PN VATI Medical Surgical Nursing Exam Prep Study Guide
2026 | Comprehensive ATI PN VATI Practice Questions,
NGN NCLEX-PN Review, Detailed Rationales & High-Yield
Content for Guaranteed Exam Success
Question 1: A nurse is caring for a client who is 2 hours postoperative following a total hip
arthroplasty. Which of the following actions should the nurse take to prevent dislocation of
the hip prosthesis?
A. Place a pillow between the client's legs when turning
B. Encourage the client to flex the hip beyond 90 degrees
C. Position the client in a low Fowler's position
D. Assist the client to cross legs at the ankles while in bed
CORRECT ANSWER: A. Place a pillow between the client's legs when turning
Rationale: After total hip arthroplasty, maintaining hip abduction prevents adduction and
internal rotation, which are common mechanisms for prosthetic dislocation. A pillow between
the legs maintains proper alignment. Flexing the hip beyond 90 degrees, crossing legs, or
excessive hip flexion increases dislocation risk. Low Fowler's position is acceptable but does not
specifically prevent dislocation like abduction positioning.
Question 2: A nurse is assessing a client with chronic obstructive pulmonary disease (COPD).
Which of the following findings should the nurse expect?
A. Decreased anteroposterior chest diameter
B. Prolonged expiratory phase
C. Increased breath sounds bilaterally
D. Normal respiratory rate at rest
CORRECT ANSWER: B. Prolonged expiratory phase
Rationale: Clients with COPD experience air trapping due to loss of elastic recoil and narrowed
airways, resulting in a prolonged expiratory phase as they struggle to exhale fully. An increased
anteroposterior diameter (barrel chest) is expected, not decreased. Breath sounds are typically
diminished, not increased. Tachypnea is common even at rest due to impaired gas exchange.
Question 3: A nurse is preparing to administer enoxaparin to a client postoperatively. Which
of the following actions should the nurse take?
A. Expel the air bubble from the prefilled syringe before injection
B. Inject the medication into the deltoid muscle
C. Massage the injection site after administration
D. Administer the injection into the abdomen at least 2 inches from the umbilicus
CORRECT ANSWER: D. Administer the injection into the abdomen at least 2 inches from the
umbilicus
Rationale: Enoxaparin, a low-molecular-weight heparin, is administered subcutaneously in the
abdomen (avoiding 2 inches around the umbilicus) to ensure consistent absorption. The air
bubble should NOT be expelled as it helps deliver the full dose and prevents medication leakage
into subcutaneous tissue. The deltoid is not recommended for anticoagulant injections.
Massaging the site increases bruising and bleeding risk.
Question 4: A nurse is caring for a client who has a new prescription for digoxin. Which of the
following findings should the nurse report to the provider immediately?
,A. Apical pulse of 58/min
B. Serum potassium level of 4.0 mEq/L
C. Blood pressure of 128/82 mm Hg
D. Report of mild nausea
CORRECT ANSWER: A. Apical pulse of 58/min
Rationale: Digoxin can cause bradycardia; an apical pulse below 60/min in an adult requires
holding the dose and notifying the provider due to risk of serious dysrhythmias. A potassium
level of 4.0 mEq/L is within normal range and does not increase digoxin toxicity risk. Mild
nausea may occur but is less urgent than bradycardia. Blood pressure of 128/82 mm Hg is
acceptable.
Question 5: A nurse is teaching a client with type 2 diabetes mellitus about foot care. Which
of the following statements by the client indicates understanding?
A. "I will soak my feet in hot water daily to keep them clean."
B. "I will walk barefoot around my house to strengthen my feet."
C. "I will inspect my feet daily using a mirror for the soles."
D. "I will apply lotion between my toes to prevent dry skin."
CORRECT ANSWER: C. "I will inspect my feet daily using a mirror for the soles."
Rationale: Daily foot inspection with a mirror allows clients with diabetes to detect cuts,
blisters, or redness early, preventing complications from neuropathy. Hot water can cause
burns due to decreased sensation. Walking barefoot increases injury risk. Lotion between toes
promotes moisture and fungal growth; lotion should be applied to tops and bottoms only.
