ATI RN ADULT MEDICAL SURGICAL EXAM – QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM
UPDATE
CORE DOMAINS
*Fluid and Electrolyte Management*
*Perioperative Nursing Care*
*Cardiovascular System Disorders*
*Endocrine System Pathophysiology*
*Respiratory Critical Care*
*Renal and Urologic Health*
*Oncology and Palliative Care*
*Neurological Assessment and Management*
INTRODUCTION
*The purpose of this examination is to evaluate the clinical
competency and nursing judgment of candidates in adult medical
surgical nursing. This assessment measures foundational knowledge,
applied professional standards, and the ability to integrate
regulatory compliance into patient care. Utilizing a rigorous
multiple-choice and scenario-based structure, the exam emphasizes
real-world clinical application and critical thinking. Successful
candidates must demonstrate the ability to prioritize nursing
interventions, analyze complex diagnostic data, and execute safe,
ethical decision-making to optimize patient outcomes in diverse
acute and chronic care environments.*
SECTION ONE: QUESTIONS 1–100
, 1. A nurse is caring for a client with a potassium level of 6.2 mEq/L. Which of the
following findings should the nurse expect to see on the ECG?
A. ST segment depression B. Prominent U waves C. Tall, peaked T waves D. Shortened QT
interval
Explanation: Hyperkalemia is characterized by tall, peaked T waves on an ECG as the
cardiac muscle becomes hyperpolarized.
2. A client is postoperative following a thyroidectomy. The nurse notes the client has
developed stridor. Which action is the priority?
A. Administer IV calcium gluconate B. Elevate the head of the bed to 45 degrees C.
Prepare for emergency airway management D. Notify the provider of the findings
Explanation: Stridor indicates laryngeal edema or airway obstruction, which is a medical
emergency that requires immediate airway intervention.
3. A nurse is assessing a client with suspected deep vein thrombosis (DVT). Which of
the following findings is most concerning?
A. Calf pain upon ambulation B. Unilateral edema of the affected limb C. Increased warmth
in the calf area D. Sudden onset of shortness of breath
Explanation: Sudden dyspnea suggests that the DVT has progressed to a pulmonary
embolism, which is a life-threatening complication.
4. A nurse is preparing to administer packed red blood cells to a client. Which action is
required prior to initiation?
A. Obtain a baseline blood pressure reading only B. Infuse with 5% dextrose in water C.
Verify the blood unit with another nurse D. Pre-medicate with acetaminophen if ordered
Explanation: Verification of blood products with a second licensed professional is a
mandatory safety step to prevent transfusion reactions caused by human error.
5. A client with type 1 diabetes mellitus is found unresponsive. Which of the following
is the priority intervention?
A. Administer subcutaneous insulin B. Check the client’s blood glucose level C.
Administer intravenous dextrose D. Assess the client’s carotid pulse
Explanation: In an unresponsive diabetic client, the nurse must assume hypoglycemia
and provide rapid glucose replacement.
6. Which assessment finding indicates a potential complication for a client receiving
total parenteral nutrition (TPN)?
,A. Serum potassium of 4.0 mEq/L B. Blood glucose of 280 mg/dL C. Weight gain of 0.5
lbs in 24 hours D. Urine output of 50 mL/hr
Explanation: Hyperglycemia is a common complication of TPN due to the high
concentration of dextrose; levels above 200 mg/dL require intervention.
7. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD).
What is the expected range for oxygen saturation for this client?
A. 95% to 100% B. 90% to 92% C. 88% to 92% D. 85% to 89%
Explanation: Clients with COPD often have chronic carbon dioxide retention, and their
respiratory drive is triggered by low oxygen levels; saturations of 88-92% are often the goal.
8. A client is diagnosed with hyperthyroidism. Which nutritional recommendation
should the nurse provide?
A. Low-calorie, low-protein diet B. High-fiber, low-calorie diet C. High-calorie, high-
protein diet D. Fluid restriction
Explanation: Hyperthyroidism increases the basal metabolic rate, leading to significant
caloric expenditure and weight loss, necessitating an increase in caloric intake.
9. A nurse is caring for a client with a chest tube. Which finding requires immediate
reporting to the provider?
A. Intermittent bubbling in the water seal chamber B. Drainage of 50 mL in 4 hours C.
Continuous bubbling in the water seal chamber D. Oscillation of the water level with
respiration
Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the
system, which must be identified and corrected immediately.
10. A client with hypertension is prescribed lisinopril. Which side effect should the nurse
instruct the client to report?
