with metabolic compensation
B. Metabolic alkalosis with respiratory compensation
C. Metabolic acidosis with respiratory compensation [CORRECT]
D. Respiratory alkalosis with metabolic compensation
Correct Answer: C
Rationale: The best answer is C. The low pH (acidemia), low bicarbonate (metabolic component), and
low PaCO2 (compensatory hyperventilation) confirm metabolic acidosis with appropriate respiratory
compensation, classic for DKA.
Q7: A patient with a stroke has a BP of 210/118. The provider orders labetalol IV. Before administering,
the nurse should first:
A. Assess the patient's neurologic status and ensure a recent CT has ruled out hemorrhage [CORRECT]
B. Administer the medication immediately to prevent further brain damage
C. Place the patient in a supine position
D. Start a second IV line for additional fluids
Correct Answer: A
Rationale: The best answer is A. In acute stroke, aggressive BP lowering can worsen ischemia by
reducing perfusion to the penumbra; confirming stroke type (ischemic vs. hemorrhagic) and current
neurologic status guides safe, individualized BP management.
Q8: A patient is receiving a blood transfusion. Ten minutes after starting, the patient reports chills, back
pain, and a temperature of 38.8°C. What is the nurse's priority action?
A. Slow the transfusion rate and administer acetaminophen
B. Stop the transfusion immediately, maintain IV access with normal saline, and notify the provider and
blood bank [CORRECT]
C. Continue the transfusion and monitor closely
D. Administer diphenhydramine and continue the transfusion
Correct Answer: B
Rationale: The best answer is B. Fever, chills, and back pain within minutes of starting a transfusion
indicate an acute hemolytic or febrile non-hemolytic reaction; stopping the transfusion immediately
prevents further antigen exposure while maintaining IV access for fluids and emergency medications.
, Q9: A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
A. Assessing a post-op patient's incision for signs of infection
B. Administering oral medications to a stable patient
C. Measuring and recording intake and output for a patient with heart failure [CORRECT]
D. Teaching a newly diagnosed diabetic about insulin administration
Correct Answer: C
Rationale: The best answer is C. Measuring and recording I&O is a routine, non-invasive task within UAP
scope; assessment, medication administration, and patient teaching require licensed nurse judgment
and cannot be delegated.
Q10: A patient with heart failure is receiving furosemide 80 mg IV. The nurse should monitor most
closely for which complication?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Hypercalcemia
Correct Answer: B
Rationale: The best answer is B. Loop diuretics cause significant potassium wasting in the urine, and
hypokalemia can precipitate dangerous arrhythmias in patients with underlying cardiac disease.
Q11: A patient with a new tracheostomy becomes dyspneic and the nurse cannot pass a suction
catheter. What is the priority action?
A. Increase the oxygen flow rate
B. Deflate the cuff, remove the inner cannula if present, and attempt to ventilate; if still obstructed,
prepare for emergency trach change [CORRECT]
C. Suction more forcefully
D. Administer a bronchodilator
Correct Answer: B
Rationale: The best answer is B. Inability to pass a catheter suggests mucus plug or displaced tube
causing airway obstruction; immediate steps to reestablish airway patency are life-saving and follow
emergency tracheostomy management protocols.
Document 2026/2027 | Adult Health Nursing, Clinical
Judgment & NGN Medical-Surgical Review | 100
Verified Questions with Detailed Rationales
NGN Clinical Judgment & Prioritization (Questions 1–20)
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient requires the nurse's
immediate attention?
A. A patient with stable atrial fibrillation whose heart rate is 88 and who is watching television
B. A patient 2 hours post-op appendectomy with a blood pressure of 110/72 and pain rated 3/10
C. A patient with COPD whose respiratory rate has increased from 18 to 32, who is using accessory
muscles, and whose SpO2 has dropped from 94% to 86% on 2L NC [CORRECT]
D. A patient with type 2 diabetes whose blood glucose is 142 mg/dL before lunch
Correct Answer: C
Rationale: The best answer is C. This patient shows classic signs of acute respiratory failure—tachypnea,
accessory muscle use, and significant desaturation—which threatens airway, breathing, and circulation
and requires immediate intervention.
Q2: A patient post-op day 3 after abdominal surgery reports sudden onset of dyspnea and pleuritic chest
pain. Vital signs: HR 118, RR 28, BP 92/58, SpO2 89% on room air. What is the nurse's priority action?
A. Administer morphine for pain relief
B. Apply supplemental oxygen, call for help, and prepare for possible pulmonary embolism workup and
stabilization [CORRECT]
C. Encourage deep breathing and coughing exercises
D. Reposition the patient on the left side
Correct Answer: B
Rationale: The best answer is B. Sudden dyspnea, pleuritic pain, tachycardia, hypotension, and
hypoxemia in a postoperative patient are classic for pulmonary embolism—a life-threatening event
requiring immediate oxygen, stabilization, and rapid diagnostic and therapeutic intervention.
,Q3: A nurse receives report on four patients. Which patient should be assessed first?
