RN ATI Adult Medical-Surgical Proctored Exam with NGN (2026/2027) |
QUESTIONS AND ANSWERS
ATI RN Adult Medical-Surgical Proctored Examination with Next Generation NCLEX® (NGN)
Integration | Core Domains: Clinical Judgment in Medical-Surgical Nursing, Complex Patient
Management (Cardiovascular, Respiratory, Gastrointestinal, Renal, Endocrine, Neurological,
Musculoskeletal, Hematology/Oncology, Immunology), Pharmacology & Advanced Medication
Administration, Perioperative & Critical Care Concepts, NGN Item Types (Bow-Tie, Extended
Multiple Response, Matrix, Cloze), Patient Safety & Risk Reduction, and Ethical/Legal
Considerations in Adult Health | NCLEX-RN® Readiness Focus | Proctored Predictor Exam Format
Exam Structure
The RN ATI Adult Medical-Surgical Proctored Exam with NGN for the 2026/2027 academic cycle is a
110-question, multiple-choice and NGN item-type examination that must be completed within a 3-
hour proctored session.
Introduction
This RN ATI Adult Medical-Surgical Proctored Exam guide for the 2026/2027 cycle prepares students
for the high-stakes proctored assessment that integrates traditional medical-surgical content with Next
Generation NCLEX® (NGN) style questions. The content emphasizes clinical judgment, application of
complex pathophysiology, safe pharmacologic management, and the use of the Clinical Judgment
Measurement Model to analyze unfolding patient scenarios.
Answer Format
All correct answers and nursing interventions must be presented in bold and green, followed by
detailed rationales that incorporate NGN clinical judgment steps, evidence-based medical-surgical
protocols, pharmacological principles, and ATI's recommended test-taking strategies.
1. A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. The client reports sudden onset of shortness of breath and chest
pain. Which action should the nurse take FIRST?
A. A. Administer oxygen via nasal cannula.
B. B. Elevate the head of the bed.
C. C. Assess oxygen saturation and respiratory status.
D. D. Notify the provider immediately.
C. Assess oxygen saturation and respiratory status.
Rationale: Using the NGN Clinical Judgment Measurement Model (Recognize Cues →
Analyze Cues → Prioritize Hypotheses → Generate Solutions → Take Action → Evaluate
Outcomes), the nurse must first gather data before intervening. Sudden dyspnea and chest
pain in a postoperative client raise concern for pulmonary embolism. While oxygen and
notification may follow, initial assessment (including SpO₂, respiratory rate, lung sounds, and
vital signs) is essential to confirm the urgency and guide appropriate action. ATI emphasizes
“assess before you act” in acute change scenarios.
2. A client with type 2 diabetes mellitus is prescribed metformin 1,000 mg twice
daily. Which statement by the client indicates understanding of the medication
teaching?
A. A. “I will stop taking this if I feel nauseated.”
B. B. “I should skip my dose on days I don’t eat much.”
C. C. “I need to have my kidney function tested regularly.”
D. D. “This medication can cause hypoglycemia if I exercise.”
, C. “I need to have my kidney function tested regularly.”
Rationale: Metformin is contraindicated in renal impairment due to the risk of lactic
acidosis. Regular monitoring of serum creatinine and eGFR is required. Metformin alone
rarely causes hypoglycemia (eliminating D). Nausea is a common side effect but not a reason
to discontinue without consulting a provider (A). Dosing should continue even with reduced
food intake unless directed otherwise (B). This reflects pharmacological safety and patient
education priorities per ATI and NGN’s focus on safe medication management.
3. A nurse is reviewing laboratory results for a client with suspected acute kidney
injury (AKI). Which finding supports this diagnosis?
A. A. Serum potassium 3.8 mEq/L
B. B. Blood urea nitrogen (BUN) 18 mg/dL
C. C. Serum creatinine 2.4 mg/dL
D. D. Glomerular filtration rate (GFR) 95 mL/min
C. Serum creatinine 2.4 mg/dL
Rationale: A serum creatinine >1.3 mg/dL in men (or >1.1 in women) suggests impaired
kidney function. AKI is marked by a rapid rise in creatinine (≥0.3 mg/dL within 48 hours or
≥1.5 times baseline). Normal BUN is 10–20 mg/dL; normal GFR is >90 mL/min; potassium
of 3.8 is within normal range (3.5–5.0 mEq/L). Recognizing abnormal lab values is a key
NGN “Recognize Cues” skill. ATI prioritizes interpretation of renal markers in medical-
surgical care.
