ATI RN ADULT MEDICAL-SURGICAL PROCTORED EXAM – PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
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CORE DOMAINS
• Fluid and Electrolyte Imbalances• Cardiac and Vascular Disorders• Perioperative Nursing Care• Neurological and Sensory Alterations• Endocrine and Metabolic Disorders•
Respiratory Management and Oxygenation• Gastrointestinal and Nutritional Support• Renal and Urinary System Management• Musculoskeletal and Integumentary Care• Oncology
and Palliative Nursing
INTRODUCTION
The ATI RN Adult Medical-Surgical Proctored Exam Practice Assessment is designed to evaluate a student's competency in the care of adult clients across various clinical settings. This
exam assesses foundational knowledge, critical thinking, and the ability to apply nursing principles to complex physiological scenarios. The assessment features a comprehensive
range of multiple-choice and scenario-based questions that mirror real-world clinical decision-making. Key areas of focus include safety, infection control, pharmacological
interventions, and the management of both acute and chronic conditions. By engaging with these questions, learners demonstrate their readiness to provide high-quality, evidence-
based care within the professional nursing scope of practice.
1. A nurse is assessing a client who has a chest tube connected to a water-seal drainage system. Which of the following findings should the nurse report to the provider?
A. Fluctuations in the water-seal chamber with respiration
B. Constant bubbling in the suction control chamber
C. Continuous bubbling in the water-seal chamber
D. 50 mL of serosanguineous drainage in the collection chamber over 2 hr
🟢 C. Continuous bubbling in the water-seal chamber
🔴 RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which requires immediate intervention. Intermittent bubbling or fluctuations
(tidaling) are normal findings.
2. A nurse is caring for a client who is 4 hr postoperative following a subtotal thyroidectomy. Which of the following is the priority assessment?
A. Level of pain
B. Laryngeal nerve damage
C. Incisional drainage
D. Urinary output
🟢 B. Laryngeal nerve damage
🔴 RATIONALE: Using the ABC priority framework, airway patency is the priority. Laryngeal nerve damage can cause vocal cord paralysis and airway obstruction.
3. A nurse is providing teaching to a client who has a new prescription for digoxin. Which of the following instructions should the nurse include?
A. Take the medication with an antacid to prevent GI upset.
B. Increase intake of dietary fiber to prevent constipation.
,C. Report manifestations of yellow-tinged vision.
D. Expect a heart rate of less than 50 beats per minute.
🟢 C. Report manifestations of yellow-tinged vision.
🔴 RATIONALE: Yellow or blurred vision, along with nausea and bradycardia, are classic signs of digoxin toxicity and must be reported immediately.
4. A nurse is planning care for a client who has a prescription for a peripheral IV. Which of the following actions should the nurse take?
A. Use a 18-gauge needle for routine fluid administration.
B. Shave the site before insertion to improve adherence.
C. Select a site on the client's non-dominant arm.
D. Cleanse the site with cool water for 30 seconds.
🟢 C. Select a site on the client's non-dominant arm.
🔴 RATIONALE: Using the non-dominant arm promotes client independence and reduces the risk of accidental dislodgement during activities of daily living.
5. A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2 52 mm Hg, HCO3 26 mEq/L. The nurse should identify these results as which of the
following?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
🟢 B. Respiratory acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis. An elevated PaCO2 (above 45 mm Hg) with a normal HCO3 confirms the origin is respiratory.
6. A nurse is preparing to administer a unit of packed RBCs to a client. Which of the following actions should the nurse take first?
A. Verify the client’s identity using two identifiers.
B. Obtain the client's pre-transfusion vital signs.
C. Prime the tubing with 0.9% sodium chloride.
D. Verify the blood product with a second nurse.
🟢 B. Obtain the client's pre-transfusion vital signs.
🔴 RATIONALE: Obtaining a baseline set of vital signs is the first step to ensure any subsequent changes during the transfusion can be accurately identified.
7. A nurse is caring for a client who has a suspected small bowel obstruction. Which of the following findings should the nurse expect?
