Study Guide ATI Med Surg 2024 Proctored Exam
ATI Med Surg 2024 Proctored Exam –
Version A & B: Full 220 Questions,
Verified Solutions
Comprehensive Study Guide for Nursing Students
Date: June 19, 2025
Introduction
This study guide is designed for nursing students preparing for the 2024 ATI Medical-Surgical
Proctored Exam, covering both versions (A and B). It includes 220 sample questions, compris-
ing traditional multiple-choice and Next Generation NCLEX (NGN) case studies with select-all-
that-apply, drag-and-drop, and prioritization formats. Topics span cardiovascular, respiratory,
gastrointestinal, neurological, endocrine, renal, musculoskeletal, and patient safety. Each ques-
tion includes a verified answer with a concise rationale to strengthen clinical judgment, aligned
with the NCSBN Clinical Judgment Measurement Model. The guide also provides study tips,
curated resources, a practice strategy, and pitfalls to avoid, offering a robust preparation frame-
work.
1 Key Topics Covered
• Cardiovascular: Heart failure, myocardial infarction, hypertension, dysrhythmias, DVT.
• Respiratory: COPD, pneumonia, pulmonary embolism, asthma, chest tubes.
• Gastrointestinal: GI bleeding, pancreatitis, cirrhosis, ostomy care, bowel obstruction.
• Neurological: Stroke, seizures, traumatic brain injury, ICP, meningitis.
• Endocrine: DKA, hypothyroidism, hyperthyroidism, adrenal disorders.
• Renal/Urinary: AKI, CKD, UTIs, nephrostomy care, dialysis.
• Musculoskeletal: Fractures, joint replacement, arthritis, compartment syndrome.
• Patient Safety: Infection control, medication errors, fall prevention, sterile procedures.
• NGN Skills: Prioritization, delegation, clinical decision-making, interdisciplinary care.
2 Sample Questions and Verified Solutions
2.1 Version A: Traditional Multiple-Choice Questions
1. A nurse assesses a client with heart failure. Which finding indicates worsening con-
dition?
A. BP 130/80 mm Hg
B. Weight gain of 3 kg in 2 days
C. Heart rate 80 bpm
D. Clear lung sounds
Answer: B. Weight gain of 3 kg in 2 days
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,Study Guide ATI Med Surg 2024 Proctored Exam
Rationale: Rapid weight gain signals fluid retention, a sign of worsening heart failure.
Normal BP (A), HR (C), and clear lungs (D) are not concerning.
2. A client on warfarin reports bruising. Which lab should the nurse review?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin
Answer: B. INR
Rationale: INR monitors warfarin’s anticoagulant effect; elevated INR increases bleeding
risk. aPTT (A) is for heparin, platelets (C) and hemoglobin (D) are secondary.
3. A nurse cares for a client with a chest tube. Which finding requires intervention?
A. Tidaling in water seal
B. Continuous bubbling in water seal
C. 100 mL drainage in 8 hours
D. Suction chamber bubbling
Answer: B. Continuous bubbling in water seal
Rationale: Continuous bubbling indicates an air leak. Tidaling (A), drainage (C), and
suction bubbling (D) are normal.
4. A client post-TURP has continuous bladder irrigation. Which output color is con-
cerning?
A. Light pink
B. Amber
C. Bright red with clots
D. Cloudy
Answer: C. Bright red with clots
Rationale: Bright red output with clots suggests hemorrhage. Light pink (A) and amber
(B) are expected, cloudy (D) may indicate infection.
5. A nurse calculates IV flow rate for 1000 mL NS over 8 hours with 15 drops/mL
tubing. How many drops/min?
A. 31
B. 28
C. 21
D. 15
Answer: A. 31
Rationale: (1000 × 15) ÷ (8 × 60) = 31.25, rounded to 31 drops/min.
6. A client with diabetes insipidus is prescribed desmopressin. Which outcome is ex-
pected?
A. Increased urine output
B. Decreased thirst
C. Elevated blood glucose
D. Weight loss
Answer: B. Decreased thirst
Rationale: Desmopressin reduces urine output, decreasing thirst. Increased output (A),
glucose (C), and weight loss (D) are incorrect.
