1
ATI Med-Surg Proctored NGN Exam 2025–2026 | 100
Verified Questions + Rationales | Graded A+
Q1. Cardiovascular – Heart Failure Case (Detailed Scenario)
A 72-year-old male presents to the emergency department with complaints of
increasing dyspnea over the past 48 hours, difficulty breathing while lying flat, and
swelling in his ankles. He has a history of hypertension and chronic heart failure
(HF). Vitals are: BP 152/88 mmHg, HR 106 bpm, RR 24/min, SpO₂ 89% on room
air. Physical exam reveals bilateral crackles in the lungs and +2 pitting edema in
both lower extremities. The nurse notes a weight gain of 5 pounds since his last
visit three days ago. Current orders include oxygen via nasal cannula, IV
furosemide, and telemetry monitoring.
Which nursing intervention should the nurse perform first?
A. Restrict fluid intake to less than 1,500 mL/day
B. Place the client in high Fowler’s position
,2
✅ C. Administer IV furosemide as prescribed
D. Monitor daily weight and input/output
✅ Correct Answer: C
💡 Rationale:
The client is experiencing acute decompensated heart failure with signs of fluid
overload and impaired gas exchange (dyspnea, crackles, edema, weight gain). The
priority action is to administer IV furosemide, which reduces preload and
pulmonary congestion. High Fowler’s position supports breathing but does not
directly remove excess fluid. Fluid restriction and monitoring are important but not
immediate life-saving interventions. According to the ABC (Airway, Breathing,
Circulation) framework and Maslow’s hierarchy, circulatory relief (via diuresis)
takes precedence to stabilize the patient’s respiratory status.
🔥 Q2. Respiratory – COPD Exacerbation Case (NGN Format)
A 65-year-old female with a history of chronic obstructive pulmonary disease
(COPD) arrives in the clinic reporting a 3-day history of worsening shortness of
breath, productive cough with green sputum, and fatigue. She states she uses her
albuterol inhaler more frequently than usual. On assessment: RR 26/min, SpO₂
,3
86% on room air, wheezing auscultated bilaterally. The provider prescribes low-
flow oxygen and nebulized bronchodilators. The nurse prepares to initiate care.
Which intervention should the nurse implement first to improve the client’s
oxygenation?
A. Encourage coughing and deep breathing exercises
B. Instruct the client to use the incentive spirometer
✅ C. Apply nasal cannula at 2 L/min oxygen
D. Administer prescribed corticosteroid PO
✅ Correct Answer: C
💡 Rationale:
The client is experiencing acute COPD exacerbation with hypoxia (SpO₂ 86%).
The first priority is oxygen administration to stabilize breathing. COPD clients
require low-flow oxygen (1–2 L/min) to prevent oxygen-induced hypoventilation.
Coughing exercises and corticosteroids are helpful later, but not the immediate
priority. Incentive spirometry is less effective during acute respiratory distress.
Always prioritize oxygenation (ABCs) during acute symptoms.
🧠 Q3. Endocrine – Diabetes Mellitus (DKA)
A 25-year-old female with type 1 diabetes mellitus arrives at the ER with nausea,
vomiting, and abdominal pain. She is disoriented and breathing rapidly. Her blood
, 4
glucose is 525 mg/dL. Arterial blood gases show: pH 7.22, HCO₃⁻ 16 mEq/L,
PaCO₂ 28 mmHg. The nurse notes fruity breath odor and dry mucous membranes.
The provider orders IV fluids and insulin.
Which intervention should the nurse prioritize first?
A. Administer regular insulin IV
✅ B. Initiate 0.9% normal saline IV bolus
C. Monitor hourly blood glucose
D. Insert a Foley catheter
✅ Correct Answer: B
💡 Rationale:
This client is in diabetic ketoacidosis (DKA), with dehydration, hyperglycemia,
and metabolic acidosis. IV fluid resuscitation (normal saline) is the first priority
to restore perfusion before initiating insulin. Administering insulin without
correcting volume depletion may cause cardiovascular collapse. Foley catheter and
glucose checks are secondary.
