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RN ATI MEDICAL SURGICAL PROCTORED EXAM 2023 WITH NGN
100 QUESTIONS
Pharmacology & Medication Management
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 .
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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
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
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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."
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.
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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?
A) Stop the infusion immediately and notify the provider
B) Slow the infusion rate and monitor closely
C) Administer diphenhydramine and continue at the same rate
D) Document the reaction and continue infusion
Answer: B) Slow the infusion rate and monitor closely
Rationale: Red Man Syndrome is related to rapid infusion; slowing the infusion rate
reduces symptoms .
13. NGN Case Study: Methimazole Monitoring
A client with hyperthyroidism is prescribed methimazole. Which lab should the nurse
monitor? A) Serum glucose
B) Liver function tests
C) Potassium
RN ATI MEDICAL SURGICAL PROCTORED EXAM 2023 WITH NGN
100 QUESTIONS
Pharmacology & Medication Management
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 .
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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
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
,3
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."
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.
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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?
A) Stop the infusion immediately and notify the provider
B) Slow the infusion rate and monitor closely
C) Administer diphenhydramine and continue at the same rate
D) Document the reaction and continue infusion
Answer: B) Slow the infusion rate and monitor closely
Rationale: Red Man Syndrome is related to rapid infusion; slowing the infusion rate
reduces symptoms .
13. NGN Case Study: Methimazole Monitoring
A client with hyperthyroidism is prescribed methimazole. Which lab should the nurse
monitor? A) Serum glucose
B) Liver function tests
C) Potassium