4. A client with heart failure is receiving furosemide 40 mg IV daily. Which
assessment finding indicates the medication is effective?
A. A. Weight loss of 1.8 kg (4 lb) in 24 hours
B. B. Heart rate of 110 beats per minute
C. C. +3 pitting edema in bilateral lower extremities
D. D. Crackles auscultated in lung bases
A. Weight loss of 1.8 kg (4 lb) in 24 hours
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart failure. A
weight loss of 0.5–1 kg (1–2 lb) per day is expected with effective diuresis; 1.8 kg in 24 hours
is within therapeutic range and indicates fluid removal. Tachycardia (B), persistent edema
(C), and crackles (D) suggest ongoing volume overload and ineffective treatment. This
question tests evaluation of therapeutic outcomes—core to NGN’s “Evaluate Outcomes” step.
5. A nurse is preparing to administer packed red blood cells (PRBCs) to a client.
Which action is essential to prevent transfusion reactions?
A. A. Use dextrose 5% in water as the primary IV fluid.
B. B. Infuse the unit over 4 hours.
C. C. Verify blood compatibility with another licensed nurse.
D. D. Administer premedication with diphenhydramine routinely.
C. Verify blood compatibility with another licensed nurse.
, Rationale: Two-person verification of blood product compatibility (client ID, blood type,
unit number, expiration) is a critical safety step to prevent hemolytic transfusion reactions.
PRBCs must be infused in 2–4 hours but never with dextrose (which causes hemolysis)—
normal saline is required. Diphenhydramine is not given routinely unless ordered for prior
reaction history. This reflects NGN’s emphasis on patient safety and error prevention in high-
risk procedures.
6. A client with a new diagnosis of systemic lupus erythematosus (SLE) asks the
nurse about expected manifestations. Which response by the nurse is
appropriate?
A. A. “You will likely develop exophthalmos.”
B. B. “Joint pain and a butterfly rash are common.”
C. C. “Weight gain and heat intolerance are typical.”
D. D. “You may experience tremors and muscle rigidity.”
B. “Joint pain and a butterfly rash are common.”
Rationale: SLE is a chronic autoimmune disorder characterized by malar (butterfly) rash,
photosensitivity, arthritis, renal involvement, and fatigue. Exophthalmos occurs in Graves’
disease (A); weight gain and cold intolerance are seen in hypothyroidism (C); tremors and
rigidity suggest Parkinson’s (D). Accurate patient education based on pathophysiology is a key
NGN competency in chronic disease management.
7. A client is admitted with diabetic ketoacidosis (DKA). Which intervention should
the nurse anticipate FIRST?
A. A. Administer subcutaneous insulin glargine.
B. B. Begin IV infusion of 0.9% sodium chloride.
C. C. Provide oral glucose tablets.
D. D. Restrict all fluids to prevent cerebral edema.
B. Begin IV infusion of 0.9% sodium chloride.
Rationale: In DKA, the priority is volume resuscitation to restore perfusion and correct
dehydration before initiating insulin therapy. Isotonic saline (0.9% NaCl) is started
immediately. Insulin is given IV (not subcutaneously) after fluid resuscitation begins. Oral
glucose is contraindicated (hyperglycemia is present). Fluid restriction increases risk of shock.
This aligns with NGN’s “Prioritize Hypotheses” and ATI’s ABCs (Airway, Breathing,
Circulation) approach.
8. A nurse is caring for a client who had a stroke 48 hours ago and has right-sided
hemiparesis. Which action promotes safety during ambulation?
A. A. Place the wheelchair on the client’s right side.
B. B. Instruct the client to lead with the unaffected leg when using stairs.
C. C. Stand on the client’s left (unaffected) side during walking.
D. D. Encourage independent ambulation to build confidence.
B. Instruct the client to lead with the unaffected leg when using stairs.
Rationale: For clients with hemiparesis, stair negotiation requires specific techniques: when
ascending, the unaffected leg leads; when descending, the affected leg leads. Teaching this
, reduces fall risk. Placing the wheelchair on the affected side (A) makes transfers difficult.
