NEXT GENERATION RN ATI ADULT MEDSURG PROCTORED
EXAM 2023 WITH NGN
1.
2. A nurse is preparing to administer vancomycin IV to an adult client. The client asks the
nurse if the medication can be given 2 hr earlier. Which of the following statements should
the nurse make?
A. "I can start the medication 30 minutes earlier."
B. "I can adjust the time and schedule for when it's convenient for you."
C. "I can infuse the medication at a faster rate."
D. "I have up to 2 hours after the usual schedule time to give you this medication."
Answer: D. "I have up to 2 hours after the usual schedule time to give you this medication."
3. A nurse is caring for a client who has end-stage kidney disease. The client's adult child asks
the nurse about becoming a living kidney donor for their parent. Which of the following
conditions in the child's medical history should the nurse identify as a contraindication to the
procedure?
A. Amputation
B. Osteoarthritis
C. Hypertension
D. Primary glaucoma
Answer: C. Hypertension
4.
5.
6. A nurse is providing preoperative teaching to an older adult client who is scheduled for
surgery. Which of the following actions should the nurse take to promote learning?
A. Speak loudly when addressing the client.
B. Connect new information with the client’s past experiences
C. Present the information to the client using abstract concepts.
D. Use a 12-pomt font when printing written materials for the client.
Answer: B. Connect new information with the client’s past experiences
7. A nurse is admitting an older adult client who is transferring from another facility. The
nurse notes pressure ulcers on the client's coccyx and abrasions around both wrists. Which of
the following actions should the nurse take to address suspicions of elder abuse?
A. Notify risk management.
B. Inform the transferring agency of the client's condition.
C. Contact the family regarding the client's condition.
D. Privately interview the client about the injuries.
Answer: D. Privately interview the client about the injuries.
8. A nurse is assessing a client who has Cushing's syndrome. Which of the following findings
should the nurse expect?
Answer: Osteoporosis
9. A nurse is inspecting the skin of a client who has basal cell carcinoma. The nurse should
identify which of the following lesion characteristics on the client's skin?
Answer: A pearly, waxy nodule
10. A nurse is assessing a client who has hypocalcemia. In which of the following areas
should the nurse tap on the client's face to detect the presence of Chvostek's sign? (You will
find hot spots to select in the artwork below. Select only the hot spot that corresponds to your
answer.)
A is correct. The nurse should tap the client's cheek just in front of the ear and below the
zygomatic arch. The client who has hypocalcemia will display a Chvostek's sign, which is a
twitching of the facial muscle.
B is incorrect. The nurse should apply upward pressure at the supraorbital ridge, below the
eyebrow, to assess for tenderness and inflammation of the frontal sinuses.
C is incorrect. The nurse should palpate the jaw and mastoid muscle of a client who has
temporomandibular joint dysfunction. This can be caused by misaligned teeth, arthritis, or
grinding of the teeth. With palpation, the nurse might feel a click, pop, or grating sensation
when the client opens or closes the jaw.
11. A nurse in an emergency department is assessing a client who is overusing prescribed
diuretics and has a sodium level of 127 mEq/L. Which of the following laboratory findings
should the nurse expect?
Answer: Low urine specific gravity
12. A home health nurse is assisting a client with planning care for a family member who has
Alzheimer's disease. Which of the following instructions should the nurse include?
Answer: Review the daily schedule with the client every morning.
13. A nurse is caring for a client who has developed acute respiratory distress syndrome
(ARDS).
Which of the following findings should the nurse identify as a manifestation of this
syndrome?
Answer: Refractory hypoxemia
14. An emergency room nurse is assessing a client who has asthma and difficulty breathing.
Which of the following findings should indicate to the nurse that the client is experiencing
status asthmaticus?
Answer: Use of accessory muscles
15. A nurse is teaching a client who has a new prescription for phenytoin to treat a seizure
disorder. Which of the following adverse effects should the nurse instruct the client to report
immediately to the provider?
Answer: Skin rash
16. A monitoring a client following a lumbar laminectomy. The client has a drain and
indwelling urinary catheter. The nurse should identify which of the following findings as an
indication of a complication of the surgery?
Answer: Clear drainage on the dressings
17. A nurse is assessing a client who has right-sided heart failure. Which of the following
findings should the nurse identify as a manifestation of right-sided heart failure?
