ATI Fundamentals Proctored Exam
2025/2026 | Actual Exam Questions With
Solutions Graded A | ATI Nursing
Assessment
✅ Sections included:
1. Cellular pathophysiology
2. Genetics & molecular mechanisms
3. Neuro, cardiac, pulmonary, renal
4. GI, endocrine, hematologic
5. Immune, inflammation, infection
6. Acid–base balance
7. Fluid & electrolyte disorders
Q1.
,A patient develops profound hypotension, warm flushed skin, and decreased systemic vascular
resistance following a severe bacterial infection. Which cytokine is the primary mediator
responsible for this distributive shock state?
A. IL-4
B. TNF-α
C. IFN-γ
D. IL-2
✔ Correct Answer: B. TNF-α
Rationale: TNF-α induces vasodilation, increases endothelial permeability, and triggers nitric
oxide release, all of which lead to septic/distributive shock.
Q2.
A client with chronic obstructive pulmonary disease (COPD) presents with chronic hypercapnia.
Which physiological adaptation is expected?
A. Decreased renal bicarbonate excretion
B. Suppressed erythropoietin release
C. Increased CSF pH
D. Decreased bicarbonate reabsorption
✔ Correct Answer: A. Decreased renal bicarbonate excretion
Rationale: In chronic respiratory acidosis, the kidneys retain bicarbonate to compensate for
elevated CO₂ levels.
Q3.
In left ventricular systolic failure, which change occurs to maintain cardiac output?
A. Increased afterload due to RAAS inhibition
B. Decreased sympathetic tone
C. Increased preload from RAAS activation
D. Decreased ventricular wall stress by dilation
✔ Correct Answer: C. Increased preload from RAAS activation
Rationale: Low cardiac output activates RAAS → sodium/water retention → increased
preload to maintain stroke volume (Frank-Starling).
,Q4.
A patient with type 2 diabetes develops microalbuminuria. What is the earliest structural change
in the kidney?
A. Basement membrane thinning
B. Expansion of mesangial matrix
C. Ischemic injury of the renal medulla
D. Podocyte hyperplasia
✔ Correct Answer: B. Expansion of mesangial matrix
Rationale: Diabetic nephropathy begins with mesangial expansion and GBM thickening,
progressing to glomerulosclerosis.
Q5.
Which mutation most commonly leads to autosomal dominant polycystic kidney disease
(ADPKD)?
A. PKD1 mutation → polycystin-1 defect
B. APOL1 mutation → podocyte injury
C. CFTR mutation → chloride channel dysfunction
D. COL4A5 mutation → defective type IV collagen
✔ Correct Answer: A. PKD1 mutation
Rationale: PKD1 mutations account for ~85% of ADPKD cases and cause abnormal tubular
cell proliferation and cyst formation.
Q6.
Which change is most responsible for early development of atherosclerotic plaque?
A. Rupture of fibrous cap
B. Foam cell formation from oxidized LDL uptake
, C. Smooth muscle cell apoptosis
D. Elastic lamina fragmentation
✔ Correct Answer: B. Foam cell formation
Rationale: Endothelial injury → LDL oxidation → macrophage uptake → foam cells, forming
the fatty streak, the earliest visible lesion.
Q7.
A patient with chronic kidney disease shows normocytic, normochromic anemia. What is the
primary mechanism?
A. Folate deficiency
B. Bone marrow fibrosis
C. Decreased erythropoietin production
D. Increased RBC destruction
✔ Correct Answer: C. Decreased erythropoietin production
Rationale: Failing kidneys cannot synthesize adequate EPO, reducing RBC production.
Q8.
Which electrolyte imbalance is most likely in a patient with tumor lysis syndrome?
A. Hypokalemia
B. Hypophosphatemia
C. Hyperuricemia
D. Hypocalcemia
✔ Correct Answer: C. Hyperuricemia
Rationale: Rapid tumor breakdown → increased DNA catabolism → uric acid elevation → risk
of renal failure.
Q9.
Which mechanism best explains insulin resistance in type 2 diabetes?
