ATI PN MEDICAL-SURGICAL PROCTORED EXAM WITH
NGN 2026/2027 | Recently Updated | A+ Graded | 100%
Correct Answers | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular & Respiratory Disorders - Priority &
Emergency Care (Q1-18)
Q1. A 72-year-old client with a history of heart failure is admitted with acute
dyspnea, orthopnea, and bilateral crackles. Vital signs: BP 168/94 mmHg, HR 118
bpm, RR 32/min, SpO2 84% on room air. Which action should the nurse take
FIRST?
A. Administer IV furosemide 80 mg STAT
B. Apply supplemental oxygen at 2 L/min via nasal cannula
C. Place the client in high-Fowler's position with legs dependent
D. Obtain a 12-lead ECG immediately
Correct Answer: C. Place the client in high-Fowler's position with legs dependent
[CORRECT]
Rationale: In acute pulmonary edema from heart failure exacerbation, the FIRST
priority is positioning to reduce venous return and improve ventilation. High-Fowler's
with legs dependent promotes pooling in the extremities, decreases preload, and
maximizes diaphragmatic excursion. Option A (furosemide) is a high-priority
intervention but requires a provider order and is not the immediate independent
nursing action. Option B (oxygen at 2 L/min) is insufficient for SpO2 84% and would
require higher flow or non-rebreather mask. Option D (ECG) is important but
secondary to immediate life-saving positioning. The ABC framework guides this
prioritization—positioning improves both airway/breathing and circulation dynamics
simultaneously.
,Q2. A client with acute myocardial infarction (STEMI) is receiving thrombolytic
therapy with alteplase (tPA). Thirty minutes after infusion initiation, the nurse
observes ecchymosis at the IV site, oozing from a previous venipuncture site, and
a drop in blood pressure from 142/88 to 98/62 mmHg. What is the nurse's
PRIORITY action?
A. Apply pressure dressings to all bleeding sites and continue tPA infusion
B. Stop the tPA infusion immediately and notify the provider
C. Administer protamine sulfate per standing protocol
D. Draw coagulation studies (PT/INR, aPTT) and continue monitoring
Correct Answer: B. Stop the tPA infusion immediately and notify the provider
[CORRECT]
Rationale: The client is demonstrating signs of systemic bleeding complications from
thrombolytic therapy—ecchymosis, oozing, and hypotension indicating internal
hemorrhage. The immediate priority is to STOP the causative agent (tPA) to prevent
progression to life-threatening hemorrhage. Option A is dangerous as it allows
continued bleeding. Option C (protamine sulfate) is the antidote for heparin, NOT
tPA—there is no specific antidote for tPA; management involves stopping the
infusion and supportive care. Option D delays critical intervention. After stopping the
infusion, the nurse should apply pressure, prepare for possible transfusion, and
monitor for intracranial bleeding signs.
Q3. A client with chronic obstructive pulmonary disease (COPD) has the following
arterial blood gas (ABG) results: pH 7.32, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3-
32 mEq/L, SpO2 88%. The provider orders oxygen therapy. Which oxygen
delivery device and flow rate should the nurse select?
A. Non-rebreather mask at 15 L/min to achieve SpO2 94%
B. Venturi mask at 24-28% FiO2 with target SpO2 88-92%
C. Nasal cannula at 6 L/min with target SpO2 96%
D. Simple face mask at 10 L/min with target SpO2 90-95%
Correct Answer: B. Venturi mask at 24-28% FiO2 with target SpO2 88-92%
[CORRECT]
,Rationale: This ABG demonstrates compensated respiratory acidosis (pH 7.32,
elevated PaCO2 58, elevated HCO3- 32) consistent with chronic CO2 retention in
COPD. These clients rely on hypoxic drive for respiration; high-concentration oxygen
can suppress this drive and cause CO2 narcosis. The Venturi mask delivers precise
low-flow oxygen (24-28%) with a target SpO2 of 88-92% per GOLD guidelines.
Option A (non-rebreather at 15 L/min) would deliver near 100% FiO2 and risk CO2
narcosis. Option C (nasal cannula at 6 L/min) is imprecise and the target SpO2 of 96%
is too high for COPD clients. Option D (simple face mask) also delivers variable high
concentrations and the target range is inappropriate.
Q4. A client is admitted with suspected pulmonary embolism (PE). Vital signs: BP
92/58 mmHg, HR 128 bpm, RR 30/min, SpO2 86% on 4 L/min nasal cannula. The
client is diaphoretic and confused. Which intervention should the nurse
implement FIRST?