Answer: Increased abdominal girth
18. A nurse is caring for a client who recently assumed the role of caregiver for their aging
parents who have chronic illnesses. The nurse should identify that which of the following
statements by the client indicates acceptance of the role change?
Answer: "I changed the floor plan of our home to accommodate my father's wheelchair."
19. A nurse is caring for a client who is receiving vancomycin intermittent IV bolus therapy
for methicillin- resistant Staphylococcus aureus (MRSA). Which of the following findings is
an indication to the nurse that the client is experiencing an adverse effect of the medication?
Answer: The client is becoming flushed.
20. A nurse is caring for a male client who has a new prescription for cyclosporine following
a kidney transplant. Which of the following findings should the nurse identify as an adverse
effect of this therapy?
Answer: BUN 24 MG DL
21. A nurse is caring for a client who has dumping syndrome following a gastric resection.
The nurse should monitor the client for which of the following complications of dumping
syndrome?
Answer: Iron-deficiency anemia
22. A nurse is assessing a client who takes salmeterol to treat moderate asthma. Which of the
following findings should indicate to the nurse that the medication has been effective?
Answer: The client's daily peak expiratory flow (PEF) measures 85% above personal best.
23. A nurse is providing teaching about health promotion activities for a client who has a new
diagnosis of type 1 diabetes mellitus. Which of the following statements by the client
indicates an understanding of the teaching?
Answer: "I will check my blood sugar level before exercising."
24. A nurse is providing teaching to a client who has a new prescription for warfarin. Which
of the following medications should the nurse instruct the client to avoid? (Select all that
apply.)
Answer: Ferrous sulfate is incorrect. Ferrous sulfate is an iron supplement and has no
known interaction with warfarin.
Echinacea is incorrect. Echinacea is a supplement that a client might take to improve the
immune system and has no known interaction with warfarin.
Aspirin is correct. Aspirin is an antiplatelet medication. It can increase the risk of bleeding
when taken with warfarin.
Dextromethorphan is incorrect. Dextromethorphan is a cough suppressant and has no
known interaction with warfarin.
Naproxen is correct. Naproxen is an NSAID that relieves mild to moderate pain. It can
increase the risk of bleeding if taken with warfarin.
25. A nurse is providing discharge teaching about infection control at home for a client who
has tuberculosis. Which of the following statements by the client indicates an understanding
of the teaching?
Answer: "I will place my used tissues in a plastic bag."
26. A teaching a client who is scheduled to receive radioactive iodine therapy for treatment of
hyperthyroidism. Which of the following instructions should the nurse include in the
teaching?
Answer: Use disposable utensils for meals.
27. A nurse is providing preoperative teaching to a client who is scheduled for a radical
prostatectomy. Which of the following information should the nurse include in the teaching?
Answer: A PCA pump will be used for postoperative pain control.
28. A nurse is assessing a client's ECG strip and notes an irregular heart rate of 98/min with
no clear P waves. Which of the following cardiac dysrhythmias should the nurse document?
Answer: The nurse should document atrial fibrillation. The irregular heart rate of 98/min
with no clear P waves is characteristic of this dysrhythmia.
29. A nurse is caring for a client who is receiving peritoneal dialysis. Which of the following
actions should the nurse take?
Answer: Report cloudy dialysate drainage to the provider.
30. A nurse is assessing a client who has suspected appendicitis. Which of the following
manifestations should the nurse expect? (Select all that apply.)
Answer: Elevated WBC count is correct. A client who has acute appendicitis will show a
moderate elevation of the WBC count from 10,000 to 18,000/mm3. If the WBC count is
greater than 20,000/mm3, it can indicate a perforated appendix.
Elevated amylase level is incorrect. Amylase levels increase with pancreatitis but not with
acute appendicitis.
Rebound tenderness is correct. A client who has appendicitis develops localized pain over
the right lower quadrant of the abdomen. When the area is palpated, pain occurs during
release of pressure on the client's abdomen.
Ascites is incorrect. Ascites can be a manifestation of cirrhosis; however, it is not associated
with appendicitis.
Anorexia is correct. A client who has acute appendicitis experiences nausea, vomiting, and
reduced appetite.
31. A planning preventative strategies for a client who is at risk for pressure injuries. Which
of the following actions should the nurse include in the plan?
