ATI RN ADULT MEDICAL-SURGICAL PROCTORED EXAM – PRACTICE QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
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Core Domains
Fluid and Electrolytes
Perioperative Care
Cardiovascular and Hematologic Disorders
Respiratory System Management
Gastrointestinal and Nutritional Health
Endocrine and Metabolic Function
Neurological and Sensory Integration
Renal and Urinary System Disorders
Musculoskeletal and Integumentary Health
Infectious Disease and Immune Response
Introduction
This practice assessment is designed to evaluate a nurse's competency and clinical judgment
within the scope of adult medical-surgical nursing. The purpose of this exam is to mirror the rigor
of professional certification, focusing on the safe and effective care of the adult client across
various healthcare settings. The assessment utilizes a blend of foundational multiple-choice
questions and complex scenario-based items to test critical thinking. Skills assessed include
diagnostic interpretation, pharmacology, prioritization, and the implementation of evidence-based
interventions. With a heavy emphasis on real-world application, this tool prepares candidates for
high-stakes decision-making and the complexities of modern clinical practice.
,SECTION ONE: QUESTIONS 1–100
1. A nurse is assessing a client who has a suspected tension pneumothorax. Which of the
following findings should the nurse expect?
A. Tracheal deviation toward the affected side
B. Paradoxical chest wall movement
C. Flattened neck veins
D. Distant or absent breath sounds on the affected side
🟢 Correct answer: D
🔴 RATIONALE: A tension pneumothorax causes a buildup of air in the pleural space, leading to
lung collapse and absent breath sounds on the affected side. Tracheal deviation occurs toward
the unaffected side, and neck veins typically become distended.
2. A nurse is caring for a client with a prescription for a transfusion of packed red blood cells.
Which of the following actions is the priority before beginning the transfusion?
A. Verify the client’s identity using two identifiers and the blood product with another nurse
B. Ensure a 22-gauge intravenous catheter is patent
C. Administer pre-medication diphenhydramine
D. Document the baseline vital signs
🟢 Correct answer: A
🔴 RATIONALE: Verification of the correct client and blood product is the highest priority to
prevent a hemolytic transfusion reaction, which can be fatal. While patent IV access and vital
signs are necessary, identification is the critical safety step.
3. A nurse is evaluating the laboratory results for a client with Addison’s disease. Which of
the following findings should the nurse anticipate?
,A. Hypernatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hyperglycemia
🟢 Correct answer: B
🔴 RATIONALE: Addison’s disease involves adrenal insufficiency, leading to decreased
aldosterone and cortisol. This results in the retention of potassium (hyperkalemia) and the loss of
sodium and water.
4. A client who is 24 hours postoperative following a total hip arthroplasty reports sudden
chest pain and dyspnea. Which of the following is the nurse’s priority action?
A. Obtain an electrocardiogram
B. Administer an oral analgesic
C. Apply supplemental oxygen via nasal cannula
D. Inspect the surgical incision site
🟢 Correct answer: C
🔴 RATIONALE: Sudden chest pain and dyspnea in a postoperative client are indicative of a
pulmonary embolism. The nurse's priority is to stabilize respiratory status by providing oxygen
before proceeding with further diagnostics.
5. A nurse is providing discharge teaching to a client following a thyroidectomy. Which of the
following symptoms should the nurse instruct the client to report immediately?
A. Hoarseness of the voice
B. Tingling in the fingers and toes
C. Incisional pain
D. Fatigue
🟢 Correct answer: B
, 🔴 RATIONALE: Tingling in the extremities (paresthesia) is a sign of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during a thyroidectomy.
This can lead to tetany and airway compromise.
6. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 2 L/min via nasal cannula. The client’s SpO2 is 89%. Which of the
following actions should the nurse take?
A. Increase the oxygen flow to 6 L/min
B. Place the client in a high-Fowler's position
C. Prepare for immediate endotracheal intubation
D. Encourage the client to breathe into a paper bag
🟢 Correct answer: B
🔴 RATIONALE: High-Fowler's position maximizes chest expansion and improves gas exchange
in clients with COPD. Increasing oxygen too high in COPD clients can potentially suppress their
hypoxic drive to breathe.
7. A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2 52
mmHg, HCO3 26 mEq/L. The nurse should interpret these results as:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
🟢 Correct answer: C
🔴 RATIONALE: A pH below 7.35 indicates acidosis. The elevated PaCO2 (above 45 mmHg)
indicates that the primary cause is respiratory, while the normal bicarbonate level shows the
condition is uncompensated.