7. A nurse reviews CSF results for a client with meningitis. Which finding is expected?
A. High glucose
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, Study Guide ATI Med Surg 2024 Proctored Exam
B. Low protein
C. Cloudy appearance
D. Low WBC count
Answer: C. Cloudy appearance
Rationale: Bacterial meningitis causes cloudy CSF, low glucose, high protein, and high
WBCs. Options (A, B, D) are incorrect.
8. A client with GERD is prescribed ranitidine. Which instruction is correct?
A. Take with meals
B. Take at bedtime
C. Avoid antacids
D. Expect weight gain
Answer: B. Take at bedtime
Rationale: Ranitidine reduces acid at night. Meals (A) are irrelevant, antacids (C) are
compatible, weight gain (D) is not expected.
9. A nurse monitors a client during a blood transfusion. Which finding suggests an
allergic reaction?
A. Fever
B. Urticaria
C. Crackles
D. Hypotension
Answer: B. Urticaria
Rationale: Urticaria indicates allergy. Fever (A) suggests febrile reaction, crackles (C)
fluid overload, hypotension (D) hemolytic reaction.
10. A nurse assesses a client post-colectomy. Which finding requires reporting?
A. Absent bowel sounds
B. Rigid abdomen
C. Incisional pain
D. Passing flatus
Answer: B. Rigid abdomen
Rationale: Rigid abdomen suggests peritonitis. Absent sounds (A) are expected initially,
pain (C) is normal, flatus (D) is positive.
11. A client with COPD reports increased dyspnea. Which finding indicates exacerba-
tion?
A. SpO2 92%
B. Wheezing
C. Barrel chest
D. Pursed-lip breathing
Answer: B. Wheezing
Rationale: Wheezing signals airway obstruction in exacerbation. Barrel chest (C) and
pursed-lip breathing (D) are chronic, SpO2 (A) is near normal.
12. A nurse administers insulin aspart. When should the meal be served?
A. Immediately
B. 30 minutes later
C. 60 minutes later
D. 90 minutes later
Answer: A. Immediately
Page 3
ATI Med Surg 2024 Proctored Exam –
Version A & B: Full 220 Questions,
Verified Solutions
Comprehensive Study Guide for Nursing Students
Date: June 19, 2025
Introduction
This study guide is designed for nursing students preparing for the 2024 ATI Medical-Surgical
Proctored Exam, covering both versions (A and B). It includes 220 sample questions, compris-
ing traditional multiple-choice and Next Generation NCLEX (NGN) case studies with select-all-
that-apply, drag-and-drop, and prioritization formats. Topics span cardiovascular, respiratory,
gastrointestinal, neurological, endocrine, renal, musculoskeletal, and patient safety. Each ques-
tion includes a verified answer with a concise rationale to strengthen clinical judgment, aligned
with the NCSBN Clinical Judgment Measurement Model. The guide also provides study tips,
curated resources, a practice strategy, and pitfalls to avoid, offering a robust preparation frame-
work.
1 Key Topics Covered
• Cardiovascular: Heart failure, myocardial infarction, hypertension, dysrhythmias, DVT.
• Respiratory: COPD, pneumonia, pulmonary embolism, asthma, chest tubes.
• Gastrointestinal: GI bleeding, pancreatitis, cirrhosis, ostomy care, bowel obstruction.
• Neurological: Stroke, seizures, traumatic brain injury, ICP, meningitis.
• Endocrine: DKA, hypothyroidism, hyperthyroidism, adrenal disorders.
• Renal/Urinary: AKI, CKD, UTIs, nephrostomy care, dialysis.
• Musculoskeletal: Fractures, joint replacement, arthritis, compartment syndrome.
• Patient Safety: Infection control, medication errors, fall prevention, sterile procedures.
• NGN Skills: Prioritization, delegation, clinical decision-making, interdisciplinary care.
2 Sample Questions and Verified Solutions
2.1 Version A: Traditional Multiple-Choice Questions
1. A nurse assesses a client with heart failure. Which finding indicates worsening con-
dition?
