ATI Adult Medical-Surgical Proctored Exam
2026/2027 Study Guide | ATI Adult Med-Surg
Practice Questions & Answers, Detailed Rationales,
Clinical Judgment, NGN-Style Case Studies &
Nursing Exam Prep
Question 1: A nurse is assessing a client who has been admitted
with an acute exacerbation of chronic obstructive pulmonary
disease (COPD). Which of the following physical findings should
the nurse expect?
A. Decreased anteroposterior chest diameter
B. Increased anteroposterior chest diameter
C. Clear breath sounds bilaterally
D. Oxygen saturation of 98% on room air
CORRECT ANSWER: B. Increased anteroposterior chest diameter
Rationale: Clients with chronic COPD often develop a barrel-shaped chest
due to chronic air trapping and hyperinflation of the lungs, which increases
the anteroposterior diameter of the chest . Decreased anteroposterior
diameter is not characteristic of COPD.
Question 2: A nurse is caring for a client who has heart failure and
reports sudden shortness of breath with pink, frothy sputum.
Which of the following actions should the nurse take first?
A. Administer furosemide IV push as prescribed
B. Place the client in high-Fowler's position
C. Apply a non-rebreather mask at 15 L/min
D. Notify the provider immediately
CORRECT ANSWER: B. Place the client in high-Fowler's position
Rationale: High-Fowler's position reduces venous return and decreases
pulmonary congestion, directly addressing the acute respiratory distress.
Airway and breathing interventions take priority before medications or
notification .
Question 3: A client who had a total knee replacement is receiving
enoxaparin. Which finding should the nurse report to the provider
immediately?
,A. Platelet count of 150,000/mm³
B. Hematocrit of 34%
C. Bloody drainage on the surgical dressing
D. Pain rated 4/10 at the incision site
CORRECT ANSWER: C. Bloody drainage on the surgical dressing
Rationale: Enoxaparin is a low-molecular-weight heparin with anticoagulant
effects. Active bleeding, evidenced by bloody drainage, requires immediate
provider notification and possible withholding of the next dose .
Question 4: A nurse is teaching a client who has COPD about
pursed-lip breathing. Which statement by the client indicates
correct understanding?
A. "I should breathe in quickly and breathe out slowly."
B. "I will inhale through my nose and exhale through pursed lips."
C. "Pursed-lip breathing helps me inhale more oxygen."
D. "I should hold my breath for 5 seconds after inhaling."
CORRECT ANSWER: B. "I will inhale through my nose and exhale
through pursed lips."
Rationale: Pursed-lip breathing prolongs exhalation, preventing airway
collapse and reducing air trapping. The correct technique involves inhaling
through the nose and exhaling slowly through pursed lips .
Question 5: A client with type 2 diabetes has a blood glucose of 58
mg/dL and is awake but drowsy. Which should the nurse
administer first?
A. One-half cup orange juice
B. Glucagon 1 mg IM
C. 50 mL dextrose 50% IV push
D. 4 oz skim milk
CORRECT ANSWER: A. One-half cup orange juice
Rationale: For a conscious client with mild hypoglycemia, 15 g of fast-
acting carbohydrate, such as orange juice, is the first-line treatment.
Glucagon and IV dextrose are reserved for clients who are unconscious or
unable to swallow .
,Question 6: A nurse is assessing a client who has chronic kidney
disease. The client's potassium level is 6.8 mEq/L. Which ECG
change should the nurse expect?
A. Flat T waves
B. Prominent U waves
C. Tall, peaked T waves
D. Prolonged PR interval
CORRECT ANSWER: C. Tall, peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves on the ECG. Flat T
waves and U waves are associated with hypokalemia .
Question 7: A client is 12 hours postoperative following abdominal
surgery. Which nursing intervention most effectively prevents deep
vein thrombosis?
A. Administering prophylactic antibiotics
B. Teaching the client to cough and deep breathe
C. Massaging the calves every 4 hours
D. Early ambulation and leg exercises
CORRECT ANSWER: D. Early ambulation and leg exercises
Rationale: Early ambulation is the most effective method to promote
venous return and prevent clot formation in the lower extremities.