2025/2026 | Actual Exam Questions With
Solutions Graded A | ATI Nursing
Assessment
✅ Sections included:
1. Cellular pathophysiology
2. Genetics & molecular mechanisms
3. Neuro, cardiac, pulmonary, renal
4. GI, endocrine, hematologic
5. Immune, inflammation, infection
6. Acid–base balance
7. Fluid & electrolyte disorders
Q1.
,A patient develops profound hypotension, warm flushed skin, and decreased systemic vascular
resistance following a severe bacterial infection. Which cytokine is the primary mediator
responsible for this distributive shock state?
A. IL-4
B. TNF-α
C. IFN-γ
D. IL-2
✔ Correct Answer: B. TNF-α
Rationale: TNF-α induces vasodilation, increases endothelial permeability, and triggers nitric
oxide release, all of which lead to septic/distributive shock.
Q2.
A client with chronic obstructive pulmonary disease (COPD) presents with chronic hypercapnia.
Which physiological adaptation is expected?
A. Decreased renal bicarbonate excretion
B. Suppressed erythropoietin release
C. Increased CSF pH
D. Decreased bicarbonate reabsorption
✔ Correct Answer: A. Decreased renal bicarbonate excretion
Rationale: In chronic respiratory acidosis, the kidneys retain bicarbonate to compensate for
elevated CO₂ levels.
Q3.
In left ventricular systolic failure, which change occurs to maintain cardiac output?
A. Increased afterload due to RAAS inhibition
B. Decreased sympathetic tone
C. Increased preload from RAAS activation
D. Decreased ventricular wall stress by dilation
✔ Correct Answer: C. Increased preload from RAAS activation
Rationale: Low cardiac output activates RAAS → sodium/water retention → increased
preload to maintain stroke volume (Frank-Starling).
,Q4.
A patient with type 2 diabetes develops microalbuminuria. What is the earliest structural change
in the kidney?
A. Basement membrane thinning
B. Expansion of mesangial matrix
C. Ischemic injury of the renal medulla
D. Podocyte hyperplasia
✔ Correct Answer: B. Expansion of mesangial matrix
Rationale: Diabetic nephropathy begins with mesangial expansion and GBM thickening,
progressing to glomerulosclerosis.
Q5.
Which mutation most commonly leads to autosomal dominant polycystic kidney disease
(ADPKD)?
A. PKD1 mutation → polycystin-1 defect
B. APOL1 mutation → podocyte injury
C. CFTR mutation → chloride channel dysfunction
D. COL4A5 mutation → defective type IV collagen
✔ Correct Answer: A. PKD1 mutation
Rationale: PKD1 mutations account for ~85% of ADPKD cases and cause abnormal tubular
cell proliferation and cyst formation.
Q6.
Which change is most responsible for early development of atherosclerotic plaque?
A. Rupture of fibrous cap
B. Foam cell formation from oxidized LDL uptake
, C. Smooth muscle cell apoptosis
D. Elastic lamina fragmentation
✔ Correct Answer: B. Foam cell formation
Rationale: Endothelial injury → LDL oxidation → macrophage uptake → foam cells, forming
the fatty streak, the earliest visible lesion.
Q7.
A patient with chronic kidney disease shows normocytic, normochromic anemia. What is the
primary mechanism?
A. Folate deficiency
B. Bone marrow fibrosis
C. Decreased erythropoietin production
D. Increased RBC destruction
✔ Correct Answer: C. Decreased erythropoietin production
Rationale: Failing kidneys cannot synthesize adequate EPO, reducing RBC production.
Q8.
Which electrolyte imbalance is most likely in a patient with tumor lysis syndrome?
A. Hypokalemia
B. Hypophosphatemia
C. Hyperuricemia
D. Hypocalcemia
✔ Correct Answer: C. Hyperuricemia
Rationale: Rapid tumor breakdown → increased DNA catabolism → uric acid elevation → risk
of renal failure.
Q9.
Which mechanism best explains insulin resistance in type 2 diabetes?