Answer: Apply moisturizer to damp skin after bathing.
32. A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. Which
of the following findings should the nurse identify as a manifestation of type 1 diabetes?
Answer: Ketones in the urine
33. A nurse is caring for a client who had a surgical repair of an abdominal aortic aneurysm 3
days ago. The client's vital signs are: temperature 38.3° C (100.9° F), heart rate 80/min,
respirations 16/min, and blood pressure 128/76 mm Hg. Which of the following actions is the
nurse's priority?
Answer: Assess the surgical incision for signs of infection.
34. A nurse is providing discharge teaching to a client following a loop electrosurgical
excision procedure (LEEP) for the treatment of cervical cancer. Which of the following
statements by the client indicates an understanding of the teaching?
Answer: "I may have mild cramping for several hours."
35. A nurse is assessing a group of clients. For which of the following clients should the nurse
make a referral to palliative care?
Answer: A client whose medications to manage Parkinson's disease are no longer effective
36. A providing teaching to a client who has a new prescription for cephalexin oral
suspension. Which of the following statements by the client indicates an understanding of the
teaching?
Answer: "I will keep the medication refrigerated."
37. A nurse is caring for a client who has acute kidney injury and a potassium level of 6.5
mEq/L. Which of the following ECG changes should the nurse expect?
Answer: WRONG Peaked T waves
38. A nurse is caring for a client who had abdominal surgery. The client tells the nurse that
"something gave way." The nurse removes the dressing and sees the wound has eviscerated.
Identify the correct sequence of steps the nurse should follow. (Move the steps into the box
on the right, placing them in the selected order of performance. Use all the steps.)
Answer: • Place the client in a low Fowler's position with the knees bent.
• Cover the client's wound with a sterile saline-soaked dressing.
• Notify the surgeon about the finding.
• Prepare the client for transfer to surgery.
Based on evidence-based practice, the nurse should immediately contact the surgeon and
notify them of the wound evisceration. The nurse should then cover the client’s wound with a
sterile saline soaked dressing to protect it from infection. The nurse should then place the
client in a low Fowler's position with their knees bent and then prepare the client to be
transferred to surgery. Bottom of Form
39. A nurse is caring for a client who is hemorrhaging and hypotensive from esophageal
variceal bleeding. Which of the following actions should the nurse take first?
Answer: Verify that the client has adequate IV access.
40. A nurse is assessing a client who has a new diagnosis of diabetes mellitus. The nurse
should
identify that which of the following findings is a manifestation of hyperglycemia?
Answer: Increased thirst
41. A nurse is reviewing the health histories of a group of clients. Which of the following
findings should the nurse identify as an indication that a client is at an increased risk for
urinary tract infections (UTIs)?
Answer: Diabetes mellitus
42. A nurse is preparing to discharge a client who is postoperative following a total hip
arthroplasty. Which of the following equipment should the nurse ensure that the client has
available at home prior to discharge?
Answer: Elevated toilet seat
43. A nurse is assessing a client who has a history of type 2 diabetes mellitus. The nurse
should identify which of the following findings as an indication of a microvascular
complication?
Answer: Retinopathy, Monitor the client for any adverse reactions.
44. A nurse is planning care for a client who had a lumbar laminectomy. Which of the
following interventions should the nurse include in the plan of care?
Answer: Turn the client by log rolling with a turning sheet.
45. A nurse is teaching a client how to obtain a specimen at home for a fecal occult blood test.
Which of the following actions should the nurse instruct the client to take for 3 days prior to
collecting the specimen?
Answer: Avoid eating red meat.
46. A nurse is caring for a client immediately following intubation with an endotracheal (ET)
tube. Which of the following methods should the nurse identify as the most reliable for
verifying placement of the ET tube?
Answer: Verifying ET tube replacement
47. A nurse notes that a client's eyes are protruding slightly from their orbits. Which of the
following laboratory findings should the nurse expect?
Answer: Increased T4 levels
48. A nurse is preparing a teaching plan for a client who is starting to receive hemodialysis
for chronic kidney disease. Which of the following instructions should the nurse include in
the teaching?
Answer: "Increase your intake of protein to 1 to 1.5 grams per kilogram per day."
