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RN ATI MEDICAL SURGICAL PROCTORED EXAM 2023 WITH NGN
100 QUESTIONS
Pharmacology & Medication Management
1. NGN Case Study: Morphine PCA
A client using a morphine PCA pump postoperatively is drowsy with a respiratory rate of
8 breaths/min. What is the nurse's priority action?
A) Encourage deep breathing and coughing
B) Administer naloxone
C) Notify the provider and prepare to reduce PCA dose
D) Increase oxygen flow rate
Answer: C) Notify the provider and prepare to reduce PCA dose
Rationale: Respiratory depression with sedation requires dose adjustment and close
monitoring. Naloxone is reserved for severe, life-threatening respiratory depression. The
priority is to address the cause by reducing the opioid dose while notifying the
provider .
2. Multiple-Response NGN: Heparin Adverse Effects
Which adverse effects should the nurse monitor for in a client receiving heparin? (Select
all that apply.)
A) Bleeding gums
B) Bruising
C) Hypertension
D) Thrombocytopenia
E) Hyperkalemia
Answer: A, B, D
Rationale: Heparin can cause bleeding (e.g., bleeding gums, bruising) and heparin-
induced thrombocytopenia (HIT). It does not typically cause hypertension or
hyperkalemia .
3. Drag-and-Drop NGN: Digoxin Administration
Put the steps for administering digoxin in the correct order.
A) Check apical pulse for 1 full minute
B) Verify digoxin dose
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C) Administer medication with or without food
D) Monitor for signs of toxicity
E) Document administration and client response
Correct Order: B → A → C → D → E
Rationale: Always verify the dose first, then assess the apical pulse for 1 full minute
(hold if pulse <60 bpm in adults). Administer after confirming safety, then monitor and
document .
4. NGN Case Study: Digoxin Toxicity
A client on digoxin has nausea, vomiting, and a heart rate of 45 bpm. What should the
nurse do?
A) Administer digoxin as ordered
B) Hold the medication and notify the provider
C) Encourage fluids and monitor
D) Check potassium level and give potassium supplement
Answer: B) Hold the medication and notify the provider
Rationale: Nausea, vomiting, and bradycardia suggest digoxin toxicity. The nurse
should hold the dose and notify the provider. Potassium should be checked, but
supplementation requires a prescription .
5. NGN Case Study: Furosemide and Hypokalemia
A client receiving furosemide complains of muscle weakness and cramps. Which
laboratory value requires immediate attention?
A) Sodium 140 mEq/L
B) Potassium 2.8 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Answer: B) Potassium 2.8 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
(normal 3.5-5.0 mEq/L) can cause muscle cramps and cardiac arrhythmias .
6. Multiple-Select NGN: Signs of Hypokalemia
Which manifestations indicate hypokalemia? (Select all that apply.)
A) Muscle weakness
B) Constipation
C) Tented T waves on ECG
D) Hypotension
E) Polyuria
Answer: A, B, D, E
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Rationale: Hypokalemia causes muscle weakness, decreased GI motility (constipation),
hypotension, and polyuria (due to impaired concentrating ability). Tented T waves are a
sign of hyperkalemia .
7. NGN Case Study: Spironolactone and Hyperkalemia
A client is prescribed spironolactone for heart failure. Lab results show potassium 5.8
mEq/L. What is the nurse’s priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider
C) Encourage intake of high-potassium foods
D) Repeat potassium level in 24 hours
Answer: B) Hold the medication and notify the provider
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia (K+ >5.0
mEq/L) is a dangerous adverse effect that requires immediate provider notification and
withholding the medication .
8. Multiple-Select NGN: Beta-Blocker Side Effects
Which adverse effects should the nurse monitor for in a client taking metoprolol? (Select
all that apply.)
A) Bradycardia
B) Bronchospasm
C) Hypoglycemia
D) Peripheral edema
E) Hypotension
Answer: A, B, E
Rationale: Beta-blockers reduce heart rate and blood pressure (bradycardia,
hypotension). They may cause bronchospasm, especially in clients with asthma or COPD.