Standing on the unaffected side (C) provides no support to the weak extremities. Independent
ambulation (D) is unsafe without assessment and assistance. This reflects NGN’s focus on
functional mobility and fall prevention in neurological care.
9. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. The nurse should titrate oxygen to maintain which target SpO₂ range?
A. A. 88% to 92%
B. B. 94% to 98%
C. C. 90% to 95%
D. D. Above 98%
A. 88% to 92%
Rationale: In COPD patients with chronic hypercapnia, oxygen should be titrated to SpO₂
88–92% to avoid suppressing the hypoxic drive to breathe, which can lead to CO₂ retention
and respiratory acidosis. Higher saturations (B, C, D) may cause hypoventilation. This is a
critical pharmacological and respiratory concept emphasized in ATI and NGN safety-focused
questions.
10. A nurse is caring for a client who is 12 hours postoperative following a
laparoscopic cholecystectomy. The client reports abdominal pain and has not
voided since surgery. What should the nurse do FIRST?
A. A. Insert an indwelling urinary catheter.
B. B. Palpate the bladder for distention.
C. C. Administer the prescribed analgesic.
D. D. Encourage ambulation in the hallway.
B. Palpate the bladder for distention.
Rationale: Postoperative urinary retention is common due to anesthesia and opioids. The
nurse must assess for bladder distention before intervening. Catheterization (A) is invasive
and not first-line. Pain (C) may contribute but doesn’t explain anuria. Ambulation (D) may
help but isn’t the priority assessment. This follows NGN’s “Analyze Cues” step—determining if
the issue is retention vs. oliguria before acting.
11. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
A. A. Platelet count
B. B. Activated partial thromboplastin time (aPTT)
C. C. International normalized ratio (INR)
D. D. Prothrombin time (PT)
C. International normalized ratio (INR)
Rationale: Warfarin therapy is monitored using the INR, which standardizes PT results
across laboratories. The therapeutic INR for atrial fibrillation is typically 2.0–3.0. aPTT is
used for heparin (B). Platelets (A) assess clotting cell count, not anticoagulation. PT (D) is the
raw value; INR is the standardized measure required for dosing.
QUESTIONS AND ANSWERS
ATI RN Adult Medical-Surgical Proctored Examination with Next Generation NCLEX® (NGN)
Integration | Core Domains: Clinical Judgment in Medical-Surgical Nursing, Complex Patient
Management (Cardiovascular, Respiratory, Gastrointestinal, Renal, Endocrine, Neurological,
Musculoskeletal, Hematology/Oncology, Immunology), Pharmacology & Advanced Medication
Administration, Perioperative & Critical Care Concepts, NGN Item Types (Bow-Tie, Extended
Multiple Response, Matrix, Cloze), Patient Safety & Risk Reduction, and Ethical/Legal
Considerations in Adult Health | NCLEX-RN® Readiness Focus | Proctored Predictor Exam Format
Exam Structure
The RN ATI Adult Medical-Surgical Proctored Exam with NGN for the 2026/2027 academic cycle is a
110-question, multiple-choice and NGN item-type examination that must be completed within a 3-
hour proctored session.
Introduction
This RN ATI Adult Medical-Surgical Proctored Exam guide for the 2026/2027 cycle prepares students
for the high-stakes proctored assessment that integrates traditional medical-surgical content with Next
Generation NCLEX® (NGN) style questions. The content emphasizes clinical judgment, application of
complex pathophysiology, safe pharmacologic management, and the use of the Clinical Judgment
Measurement Model to analyze unfolding patient scenarios.
Answer Format
All correct answers and nursing interventions must be presented in bold and green, followed by
detailed rationales that incorporate NGN clinical judgment steps, evidence-based medical-surgical
protocols, pharmacological principles, and ATI's recommended test-taking strategies.
1. A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. The client reports sudden onset of shortness of breath and chest
pain. Which action should the nurse take FIRST?
