ATI RN ADULT MEDICAL SURGICAL
2026 PROCTORED EXAM QUESTIONS
AND ANSWERS
1. A nurse is reviewing the arterial blood gas (ABG) results of a client with COPD. The results
are: pH 7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L. Which of the following acid-base
imbalances is the client experiencing?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: B
Conceptual Explanation: A pH below 7.35 indicates acidosis. The elevated PaCO2 (normal
35-45) indicates a respiratory cause. The HCO3 is within the normal range, confirming
uncompensated respiratory acidosis.
2. A nurse is caring for a client who is 24 hours post-operative following a total hip
arthroplasty. Which of the following findings should the nurse identify as a potential
complication?
A. A temperature of 37.6 C (99.7 F)
,B. Pain level of 4 on a scale of 0 to 10
C. A sudden onset of shortness of breath and chest pain
D. Small amount of serosanguineous drainage on the dressing
Answer: C
Conceptual Explanation: Sudden shortness of breath and chest pain are classic signs of a
pulmonary embolism, which is a life-threatening complication of major orthopedic surgery.
3. A client is prescribed digoxin for heart failure. Which of the following electrolyte
imbalances should the nurse monitor for, as it increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Answer: B
Conceptual Explanation: Hypokalemia (low potassium) sensitizes the myocardium to
digoxin, significantly increasing the risk of toxicity, even when digoxin levels are within the
therapeutic range.
4. A nurse is teaching a client who has a new prescription for levothyroxine to treat
hypothyroidism. Which of the following instructions should the nurse include?
A. Take the medication with a high-calcium snack
, B. Take the medication at bedtime with water
C. Take the medication on an empty stomach 30 to 60 minutes before breakfast
D. Wait 1 hour after taking the medication to drink coffee
Answer: C
Conceptual Explanation: Levothyroxine should be taken on an empty stomach in the
morning to maximize absorption and prevent interference from food or other medications.
5. A client with type 1 diabetes mellitus presents to the ER with a blood glucose of 650 mg/dL,
fruity breath, and Kussmaul respirations. What is the priority nursing intervention?
A. Initiating a rapid infusion of 0.9% sodium chloride
B. Administering subcutaneous glargine insulin
C. Administering oral glucose gel
D. Applying a cooling blanket for hyperthermia
Answer: A
Conceptual Explanation: The client is exhibiting signs of Diabetic Ketoacidosis (DKA).
Fluid resuscitation with normal saline is the immediate priority to restore circulatory
volume and perfusion.
6. A nurse is assessing a client with Cushing’s syndrome. Which of the following findings is
expected?
A. Weight loss and hypotension
2026 PROCTORED EXAM QUESTIONS
AND ANSWERS
1. A nurse is reviewing the arterial blood gas (ABG) results of a client with COPD. The results
are: pH 7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L. Which of the following acid-base
imbalances is the client experiencing?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: B
Conceptual Explanation: A pH below 7.35 indicates acidosis. The elevated PaCO2 (normal
35-45) indicates a respiratory cause. The HCO3 is within the normal range, confirming
uncompensated respiratory acidosis.
2. A nurse is caring for a client who is 24 hours post-operative following a total hip
arthroplasty. Which of the following findings should the nurse identify as a potential
complication?
A. A temperature of 37.6 C (99.7 F)
,B. Pain level of 4 on a scale of 0 to 10
C. A sudden onset of shortness of breath and chest pain
D. Small amount of serosanguineous drainage on the dressing
Answer: C
Conceptual Explanation: Sudden shortness of breath and chest pain are classic signs of a
pulmonary embolism, which is a life-threatening complication of major orthopedic surgery.
3. A client is prescribed digoxin for heart failure. Which of the following electrolyte
imbalances should the nurse monitor for, as it increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Answer: B
Conceptual Explanation: Hypokalemia (low potassium) sensitizes the myocardium to
digoxin, significantly increasing the risk of toxicity, even when digoxin levels are within the
therapeutic range.
4. A nurse is teaching a client who has a new prescription for levothyroxine to treat
hypothyroidism. Which of the following instructions should the nurse include?
A. Take the medication with a high-calcium snack
, B. Take the medication at bedtime with water
C. Take the medication on an empty stomach 30 to 60 minutes before breakfast
D. Wait 1 hour after taking the medication to drink coffee
Answer: C
Conceptual Explanation: Levothyroxine should be taken on an empty stomach in the
morning to maximize absorption and prevent interference from food or other medications.
5. A client with type 1 diabetes mellitus presents to the ER with a blood glucose of 650 mg/dL,
fruity breath, and Kussmaul respirations. What is the priority nursing intervention?
A. Initiating a rapid infusion of 0.9% sodium chloride
B. Administering subcutaneous glargine insulin
C. Administering oral glucose gel
D. Applying a cooling blanket for hyperthermia
Answer: A
Conceptual Explanation: The client is exhibiting signs of Diabetic Ketoacidosis (DKA).
Fluid resuscitation with normal saline is the immediate priority to restore circulatory
volume and perfusion.
6. A nurse is assessing a client with Cushing’s syndrome. Which of the following findings is
expected?
A. Weight loss and hypotension
