ATI RN Adult Medical-Surgical (Advanced Med-Surg) CMS Proctored
Exam with NGN : Complete Study Guide for First-Attempt Success
1. A nurse is assessing a client who has a suspected small bowel obstruction. Which of the following
findings should the nurse expect?
A) Significant lower abdominal distension
B) High-pitched bowel sounds above the obstruction
C) Bradycardia and hypertension
D) Increased passage of flatus
<span style='color: #16a34a'>Accurate answer: B</span>
<span style='color: #16a34a'>Rationale: In early small bowel obstruction, bowel sounds are typically
hyperactive and high-pitched (borborygmi) proximal to the obstruction as the intestine attempts to push
contents past the blockage. Lower abdominal distension is more characteristic of large bowel
obstructions.</span>
2. A nurse is caring for a client with a small bowel obstruction. Which of the following findings is a late -
stage manifestation of this condition?
,A) Projectile vomiting of bile
B) Fecal odor to the emesis
C) Diarrhea with mucus and blood
D) Sharp, localized pain in the left lower quadrant
<span style='color: #16a34a'>Accurate answer: B</span>
<span style='color: #16a34a'>Rationale: As a small bowel obstruction progresses, bacterial overgrowth
occurs in the stagnant contents of the proximal bowel, leading to emesis that has a distinct fecal odor.
Projectile vomiting of bile is an earlier sign.</span>
3. A nurse in the emergency department is triaging four clients. Which of the following clients should the
nurse recommend for immediate treatment?
A) A client who has a fractured tibia and reports a pain level of 8 on a scale of 0 to 10.
B) A client who has a history of heart failure and reports 2+ pitting edema in the lower extremities.
C) A client who has a sucking chest wound and is experiencing respiratory distress.
D) A client who is 2 days postoperative and has a temperature of 38.4°C (101.1°F).
<span style='color: #16a34a'>Accurate answer: C</span>
<span style='color: #16a34a'>Rationale: Using the ABC (Airway, Breathing, Circulation) priority
framework, a sucking chest wound is a life-threatening emergency that compromises breathing and
requires immediate intervention to prevent a tension pneumothorax.</span>
,4. A nurse is assessing a client who is 4 hours postoperative following an abdominal hysterectomy.
Which of the following findings is the priority for the nurse to report to the provider?
A) Urinary output of 20 mL/hr
B) Serosanguineous drainage on the abdominal dressing
C) Reports of severe incisional pain
D) Absent bowel sounds in all four quadrants
<span style='color: #16a34a'>Accurate answer: A</span>
<span style='color: #16a34a'>Rationale: A urinary output of less than 30 mL/hr can indicate decreased
renal perfusion, hypovolemia, or impending shock in the postoperative period. While pain and absent
bowel sounds are expected findings 4 hours post-op, low urine output requires immediate clinical
attention.</span>
5. (SATA) A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of
the following actions should the nurse take to prevent deep-vein thrombosis (DVT)? (Select all that
apply.)
A) Apply sequential compression devices (SCDs) to both legs.
B) Encourage the client to perform foot pumps every hour while awake.
C) Place a pillow under the client's knees while in bed.
, D) Administer prophylactic anticoagulants as prescribed.
E) Massage the client's calves daily to promote circulation.
<span style='color: #16a34a'>Accurate answer: A, B, D</span>
<span style='color: #16a34a'>Rationale: SCDs and foot pumps promote venous return through
mechanical means. Anticoagulants provide pharmacological prophylaxis. Pillows under the knees (C) can
cause venous stasis by compressing popliteal vessels, and massaging calves (E) is contraindicated as it
could dislodge an existing clot.</span>
6. A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2 52 mm Hg, HCO3
24 mEq/L. The nurse should identify that the client is experiencing which of the following acid-base
imbalances?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
<span style='color: #16a34a'>Accurate answer: C</span>
<span style='color: #16a34a'>Rationale: The pH is below 7.35 (acidosis). The PaCO2 is above 45 mm Hg
(respiratory origin), and the HCO3 is within the normal range (22-26 mEq/L), indicating an
uncompensated respiratory acidosis.</span>
Exam with NGN : Complete Study Guide for First-Attempt Success
1. A nurse is assessing a client who has a suspected small bowel obstruction. Which of the following
findings should the nurse expect?