49. A nurse is caring for a client who has deep-vein thrombosis and is receiving heparin via
continuous IV infusion. The client's weight is 80 kg (176.4 lb). Using the client information
provided, which of the following actions should the nurse take? (Click on the "Exhibit"
button below for additional information about the client. There are three tabs that contain
separate categories of data.)
Answer: Stop the heparin infusion for 1 hr.
50. A nurse is caring for a client who is intubated and receiving mechanical ventilation for
heroin toxicity. Which of the following assessments is the nurse's priority?
Answer: ABGs
51. A nurse is assessing a client who has a new diagnosis of pericarditis. Which of the
following findings should the nurse identify as a manifestation of cardiac tamponade?
Answer: Atrial fibrillation
52. A nurse is assessing a client who is undergoing radiation therapy for breast cancer. Which
of the following findings is an indication to the nurse that the client is experiencing an
adverse effect of the therapy?
Answer: Skin changes
53. A nurse is preparing to administer enoxaparin 0.75 mg/kg subcutaneously to a client who
weighs 154 lb. The amount available is enoxaparin 60 mg/0.6 mL. How many mL should the
nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do
not use a trailing zero.)
Answer: 0.5 ml.
54. A nurse is caring for a group of clients. In which of the following scenarios is the nurse
acting as a client advocate?
Answer: The nurse refers a client who has chronic obstructive pulmonary disease for
palliative care services.
55. A nurse is assessing a client who recently had a myocardial infarction. Which of the
following findings indicates that the client might be developing pulmonary edema? (Select all
that apply.)
Answer: Excessive somnolence is correct. Manifestations of pulmonary edema can include
a change in orientation or mental status. A client who has excessive somnolence might be
experiencing pulmonary edema.
Epistaxis is incorrect. Epistaxis, or a nosebleed, can be an indication of a low platelet count;
however, it is not a manifestation associated with pulmonary edema.
Pink, frothy sputum is correct. A client who has pulmonary edema can develop pink, frothy
sputum, wheezing, and tachypnea.
Tachypnea is correct. A client who has pulmonary edema can develop pink, frothy sputum,
wheezing, and tachypnea.
Urinary frequency is incorrect. The client who is developing pulmonary edema is retaining
fluid. Once treated with diuretics, the kidneys will begin excreting sodium and water.
56. A nurse is teaching a client about preventing the transmission of HIV. Which of the
following information should the nurse include?
Answer: Medication is available that will reduce the risk for HIV transmission.
57. A nurse is caring for a client who has multiple leg fractures and is 24 hr postoperative
following placement of skeletal traction. Which of the following actions should the nurse
take?
Answer: Inspect the pin sites at least every 8 hr.
58. A nurse in a long-term care facility is caring for a client who has dementia. Which of the
following actions should the nurse take?
Answer: Provide finger food at mealtime.
59. A nurse is completing an admission assessment for a client who has bacterial meningitis.
Which of the following personal protective equipment should the nurse use while caring for
the client?
Answer: Surgical mask
60. A nurse is assessing a client for fluid volume deficit following lumbar spinal surgery. The
nurse should identify which of the following findings as an indication the client is at risk for
fluid volume deficit?
Answer: Surgical drain output 300 mL during an 8-hr shift
61. A nurse is assessing a client who has a central venous catheter (CVC) with intravenous
(IV) fluids infusing. The client suddenly develops shortness of breath, and the nurse notes
that the IV tubing and needleless connector device are disconnected. Which of the following
actions should the nurse take first?
Answer: Close the pinch clamp on the CVC.
62. A nurse is planning care for a client who is scheduled for surgery and has a latex allergy.
Which of the following actions should the nurse plan to take?
Answer: Place monitoring cords and tubes in a stockinette.
63. A nurse is providing preoperative teaching about stool consistency to a client who will
undergo a colectomy with the placement of an ileostomy. Which of the following information
about stool consistency should the nurse include in the teaching?
Answer: The stool will have a high volume of liquid.
64. A nurse is providing teaching to a client who has a new prescription for levothyroxine to
treat hypothyroidism. Which of the following statements by the client indicates an
understanding of the teaching?
Answer: "If my heart starts racing, my provider might need to adjust my dosage."
65. A nurse is assessing a client who has an exacerbation of diverticular disease. In which of
the following quadrants should the nurse anticipate the client to be experiencing abdominal
pain?
