ATI RN MEDICAL SURGICAL 2023/2024
PROCTORED EXAM | LATEST | 100 QUESTION AND
ANSWERS
Question 1: NGN Case Study - Heart Failure Management
A client with heart failure is receiving IV furosemide. Which assessment finding indicates
the medication is having the desired therapeutic effect?
A) Increased jugular venous distension
B) Decreased peripheral edema
C) Increased blood pressure
D) Decreased urine output
Answer: B) Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired effect is reduction of edema, crackles, and JVD. Increased urine
output, not decreased, would be expected. Blood pressure typically decreases due to
reduced preload.
💊 Question 2: Multiple-Select NGN - Warfarin Teaching
Which statements indicate a client understands warfarin therapy? (Select all that apply.)
A) "I will avoid eating large amounts of green leafy vegetables."
B) "I will use a soft-bristled toothbrush."
C) "I will take ibuprofen for headaches."
D) "I will report any bruising or bleeding to my provider."
E) "I will have my blood drawn regularly to check my INR."
,Answer: A, B, D, E
Rationale: Warfarin is a vitamin K antagonist. Clients should maintain consistent vitamin
K intake (avoid large changes), use soft toothbrushes to prevent gum bleeding, avoid
NSAIDs (like ibuprofen) due to bleeding risk, report bleeding/bruising, and monitor INR
regularly.
🫁 Question 3: NGN Case Study - COPD Exacerbation
A client with COPD is admitted with acute exacerbation. Arterial blood gas (ABG) shows:
pH 7.28, PaCO2 60 mm Hg, HCO3 26 mEq/L. The provider orders non-invasive positive
pressure ventilation (NIPPV). Which finding indicates the therapy is effective?
A) PaCO2 increases to 65 mm Hg
B) pH increases toward 7.35
C) Respiratory rate increases to 30/min
D) HCO3 decreases to 22 mEq/L
Answer: B) pH increases toward 7.35
Rationale: In acute hypercapnic respiratory failure, the goal of NIPPV is to improve
ventilation and correct acidosis. An increasing pH toward normal indicates the therapy is
working. PaCO2 should decrease, and respiratory rate should decrease as work of
breathing improves.
❤️ Question 4: NGN Case Study - Myocardial Infarction
A client presents with chest pain radiating to the left arm, diaphoresis, and nausea. The
ECG shows ST-segment elevation in leads II, III, and aVF. Which intervention should the
nurse anticipate first?
,A) Administer sublingual nitroglycerin
B) Prepare for percutaneous coronary intervention (PCI)
C) Administer IV morphine sulfate
D) Obtain cardiac enzymes
Answer: B) Prepare for percutaneous coronary intervention (PCI)
Rationale: ST-elevation MI (STEMI) is a medical emergency. The priority is rapid
reperfusion, with PCI being the gold standard if available within 90 minutes of arrival.
While nitroglycerin, morphine, and enzymes are all important, PCI is the definitive
treatment.
🧠 Question 5: NGN Case Study - Stroke Assessment
A client is brought to the emergency department with sudden onset of right-sided
weakness, facial droop, and slurred speech. The client's symptoms began 1 hour ago.
Which action should the nurse take first?
A) Obtain a CT scan of the head
B) Start an IV line
C) Perform a bedside swallow screening
D) Administer aspirin
Answer: A) Obtain a CT scan of the head
Rationale: For a client with suspected acute ischemic stroke, a non-contrast CT scan
must be obtained immediately to differentiate between ischemic and hemorrhagic
stroke. This determines whether thrombolytics (tPA) can be administered. The time
frame is critical (within 3-4.5 hours of symptom onset).
, 🩸 Question 6: Multiple-Select NGN - Transfusion Reaction
A client is receiving a blood transfusion and suddenly reports chills, lower back pain, and
nausea. What are the nurse's priority actions? (Select all that apply.)
A) Stop the blood transfusion
B) Maintain IV access with normal saline
C) Notify the blood bank
D) Administer diphenhydramine
E) Document the reaction
Answer: A, B, C, D, E
Rationale: A transfusion reaction is an emergency. The nurse should stop the
transfusion, maintain IV access with normal saline (using new tubing), notify the provider
and blood bank, administer antihistamines as prescribed, and document all findings and
actions.
🫀 Question 7: NGN Case Study - Cardiac Tamponade
A client who had cardiac surgery 2 days ago develops muffled heart sounds, jugular
venous distension, and hypotension. Which condition should the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Myocardial infarction
D) Aortic dissection
Answer: A) Cardiac tamponade
Rationale: The classic triad of cardiac tamponade is Beck's triad: muffled heart sounds,
JVD, and hypotension. This occurs due to fluid accumulation in the pericardial sac
compressing the heart. It is a medical emergency requiring pericardiocentesis.
