ATI PN Medical Surgical Proctored Exam
Version 17 (2026) | Verified Practice
Questions & Answers | Comprehensive Med-
Surg Study Guide, Practice Exam & NCLEX-
PN Review
ATI PN MEDICAL SURGICAL PROCTORED EXAM VERSION 17 (2026)
Verified Practice Questions & Answers | Comprehensive Med-Surg Study
Guide
• Comprehensive question practice exam designed to mirror the ATI PN
Medical-Surgical proctored assessment with detailed evidence-based
rationales for each answer
• Study guide for independent review—work through questions
systematically, focus on rationales to understand clinical concepts, and use
incorrect answers as learning opportunities to strengthen foundational med-
surg knowledge
1. A 68-year-old client is admitted with a diagnosis of acute myocardial
infarction (AMI). The client complains of chest pain radiating to the left
shoulder and arm. Which of the following nursing interventions is the
priority?
A) Administer oxygen and establish IV access
B) Obtain a 12-lead electrocardiogram (ECG)
C) Assess vital signs and pain characteristics
D) Administer aspirin and nitroglycerin
E) Notify the provider immediately without delay
CORRECT ANSWER: B) Obtain a 12-lead electrocardiogram (ECG)
,RATIONALE: According to American Heart Association guidelines, a 12-lead ECG
should be obtained and interpreted within 10 minutes of client arrival to confirm
AMI diagnosis and guide intervention. While oxygen, IV access, and medications are
important, the ECG is the definitive diagnostic tool that determines further
treatment decisions. This takes priority to establish the diagnosis and baseline
cardiac status.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy via nasal cannula at 2 L/min. The client's respiratory rate is 32
breaths/minute and appears anxious. What is the most appropriate nursing
action?
A) Increase oxygen flow to 4 L/min immediately
B) Assess the client for hypoxia and anxiety triggers
C) Encourage pursed-lip breathing and calm the client
D) Call respiratory therapy to switch to a non-rebreather mask
E) Administer prescribed anxiolytic medication
CORRECT ANSWER: C) Encourage pursed-lip breathing and calm the client
RATIONALE: Pursed-lip breathing is a first-line intervention for COPD clients
experiencing dyspnea because it increases positive airway pressure and prolongs
expiration, promoting CO2 elimination. Calming the client reduces anxiety-related
tachypnea. Increasing oxygen without provider order risks CO2 retention in COPD
clients who rely on hypoxic drive for respiration. Assessment is warranted, but
intervention via pursed-lip breathing and reassurance addresses the immediate
concern.
3. A 45-year-old client is post-operative day 1 following abdominal surgery.
The client has a Jackson-Pratt (JP) drain with 250 mL of serosanguineous
drainage in 24 hours. What is the most appropriate nursing action?
A) Notify the provider immediately; this indicates hemorrhage
,B) Document the finding; this is expected drainage
C) Clamp the drain to prevent further drainage
D) Prepare for drain removal
E) Increase antibiotic coverage
CORRECT ANSWER: B) Document the finding; this is expected drainage
RATIONALE: Serosanguineous drainage (mixture of serum and blood) in moderate
amounts (200-400 mL per 24 hours) on post-operative day 1 is normal and
expected. This indicates adequate healing and absence of major vessel damage.
Documentation is appropriate. Notifying the provider for normal drainage is
unnecessary. Clamping the drain compromises wound healing. Drain removal and
antibiotic changes are not indicated for normal drainage.
4. A client with diabetes mellitus type 2 presents with complaints of increased
thirst, frequent urination, and fatigue. Blood glucose is 450 mg/dL. Which
condition is this client most likely experiencing?
A) Hypoglycemia
B) Diabetic ketoacidosis (DKA)
C) Hyperglycemic hyperosmolar state (HHS)
D) Somogyi effect
E) Dawn phenomenon
CORRECT ANSWER: C) Hyperglycemic hyperosmolar state (HHS)
RATIONALE: HHS is characterized by severe hyperglycemia (>600 mg/dL), increased
osmolality, and minimal or absent ketosis, occurring primarily in type 2 diabetes.
Classic symptoms include polydipsia, polyuria, and fatigue due to osmotic diuresis.
DKA occurs in type 1 diabetes with ketones present. Hypoglycemia presents with
shakiness and diaphoresis. Somogyi effect and dawn phenomenon are related to
insulin dynamics, not acute hyperglycemia of this magnitude.
, 5. A 72-year-old client with congestive heart failure (CHF) is prescribed
furosemide 40 mg daily. Which lab value should the nurse monitor closely?
A) Sodium and chloride levels
B) Potassium and magnesium levels
C) Calcium and phosphate levels
D) Albumin and prealbumin levels
E) Creatinine and BUN levels
CORRECT ANSWER: B) Potassium and magnesium levels
RATIONALE: Loop diuretics like furosemide promote excretion of potassium and
magnesium along with sodium and water. Hypokalemia and hypomagnesemia
increase risk of cardiac arrhythmias, muscle weakness, and muscle cramps. While
sodium and chloride are also affected, potassium depletion is the most clinically
significant concern requiring monitoring and possible supplementation. The nurse
should assess for signs of hypokalemia including weakness, palpitations, and ECG
changes.
6. A 55-year-old client is post-operative day 2 following a total knee
replacement. The client reports calf pain and swelling. Which assessment
finding would increase suspicion for deep vein thrombosis (DVT)?