Question 6: A nurse is caring for a client who is experiencing an acute asthma exacerbation.
Which of the following medications should the nurse anticipate administering first?
A. Ipratropium bromide
B. Fluticasone
C. Albuterol
D. Montelukast
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol, a short-acting beta-2 agonist (SABA), is the first-line treatment for acute
asthma exacerbations because it rapidly relaxes bronchial smooth muscle. Ipratropium may be
added but is not first-line. Fluticasone (an inhaled corticosteroid) and montelukast (a
leukotriene modifier) are for long-term control, not acute relief.
Question 7: A nurse is reviewing the laboratory results of a client with chronic kidney disease.
Which of the following values should the nurse expect to be elevated?
A. Hemoglobin
B. Serum creatinine
C. Serum calcium
D. Glomerular filtration rate (GFR)
CORRECT ANSWER: B. Serum creatinine
Rationale: In chronic kidney disease, decreased kidney function reduces creatinine excretion,
causing serum creatinine to rise. Hemoglobin is typically decreased due to reduced
,erythropoietin production. Serum calcium is often low due to impaired vitamin D activation.
GFR is decreased, not elevated, reflecting reduced kidney function.
Question 8: A nurse is caring for a client who has a chest tube connected to a water-seal
drainage system. Which of the following actions should the nurse take?
A. Clamp the chest tube during ambulation
B. Keep the drainage system below the level of the client's chest
C. Empty the drainage chamber when it is completely full
D. Add water to the suction control chamber as needed to maintain 20 cm H₂O
CORRECT ANSWER: B. Keep the drainage system below the level of the client's chest
Rationale: Keeping the drainage system below chest level prevents backflow of drainage into
the pleural space, reducing infection and tension pneumothorax risk. Chest tubes should never
be clamped routinely during ambulation. The drainage chamber should be emptied when half
full to avoid tipping. Water in the suction control chamber is set to prescribed level (e.g., 20 cm
H₂O) and not adjusted based on need during use.
Question 9: A nurse is assessing a client with heart failure. Which of the following findings
indicates worsening left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Crackles in the lung bases
D. Hepatomegaly
CORRECT ANSWER: C. Crackles in the lung bases
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood in the
pulmonary circulation, resulting in crackles (rales) from fluid in alveoli. Peripheral edema,
jugular vein distention, and hepatomegaly are signs of right-sided heart failure.
Question 10: A nurse is preparing to administer a blood transfusion to a client. Which of the
following actions should the nurse take immediately before starting the transfusion?
A. Prime the blood tubing with normal saline
B. Verify the blood product with another nurse
C. Administer diphenhydramine prophylactically
D. Obtain baseline vital signs
CORRECT ANSWER: B. Verify the blood product with another nurse
Rationale: Two licensed nurses must verify the blood product against the client's identification,
blood type, and crossmatch immediately before transfusion to prevent fatal hemolytic
reactions. Priming tubing with saline is done earlier. Baseline vital signs are obtained before
verification but verification is the final safety step immediately before starting. Prophylactic
antihistamines are not routine.
Question 11: A nurse is caring for a client who has a new colostomy. Which of the following
statements by the client indicates a need for further teaching?
A. "I will empty the pouch when it is one-third full."
B. "I will cut the skin barrier opening 1/8 inch larger than the stoma."
C. "I will use soap and water to clean the peristomal skin."
D. "I will change the pouching system every 7 days."
, CORRECT ANSWER: D. "I will change the pouching system every 7 days."
Rationale: Pouching systems typically require changing every 3-5 days or immediately if leaking;
waiting 7 days increases skin breakdown risk. Emptying when one-third full prevents weight-
related detachment. Cutting the barrier 1/8 inch larger than the stoma protects peristomal
skin. Soap and water are appropriate for cleaning.
Question 12: A nurse is assessing a client who is 1 day postoperative following a
thyroidectomy. Which of the following findings should the nurse report to the provider
immediately?
