ATI RN Medical-Surgical Proctored Exam 2026/2027 | ATI Adult Medical-Surgical
Exam Prep & Study Guide | NGN-Style Clinical Judgment Practice | Cardiovascular,
Respiratory, Neurological, Renal, Endocrine, GI, Musculoskeletal & Perioperative
Nursing | Practice Questions, Answers & Detailed Rationales
Question 1: A patient with chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea and a productive cough. Arterial blood gas (ABG) analysis reveals a pH of
7.30, PaCO2 of 55 mmHg, and HCO3- of 28 mEq/L. Which of the following acid-base
imbalances is most consistent with these findings?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Uncompensated metabolic alkalosis
D. Partially compensated metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The ABG values show a low pH (acidemia), elevated PaCO2 (respiratory acidosis), and
an elevated HCO3- (renal compensation). The pH remains below normal, indicating that
compensation is incomplete. Therefore, this is a partially compensated respiratory acidosis.
Question 2: A nurse is providing discharge teaching to a patient with a new diagnosis of heart
failure. Which of the following statements by the patient indicates a need for further
teaching?
A. "I will weigh myself every morning before breakfast."
B. "I should limit my fluid intake to 2 liters per day."
C. "It is okay to take ibuprofen for my occasional headaches."
D. "I will rest when I feel short of breath."
CORRECT ANSWER: C. "It is okay to take ibuprofen for my occasional headaches."
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can cause sodium and
water retention, worsening heart failure. Patients with heart failure should avoid NSAIDs and
use alternative analgesics like acetaminophen.
Question 3: A patient is receiving a continuous heparin infusion for a deep vein thrombosis.
Which laboratory value is the most important to monitor to ensure the therapeutic effect of
the medication?
A. Partial thromboplastin time (PTT)
B. Prothrombin time (PT)
C. International normalized ratio (INR)
D. Platelet count
,CORRECT ANSWER: A. Partial thromboplastin time (PTT)
Rationale: Heparin primarily affects the intrinsic pathway of the coagulation cascade, which is
monitored by the PTT. The therapeutic goal is typically 1.5 to 2.5 times the patient's baseline
PTT.
Question 4: A patient with type 1 diabetes mellitus is exhibiting signs of diabetic ketoacidosis
(DKA). Which of the following clinical manifestations is the nurse likely to assess?
A. Hyperventilation and fruity breath odor
B. Slow, shallow respirations and lethargy
C. Bradycardia and hypertension
D. Decreased urine output and edema
CORRECT ANSWER: A. Hyperventilation and fruity breath odor
Rationale: In DKA, the body produces ketones as an alternative fuel source. The accumulation
of ketones leads to metabolic acidosis, which stimulates Kussmaul respirations (deep, rapid
breathing) to blow off CO2. Acetone, a ketone body, is exhaled, producing a fruity breath odor.
Question 5: A patient is diagnosed with tuberculosis (TB). Which type of isolation precaution
should the nurse initiate?
A. Contact Precautions
B. Droplet Precautions
C. Airborne Precautions
D. Standard Precautions
CORRECT ANSWER: C. Airborne Precautions
Rationale: Tuberculosis is transmitted via airborne nuclei that can remain suspended in the air.
Airborne Precautions require a negative pressure room, an N95 respirator mask, and a closed
door.
Question 6: The nurse is caring for a patient with a nasogastric (NG) tube attached to low
intermittent suction. Which assessment finding indicates a potential complication related to
the NG tube?
A. The patient reports mild nausea.
B. The skin around the nares is slightly red.
,C. The patient complains of severe abdominal pain and distention.
D. A small amount of clear, green drainage is noted in the collection canister.
CORRECT ANSWER: C. The patient complains of severe abdominal pain and distention.
Rationale: Severe abdominal pain and distention can indicate a bowel obstruction or that the
NG tube is not functioning properly, leading to a distended stomach. This is a priority finding
that requires immediate assessment and intervention.
Question 7: A patient is scheduled for a paracentesis to relieve respiratory distress from
ascites. What is the priority nursing action before the procedure?
A. Administering a sedative as prescribed.
B. Ensuring the patient has a full bladder.
C. Having the patient empty the bladder.
D. Obtaining a baseline serum albumin level.
CORRECT ANSWER: C. Having the patient empty the bladder.
Rationale: An empty bladder is essential before a paracentesis to prevent accidental puncture
of the bladder during the procedure. The patient should be instructed to void immediately
before the procedure.