A) Homan's sign is negative bilaterally
B) Calf circumference is 1 cm larger on the affected side
C) Calf circumference is 3 cm larger on the affected side with redness
D) Pedal pulses are normal and equal bilaterally
E) Skin temperature is normal on both calves
CORRECT ANSWER: C) Calf circumference is 3 cm larger on the affected side
with redness
Version 17 (2026) | Verified Practice
Questions & Answers | Comprehensive Med-
Surg Study Guide, Practice Exam & NCLEX-
PN Review
ATI PN MEDICAL SURGICAL PROCTORED EXAM VERSION 17 (2026)
Verified Practice Questions & Answers | Comprehensive Med-Surg Study
Guide
• Comprehensive question practice exam designed to mirror the ATI PN
Medical-Surgical proctored assessment with detailed evidence-based
rationales for each answer
• Study guide for independent review—work through questions
systematically, focus on rationales to understand clinical concepts, and use
incorrect answers as learning opportunities to strengthen foundational med-
surg knowledge
1. A 68-year-old client is admitted with a diagnosis of acute myocardial
infarction (AMI). The client complains of chest pain radiating to the left
shoulder and arm. Which of the following nursing interventions is the
priority?
A) Administer oxygen and establish IV access
B) Obtain a 12-lead electrocardiogram (ECG)
C) Assess vital signs and pain characteristics
D) Administer aspirin and nitroglycerin
E) Notify the provider immediately without delay
CORRECT ANSWER: B) Obtain a 12-lead electrocardiogram (ECG)
,RATIONALE: According to American Heart Association guidelines, a 12-lead ECG
should be obtained and interpreted within 10 minutes of client arrival to confirm
AMI diagnosis and guide intervention. While oxygen, IV access, and medications are
important, the ECG is the definitive diagnostic tool that determines further
treatment decisions. This takes priority to establish the diagnosis and baseline
cardiac status.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy via nasal cannula at 2 L/min. The client's respiratory rate is 32
breaths/minute and appears anxious. What is the most appropriate nursing
action?
A) Increase oxygen flow to 4 L/min immediately
B) Assess the client for hypoxia and anxiety triggers
C) Encourage pursed-lip breathing and calm the client
D) Call respiratory therapy to switch to a non-rebreather mask
E) Administer prescribed anxiolytic medication
CORRECT ANSWER: C) Encourage pursed-lip breathing and calm the client
RATIONALE: Pursed-lip breathing is a first-line intervention for COPD clients
experiencing dyspnea because it increases positive airway pressure and prolongs
expiration, promoting CO2 elimination. Calming the client reduces anxiety-related
tachypnea. Increasing oxygen without provider order risks CO2 retention in COPD
clients who rely on hypoxic drive for respiration. Assessment is warranted, but
intervention via pursed-lip breathing and reassurance addresses the immediate
concern.
3. A 45-year-old client is post-operative day 1 following abdominal surgery.
The client has a Jackson-Pratt (JP) drain with 250 mL of serosanguineous
drainage in 24 hours. What is the most appropriate nursing action?
A) Notify the provider immediately; this indicates hemorrhage
,B) Document the finding; this is expected drainage
C) Clamp the drain to prevent further drainage
D) Prepare for drain removal
E) Increase antibiotic coverage
CORRECT ANSWER: B) Document the finding; this is expected drainage
RATIONALE: Serosanguineous drainage (mixture of serum and blood) in moderate
amounts (200-400 mL per 24 hours) on post-operative day 1 is normal and
expected. This indicates adequate healing and absence of major vessel damage.
Documentation is appropriate. Notifying the provider for normal drainage is
unnecessary. Clamping the drain compromises wound healing. Drain removal and
antibiotic changes are not indicated for normal drainage.
4. A client with diabetes mellitus type 2 presents with complaints of increased
thirst, frequent urination, and fatigue. Blood glucose is 450 mg/dL. Which
condition is this client most likely experiencing?
A) Hypoglycemia
B) Diabetic ketoacidosis (DKA)
C) Hyperglycemic hyperosmolar state (HHS)
D) Somogyi effect
E) Dawn phenomenon
CORRECT ANSWER: C) Hyperglycemic hyperosmolar state (HHS)
RATIONALE: HHS is characterized by severe hyperglycemia (>600 mg/dL), increased
osmolality, and minimal or absent ketosis, occurring primarily in type 2 diabetes.
Classic symptoms include polydipsia, polyuria, and fatigue due to osmotic diuresis.
DKA occurs in type 1 diabetes with ketones present. Hypoglycemia presents with
shakiness and diaphoresis. Somogyi effect and dawn phenomenon are related to
insulin dynamics, not acute hyperglycemia of this magnitude.
, 5. A 72-year-old client with congestive heart failure (CHF) is prescribed
furosemide 40 mg daily. Which lab value should the nurse monitor closely?
A) Sodium and chloride levels
B) Potassium and magnesium levels
C) Calcium and phosphate levels
D) Albumin and prealbumin levels
E) Creatinine and BUN levels
CORRECT ANSWER: B) Potassium and magnesium levels
RATIONALE: Loop diuretics like furosemide promote excretion of potassium and
magnesium along with sodium and water. Hypokalemia and hypomagnesemia
increase risk of cardiac arrhythmias, muscle weakness, and muscle cramps. While
sodium and chloride are also affected, potassium depletion is the most clinically
significant concern requiring monitoring and possible supplementation. The nurse
should assess for signs of hypokalemia including weakness, palpitations, and ECG
changes.
6. A 55-year-old client is post-operative day 2 following a total knee
replacement. The client reports calf pain and swelling. Which assessment
finding would increase suspicion for deep vein thrombosis (DVT)?
A) Homan's sign is negative bilaterally
B) Calf circumference is 1 cm larger on the affected side
C) Calf circumference is 3 cm larger on the affected side with redness
D) Pedal pulses are normal and equal bilaterally
E) Skin temperature is normal on both calves
CORRECT ANSWER: C) Calf circumference is 3 cm larger on the affected side
with redness
