2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM
WITH NGN /RN ADULT MED SURG ATI 2023 VERSION
QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
120 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Demonstrate mastery of core concepts
2 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN
3 RN ADULT MED SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH
EXPLANATION.
4 Foundations of 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT
MED SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
5 Applied 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT MED
SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
6 Advanced 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT MED
SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
7 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT MED SURG ATI
2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION. Review
Q1 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with sepsis and acute kidney injury has an indwelling urinary catheter.
The nurse notes a sudden decrease in urine output. Which action is most
appropriate?
A. Irrigate the catheter with sterile saline
B. Assess for catheter patency and kinks CORRECT
C. Increase IV fluid rate
D. Notify the provider immediately
RATIONALE: Sudden decrease in urine output in a catheterized patient often indicates
mechanical obstruction. The nurse should first assess for kinks, obstruction, or catheter position.
Irrigating without assessment can cause trauma or infection. Increasing fluids may worsen fluid
overload in AKI. Notifying the provider is premature before basic assessment.
Page 1
,Q2 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with a history of heart failure is receiving a blood transfusion. Which
assessment finding is most indicative of transfusion-associated circulatory
overload (TACO)?
A. Temperature increase to 38.5°C
B. Bounding pulse and jugular venous distention CORRECT
C. Urticaria and pruritus
D. Wheezing and stridor
RATIONALE: TACO is caused by volume overload, leading to signs of heart failure such as
bounding pulse, JVD, dyspnea, and hypertension. Fever and urticaria suggest febrile or allergic
reactions. Wheezing and stridor indicate anaphylaxis or respiratory distress, but JVD and
bounding pulse are specific to TACO.
Q3 DEMONSTRATE MASTERY OF CORE CONCEPTS
Which finding is most consistent with moderate sedation (conscious sedation) in a
patient undergoing a colonoscopy?
A. Patient responds to tactile stimulation only
B. Patient is easily aroused by voice and maintains patent airway CORRECT
C. Patient has a Glasgow Coma Scale score of 8
D. Patient requires mechanical ventilation
RATIONALE: Moderate sedation is characterized by purposeful response to verbal or tactile
stimulation, with airway and cardiovascular function maintained. Responding only to tactile
stimulation indicates deep sedation. GCS of 8 and mechanical ventilation indicate general
anesthesia or deep sedation with loss of protective reflexes.
Page 2
,Q4 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with chronic kidney disease is about to receive a dose of magnesium
hydroxide. Which assessment finding is most concerning?
A. Serum magnesium level of 2.0 mEq/L
B. Absent deep tendon reflexes CORRECT
C. Blood pressure of 110/70 mmHg
D. Urine output of 40 mL/hr
RATIONALE: Absent deep tendon reflexes indicate hypermagnesemia, which can occur in CKD
due to decreased excretion. Magnesium level of 2.0 is normal. BP and urine output are not
specific to magnesium toxicity. The nurse should withhold the medication and notify the provider.
Q5 DEMONSTRATE MASTERY OF CORE CONCEPTS
When caring for a patient with acute pancreatitis, which assessment finding
indicates a poor prognosis?
A. Serum calcium of 8.5 mg/dL
B. Cullen's sign CORRECT
C. Amylase level of 600 units/L
D. WBC count of 12,000/mm³
RATIONALE: Cullen's sign (periumbilical ecchymosis) indicates retroperitoneal hemorrhage and
is associated with severe, necrotizing pancreatitis and high mortality. Hypocalcemia (below 8
mg/dL) is also a poor sign, but 8.5 is borderline low. Elevated amylase and WBC are common
but not specifically prognostic.
Page 3
, Q6 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with a chest tube for a pneumothorax has continuous bubbling in the
water seal chamber. Which action should the nurse take?
A. Clamp the chest tube immediately
B. Document and continue to monitor
C. Strip the tubing to maintain patency
D. Notify the provider of a possible air leak CORRECT
RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak, which can be
from the lung or the system. The nurse should notify the provider and assess the system for
leaks. Clamping can cause tension pneumothorax. Stripping is not indicated. Documentation
alone is insufficient.
Q7 DEMONSTRATE MASTERY OF CORE CONCEPTS
Which intervention is most effective in preventing ventilator-associated
pneumonia (VAP) in a mechanically ventilated patient?
A. Daily sedation vacation
B. Elevation of the head of the bed to 30-45 degrees CORRECT
C. Use of a heat and moisture exchanger
D. Routine change of ventilator circuit every 24 hours
RATIONALE: Elevating the head of the bed to 30-45 degrees reduces aspiration of gastric
contents, a key VAP prevention strategy. Sedation vacations reduce duration of ventilation but
are not directly VAP prevention. Heat-moisture exchangers are not superior. Routine circuit
changes are not recommended (less frequent is better).
Page 4
WITH NGN /RN ADULT MED SURG ATI 2023 VERSION
QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
120 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Demonstrate mastery of core concepts
2 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN
3 RN ADULT MED SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH
EXPLANATION.
