ATI RN Adult Medical Surgical Respiratory
Proctored Exam 2026/2027 | Real Exam Q&As |
Verified Answers & Detailed Rationales | Graded
A+ | pdf
Covering Diagnostic Procedures (Thoracentesis, Bronchoscopy), Chronic Conditions (COPD,
Asthma, CF), Infections (TB, Pneumonia), and Critical Care (ARDS, Ventilator Alarms, Chest
Tubes).
Section 1 Diagnostics, Assessments & Chronic Care
1. A nurse is assessing a client following a bronchoscopy. Which of the following
findings should the nurse report to the provider immediately?
A) Blood-tinged sputum
B) Dry, nonproductive cough
C) Laryngospasm
D) Sore throat
Answer: C) Laryngospasm
[!NOTE]
Explanation: Laryngospasm is a life-threatening complication where the vocal cords
seize, obstructing the airway. While blood-tinged sputum and a sore throat are expected
findings after the scope, respiratory distress or stridor requires immediate intervention
(ABCs).
2. A nurse is preparing a client for a thoracentesis. In which position should the
nurse place the client?
A) Prone with the head turned to the side
B) High-Fowler's with the arms at the side
C) Sitting on the edge of the bed leaning over a bedside table
D) Supine with the affected side elevated
Answer: C) Sitting on the edge of the bed leaning over a bedside table
,[!NOTE]
Explanation: This position spreads the ribs and widens the intercostal spaces,
providing the best access to the pleural space while allowing the lungs to expand.
3. A nurse is caring for a client with a chest tube connected to a water seal
drainage system. The nurse notes continuous bubbling in the water seal
chamber. Which of the following is the correct interpretation?
A) The lung has fully re-expanded.
B) The system is functioning normally.
C) There is an air leak in the system.
D) The suction pressure is too high.
Answer: C) There is an air leak in the system.
[!NOTE]
Explanation: Continuous bubbling in the water seal chamber indicates air is entering
the system from a leak. "Tidaling" (intermittent bubbling or rising/falling with breath) is
normal; continuous bubbling is not.
4. A nurse is providing discharge teaching to a client with a new prescription for
Albuterol and Beclomethasone inhalers. Which instruction is the priority?
A) "Rinse your mouth after using the beclomethasone."
B) "Use the albuterol inhaler first, then wait 5 minutes before using the
beclomethasone."
C) "Clean the mouthpieces with soap and water daily."
D) "Carry the beclomethasone with you for sudden shortness of breath."
Answer: B) "Use the albuterol inhaler first, then wait 5 minutes before using the
beclomethasone."
[!NOTE]
Explanation: Albuterol is a bronchodilator (rescue) and beclomethasone is a
corticosteroid (maintenance). Using the bronchodilator first opens the airways, allowing
the steroid to penetrate deeper into the lung tissue.
5. A nurse is assessing a client with a suspected pulmonary embolism (PE).
Which of the following is the most common clinical manifestation?
,A) Bradypnea
B) Sudden onset of dyspnea
C) Clubbing of the fingers
D) Non-productive, hacking cough
Answer: B) Sudden onset of dyspnea
[!NOTE]
Explanation: PE typically presents with sudden shortness of breath, pleuritic chest
pain, and restlessness/apprehension due to impaired gas exchange.
6. A nurse is interpreting Arterial Blood Gas (ABG) results for a client with COPD:
pH 7.31, PaCO2 52 mmHg, HCO3 25 mEq/L. Which imbalance is present?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C) Respiratory acidosis
[!NOTE]
Explanation: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45),
indicating a respiratory cause (CO2 retention). This is the classic ABG pattern for
COPD.
7. A nurse is assessing a client with emphysema. Which of the following physical
findings is expected?
A) Pectus excavatum
B) Increased tactile fremitus
C) Barrel chest
D) Tracheal deviation
Answer: C) Barrel chest
[!NOTE]
Explanation: Chronic air trapping and hyperinflation in emphysema lead to an
increased anteroposterior diameter of the chest, commonly called a barrel chest.
, 8. A nurse is monitoring a client with a chest tube. The nurse notes the tidaling in
the water seal chamber has stopped. What is the most likely reason?
A) The client is experiencing a tension pneumothorax.
B) The lung has fully re-expanded.
C) The suction has been turned off.
D) The client is hyperventilating.
Answer: B) The lung has fully re-expanded.
[!NOTE]
Explanation: Tidaling stops when the lung is fully re-expanded (blocking the eyelets of
the tube) or if there is a kink/obstruction in the tubing.
9. A nurse is caring for a client with bacterial pneumonia. Which of the following
adventitious breath sounds should the nurse expect to hear?
A) Sibilant wheezes
B) Crackles
C) Friction rub
D) Stridor
Answer: B) Crackles
[!NOTE]
Explanation: Crackles (râles) are caused by air passing through fluid or exudate in the
small airways and alveoli, which is characteristic of pneumonia consolidation.
10. A nurse is providing education to a client with Tuberculosis (TB) who is
starting Rifampin. Which side effect should the nurse tell the client to expect?
A) Tingling in the hands and feet
B) Orange discoloration of urine and sweat
C) Blurred vision or color blindness
D) Persistent dry cough
Answer: B) Orange discoloration of urine and sweat
[!NOTE]
Explanation: Rifampin causes a harmless orange-red discoloration of body fluids
(urine, sweat, tears, saliva).