Coughing and deep breathing prevent respiratory complications, not DVT .
Question 8: A nurse is caring for a client who has a chest tube
connected to a water-seal drainage system. The nurse observes
continuous bubbling in the water-seal chamber. Which action
should the nurse take first?
A. Clamp the chest tube
B. Assess for an air leak
C. Increase the suction pressure
D. Document the finding as normal
CORRECT ANSWER: B. Assess for an air leak
Rationale: Continuous bubbling in the water-seal chamber indicates an air
leak in the system. The nurse's first action is to assess the system to locate
, the source of the leak. Clamping the tube is not the initial action and can be
dangerous .
Question 9: A client with a new diagnosis of atrial fibrillation is
prescribed warfarin. Which food should the nurse instruct the
client to consume consistently?
A. Bananas
B. Spinach
C. Chicken
D. Rice
CORRECT ANSWER: B. Spinach
Rationale: Spinach is high in vitamin K, which antagonizes warfarin. Clients
should maintain consistent vitamin K intake rather than eliminate it, so the
nurse instructs consistent consumption to prevent fluctuations in INR .
Question 10: A nurse is assessing a client who has suspected
appendicitis. Which finding should the nurse prioritize for
immediate reporting?
A. Rebound tenderness in the right lower quadrant
B. Mild fever of 100.4°F
C. Nausea without vomiting
D. Decreased bowel sounds
CORRECT ANSWER: A. Rebound tenderness in the right lower
quadrant
Rationale: Rebound tenderness indicates peritoneal irritation and potential
perforation, which is a surgical emergency requiring immediate
intervention. Other findings are consistent with appendicitis but are not as
urgent .
Question 11: A nurse is preparing a client for surgery. Which action
is the nurse's primary responsibility regarding informed consent?
A. Explaining the risks and benefits of the procedure
B. Obtaining the surgical consent from the client
C. Witnessing the client's signature on the consent form
D. Determining if the client is competent to sign
2026/2027 Study Guide | ATI Adult Med-Surg
Practice Questions & Answers, Detailed Rationales,
Clinical Judgment, NGN-Style Case Studies &
Nursing Exam Prep
Question 1: A nurse is assessing a client who has been admitted
with an acute exacerbation of chronic obstructive pulmonary
disease (COPD). Which of the following physical findings should
the nurse expect?
A. Decreased anteroposterior chest diameter
B. Increased anteroposterior chest diameter
C. Clear breath sounds bilaterally
D. Oxygen saturation of 98% on room air
CORRECT ANSWER: B. Increased anteroposterior chest diameter
Rationale: Clients with chronic COPD often develop a barrel-shaped chest
due to chronic air trapping and hyperinflation of the lungs, which increases
the anteroposterior diameter of the chest . Decreased anteroposterior
diameter is not characteristic of COPD.
Question 2: A nurse is caring for a client who has heart failure and
reports sudden shortness of breath with pink, frothy sputum.
Which of the following actions should the nurse take first?
A. Administer furosemide IV push as prescribed
B. Place the client in high-Fowler's position
C. Apply a non-rebreather mask at 15 L/min
D. Notify the provider immediately
CORRECT ANSWER: B. Place the client in high-Fowler's position
Rationale: High-Fowler's position reduces venous return and decreases
pulmonary congestion, directly addressing the acute respiratory distress.
Airway and breathing interventions take priority before medications or
notification .
Question 3: A client who had a total knee replacement is receiving
enoxaparin. Which finding should the nurse report to the provider
immediately?
,A. Platelet count of 150,000/mm³
B. Hematocrit of 34%
C. Bloody drainage on the surgical dressing
D. Pain rated 4/10 at the incision site
CORRECT ANSWER: C. Bloody drainage on the surgical dressing
Rationale: Enoxaparin is a low-molecular-weight heparin with anticoagulant
effects. Active bleeding, evidenced by bloody drainage, requires immediate
provider notification and possible withholding of the next dose .
