ATI PN Medical Surgical Proctored Exam Newest
/ATI PN Medical Surgical Proctored Preparation
/ATI PN Medical Surgical Proctored Practice
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Question 1 (Priority/Complications)
A client 12 hours post-open cholecystectomy has a sudden increase in bright red
drainage from the JP drain (300 mL in 1 hour), BP 88/50 mmHg, and HR 128. What is
the nurse’s FIRST action?
a. Elevate the head of the bed to 45°
b. Notify the surgeon immediately
c. Increase the IV fluid rate
d. Apply a pressure dressing to the incision
Correct Answer-: b. Notify the surgeon immediately
Rationale: Massive bright red drainage + hypotension + tachycardia = hemorrhagic
shock from intra-abdominal bleeding (most common life-threatening complication after
cholecystectomy). This is an emergency requiring immediate surgical intervention. All
other actions are supportive but not first when the client is unstable.
Question 2 (SATA – Postoperative Complications)
Which findings indicate a client is developing malignant hyperthermia 30 minutes after
receiving succinylcholine? (Select all that apply)
a. Temperature 104.8°F (40.4°C)
b. Muscle rigidity
c. Dark cola-colored urine
d. ETCO2 68 mmHg
,e. Heart rate 68 bpm
Correct Answer-:: a, b, d
Rationale: Classic triad of malignant hyperthermia: hyperthermia, muscle rigidity, and
rising ETCO2 (hypermetabolism). Bradycardia is NOT seen (tachycardia is expected).
Myoglobinuria (dark urine) occurs later.
Question 3 (Pharmacology – Priority Adverse Effect)
A client with heart failure is started on milrinone IV. Which finding requires the nurse
to stop the infusion and notify the provider immediately?
a. Serum potassium 3.8 mEq/L
b. Ventricular dysrhythmias on telemetry
c. Blood pressure 110/70 mmHg
d. Urine output 40 mL/hr
Correct Answer-: b. Ventricular dysrhythmias
Rationale: Milrinone is a phosphodiesterase inhibitor that can cause life-threatening
ventricular dysrhythmias (biggest ATI-tested adverse effect). Hypotension is common
but dysrhythmias are priority to stop.
Question 4 (Delegation)
Which task can the LPN safely delegate to the UAP for a client with total hip
replacement on postoperative day 1?
a. Assess the neurovascular status of the affected leg
b. Teach the client how to use the incentive spirometer
c. Remind the client to keep the leg abducted with an abductor pillow
d. Administer enoxaparin (Lovenox) subcutaneously
Correct Answer-: c. Remind the client to keep the leg abducted
Rationale: Reminding/reinforcing is within UAP scope. Assessment, teaching new
material, and giving anticoagulants are RN responsibilities.
Question 5 (SATA – Cushing’s Triad)
A client with a traumatic brain injury is deteriorating. Which findings are consistent
with Cushing’s triad indicating increased intracranial pressure? (Select all that apply)
a. Blood pressure 180/60 mmHg (wide pulse pressure)
b. Heart rate 52 bpm
,c. Irregular respiratory pattern
d. Temperature 102.2°F
e. Pupil dilation on one side
Correct Answer-:: a, b, c
Rationale: Cushing’s triad = hypertension with widening pulse pressure + bradycardia +
irregular respirations. Late, life-threatening sign of herniation.
Question 6 (Burns – Fluid Resuscitation)
A 70-kg client with 45% TBSA flame burns arrives 2 hours post-injury. Using the
Parkland formula, how many mL of Lactated Ringer’s should the client receive in the
first 8 hours?
a. 6,300 mL
b. 12,600 mL
c. 5,040 mL
d. 10,080 mL
Correct Answer-: a. 6,300 mL
Calculation: 4 mL × 70 kg × 45% = 12,600 mL total in 24 hours
→ Half in first 8 hours = 6,300 mL (from time of injury, so already 2 hours behind)
Question 7 (Diabetes – DKA vs HHNS)
Which laboratory finding is most consistent with hyperglycemic hyperosmolar
nonketotic syndrome (HHNS) rather than DKA?
a. pH 7.12
b. Serum osmolality 360 mOsm/kg
c. Large ketones in urine
d. Blood glucose 480 mg/dL
Correct Answer-: b. Serum osmolality 360 mOsm/kg
Rationale: HHNS: glucose often >600, osmolality >320, NO significant ketones, pH
usually >7.3. DKA has acidosis and ketones.