A. Profuse vomiting
B. Ribbon-like stools
C. Distention of the lower abdomen
D. Increased flatulence
, 🟢 A. Profuse vomiting
🔴 RATIONALE: Small bowel obstructions typically present with rapid onset of projectile or profuse vomiting, whereas large bowel obstructions often involve lower abdominal
distention and constipation.
8. A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following statements should the nurse include?
A. Exercise during the peak of insulin action.
B. Avoid exercise if blood glucose is greater than 250 mg/dL and ketones are present.
C. Decrease carbohydrate intake before exercising.
D. Perform exercise in the late evening before bed.
🟢 B. Avoid exercise if blood glucose is greater than 250 mg/dL and ketones are present.
🔴 RATIONALE: Exercising when ketones are present can lead to further hyperglycemia and ketoacidosis due to the lack of available insulin.
9. A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect?
A. Hypotension
B. Weight loss
C. Moon face
D. Hyponatremia
🟢 C. Moon face
🔴 RATIONALE: Cushing's syndrome results from excess cortisol, leading to fat redistribution (moon face, buffalo hump), weight gain, and hypertension.
10. A nurse is caring for a client who has a stage 3 pressure injury. Which of the following findings should the nurse expect?
A. Intact skin with non-blanchable redness
B. Partial-thickness skin loss involving the dermis
C. Deep tissue destruction with exposed bone
D. Full-thickness skin loss with visible subcutaneous fat
🟢 D. Full-thickness skin loss with visible subcutaneous fat
🔴 RATIONALE: Stage 3 pressure injuries involve full-thickness skin loss where subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed.
11. A nurse is providing discharge instructions to a client who had a total hip arthroplasty. Which of the following instructions should the nurse include?
A. Cross your legs at the ankles when sitting.
B. Clean the incision with hydrogen peroxide daily.
C. Avoid flexing the hip more than 90 degrees.
D. Use a low-seat chair for comfort.
🟢 C. Avoid flexing the hip more than 90 degrees.
🔴 RATIONALE: To prevent hip dislocation, the client should avoid hip flexion greater than 90 degrees and avoid crossing the legs or adduction of the affected limb.
INSTANT DOWNLOAD PDF.
CORE DOMAINS
• Fluid and Electrolyte Imbalances• Cardiac and Vascular Disorders• Perioperative Nursing Care• Neurological and Sensory Alterations• Endocrine and Metabolic Disorders•
Respiratory Management and Oxygenation• Gastrointestinal and Nutritional Support• Renal and Urinary System Management• Musculoskeletal and Integumentary Care• Oncology
and Palliative Nursing
INTRODUCTION
The ATI RN Adult Medical-Surgical Proctored Exam Practice Assessment is designed to evaluate a student's competency in the care of adult clients across various clinical settings. This
exam assesses foundational knowledge, critical thinking, and the ability to apply nursing principles to complex physiological scenarios. The assessment features a comprehensive
range of multiple-choice and scenario-based questions that mirror real-world clinical decision-making. Key areas of focus include safety, infection control, pharmacological
interventions, and the management of both acute and chronic conditions. By engaging with these questions, learners demonstrate their readiness to provide high-quality, evidence-
based care within the professional nursing scope of practice.
1. A nurse is assessing a client who has a chest tube connected to a water-seal drainage system. Which of the following findings should the nurse report to the provider?
A. Fluctuations in the water-seal chamber with respiration
B. Constant bubbling in the suction control chamber
C. Continuous bubbling in the water-seal chamber
D. 50 mL of serosanguineous drainage in the collection chamber over 2 hr
🟢 C. Continuous bubbling in the water-seal chamber
🔴 RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which requires immediate intervention. Intermittent bubbling or fluctuations
(tidaling) are normal findings.
2. A nurse is caring for a client who is 4 hr postoperative following a subtotal thyroidectomy. Which of the following is the priority assessment?
A. Level of pain
B. Laryngeal nerve damage
C. Incisional drainage
D. Urinary output
🟢 B. Laryngeal nerve damage
🔴 RATIONALE: Using the ABC priority framework, airway patency is the priority. Laryngeal nerve damage can cause vocal cord paralysis and airway obstruction.