PROCTORED EXAM | LATEST | 100 QUESTION AND
ANSWERS
Question 1: NGN Case Study - Heart Failure Management
A client with heart failure is receiving IV furosemide. Which assessment finding indicates
the medication is having the desired therapeutic effect?
A) Increased jugular venous distension
B) Decreased peripheral edema
C) Increased blood pressure
D) Decreased urine output
Answer: B) Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired effect is reduction of edema, crackles, and JVD. Increased urine
output, not decreased, would be expected. Blood pressure typically decreases due to
reduced preload.
💊 Question 2: Multiple-Select NGN - Warfarin Teaching
Which statements indicate a client understands warfarin therapy? (Select all that apply.)
A) "I will avoid eating large amounts of green leafy vegetables."
B) "I will use a soft-bristled toothbrush."
C) "I will take ibuprofen for headaches."
D) "I will report any bruising or bleeding to my provider."
E) "I will have my blood drawn regularly to check my INR."
,Answer: A, B, D, E
Rationale: Warfarin is a vitamin K antagonist. Clients should maintain consistent vitamin
K intake (avoid large changes), use soft toothbrushes to prevent gum bleeding, avoid
NSAIDs (like ibuprofen) due to bleeding risk, report bleeding/bruising, and monitor INR
regularly.
🫁 Question 3: NGN Case Study - COPD Exacerbation
A client with COPD is admitted with acute exacerbation. Arterial blood gas (ABG) shows:
pH 7.28, PaCO2 60 mm Hg, HCO3 26 mEq/L. The provider orders non-invasive positive
pressure ventilation (NIPPV). Which finding indicates the therapy is effective?
A) PaCO2 increases to 65 mm Hg
B) pH increases toward 7.35
C) Respiratory rate increases to 30/min
D) HCO3 decreases to 22 mEq/L
Answer: B) pH increases toward 7.35
Rationale: In acute hypercapnic respiratory failure, the goal of NIPPV is to improve
ventilation and correct acidosis. An increasing pH toward normal indicates the therapy is
working. PaCO2 should decrease, and respiratory rate should decrease as work of
breathing improves.
❤️ Question 4: NGN Case Study - Myocardial Infarction
A client presents with chest pain radiating to the left arm, diaphoresis, and nausea. The
ECG shows ST-segment elevation in leads II, III, and aVF. Which intervention should the
nurse anticipate first?
,A) Administer sublingual nitroglycerin
B) Prepare for percutaneous coronary intervention (PCI)
C) Administer IV morphine sulfate
D) Obtain cardiac enzymes
Answer: B) Prepare for percutaneous coronary intervention (PCI)
Rationale: ST-elevation MI (STEMI) is a medical emergency. The priority is rapid
reperfusion, with PCI being the gold standard if available within 90 minutes of arrival.
While nitroglycerin, morphine, and enzymes are all important, PCI is the definitive
treatment.
🧠 Question 5: NGN Case Study - Stroke Assessment
A client is brought to the emergency department with sudden onset of right-sided
weakness, facial droop, and slurred speech. The client's symptoms began 1 hour ago.
Which action should the nurse take first?
A) Obtain a CT scan of the head
B) Start an IV line
C) Perform a bedside swallow screening
D) Administer aspirin
Answer: A) Obtain a CT scan of the head
Rationale: For a client with suspected acute ischemic stroke, a non-contrast CT scan
must be obtained immediately to differentiate between ischemic and hemorrhagic
stroke. This determines whether thrombolytics (tPA) can be administered. The time
frame is critical (within 3-4.5 hours of symptom onset).
, 🩸 Question 6: Multiple-Select NGN - Transfusion Reaction
A client is receiving a blood transfusion and suddenly reports chills, lower back pain, and
nausea. What are the nurse's priority actions? (Select all that apply.)
A) Stop the blood transfusion
B) Maintain IV access with normal saline
C) Notify the blood bank
D) Administer diphenhydramine
E) Document the reaction
Answer: A, B, C, D, E
Rationale: A transfusion reaction is an emergency. The nurse should stop the
transfusion, maintain IV access with normal saline (using new tubing), notify the provider
and blood bank, administer antihistamines as prescribed, and document all findings and
actions.
🫀 Question 7: NGN Case Study - Cardiac Tamponade
A client who had cardiac surgery 2 days ago develops muffled heart sounds, jugular
venous distension, and hypotension. Which condition should the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Myocardial infarction
D) Aortic dissection
Answer: A) Cardiac tamponade
Rationale: The classic triad of cardiac tamponade is Beck's triad: muffled heart sounds,
JVD, and hypotension. This occurs due to fluid accumulation in the pericardial sac
compressing the heart. It is a medical emergency requiring pericardiocentesis.