A. A patient with heart failure whose weight increased 1 pound since yesterday
B. A patient with a new ileostomy whose stoma is pink and moist with active output
C. A patient with sepsis whose temperature is 39.2°C, HR 128, RR 32, and BP 82/48 despite 2L fluid
resuscitation [CORRECT]
D. A patient with osteoarthritis requesting their scheduled acetaminophen
Correct Answer: C
Rationale: The best answer is C. This patient meets criteria for septic shock with persistent hypotension
despite fluid resuscitation, representing a medical emergency that will rapidly progress to multi-organ
failure without immediate vasopressor support and source control.
Q4: A patient with a chest tube for pneumothorax accidentally dislodges the tube while turning in bed.
What is the nurse's first action?
A. Call the provider immediately
B. Cover the insertion site with a sterile petroleum gauze and tape on three sides, leaving one side open
to prevent tension pneumothorax [CORRECT]
C. Reinsert the chest tube using sterile technique
D. Place the patient in Trendelenburg position
Correct Answer: B
Rationale: The best answer is B. An occlusive three-sided dressing allows air to escape during exhalation
while preventing air entry during inhalation, avoiding a life-threatening tension pneumothorax until a
new tube can be placed.
Q5: A nurse is reviewing morning labs. Which result requires immediate notification of the provider?
A. Potassium 4.2 mEq/L
B. Hemoglobin 11.8 g/dL in a patient with CKD
C. Sodium 118 mEq/L [CORRECT]
D. INR 2.5 in a patient on warfarin
Correct Answer: C
Rationale: The best answer is C. Severe hyponatremia (118 mEq/L) can cause cerebral edema, seizures,
and death; it requires immediate provider notification and careful correction to avoid osmotic
demyelination syndrome.
,Q6: A patient with DKA has the following ABG: pH 7.22, PaCO2 28, HCO3 12, PaO2 88. The nurse
recognizes this as:
A. Respiratory acidosis with metabolic compensation
B. Metabolic alkalosis with respiratory compensation
C. Metabolic acidosis with respiratory compensation [CORRECT]
D. Respiratory alkalosis with metabolic compensation
Correct Answer: C
Rationale: The best answer is C. The low pH (acidemia), low bicarbonate (metabolic component), and
low PaCO2 (compensatory hyperventilation) confirm metabolic acidosis with appropriate respiratory
compensation, classic for DKA.
Q7: A patient with a stroke has a BP of 210/118. The provider orders labetalol IV. Before administering,
the nurse should first:
A. Assess the patient's neurologic status and ensure a recent CT has ruled out hemorrhage [CORRECT]
B. Administer the medication immediately to prevent further brain damage
C. Place the patient in a supine position
D. Start a second IV line for additional fluids
Correct Answer: A
Rationale: The best answer is A. In acute stroke, aggressive BP lowering can worsen ischemia by
reducing perfusion to the penumbra; confirming stroke type (ischemic vs. hemorrhagic) and current
neurologic status guides safe, individualized BP management.
Q8: A patient is receiving a blood transfusion. Ten minutes after starting, the patient reports chills, back
pain, and a temperature of 38.8°C. What is the nurse's priority action?
A. Slow the transfusion rate and administer acetaminophen
B. Stop the transfusion immediately, maintain IV access with normal saline, and notify the provider and
blood bank [CORRECT]
C. Continue the transfusion and monitor closely
D. Administer diphenhydramine and continue the transfusion
Correct Answer: B
Rationale: The best answer is B. Fever, chills, and back pain within minutes of starting a transfusion
indicate an acute hemolytic or febrile non-hemolytic reaction; stopping the transfusion immediately
prevents further antigen exposure while maintaining IV access for fluids and emergency medications.
, Q9: A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
A. Assessing a post-op patient's incision for signs of infection
B. Administering oral medications to a stable patient
C. Measuring and recording intake and output for a patient with heart failure [CORRECT]
D. Teaching a newly diagnosed diabetic about insulin administration
Correct Answer: C
Rationale: The best answer is C. Measuring and recording I&O is a routine, non-invasive task within UAP
scope; assessment, medication administration, and patient teaching require licensed nurse judgment
and cannot be delegated.
Q10: A patient with heart failure is receiving furosemide 80 mg IV. The nurse should monitor most
closely for which complication?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Hypercalcemia
Correct Answer: B
Rationale: The best answer is B. Loop diuretics cause significant potassium wasting in the urine, and
hypokalemia can precipitate dangerous arrhythmias in patients with underlying cardiac disease.
Q11: A patient with a new tracheostomy becomes dyspneic and the nurse cannot pass a suction
catheter. What is the priority action?
A. Increase the oxygen flow rate
B. Deflate the cuff, remove the inner cannula if present, and attempt to ventilate; if still obstructed,
prepare for emergency trach change [CORRECT]
C. Suction more forcefully
D. Administer a bronchodilator
Correct Answer: B
Rationale: The best answer is B. Inability to pass a catheter suggests mucus plug or displaced tube
causing airway obstruction; immediate steps to reestablish airway patency are life-saving and follow
emergency tracheostomy management protocols.