A. Prepare the client for a CT pulmonary angiography (CTPA)
B. Initiate IV heparin infusion per protocol
C. Administer supplemental oxygen and prepare for possible thrombolysis
D. Obtain a D-dimer level and chest X-ray
Correct Answer: C. Administer supplemental oxygen and prepare for possible
thrombolysis [CORRECT]
Rationale: This client presents with massive PE (hypotension, tachycardia,
hypoxemia, altered mental status) indicating hemodynamic instability and shock. The
FIRST priority is oxygenation support—current 4 L/min nasal cannula is insufficient
for SpO2 86%. The nurse must increase oxygen delivery (non-rebreather or prepare
for intubation) while simultaneously preparing for systemic thrombolysis, which is
indicated for massive PE with hemodynamic compromise. Option A (CTPA) is the
diagnostic gold standard but is contraindicated in unstable clients and delays
treatment. Option B (heparin) is appropriate for submassive PE but massive PE
requires thrombolysis. Option D (D-dimer) is a screening tool with poor specificity
and delays definitive care.
, Q5. A client with pneumonia develops sudden severe dyspnea, tachypnea, and
pleuritic chest pain. On auscultation, the nurse notes absent breath sounds on the
right side. Tracheal deviation to the LEFT is observed. What is the nurse's
immediate action?
A. Position the client on the affected (right) side and prepare for chest tube insertion
B. Position the client on the unaffected (left) side and prepare for needle
decompression
C. Administer high-flow oxygen and obtain a STAT chest X-ray
D. Perform a thoracentesis at the bedside to relieve pressure
Correct Answer: A. Position the client on the affected (right) side and prepare for
chest tube insertion [CORRECT]
Rationale: Tracheal deviation to the LEFT (away from the affected side) indicates a
tension pneumothorax on the RIGHT side caused by pneumonia-related lung rupture
or barotrauma. In tension pneumothorax, pressure builds on the affected side,
collapsing the lung and shifting mediastinal structures. Positioning on the affected
side helps splint the chest wall and may reduce tension while preparing for definitive
treatment. However, the true emergency intervention for tension pneumothorax is
immediate needle decompression (2nd intercostal space, midclavicular line) followed
by chest tube insertion. Option B incorrectly positions the client on the unaffected
side, which could worsen mediastinal shift. Option C delays critical intervention.
Option D (thoracentesis) is inappropriate for pneumothorax and risks converting to
open pneumothorax.
Q6. A client receiving a blood transfusion develops chills, fever (38.9°C/102°F),
back pain, and dark urine within 15 minutes of starting the infusion. The nurse's
FIRST action is to:
A. Slow the transfusion to 50 mL/hr and administer diphenhydramine
B. Stop the transfusion immediately, maintain IV access with normal saline, and notify
the provider
C. Draw blood cultures from the client and the blood bag, then continue the
NGN 2026/2027 | Recently Updated | A+ Graded | 100%
Correct Answers | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular & Respiratory Disorders - Priority &
Emergency Care (Q1-18)
Q1. A 72-year-old client with a history of heart failure is admitted with acute
dyspnea, orthopnea, and bilateral crackles. Vital signs: BP 168/94 mmHg, HR 118
bpm, RR 32/min, SpO2 84% on room air. Which action should the nurse take
FIRST?
A. Administer IV furosemide 80 mg STAT
B. Apply supplemental oxygen at 2 L/min via nasal cannula
C. Place the client in high-Fowler's position with legs dependent
D. Obtain a 12-lead ECG immediately
Correct Answer: C. Place the client in high-Fowler's position with legs dependent
[CORRECT]
Rationale: In acute pulmonary edema from heart failure exacerbation, the FIRST
priority is positioning to reduce venous return and improve ventilation. High-Fowler's
with legs dependent promotes pooling in the extremities, decreases preload, and
maximizes diaphragmatic excursion. Option A (furosemide) is a high-priority
intervention but requires a provider order and is not the immediate independent
nursing action. Option B (oxygen at 2 L/min) is insufficient for SpO2 84% and would
require higher flow or non-rebreather mask. Option D (ECG) is important but
secondary to immediate life-saving positioning. The ABC framework guides this
prioritization—positioning improves both airway/breathing and circulation dynamics
simultaneously.
,Q2. A client with acute myocardial infarction (STEMI) is receiving thrombolytic
therapy with alteplase (tPA). Thirty minutes after infusion initiation, the nurse
observes ecchymosis at the IV site, oozing from a previous venipuncture site, and
a drop in blood pressure from 142/88 to 98/62 mmHg. What is the nurse's
PRIORITY action?
A. Apply pressure dressings to all bleeding sites and continue tPA infusion
B. Stop the tPA infusion immediately and notify the provider
C. Administer protamine sulfate per standing protocol
D. Draw coagulation studies (PT/INR, aPTT) and continue monitoring
Correct Answer: B. Stop the tPA infusion immediately and notify the provider
[CORRECT]
Rationale: The client is demonstrating signs of systemic bleeding complications from
thrombolytic therapy—ecchymosis, oozing, and hypotension indicating internal
hemorrhage. The immediate priority is to STOP the causative agent (tPA) to prevent
progression to life-threatening hemorrhage. Option A is dangerous as it allows
continued bleeding. Option C (protamine sulfate) is the antidote for heparin, NOT
tPA—there is no specific antidote for tPA; management involves stopping the
infusion and supportive care. Option D delays critical intervention. After stopping the
infusion, the nurse should apply pressure, prepare for possible transfusion, and
monitor for intracranial bleeding signs.
