2025/26 ATI RN ADULT MEDICAL SURGICAL 2023 EXAM AND RETAKE PROCTORED 100
QUESTIONS FOR LEVEL 3 TOP SCORE
2025/26 ATI RN Adult Medical Surgical 2023 Exam and Retake
Proctored ASSESSEMENT 100 Questions for Level 3 Top Score
\Q\.A nurse is caring for a postoperative client who has just undergone abdominal surgery and
begins complaining of sudden shortness of breath and chest pain. The nurse notes tachypnea,
decreased oxygen saturation, and restlessness. What should the nurse do first?
A. Notify the healthcare provider.
B. Administer prescribed analgesics.
C. Elevate the head of the bed.
D.Apply warm compresses to the chest.
The correct answer is C. Elevate the head of the bed. Elevating the head of the bed facilitates
lung expansion and reduces the work of breathing, which is a priority action for a client
experiencing acute respiratory symptoms. While notifying the healthcare provider is essential, it
is not the immediate priority when the client’s oxygenation is compromised. Administering
analgesics does not address the underlying respiratory issue and may further depress
respiration. Warm compresses have no therapeutic value in this context. The nurse’s immediate
action should focus on airway, breathing, and circulation (the ABCs), and promoting oxygenation
is the primary concern in this situation. Once the client is positioned for optimal breathing, the
nurse can then notify the healthcare provider and implement additional interventions as
ordered.
\Q\.A nurse is monitoring a client with chronic heart failure who presents with increasing
shortness of breath, orthopnea, and bilateral crackles on auscultation. The client also has 3+
pitting edema in both lower extremities. Which prescription should the nurse question?
A. Furosemide 40 mg IV twice daily.
B. Sodium-restricted diet at 2 grams daily.
C. Intravenous 0.9% normal saline at 125 mL/hr.
D. Daily weights every morning.
The correct answer is C. Intravenous 0.9% normal saline at 125 mL/hr. In a client with worsening
heart failure, additional fluid administration via IV normal saline may exacerbate fluid overload
and pulmonary edema. The nurse should question any order that could worsen the patient’s
volume status. Furosemide is appropriate because it is a loop diuretic that reduces fluid volume
,2025/26 ATI RN ADULT MEDICAL SURGICAL 2023 EXAM AND RETAKE PROCTORED 100
QUESTIONS FOR LEVEL 3 TOP SCORE
and relieves pulmonary and peripheral congestion. A sodium-restricted diet is also suitable, as
sodium contributes to water retention. Daily weights are essential in evaluating fluid retention
or diuresis effectiveness. The nurse must critically assess whether ordered therapies align with
the patient’s evolving clinical status, especially in conditions like heart failure where fluid
balance is delicate.
\Q\.During care for a client with a new tracheostomy, the nurse observes that the client is
agitated, has a heart rate of 118 bpm, respiratory rate of 32 breaths per minute, and oxygen
saturation of 87% on room air. What is the priority nursing action?
A. Suction the tracheostomy.
B. Call the rapid response team.
C. Apply oxygen via tracheostomy collar.
D. Reassure the client and observe.
The correct answer is C. Apply oxygen via tracheostomy collar. The priority for this client is to
ensure adequate oxygenation, as evidenced by signs of respiratory distress and hypoxia.
Administering oxygen directly to the tracheostomy site can immediately improve oxygen
saturation and relieve symptoms. Suctioning may be necessary if secretions are suspected, but
oxygen should be applied first to address hypoxia. Calling the rapid response team may be
necessary if the patient does not improve after oxygenation is initiated, but it is not the initial
step. Reassuring and observing does not address the emergent need for oxygen. This scenario
illustrates the importance of prompt and prioritized interventions to maintain a patient’s airway
and respiratory function, especially in postoperative or vulnerable populations.
\Q\.A nurse is caring for a client who is scheduled for a colonoscopy in the morning. The
provider orders polyethylene glycol-electrolyte solution (GoLYTELY). The client becomes
nauseated and refuses to drink the solution. What should the nurse do next?
A. Encourage the client to drink the solution slowly over time.
B. Notify the provider and request a different bowel prep.
C. Cancel the procedure.
D. Administer an antiemetic and try again later.
The correct answer is A. Encourage the client to drink the solution slowly over time. Nausea is a
common side effect of bowel preparation agents like polyethylene glycol. Encouraging the client
to drink the solution slowly over a longer period can help minimize gastrointestinal distress and
promote compliance. Notifying the provider may be warranted if the client continues to refuse,
, 2025/26 ATI RN ADULT MEDICAL SURGICAL 2023 EXAM AND RETAKE PROCTORED 100
QUESTIONS FOR LEVEL 3 TOP SCORE
but the nurse should first attempt to resolve the issue with simple interventions. Canceling the
procedure prematurely is inappropriate. Administering an antiemetic may be helpful in some
cases, but encouraging fluid intake slowly is a less invasive first step. Nurses must balance
patient comfort with procedural requirements, using evidence-based strategies to ensure safe
and effective preparation.
