ATI MED-SURG CMS PROCTORED EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027]
– QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
CORE DOMAINS
1. Cardiovascular System
2. Respiratory System
3. Neurological System
4. Gastrointestinal System
5. Endocrine System
6. Renal and Urinary System
7. Musculoskeletal System
8. Hematologic and Oncologic Disorders
9. Perioperative and Emergency Nursing
10. Professional Standards, Ethics, and Legal Compliance
INTRODUCTION
The ATI Medical-Surgical CMS Proctored Exam assesses the comprehensive knowledge and clinical
judgment required of entry-level registered nurses in medical-surgical practice. This examination
evaluates foundational theory, applied professional knowledge, technical concepts, regulatory and
legal compliance, ethics, and professional standards. Questions are presented in multiple-choice and
scenario-based formats that emphasize real-world application, critical thinking, problem-solving, and
professional decision-making. Candidates must demonstrate the ability to interpret clinical data,
prioritize safe interventions, and make sound clinical judgments across diverse patient populations and
healthcare settings. This assessment is designed to measure readiness for professional nursing
practice.
SECTION ONE – QUESTIONS 1–100
Question 1
A nurse is assessing a client who has been admitted with exacerbation of heart failure. Which of the
following findings should the nurse report to the provider immediately?
A. Weight gain of 1 kg (2.2 lb) over 24 hours
B. Oxygen saturation of 94% on room air
C. Bibasilar crackles and Pink frothy sputum
D. Heart rate of 92 beats per minute
🟢 Correct answer: C
🔴 Explanation: Pink frothy sputum and bibasilar crackles indicate pulmonary edema, a life-
threatening complication of heart failure that requires immediate intervention. Weight gain, mild
oxygen desaturation, and slight tachycardia are concerning but not immediately life-threatening.
,Question 2
A nurse is caring for a client who is receiving heparin therapy. Which of the following laboratory values
should the nurse monitor to evaluate the therapeutic effect of heparin?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
🟢 Correct answer: C
🔴 Explanation: Heparin therapy is monitored using aPTT, with a therapeutic range typically 1.5 to 2.5
times the control value. PT and INR are used to monitor warfarin therapy.
Question 3
A nurse is teaching a client who has a new prescription for metformin. Which of the following
instructions should the nurse include?
A. Take the medication with food to reduce gastrointestinal upset.
B. Discontinue the medication if blood glucose is normal.
C. Expect weight gain as a common adverse effect.
D. Avoid alcohol consumption only while taking the medication.
🟢 Correct answer: A
🔴 Explanation: Metformin should be taken with meals to minimize gastrointestinal side effects such
as nausea and diarrhea. It does not cause weight gain and should not be discontinued without
provider direction.
Question 4
A nurse is caring for a client who has a chest tube following a thoracotomy. Which of the following
findings indicates a need for immediate intervention?
A. Continuous bubbling in the water seal chamber
B. Fluctuation of the fluid level in the water seal chamber with respiration
C. Serosanguineous drainage of 50 mL in the first hour
D. Insertion site covered with an occlusive dressing
🟢 Correct answer: A
🔴 Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which requires immediate assessment and intervention. Tidaling is expected, and serosanguineous
drainage is normal in the immediate postoperative period.
Question 5
A nurse is assessing a client who has increased intracranial pressure (ICP). Which of the following
findings should the nurse expect?
A. Decreased level of consciousness
B. Bradycardia
C. Hypertension
D. All of the above
🟢 Correct answer: D
🔴 Explanation: Increased ICP manifests with Cushing's triad: decreased level of consciousness,
bradycardia, and hypertension. All listed findings are expected.
,Question 6
A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the
following interventions should the nurse implement to prevent dislocation of the prosthesis?