Question 8 (Priority – Chest Pain)
A client with a history of angina reports chest pain rated 8/10, diaphoretic, nauseated.
ECG shows ST elevation in leads II, III, aVF. What is the nurse’s priority action?
a. Administer aspirin 325 mg chewed
, b. Obtain 12-lead ECG
c. Administer morphine IV
d. Call rapid response team
Correct Answer-: a. Administer aspirin 325 mg chewed
Rationale: STEMI = time = muscle time. MONA protocol: Morphine, Oxygen,
Nitroglycerin, Aspirin — but Aspirin is the ONLY medication proven to reduce mortality
in STEMI and is given first if not contraindicated.
Question 9 (SATA – Compartment Syndrome)
A client with a tibia fracture reports 9/10 leg pain 6 hours after cast placement. Which
findings require immediate provider notification for suspected compartment syndrome?
(Select all that apply)
a. Pain unrelieved by opioids
b. Paresthesia of the toes
c. Pulses 2+ bilaterally
d. Pain on passive stretch
e. Pale, cool foot
Correct Answer-:: a, b, d, e
Rationale: 6 P’s: Pain (early), Paresthesia, Pallor, Paralysis, Pulselessness (late), Pain on
passive stretch. Normal pulses do NOT rule out compartment syndrome.
Question 10 (Infection Control)
A client with vancomycin-resistant Enterococcus (VRE) is in contact precautions. Which
action by the UAP requires immediate intervention?
a. Wearing gown and gloves to empty the urinal
b. Removing gown and gloves before leaving the room
c. Using alcohol-based hand rub after removing PPE
d. Placing the stethoscope in a plastic bag after use
Correct Answer-: c. Using alcohol-based hand rub after removing PPE
Rationale: Alcohol does NOT kill VRE (spore-forming). Soap and water handwashing is
required for C. difficile and VRE.
Question 11 (Renal – Acute Kidney Injury)
/ATI PN Medical Surgical Proctored Preparation
/ATI PN Medical Surgical Proctored Practice
Exam With Complete Questions And Correct
Answers |Already Graded A+||Brand New
Versions!!
Question 1 (Priority/Complications)
A client 12 hours post-open cholecystectomy has a sudden increase in bright red
drainage from the JP drain (300 mL in 1 hour), BP 88/50 mmHg, and HR 128. What is
the nurse’s FIRST action?
a. Elevate the head of the bed to 45°
b. Notify the surgeon immediately
c. Increase the IV fluid rate
d. Apply a pressure dressing to the incision
Correct Answer-: b. Notify the surgeon immediately
Rationale: Massive bright red drainage + hypotension + tachycardia = hemorrhagic
shock from intra-abdominal bleeding (most common life-threatening complication after
cholecystectomy). This is an emergency requiring immediate surgical intervention. All
other actions are supportive but not first when the client is unstable.
Question 2 (SATA – Postoperative Complications)
Which findings indicate a client is developing malignant hyperthermia 30 minutes after
receiving succinylcholine? (Select all that apply)
a. Temperature 104.8°F (40.4°C)
b. Muscle rigidity
c. Dark cola-colored urine
d. ETCO2 68 mmHg
,e. Heart rate 68 bpm
Correct Answer-:: a, b, d
Rationale: Classic triad of malignant hyperthermia: hyperthermia, muscle rigidity, and
rising ETCO2 (hypermetabolism). Bradycardia is NOT seen (tachycardia is expected).
Myoglobinuria (dark urine) occurs later.
Question 3 (Pharmacology – Priority Adverse Effect)
A client with heart failure is started on milrinone IV. Which finding requires the nurse
to stop the infusion and notify the provider immediately?
a. Serum potassium 3.8 mEq/L
b. Ventricular dysrhythmias on telemetry
c. Blood pressure 110/70 mmHg
d. Urine output 40 mL/hr
Correct Answer-: b. Ventricular dysrhythmias
Rationale: Milrinone is a phosphodiesterase inhibitor that can cause life-threatening
ventricular dysrhythmias (biggest ATI-tested adverse effect). Hypotension is common
but dysrhythmias are priority to stop.