\Q\.A nurse is providing discharge instructions to a client with a new prescription for warfarin.
Which statement by the client indicates a need for further teaching?
A. "I will eat a consistent amount of green leafy vegetables each week."
B. "I will inform all healthcare providers that I’m taking warfarin."
C. "I will take aspirin every day to help thin my blood further."
D. "I will have my INR checked regularly."
The correct answer is C. "I will take aspirin every day to help thin my blood further." This
statement indicates a need for further teaching because taking aspirin in combination with
warfarin significantly increases the risk of bleeding unless explicitly prescribed. Clients on
warfarin must be educated about drug interactions and the potential for additive anticoagulant
effects with other medications like aspirin or NSAIDs. The other statements reflect appropriate
understanding of warfarin management, including the importance of maintaining consistent
dietary intake of vitamin K, notifying all healthcare providers, and monitoring INR to maintain
therapeutic anticoagulation. Patient education is a cornerstone of safe medication use,
especially with high-risk medications such as anticoagulants, where mismanagement can lead to
serious complications like hemorrhage.
The knowledge and skills acquired in medical-surgical nursing courses are crucial to shaping the
competency and confidence of future registered nurses. Throughout training, nurses are
introduced to complex physiological concepts, pathophysiology, pharmacological interventions,
and holistic care strategies needed for a diverse adult patient population. These foundational
teachings equip nursing students to assess, diagnose, plan, implement, and evaluate care in a
wide range of clinical settings, from acute care hospitals to outpatient rehabilitation facilities.
For instance, understanding the progression of chronic diseases such as diabetes mellitus, heart
failure, or COPD enables nurses to anticipate complications, implement preventative strategies,
and respond effectively in emergencies. This predictive capacity is not only vital in acute care
but also supports nurses in long-term and community health management.
In practice, medical-surgical content supports the nurse’s ability to prioritize care effectively
using frameworks like Maslow’s hierarchy of needs or the ABCs—airway, breathing, circulation.
Nurses learn to triage appropriately, manage multiple patients simultaneously, and adapt care
based on rapidly changing clinical presentations. This clinical judgment is honed through case
studies, simulation labs, and critical thinking exercises taught during med-surg rotations.
QUESTIONS FOR LEVEL 3 TOP SCORE
2025/26 ATI RN Adult Medical Surgical 2023 Exam and Retake
Proctored ASSESSEMENT 100 Questions for Level 3 Top Score
\Q\.A nurse is caring for a postoperative client who has just undergone abdominal surgery and
begins complaining of sudden shortness of breath and chest pain. The nurse notes tachypnea,
decreased oxygen saturation, and restlessness. What should the nurse do first?
A. Notify the healthcare provider.
B. Administer prescribed analgesics.
C. Elevate the head of the bed.
D.Apply warm compresses to the chest.
The correct answer is C. Elevate the head of the bed. Elevating the head of the bed facilitates
lung expansion and reduces the work of breathing, which is a priority action for a client
experiencing acute respiratory symptoms. While notifying the healthcare provider is essential, it
is not the immediate priority when the client’s oxygenation is compromised. Administering
analgesics does not address the underlying respiratory issue and may further depress
respiration. Warm compresses have no therapeutic value in this context. The nurse’s immediate
action should focus on airway, breathing, and circulation (the ABCs), and promoting oxygenation
is the primary concern in this situation. Once the client is positioned for optimal breathing, the
nurse can then notify the healthcare provider and implement additional interventions as
ordered.
\Q\.A nurse is monitoring a client with chronic heart failure who presents with increasing
shortness of breath, orthopnea, and bilateral crackles on auscultation. The client also has 3+
pitting edema in both lower extremities. Which prescription should the nurse question?
A. Furosemide 40 mg IV twice daily.
B. Sodium-restricted diet at 2 grams daily.
C. Intravenous 0.9% normal saline at 125 mL/hr.
D. Daily weights every morning.
The correct answer is C. Intravenous 0.9% normal saline at 125 mL/hr. In a client with worsening
heart failure, additional fluid administration via IV normal saline may exacerbate fluid overload
and pulmonary edema. The nurse should question any order that could worsen the patient’s
volume status. Furosemide is appropriate because it is a loop diuretic that reduces fluid volume
,2025/26 ATI RN ADULT MEDICAL SURGICAL 2023 EXAM AND RETAKE PROCTORED 100
QUESTIONS FOR LEVEL 3 TOP SCORE
and relieves pulmonary and peripheral congestion. A sodium-restricted diet is also suitable, as
sodium contributes to water retention. Daily weights are essential in evaluating fluid retention
or diuresis effectiveness. The nurse must critically assess whether ordered therapies align with
the patient’s evolving clinical status, especially in conditions like heart failure where fluid
balance is delicate.
