1
RN ADULT MEDICAL-SURGICAL NURSING PROCTORED
EXAM QUESTION AND ANSWERS UPDATED 2026-2027
100% VERIFIED DETAILED RATIONALES – PASS
GUARANTEED A+ GRADED INSTANT DOWNLOAD
INTRODUCTION
The RN Adult Medical-Surgical Nursing Proctored Exam is a comprehensive, high-stakes assessment designed
by ATI Nursing Education to evaluate nursing students' mastery of medical-surgical nursing content and their
readiness for clinical practice. This exam, a cornerstone of the Content Mastery Series, tests the application of
nursing knowledge across cardiovascular, respiratory, endocrine, renal, gastrointestinal, neurological, and
musculoskeletal systems, while integrating pharmacology, fluid/electrolyte balance, and perioperative care.
Aligned with the Next Generation NCLEX (NGN) format, the exam challenges students to demonstrate clinical
judgment, prioritization, and critical thinking through multiple-choice, multiple-select, and unfolding case study
items. This question bank contains 150 advanced, exam-style questions that mirror the content, difficulty, and
format of the actual ATI RN Adult Medical-Surgical Proctored Exam. Each question includes a detailed rationale
explaining the correct answer and why other options are incorrect. With this resource, you will identify
knowledge gaps, build confidence, and develop the test-taking strategies needed to pass the exam on your first
attempt.
CORE DOMAINS TESTED
1. Cardiovascular System – Heart failure, coronary artery disease, hypertension, dysrhythmias,
myocardial infarction, valvular disorders, peripheral vascular disease, and cardiac medications.
2. Respiratory System – COPD, asthma, pneumonia, pulmonary embolism, tuberculosis, chest tube
management, oxygen therapy, and mechanical ventilation.
3. Endocrine System – Diabetes mellitus (Type 1 and Type 2), diabetic ketoacidosis (DKA), hyperglycemic
hyperosmolar state (HHS), thyroid disorders, Cushing's syndrome, and adrenal insufficiency.
4. Renal and Urinary System – Acute kidney injury, chronic kidney disease, dialysis, urinary tract
infections, renal calculi, and bladder irrigation.
5. Gastrointestinal System – Peptic ulcer disease, inflammatory bowel disease, diverticulitis,
cholecystitis, pancreatitis, ostomy care, and GI bleeding.
6. Neurological System – Stroke, seizures, increased intracranial pressure (ICP), traumatic brain injury,
Parkinson's disease, and Glasgow Coma Scale (GCS) assessment.
7. Musculoskeletal and Integumentary – Fractures, joint replacements, pressure ulcers, wound care,
and amputation care.
8. Fluid, Electrolyte, and Acid-Base Balance – Dehydration, hypovolemia, hypervolemia, electrolyte
imbalances (potassium, sodium, calcium), and acid-base disturbances.
9. Pharmacology and Medication Administration – Anticoagulants, antiarrhythmics, antihypertensives,
bronchodilators, corticosteroids, insulins, and medication safety.
10. Perioperative and Emergency Nursing – Preoperative care, postoperative complications, emergency
interventions, and triage prioritization.
,2
QUESTIONS 1-100
Q1: A nurse is caring for a client who has a severe burn injury.
Which finding should the nurse recognize as an indication of
hypovolemic shock?
A) Serum potassium 3.2 mEq/L
B) Serum potassium 5.2 mEq/L
C) Serum sodium 142 mEq/L
D) Serum glucose 110 mg/dL
Rationale: The correct answer is B. Burn injuries cause massive fluid
shifts, leading to hypovolemia. Potassium shifts from the intracellular
to the extracellular space as a result of cellular injury, causing
hyperkalemia. A potassium level of 5.2 mEq/L is elevated and
indicates potassium released from damaged cells. Hypovolemic shock
is also characterized by tachycardia, hypotension, and cool, clammy
skin. The other values are within normal limits or not consistent with
hypovolemic shock .
Q2: A nurse is teaching a client who has asthma about the use of a
peak flow meter. What is the correct sequence of steps the nurse
should instruct the client to take?
A) Seal lips around mouthpiece, stand upright, fill lungs with deep
breath, exhale forcefully and quickly, record highest of three readings
B) Stand upright, fill lungs with deep breath, seal lips around
mouthpiece, exhale forcefully and quickly, record highest of three
readings
C) Fill lungs with deep breath, stand upright, seal lips around
mouthpiece, exhale forcefully and quickly, record highest of three
readings
,3
D) Stand upright, seal lips around mouthpiece, fill lungs with deep
breath, exhale forcefully and quickly, record highest of three readings
Rationale: The correct answer is B. The correct sequence for peak
flow meter use is: (1) stand upright, (2) fill lungs with a deep breath,
(3) seal lips around the mouthpiece, (4) exhale forcefully and quickly,
and (5) record the highest of three consecutive readings. This order
ensures accurate measurement of peak expiratory flow rate .