A. Hoarseness of voice
B. Tingling around the mouth
C. Mild incisional pain
D. Temperature of 37.8°C (100°F)
CORRECT ANSWER: B. Tingling around the mouth
Rationale: Tingling around the mouth suggests hypocalcemia from accidental parathyroid gland
removal during thyroidectomy, which can progress to tetany or laryngospasm. Hoarseness may
occur from recurrent laryngeal nerve irritation and often resolves. Mild pain and low-grade
fever are expected postoperatively.
Question 13: A nurse is caring for a client with a suspected pulmonary embolism. Which of
the following diagnostic tests should the nurse anticipate being ordered first?
A. Chest X-ray
B. D-dimer assay
C. Ventilation-perfusion (V/Q) scan
D. Pulmonary angiography
CORRECT ANSWER: B. D-dimer assay
Rationale: D-dimer is a sensitive screening test for pulmonary embolism; a negative result helps
rule out PE in low-risk clients. Chest X-ray is nonspecific. V/Q scan or CT pulmonary angiography
are confirmatory tests ordered if D-dimer is positive or clinical suspicion is high. Pulmonary
angiography is invasive and rarely first-line.
Question 14: A nurse is teaching a client about warfarin therapy. Which of the following
statements by the client indicates understanding?
A. "I will take my warfarin with a high-vitamin K meal."
B. "I will use a soft-bristled toothbrush to prevent bleeding."
C. "I will stop taking warfarin if I notice bruising."
D. "I will take ibuprofen for headache relief."
CORRECT ANSWER: B. "I will use a soft-bristled toothbrush to prevent bleeding."
Rationale: Warfarin increases bleeding risk; using a soft-bristled toothbrush minimizes gum
trauma. Vitamin K intake should be consistent, not increased with doses. Bruising requires
provider notification but not abrupt discontinuation. NSAIDs like ibuprofen increase bleeding
risk and should be avoided.
Question 15: A nurse is caring for a client with a closed head injury. Which of the following
assessment findings is the earliest indicator of increasing intracranial pressure (ICP)?
2026 | Comprehensive ATI PN VATI Practice Questions,
NGN NCLEX-PN Review, Detailed Rationales & High-Yield
Content for Guaranteed Exam Success
Question 1: A nurse is caring for a client who is 2 hours postoperative following a total hip
arthroplasty. Which of the following actions should the nurse take to prevent dislocation of
the hip prosthesis?
A. Place a pillow between the client's legs when turning
B. Encourage the client to flex the hip beyond 90 degrees
C. Position the client in a low Fowler's position
D. Assist the client to cross legs at the ankles while in bed
CORRECT ANSWER: A. Place a pillow between the client's legs when turning
Rationale: After total hip arthroplasty, maintaining hip abduction prevents adduction and
internal rotation, which are common mechanisms for prosthetic dislocation. A pillow between
the legs maintains proper alignment. Flexing the hip beyond 90 degrees, crossing legs, or
excessive hip flexion increases dislocation risk. Low Fowler's position is acceptable but does not
specifically prevent dislocation like abduction positioning.
Question 2: A nurse is assessing a client with chronic obstructive pulmonary disease (COPD).
Which of the following findings should the nurse expect?
A. Decreased anteroposterior chest diameter
B. Prolonged expiratory phase
C. Increased breath sounds bilaterally
D. Normal respiratory rate at rest
CORRECT ANSWER: B. Prolonged expiratory phase
Rationale: Clients with COPD experience air trapping due to loss of elastic recoil and narrowed
airways, resulting in a prolonged expiratory phase as they struggle to exhale fully. An increased
anteroposterior diameter (barrel chest) is expected, not decreased. Breath sounds are typically
diminished, not increased. Tachypnea is common even at rest due to impaired gas exchange.
Question 3: A nurse is preparing to administer enoxaparin to a client postoperatively. Which
of the following actions should the nurse take?