\Q\.During care for a client with a new tracheostomy, the nurse observes that the client is
agitated, has a heart rate of 118 bpm, respiratory rate of 32 breaths per minute, and oxygen
saturation of 87% on room air. What is the priority nursing action?
A. Suction the tracheostomy.
B. Call the rapid response team.
C. Apply oxygen via tracheostomy collar.
D. Reassure the client and observe.
The correct answer is C. Apply oxygen via tracheostomy collar. The priority for this client is to
ensure adequate oxygenation, as evidenced by signs of respiratory distress and hypoxia.
Administering oxygen directly to the tracheostomy site can immediately improve oxygen
saturation and relieve symptoms. Suctioning may be necessary if secretions are suspected, but
oxygen should be applied first to address hypoxia. Calling the rapid response team may be
necessary if the patient does not improve after oxygenation is initiated, but it is not the initial
step. Reassuring and observing does not address the emergent need for oxygen. This scenario
illustrates the importance of prompt and prioritized interventions to maintain a patient’s airway
and respiratory function, especially in postoperative or vulnerable populations.
\Q\.A nurse is caring for a client who is scheduled for a colonoscopy in the morning. The
provider orders polyethylene glycol-electrolyte solution (GoLYTELY). The client becomes
nauseated and refuses to drink the solution. What should the nurse do next?
A. Encourage the client to drink the solution slowly over time.
B. Notify the provider and request a different bowel prep.
C. Cancel the procedure.
D. Administer an antiemetic and try again later.
The correct answer is A. Encourage the client to drink the solution slowly over time. Nausea is a
common side effect of bowel preparation agents like polyethylene glycol. Encouraging the client
to drink the solution slowly over a longer period can help minimize gastrointestinal distress and
promote compliance. Notifying the provider may be warranted if the client continues to refuse,
, 2025/26 ATI RN ADULT MEDICAL SURGICAL 2023 EXAM AND RETAKE PROCTORED 100
QUESTIONS FOR LEVEL 3 TOP SCORE
but the nurse should first attempt to resolve the issue with simple interventions. Canceling the
procedure prematurely is inappropriate. Administering an antiemetic may be helpful in some
cases, but encouraging fluid intake slowly is a less invasive first step. Nurses must balance
patient comfort with procedural requirements, using evidence-based strategies to ensure safe
and effective preparation.
\Q\.A nurse is providing discharge instructions to a client with a new prescription for warfarin.
Which statement by the client indicates a need for further teaching?
A. "I will eat a consistent amount of green leafy vegetables each week."
B. "I will inform all healthcare providers that I’m taking warfarin."
C. "I will take aspirin every day to help thin my blood further."
D. "I will have my INR checked regularly."
The correct answer is C. "I will take aspirin every day to help thin my blood further." This
statement indicates a need for further teaching because taking aspirin in combination with
warfarin significantly increases the risk of bleeding unless explicitly prescribed. Clients on
warfarin must be educated about drug interactions and the potential for additive anticoagulant
effects with other medications like aspirin or NSAIDs. The other statements reflect appropriate
understanding of warfarin management, including the importance of maintaining consistent
dietary intake of vitamin K, notifying all healthcare providers, and monitoring INR to maintain
therapeutic anticoagulation. Patient education is a cornerstone of safe medication use,
especially with high-risk medications such as anticoagulants, where mismanagement can lead to
serious complications like hemorrhage.
The knowledge and skills acquired in medical-surgical nursing courses are crucial to shaping the
competency and confidence of future registered nurses. Throughout training, nurses are
introduced to complex physiological concepts, pathophysiology, pharmacological interventions,
and holistic care strategies needed for a diverse adult patient population. These foundational
teachings equip nursing students to assess, diagnose, plan, implement, and evaluate care in a
wide range of clinical settings, from acute care hospitals to outpatient rehabilitation facilities.
For instance, understanding the progression of chronic diseases such as diabetes mellitus, heart
failure, or COPD enables nurses to anticipate complications, implement preventative strategies,
and respond effectively in emergencies. This predictive capacity is not only vital in acute care
but also supports nurses in long-term and community health management.
In practice, medical-surgical content supports the nurse’s ability to prioritize care effectively
using frameworks like Maslow’s hierarchy of needs or the ABCs—airway, breathing, circulation.
Nurses learn to triage appropriately, manage multiple patients simultaneously, and adapt care
based on rapidly changing clinical presentations. This clinical judgment is honed through case
studies, simulation labs, and critical thinking exercises taught during med-surg rotations.