A. Place a pillow between the client's legs when turning.
B. Encourage the client to cross the legs when sitting.
C. Keep the client's hips flexed beyond 90 degrees.
D. Avoid using an abduction pillow.
🟢 Correct answer: A
🔴 Explanation: Placing a pillow between the legs maintains abduction and prevents hip flexion
beyond 90 degrees, reducing the risk of prosthesis dislocation. Crossing the legs and excessive hip
flexion increase dislocation risk.
Question 7
A nurse is reviewing laboratory results for a client who has chronic kidney disease. Which of the
following findings should the nurse expect?
A. Increased creatinine clearance
B. Decreased blood urea nitrogen (BUN)
C. Increased serum potassium
D. Increased serum calcium
🟢 Correct answer: C
🔴 Explanation: In chronic kidney disease, the kidneys cannot excrete potassium effectively, leading to
hyperkalemia. Creatinine clearance decreases, BUN increases, and serum calcium typically decreases
due to impaired activation of vitamin D.
Question 8
A nurse is providing discharge teaching to a client who has COPD. Which of the following statements
by the client indicates understanding of the teaching?
A. "I will use my inhaler only when I feel short of breath."
B. "I will eat three large meals each day."
C. "I will practice pursed-lip breathing during activities."
D. "I will avoid getting the influenza vaccine."
🟢 Correct answer: C
🔴 Explanation: Pursed-lip breathing helps prevent airway collapse and improves oxygenation in
clients with COPD. Clients should use inhalers as prescribed, eat small frequent meals, and receive
annual influenza vaccinations.
Question 9
A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following
actions should the nurse take?
A. Change the TPN tubing every 72 hours.
B. Monitor blood glucose levels every 6 hours.
C. Administer TPN through a peripheral IV line.
D. Stop the infusion abruptly if the client reports nausea.
🟢 Correct answer: B
🔴 Explanation: TPN contains high concentrations of dextrose, requiring frequent blood glucose
monitoring. TPN tubing should be changed every 24 hours, TPN is administered through a central line,
and the infusion should never be stopped abruptly to prevent hypoglycemia.
, Question 10
A nurse is assessing a client who has a new diagnosis of type 1 diabetes mellitus. Which of the
following findings should the nurse identify as a manifestation of hypoglycemia?
A. Kussmaul respirations
B. Fruity breath odor
C. Diaphoresis and tremors
D. Polyuria and polydipsia
🟢 Correct answer: C
🔴 Explanation: Diaphoresis, tremors, palpitations, and anxiety are manifestations of hypoglycemia.
Kussmaul respirations, fruity breath, polyuria, and polydipsia are manifestations of hyperglycemia.
Question 11
A nurse is caring for a client who has a new prescription for warfarin. Which of the following foods
should the nurse instruct the client to maintain a consistent intake of?
A. Bananas
B. Leafy green vegetables
C. Dairy products
D. Citrus fruits
🟢 Correct answer: B
🔴 Explanation: Leafy green vegetables are high in vitamin K, which antagonizes warfarin. Clients
should maintain a consistent intake rather than eliminate these foods to keep INR stable.
Question 12
A nurse is assessing a client who has acute pancreatitis. Which of the following findings should the
nurse expect?
A. Decreased serum amylase
B. Elevated serum lipase
C. Hypoglycemia
D. Decreased heart rate
🟢 Correct answer: B
🔴 Explanation: Acute pancreatitis causes elevation of serum amylase and lipase. Hyperglycemia and
tachycardia are also common due to inflammation and stress response.
Question 13
A nurse is caring for a client who is receiving a blood transfusion. Which of the following findings
indicates an acute hemolytic reaction?
A. Urticaria
B. Fever and chills
C. Low back pain and dark urine
D. Hypertension and bradycardia
🟢 Correct answer: C
🔴 Explanation: Acute hemolytic reaction manifests with low back pain, dark urine (hemoglobinuria),
fever, chills, and hypotension. Urticaria indicates an allergic reaction.
Question 14
A nurse is teaching a client who has osteoporosis about dietary sources of calcium. Which of the
following foods should the nurse recommend as the best source of calcium?
