NGN ATI Med-Surg Proctored Exam | 2026/2027
NGN ATI MED-SURG PROCTORED EXAM | 2026/2027
75 Questions | Graded A+ | 100% Verified
Medical-Surgical Nursing & General Surgery Care | ATI/NCSBN NGN Aligned | NCLEX-RN Ready
Instructions: Select the best answer for each question. Correct answers appear in bold cyan.
Each question is followed by a rationale explaining clinical reasoning, alignment with
ATI/NCSBN NGN test plans, and why alternative options are less appropriate. This exam
covers the NCSBN Clinical Judgment Model, perioperative care, major body system
disorders, wound management, IV therapy, pharmacology, patient education, and NCLEX-
RN prioritization strategies.
DOMAIN 1: CLINICAL JUDGMENT & NGN ITEM TYPES (Q1–Q6)
1. A nurse is using the NCSBN Clinical Judgment Model to care for a patient with acute
respiratory distress. Which step involves identifying that the patient's oxygen saturation has
dropped to 88%?
A) Analyze cues
B) Recognize cues
C) Generate solutions
D) Evaluate outcomes
Correct Answer: B) Recognize cues
Rationale: Recognizing cues involves identifying relevant assessment data and clinical findings. A drop
in oxygen saturation to 88% is a recognized cue that requires clinical action. Analyzing cues involves
interpreting the significance of recognized cues.
2. A nurse delegates vital signs to a nursing assistant. Which action is most important for the
nurse to take regarding delegation?
A) Document the delegation in the chart
B) Verify that the UAP has been trained to perform the task
C) Ask the UAP to report only abnormal findings
D) Delegate all vital signs for the shift at once
Correct Answer: B) Verify that the UAP has been trained to perform the task
Rationale: The nurse must verify the delegatee's competency and training before delegating a task. The
nurse retains accountability for the delegated task and must ensure the UAP has the appropriate
knowledge and skills. Delegation should match the delegatee's scope of practice.
3. The nurse receives report on four patients. Using the ABC (Airway-Breathing-Circulation)
framework, which patient should the nurse assess first?
A) A patient with a suspected airway obstruction who is clutching their throat and
unable to speak
B) A patient with active gastrointestinal bleeding and a heart rate of 110/min
C) A patient reporting severe postoperative pain rated 8/10
D) A patient with a new onset of confusion following a fall
Correct Answer: A) A patient with a suspected airway obstruction who is clutching their throat
and unable to speak
Rationale: According to the ABC framework, airway is the highest priority. A patient with a suspected
airway obstruction who cannot speak requires immediate life-saving intervention. While bleeding
(circulation), pain, and confusion are important, a compromised airway takes precedence as it can lead
to death within minutes.
4. A nurse is caring for multiple patients on a medical-surgical unit. Which intervention is the
single most effective measure to break the chain of infection?
A) Wearing gloves for all patient contact
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, NGN ATI Med-Surg Proctored Exam | 2026/2027
B) Administering prophylactic antibiotics as prescribed
C) Placing patients in private rooms
D) Performing hand hygiene before and after patient contact
Correct Answer: D) Performing hand hygiene before and after patient contact
Rationale: Hand hygiene is considered the single most effective measure to prevent the spread of
infection and break the chain of infection at the portal of entry and mode of transmission. The CDC and
WHO identify hand hygiene as the primary intervention for infection control. While other measures are
important, hand hygiene addresses the most common mode of transmission.
5. A nurse is prioritizing care for four patients using Maslow's hierarchy of needs. Which
patient need should the nurse address first?
A) A patient who is expressing anxiety about an upcoming procedure
B) A patient who requests to speak with a chaplain for spiritual support
C) A patient who expresses feelings of low self-esteem after a new diagnosis
D) A patient with a blood pressure of 84/50 mmHg who appears pale and diaphoretic
Correct Answer: D) A patient with a blood pressure of 84/50 mmHg who appears pale and
diaphoretic
Rationale: According to Maslow's hierarchy, physiological needs take the highest priority. A blood
pressure of 84/50 mmHg with signs of shock (pale, diaphoretic) represents an immediate physiological
threat to life. Safety needs come next, followed by love/belonging, esteem, and self-actualization.
6. A nurse administered a bronchodilator to a patient with wheezing. Thirty minutes later, the
nurse reassesses the patient and notes the wheezing has diminished and the respiratory rate
has decreased from 28 to 18 breaths/min. Which step of the NCSBN Clinical Judgment
Model is the nurse performing?
