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RN ATI ADULT MEDICAL SURGICAL PROCTORED EXAM 2019
WITH 600 NGN STYLE QUESTIONS WITH HIGHLIGHTED
CORRECT SOLUTIONS PLUS DETAILED RATIONALES 2025/2026
NEWEST VERSION
CARDIOVASCULAR & HEMATOLOGIC DISORDERS
1. A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor. Which of the
following should the nurse analyze to determine whether the client is experiencing a myocardial infarction?
A. PR interval
B. QRS duration
C. T wave
D. ST segment
Rationale: ST elevation indicates myocardial infarction. ST depression indicates ischemia. PR interval relates to
first-degree heart block; QRS duration indicates ventricular conduction delay; T wave changes may indicate
electrolyte imbalances or ischemia but are not diagnostic for MI.
2. A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that the client has
bounding peripheral pulses, hypertension, and distended jugular veins. The nurse should anticipate
administering which of the following prescribed medications?
A. Diphenhydramine
B. Acetaminophen
C. Pantoprazole
D. Furosemide
Rationale: These signs (bounding pulses, hypertension, JVD) indicate fluid overload or heart failure from
transfusion. Furosemide is a loop diuretic that reduces preload and alleviates cardiovascular/respiratory
distress.
3. A nurse is monitoring the ECG of a client who has hypocalcemia. Which of the following findings should the
nurse expect?
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A. Flattened T waves
B. Prolonged QT intervals
C. Shortened QT intervals
D. Widened QRS complexes
Rationale: Hypocalcemia prolongs the QT interval on ECG. Flattened T waves are seen with hypokalemia;
widened QRS complexes occur with hyperkalemia.
4. A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower
extremities and is pending an escharotomy. Which of the following nursing statements is appropriate when the
client's spouse asks what the procedure entails?
A. "Large incisions will be made in the eschar to improve circulation."
B. "I can call the doctor back here if you want me to."
C. "A piece of skin will be removed and grafted over the burned area."
D. "Dead tissue will be surgically removed."
Rationale: Escharotomy involves incisions through the eschar (hardened burned tissue) to relieve pressure and
restore circulation. This prevents compartment syndrome. Skin grafting (C) is a separate procedure;
debridement (D) removes dead tissue.
5. A nurse is caring for a client who has a deep partial thickness burns over 15% of her body. Which of the
following labs should the nurse expect during the first 24 hours?
A. Decreased BUN
B. Hypoglycemia
C. Hypoalbuminemia
D. Decreased Hematocrit
Rationale: Burn injury causes fluid loss and third-spacing, leading to decreased serum protein
(hypoalbuminemia). BUN is elevated due to dehydration, blood glucose is elevated due to stress response, and
hematocrit is elevated due to hemoconcentration
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6. A nurse is reviewing a client's ABG results: pH 7.42, PaCO₂ 30 mm Hg, and HCO₃ 21 mEq/L. The nurse should
recognize these findings as indication of which of the following conditions?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Compensated respiratory alkalosis
D. Uncompensated respiratory acidosis
Rationale: pH is within normal range (7.35-7.45). PaCO₂ is low (normal 35-45), indicating respiratory alkalosis.
HCO₃ is slightly low (normal 22-26), indicating metabolic compensation. The kidneys have decreased HCO₃ to
compensate for the low PaCO₂.
ENDOCRINE DISORDERS
7. A nurse is caring for a client who has diabetes insipidus. Which of the following medications should the nurse
plan to administer?
A. Desmopressin
B. Regular insulin
C. Furosemide
D. Lithium carbonate
Rationale: Diabetes insipidus results from decreased ADH secretion (central) or decreased kidney response
(nephrogenic). Desmopressin (synthetic ADH) replaces ADH, reducing urine output and thirst. Lithium can
actually cause nephrogenic diabetes insipidus.
8. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse
expect?
A. Low urine specific gravity
B. High urine specific gravity
C. Hyperglycemia
D. Hypertension
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Rationale: Diabetes insipidus causes excessive dilute urine output. Urine specific gravity is low (1.001-1.005).
High specific gravity occurs with dehydration or SIADH. Hyperglycemia is seen in diabetes mellitus.
9. A nurse is reviewing the medical record of a client who has systemic lupus erythematosus (SLE). Which of the
following findings should the nurse expect?
A. Facial butterfly rash
B. Weight gain
C. Bradycardia
D. Hypothermia
Rationale: A butterfly (malar) rash across the cheeks and nose is a classic manifestation of SLE. Other findings
include photosensitivity, joint pain, fatigue, and renal involvement.
GASTROINTESTINAL DISORDERS
10. A nurse is assessing a client who is 12 hr postoperative following a colon resection. Which of the following
findings should the nurse report to the surgeon?
A. Heart rate 90/min
B. Absent bowel sounds
C. Hgb 8.2 g/dL
D. Gastric pH of 3.0
Rationale: Hemoglobin of 8.2 g/dL is significantly low (normal male 13-18, female 12-16) and may indicate
postoperative hemorrhage. Tachycardia (90/min) is mild and expected post-op. Absent bowel sounds are
normal immediately after bowel surgery. Gastric pH 3.0 is normal.
11. A nurse is caring for a client who has dumping syndrome following a gastrectomy. Which of the following
actions should the nurse take?