Q3: A nurse is caring for a client who has hypotension, cool and
clammy skin, and tachycardia. In which position should the nurse
place the client?
A) Supine with head elevated 45 degrees
B) Feet elevated
C) Left lateral recumbent
D) Trendelenburg position
Rationale: The correct answer is B. The client is showing signs of
hypovolemic shock (hypotension, tachycardia, cool/clammy skin).
Elevating the feet (passive leg raising) promotes venous return,
increasing cardiac preload and improving blood pressure. The
Trendelenburg position is no longer recommended; it can increase
intracranial pressure and impair ventilation .
Q4: A nurse is planning care for a client who has a pulmonary
embolism and a prescription for enoxaparin via subcutaneous
injection. Which intervention should the nurse include?
A) Monitor aPTT levels daily
B) Assess the client's stools for occult blood
C) Administer aspirin concurrently
D) Have protamine sulfate available at the bedside
, 4
Rationale: The correct answer is B. Enoxaparin is a low-molecular-
weight heparin (LMWH) that increases the risk of bleeding. The nurse
should monitor for signs of bleeding, including occult blood in the
stools. aPTT monitoring is not required for LMWH as it is for
unfractionated heparin. Protamine sulfate is the antidote for heparin,
not enoxaparin .
Q5: A nurse is caring for a client who has a sealed radiation implant.
Which action should the nurse take?
A) Limit family member visits to 15 min per day
B) Limit family member visits to 30 min per day
C) Allow unlimited visits if visitors stay 6 feet away
D) Restrict all visitors until the implant is removed
Rationale: The correct answer is B. For clients with sealed radiation
implants, safety precautions include limiting visitors to 30 minutes
per day and maintaining a 6-foot distance from the radiation source.
Pregnant women and children should not visit. The nurse should also
wear a dosimeter badge and lead apron when providing care .
Q6: A nurse is providing teaching for a client who has chronic
kidney disease. Which statement by the client indicates an
understanding of the teaching?
A) "I will eat a high-protein diet to build muscle."
B) "I will spread my protein allowances over the entire day."
C) "I will limit my fluid intake to 1 L per day."
D) "I will take calcium supplements with my meals."
Rationale: The correct answer is B. Clients with CKD often have
dietary protein restrictions. Spreading protein intake evenly
throughout the day allows for optimal absorption and reduces the
burden on the kidneys. The other options are incorrect: protein is
RN ADULT MEDICAL-SURGICAL NURSING PROCTORED
EXAM QUESTION AND ANSWERS UPDATED 2026-2027
100% VERIFIED DETAILED RATIONALES – PASS
GUARANTEED A+ GRADED INSTANT DOWNLOAD
INTRODUCTION
The RN Adult Medical-Surgical Nursing Proctored Exam is a comprehensive, high-stakes assessment designed
by ATI Nursing Education to evaluate nursing students' mastery of medical-surgical nursing content and their
readiness for clinical practice. This exam, a cornerstone of the Content Mastery Series, tests the application of
nursing knowledge across cardiovascular, respiratory, endocrine, renal, gastrointestinal, neurological, and
musculoskeletal systems, while integrating pharmacology, fluid/electrolyte balance, and perioperative care.
Aligned with the Next Generation NCLEX (NGN) format, the exam challenges students to demonstrate clinical
judgment, prioritization, and critical thinking through multiple-choice, multiple-select, and unfolding case study
items. This question bank contains 150 advanced, exam-style questions that mirror the content, difficulty, and
format of the actual ATI RN Adult Medical-Surgical Proctored Exam. Each question includes a detailed rationale
explaining the correct answer and why other options are incorrect. With this resource, you will identify
knowledge gaps, build confidence, and develop the test-taking strategies needed to pass the exam on your first
attempt.
CORE DOMAINS TESTED
1. Cardiovascular System – Heart failure, coronary artery disease, hypertension, dysrhythmias,
myocardial infarction, valvular disorders, peripheral vascular disease, and cardiac medications.
2. Respiratory System – COPD, asthma, pneumonia, pulmonary embolism, tuberculosis, chest tube
management, oxygen therapy, and mechanical ventilation.
3. Endocrine System – Diabetes mellitus (Type 1 and Type 2), diabetic ketoacidosis (DKA), hyperglycemic
hyperosmolar state (HHS), thyroid disorders, Cushing's syndrome, and adrenal insufficiency.
4. Renal and Urinary System – Acute kidney injury, chronic kidney disease, dialysis, urinary tract
infections, renal calculi, and bladder irrigation.
5. Gastrointestinal System – Peptic ulcer disease, inflammatory bowel disease, diverticulitis,
cholecystitis, pancreatitis, ostomy care, and GI bleeding.
6. Neurological System – Stroke, seizures, increased intracranial pressure (ICP), traumatic brain injury,
Parkinson's disease, and Glasgow Coma Scale (GCS) assessment.