A. A. Administer oxygen via nasal cannula.
B. B. Elevate the head of the bed.
C. C. Assess oxygen saturation and respiratory status.
D. D. Notify the provider immediately.
C. Assess oxygen saturation and respiratory status.
Rationale: Using the NGN Clinical Judgment Measurement Model (Recognize Cues →
Analyze Cues → Prioritize Hypotheses → Generate Solutions → Take Action → Evaluate
Outcomes), the nurse must first gather data before intervening. Sudden dyspnea and chest
pain in a postoperative client raise concern for pulmonary embolism. While oxygen and
notification may follow, initial assessment (including SpO₂, respiratory rate, lung sounds, and
vital signs) is essential to confirm the urgency and guide appropriate action. ATI emphasizes
“assess before you act” in acute change scenarios.
2. A client with type 2 diabetes mellitus is prescribed metformin 1,000 mg twice
daily. Which statement by the client indicates understanding of the medication
teaching?
A. A. “I will stop taking this if I feel nauseated.”
B. B. “I should skip my dose on days I don’t eat much.”
C. C. “I need to have my kidney function tested regularly.”
D. D. “This medication can cause hypoglycemia if I exercise.”
, C. “I need to have my kidney function tested regularly.”
Rationale: Metformin is contraindicated in renal impairment due to the risk of lactic
acidosis. Regular monitoring of serum creatinine and eGFR is required. Metformin alone
rarely causes hypoglycemia (eliminating D). Nausea is a common side effect but not a reason
to discontinue without consulting a provider (A). Dosing should continue even with reduced
food intake unless directed otherwise (B). This reflects pharmacological safety and patient
education priorities per ATI and NGN’s focus on safe medication management.
3. A nurse is reviewing laboratory results for a client with suspected acute kidney
injury (AKI). Which finding supports this diagnosis?
A. A. Serum potassium 3.8 mEq/L
B. B. Blood urea nitrogen (BUN) 18 mg/dL
C. C. Serum creatinine 2.4 mg/dL
D. D. Glomerular filtration rate (GFR) 95 mL/min
C. Serum creatinine 2.4 mg/dL
Rationale: A serum creatinine >1.3 mg/dL in men (or >1.1 in women) suggests impaired
kidney function. AKI is marked by a rapid rise in creatinine (≥0.3 mg/dL within 48 hours or
≥1.5 times baseline). Normal BUN is 10–20 mg/dL; normal GFR is >90 mL/min; potassium
of 3.8 is within normal range (3.5–5.0 mEq/L). Recognizing abnormal lab values is a key
NGN “Recognize Cues” skill. ATI prioritizes interpretation of renal markers in medical-
surgical care.
4. A client with heart failure is receiving furosemide 40 mg IV daily. Which
assessment finding indicates the medication is effective?
A. A. Weight loss of 1.8 kg (4 lb) in 24 hours
B. B. Heart rate of 110 beats per minute
C. C. +3 pitting edema in bilateral lower extremities
D. D. Crackles auscultated in lung bases
A. Weight loss of 1.8 kg (4 lb) in 24 hours
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart failure. A
weight loss of 0.5–1 kg (1–2 lb) per day is expected with effective diuresis; 1.8 kg in 24 hours
is within therapeutic range and indicates fluid removal. Tachycardia (B), persistent edema
(C), and crackles (D) suggest ongoing volume overload and ineffective treatment. This
question tests evaluation of therapeutic outcomes—core to NGN’s “Evaluate Outcomes” step.
5. A nurse is preparing to administer packed red blood cells (PRBCs) to a client.
Which action is essential to prevent transfusion reactions?
A. A. Use dextrose 5% in water as the primary IV fluid.
B. B. Infuse the unit over 4 hours.
C. C. Verify blood compatibility with another licensed nurse.
D. D. Administer premedication with diphenhydramine routinely.
C. Verify blood compatibility with another licensed nurse.
, Rationale: Two-person verification of blood product compatibility (client ID, blood type,
unit number, expiration) is a critical safety step to prevent hemolytic transfusion reactions.
PRBCs must be infused in 2–4 hours but never with dextrose (which causes hemolysis)—
normal saline is required. Diphenhydramine is not given routinely unless ordered for prior
reaction history. This reflects NGN’s emphasis on patient safety and error prevention in high-
risk procedures.
6. A client with a new diagnosis of systemic lupus erythematosus (SLE) asks the
nurse about expected manifestations. Which response by the nurse is
appropriate?