A. Offer the client high carbohydrate meal options
B. Provide the client with four full meals a day
C. Encourage the client to drink at least 360 mL of fluids with meals
4 SUCCESS!!!
RN ATI ADULT MEDICAL SURGICAL PROCTORED EXAM 2019
WITH 600 NGN STYLE QUESTIONS WITH HIGHLIGHTED
CORRECT SOLUTIONS PLUS DETAILED RATIONALES 2025/2026
NEWEST VERSION
CARDIOVASCULAR & HEMATOLOGIC DISORDERS
1. A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor. Which of the
following should the nurse analyze to determine whether the client is experiencing a myocardial infarction?
A. PR interval
B. QRS duration
C. T wave
D. ST segment
Rationale: ST elevation indicates myocardial infarction. ST depression indicates ischemia. PR interval relates to
first-degree heart block; QRS duration indicates ventricular conduction delay; T wave changes may indicate
electrolyte imbalances or ischemia but are not diagnostic for MI.
2. A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that the client has
bounding peripheral pulses, hypertension, and distended jugular veins. The nurse should anticipate
administering which of the following prescribed medications?
A. Diphenhydramine
B. Acetaminophen
C. Pantoprazole
D. Furosemide
Rationale: These signs (bounding pulses, hypertension, JVD) indicate fluid overload or heart failure from
transfusion. Furosemide is a loop diuretic that reduces preload and alleviates cardiovascular/respiratory
distress.
3. A nurse is monitoring the ECG of a client who has hypocalcemia. Which of the following findings should the
nurse expect?
1 SUCCESS!!!
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A. Flattened T waves
B. Prolonged QT intervals
C. Shortened QT intervals
D. Widened QRS complexes
Rationale: Hypocalcemia prolongs the QT interval on ECG. Flattened T waves are seen with hypokalemia;
widened QRS complexes occur with hyperkalemia.
4. A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower
extremities and is pending an escharotomy. Which of the following nursing statements is appropriate when the
client's spouse asks what the procedure entails?
A. "Large incisions will be made in the eschar to improve circulation."
B. "I can call the doctor back here if you want me to."
C. "A piece of skin will be removed and grafted over the burned area."
D. "Dead tissue will be surgically removed."
Rationale: Escharotomy involves incisions through the eschar (hardened burned tissue) to relieve pressure and
restore circulation. This prevents compartment syndrome. Skin grafting (C) is a separate procedure;
debridement (D) removes dead tissue.
5. A nurse is caring for a client who has a deep partial thickness burns over 15% of her body. Which of the
following labs should the nurse expect during the first 24 hours?
A. Decreased BUN
B. Hypoglycemia
C. Hypoalbuminemia
D. Decreased Hematocrit
Rationale: Burn injury causes fluid loss and third-spacing, leading to decreased serum protein
(hypoalbuminemia). BUN is elevated due to dehydration, blood glucose is elevated due to stress response, and
hematocrit is elevated due to hemoconcentration
2 SUCCESS!!!
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6. A nurse is reviewing a client's ABG results: pH 7.42, PaCO₂ 30 mm Hg, and HCO₃ 21 mEq/L. The nurse should
recognize these findings as indication of which of the following conditions?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Compensated respiratory alkalosis
D. Uncompensated respiratory acidosis
Rationale: pH is within normal range (7.35-7.45). PaCO₂ is low (normal 35-45), indicating respiratory alkalosis.
HCO₃ is slightly low (normal 22-26), indicating metabolic compensation. The kidneys have decreased HCO₃ to
compensate for the low PaCO₂.
ENDOCRINE DISORDERS
7. A nurse is caring for a client who has diabetes insipidus. Which of the following medications should the nurse
plan to administer?
A. Desmopressin
B. Regular insulin
C. Furosemide
D. Lithium carbonate
Rationale: Diabetes insipidus results from decreased ADH secretion (central) or decreased kidney response
(nephrogenic). Desmopressin (synthetic ADH) replaces ADH, reducing urine output and thirst. Lithium can
actually cause nephrogenic diabetes insipidus.
8. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse
expect?
A. Low urine specific gravity
B. High urine specific gravity
C. Hyperglycemia
D. Hypertension
3 SUCCESS!!!
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Rationale: Diabetes insipidus causes excessive dilute urine output. Urine specific gravity is low (1.001-1.005).
High specific gravity occurs with dehydration or SIADH. Hyperglycemia is seen in diabetes mellitus.
9. A nurse is reviewing the medical record of a client who has systemic lupus erythematosus (SLE). Which of the
following findings should the nurse expect?
A. Facial butterfly rash
B. Weight gain
C. Bradycardia
D. Hypothermia
Rationale: A butterfly (malar) rash across the cheeks and nose is a classic manifestation of SLE. Other findings
include photosensitivity, joint pain, fatigue, and renal involvement.
GASTROINTESTINAL DISORDERS
10. A nurse is assessing a client who is 12 hr postoperative following a colon resection. Which of the following
findings should the nurse report to the surgeon?
A. Heart rate 90/min
B. Absent bowel sounds
C. Hgb 8.2 g/dL
D. Gastric pH of 3.0
Rationale: Hemoglobin of 8.2 g/dL is significantly low (normal male 13-18, female 12-16) and may indicate
postoperative hemorrhage. Tachycardia (90/min) is mild and expected post-op. Absent bowel sounds are
normal immediately after bowel surgery. Gastric pH 3.0 is normal.
11. A nurse is caring for a client who has dumping syndrome following a gastrectomy. Which of the following
actions should the nurse take?
A. Offer the client high carbohydrate meal options
B. Provide the client with four full meals a day
C. Encourage the client to drink at least 360 mL of fluids with meals
4 SUCCESS!!!