A. BP 130/80 mm Hg
B. Weight gain of 3 kg in 2 days
C. Heart rate 80 bpm
D. Clear lung sounds
Answer: B. Weight gain of 3 kg in 2 days
Page 1
,Study Guide ATI Med Surg 2024 Proctored Exam
Rationale: Rapid weight gain signals fluid retention, a sign of worsening heart failure.
Normal BP (A), HR (C), and clear lungs (D) are not concerning.
2. A client on warfarin reports bruising. Which lab should the nurse review?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin
Answer: B. INR
Rationale: INR monitors warfarin’s anticoagulant effect; elevated INR increases bleeding
risk. aPTT (A) is for heparin, platelets (C) and hemoglobin (D) are secondary.
3. A nurse cares for a client with a chest tube. Which finding requires intervention?
A. Tidaling in water seal
B. Continuous bubbling in water seal
C. 100 mL drainage in 8 hours
D. Suction chamber bubbling
Answer: B. Continuous bubbling in water seal
Rationale: Continuous bubbling indicates an air leak. Tidaling (A), drainage (C), and
suction bubbling (D) are normal.
4. A client post-TURP has continuous bladder irrigation. Which output color is con-
cerning?
A. Light pink
B. Amber
C. Bright red with clots
D. Cloudy
Answer: C. Bright red with clots
Rationale: Bright red output with clots suggests hemorrhage. Light pink (A) and amber
(B) are expected, cloudy (D) may indicate infection.
5. A nurse calculates IV flow rate for 1000 mL NS over 8 hours with 15 drops/mL
tubing. How many drops/min?
A. 31
B. 28
C. 21
D. 15
Answer: A. 31
Rationale: (1000 × 15) ÷ (8 × 60) = 31.25, rounded to 31 drops/min.
6. A client with diabetes insipidus is prescribed desmopressin. Which outcome is ex-
pected?
A. Increased urine output
B. Decreased thirst
C. Elevated blood glucose
D. Weight loss
Answer: B. Decreased thirst
Rationale: Desmopressin reduces urine output, decreasing thirst. Increased output (A),
glucose (C), and weight loss (D) are incorrect.
7. A nurse reviews CSF results for a client with meningitis. Which finding is expected?
A. High glucose
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, Study Guide ATI Med Surg 2024 Proctored Exam
B. Low protein
C. Cloudy appearance
D. Low WBC count
Answer: C. Cloudy appearance
Rationale: Bacterial meningitis causes cloudy CSF, low glucose, high protein, and high
WBCs. Options (A, B, D) are incorrect.
8. A client with GERD is prescribed ranitidine. Which instruction is correct?
A. Take with meals
B. Take at bedtime
C. Avoid antacids
D. Expect weight gain
Answer: B. Take at bedtime
Rationale: Ranitidine reduces acid at night. Meals (A) are irrelevant, antacids (C) are
compatible, weight gain (D) is not expected.
9. A nurse monitors a client during a blood transfusion. Which finding suggests an
allergic reaction?
A. Fever
B. Urticaria
C. Crackles
D. Hypotension
Answer: B. Urticaria
Rationale: Urticaria indicates allergy. Fever (A) suggests febrile reaction, crackles (C)
fluid overload, hypotension (D) hemolytic reaction.
10. A nurse assesses a client post-colectomy. Which finding requires reporting?
A. Absent bowel sounds
B. Rigid abdomen
C. Incisional pain
D. Passing flatus
Answer: B. Rigid abdomen
Rationale: Rigid abdomen suggests peritonitis. Absent sounds (A) are expected initially,
pain (C) is normal, flatus (D) is positive.
11. A client with COPD reports increased dyspnea. Which finding indicates exacerba-
tion?
A. SpO2 92%
B. Wheezing
C. Barrel chest
D. Pursed-lip breathing
Answer: B. Wheezing
Rationale: Wheezing signals airway obstruction in exacerbation. Barrel chest (C) and
pursed-lip breathing (D) are chronic, SpO2 (A) is near normal.
12. A nurse administers insulin aspart. When should the meal be served?
A. Immediately
B. 30 minutes later
C. 60 minutes later
D. 90 minutes later
Answer: A. Immediately
Page 3