Beta-blockers can mask hypoglycemia symptoms but do not directly cause
hypoglycemia .
9. NGN Case Study: Levothyroxine Administration
A client with hypothyroidism is started on levothyroxine. Which statement by the client
indicates understanding?
A) "I should take this medication with my breakfast."
B) "I will take this medication in the morning on an empty stomach."
C) "If I feel better, I can stop taking this medication."
D) "I will avoid exercising while on this medication."
Answer: B) "I will take this medication in the morning on an empty stomach."
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Rationale: Levothyroxine should be taken on an empty stomach in the morning, at least
30-60 minutes before meals, to enhance absorption .
10. Multiple-Select NGN: Corticosteroid Adverse Effects
A client is prescribed prednisone. Which adverse effects should the nurse monitor for?
(Select all that apply.)
A) Hyperglycemia
B) Weight gain
C) Osteoporosis
D) Bradycardia
E) Increased susceptibility to infection
Answer: A, B, C, E
Rationale: Corticosteroids cause hyperglycemia, weight gain, bone loss (osteoporosis),
and immunosuppression, but not bradycardia .
11. Matrix NGN: Metformin Client Education
A nurse is providing teaching to a client starting on metformin. Indicate whether each
statement is True or False.
Statement True False
Take with meals to reduce GI upset
Risk of lactic acidosis if dehydrated
May cause hypoglycemia when taken alone
Avoid alcohol to reduce risk of adverse effects
Rationale: Metformin should be taken with meals to minimize GI upset. Lactic acidosis
is a rare but serious risk, especially when dehydrated. Metformin does not cause
hypoglycemia when taken alone. Alcohol should be avoided to reduce the risk of lactic
acidosis .
12. NGN Case Study: Red Man Syndrome
A client receiving vancomycin reports itching and redness on the upper chest during
infusion. Vital signs are stable. What should the nurse do?
RN ATI MEDICAL SURGICAL PROCTORED EXAM 2023 WITH NGN
100 QUESTIONS
Pharmacology & Medication Management
1. NGN Case Study: Morphine PCA
A client using a morphine PCA pump postoperatively is drowsy with a respiratory rate of
8 breaths/min. What is the nurse's priority action?
A) Encourage deep breathing and coughing
B) Administer naloxone
C) Notify the provider and prepare to reduce PCA dose
D) Increase oxygen flow rate
Answer: C) Notify the provider and prepare to reduce PCA dose
Rationale: Respiratory depression with sedation requires dose adjustment and close
monitoring. Naloxone is reserved for severe, life-threatening respiratory depression. The
priority is to address the cause by reducing the opioid dose while notifying the
provider .
2. Multiple-Response NGN: Heparin Adverse Effects
Which adverse effects should the nurse monitor for in a client receiving heparin? (Select
all that apply.)
A) Bleeding gums
B) Bruising
C) Hypertension
D) Thrombocytopenia
E) Hyperkalemia
Answer: A, B, D
Rationale: Heparin can cause bleeding (e.g., bleeding gums, bruising) and heparin-
induced thrombocytopenia (HIT). It does not typically cause hypertension or
hyperkalemia .
3. Drag-and-Drop NGN: Digoxin Administration
Put the steps for administering digoxin in the correct order.
A) Check apical pulse for 1 full minute
B) Verify digoxin dose
,2
C) Administer medication with or without food
D) Monitor for signs of toxicity
E) Document administration and client response
Correct Order: B → A → C → D → E
Rationale: Always verify the dose first, then assess the apical pulse for 1 full minute
(hold if pulse <60 bpm in adults). Administer after confirming safety, then monitor and
document .
4. NGN Case Study: Digoxin Toxicity
A client on digoxin has nausea, vomiting, and a heart rate of 45 bpm. What should the
nurse do?