Question 4: A nurse is teaching a client who has COPD about
pursed-lip breathing. Which statement by the client indicates
correct understanding?
A. "I should breathe in quickly and breathe out slowly."
B. "I will inhale through my nose and exhale through pursed lips."
C. "Pursed-lip breathing helps me inhale more oxygen."
D. "I should hold my breath for 5 seconds after inhaling."
CORRECT ANSWER: B. "I will inhale through my nose and exhale
through pursed lips."
Rationale: Pursed-lip breathing prolongs exhalation, preventing airway
collapse and reducing air trapping. The correct technique involves inhaling
through the nose and exhaling slowly through pursed lips .
Question 5: A client with type 2 diabetes has a blood glucose of 58
mg/dL and is awake but drowsy. Which should the nurse
administer first?
A. One-half cup orange juice
B. Glucagon 1 mg IM
C. 50 mL dextrose 50% IV push
D. 4 oz skim milk
CORRECT ANSWER: A. One-half cup orange juice
Rationale: For a conscious client with mild hypoglycemia, 15 g of fast-
acting carbohydrate, such as orange juice, is the first-line treatment.
Glucagon and IV dextrose are reserved for clients who are unconscious or
unable to swallow .
,Question 6: A nurse is assessing a client who has chronic kidney
disease. The client's potassium level is 6.8 mEq/L. Which ECG
change should the nurse expect?
A. Flat T waves
B. Prominent U waves
C. Tall, peaked T waves
D. Prolonged PR interval
CORRECT ANSWER: C. Tall, peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves on the ECG. Flat T
waves and U waves are associated with hypokalemia .
Question 7: A client is 12 hours postoperative following abdominal
surgery. Which nursing intervention most effectively prevents deep
vein thrombosis?
A. Administering prophylactic antibiotics
B. Teaching the client to cough and deep breathe
C. Massaging the calves every 4 hours
D. Early ambulation and leg exercises
CORRECT ANSWER: D. Early ambulation and leg exercises
Rationale: Early ambulation is the most effective method to promote
venous return and prevent clot formation in the lower extremities.
Coughing and deep breathing prevent respiratory complications, not DVT .
Question 8: A nurse is caring for a client who has a chest tube
connected to a water-seal drainage system. The nurse observes
continuous bubbling in the water-seal chamber. Which action
should the nurse take first?
A. Clamp the chest tube
B. Assess for an air leak
C. Increase the suction pressure
D. Document the finding as normal
CORRECT ANSWER: B. Assess for an air leak
Rationale: Continuous bubbling in the water-seal chamber indicates an air
leak in the system. The nurse's first action is to assess the system to locate
, the source of the leak. Clamping the tube is not the initial action and can be
dangerous .
Question 9: A client with a new diagnosis of atrial fibrillation is
prescribed warfarin. Which food should the nurse instruct the
client to consume consistently?
A. Bananas
B. Spinach
C. Chicken
D. Rice
CORRECT ANSWER: B. Spinach
Rationale: Spinach is high in vitamin K, which antagonizes warfarin. Clients
should maintain consistent vitamin K intake rather than eliminate it, so the
nurse instructs consistent consumption to prevent fluctuations in INR .
Question 10: A nurse is assessing a client who has suspected
appendicitis. Which finding should the nurse prioritize for
immediate reporting?
A. Rebound tenderness in the right lower quadrant
B. Mild fever of 100.4°F
C. Nausea without vomiting
D. Decreased bowel sounds
CORRECT ANSWER: A. Rebound tenderness in the right lower
quadrant
Rationale: Rebound tenderness indicates peritoneal irritation and potential
perforation, which is a surgical emergency requiring immediate
intervention. Other findings are consistent with appendicitis but are not as
urgent .
Question 11: A nurse is preparing a client for surgery. Which action
is the nurse's primary responsibility regarding informed consent?
A. Explaining the risks and benefits of the procedure
B. Obtaining the surgical consent from the client
C. Witnessing the client's signature on the consent form
D. Determining if the client is competent to sign