A) Significant lower abdominal distension
B) High-pitched bowel sounds above the obstruction
C) Bradycardia and hypertension
D) Increased passage of flatus
<span style='color: #16a34a'>Accurate answer: B</span>
<span style='color: #16a34a'>Rationale: In early small bowel obstruction, bowel sounds are typically
hyperactive and high-pitched (borborygmi) proximal to the obstruction as the intestine attempts to push
contents past the blockage. Lower abdominal distension is more characteristic of large bowel
obstructions.</span>
2. A nurse is caring for a client with a small bowel obstruction. Which of the following findings is a late -
stage manifestation of this condition?
,A) Projectile vomiting of bile
B) Fecal odor to the emesis
C) Diarrhea with mucus and blood
D) Sharp, localized pain in the left lower quadrant
<span style='color: #16a34a'>Accurate answer: B</span>
<span style='color: #16a34a'>Rationale: As a small bowel obstruction progresses, bacterial overgrowth
occurs in the stagnant contents of the proximal bowel, leading to emesis that has a distinct fecal odor.
Projectile vomiting of bile is an earlier sign.</span>
3. A nurse in the emergency department is triaging four clients. Which of the following clients should the
nurse recommend for immediate treatment?
A) A client who has a fractured tibia and reports a pain level of 8 on a scale of 0 to 10.
B) A client who has a history of heart failure and reports 2+ pitting edema in the lower extremities.
C) A client who has a sucking chest wound and is experiencing respiratory distress.
D) A client who is 2 days postoperative and has a temperature of 38.4°C (101.1°F).
<span style='color: #16a34a'>Accurate answer: C</span>
<span style='color: #16a34a'>Rationale: Using the ABC (Airway, Breathing, Circulation) priority
framework, a sucking chest wound is a life-threatening emergency that compromises breathing and
requires immediate intervention to prevent a tension pneumothorax.</span>
,4. A nurse is assessing a client who is 4 hours postoperative following an abdominal hysterectomy.
Which of the following findings is the priority for the nurse to report to the provider?
A) Urinary output of 20 mL/hr
B) Serosanguineous drainage on the abdominal dressing
C) Reports of severe incisional pain
D) Absent bowel sounds in all four quadrants
<span style='color: #16a34a'>Accurate answer: A</span>
<span style='color: #16a34a'>Rationale: A urinary output of less than 30 mL/hr can indicate decreased
renal perfusion, hypovolemia, or impending shock in the postoperative period. While pain and absent
bowel sounds are expected findings 4 hours post-op, low urine output requires immediate clinical
attention.</span>
5. (SATA) A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of
the following actions should the nurse take to prevent deep-vein thrombosis (DVT)? (Select all that
apply.)
A) Apply sequential compression devices (SCDs) to both legs.
B) Encourage the client to perform foot pumps every hour while awake.
C) Place a pillow under the client's knees while in bed.
, D) Administer prophylactic anticoagulants as prescribed.
E) Massage the client's calves daily to promote circulation.
<span style='color: #16a34a'>Accurate answer: A, B, D</span>
<span style='color: #16a34a'>Rationale: SCDs and foot pumps promote venous return through
mechanical means. Anticoagulants provide pharmacological prophylaxis. Pillows under the knees (C) can
cause venous stasis by compressing popliteal vessels, and massaging calves (E) is contraindicated as it
could dislodge an existing clot.</span>
6. A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2 52 mm Hg, HCO3
24 mEq/L. The nurse should identify that the client is experiencing which of the following acid-base
imbalances?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
<span style='color: #16a34a'>Accurate answer: C</span>
<span style='color: #16a34a'>Rationale: The pH is below 7.35 (acidosis). The PaCO2 is above 45 mm Hg
(respiratory origin), and the HCO3 is within the normal range (22-26 mEq/L), indicating an
uncompensated respiratory acidosis.</span>