Question 4 (Delegation)
Which task can the LPN safely delegate to the UAP for a client with total hip
replacement on postoperative day 1?
a. Assess the neurovascular status of the affected leg
b. Teach the client how to use the incentive spirometer
c. Remind the client to keep the leg abducted with an abductor pillow
d. Administer enoxaparin (Lovenox) subcutaneously
Correct Answer-: c. Remind the client to keep the leg abducted
Rationale: Reminding/reinforcing is within UAP scope. Assessment, teaching new
material, and giving anticoagulants are RN responsibilities.
Question 5 (SATA – Cushing’s Triad)
A client with a traumatic brain injury is deteriorating. Which findings are consistent
with Cushing’s triad indicating increased intracranial pressure? (Select all that apply)
a. Blood pressure 180/60 mmHg (wide pulse pressure)
b. Heart rate 52 bpm
,c. Irregular respiratory pattern
d. Temperature 102.2°F
e. Pupil dilation on one side
Correct Answer-:: a, b, c
Rationale: Cushing’s triad = hypertension with widening pulse pressure + bradycardia +
irregular respirations. Late, life-threatening sign of herniation.
Question 6 (Burns – Fluid Resuscitation)
A 70-kg client with 45% TBSA flame burns arrives 2 hours post-injury. Using the
Parkland formula, how many mL of Lactated Ringer’s should the client receive in the
first 8 hours?
a. 6,300 mL
b. 12,600 mL
c. 5,040 mL
d. 10,080 mL
Correct Answer-: a. 6,300 mL
Calculation: 4 mL × 70 kg × 45% = 12,600 mL total in 24 hours
→ Half in first 8 hours = 6,300 mL (from time of injury, so already 2 hours behind)
Question 7 (Diabetes – DKA vs HHNS)
Which laboratory finding is most consistent with hyperglycemic hyperosmolar
nonketotic syndrome (HHNS) rather than DKA?
a. pH 7.12
b. Serum osmolality 360 mOsm/kg
c. Large ketones in urine
d. Blood glucose 480 mg/dL
Correct Answer-: b. Serum osmolality 360 mOsm/kg
Rationale: HHNS: glucose often >600, osmolality >320, NO significant ketones, pH
usually >7.3. DKA has acidosis and ketones.
Question 8 (Priority – Chest Pain)
A client with a history of angina reports chest pain rated 8/10, diaphoretic, nauseated.
ECG shows ST elevation in leads II, III, aVF. What is the nurse’s priority action?
a. Administer aspirin 325 mg chewed
, b. Obtain 12-lead ECG
c. Administer morphine IV
d. Call rapid response team
Correct Answer-: a. Administer aspirin 325 mg chewed
Rationale: STEMI = time = muscle time. MONA protocol: Morphine, Oxygen,
Nitroglycerin, Aspirin — but Aspirin is the ONLY medication proven to reduce mortality
in STEMI and is given first if not contraindicated.
Question 9 (SATA – Compartment Syndrome)
A client with a tibia fracture reports 9/10 leg pain 6 hours after cast placement. Which
findings require immediate provider notification for suspected compartment syndrome?
(Select all that apply)
a. Pain unrelieved by opioids
b. Paresthesia of the toes
c. Pulses 2+ bilaterally
d. Pain on passive stretch
e. Pale, cool foot
Correct Answer-:: a, b, d, e
Rationale: 6 P’s: Pain (early), Paresthesia, Pallor, Paralysis, Pulselessness (late), Pain on
passive stretch. Normal pulses do NOT rule out compartment syndrome.
Question 10 (Infection Control)
A client with vancomycin-resistant Enterococcus (VRE) is in contact precautions. Which
action by the UAP requires immediate intervention?
a. Wearing gown and gloves to empty the urinal
b. Removing gown and gloves before leaving the room
c. Using alcohol-based hand rub after removing PPE
d. Placing the stethoscope in a plastic bag after use
Correct Answer-: c. Using alcohol-based hand rub after removing PPE
Rationale: Alcohol does NOT kill VRE (spore-forming). Soap and water handwashing is
required for C. difficile and VRE.
Question 11 (Renal – Acute Kidney Injury)