Question 8: Which medication is most commonly administered to a patient experiencing an
acute exacerbation of asthma to quickly relieve bronchospasm?
A. Oral prednisone
B. Inhaled albuterol
C. Inhaled fluticasone
D. Intravenous methylprednisolone
CORRECT ANSWER: B. Inhaled albuterol
Rationale: Inhaled albuterol is a short-acting beta-2 agonist (SABA) that acts as a
bronchodilator, providing rapid relief of acute bronchospasm. It is considered the first-line
treatment for an acute asthma attack.
Question 9: The nurse is caring for a patient who is 2 days post-operative from a total hip
arthroplasty. Which nursing intervention is most important to prevent dislocation of the new
joint?
, A. Keeping the patient's legs in an abducted position.
B. Encouraging the patient to cross their legs while sitting.
C. Placing a pillow under the patient's knees while supine.
D. Allowing the patient to flex the hip to 120 degrees.
CORRECT ANSWER: A. Keeping the patient's legs in an abducted position.
Rationale: To prevent dislocation after a hip arthroplasty, the hip must not be adducted past
the midline. Maintaining abduction (e.g., with an abduction pillow) keeps the femoral head in
the acetabulum. Flexion should not exceed 90 degrees.
Question 10: A patient presents with a sudden onset of severe chest pain, diaphoresis, and
nausea. The 12-lead ECG shows ST-segment elevation in leads V1-V4. Which area of the heart
is likely affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall
D. Posterior wall
CORRECT ANSWER: C. Anterior wall
Rationale: The anterior wall of the left ventricle is supplied by the left anterior descending (LAD)
artery. ST-segment elevation in leads V1 to V4 is classic for an anterior wall ST-elevation
myocardial infarction (STEMI).
Question 11: A patient with chronic kidney disease (CKD) is prescribed epoetin alfa (Epogen).
The nurse should monitor the patient's laboratory results for which intended effect of this
medication?
A. An increase in the red blood cell count.
B. A decrease in serum potassium levels.
C. An increase in serum calcium levels.
D. A decrease in serum phosphate levels.
CORRECT ANSWER: A. An increase in the red blood cell count.
Rationale: Epoetin alfa is a synthetic form of erythropoietin, a hormone that stimulates the
bone marrow to produce red blood cells. It is used to treat anemia associated with CKD.
Exam Prep & Study Guide | NGN-Style Clinical Judgment Practice | Cardiovascular,
Respiratory, Neurological, Renal, Endocrine, GI, Musculoskeletal & Perioperative
Nursing | Practice Questions, Answers & Detailed Rationales
Question 1: A patient with chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea and a productive cough. Arterial blood gas (ABG) analysis reveals a pH of
7.30, PaCO2 of 55 mmHg, and HCO3- of 28 mEq/L. Which of the following acid-base
imbalances is most consistent with these findings?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Uncompensated metabolic alkalosis
D. Partially compensated metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The ABG values show a low pH (acidemia), elevated PaCO2 (respiratory acidosis), and
an elevated HCO3- (renal compensation). The pH remains below normal, indicating that
compensation is incomplete. Therefore, this is a partially compensated respiratory acidosis.
Question 2: A nurse is providing discharge teaching to a patient with a new diagnosis of heart
failure. Which of the following statements by the patient indicates a need for further
teaching?
A. "I will weigh myself every morning before breakfast."
B. "I should limit my fluid intake to 2 liters per day."
C. "It is okay to take ibuprofen for my occasional headaches."
D. "I will rest when I feel short of breath."
CORRECT ANSWER: C. "It is okay to take ibuprofen for my occasional headaches."
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can cause sodium and
water retention, worsening heart failure. Patients with heart failure should avoid NSAIDs and
use alternative analgesics like acetaminophen.
Question 3: A patient is receiving a continuous heparin infusion for a deep vein thrombosis.
Which laboratory value is the most important to monitor to ensure the therapeutic effect of
the medication?
A. Partial thromboplastin time (PTT)
B. Prothrombin time (PT)
C. International normalized ratio (INR)
D. Platelet count
,CORRECT ANSWER: A. Partial thromboplastin time (PTT)
Rationale: Heparin primarily affects the intrinsic pathway of the coagulation cascade, which is
monitored by the PTT. The therapeutic goal is typically 1.5 to 2.5 times the patient's baseline
PTT.
Question 4: A patient with type 1 diabetes mellitus is exhibiting signs of diabetic ketoacidosis
(DKA). Which of the following clinical manifestations is the nurse likely to assess?