A) Evaluate outcomes
B) Recognize cues
C) Analyze cues
D) Generate solutions
Correct Answer: A) Evaluate outcomes
Rationale: Evaluating outcomes involves reassessing the patient after an intervention to determine its
effectiveness. By reassessing lung sounds and respiratory rate after administering the bronchodilator, the
nurse is evaluating whether the intervention achieved the desired outcome. Recognizing cues occurs
before intervention, and analyzing cues involves interpreting the significance of data.
DOMAIN 2: PERIOPERATIVE NURSING MANAGEMENT (Q7–Q12)
7. A patient is scheduled for surgery at 0800. The nurse notes the patient ate breakfast at
0600. Which action should the nurse take?
A) Proceed with surgery since it was a light meal
B) Notify the anesthesia provider and surgical team
C) Administer a proton pump inhibitor
D) Increase the IV fluid rate
Correct Answer: B) Notify the anesthesia provider and surgical team
Rationale: The patient consumed food within the required NPO period (typically 8 hours for solids, 2
hours for clear liquids before surgery). Aspiration risk is increased under anesthesia. The nurse must
notify the surgical team, as the procedure may need to be delayed.
8. In the post-anesthesia care unit (PACU), a patient's Aldrete score is 7. Which action should
the nurse take?
A) Transfer the patient to the nursing unit
B) Continue monitoring in the PACU
C) Discharge the patient home
D) Begin physical therapy
Correct Answer: B) Continue monitoring in the PACU
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, NGN ATI Med-Surg Proctored Exam | 2026/2027
Rationale: An Aldrete score of 7 or below indicates the patient should remain in the PACU for continued
monitoring. A score of 8-10 indicates readiness for transfer to the surgical nursing unit or discharge. The
Aldrete score assesses activity, respiration, circulation, consciousness, and oxygen saturation.
9. A postoperative patient on day 5 following abdominal surgery coughs and the nurse notices
a sudden evisceration of the wound with loops of bowel visible. Which action should the
nurse take first?
A) Administer an opioid analgesic for pain
B) Push the protruding organs back into the abdominal cavity
C) Cover the wound with a sterile saline-moistened dressing and position the patient in
semi-Fowler's
D) Apply a dry sterile dressing and tape tightly
Correct Answer: C) Cover the wound with a sterile saline-moistened dressing and position the
patient in semi-Fowler's
Rationale: Wound evisceration is a surgical emergency. The nurse should cover the protruding organs
with a sterile saline-moistened dressing to prevent drying and tissue damage, position the patient in semi-
Fowler's to reduce abdominal tension, and notify the surgeon immediately. The nurse must never push
organs back in, as this can cause further damage and contamination.
10. A postoperative patient is at risk for deep vein thrombosis (DVT). Which intervention is
most effective for DVT prevention?
A) Apply sequential compression devices (SCDs) and encourage early ambulation
B) Massage the lower extremities to improve circulation
C) Place pillows under the knees to elevate the legs
D) Apply warm compresses to the calf area
Correct Answer: A) Apply sequential compression devices (SCDs) and encourage early
ambulation
Rationale: Sequential compression devices and early ambulation are the most effective mechanical
interventions for DVT prevention, as they promote venous return and reduce venous stasis (Virchow
triad). Massaging the legs is contraindicated in patients at risk for DVT as it may dislodge a clot. Knee
pillows can compress popliteal vessels and impede venous return.
11. A patient who had abdominal surgery yesterday is at risk for atelectasis. Which
intervention should the nurse include in the plan of care?
A) Restrict fluid intake to decrease pulmonary congestion
B) Maintain the patient in a supine position to conserve energy
C) Encourage use of incentive spirometry every 1 to 2 hours while awake, along with
deep breathing exercises
D) Administer prescribed opioids around the clock to prevent pain
Correct Answer: C) Encourage use of incentive spirometry every 1 to 2 hours while awake, along
with deep breathing exercises
Rationale: Incentive spirometry is the gold standard intervention for preventing atelectasis in
postoperative patients. It encourages deep inspiration, opens alveoli, and promotes lung expansion.
Adequate pain management facilitates deep breathing and coughing. Fluids should be encouraged (not
restricted) to keep secretions thin. Supine position should be avoided; semi-Fowler's or high-Fowler's is
preferred.
12. A postoperative patient develops abdominal distension, absent bowel sounds, nausea, and
vomiting on the second day after intestinal surgery. The nurse should anticipate which
intervention?
A) Administer a laxative to stimulate bowel function
B) Encourage the patient to eat a high-fiber diet
C) Increase the patient's oral fluid intake to 3 L/day
D) Insert a nasogastric (NG) tube for decompression and maintain NPO status
Correct Answer: D) Insert a nasogastric (NG) tube for decompression and maintain NPO status
Rationale: The findings indicate a paralytic ileus, a common postoperative complication where
peristalsis is temporarily absent. NG tube insertion provides gastric decompression, and NPO status
Page 3
NGN ATI MED-SURG PROCTORED EXAM | 2026/2027
75 Questions | Graded A+ | 100% Verified
Medical-Surgical Nursing & General Surgery Care | ATI/NCSBN NGN Aligned | NCLEX-RN Ready
Instructions: Select the best answer for each question. Correct answers appear in bold cyan.