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF.
Core Domains
Fluid and Electrolytes
Perioperative Care
Cardiovascular and Hematologic Disorders
Respiratory System Management
Gastrointestinal and Nutritional Health
Endocrine and Metabolic Function
Neurological and Sensory Integration
Renal and Urinary System Disorders
Musculoskeletal and Integumentary Health
Infectious Disease and Immune Response
Introduction
This practice assessment is designed to evaluate a nurse's competency and clinical judgment
within the scope of adult medical-surgical nursing. The purpose of this exam is to mirror the rigor
of professional certification, focusing on the safe and effective care of the adult client across
various healthcare settings. The assessment utilizes a blend of foundational multiple-choice
questions and complex scenario-based items to test critical thinking. Skills assessed include
diagnostic interpretation, pharmacology, prioritization, and the implementation of evidence-based
interventions. With a heavy emphasis on real-world application, this tool prepares candidates for
high-stakes decision-making and the complexities of modern clinical practice.
,SECTION ONE: QUESTIONS 1–100
1. A nurse is assessing a client who has a suspected tension pneumothorax. Which of the
following findings should the nurse expect?
A. Tracheal deviation toward the affected side
B. Paradoxical chest wall movement
C. Flattened neck veins
D. Distant or absent breath sounds on the affected side
🟢 Correct answer: D
🔴 RATIONALE: A tension pneumothorax causes a buildup of air in the pleural space, leading to
lung collapse and absent breath sounds on the affected side. Tracheal deviation occurs toward
the unaffected side, and neck veins typically become distended.
2. A nurse is caring for a client with a prescription for a transfusion of packed red blood cells.
Which of the following actions is the priority before beginning the transfusion?
A. Verify the client’s identity using two identifiers and the blood product with another nurse
B. Ensure a 22-gauge intravenous catheter is patent
C. Administer pre-medication diphenhydramine
D. Document the baseline vital signs
🟢 Correct answer: A
🔴 RATIONALE: Verification of the correct client and blood product is the highest priority to
prevent a hemolytic transfusion reaction, which can be fatal. While patent IV access and vital
signs are necessary, identification is the critical safety step.
3. A nurse is evaluating the laboratory results for a client with Addison’s disease. Which of
the following findings should the nurse anticipate?
,A. Hypernatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hyperglycemia
🟢 Correct answer: B
🔴 RATIONALE: Addison’s disease involves adrenal insufficiency, leading to decreased
aldosterone and cortisol. This results in the retention of potassium (hyperkalemia) and the loss of
sodium and water.
4. A client who is 24 hours postoperative following a total hip arthroplasty reports sudden
chest pain and dyspnea. Which of the following is the nurse’s priority action?
A. Obtain an electrocardiogram
B. Administer an oral analgesic
C. Apply supplemental oxygen via nasal cannula
D. Inspect the surgical incision site
🟢 Correct answer: C
🔴 RATIONALE: Sudden chest pain and dyspnea in a postoperative client are indicative of a
pulmonary embolism. The nurse's priority is to stabilize respiratory status by providing oxygen
before proceeding with further diagnostics.
5. A nurse is providing discharge teaching to a client following a thyroidectomy. Which of the
following symptoms should the nurse instruct the client to report immediately?
A. Hoarseness of the voice
B. Tingling in the fingers and toes
C. Incisional pain
D. Fatigue
🟢 Correct answer: B
, 🔴 RATIONALE: Tingling in the extremities (paresthesia) is a sign of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during a thyroidectomy.
This can lead to tetany and airway compromise.
6. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 2 L/min via nasal cannula. The client’s SpO2 is 89%. Which of the
following actions should the nurse take?
A. Increase the oxygen flow to 6 L/min
B. Place the client in a high-Fowler's position
C. Prepare for immediate endotracheal intubation
D. Encourage the client to breathe into a paper bag
🟢 Correct answer: B
🔴 RATIONALE: High-Fowler's position maximizes chest expansion and improves gas exchange
in clients with COPD. Increasing oxygen too high in COPD clients can potentially suppress their
hypoxic drive to breathe.
7. A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2 52
mmHg, HCO3 26 mEq/L. The nurse should interpret these results as:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
🟢 Correct answer: C
🔴 RATIONALE: A pH below 7.35 indicates acidosis. The elevated PaCO2 (above 45 mmHg)
indicates that the primary cause is respiratory, while the normal bicarbonate level shows the
condition is uncompensated.