3. A nurse is providing teaching to a client who has a new prescription for digoxin. Which of the following instructions should the nurse include?
A. Take the medication with an antacid to prevent GI upset.
B. Increase intake of dietary fiber to prevent constipation.
,C. Report manifestations of yellow-tinged vision.
D. Expect a heart rate of less than 50 beats per minute.
🟢 C. Report manifestations of yellow-tinged vision.
🔴 RATIONALE: Yellow or blurred vision, along with nausea and bradycardia, are classic signs of digoxin toxicity and must be reported immediately.
4. A nurse is planning care for a client who has a prescription for a peripheral IV. Which of the following actions should the nurse take?
A. Use a 18-gauge needle for routine fluid administration.
B. Shave the site before insertion to improve adherence.
C. Select a site on the client's non-dominant arm.
D. Cleanse the site with cool water for 30 seconds.
🟢 C. Select a site on the client's non-dominant arm.
🔴 RATIONALE: Using the non-dominant arm promotes client independence and reduces the risk of accidental dislodgement during activities of daily living.
5. A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2 52 mm Hg, HCO3 26 mEq/L. The nurse should identify these results as which of the
following?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
🟢 B. Respiratory acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis. An elevated PaCO2 (above 45 mm Hg) with a normal HCO3 confirms the origin is respiratory.
6. A nurse is preparing to administer a unit of packed RBCs to a client. Which of the following actions should the nurse take first?
A. Verify the client’s identity using two identifiers.
B. Obtain the client's pre-transfusion vital signs.
C. Prime the tubing with 0.9% sodium chloride.
D. Verify the blood product with a second nurse.
🟢 B. Obtain the client's pre-transfusion vital signs.
🔴 RATIONALE: Obtaining a baseline set of vital signs is the first step to ensure any subsequent changes during the transfusion can be accurately identified.
7. A nurse is caring for a client who has a suspected small bowel obstruction. Which of the following findings should the nurse expect?
A. Profuse vomiting
B. Ribbon-like stools
C. Distention of the lower abdomen
D. Increased flatulence
, 🟢 A. Profuse vomiting
🔴 RATIONALE: Small bowel obstructions typically present with rapid onset of projectile or profuse vomiting, whereas large bowel obstructions often involve lower abdominal
distention and constipation.
8. A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following statements should the nurse include?
A. Exercise during the peak of insulin action.
B. Avoid exercise if blood glucose is greater than 250 mg/dL and ketones are present.
C. Decrease carbohydrate intake before exercising.
D. Perform exercise in the late evening before bed.
🟢 B. Avoid exercise if blood glucose is greater than 250 mg/dL and ketones are present.
🔴 RATIONALE: Exercising when ketones are present can lead to further hyperglycemia and ketoacidosis due to the lack of available insulin.
9. A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect?
A. Hypotension
B. Weight loss
C. Moon face
D. Hyponatremia
🟢 C. Moon face
🔴 RATIONALE: Cushing's syndrome results from excess cortisol, leading to fat redistribution (moon face, buffalo hump), weight gain, and hypertension.
10. A nurse is caring for a client who has a stage 3 pressure injury. Which of the following findings should the nurse expect?
A. Intact skin with non-blanchable redness
B. Partial-thickness skin loss involving the dermis
C. Deep tissue destruction with exposed bone
D. Full-thickness skin loss with visible subcutaneous fat
🟢 D. Full-thickness skin loss with visible subcutaneous fat
🔴 RATIONALE: Stage 3 pressure injuries involve full-thickness skin loss where subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed.
11. A nurse is providing discharge instructions to a client who had a total hip arthroplasty. Which of the following instructions should the nurse include?
A. Cross your legs at the ankles when sitting.
B. Clean the incision with hydrogen peroxide daily.
C. Avoid flexing the hip more than 90 degrees.
D. Use a low-seat chair for comfort.
🟢 C. Avoid flexing the hip more than 90 degrees.
🔴 RATIONALE: To prevent hip dislocation, the client should avoid hip flexion greater than 90 degrees and avoid crossing the legs or adduction of the affected limb.