A. A persistent, dry cough B. Dizziness upon standing C. Mild headache D. Increased
thirst
Explanation: A persistent, dry cough is a common and known side effect of ACE
inhibitors like lisinopril, caused by bradykinin accumulation.
11. A client is in the oliguric phase of acute kidney injury. Which laboratory finding
should the nurse expect?
A. Decreased serum creatinine B. Decreased serum potassium C. Increased serum calcium
D. Increased serum creatinine
, Explanation: In the oliguric phase, the kidneys cannot adequately filter waste, leading to
a rise in nitrogenous wastes such as creatinine.
12. A nurse is teaching a client about self-administration of insulin. Which statement
indicates the client understands the instructions?
A. I will shake the vial vigorously before drawing up the insulin. B. I will rotate sites only
when I feel pain at the injection site. C. I will inject the needle at a 90-degree angle. D. I
will rub the site immediately after injection to increase absorption.
Explanation: For most subcutaneous insulin injections, a 90-degree angle ensures the
medication reaches the subcutaneous tissue appropriately.
13. A client is admitted with heart failure. Which assessment finding suggests fluid
volume overload?
A. Flattened neck veins B. Bounding peripheral pulses C. Decreased blood pressure D.
Dry mucous membranes
Explanation: Fluid volume overload leads to increased intravascular volume, resulting in
bounding pulses and elevated blood pressure.
14. A nurse is caring for a client who is post-cardiac catheterization. What is the priority
nursing action?
A. Increase oral fluid intake B. Ambulate the client to prevent DVT C. Monitor the heart rate
every 4 hours D. Assess the access site for bleeding
Explanation: The access site is at high risk for hematoma or hemorrhage following
catheterization, making site assessment the highest priority.
15. A client with cirrhosis is at risk for esophageal varices. Which medication should the
nurse anticipate administering?
A. Aspirin B. Ibuprofen C. Furosemide D. Propranolol
Explanation: Beta-blockers like propranolol are used to decrease portal venous pressure
and reduce the risk of bleeding from esophageal varices.
16. A nurse is caring for a client who has a new prescription for heparin. Which lab value
should the nurse monitor?
A. PT/INR B. aPTT C. Platelet count D. Hematocrit
Explanation: The activated partial thromboplastin time (aPTT) is the standard lab test
used to monitor the effectiveness of heparin therapy.
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM
UPDATE
CORE DOMAINS
*Fluid and Electrolyte Management*
*Perioperative Nursing Care*
*Cardiovascular System Disorders*
*Endocrine System Pathophysiology*
*Respiratory Critical Care*
*Renal and Urologic Health*
*Oncology and Palliative Care*
*Neurological Assessment and Management*
INTRODUCTION
*The purpose of this examination is to evaluate the clinical
competency and nursing judgment of candidates in adult medical
surgical nursing. This assessment measures foundational knowledge,
applied professional standards, and the ability to integrate
regulatory compliance into patient care. Utilizing a rigorous
multiple-choice and scenario-based structure, the exam emphasizes
real-world clinical application and critical thinking. Successful
candidates must demonstrate the ability to prioritize nursing
interventions, analyze complex diagnostic data, and execute safe,
ethical decision-making to optimize patient outcomes in diverse
acute and chronic care environments.*
SECTION ONE: QUESTIONS 1–100
, 1. A nurse is caring for a client with a potassium level of 6.2 mEq/L. Which of the
following findings should the nurse expect to see on the ECG?
A. ST segment depression B. Prominent U waves C. Tall, peaked T waves D. Shortened QT
interval
Explanation: Hyperkalemia is characterized by tall, peaked T waves on an ECG as the
cardiac muscle becomes hyperpolarized.
2. A client is postoperative following a thyroidectomy. The nurse notes the client has
developed stridor. Which action is the priority?
A. Administer IV calcium gluconate B. Elevate the head of the bed to 45 degrees C.
Prepare for emergency airway management D. Notify the provider of the findings
Explanation: Stridor indicates laryngeal edema or airway obstruction, which is a medical
emergency that requires immediate airway intervention.
3. A nurse is assessing a client with suspected deep vein thrombosis (DVT). Which of
the following findings is most concerning?
A. Calf pain upon ambulation B. Unilateral edema of the affected limb C. Increased warmth
in the calf area D. Sudden onset of shortness of breath
Explanation: Sudden dyspnea suggests that the DVT has progressed to a pulmonary
embolism, which is a life-threatening complication.
4. A nurse is preparing to administer packed red blood cells to a client. Which action is
required prior to initiation?