A. Expel the air bubble from the prefilled syringe before injection
B. Inject the medication into the deltoid muscle
C. Massage the injection site after administration
D. Administer the injection into the abdomen at least 2 inches from the umbilicus
CORRECT ANSWER: D. Administer the injection into the abdomen at least 2 inches from the
umbilicus
Rationale: Enoxaparin, a low-molecular-weight heparin, is administered subcutaneously in the
abdomen (avoiding 2 inches around the umbilicus) to ensure consistent absorption. The air
bubble should NOT be expelled as it helps deliver the full dose and prevents medication leakage
into subcutaneous tissue. The deltoid is not recommended for anticoagulant injections.
Massaging the site increases bruising and bleeding risk.
Question 4: A nurse is caring for a client who has a new prescription for digoxin. Which of the
following findings should the nurse report to the provider immediately?
,A. Apical pulse of 58/min
B. Serum potassium level of 4.0 mEq/L
C. Blood pressure of 128/82 mm Hg
D. Report of mild nausea
CORRECT ANSWER: A. Apical pulse of 58/min
Rationale: Digoxin can cause bradycardia; an apical pulse below 60/min in an adult requires
holding the dose and notifying the provider due to risk of serious dysrhythmias. A potassium
level of 4.0 mEq/L is within normal range and does not increase digoxin toxicity risk. Mild
nausea may occur but is less urgent than bradycardia. Blood pressure of 128/82 mm Hg is
acceptable.
Question 5: A nurse is teaching a client with type 2 diabetes mellitus about foot care. Which
of the following statements by the client indicates understanding?
A. "I will soak my feet in hot water daily to keep them clean."
B. "I will walk barefoot around my house to strengthen my feet."
C. "I will inspect my feet daily using a mirror for the soles."
D. "I will apply lotion between my toes to prevent dry skin."
CORRECT ANSWER: C. "I will inspect my feet daily using a mirror for the soles."
Rationale: Daily foot inspection with a mirror allows clients with diabetes to detect cuts,
blisters, or redness early, preventing complications from neuropathy. Hot water can cause
burns due to decreased sensation. Walking barefoot increases injury risk. Lotion between toes
promotes moisture and fungal growth; lotion should be applied to tops and bottoms only.
Question 6: A nurse is caring for a client who is experiencing an acute asthma exacerbation.
Which of the following medications should the nurse anticipate administering first?
A. Ipratropium bromide
B. Fluticasone
C. Albuterol
D. Montelukast
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol, a short-acting beta-2 agonist (SABA), is the first-line treatment for acute
asthma exacerbations because it rapidly relaxes bronchial smooth muscle. Ipratropium may be
added but is not first-line. Fluticasone (an inhaled corticosteroid) and montelukast (a
leukotriene modifier) are for long-term control, not acute relief.
Question 7: A nurse is reviewing the laboratory results of a client with chronic kidney disease.
Which of the following values should the nurse expect to be elevated?
A. Hemoglobin
B. Serum creatinine
C. Serum calcium
D. Glomerular filtration rate (GFR)
CORRECT ANSWER: B. Serum creatinine
Rationale: In chronic kidney disease, decreased kidney function reduces creatinine excretion,
causing serum creatinine to rise. Hemoglobin is typically decreased due to reduced
,erythropoietin production. Serum calcium is often low due to impaired vitamin D activation.
GFR is decreased, not elevated, reflecting reduced kidney function.
Question 8: A nurse is caring for a client who has a chest tube connected to a water-seal
drainage system. Which of the following actions should the nurse take?
A. Clamp the chest tube during ambulation
B. Keep the drainage system below the level of the client's chest
C. Empty the drainage chamber when it is completely full
D. Add water to the suction control chamber as needed to maintain 20 cm H₂O
CORRECT ANSWER: B. Keep the drainage system below the level of the client's chest
Rationale: Keeping the drainage system below chest level prevents backflow of drainage into
the pleural space, reducing infection and tension pneumothorax risk. Chest tubes should never
be clamped routinely during ambulation. The drainage chamber should be emptied when half
full to avoid tipping. Water in the suction control chamber is set to prescribed level (e.g., 20 cm
H₂O) and not adjusted based on need during use.
