1
ATI RN ADULT MEDICAL SURGICAL 2023 EXAM AND
RETAKE PROCTORED QUESTIONS FOR LEVEL 3 TOP SCORE
WITH WELL EXPLAINED ANSWERS 2026 VERSION
A nurse is caring for a postoperative client who has just undergone abdominal
surgery and begins complaining of sudden shortness of breath and chest pain. The
nurse notes tachypnea, decreased oxygen saturation, and restlessness. What
should the nurse do first? A. Notify the healthcare provider. B. Administer
prescribed analgesics. C. Elevate the head of the bed. D. Apply warm compresses
to the chest. The correct answer is C. Elevate the head of the bed. Elevating the
head of the bed facilitates lung expansion and reduces the work of breathing,
which is a priority action for a client experiencing acute respiratory symptoms.
While notifying the healthcare provider is essential, it is not the immediate
priority when the client’s oxygenation is compromised. Administering analgesics
does not address the underlying respiratory issue and may further depress
respiration. Warm compresses have no therapeutic value in this context. The
nurse’s immediate action should focus on airway, breathing, and circulation (the
ABCs), and promoting oxygenation is the primary concern in this situation. Once
the client is positioned for optimal breathing, the nurse can then notify the
healthcare provider and implement additional interventions as ordered.
A nurse is monitoring a client with chronic heart failure who presents with
increasing shortness of breath, orthopnea, and bilateral crackles on auscultation.
The client also has 3+ pitting edema in both lower extremities. Which prescription
should the nurse question? A. Furosemide 40 mg IV twice daily. B. Sodium-
restricted diet at 2 grams daily. C. Intravenous 0.9% normal saline at 125 mL/hr.
D. Daily weights every morning. The correct answer is C. Intravenous 0.9% normal
saline at 125 mL/hr. In a client with worsening heart failure, additional fluid
administration via IV normal saline may exacerbate fluid overload and pulmonary
edema. The nurse should question any order that could worsen the patient’s
volume status. Furosemide is appropriate because it is a loop diuretic that
reduces fluid volume and relieves pulmonary and peripheral congestion. A
sodium-restricted diet is also suitable, as sodium contributes to water retention.
Daily weights are essential in evaluating fluid retention or diuresis effectiveness.
The nurse must critically assess whether ordered therapies align with the
,2
patient’s evolving clinical status, especially in conditions like heart failure where
fluid balance is delicate.
During care for a client with a new tracheostomy, the nurse observes that the
client is agitated, has a heart rate of 118 bpm, respiratory rate of 32 breaths per
minute, and oxygen saturation of 87% on room air. What is the priority nursing
action? A. Suction the tracheostomy. B. Call the rapid response team. C. Apply
oxygen via tracheostomy collar. D. Reassure the client and observe. The correct
answer is C. Apply oxygen via tracheostomy collar. The priority for this client is to
ensure adequate oxygenation, as evidenced by signs of respiratory distress and
hypoxia. Administering oxygen directly to the tracheostomy site can immediately
improve oxygen saturation and relieve symptoms. Suctioning may be necessary if
secretions are suspected, but oxygen should be applied first to address hypoxia.
Calling the rapid response team may be necessary if the patient does not improve
after oxygenation is initiated, but it is not the initial step. Reassuring and
observing does not address the emergent need for oxygen. This scenario
illustrates the importance of prompt and prioritized interventions to maintain a
patient’s airway and respiratory function, especially in postoperative or
vulnerable populations.
A nurse is caring for a client who is scheduled for a colonoscopy in the morning.
The provider orders polyethylene glycol-electrolyte solution (GoLYTELY). The
client becomes nauseated and refuses to drink the solution. What should the
nurse do next? A. Encourage the client to drink the solution slowly over time. B.
Notify the provider and request a different bowel prep. C. Cancel the procedure.
D. Administer an antiemetic and try again later. The correct answer is A.
Encourage the client to drink the solution slowly over time. Nausea is a common
side effect of bowel preparation agents like polyethylene glycol. Encouraging the
client to drink the solution slowly over a longer period can help minimize
gastrointestinal distress and promote compliance. Notifying the provider may be
warranted if the client continues to refuse, but the nurse should first attempt to
resolve the issue with simple interventions. Canceling the procedure prematurely
is inappropriate. Administering an antiemetic may be helpful in some cases, but
encouraging fluid intake slowly is a less invasive first step. Nurses must balance
patient comfort with procedural requirements, using evidence-based strategies to
ensure safe and effective preparation.
