ATI RN Adult Medical-Surgical Proctored
Practice Test 2026/2027 | Complete Exam-
Style Questions with Answers & Detailed
Rationales
Question 1
A nurse is caring for a client who was admitted with acute
decompensated heart failure. Which finding requires the
nurse's immediate intervention?
A. Bilateral 2+ ankle edema
B. Weight gain of 1.5 kg (3.3 lb) over 3 days
C. Pink, frothy sputum and severe dyspnea
D. Blood pressure of 148/88 mm Hg
Correct answer: C. Pink, frothy sputum and severe dyspnea
Pink, frothy sputum accompanied by severe dyspnea is
consistent with acute pulmonary edema, a life-threatening
complication of left-sided heart failure. The nurse should
prioritize airway and breathing, provide oxygen as indicated,
position the client upright, and promptly initiate prescribed
emergency interventions. Peripheral edema and recent weight
,gain indicate fluid retention but are not as immediately life-
threatening. The blood pressure is elevated but does not by
itself indicate the same degree of acute compromise.
Question 2
A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The client
becomes increasingly somnolent and difficult to arouse. Which
action should the nurse take first?
A. Increase the oxygen flow rate
B. Assess the client's respiratory status and level of
consciousness
C. Administer the prescribed opioid analgesic
D. Encourage the client to drink fluids
Correct answer: B. Assess the client's respiratory status and
level of consciousness
Increasing somnolence in a client with COPD receiving oxygen
can indicate worsening hypercapnia and respiratory failure. The
nurse should immediately assess airway, breathing, respiratory
rate and effort, oxygen saturation, and mental status.
Increasing oxygen without assessment could worsen
hypercapnia in susceptible clients and would not address the
underlying deterioration. An opioid could further depress
,respiratory function, and oral fluids are not the priority in an
acutely deteriorating client.
Question 3
A nurse is assessing a client 12 hours after a total
thyroidectomy. Which finding requires immediate action?
A. Mild incisional pain
B. Hoarse voice
C. Tingling around the mouth and fingers
D. Small amount of serosanguineous drainage
Correct answer: C. Tingling around the mouth and fingers
Tingling around the mouth and fingers can indicate
hypocalcemia caused by impaired parathyroid function
following thyroid surgery. Hypocalcemia can progress to tetany,
laryngospasm, and airway compromise. The nurse should
promptly assess for additional manifestations and notify the
provider while preparing to administer calcium replacement if
prescribed. Mild pain and a small amount of expected drainage
are common postoperative findings. Hoarseness can occur
because of temporary irritation or injury involving the recurrent
laryngeal nerve, but perioral and digital paresthesias are a
more urgent indication of hypocalcemia.
, Question 4
A client with type 1 diabetes mellitus has a blood glucose level
of 320 mg/dL (17.8 mmol/L) and reports nausea and abdominal
pain. Which additional finding most strongly supports diabetic
ketoacidosis (DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Peripheral edema
D. Hypothermia
Correct answer: B. Kussmaul respirations
Kussmaul respirations are deep, rapid respirations that develop
as the body attempts to compensate for metabolic acidosis
associated with DKA. Other classic findings include
hyperglycemia, ketonemia or ketonuria, dehydration,
abdominal pain, nausea, and altered mental status.
Bradycardia and peripheral edema are not characteristic
findings of DKA. Temperature may be normal or elevated
depending on the presence of an underlying infection.
Question 5
A client is receiving a continuous IV infusion of unfractionated
heparin. Which laboratory result is most directly used to
monitor the therapeutic effect of this medication?
Practice Test 2026/2027 | Complete Exam-
Style Questions with Answers & Detailed
Rationales
Question 1
A nurse is caring for a client who was admitted with acute
decompensated heart failure. Which finding requires the
nurse's immediate intervention?
A. Bilateral 2+ ankle edema
B. Weight gain of 1.5 kg (3.3 lb) over 3 days
C. Pink, frothy sputum and severe dyspnea
D. Blood pressure of 148/88 mm Hg
Correct answer: C. Pink, frothy sputum and severe dyspnea
Pink, frothy sputum accompanied by severe dyspnea is
consistent with acute pulmonary edema, a life-threatening
complication of left-sided heart failure. The nurse should
prioritize airway and breathing, provide oxygen as indicated,
position the client upright, and promptly initiate prescribed
emergency interventions. Peripheral edema and recent weight
,gain indicate fluid retention but are not as immediately life-
threatening. The blood pressure is elevated but does not by
itself indicate the same degree of acute compromise.
Question 2
A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The client
becomes increasingly somnolent and difficult to arouse. Which
action should the nurse take first?
A. Increase the oxygen flow rate
B. Assess the client's respiratory status and level of
consciousness
C. Administer the prescribed opioid analgesic
D. Encourage the client to drink fluids
Correct answer: B. Assess the client's respiratory status and
level of consciousness
Increasing somnolence in a client with COPD receiving oxygen
can indicate worsening hypercapnia and respiratory failure. The
nurse should immediately assess airway, breathing, respiratory
rate and effort, oxygen saturation, and mental status.
Increasing oxygen without assessment could worsen
hypercapnia in susceptible clients and would not address the
underlying deterioration. An opioid could further depress
,respiratory function, and oral fluids are not the priority in an
acutely deteriorating client.
Question 3
A nurse is assessing a client 12 hours after a total
thyroidectomy. Which finding requires immediate action?
A. Mild incisional pain
B. Hoarse voice
C. Tingling around the mouth and fingers
D. Small amount of serosanguineous drainage
Correct answer: C. Tingling around the mouth and fingers
Tingling around the mouth and fingers can indicate
hypocalcemia caused by impaired parathyroid function
following thyroid surgery. Hypocalcemia can progress to tetany,
laryngospasm, and airway compromise. The nurse should
promptly assess for additional manifestations and notify the
provider while preparing to administer calcium replacement if
prescribed. Mild pain and a small amount of expected drainage
are common postoperative findings. Hoarseness can occur
because of temporary irritation or injury involving the recurrent
laryngeal nerve, but perioral and digital paresthesias are a
more urgent indication of hypocalcemia.
, Question 4
A client with type 1 diabetes mellitus has a blood glucose level
of 320 mg/dL (17.8 mmol/L) and reports nausea and abdominal
pain. Which additional finding most strongly supports diabetic
ketoacidosis (DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Peripheral edema
D. Hypothermia
Correct answer: B. Kussmaul respirations
Kussmaul respirations are deep, rapid respirations that develop
as the body attempts to compensate for metabolic acidosis
associated with DKA. Other classic findings include
hyperglycemia, ketonemia or ketonuria, dehydration,
abdominal pain, nausea, and altered mental status.
Bradycardia and peripheral edema are not characteristic
findings of DKA. Temperature may be normal or elevated
depending on the presence of an underlying infection.
Question 5
A client is receiving a continuous IV infusion of unfractionated
heparin. Which laboratory result is most directly used to
monitor the therapeutic effect of this medication?
