ATI RN Adult Medical-Surgical Advanced Prep: Master
NGN-Style Clinical Judgment & Practice Questions
Subject: Adult Medical-Surgical Nursing (Comprehensive Review)
Question 1: A nurse is caring for a client who is 24 hours postoperative following a total
thyroidectomy. The client suddenly reports tingling in the fingers and circumoral numbness. The
nurse notes a positive Trousseau’s sign. Which action is the priority?
A) Administer IV morphine sulfate for pain.
B) Prepare to administer IV calcium gluconate.
C) Increase the rate of the maintenance IV fluids.
D) Elevate the head of the bed to 45 degrees.
Correct Answer: B) Prepare to administer IV calcium gluconate.
Explanation: The client is exhibiting classic signs of acute hypocalcemia (tetany), likely due to
accidental damage or removal of the parathyroid glands during the thyroidectomy.
Hypocalcemia can lead to laryngeal stridor and cardiac dysrhythmias; therefore, immediate
administration of calcium gluconate is the priority intervention to prevent airway compromise
and cardiac instability.
Question 2: A nurse is assessing a client with acute heart failure who is receiving an infusion of
milrinone. Which assessment finding is most concerning?
A) A blood pressure change from 110/70 mmHg to 90/60 mmHg.
B) A decrease in peripheral edema.
C) A heart rate increase from 80/min to 88/min.
D) A clear lung assessment after previous crackles.
Correct Answer: A) A blood pressure change from 110/70 mmHg to 90/60 mmHg.
Explanation: Milrinone is a phosphodiesterase inhibitor used for heart failure that provides both
positive inotropy and systemic vasodilation. While it improves cardiac output, its vasodilatory
effect can cause significant hypotension. A drop in blood pressure to 90/60 mmHg indicates that
the dose may need to be titrated down to maintain adequate tissue perfusion.
Question 3: A nurse is caring for a client with acute pancreatitis. Which dietary instruction is
most appropriate for the client to follow during the recovery phase?
, A) A high-fat, high-protein diet to compensate for weight loss.
B) A bland, low-fat diet with frequent, small meals.
C) A diet restricted to clear liquids only for 2 weeks.
D) A high-fiber diet to prevent constipation from opioid use.
Correct Answer: B) A bland, low-fat diet with frequent, small meals.
Explanation: Pancreatitis requires "pancreatic rest." Fat stimulates the release of
cholecystokinin, which in turn stimulates pancreatic enzyme secretion. A low-fat diet reduces this
stimulation, allowing the pancreas to heal. Frequent, small meals are easier to digest than three
large meals.
Question 4: A nurse is preparing a client for a colonoscopy. Which assessment finding should be
reported to the provider immediately?
A) The client reports a mild headache.
B) The client’s morning dose of metformin was held.
C) The client has a history of a shellfish allergy.
D) The client’s bowel preparation resulted in clear yellow liquid stools.
Correct Answer: C) The client has a history of a shellfish allergy.
Explanation: While shellfish allergies are often associated with iodine, a significant history of
allergic reaction (anaphylaxis) is critical because contrast agents or certain sedatives used
during the procedure could trigger a cross-reaction or allergic event. This must be assessed and
communicated to the anesthesia team.
Question 5: A nurse is caring for a client who is in the oliguric phase of acute kidney injury
(AKI). Which laboratory result should the nurse expect?
A) Serum potassium 3.2 mEq/L.
B) Serum creatinine 0.8 mg/dL.
C) Serum potassium 6.2 mEq/L.
D) Blood urea nitrogen (BUN) 15 mg/dL.
Correct Answer: C) Serum potassium 6.2 mEq/L.
NGN-Style Clinical Judgment & Practice Questions
Subject: Adult Medical-Surgical Nursing (Comprehensive Review)
Question 1: A nurse is caring for a client who is 24 hours postoperative following a total
thyroidectomy. The client suddenly reports tingling in the fingers and circumoral numbness. The
nurse notes a positive Trousseau’s sign. Which action is the priority?
A) Administer IV morphine sulfate for pain.
B) Prepare to administer IV calcium gluconate.
C) Increase the rate of the maintenance IV fluids.
D) Elevate the head of the bed to 45 degrees.
Correct Answer: B) Prepare to administer IV calcium gluconate.
Explanation: The client is exhibiting classic signs of acute hypocalcemia (tetany), likely due to
accidental damage or removal of the parathyroid glands during the thyroidectomy.
Hypocalcemia can lead to laryngeal stridor and cardiac dysrhythmias; therefore, immediate
administration of calcium gluconate is the priority intervention to prevent airway compromise
and cardiac instability.
Question 2: A nurse is assessing a client with acute heart failure who is receiving an infusion of
milrinone. Which assessment finding is most concerning?
A) A blood pressure change from 110/70 mmHg to 90/60 mmHg.
B) A decrease in peripheral edema.
C) A heart rate increase from 80/min to 88/min.
D) A clear lung assessment after previous crackles.
Correct Answer: A) A blood pressure change from 110/70 mmHg to 90/60 mmHg.
Explanation: Milrinone is a phosphodiesterase inhibitor used for heart failure that provides both
positive inotropy and systemic vasodilation. While it improves cardiac output, its vasodilatory
effect can cause significant hypotension. A drop in blood pressure to 90/60 mmHg indicates that
the dose may need to be titrated down to maintain adequate tissue perfusion.
Question 3: A nurse is caring for a client with acute pancreatitis. Which dietary instruction is
most appropriate for the client to follow during the recovery phase?
, A) A high-fat, high-protein diet to compensate for weight loss.
B) A bland, low-fat diet with frequent, small meals.
C) A diet restricted to clear liquids only for 2 weeks.
D) A high-fiber diet to prevent constipation from opioid use.
Correct Answer: B) A bland, low-fat diet with frequent, small meals.
Explanation: Pancreatitis requires "pancreatic rest." Fat stimulates the release of
cholecystokinin, which in turn stimulates pancreatic enzyme secretion. A low-fat diet reduces this
stimulation, allowing the pancreas to heal. Frequent, small meals are easier to digest than three
large meals.
Question 4: A nurse is preparing a client for a colonoscopy. Which assessment finding should be
reported to the provider immediately?
A) The client reports a mild headache.
B) The client’s morning dose of metformin was held.
C) The client has a history of a shellfish allergy.
D) The client’s bowel preparation resulted in clear yellow liquid stools.
Correct Answer: C) The client has a history of a shellfish allergy.
Explanation: While shellfish allergies are often associated with iodine, a significant history of
allergic reaction (anaphylaxis) is critical because contrast agents or certain sedatives used
during the procedure could trigger a cross-reaction or allergic event. This must be assessed and
communicated to the anesthesia team.
Question 5: A nurse is caring for a client who is in the oliguric phase of acute kidney injury
(AKI). Which laboratory result should the nurse expect?
A) Serum potassium 3.2 mEq/L.
B) Serum creatinine 0.8 mg/dL.
C) Serum potassium 6.2 mEq/L.
D) Blood urea nitrogen (BUN) 15 mg/dL.
Correct Answer: C) Serum potassium 6.2 mEq/L.