, 3
A nurse is providing discharge instructions to a client with a new prescription for
warfarin. Which statement by the client indicates a need for further teaching? A.
"I will eat a consistent amount of green leafy vegetables each week." B. "I will
inform all healthcare providers that I’m taking warfarin." C. "I will take aspirin
every day to help thin my blood further." D. "I will have my INR checked
regularly." The correct answer is C. "I will take aspirin every day to help thin my
blood further." This statement indicates a need for further teaching because
taking aspirin in combination with warfarin significantly increases the risk of
bleeding unless explicitly prescribed. Clients on warfarin must be educated about
drug interactions and the potential for additive anticoagulant effects with other
medications like aspirin or NSAIDs. The other statements reflect appropriate
understanding of warfarin management, including the importance of maintaining
consistent dietary intake of vitamin K, notifying all healthcare providers, and
monitoring INR to maintain therapeutic anticoagulation. Patient education is a
cornerstone of safe medication use, especially with high-risk medications such as
anticoagulants, where mismanagement can lead to serious complications like
hemorrhage.
The knowledge and skills acquired in medical-surgical nursing courses are crucial
to shaping the competency and confidence of future registered nurses.
Throughout training, nurses are introduced to complex physiological concepts,
pathophysiology, pharmacological interventions, and holistic care strategies
needed for a diverse adult patient population. These foundational teachings equip
nursing students to assess, diagnose, plan, implement, and evaluate care in a
wide range of clinical settings, from acute care hospitals to outpatient
rehabilitation facilities. For instance, understanding the progression of chronic
diseases such as diabetes mellitus, heart failure, or COPD enables nurses to
anticipate complications, implement preventative strategies, and respond
effectively in emergencies. This predictive capacity is not only vital in acute care
but also supports nurses in long-term and community health management.
In practice, medical-surgical content supports the nurse’s ability to prioritize care
effectively using frameworks like Maslow’s hierarchy of needs or the ABCs—
airway, breathing, circulation. Nurses learn to triage appropriately, manage
multiple patients simultaneously, and adapt care based on rapidly changing
clinical presentations. This clinical judgment is honed through case studies,
simulation labs, and critical thinking exercises taught during med-surg rotations.
Moreover, these skills translate seamlessly into any nursing specialty, whether it's
ATI RN ADULT MEDICAL SURGICAL 2023 EXAM AND
RETAKE PROCTORED QUESTIONS FOR LEVEL 3 TOP SCORE
WITH WELL EXPLAINED ANSWERS 2026 VERSION
A nurse is caring for a postoperative client who has just undergone abdominal
surgery and begins complaining of sudden shortness of breath and chest pain. The
nurse notes tachypnea, decreased oxygen saturation, and restlessness. What
should the nurse do first? A. Notify the healthcare provider. B. Administer
prescribed analgesics. C. Elevate the head of the bed. D. Apply warm compresses
to the chest. The correct answer is C. Elevate the head of the bed. Elevating the
head of the bed facilitates lung expansion and reduces the work of breathing,
which is a priority action for a client experiencing acute respiratory symptoms.
While notifying the healthcare provider is essential, it is not the immediate
priority when the client’s oxygenation is compromised. Administering analgesics
does not address the underlying respiratory issue and may further depress
respiration. Warm compresses have no therapeutic value in this context. The
nurse’s immediate action should focus on airway, breathing, and circulation (the
ABCs), and promoting oxygenation is the primary concern in this situation. Once
the client is positioned for optimal breathing, the nurse can then notify the
healthcare provider and implement additional interventions as ordered.
A nurse is monitoring a client with chronic heart failure who presents with
increasing shortness of breath, orthopnea, and bilateral crackles on auscultation.
The client also has 3+ pitting edema in both lower extremities. Which prescription
should the nurse question? A. Furosemide 40 mg IV twice daily. B. Sodium-
restricted diet at 2 grams daily. C. Intravenous 0.9% normal saline at 125 mL/hr.
D. Daily weights every morning. The correct answer is C. Intravenous 0.9% normal
saline at 125 mL/hr. In a client with worsening heart failure, additional fluid
administration via IV normal saline may exacerbate fluid overload and pulmonary
edema. The nurse should question any order that could worsen the patient’s
volume status. Furosemide is appropriate because it is a loop diuretic that
reduces fluid volume and relieves pulmonary and peripheral congestion. A
sodium-restricted diet is also suitable, as sodium contributes to water retention.
Daily weights are essential in evaluating fluid retention or diuresis effectiveness.
