RN Adult Medical-Surgical Proctored Exam
(NGN-Style Practice) Exam Questions
And Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A
Question 1 — Heart Failure
A nurse is caring for a client admitted with worsening left-sided heart
failure. Which finding requires immediate intervention?
A. Weight gain of 1 lb in 24 hr
B. Bibasilar crackles and oxygen saturation 88%
C. Fatigue when ambulating
D. Mild ankle edema
Correct Answer: B. Bibasilar crackles and oxygen saturation 88%
Explanation:
Crackles and low oxygen saturation indicate pulmonary edema and
impaired gas exchange, which are priority concerns requiring
immediate action. Mild edema and small weight changes are expected
findings in heart failure but are less urgent.
Question 2 — NGN Case Study: COPD Exacerbation
A nurse reviews the following assessment findings for a client with
COPD exacerbation:
• Respiratory rate: 30/min
• SpO₂: 86% on room air
, • Productive cough with thick sputum
• Uses accessory muscles
• Confused and restless
Which actions should the nurse take?
Select all that apply.
A. Apply oxygen therapy
B. Encourage fluid restriction
C. Position client in high-Fowler’s
D. Administer prescribed bronchodilator
E. Instruct client to lie flat
Correct Answers: A, C, D
Explanation:
Clients with COPD exacerbation need improved oxygenation and airway
opening. High-Fowler’s promotes lung expansion, oxygen treats
hypoxemia, and bronchodilators reduce bronchospasm. Fluid
restriction is generally not indicated because hydration helps thin
secretions. Lying flat worsens breathing.
Question 3 — Diabetes Mellitus
A nurse is teaching a client with type 1 diabetes about hypoglycemia.
Which manifestation should the nurse include?
A. Fruity breath odor
B. Bradycardia
C. Cool clammy skin
D. Deep rapid respirations
Correct Answer: C. Cool clammy skin
,Explanation:
Hypoglycemia activates the sympathetic nervous system, causing
sweating, shakiness, tachycardia, and cool clammy skin. Fruity breath
and Kussmaul respirations occur with diabetic ketoacidosis.
Question 4 — Priority Setting
A nurse on a medical-surgical unit receives report on four clients. Which
client should the nurse assess first?
A. Client with pneumonia and temperature 38.1°C (100.6°F)
B. Client with heart failure who has new confusion
C. Client post-op day 2 requesting pain medication
D. Client with chronic kidney disease awaiting dialysis
Correct Answer: B. Client with heart failure who has new confusion
Explanation:
New confusion may indicate hypoxia or decreased cardiac output and
represents an acute change in condition. Acute neurological changes
take priority.
Question 5 — NGN Bow-Tie Item: Pulmonary Embolism
Scenario:
A client suddenly develops:
• Sharp chest pain
• Dyspnea
• Tachycardia
• SpO₂ 84%
, Complete the diagram by identifying:
Condition Most Likely:
• Pulmonary embolism
2 Actions the Nurse Should Take:
• Administer oxygen
• Prepare for anticoagulant therapy
2 Parameters to Monitor:
• Oxygen saturation
• Respiratory status
Explanation:
Pulmonary embolism commonly presents with sudden chest pain,
hypoxia, dyspnea, and tachycardia. Immediate oxygenation and
anticoagulation are priorities.
Question 6 — Fluid & Electrolytes
A client’s laboratory results show:
• Potassium: 2.9 mEq/L
Which assessment finding should the nurse expect?
A. Hyperactive bowel sounds
B. Muscle weakness
C. Peaked T waves
D. Bradycardia
Correct Answer: B. Muscle weakness
(NGN-Style Practice) Exam Questions
And Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A
Question 1 — Heart Failure
A nurse is caring for a client admitted with worsening left-sided heart
failure. Which finding requires immediate intervention?
A. Weight gain of 1 lb in 24 hr
B. Bibasilar crackles and oxygen saturation 88%
C. Fatigue when ambulating
D. Mild ankle edema
Correct Answer: B. Bibasilar crackles and oxygen saturation 88%
Explanation:
Crackles and low oxygen saturation indicate pulmonary edema and
impaired gas exchange, which are priority concerns requiring
immediate action. Mild edema and small weight changes are expected
findings in heart failure but are less urgent.
Question 2 — NGN Case Study: COPD Exacerbation
A nurse reviews the following assessment findings for a client with
COPD exacerbation:
• Respiratory rate: 30/min
• SpO₂: 86% on room air
, • Productive cough with thick sputum
• Uses accessory muscles
• Confused and restless
Which actions should the nurse take?
Select all that apply.
A. Apply oxygen therapy
B. Encourage fluid restriction
C. Position client in high-Fowler’s
D. Administer prescribed bronchodilator
E. Instruct client to lie flat
Correct Answers: A, C, D
Explanation:
Clients with COPD exacerbation need improved oxygenation and airway
opening. High-Fowler’s promotes lung expansion, oxygen treats
hypoxemia, and bronchodilators reduce bronchospasm. Fluid
restriction is generally not indicated because hydration helps thin
secretions. Lying flat worsens breathing.
Question 3 — Diabetes Mellitus
A nurse is teaching a client with type 1 diabetes about hypoglycemia.
Which manifestation should the nurse include?
A. Fruity breath odor
B. Bradycardia
C. Cool clammy skin
D. Deep rapid respirations
Correct Answer: C. Cool clammy skin
,Explanation:
Hypoglycemia activates the sympathetic nervous system, causing
sweating, shakiness, tachycardia, and cool clammy skin. Fruity breath
and Kussmaul respirations occur with diabetic ketoacidosis.
Question 4 — Priority Setting
A nurse on a medical-surgical unit receives report on four clients. Which
client should the nurse assess first?
A. Client with pneumonia and temperature 38.1°C (100.6°F)
B. Client with heart failure who has new confusion
C. Client post-op day 2 requesting pain medication
D. Client with chronic kidney disease awaiting dialysis
Correct Answer: B. Client with heart failure who has new confusion
Explanation:
New confusion may indicate hypoxia or decreased cardiac output and
represents an acute change in condition. Acute neurological changes
take priority.
Question 5 — NGN Bow-Tie Item: Pulmonary Embolism
Scenario:
A client suddenly develops:
• Sharp chest pain
• Dyspnea
• Tachycardia
• SpO₂ 84%
, Complete the diagram by identifying:
Condition Most Likely:
• Pulmonary embolism
2 Actions the Nurse Should Take:
• Administer oxygen
• Prepare for anticoagulant therapy
2 Parameters to Monitor:
• Oxygen saturation
• Respiratory status
Explanation:
Pulmonary embolism commonly presents with sudden chest pain,
hypoxia, dyspnea, and tachycardia. Immediate oxygenation and
anticoagulation are priorities.
Question 6 — Fluid & Electrolytes
A client’s laboratory results show:
• Potassium: 2.9 mEq/L
Which assessment finding should the nurse expect?
A. Hyperactive bowel sounds
B. Muscle weakness
C. Peaked T waves
D. Bradycardia
Correct Answer: B. Muscle weakness