A. Obtain a baseline blood pressure reading only B. Infuse with 5% dextrose in water C.
Verify the blood unit with another nurse D. Pre-medicate with acetaminophen if ordered
Explanation: Verification of blood products with a second licensed professional is a
mandatory safety step to prevent transfusion reactions caused by human error.
5. A client with type 1 diabetes mellitus is found unresponsive. Which of the following
is the priority intervention?
A. Administer subcutaneous insulin B. Check the client’s blood glucose level C.
Administer intravenous dextrose D. Assess the client’s carotid pulse
Explanation: In an unresponsive diabetic client, the nurse must assume hypoglycemia
and provide rapid glucose replacement.
6. Which assessment finding indicates a potential complication for a client receiving
total parenteral nutrition (TPN)?
,A. Serum potassium of 4.0 mEq/L B. Blood glucose of 280 mg/dL C. Weight gain of 0.5
lbs in 24 hours D. Urine output of 50 mL/hr
Explanation: Hyperglycemia is a common complication of TPN due to the high
concentration of dextrose; levels above 200 mg/dL require intervention.
7. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD).
What is the expected range for oxygen saturation for this client?
A. 95% to 100% B. 90% to 92% C. 88% to 92% D. 85% to 89%
Explanation: Clients with COPD often have chronic carbon dioxide retention, and their
respiratory drive is triggered by low oxygen levels; saturations of 88-92% are often the goal.
8. A client is diagnosed with hyperthyroidism. Which nutritional recommendation
should the nurse provide?
A. Low-calorie, low-protein diet B. High-fiber, low-calorie diet C. High-calorie, high-
protein diet D. Fluid restriction
Explanation: Hyperthyroidism increases the basal metabolic rate, leading to significant
caloric expenditure and weight loss, necessitating an increase in caloric intake.
9. A nurse is caring for a client with a chest tube. Which finding requires immediate
reporting to the provider?
A. Intermittent bubbling in the water seal chamber B. Drainage of 50 mL in 4 hours C.
Continuous bubbling in the water seal chamber D. Oscillation of the water level with
respiration
Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the
system, which must be identified and corrected immediately.
10. A client with hypertension is prescribed lisinopril. Which side effect should the nurse
instruct the client to report?
A. A persistent, dry cough B. Dizziness upon standing C. Mild headache D. Increased
thirst
Explanation: A persistent, dry cough is a common and known side effect of ACE
inhibitors like lisinopril, caused by bradykinin accumulation.
11. A client is in the oliguric phase of acute kidney injury. Which laboratory finding
should the nurse expect?
A. Decreased serum creatinine B. Decreased serum potassium C. Increased serum calcium
D. Increased serum creatinine
, Explanation: In the oliguric phase, the kidneys cannot adequately filter waste, leading to
a rise in nitrogenous wastes such as creatinine.
12. A nurse is teaching a client about self-administration of insulin. Which statement
indicates the client understands the instructions?
A. I will shake the vial vigorously before drawing up the insulin. B. I will rotate sites only
when I feel pain at the injection site. C. I will inject the needle at a 90-degree angle. D. I
will rub the site immediately after injection to increase absorption.
Explanation: For most subcutaneous insulin injections, a 90-degree angle ensures the
medication reaches the subcutaneous tissue appropriately.
13. A client is admitted with heart failure. Which assessment finding suggests fluid
volume overload?
A. Flattened neck veins B. Bounding peripheral pulses C. Decreased blood pressure D.
Dry mucous membranes
Explanation: Fluid volume overload leads to increased intravascular volume, resulting in
bounding pulses and elevated blood pressure.
14. A nurse is caring for a client who is post-cardiac catheterization. What is the priority
nursing action?
A. Increase oral fluid intake B. Ambulate the client to prevent DVT C. Monitor the heart rate
every 4 hours D. Assess the access site for bleeding
Explanation: The access site is at high risk for hematoma or hemorrhage following
catheterization, making site assessment the highest priority.
15. A client with cirrhosis is at risk for esophageal varices. Which medication should the
nurse anticipate administering?
A. Aspirin B. Ibuprofen C. Furosemide D. Propranolol
Explanation: Beta-blockers like propranolol are used to decrease portal venous pressure
and reduce the risk of bleeding from esophageal varices.
16. A nurse is caring for a client who has a new prescription for heparin. Which lab value
should the nurse monitor?
A. PT/INR B. aPTT C. Platelet count D. Hematocrit
Explanation: The activated partial thromboplastin time (aPTT) is the standard lab test
used to monitor the effectiveness of heparin therapy.