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027]
– QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
CORE DOMAINS
1. Cardiovascular System
2. Respiratory System
3. Neurological System
4. Gastrointestinal System
5. Endocrine System
6. Renal and Urinary System
7. Musculoskeletal System
8. Hematologic and Oncologic Disorders
9. Perioperative and Emergency Nursing
10. Professional Standards, Ethics, and Legal Compliance
INTRODUCTION
The ATI Medical-Surgical CMS Proctored Exam assesses the comprehensive knowledge and clinical
judgment required of entry-level registered nurses in medical-surgical practice. This examination
evaluates foundational theory, applied professional knowledge, technical concepts, regulatory and
legal compliance, ethics, and professional standards. Questions are presented in multiple-choice and
scenario-based formats that emphasize real-world application, critical thinking, problem-solving, and
professional decision-making. Candidates must demonstrate the ability to interpret clinical data,
prioritize safe interventions, and make sound clinical judgments across diverse patient populations and
healthcare settings. This assessment is designed to measure readiness for professional nursing
practice.
SECTION ONE – QUESTIONS 1–100
Question 1
A nurse is assessing a client who has been admitted with exacerbation of heart failure. Which of the
following findings should the nurse report to the provider immediately?
A. Weight gain of 1 kg (2.2 lb) over 24 hours
B. Oxygen saturation of 94% on room air
C. Bibasilar crackles and Pink frothy sputum
D. Heart rate of 92 beats per minute
🟢 Correct answer: C
🔴 Explanation: Pink frothy sputum and bibasilar crackles indicate pulmonary edema, a life-
threatening complication of heart failure that requires immediate intervention. Weight gain, mild
oxygen desaturation, and slight tachycardia are concerning but not immediately life-threatening.
,Question 2
A nurse is caring for a client who is receiving heparin therapy. Which of the following laboratory values
should the nurse monitor to evaluate the therapeutic effect of heparin?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
🟢 Correct answer: C
🔴 Explanation: Heparin therapy is monitored using aPTT, with a therapeutic range typically 1.5 to 2.5
times the control value. PT and INR are used to monitor warfarin therapy.
Question 3
A nurse is teaching a client who has a new prescription for metformin. Which of the following
instructions should the nurse include?
A. Take the medication with food to reduce gastrointestinal upset.
B. Discontinue the medication if blood glucose is normal.
C. Expect weight gain as a common adverse effect.
D. Avoid alcohol consumption only while taking the medication.
🟢 Correct answer: A
🔴 Explanation: Metformin should be taken with meals to minimize gastrointestinal side effects such
as nausea and diarrhea. It does not cause weight gain and should not be discontinued without
provider direction.
Question 4
A nurse is caring for a client who has a chest tube following a thoracotomy. Which of the following
findings indicates a need for immediate intervention?
A. Continuous bubbling in the water seal chamber
B. Fluctuation of the fluid level in the water seal chamber with respiration
C. Serosanguineous drainage of 50 mL in the first hour
D. Insertion site covered with an occlusive dressing
🟢 Correct answer: A
🔴 Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which requires immediate assessment and intervention. Tidaling is expected, and serosanguineous
drainage is normal in the immediate postoperative period.
Question 5
A nurse is assessing a client who has increased intracranial pressure (ICP). Which of the following
findings should the nurse expect?
A. Decreased level of consciousness
B. Bradycardia
C. Hypertension
D. All of the above
🟢 Correct answer: D
🔴 Explanation: Increased ICP manifests with Cushing's triad: decreased level of consciousness,
bradycardia, and hypertension. All listed findings are expected.
,Question 6
A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the
following interventions should the nurse implement to prevent dislocation of the prosthesis?