4 Foundations of 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT
MED SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
5 Applied 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT MED
SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
6 Advanced 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT MED
SURG ATI 2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION.
7 2025 RN ADULT MEDICAL SURGICAL PROCTORED EXAM WITH NGN /RN ADULT MED SURG ATI
2023 VERSION QUESTION AND CORRECT ANSWERS WITH EXPLANATION. Review
Q1 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with sepsis and acute kidney injury has an indwelling urinary catheter.
The nurse notes a sudden decrease in urine output. Which action is most
appropriate?
A. Irrigate the catheter with sterile saline
B. Assess for catheter patency and kinks CORRECT
C. Increase IV fluid rate
D. Notify the provider immediately
RATIONALE: Sudden decrease in urine output in a catheterized patient often indicates
mechanical obstruction. The nurse should first assess for kinks, obstruction, or catheter position.
Irrigating without assessment can cause trauma or infection. Increasing fluids may worsen fluid
overload in AKI. Notifying the provider is premature before basic assessment.
Page 1
,Q2 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with a history of heart failure is receiving a blood transfusion. Which
assessment finding is most indicative of transfusion-associated circulatory
overload (TACO)?
A. Temperature increase to 38.5°C
B. Bounding pulse and jugular venous distention CORRECT
C. Urticaria and pruritus
D. Wheezing and stridor
RATIONALE: TACO is caused by volume overload, leading to signs of heart failure such as
bounding pulse, JVD, dyspnea, and hypertension. Fever and urticaria suggest febrile or allergic
reactions. Wheezing and stridor indicate anaphylaxis or respiratory distress, but JVD and
bounding pulse are specific to TACO.
Q3 DEMONSTRATE MASTERY OF CORE CONCEPTS
Which finding is most consistent with moderate sedation (conscious sedation) in a
patient undergoing a colonoscopy?
A. Patient responds to tactile stimulation only
B. Patient is easily aroused by voice and maintains patent airway CORRECT
C. Patient has a Glasgow Coma Scale score of 8
D. Patient requires mechanical ventilation
RATIONALE: Moderate sedation is characterized by purposeful response to verbal or tactile
stimulation, with airway and cardiovascular function maintained. Responding only to tactile
stimulation indicates deep sedation. GCS of 8 and mechanical ventilation indicate general
anesthesia or deep sedation with loss of protective reflexes.
Page 2
,Q4 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with chronic kidney disease is about to receive a dose of magnesium
hydroxide. Which assessment finding is most concerning?
A. Serum magnesium level of 2.0 mEq/L
B. Absent deep tendon reflexes CORRECT
C. Blood pressure of 110/70 mmHg
D. Urine output of 40 mL/hr
RATIONALE: Absent deep tendon reflexes indicate hypermagnesemia, which can occur in CKD
due to decreased excretion. Magnesium level of 2.0 is normal. BP and urine output are not
specific to magnesium toxicity. The nurse should withhold the medication and notify the provider.
Q5 DEMONSTRATE MASTERY OF CORE CONCEPTS
When caring for a patient with acute pancreatitis, which assessment finding
indicates a poor prognosis?
A. Serum calcium of 8.5 mg/dL
B. Cullen's sign CORRECT
C. Amylase level of 600 units/L
D. WBC count of 12,000/mm³
RATIONALE: Cullen's sign (periumbilical ecchymosis) indicates retroperitoneal hemorrhage and
is associated with severe, necrotizing pancreatitis and high mortality. Hypocalcemia (below 8
mg/dL) is also a poor sign, but 8.5 is borderline low. Elevated amylase and WBC are common
but not specifically prognostic.
Page 3
, Q6 DEMONSTRATE MASTERY OF CORE CONCEPTS
A patient with a chest tube for a pneumothorax has continuous bubbling in the
water seal chamber. Which action should the nurse take?
A. Clamp the chest tube immediately
B. Document and continue to monitor
C. Strip the tubing to maintain patency
D. Notify the provider of a possible air leak CORRECT
RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak, which can be
from the lung or the system. The nurse should notify the provider and assess the system for
leaks. Clamping can cause tension pneumothorax. Stripping is not indicated. Documentation
alone is insufficient.
Q7 DEMONSTRATE MASTERY OF CORE CONCEPTS
Which intervention is most effective in preventing ventilator-associated
pneumonia (VAP) in a mechanically ventilated patient?
A. Daily sedation vacation
B. Elevation of the head of the bed to 30-45 degrees CORRECT
C. Use of a heat and moisture exchanger
D. Routine change of ventilator circuit every 24 hours
RATIONALE: Elevating the head of the bed to 30-45 degrees reduces aspiration of gastric
contents, a key VAP prevention strategy. Sedation vacations reduce duration of ventilation but
are not directly VAP prevention. Heat-moisture exchangers are not superior. Routine circuit
changes are not recommended (less frequent is better).
Page 4