Proctored Exam 2026/2027 | Real Exam Q&As |
Verified Answers & Detailed Rationales | Graded
A+ | pdf
Covering Diagnostic Procedures (Thoracentesis, Bronchoscopy), Chronic Conditions (COPD,
Asthma, CF), Infections (TB, Pneumonia), and Critical Care (ARDS, Ventilator Alarms, Chest
Tubes).
Section 1 Diagnostics, Assessments & Chronic Care
1. A nurse is assessing a client following a bronchoscopy. Which of the following
findings should the nurse report to the provider immediately?
A) Blood-tinged sputum
B) Dry, nonproductive cough
C) Laryngospasm
D) Sore throat
Answer: C) Laryngospasm
[!NOTE]
Explanation: Laryngospasm is a life-threatening complication where the vocal cords
seize, obstructing the airway. While blood-tinged sputum and a sore throat are expected
findings after the scope, respiratory distress or stridor requires immediate intervention
(ABCs).
2. A nurse is preparing a client for a thoracentesis. In which position should the
nurse place the client?
A) Prone with the head turned to the side
B) High-Fowler's with the arms at the side
C) Sitting on the edge of the bed leaning over a bedside table
D) Supine with the affected side elevated
Answer: C) Sitting on the edge of the bed leaning over a bedside table
,[!NOTE]
Explanation: This position spreads the ribs and widens the intercostal spaces,
providing the best access to the pleural space while allowing the lungs to expand.
3. A nurse is caring for a client with a chest tube connected to a water seal
drainage system. The nurse notes continuous bubbling in the water seal
chamber. Which of the following is the correct interpretation?
A) The lung has fully re-expanded.
B) The system is functioning normally.
C) There is an air leak in the system.
D) The suction pressure is too high.
Answer: C) There is an air leak in the system.
[!NOTE]
Explanation: Continuous bubbling in the water seal chamber indicates air is entering
the system from a leak. "Tidaling" (intermittent bubbling or rising/falling with breath) is
normal; continuous bubbling is not.
4. A nurse is providing discharge teaching to a client with a new prescription for
Albuterol and Beclomethasone inhalers. Which instruction is the priority?
A) "Rinse your mouth after using the beclomethasone."
B) "Use the albuterol inhaler first, then wait 5 minutes before using the
beclomethasone."
C) "Clean the mouthpieces with soap and water daily."
D) "Carry the beclomethasone with you for sudden shortness of breath."
Answer: B) "Use the albuterol inhaler first, then wait 5 minutes before using the
beclomethasone."
[!NOTE]
Explanation: Albuterol is a bronchodilator (rescue) and beclomethasone is a
corticosteroid (maintenance). Using the bronchodilator first opens the airways, allowing
the steroid to penetrate deeper into the lung tissue.
5. A nurse is assessing a client with a suspected pulmonary embolism (PE).
Which of the following is the most common clinical manifestation?
,A) Bradypnea
B) Sudden onset of dyspnea
C) Clubbing of the fingers
D) Non-productive, hacking cough
Answer: B) Sudden onset of dyspnea
[!NOTE]
Explanation: PE typically presents with sudden shortness of breath, pleuritic chest
pain, and restlessness/apprehension due to impaired gas exchange.
6. A nurse is interpreting Arterial Blood Gas (ABG) results for a client with COPD:
pH 7.31, PaCO2 52 mmHg, HCO3 25 mEq/L. Which imbalance is present?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C) Respiratory acidosis
[!NOTE]
Explanation: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45),
indicating a respiratory cause (CO2 retention). This is the classic ABG pattern for
COPD.
7. A nurse is assessing a client with emphysema. Which of the following physical
findings is expected?
A) Pectus excavatum
B) Increased tactile fremitus
C) Barrel chest
D) Tracheal deviation
Answer: C) Barrel chest
[!NOTE]
Explanation: Chronic air trapping and hyperinflation in emphysema lead to an
increased anteroposterior diameter of the chest, commonly called a barrel chest.
, 8. A nurse is monitoring a client with a chest tube. The nurse notes the tidaling in
the water seal chamber has stopped. What is the most likely reason?
A) The client is experiencing a tension pneumothorax.
B) The lung has fully re-expanded.
C) The suction has been turned off.
D) The client is hyperventilating.
Answer: B) The lung has fully re-expanded.
[!NOTE]
Explanation: Tidaling stops when the lung is fully re-expanded (blocking the eyelets of
the tube) or if there is a kink/obstruction in the tubing.
9. A nurse is caring for a client with bacterial pneumonia. Which of the following
adventitious breath sounds should the nurse expect to hear?
A) Sibilant wheezes
B) Crackles
C) Friction rub
D) Stridor
Answer: B) Crackles
[!NOTE]
Explanation: Crackles (râles) are caused by air passing through fluid or exudate in the
small airways and alveoli, which is characteristic of pneumonia consolidation.
10. A nurse is providing education to a client with Tuberculosis (TB) who is
starting Rifampin. Which side effect should the nurse tell the client to expect?
A) Tingling in the hands and feet
B) Orange discoloration of urine and sweat
C) Blurred vision or color blindness
D) Persistent dry cough
Answer: B) Orange discoloration of urine and sweat
[!NOTE]
Explanation: Rifampin causes a harmless orange-red discoloration of body fluids
(urine, sweat, tears, saliva).