A) Administer digoxin as ordered
B) Hold the medication and notify the provider
C) Encourage fluids and monitor
D) Check potassium level and give potassium supplement
Answer: B) Hold the medication and notify the provider
Rationale: Nausea, vomiting, and bradycardia suggest digoxin toxicity. The nurse
should hold the dose and notify the provider. Potassium should be checked, but
supplementation requires a prescription .
5. NGN Case Study: Furosemide and Hypokalemia
A client receiving furosemide complains of muscle weakness and cramps. Which
laboratory value requires immediate attention?
A) Sodium 140 mEq/L
B) Potassium 2.8 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Answer: B) Potassium 2.8 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
(normal 3.5-5.0 mEq/L) can cause muscle cramps and cardiac arrhythmias .
6. Multiple-Select NGN: Signs of Hypokalemia
Which manifestations indicate hypokalemia? (Select all that apply.)
A) Muscle weakness
B) Constipation
C) Tented T waves on ECG
D) Hypotension
E) Polyuria
Answer: A, B, D, E
,3
Rationale: Hypokalemia causes muscle weakness, decreased GI motility (constipation),
hypotension, and polyuria (due to impaired concentrating ability). Tented T waves are a
sign of hyperkalemia .
7. NGN Case Study: Spironolactone and Hyperkalemia
A client is prescribed spironolactone for heart failure. Lab results show potassium 5.8
mEq/L. What is the nurse’s priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider
C) Encourage intake of high-potassium foods
D) Repeat potassium level in 24 hours
Answer: B) Hold the medication and notify the provider
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia (K+ >5.0
mEq/L) is a dangerous adverse effect that requires immediate provider notification and
withholding the medication .
8. Multiple-Select NGN: Beta-Blocker Side Effects
Which adverse effects should the nurse monitor for in a client taking metoprolol? (Select
all that apply.)
A) Bradycardia
B) Bronchospasm
C) Hypoglycemia
D) Peripheral edema
E) Hypotension
Answer: A, B, E
Rationale: Beta-blockers reduce heart rate and blood pressure (bradycardia,
hypotension). They may cause bronchospasm, especially in clients with asthma or COPD.
Beta-blockers can mask hypoglycemia symptoms but do not directly cause
hypoglycemia .
9. NGN Case Study: Levothyroxine Administration
A client with hypothyroidism is started on levothyroxine. Which statement by the client
indicates understanding?
A) "I should take this medication with my breakfast."
B) "I will take this medication in the morning on an empty stomach."
C) "If I feel better, I can stop taking this medication."
D) "I will avoid exercising while on this medication."
Answer: B) "I will take this medication in the morning on an empty stomach."
, 4
Rationale: Levothyroxine should be taken on an empty stomach in the morning, at least
30-60 minutes before meals, to enhance absorption .
10. Multiple-Select NGN: Corticosteroid Adverse Effects
A client is prescribed prednisone. Which adverse effects should the nurse monitor for?
(Select all that apply.)
A) Hyperglycemia
B) Weight gain
C) Osteoporosis
D) Bradycardia
E) Increased susceptibility to infection
Answer: A, B, C, E
Rationale: Corticosteroids cause hyperglycemia, weight gain, bone loss (osteoporosis),
and immunosuppression, but not bradycardia .
11. Matrix NGN: Metformin Client Education
A nurse is providing teaching to a client starting on metformin. Indicate whether each
statement is True or False.
Statement True False
Take with meals to reduce GI upset
Risk of lactic acidosis if dehydrated
May cause hypoglycemia when taken alone
Avoid alcohol to reduce risk of adverse effects
Rationale: Metformin should be taken with meals to minimize GI upset. Lactic acidosis
is a rare but serious risk, especially when dehydrated. Metformin does not cause
hypoglycemia when taken alone. Alcohol should be avoided to reduce the risk of lactic
acidosis .
12. NGN Case Study: Red Man Syndrome
A client receiving vancomycin reports itching and redness on the upper chest during
infusion. Vital signs are stable. What should the nurse do?