🩺 Q4. GI – Upper GI Bleed
A 60-year-old male with a history of peptic ulcer disease presents with black tarry
stools, weakness, and dizziness. Vitals: BP 90/60 mmHg, HR 118 bpm, RR
ATI Med-Surg Proctored NGN Exam 2025–2026 | 100
Verified Questions + Rationales | Graded A+
Q1. Cardiovascular – Heart Failure Case (Detailed Scenario)
A 72-year-old male presents to the emergency department with complaints of
increasing dyspnea over the past 48 hours, difficulty breathing while lying flat, and
swelling in his ankles. He has a history of hypertension and chronic heart failure
(HF). Vitals are: BP 152/88 mmHg, HR 106 bpm, RR 24/min, SpO₂ 89% on room
air. Physical exam reveals bilateral crackles in the lungs and +2 pitting edema in
both lower extremities. The nurse notes a weight gain of 5 pounds since his last
visit three days ago. Current orders include oxygen via nasal cannula, IV
furosemide, and telemetry monitoring.
Which nursing intervention should the nurse perform first?
A. Restrict fluid intake to less than 1,500 mL/day
B. Place the client in high Fowler’s position
,2
✅ C. Administer IV furosemide as prescribed
D. Monitor daily weight and input/output
✅ Correct Answer: C
💡 Rationale:
The client is experiencing acute decompensated heart failure with signs of fluid
overload and impaired gas exchange (dyspnea, crackles, edema, weight gain). The
priority action is to administer IV furosemide, which reduces preload and
pulmonary congestion. High Fowler’s position supports breathing but does not
directly remove excess fluid. Fluid restriction and monitoring are important but not
immediate life-saving interventions. According to the ABC (Airway, Breathing,
Circulation) framework and Maslow’s hierarchy, circulatory relief (via diuresis)
takes precedence to stabilize the patient’s respiratory status.
🔥 Q2. Respiratory – COPD Exacerbation Case (NGN Format)
A 65-year-old female with a history of chronic obstructive pulmonary disease
(COPD) arrives in the clinic reporting a 3-day history of worsening shortness of
breath, productive cough with green sputum, and fatigue. She states she uses her
albuterol inhaler more frequently than usual. On assessment: RR 26/min, SpO₂
,3
86% on room air, wheezing auscultated bilaterally. The provider prescribes low-
flow oxygen and nebulized bronchodilators. The nurse prepares to initiate care.
Which intervention should the nurse implement first to improve the client’s
oxygenation?
A. Encourage coughing and deep breathing exercises
B. Instruct the client to use the incentive spirometer
✅ C. Apply nasal cannula at 2 L/min oxygen
D. Administer prescribed corticosteroid PO
✅ Correct Answer: C
💡 Rationale:
The client is experiencing acute COPD exacerbation with hypoxia (SpO₂ 86%).
The first priority is oxygen administration to stabilize breathing. COPD clients
require low-flow oxygen (1–2 L/min) to prevent oxygen-induced hypoventilation.
Coughing exercises and corticosteroids are helpful later, but not the immediate
priority. Incentive spirometry is less effective during acute respiratory distress.
Always prioritize oxygenation (ABCs) during acute symptoms.
🧠 Q3. Endocrine – Diabetes Mellitus (DKA)
A 25-year-old female with type 1 diabetes mellitus arrives at the ER with nausea,
vomiting, and abdominal pain. She is disoriented and breathing rapidly. Her blood
, 4
glucose is 525 mg/dL. Arterial blood gases show: pH 7.22, HCO₃⁻ 16 mEq/L,
PaCO₂ 28 mmHg. The nurse notes fruity breath odor and dry mucous membranes.
The provider orders IV fluids and insulin.
Which intervention should the nurse prioritize first?
A. Administer regular insulin IV
✅ B. Initiate 0.9% normal saline IV bolus
C. Monitor hourly blood glucose
D. Insert a Foley catheter
✅ Correct Answer: B
💡 Rationale:
This client is in diabetic ketoacidosis (DKA), with dehydration, hyperglycemia,
and metabolic acidosis. IV fluid resuscitation (normal saline) is the first priority
to restore perfusion before initiating insulin. Administering insulin without
correcting volume depletion may cause cardiovascular collapse. Foley catheter and
glucose checks are secondary.
🩺 Q4. GI – Upper GI Bleed
A 60-year-old male with a history of peptic ulcer disease presents with black tarry
stools, weakness, and dizziness. Vitals: BP 90/60 mmHg, HR 118 bpm, RR
