RN ATI Advanced Medical Surgical Proctored EXAM 2023-2024
WITH NGN. Course
1. An adolescent client with conduct disorder arrives at the emergency
department after threatening suicide to a teacher. Which statement should the
nurse include during the assessment?
• A) "Tell me about your siblings?"
• B) "Tell me what kind of music you like?"
• C) "Tell me how often you drink alcohol?"
• D) "Tell me about your school schedule?"
Answer: C
Rationale: Assessing for substance use, including alcohol, is critical in adolescents
with conduct disorder and suicidal ideation, as substance misuse can exacerbate
mental health issues. The other options can offer general psychosocial
information but do not directly address a key risk factor .
2. A nurse is creating a plan of care for a child who has acute lymphoid leukemia
and a severely low absolute neutrophil count (ANC) of 400/mm³ (normal: 2500–
8000/mm³). Which intervention should the nurse include?
• A) Place the child in a room with a child who has a respiratory infection.
• B) Encourage the child to have fresh flowers in the room.
• C) Implement neutropenic precautions.
• D) Administer all immunizations.
Answer: C
Rationale: An ANC of 400/mm³ indicates severe neutropenia. The child is at high
risk for infection. Neutropenic precautions, including a private room, strict
handwashing, and avoiding fresh flowers and plants (which can harbor mold), are
essential. Immunizations are contraindicated because the immune system is
compromised .
,3. A client is prescribed isoniazid for tuberculosis. Which of the following should
be included in the teaching? (Select all that apply.)
• A) "Avoid alcohol while on this medication."
• B) "Report any tingling or numbness in your hands or feet."
• C) "You may notice orange-colored urine."
• D) "Take vitamin B6 supplements to reduce side effects."
Answer: A, B, D
Rationale: Isoniazid can cause hepatotoxicity, which is worsened by alcohol. It can
also cause peripheral neuropathy, which can be prevented with vitamin B6
(pyridoxine) supplementation. The client should report any tingling or numbness.
Orange-colored urine is a side effect of rifampin, not isoniazid .
4. A nurse is caring for a client who had abdominal surgery 24 hours ago. Which
action is the priority to reduce postoperative complications?
• A) Assess fluid intake every 24 hours.
• B) Ambulate the client three times a day.
• C) Assist with coughing and deep breathing exercises.
• D) Monitor the incision site for infection.
Answer: C
Rationale: Using the ABC (airway, breathing, circulation) approach, promoting
airway clearance by encouraging coughing and deep breathing helps prevent
pneumonia and other pulmonary complications, which are a significant risk post-
operatively .
5. A nurse in an acute mental health facility is planning care for a client who has
anorexia nervosa. Which intervention should the nurse include in the client’s
plan of care?
• A) Allow the client to choose from a variety of foods and beverages.
• B) Supervise the client during and after meals.
• C) Encourage relaxed, friendly discussions about food during mealtimes.
, • D) Provide opportunities for the client to select their own mealtimes.
Answer: B
Rationale: Supervision during and after meals (typically for at least one hour post-
meal) is essential to ensure the client does not conceal or discard food and does
not engage in purging behaviors .
6. A client is prescribed clozapine and reports fatigue and a sore throat. Which
lab value is most important to review?
• A) Hemoglobin.
• B) WBC count.
• C) Platelet count.
• D) Blood glucose.
Answer: B
Rationale: Clozapine can cause agranulocytosis, a dangerous drop in white blood
cells (WBCs), which significantly increases the risk of infection. A sore throat is a
key sign of this potentially life-threatening side effect .
7. A competent adult client refuses a blood transfusion for religious reasons.
Which actions should the nurse take? (Select all that apply.)
• A) Verify the client understands risks
• B) Document the refusal
• C) Administer the transfusion if Hgb is critical
• D) Notify the provider
• E) Ask the family to override the decision
Answer: A, B, D
Rationale: Competent adults have the right to autonomy and informed refusal.
The nurse ensures the client understands the risks, documents the refusal, and
notifies the provider .
8. A client receiving vancomycin IV reports itching, facial flushing, and a rapid
heart rate during infusion. What is the nurse’s priority action?
, • A) Notify the provider immediately
• B) Stop the infusion and assess the airway
• C) Slow the infusion rate and monitor the client
• D) Administer diphenhydramine IV push
Answer: C
Rationale: These are signs of "Red Man Syndrome," a non-allergic histamine-
release reaction caused by rapid vancomycin infusion. Slowing the infusion rate
typically resolves the symptoms. It is not a true allergy .
9. A nurse is caring for a client who has been taking rifampin for tuberculosis.
Which client statement indicates understanding of the medication?
• A) "I should avoid sunlight due to photosensitivity."
• B) "My urine may turn orange, and that’s expected."
• C) "I will stop the medication if I feel better in a week."
• D) "I should take this drug with an antacid to avoid upset stomach."
Answer: B
Rationale: Rifampin causes a harmless orange-red discoloration of urine, sweat,
tears, and other body fluids. Patients must be warned so they do not panic. It
should not be stopped early or taken with antacids .
10. A nurse is preparing to administer 0900 medications when the pharmacy
notifies them that the required medications are unavailable. This has been a
recurring problem. Which action should the charge nurse take first?
• A) Document the actual times of medication administration.
• B) Notify the risk manager.
• C) Complete an incident report.
• D) Inform the nurse manager of the issue.