Answer: Left lower quadrant
66. A nurse is planning care for a client who has a lump in their right breast. Which of the
following findings increases the client's risk of developing breast cancer?
Answer: Oral contraceptives were taken for the last 6 years
67. A nurse is providing teaching for a client who has constipation-predominant irritable
bowel syndrome (IBS-C). Which of the following statements should the nurse include in the
teaching?
Answer: A client who has IBS-C should take a bulk-forming laxative, such as psyllium, to
increase the bulk of the stool, reduce constipation, and promote regular bowel movements.
68. A nurse is caring for a client who is receiving mechanical ventilation. Which of the
following actions should the nurse implement to decrease the client's risk for ventilator
associated pneumonia (VAP)? (Select all that apply.)
Answer: Wear a protective gown when suctioning the client's airway is incorrect. The
nurse should use standard precautions when exposure to bodily secretions is possible.
However, a protective gown will not prevent VAP in the client.
Monitor for oral secretions every 2 hr is correct. The nurse should monitor for oral
secretions at least every 2 hr to decrease the likelihood of micro-organisms moving from the
mouth into the respiratory tract.
Provide oral care every 2 hr is correct. The nurse should provide oral care every 2 hr using
chlorhexidine rinse or sodium chloride solution with swabbing or tooth brushing.
Maintain the client in a supine position is incorrect. The nurse should position the client
with the head of the bed elevated at least 30° to prevent aspiration of bacteria into the airway.
Assess the client daily for readiness of extubation is correct. To lower the risk of the client
acquiring VAP, the nurse should assess the client daily for neurological readiness for
discontinuing mechanical ventilation. Bottom of Form
69. A nurse is planning care for a client who is receiving intermittent IV fluids via a
peripherally inserted central catheter (PICC). Which of the following information should the
nurse include in the client's plan of care?
Answer: Assess the PICC infusion system systematically.
70. A nurse is performing a risk assessment for a client. Which of the following factors
should the nurse identify as increasing the client's risk for falls?
Answer: The client had cataract surgery 1 day ago.
71. A nurse is providing teaching to a group of clients about the prevention of coronary artery
disease. Which of the following information should the nurse include in the teaching?
Answer: Walk 30 min daily at a comfortable pace.
72. A home health nurse is inspecting a client's residence for electrical hazards as part of the
agency's quality improvement plan. Which of the following findings should the nurse identify
as a safety hazard?
Answer: An IV pump is plugged into an outlet near a sink.
73. A nurse is teaching a client about self-management of their halo fixator device. Which of
the following information should the nurse include in the teaching?
Answer: Place a small pillow under the head while lying supine.
73a. A nurse is providing teaching to a client about strategies to manage menopausal
symptoms. Which of the following instructions should the nurse include in the teaching?
Answer: "Use water-based lubricant during intercourse to reduce discomfort."
74. A nurse is caring for a client who has chronic venous insufficiency. Which of following
areas should the nurse assess for the presence of a venous ulcer? (You will find hot spots to
select in the artwork below. Select only the hot spot that corresponds to your
answer.)
Answer: A is correct. The nurse should assess the medial malleolus (ankle) of a client who
has chronic venous insufficiency for the presence of a venous ulcer. The ankle is the most
common area for a venous ulcer. A client who has venous insufficiency can exhibit skin
discoloration and edema as well as a large or superficial ulcer with irregular borders at the
site of the medial or lateral malleolus that weeps exudate.
A pulse is palpable in this area and the client typically experiences a moderate level of pain at
the site.
B is incorrect. The nurse should assess the tip of the toe and between the toes of a client who
has arterial insufficiency for the presence of an arterial ulcer. A client who has an arterial
ulcer can exhibit cyanosis in the extremity, cool temperature to the touch, and weak or absent
pulses.
C is incorrect. The nurse should assess the ball of the foot of a client who has diabetes
mellitus. A client who has a diabetic ulcer can exhibit wounds or ulcers on the plantar or other
pressure areas of the feet. These wounds are deep with pale, even edges, and little granulation
in the wound bed. Bottom of Form
75. A nurse in an emergency department is caring for a client who is confused, has a
temperature of 40° C (104° F), a BP of 74/52 mm Hg, and a diagnosis of exertional heat
stroke. Which of the following actions should the nurse take first?
