RN ATI ADULT MEDICAL SURGICAL
PROCTORED EXAM STUDY GUIDE WITH NGN
PRACTICE QUESTIONS & DETAILED
RATIONALES | COMPREHENSIVE MEDICAL-
SURGICAL NURSING EXAM PREP 2026
• This 200-question NGN-style practice exam mirrors the RN ATI Adult Medical-
Surgical Proctored Exam, covering all high-yield systems and priority nursing
concepts tested in 2026.
• Read each question carefully, select your answer independently before checking
the bold correct answer and EXPERT RATIONALE below — spaced repetition of
missed items yields the strongest results.
1. A nurse is caring for a client who has chronic obstructive pulmonary
disease (COPD) and is receiving oxygen therapy. Which oxygen delivery
method should the nurse anticipate using to deliver a precise concentration
of oxygen?
A. Nasal cannula
B. Simple face mask
C. Non-rebreather mask
D. Venturi mask
E. Partial rebreather mask
Correct Answer: D. Venturi mask
EXPERT RATIONALE: The Venturi mask delivers a precise, controlled FiO₂ by mixing
room air with oxygen at fixed ratios. Clients with COPD rely on a hypoxic drive to
breathe, making accurate low-flow oxygen delivery critical to avoid suppressing
their respiratory stimulus.
2. A nurse is assessing a client who has left-sided heart failure. Which finding
should the nurse expect?
,A. Jugular vein distension
B. Peripheral edema
C. Crackles in the lung bases
D. Hepatomegaly
E. Ascites
Correct Answer: C. Crackles in the lung bases
EXPERT RATIONALE: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary edema. Crackles (rales) in the lung
bases are the hallmark finding. Jugular vein distension, peripheral edema,
hepatomegaly, and ascites are signs of right-sided heart failure.
3. A nurse is caring for a client who has a serum potassium level of 6.8 mEq/L.
Which ECG change should the nurse anticipate?
A. U waves
B. Prolonged QT interval
C. Tall, peaked T waves
D. ST depression
E. Widened QRS complex only
Correct Answer: C. Tall, peaked T waves
EXPERT RATIONALE: Hyperkalemia causes characteristic tall, peaked (tented) T
waves on the ECG as one of its earliest signs. As potassium rises further, the PR
interval widens and the QRS widens, eventually leading to a sine wave pattern and
cardiac arrest.
4. A nurse is preparing to administer a unit of packed red blood cells. Which
action is the priority before starting the transfusion?
,A. Obtain baseline vital signs
B. Prime the IV tubing with normal saline
C. Verify the client's blood type and crossmatch with another nurse
D. Assess the IV site for patency
E. Educate the client about the transfusion process
Correct Answer: C. Verify the client's blood type and crossmatch with another
nurse
EXPERT RATIONALE: Verification of blood type, Rh factor, and crossmatch with two
nurses at the bedside is the priority safety step before blood transfusion to prevent
a potentially fatal hemolytic transfusion reaction. All other steps are important but
secondary to this verification.
5. A nurse is caring for a client who develops a transfusion reaction 15
minutes after a blood transfusion is started. The client reports chills, back
pain, and has hematuria. Which action should the nurse take first?
A. Administer diphenhydramine IV
B. Slow the transfusion rate
C. Notify the provider
D. Stop the transfusion immediately
E. Obtain a urine specimen
Correct Answer: D. Stop the transfusion immediately
EXPERT RATIONALE: The symptoms described — chills, back pain, and hematuria
— indicate an acute hemolytic transfusion reaction, which is life-threatening. The
priority action is to stop the transfusion immediately to prevent further hemolysis.
The IV line should be kept open with normal saline, and the provider notified
thereafter.
, 6. A nurse is assessing a client who has diabetic ketoacidosis (DKA). Which
finding is expected?
A. Bradypnea
B. Kussmaul respirations
C. Hypertension
D. Bradycardia
E. Metabolic alkalosis
Correct Answer: B. Kussmaul respirations
EXPERT RATIONALE: Kussmaul respirations are deep, rapid breaths that occur as
the body compensates for metabolic acidosis in DKA by blowing off carbon dioxide.
Other findings include fruity breath odor, polyuria, polydipsia, and hypotension.
7. A nurse is caring for a client with acute pancreatitis. Which position should
the nurse place the client in to reduce pain?
A. Supine with legs extended
B. High Fowler's with legs dangling
C. Side-lying with knees drawn to chest (fetal position)
D. Prone with a pillow under the abdomen
E. Semi-Fowler's with legs flat
Correct Answer: C. Side-lying with knees drawn to chest (fetal position)
EXPERT RATIONALE: The fetal position reduces tension on the inflamed pancreas
and decreases abdominal pain in pancreatitis. Sitting up and leaning forward may
also offer relief. Supine and prone positions increase discomfort by stretching
peritoneal structures.