Question 9: A nurse is assessing a client with heart failure. Which of the following findings
indicates worsening left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Crackles in the lung bases
D. Hepatomegaly
CORRECT ANSWER: C. Crackles in the lung bases
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood in the
pulmonary circulation, resulting in crackles (rales) from fluid in alveoli. Peripheral edema,
jugular vein distention, and hepatomegaly are signs of right-sided heart failure.
Question 10: A nurse is preparing to administer a blood transfusion to a client. Which of the
following actions should the nurse take immediately before starting the transfusion?
A. Prime the blood tubing with normal saline
B. Verify the blood product with another nurse
C. Administer diphenhydramine prophylactically
D. Obtain baseline vital signs
CORRECT ANSWER: B. Verify the blood product with another nurse
Rationale: Two licensed nurses must verify the blood product against the client's identification,
blood type, and crossmatch immediately before transfusion to prevent fatal hemolytic
reactions. Priming tubing with saline is done earlier. Baseline vital signs are obtained before
verification but verification is the final safety step immediately before starting. Prophylactic
antihistamines are not routine.
Question 11: A nurse is caring for a client who has a new colostomy. Which of the following
statements by the client indicates a need for further teaching?
A. "I will empty the pouch when it is one-third full."
B. "I will cut the skin barrier opening 1/8 inch larger than the stoma."
C. "I will use soap and water to clean the peristomal skin."
D. "I will change the pouching system every 7 days."
, CORRECT ANSWER: D. "I will change the pouching system every 7 days."
Rationale: Pouching systems typically require changing every 3-5 days or immediately if leaking;
waiting 7 days increases skin breakdown risk. Emptying when one-third full prevents weight-
related detachment. Cutting the barrier 1/8 inch larger than the stoma protects peristomal
skin. Soap and water are appropriate for cleaning.
Question 12: A nurse is assessing a client who is 1 day postoperative following a
thyroidectomy. Which of the following findings should the nurse report to the provider
immediately?
A. Hoarseness of voice
B. Tingling around the mouth
C. Mild incisional pain
D. Temperature of 37.8°C (100°F)
CORRECT ANSWER: B. Tingling around the mouth
Rationale: Tingling around the mouth suggests hypocalcemia from accidental parathyroid gland
removal during thyroidectomy, which can progress to tetany or laryngospasm. Hoarseness may
occur from recurrent laryngeal nerve irritation and often resolves. Mild pain and low-grade
fever are expected postoperatively.
Question 13: A nurse is caring for a client with a suspected pulmonary embolism. Which of
the following diagnostic tests should the nurse anticipate being ordered first?
A. Chest X-ray
B. D-dimer assay
C. Ventilation-perfusion (V/Q) scan
D. Pulmonary angiography
CORRECT ANSWER: B. D-dimer assay
Rationale: D-dimer is a sensitive screening test for pulmonary embolism; a negative result helps
rule out PE in low-risk clients. Chest X-ray is nonspecific. V/Q scan or CT pulmonary angiography
are confirmatory tests ordered if D-dimer is positive or clinical suspicion is high. Pulmonary
angiography is invasive and rarely first-line.
Question 14: A nurse is teaching a client about warfarin therapy. Which of the following
statements by the client indicates understanding?
A. "I will take my warfarin with a high-vitamin K meal."
B. "I will use a soft-bristled toothbrush to prevent bleeding."
C. "I will stop taking warfarin if I notice bruising."
D. "I will take ibuprofen for headache relief."
CORRECT ANSWER: B. "I will use a soft-bristled toothbrush to prevent bleeding."
Rationale: Warfarin increases bleeding risk; using a soft-bristled toothbrush minimizes gum
trauma. Vitamin K intake should be consistent, not increased with doses. Bruising requires
provider notification but not abrupt discontinuation. NSAIDs like ibuprofen increase bleeding
risk and should be avoided.
Question 15: A nurse is caring for a client with a closed head injury. Which of the following
assessment findings is the earliest indicator of increasing intracranial pressure (ICP)?