Answer: Administer oxygen using a high-concentration mask.
76. A nurse is caring for a client who has a prescription for lactated Ringer's by continuous IV
infusion to replace output from an NG tube. Which of the following findings should
indicate to the nurse that this therapy is effective?
Answer: Urine specific gravity 1.020
77. A nurse is caring for a client who is 3 hr postoperative and exhibiting signs of
hypovolemia. Which of the following findings should the nurse identify as a manifestation of
hypovolemia?
Answer: Rapid pulse rate
78. A nurse is planning care for a client who has tuberculosis. Which of the following
precautions should the nurse implement for this client?
Answer: Airborne precautions MY
79. A nurse is analyzing the ABG results of a client who is in respiratory acidosis. Which of
the following mechanisms should the nurse identify as responsible for this acidbase
imbalance?
Answer: Retention of carbon dioxide
80. A nurse is preparing to administer propranolol to several clients. For which of the
following clients should the nurse clarify the prescription with the provider before
administration?
Answer: A client who has a history of asthma
81. A nurse is providing teaching for a client who has neutropenia and is receiving
chemotherapy. Which of the following client statements indicates an understanding of the
teaching? (Select all that apply.)
Answer: "I will avoid crowds" is correct. The client who is immunocompromised should
avoid crowds while undergoing chemotherapy to reduce the risk of infection.
"I will wash my toothbrush weekly" is incorrect. The client who is immunocompromised
should wash their toothbrush daily in the dishwasher or rinse it in a bleach solution to prevent
bacterial growth.
"I will change my cat's litter box twice weekly" is incorrect. The client who is
immunocompromised should have someone else change the litter box to avoid infections.
"I will take my temperature daily" is correct. The client who is immunocompromised
should take daily temperature readings and report an elevated temperature to the provider.
"I will eat plenty of fresh fruits and vegetables" is incorrect. The client who is
immunocompromised should avoid food sources that contain bacteria, such as fresh fruits and
vegetables, undercooked meat, fish, and eggs.
82. A nurse is assessing a client who has a chest tube connected to a closed water-seal
drainage system. Which of the following findings should the nurse report to the provider?
Answer: Constant bubbling in the water seal chamber
83. A nurse is caring for a client who has a small bowel obstruction and an NG tube in place.
Which of the following actions should the nurse take?
Answer: Maintain low intermittent suction.
84. A nurse is teaching a client who has a new diagnosis of type 1 diabetes mellitus. Which of
the following statements by the client indicates an understanding of the teaching?
Answer: "I am aware that my diabetes is caused by an autoimmune disorder."
85. A nurse is monitoring a client who has a traumatic brain injury. Which of the following
findings should the nurse identify as a manifestation of Cushing's triad?
Answer: Increase in blood pressure from 130/80 mm Hg to 180/100 mm Hg
86. A nurse is preparing to administer potassium chloride 10 mEq IV over 1 hr to a client.
Available is potassium chloride 10 mEq in 100 mL of 0.9% sodium chloride. The nurse
should set the infusion pump to deliver how many mL/hr? (Round the answer to the nearest
whole number. Use a leading zero if it applies. Do not use a trailing zero.) 100?
Answer: The nurse should set the infusion pump to deliver 100 mL/hr.
87. A nurse is providing teaching about dietary options for a client who has cholelithiasis.
Which of the following statements should the nurse include in the teaching?
Answer: cuts of meat
88. A nurse is providing discharge teaching to a client who has COPD. Which of the
following instructions should the nurse include in the teaching?
Answer: "Consume a diet that is high in calories."
89. A nurse is assessing a client's understanding of a surgical procedure prior to witnessing
their signature on the informed consent form. The nurse determines that the client does not
understand what the procedure will involve. Which of the following actions should the nurse
take?
Answer: Contact the provider who will be performing the procedure.
90. A nurse is providing teaching to a client who is scheduled for a bronchoscopy. Which of
the following statements should the nurse include in the teaching?
Answer: "You will not be able to eat or drink after the procedure until you are able to
cough."
91. A nurse is caring for a client who is 24 hr postoperative following a total hip arthroplasty.
Which of the following actions should the nurse take?
Answer: Maintain abduction of the affected extremity.