A. Hyperventilation and fruity breath odor
B. Slow, shallow respirations and lethargy
C. Bradycardia and hypertension
D. Decreased urine output and edema
CORRECT ANSWER: A. Hyperventilation and fruity breath odor
Rationale: In DKA, the body produces ketones as an alternative fuel source. The accumulation
of ketones leads to metabolic acidosis, which stimulates Kussmaul respirations (deep, rapid
breathing) to blow off CO2. Acetone, a ketone body, is exhaled, producing a fruity breath odor.
Question 5: A patient is diagnosed with tuberculosis (TB). Which type of isolation precaution
should the nurse initiate?
A. Contact Precautions
B. Droplet Precautions
C. Airborne Precautions
D. Standard Precautions
CORRECT ANSWER: C. Airborne Precautions
Rationale: Tuberculosis is transmitted via airborne nuclei that can remain suspended in the air.
Airborne Precautions require a negative pressure room, an N95 respirator mask, and a closed
door.
Question 6: The nurse is caring for a patient with a nasogastric (NG) tube attached to low
intermittent suction. Which assessment finding indicates a potential complication related to
the NG tube?
A. The patient reports mild nausea.
B. The skin around the nares is slightly red.
,C. The patient complains of severe abdominal pain and distention.
D. A small amount of clear, green drainage is noted in the collection canister.
CORRECT ANSWER: C. The patient complains of severe abdominal pain and distention.
Rationale: Severe abdominal pain and distention can indicate a bowel obstruction or that the
NG tube is not functioning properly, leading to a distended stomach. This is a priority finding
that requires immediate assessment and intervention.
Question 7: A patient is scheduled for a paracentesis to relieve respiratory distress from
ascites. What is the priority nursing action before the procedure?
A. Administering a sedative as prescribed.
B. Ensuring the patient has a full bladder.
C. Having the patient empty the bladder.
D. Obtaining a baseline serum albumin level.
CORRECT ANSWER: C. Having the patient empty the bladder.
Rationale: An empty bladder is essential before a paracentesis to prevent accidental puncture
of the bladder during the procedure. The patient should be instructed to void immediately
before the procedure.
Question 8: Which medication is most commonly administered to a patient experiencing an
acute exacerbation of asthma to quickly relieve bronchospasm?
A. Oral prednisone
B. Inhaled albuterol
C. Inhaled fluticasone
D. Intravenous methylprednisolone
CORRECT ANSWER: B. Inhaled albuterol
Rationale: Inhaled albuterol is a short-acting beta-2 agonist (SABA) that acts as a
bronchodilator, providing rapid relief of acute bronchospasm. It is considered the first-line
treatment for an acute asthma attack.
Question 9: The nurse is caring for a patient who is 2 days post-operative from a total hip
arthroplasty. Which nursing intervention is most important to prevent dislocation of the new
joint?
, A. Keeping the patient's legs in an abducted position.
B. Encouraging the patient to cross their legs while sitting.
C. Placing a pillow under the patient's knees while supine.
D. Allowing the patient to flex the hip to 120 degrees.
CORRECT ANSWER: A. Keeping the patient's legs in an abducted position.
Rationale: To prevent dislocation after a hip arthroplasty, the hip must not be adducted past
the midline. Maintaining abduction (e.g., with an abduction pillow) keeps the femoral head in
the acetabulum. Flexion should not exceed 90 degrees.
Question 10: A patient presents with a sudden onset of severe chest pain, diaphoresis, and
nausea. The 12-lead ECG shows ST-segment elevation in leads V1-V4. Which area of the heart
is likely affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall
D. Posterior wall
CORRECT ANSWER: C. Anterior wall
Rationale: The anterior wall of the left ventricle is supplied by the left anterior descending (LAD)
artery. ST-segment elevation in leads V1 to V4 is classic for an anterior wall ST-elevation
myocardial infarction (STEMI).
Question 11: A patient with chronic kidney disease (CKD) is prescribed epoetin alfa (Epogen).
The nurse should monitor the patient's laboratory results for which intended effect of this
medication?
A. An increase in the red blood cell count.
B. A decrease in serum potassium levels.
C. An increase in serum calcium levels.
D. A decrease in serum phosphate levels.
CORRECT ANSWER: A. An increase in the red blood cell count.
Rationale: Epoetin alfa is a synthetic form of erythropoietin, a hormone that stimulates the
bone marrow to produce red blood cells. It is used to treat anemia associated with CKD.