Answer: D
Rationale: The priority is to use the chain of command to address a recurring and
WITH NGN. Course
1. An adolescent client with conduct disorder arrives at the emergency
department after threatening suicide to a teacher. Which statement should the
nurse include during the assessment?
• A) "Tell me about your siblings?"
• B) "Tell me what kind of music you like?"
• C) "Tell me how often you drink alcohol?"
• D) "Tell me about your school schedule?"
Answer: C
Rationale: Assessing for substance use, including alcohol, is critical in adolescents
with conduct disorder and suicidal ideation, as substance misuse can exacerbate
mental health issues. The other options can offer general psychosocial
information but do not directly address a key risk factor .
2. A nurse is creating a plan of care for a child who has acute lymphoid leukemia
and a severely low absolute neutrophil count (ANC) of 400/mm³ (normal: 2500–
8000/mm³). Which intervention should the nurse include?
• A) Place the child in a room with a child who has a respiratory infection.
• B) Encourage the child to have fresh flowers in the room.
• C) Implement neutropenic precautions.
• D) Administer all immunizations.
Answer: C
Rationale: An ANC of 400/mm³ indicates severe neutropenia. The child is at high
risk for infection. Neutropenic precautions, including a private room, strict
handwashing, and avoiding fresh flowers and plants (which can harbor mold), are
essential. Immunizations are contraindicated because the immune system is
compromised .
,3. A client is prescribed isoniazid for tuberculosis. Which of the following should
be included in the teaching? (Select all that apply.)
• A) "Avoid alcohol while on this medication."
• B) "Report any tingling or numbness in your hands or feet."
• C) "You may notice orange-colored urine."
• D) "Take vitamin B6 supplements to reduce side effects."
Answer: A, B, D
Rationale: Isoniazid can cause hepatotoxicity, which is worsened by alcohol. It can
also cause peripheral neuropathy, which can be prevented with vitamin B6
(pyridoxine) supplementation. The client should report any tingling or numbness.
Orange-colored urine is a side effect of rifampin, not isoniazid .
4. A nurse is caring for a client who had abdominal surgery 24 hours ago. Which
action is the priority to reduce postoperative complications?
• A) Assess fluid intake every 24 hours.
• B) Ambulate the client three times a day.
• C) Assist with coughing and deep breathing exercises.
• D) Monitor the incision site for infection.
Answer: C
Rationale: Using the ABC (airway, breathing, circulation) approach, promoting
airway clearance by encouraging coughing and deep breathing helps prevent
pneumonia and other pulmonary complications, which are a significant risk post-
operatively .
5. A nurse in an acute mental health facility is planning care for a client who has
anorexia nervosa. Which intervention should the nurse include in the client’s
plan of care?
• A) Allow the client to choose from a variety of foods and beverages.
• B) Supervise the client during and after meals.
• C) Encourage relaxed, friendly discussions about food during mealtimes.
, • D) Provide opportunities for the client to select their own mealtimes.
Answer: B
Rationale: Supervision during and after meals (typically for at least one hour post-
meal) is essential to ensure the client does not conceal or discard food and does
not engage in purging behaviors .
6. A client is prescribed clozapine and reports fatigue and a sore throat. Which
lab value is most important to review?
• A) Hemoglobin.
• B) WBC count.
• C) Platelet count.
• D) Blood glucose.
Answer: B
Rationale: Clozapine can cause agranulocytosis, a dangerous drop in white blood
cells (WBCs), which significantly increases the risk of infection. A sore throat is a
key sign of this potentially life-threatening side effect .
7. A competent adult client refuses a blood transfusion for religious reasons.
Which actions should the nurse take? (Select all that apply.)
• A) Verify the client understands risks
• B) Document the refusal
• C) Administer the transfusion if Hgb is critical
• D) Notify the provider
• E) Ask the family to override the decision
Answer: A, B, D
Rationale: Competent adults have the right to autonomy and informed refusal.
The nurse ensures the client understands the risks, documents the refusal, and
notifies the provider .
8. A client receiving vancomycin IV reports itching, facial flushing, and a rapid
heart rate during infusion. What is the nurse’s priority action?
, • A) Notify the provider immediately
• B) Stop the infusion and assess the airway
• C) Slow the infusion rate and monitor the client
• D) Administer diphenhydramine IV push
Answer: C
Rationale: These are signs of "Red Man Syndrome," a non-allergic histamine-
release reaction caused by rapid vancomycin infusion. Slowing the infusion rate
typically resolves the symptoms. It is not a true allergy .
9. A nurse is caring for a client who has been taking rifampin for tuberculosis.
Which client statement indicates understanding of the medication?
• A) "I should avoid sunlight due to photosensitivity."
• B) "My urine may turn orange, and that’s expected."
• C) "I will stop the medication if I feel better in a week."
• D) "I should take this drug with an antacid to avoid upset stomach."
Answer: B
Rationale: Rifampin causes a harmless orange-red discoloration of urine, sweat,
tears, and other body fluids. Patients must be warned so they do not panic. It
should not be stopped early or taken with antacids .
10. A nurse is preparing to administer 0900 medications when the pharmacy
notifies them that the required medications are unavailable. This has been a
recurring problem. Which action should the charge nurse take first?
• A) Document the actual times of medication administration.
• B) Notify the risk manager.
• C) Complete an incident report.
• D) Inform the nurse manager of the issue.
Answer: D
Rationale: The priority is to use the chain of command to address a recurring and