A. Place a pillow between the client's legs when turning.
B. Encourage the client to cross the legs when sitting.
C. Keep the client's hips flexed beyond 90 degrees.
D. Avoid using an abduction pillow.
🟢 Correct answer: A
🔴 Explanation: Placing a pillow between the legs maintains abduction and prevents hip flexion
beyond 90 degrees, reducing the risk of prosthesis dislocation. Crossing the legs and excessive hip
flexion increase dislocation risk.
Question 7
A nurse is reviewing laboratory results for a client who has chronic kidney disease. Which of the
following findings should the nurse expect?
A. Increased creatinine clearance
B. Decreased blood urea nitrogen (BUN)
C. Increased serum potassium
D. Increased serum calcium
🟢 Correct answer: C
🔴 Explanation: In chronic kidney disease, the kidneys cannot excrete potassium effectively, leading to
hyperkalemia. Creatinine clearance decreases, BUN increases, and serum calcium typically decreases
due to impaired activation of vitamin D.
Question 8
A nurse is providing discharge teaching to a client who has COPD. Which of the following statements
by the client indicates understanding of the teaching?
A. "I will use my inhaler only when I feel short of breath."
B. "I will eat three large meals each day."
C. "I will practice pursed-lip breathing during activities."
D. "I will avoid getting the influenza vaccine."
🟢 Correct answer: C
🔴 Explanation: Pursed-lip breathing helps prevent airway collapse and improves oxygenation in
clients with COPD. Clients should use inhalers as prescribed, eat small frequent meals, and receive
annual influenza vaccinations.
Question 9
A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following
actions should the nurse take?
A. Change the TPN tubing every 72 hours.
B. Monitor blood glucose levels every 6 hours.
C. Administer TPN through a peripheral IV line.
D. Stop the infusion abruptly if the client reports nausea.
🟢 Correct answer: B
🔴 Explanation: TPN contains high concentrations of dextrose, requiring frequent blood glucose
monitoring. TPN tubing should be changed every 24 hours, TPN is administered through a central line,
and the infusion should never be stopped abruptly to prevent hypoglycemia.
, Question 10
A nurse is assessing a client who has a new diagnosis of type 1 diabetes mellitus. Which of the
following findings should the nurse identify as a manifestation of hypoglycemia?
A. Kussmaul respirations
B. Fruity breath odor
C. Diaphoresis and tremors
D. Polyuria and polydipsia
🟢 Correct answer: C
🔴 Explanation: Diaphoresis, tremors, palpitations, and anxiety are manifestations of hypoglycemia.
Kussmaul respirations, fruity breath, polyuria, and polydipsia are manifestations of hyperglycemia.
Question 11
A nurse is caring for a client who has a new prescription for warfarin. Which of the following foods
should the nurse instruct the client to maintain a consistent intake of?
A. Bananas
B. Leafy green vegetables
C. Dairy products
D. Citrus fruits
🟢 Correct answer: B
🔴 Explanation: Leafy green vegetables are high in vitamin K, which antagonizes warfarin. Clients
should maintain a consistent intake rather than eliminate these foods to keep INR stable.
Question 12
A nurse is assessing a client who has acute pancreatitis. Which of the following findings should the
nurse expect?
A. Decreased serum amylase
B. Elevated serum lipase
C. Hypoglycemia
D. Decreased heart rate
🟢 Correct answer: B
🔴 Explanation: Acute pancreatitis causes elevation of serum amylase and lipase. Hyperglycemia and
tachycardia are also common due to inflammation and stress response.
Question 13
A nurse is caring for a client who is receiving a blood transfusion. Which of the following findings
indicates an acute hemolytic reaction?
A. Urticaria
B. Fever and chills
C. Low back pain and dark urine
D. Hypertension and bradycardia
🟢 Correct answer: C
🔴 Explanation: Acute hemolytic reaction manifests with low back pain, dark urine (hemoglobinuria),
fever, chills, and hypotension. Urticaria indicates an allergic reaction.
Question 14
A nurse is teaching a client who has osteoporosis about dietary sources of calcium. Which of the
following foods should the nurse recommend as the best source of calcium?