A. A. “You will likely develop exophthalmos.”
B. B. “Joint pain and a butterfly rash are common.”
C. C. “Weight gain and heat intolerance are typical.”
D. D. “You may experience tremors and muscle rigidity.”
B. “Joint pain and a butterfly rash are common.”
Rationale: SLE is a chronic autoimmune disorder characterized by malar (butterfly) rash,
photosensitivity, arthritis, renal involvement, and fatigue. Exophthalmos occurs in Graves’
disease (A); weight gain and cold intolerance are seen in hypothyroidism (C); tremors and
rigidity suggest Parkinson’s (D). Accurate patient education based on pathophysiology is a key
NGN competency in chronic disease management.
7. A client is admitted with diabetic ketoacidosis (DKA). Which intervention should
the nurse anticipate FIRST?
A. A. Administer subcutaneous insulin glargine.
B. B. Begin IV infusion of 0.9% sodium chloride.
C. C. Provide oral glucose tablets.
D. D. Restrict all fluids to prevent cerebral edema.
B. Begin IV infusion of 0.9% sodium chloride.
Rationale: In DKA, the priority is volume resuscitation to restore perfusion and correct
dehydration before initiating insulin therapy. Isotonic saline (0.9% NaCl) is started
immediately. Insulin is given IV (not subcutaneously) after fluid resuscitation begins. Oral
glucose is contraindicated (hyperglycemia is present). Fluid restriction increases risk of shock.
This aligns with NGN’s “Prioritize Hypotheses” and ATI’s ABCs (Airway, Breathing,
Circulation) approach.
8. A nurse is caring for a client who had a stroke 48 hours ago and has right-sided
hemiparesis. Which action promotes safety during ambulation?
A. A. Place the wheelchair on the client’s right side.
B. B. Instruct the client to lead with the unaffected leg when using stairs.
C. C. Stand on the client’s left (unaffected) side during walking.
D. D. Encourage independent ambulation to build confidence.
B. Instruct the client to lead with the unaffected leg when using stairs.
Rationale: For clients with hemiparesis, stair negotiation requires specific techniques: when
ascending, the unaffected leg leads; when descending, the affected leg leads. Teaching this
, reduces fall risk. Placing the wheelchair on the affected side (A) makes transfers difficult.
Standing on the unaffected side (C) provides no support to the weak extremities. Independent
ambulation (D) is unsafe without assessment and assistance. This reflects NGN’s focus on
functional mobility and fall prevention in neurological care.
9. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. The nurse should titrate oxygen to maintain which target SpO₂ range?
A. A. 88% to 92%
B. B. 94% to 98%
C. C. 90% to 95%
D. D. Above 98%
A. 88% to 92%
Rationale: In COPD patients with chronic hypercapnia, oxygen should be titrated to SpO₂
88–92% to avoid suppressing the hypoxic drive to breathe, which can lead to CO₂ retention
and respiratory acidosis. Higher saturations (B, C, D) may cause hypoventilation. This is a
critical pharmacological and respiratory concept emphasized in ATI and NGN safety-focused
questions.
10. A nurse is caring for a client who is 12 hours postoperative following a
laparoscopic cholecystectomy. The client reports abdominal pain and has not
voided since surgery. What should the nurse do FIRST?
A. A. Insert an indwelling urinary catheter.
B. B. Palpate the bladder for distention.
C. C. Administer the prescribed analgesic.
D. D. Encourage ambulation in the hallway.
B. Palpate the bladder for distention.
Rationale: Postoperative urinary retention is common due to anesthesia and opioids. The
nurse must assess for bladder distention before intervening. Catheterization (A) is invasive
and not first-line. Pain (C) may contribute but doesn’t explain anuria. Ambulation (D) may
help but isn’t the priority assessment. This follows NGN’s “Analyze Cues” step—determining if
the issue is retention vs. oliguria before acting.
11. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
A. A. Platelet count
B. B. Activated partial thromboplastin time (aPTT)
C. C. International normalized ratio (INR)
D. D. Prothrombin time (PT)
C. International normalized ratio (INR)
Rationale: Warfarin therapy is monitored using the INR, which standardizes PT results
across laboratories. The therapeutic INR for atrial fibrillation is typically 2.0–3.0. aPTT is
used for heparin (B). Platelets (A) assess clotting cell count, not anticoagulation. PT (D) is the
raw value; INR is the standardized measure required for dosing.