PROCTORED EXAM STUDY GUIDE WITH NGN
PRACTICE QUESTIONS & DETAILED
RATIONALES | COMPREHENSIVE MEDICAL-
SURGICAL NURSING EXAM PREP 2026
• This 200-question NGN-style practice exam mirrors the RN ATI Adult Medical-
Surgical Proctored Exam, covering all high-yield systems and priority nursing
concepts tested in 2026.
• Read each question carefully, select your answer independently before checking
the bold correct answer and EXPERT RATIONALE below — spaced repetition of
missed items yields the strongest results.
1. A nurse is caring for a client who has chronic obstructive pulmonary
disease (COPD) and is receiving oxygen therapy. Which oxygen delivery
method should the nurse anticipate using to deliver a precise concentration
of oxygen?
A. Nasal cannula
B. Simple face mask
C. Non-rebreather mask
D. Venturi mask
E. Partial rebreather mask
Correct Answer: D. Venturi mask
EXPERT RATIONALE: The Venturi mask delivers a precise, controlled FiO₂ by mixing
room air with oxygen at fixed ratios. Clients with COPD rely on a hypoxic drive to
breathe, making accurate low-flow oxygen delivery critical to avoid suppressing
their respiratory stimulus.
2. A nurse is assessing a client who has left-sided heart failure. Which finding
should the nurse expect?
,A. Jugular vein distension
B. Peripheral edema
C. Crackles in the lung bases
D. Hepatomegaly
E. Ascites
Correct Answer: C. Crackles in the lung bases
EXPERT RATIONALE: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary edema. Crackles (rales) in the lung
bases are the hallmark finding. Jugular vein distension, peripheral edema,
hepatomegaly, and ascites are signs of right-sided heart failure.
3. A nurse is caring for a client who has a serum potassium level of 6.8 mEq/L.
Which ECG change should the nurse anticipate?
A. U waves
B. Prolonged QT interval
C. Tall, peaked T waves
D. ST depression
E. Widened QRS complex only
Correct Answer: C. Tall, peaked T waves
EXPERT RATIONALE: Hyperkalemia causes characteristic tall, peaked (tented) T
waves on the ECG as one of its earliest signs. As potassium rises further, the PR
interval widens and the QRS widens, eventually leading to a sine wave pattern and
cardiac arrest.
4. A nurse is preparing to administer a unit of packed red blood cells. Which
action is the priority before starting the transfusion?
,A. Obtain baseline vital signs
B. Prime the IV tubing with normal saline
C. Verify the client's blood type and crossmatch with another nurse
D. Assess the IV site for patency
E. Educate the client about the transfusion process
Correct Answer: C. Verify the client's blood type and crossmatch with another
nurse
EXPERT RATIONALE: Verification of blood type, Rh factor, and crossmatch with two
nurses at the bedside is the priority safety step before blood transfusion to prevent
a potentially fatal hemolytic transfusion reaction. All other steps are important but
secondary to this verification.
5. A nurse is caring for a client who develops a transfusion reaction 15
minutes after a blood transfusion is started. The client reports chills, back
pain, and has hematuria. Which action should the nurse take first?
A. Administer diphenhydramine IV
B. Slow the transfusion rate
C. Notify the provider
D. Stop the transfusion immediately
E. Obtain a urine specimen
Correct Answer: D. Stop the transfusion immediately
EXPERT RATIONALE: The symptoms described — chills, back pain, and hematuria
— indicate an acute hemolytic transfusion reaction, which is life-threatening. The
priority action is to stop the transfusion immediately to prevent further hemolysis.
The IV line should be kept open with normal saline, and the provider notified
thereafter.
, 6. A nurse is assessing a client who has diabetic ketoacidosis (DKA). Which
finding is expected?
A. Bradypnea
B. Kussmaul respirations
C. Hypertension
D. Bradycardia
E. Metabolic alkalosis
Correct Answer: B. Kussmaul respirations
EXPERT RATIONALE: Kussmaul respirations are deep, rapid breaths that occur as
the body compensates for metabolic acidosis in DKA by blowing off carbon dioxide.
Other findings include fruity breath odor, polyuria, polydipsia, and hypotension.
7. A nurse is caring for a client with acute pancreatitis. Which position should
the nurse place the client in to reduce pain?
A. Supine with legs extended
B. High Fowler's with legs dangling
C. Side-lying with knees drawn to chest (fetal position)
D. Prone with a pillow under the abdomen
E. Semi-Fowler's with legs flat
Correct Answer: C. Side-lying with knees drawn to chest (fetal position)
EXPERT RATIONALE: The fetal position reduces tension on the inflamed pancreas
and decreases abdominal pain in pancreatitis. Sitting up and leaning forward may
also offer relief. Supine and prone positions increase discomfort by stretching
peritoneal structures.