Each question is followed by a rationale explaining clinical reasoning, alignment with
ATI/NCSBN NGN test plans, and why alternative options are less appropriate. This exam
covers the NCSBN Clinical Judgment Model, perioperative care, major body system
disorders, wound management, IV therapy, pharmacology, patient education, and NCLEX-
RN prioritization strategies.
DOMAIN 1: CLINICAL JUDGMENT & NGN ITEM TYPES (Q1–Q6)
1. A nurse is using the NCSBN Clinical Judgment Model to care for a patient with acute
respiratory distress. Which step involves identifying that the patient's oxygen saturation has
dropped to 88%?
A) Analyze cues
B) Recognize cues
C) Generate solutions
D) Evaluate outcomes
Correct Answer: B) Recognize cues
Rationale: Recognizing cues involves identifying relevant assessment data and clinical findings. A drop
in oxygen saturation to 88% is a recognized cue that requires clinical action. Analyzing cues involves
interpreting the significance of recognized cues.
2. A nurse delegates vital signs to a nursing assistant. Which action is most important for the
nurse to take regarding delegation?
A) Document the delegation in the chart
B) Verify that the UAP has been trained to perform the task
C) Ask the UAP to report only abnormal findings
D) Delegate all vital signs for the shift at once
Correct Answer: B) Verify that the UAP has been trained to perform the task
Rationale: The nurse must verify the delegatee's competency and training before delegating a task. The
nurse retains accountability for the delegated task and must ensure the UAP has the appropriate
knowledge and skills. Delegation should match the delegatee's scope of practice.
3. The nurse receives report on four patients. Using the ABC (Airway-Breathing-Circulation)
framework, which patient should the nurse assess first?
A) A patient with a suspected airway obstruction who is clutching their throat and
unable to speak
B) A patient with active gastrointestinal bleeding and a heart rate of 110/min
C) A patient reporting severe postoperative pain rated 8/10
D) A patient with a new onset of confusion following a fall
Correct Answer: A) A patient with a suspected airway obstruction who is clutching their throat
and unable to speak
Rationale: According to the ABC framework, airway is the highest priority. A patient with a suspected
airway obstruction who cannot speak requires immediate life-saving intervention. While bleeding
(circulation), pain, and confusion are important, a compromised airway takes precedence as it can lead
to death within minutes.
4. A nurse is caring for multiple patients on a medical-surgical unit. Which intervention is the
single most effective measure to break the chain of infection?
A) Wearing gloves for all patient contact
Page 1
, NGN ATI Med-Surg Proctored Exam | 2026/2027
B) Administering prophylactic antibiotics as prescribed
C) Placing patients in private rooms
D) Performing hand hygiene before and after patient contact
Correct Answer: D) Performing hand hygiene before and after patient contact
Rationale: Hand hygiene is considered the single most effective measure to prevent the spread of
infection and break the chain of infection at the portal of entry and mode of transmission. The CDC and
WHO identify hand hygiene as the primary intervention for infection control. While other measures are
important, hand hygiene addresses the most common mode of transmission.
5. A nurse is prioritizing care for four patients using Maslow's hierarchy of needs. Which
patient need should the nurse address first?
A) A patient who is expressing anxiety about an upcoming procedure
B) A patient who requests to speak with a chaplain for spiritual support
C) A patient who expresses feelings of low self-esteem after a new diagnosis
D) A patient with a blood pressure of 84/50 mmHg who appears pale and diaphoretic
Correct Answer: D) A patient with a blood pressure of 84/50 mmHg who appears pale and
diaphoretic
Rationale: According to Maslow's hierarchy, physiological needs take the highest priority. A blood
pressure of 84/50 mmHg with signs of shock (pale, diaphoretic) represents an immediate physiological
threat to life. Safety needs come next, followed by love/belonging, esteem, and self-actualization.
6. A nurse administered a bronchodilator to a patient with wheezing. Thirty minutes later, the
nurse reassesses the patient and notes the wheezing has diminished and the respiratory rate
has decreased from 28 to 18 breaths/min. Which step of the NCSBN Clinical Judgment
Model is the nurse performing?
A) Evaluate outcomes
B) Recognize cues
C) Analyze cues
D) Generate solutions
Correct Answer: A) Evaluate outcomes
Rationale: Evaluating outcomes involves reassessing the patient after an intervention to determine its
effectiveness. By reassessing lung sounds and respiratory rate after administering the bronchodilator, the
nurse is evaluating whether the intervention achieved the desired outcome. Recognizing cues occurs
before intervention, and analyzing cues involves interpreting the significance of data.