7. Musculoskeletal and Integumentary – Fractures, joint replacements, pressure ulcers, wound care,
and amputation care.
8. Fluid, Electrolyte, and Acid-Base Balance – Dehydration, hypovolemia, hypervolemia, electrolyte
imbalances (potassium, sodium, calcium), and acid-base disturbances.
9. Pharmacology and Medication Administration – Anticoagulants, antiarrhythmics, antihypertensives,
bronchodilators, corticosteroids, insulins, and medication safety.
10. Perioperative and Emergency Nursing – Preoperative care, postoperative complications, emergency
interventions, and triage prioritization.
,2
QUESTIONS 1-100
Q1: A nurse is caring for a client who has a severe burn injury.
Which finding should the nurse recognize as an indication of
hypovolemic shock?
A) Serum potassium 3.2 mEq/L
B) Serum potassium 5.2 mEq/L
C) Serum sodium 142 mEq/L
D) Serum glucose 110 mg/dL
Rationale: The correct answer is B. Burn injuries cause massive fluid
shifts, leading to hypovolemia. Potassium shifts from the intracellular
to the extracellular space as a result of cellular injury, causing
hyperkalemia. A potassium level of 5.2 mEq/L is elevated and
indicates potassium released from damaged cells. Hypovolemic shock
is also characterized by tachycardia, hypotension, and cool, clammy
skin. The other values are within normal limits or not consistent with
hypovolemic shock .
Q2: A nurse is teaching a client who has asthma about the use of a
peak flow meter. What is the correct sequence of steps the nurse
should instruct the client to take?
A) Seal lips around mouthpiece, stand upright, fill lungs with deep
breath, exhale forcefully and quickly, record highest of three readings
B) Stand upright, fill lungs with deep breath, seal lips around
mouthpiece, exhale forcefully and quickly, record highest of three
readings
C) Fill lungs with deep breath, stand upright, seal lips around
mouthpiece, exhale forcefully and quickly, record highest of three
readings
,3
D) Stand upright, seal lips around mouthpiece, fill lungs with deep
breath, exhale forcefully and quickly, record highest of three readings
Rationale: The correct answer is B. The correct sequence for peak
flow meter use is: (1) stand upright, (2) fill lungs with a deep breath,
(3) seal lips around the mouthpiece, (4) exhale forcefully and quickly,
and (5) record the highest of three consecutive readings. This order
ensures accurate measurement of peak expiratory flow rate .
Q3: A nurse is caring for a client who has hypotension, cool and
clammy skin, and tachycardia. In which position should the nurse
place the client?
A) Supine with head elevated 45 degrees
B) Feet elevated
C) Left lateral recumbent
D) Trendelenburg position
Rationale: The correct answer is B. The client is showing signs of
hypovolemic shock (hypotension, tachycardia, cool/clammy skin).
Elevating the feet (passive leg raising) promotes venous return,
increasing cardiac preload and improving blood pressure. The
Trendelenburg position is no longer recommended; it can increase
intracranial pressure and impair ventilation .
Q4: A nurse is planning care for a client who has a pulmonary
embolism and a prescription for enoxaparin via subcutaneous
injection. Which intervention should the nurse include?
A) Monitor aPTT levels daily
B) Assess the client's stools for occult blood
C) Administer aspirin concurrently
D) Have protamine sulfate available at the bedside
, 4
Rationale: The correct answer is B. Enoxaparin is a low-molecular-
weight heparin (LMWH) that increases the risk of bleeding. The nurse
should monitor for signs of bleeding, including occult blood in the
stools. aPTT monitoring is not required for LMWH as it is for
unfractionated heparin. Protamine sulfate is the antidote for heparin,
not enoxaparin .
Q5: A nurse is caring for a client who has a sealed radiation implant.
Which action should the nurse take?
A) Limit family member visits to 15 min per day
B) Limit family member visits to 30 min per day
C) Allow unlimited visits if visitors stay 6 feet away
D) Restrict all visitors until the implant is removed
Rationale: The correct answer is B. For clients with sealed radiation
implants, safety precautions include limiting visitors to 30 minutes
per day and maintaining a 6-foot distance from the radiation source.
Pregnant women and children should not visit. The nurse should also
wear a dosimeter badge and lead apron when providing care .
Q6: A nurse is providing teaching for a client who has chronic
kidney disease. Which statement by the client indicates an
understanding of the teaching?
A) "I will eat a high-protein diet to build muscle."
B) "I will spread my protein allowances over the entire day."
C) "I will limit my fluid intake to 1 L per day."
D) "I will take calcium supplements with my meals."
Rationale: The correct answer is B. Clients with CKD often have
dietary protein restrictions. Spreading protein intake evenly
throughout the day allows for optimal absorption and reduces the
burden on the kidneys. The other options are incorrect: protein is
