ATI RN ADULT MEDICAL SURGICAL
NURSING - HIGH DIFFICULTY
PROCTORED EXAM QUESTIONS AND
ANSWERS
1. A nurse is assessing a client with left-sided heart failure. Which clinical finding should the
nurse expect to observe?
A. Jugular vein distension
B. Peripheral edema
C. Abdominal distension
D. Crackles in the lung bases
Answer: D
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion, which
manifests as crackles, dyspnea, and orthopnea. Right-sided heart failure causes systemic
congestion such as JVD and peripheral edema.
2. A client is admitted with Diabetic Ketoacidosis (DKA). Which of the following arterial blood
gas (ABG) results is most consistent with this diagnosis?
A. pH 7.50, PaCO2 35, HCO3 30
,B. pH 7.30, PaCO2 30, HCO3 16
C. pH 7.32, PaCO2 50, HCO3 26
D. pH 7.48, PaCO2 28, HCO3 22
Answer: B
Conceptual Explanation: DKA results in metabolic acidosis with respiratory
compensation. A low pH (<7.35), low bicarbonate (<22), and low PaCO2 (due to Kussmaul
respirations) reflect this state.
3. A nurse is caring for a client post-thyroidectomy. The client reports tingling in the fingers
and around the mouth. Which medication should the nurse prepare?
A. Calcium gluconate
B. Levothyroxine
C. Potassium chloride
D. Sodium bicarbonate
Answer: A
Conceptual Explanation: Hypocalcemia can occur after a thyroidectomy if the parathyroid
glands are accidentally damaged or removed. Tingling and numbness are early signs of
tetany, requiring IV calcium gluconate.
, 4. Which assessment finding is a priority to report for a client with a femur fracture in skeletal
traction?
A. Chest pain and petechiae over the chest
B. Muscle spasms in the affected leg
C. Serosanguinous drainage at pin sites
D. Pain level of 6 out of 10
Answer: A
Conceptual Explanation: Chest pain and petechiae are classic signs of Fat Embolism
Syndrome (FES), which is a life-threatening complication of long bone fractures.
5. A client is prescribed Digoxin for heart failure. Which electrolyte imbalance increases the
risk of Digoxin toxicity?
A. Hypernatremia
B. Hypomagnesemia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Conceptual Explanation: Low potassium levels increase the sensitivity of cardiac cells to
Digoxin, significantly increasing the risk of toxicity, even with therapeutic drug levels.
NURSING - HIGH DIFFICULTY
PROCTORED EXAM QUESTIONS AND
ANSWERS
1. A nurse is assessing a client with left-sided heart failure. Which clinical finding should the
nurse expect to observe?
A. Jugular vein distension
B. Peripheral edema
C. Abdominal distension
D. Crackles in the lung bases
Answer: D
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion, which
manifests as crackles, dyspnea, and orthopnea. Right-sided heart failure causes systemic
congestion such as JVD and peripheral edema.
2. A client is admitted with Diabetic Ketoacidosis (DKA). Which of the following arterial blood
gas (ABG) results is most consistent with this diagnosis?
A. pH 7.50, PaCO2 35, HCO3 30
,B. pH 7.30, PaCO2 30, HCO3 16
C. pH 7.32, PaCO2 50, HCO3 26
D. pH 7.48, PaCO2 28, HCO3 22
Answer: B
Conceptual Explanation: DKA results in metabolic acidosis with respiratory
compensation. A low pH (<7.35), low bicarbonate (<22), and low PaCO2 (due to Kussmaul
respirations) reflect this state.
3. A nurse is caring for a client post-thyroidectomy. The client reports tingling in the fingers
and around the mouth. Which medication should the nurse prepare?
A. Calcium gluconate
B. Levothyroxine
C. Potassium chloride
D. Sodium bicarbonate
Answer: A
Conceptual Explanation: Hypocalcemia can occur after a thyroidectomy if the parathyroid
glands are accidentally damaged or removed. Tingling and numbness are early signs of
tetany, requiring IV calcium gluconate.
, 4. Which assessment finding is a priority to report for a client with a femur fracture in skeletal
traction?
A. Chest pain and petechiae over the chest
B. Muscle spasms in the affected leg
C. Serosanguinous drainage at pin sites
D. Pain level of 6 out of 10
Answer: A
Conceptual Explanation: Chest pain and petechiae are classic signs of Fat Embolism
Syndrome (FES), which is a life-threatening complication of long bone fractures.
5. A client is prescribed Digoxin for heart failure. Which electrolyte imbalance increases the
risk of Digoxin toxicity?
A. Hypernatremia
B. Hypomagnesemia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Conceptual Explanation: Low potassium levels increase the sensitivity of cardiac cells to
Digoxin, significantly increasing the risk of toxicity, even with therapeutic drug levels.