DOMAIN 2: PERIOPERATIVE NURSING MANAGEMENT (Q7–Q12)
7. A patient is scheduled for surgery at 0800. The nurse notes the patient ate breakfast at
0600. Which action should the nurse take?
A) Proceed with surgery since it was a light meal
B) Notify the anesthesia provider and surgical team
C) Administer a proton pump inhibitor
D) Increase the IV fluid rate
Correct Answer: B) Notify the anesthesia provider and surgical team
Rationale: The patient consumed food within the required NPO period (typically 8 hours for solids, 2
hours for clear liquids before surgery). Aspiration risk is increased under anesthesia. The nurse must
notify the surgical team, as the procedure may need to be delayed.
8. In the post-anesthesia care unit (PACU), a patient's Aldrete score is 7. Which action should
the nurse take?
A) Transfer the patient to the nursing unit
B) Continue monitoring in the PACU
C) Discharge the patient home
D) Begin physical therapy
Correct Answer: B) Continue monitoring in the PACU
Page 2
, NGN ATI Med-Surg Proctored Exam | 2026/2027
Rationale: An Aldrete score of 7 or below indicates the patient should remain in the PACU for continued
monitoring. A score of 8-10 indicates readiness for transfer to the surgical nursing unit or discharge. The
Aldrete score assesses activity, respiration, circulation, consciousness, and oxygen saturation.
9. A postoperative patient on day 5 following abdominal surgery coughs and the nurse notices
a sudden evisceration of the wound with loops of bowel visible. Which action should the
nurse take first?
A) Administer an opioid analgesic for pain
B) Push the protruding organs back into the abdominal cavity
C) Cover the wound with a sterile saline-moistened dressing and position the patient in
semi-Fowler's
D) Apply a dry sterile dressing and tape tightly
Correct Answer: C) Cover the wound with a sterile saline-moistened dressing and position the
patient in semi-Fowler's
Rationale: Wound evisceration is a surgical emergency. The nurse should cover the protruding organs
with a sterile saline-moistened dressing to prevent drying and tissue damage, position the patient in semi-
Fowler's to reduce abdominal tension, and notify the surgeon immediately. The nurse must never push
organs back in, as this can cause further damage and contamination.
10. A postoperative patient is at risk for deep vein thrombosis (DVT). Which intervention is
most effective for DVT prevention?
A) Apply sequential compression devices (SCDs) and encourage early ambulation
B) Massage the lower extremities to improve circulation
C) Place pillows under the knees to elevate the legs
D) Apply warm compresses to the calf area
Correct Answer: A) Apply sequential compression devices (SCDs) and encourage early
ambulation
Rationale: Sequential compression devices and early ambulation are the most effective mechanical
interventions for DVT prevention, as they promote venous return and reduce venous stasis (Virchow
triad). Massaging the legs is contraindicated in patients at risk for DVT as it may dislodge a clot. Knee
pillows can compress popliteal vessels and impede venous return.
11. A patient who had abdominal surgery yesterday is at risk for atelectasis. Which
intervention should the nurse include in the plan of care?
A) Restrict fluid intake to decrease pulmonary congestion
B) Maintain the patient in a supine position to conserve energy
C) Encourage use of incentive spirometry every 1 to 2 hours while awake, along with
deep breathing exercises
D) Administer prescribed opioids around the clock to prevent pain
Correct Answer: C) Encourage use of incentive spirometry every 1 to 2 hours while awake, along
with deep breathing exercises
Rationale: Incentive spirometry is the gold standard intervention for preventing atelectasis in
postoperative patients. It encourages deep inspiration, opens alveoli, and promotes lung expansion.
Adequate pain management facilitates deep breathing and coughing. Fluids should be encouraged (not
restricted) to keep secretions thin. Supine position should be avoided; semi-Fowler's or high-Fowler's is
preferred.
12. A postoperative patient develops abdominal distension, absent bowel sounds, nausea, and
vomiting on the second day after intestinal surgery. The nurse should anticipate which
intervention?
A) Administer a laxative to stimulate bowel function
B) Encourage the patient to eat a high-fiber diet
C) Increase the patient's oral fluid intake to 3 L/day
D) Insert a nasogastric (NG) tube for decompression and maintain NPO status
Correct Answer: D) Insert a nasogastric (NG) tube for decompression and maintain NPO status
Rationale: The findings indicate a paralytic ileus, a common postoperative complication where
peristalsis is temporarily absent. NG tube insertion provides gastric decompression, and NPO status
Page 3