Q3. A client with chronic obstructive pulmonary disease (COPD) has the following
arterial blood gas (ABG) results: pH 7.32, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3-
32 mEq/L, SpO2 88%. The provider orders oxygen therapy. Which oxygen
delivery device and flow rate should the nurse select?
A. Non-rebreather mask at 15 L/min to achieve SpO2 94%
B. Venturi mask at 24-28% FiO2 with target SpO2 88-92%
C. Nasal cannula at 6 L/min with target SpO2 96%
D. Simple face mask at 10 L/min with target SpO2 90-95%
Correct Answer: B. Venturi mask at 24-28% FiO2 with target SpO2 88-92%
[CORRECT]
,Rationale: This ABG demonstrates compensated respiratory acidosis (pH 7.32,
elevated PaCO2 58, elevated HCO3- 32) consistent with chronic CO2 retention in
COPD. These clients rely on hypoxic drive for respiration; high-concentration oxygen
can suppress this drive and cause CO2 narcosis. The Venturi mask delivers precise
low-flow oxygen (24-28%) with a target SpO2 of 88-92% per GOLD guidelines.
Option A (non-rebreather at 15 L/min) would deliver near 100% FiO2 and risk CO2
narcosis. Option C (nasal cannula at 6 L/min) is imprecise and the target SpO2 of 96%
is too high for COPD clients. Option D (simple face mask) also delivers variable high
concentrations and the target range is inappropriate.
Q4. A client is admitted with suspected pulmonary embolism (PE). Vital signs: BP
92/58 mmHg, HR 128 bpm, RR 30/min, SpO2 86% on 4 L/min nasal cannula. The
client is diaphoretic and confused. Which intervention should the nurse
implement FIRST?
A. Prepare the client for a CT pulmonary angiography (CTPA)
B. Initiate IV heparin infusion per protocol
C. Administer supplemental oxygen and prepare for possible thrombolysis
D. Obtain a D-dimer level and chest X-ray
Correct Answer: C. Administer supplemental oxygen and prepare for possible
thrombolysis [CORRECT]
Rationale: This client presents with massive PE (hypotension, tachycardia,
hypoxemia, altered mental status) indicating hemodynamic instability and shock. The
FIRST priority is oxygenation support—current 4 L/min nasal cannula is insufficient
for SpO2 86%. The nurse must increase oxygen delivery (non-rebreather or prepare
for intubation) while simultaneously preparing for systemic thrombolysis, which is
indicated for massive PE with hemodynamic compromise. Option A (CTPA) is the
diagnostic gold standard but is contraindicated in unstable clients and delays
treatment. Option B (heparin) is appropriate for submassive PE but massive PE
requires thrombolysis. Option D (D-dimer) is a screening tool with poor specificity
and delays definitive care.
, Q5. A client with pneumonia develops sudden severe dyspnea, tachypnea, and
pleuritic chest pain. On auscultation, the nurse notes absent breath sounds on the
right side. Tracheal deviation to the LEFT is observed. What is the nurse's
immediate action?
A. Position the client on the affected (right) side and prepare for chest tube insertion
B. Position the client on the unaffected (left) side and prepare for needle
decompression
C. Administer high-flow oxygen and obtain a STAT chest X-ray
D. Perform a thoracentesis at the bedside to relieve pressure
Correct Answer: A. Position the client on the affected (right) side and prepare for
chest tube insertion [CORRECT]
Rationale: Tracheal deviation to the LEFT (away from the affected side) indicates a
tension pneumothorax on the RIGHT side caused by pneumonia-related lung rupture
or barotrauma. In tension pneumothorax, pressure builds on the affected side,
collapsing the lung and shifting mediastinal structures. Positioning on the affected
side helps splint the chest wall and may reduce tension while preparing for definitive
treatment. However, the true emergency intervention for tension pneumothorax is
immediate needle decompression (2nd intercostal space, midclavicular line) followed
by chest tube insertion. Option B incorrectly positions the client on the unaffected
side, which could worsen mediastinal shift. Option C delays critical intervention.
Option D (thoracentesis) is inappropriate for pneumothorax and risks converting to
open pneumothorax.
Q6. A client receiving a blood transfusion develops chills, fever (38.9°C/102°F),
back pain, and dark urine within 15 minutes of starting the infusion. The nurse's
FIRST action is to:
A. Slow the transfusion to 50 mL/hr and administer diphenhydramine
B. Stop the transfusion immediately, maintain IV access with normal saline, and notify
the provider
C. Draw blood cultures from the client and the blood bag, then continue the