The nurse must critically assess whether ordered therapies align with the
,2
patient’s evolving clinical status, especially in conditions like heart failure where
fluid balance is delicate.
During care for a client with a new tracheostomy, the nurse observes that the
client is agitated, has a heart rate of 118 bpm, respiratory rate of 32 breaths per
minute, and oxygen saturation of 87% on room air. What is the priority nursing
action? A. Suction the tracheostomy. B. Call the rapid response team. C. Apply
oxygen via tracheostomy collar. D. Reassure the client and observe. The correct
answer is C. Apply oxygen via tracheostomy collar. The priority for this client is to
ensure adequate oxygenation, as evidenced by signs of respiratory distress and
hypoxia. Administering oxygen directly to the tracheostomy site can immediately
improve oxygen saturation and relieve symptoms. Suctioning may be necessary if
secretions are suspected, but oxygen should be applied first to address hypoxia.
Calling the rapid response team may be necessary if the patient does not improve
after oxygenation is initiated, but it is not the initial step. Reassuring and
observing does not address the emergent need for oxygen. This scenario
illustrates the importance of prompt and prioritized interventions to maintain a
patient’s airway and respiratory function, especially in postoperative or
vulnerable populations.
A nurse is caring for a client who is scheduled for a colonoscopy in the morning.
The provider orders polyethylene glycol-electrolyte solution (GoLYTELY). The
client becomes nauseated and refuses to drink the solution. What should the
nurse do next? A. Encourage the client to drink the solution slowly over time. B.
Notify the provider and request a different bowel prep. C. Cancel the procedure.
D. Administer an antiemetic and try again later. The correct answer is A.
Encourage the client to drink the solution slowly over time. Nausea is a common
side effect of bowel preparation agents like polyethylene glycol. Encouraging the
client to drink the solution slowly over a longer period can help minimize
gastrointestinal distress and promote compliance. Notifying the provider may be
warranted if the client continues to refuse, but the nurse should first attempt to
resolve the issue with simple interventions. Canceling the procedure prematurely
is inappropriate. Administering an antiemetic may be helpful in some cases, but
encouraging fluid intake slowly is a less invasive first step. Nurses must balance
patient comfort with procedural requirements, using evidence-based strategies to
ensure safe and effective preparation.
, 3
A nurse is providing discharge instructions to a client with a new prescription for
warfarin. Which statement by the client indicates a need for further teaching? A.
"I will eat a consistent amount of green leafy vegetables each week." B. "I will
inform all healthcare providers that I’m taking warfarin." C. "I will take aspirin
every day to help thin my blood further." D. "I will have my INR checked
regularly." The correct answer is C. "I will take aspirin every day to help thin my
blood further." This statement indicates a need for further teaching because
taking aspirin in combination with warfarin significantly increases the risk of
bleeding unless explicitly prescribed. Clients on warfarin must be educated about
drug interactions and the potential for additive anticoagulant effects with other
medications like aspirin or NSAIDs. The other statements reflect appropriate
understanding of warfarin management, including the importance of maintaining
consistent dietary intake of vitamin K, notifying all healthcare providers, and
monitoring INR to maintain therapeutic anticoagulation. Patient education is a
cornerstone of safe medication use, especially with high-risk medications such as
anticoagulants, where mismanagement can lead to serious complications like
hemorrhage.
The knowledge and skills acquired in medical-surgical nursing courses are crucial
to shaping the competency and confidence of future registered nurses.
Throughout training, nurses are introduced to complex physiological concepts,
pathophysiology, pharmacological interventions, and holistic care strategies
needed for a diverse adult patient population. These foundational teachings equip
nursing students to assess, diagnose, plan, implement, and evaluate care in a
wide range of clinical settings, from acute care hospitals to outpatient
rehabilitation facilities. For instance, understanding the progression of chronic
diseases such as diabetes mellitus, heart failure, or COPD enables nurses to
anticipate complications, implement preventative strategies, and respond
effectively in emergencies. This predictive capacity is not only vital in acute care
but also supports nurses in long-term and community health management.
In practice, medical-surgical content supports the nurse’s ability to prioritize care
effectively using frameworks like Maslow’s hierarchy of needs or the ABCs—
airway, breathing, circulation. Nurses learn to triage appropriately, manage
multiple patients simultaneously, and adapt care based on rapidly changing
clinical presentations. This clinical judgment is honed through case studies,
simulation labs, and critical thinking exercises taught during med-surg rotations.
Moreover, these skills translate seamlessly into any nursing specialty, whether it's
