ATI RN Adult Medical-Surgical Proctored Exam
2026/2027 Study Guide | ATI Adult Med-Surg
Proctored Exam Prep | NGN Clinical Judgment
Practice Questions & Answers, Detailed Rationales,
SATA, Case Studies, Adult Health Nursing &
Comprehensive NCLEX-RN Review
Question 1: A nurse is assessing a client who is 24 hours post-operative
following an abdominal aortic aneurysm repair. Which of the following
findings is the earliest indicator of graft occlusion?
A. Decreased urine output
B. Absent dorsalis pedis pulses
C. Severe, sudden back pain
D. Hypertension
CORRECT ANSWER: B. Absent dorsalis pedis pulses
Rationale: Graft occlusion is a critical complication following AAA repair. The earliest
clinical sign is the loss of palpable distal pulses (e.g., dorsalis pedis or posterior tibial)
due to thrombus formation at the graft site. This precedes other signs like pain, pallor, or
paresthesia. While decreased urine output and pain can occur, they are later signs of
ischemia or renal compromise. Hypertension is a risk factor, not an indicator of acute
occlusion.
Question 2: A nurse is providing dietary teaching to a client with acute
pancreatitis. Which of the following food choices by the client indicates an
understanding of the teaching?
A. A grilled cheese sandwich with tomato soup
B. A bagel with cream cheese and a banana
C. A salad with avocado, eggs, and ranch dressing
D. A cup of broth with crackers
CORRECT ANSWER: B. A bagel with cream cheese and a banana
Rationale: Acute pancreatitis requires a low-fat diet to reduce stimulation of the
pancreas. A bagel is a complex carbohydrate, cream cheese is low-fat (if used sparingly),
and a banana is a fruit; this meal is the lowest in fat among the options. The grilled
cheese, avocado/eggs, and ranch dressing are all high in fat, which would exacerbate
pain and stimulate pancreatic enzyme release.
Question 3: A nurse is caring for a client with heart failure who is receiving
furosemide. Which of the following assessment findings indicates the
medication is effective?
A. Decreased peripheral edema and clear breath sounds
B. Increased urine output and blood pressure
C. Weight gain of 1 kg in 24 hours
D. Increased jugular venous distention
,CORRECT ANSWER: A. Decreased peripheral edema and clear breath sounds
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. Effectiveness is evidenced by a reduction in symptoms of fluid overload, such as
peripheral edema, pulmonary congestion (clear breath sounds), and decreased dyspnea.
Increased blood pressure and weight gain would indicate fluid retention, while JVD is a
sign of worsening right-sided heart failure.
Question 4: A nurse is preparing to administer a blood transfusion to a client.
Which of the following actions should the nurse take first?
A. Verify the client's identity using two identifiers
B. Obtain the client's baseline vital signs
C. Check the blood product for discoloration
D. Prime the IV tubing with 0.9% sodium chloride
CORRECT ANSWER: A. Verify the client's identity using two identifiers
Rationale: According to the "Rights" of medication and blood administration, client
identification is the most critical step to prevent a transfusion reaction. The nurse must
verify the client's identity using at least two unique identifiers (e.g., name and date of
birth) against the blood product tag. While baseline vitals and checking the product are
important, they occur after identification.
Question 5: A nurse is caring for a client with a chest tube connected to a
water seal drainage system. Which of the following findings requires
immediate intervention?
A. Tidaling in the water seal chamber with respiration
B. Bubbling in the suction control chamber
C. Continuous bubbling in the water seal chamber
D. Drainage of 50 mL in the first hour
CORRECT ANSWER: C. Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which
could be from the client, the tubing, or the connection site. This compromises the
negative pressure in the pleural space and must be investigated immediately. Tidaling is
normal, bubbling in the suction chamber is expected, and 50 mL drainage is within
acceptable limits.
Question 6: A nurse is assessing a client with chronic kidney disease who is on
a fluid restriction. Which of the following findings is a sign of fluid volume
excess?
A. Postural hypotension
B. Dry mucous membranes
C. Crackles in the lung bases
D. Poor skin turgor
,CORRECT ANSWER: C. Crackles in the lung bases
Rationale: Fluid volume excess (hypervolemia) is common in CKD due to impaired
excretion. Crackles in the lung bases indicate pulmonary congestion from fluid overload.
Postural hypotension, dry mucous membranes, and poor skin turgor are signs of fluid
volume deficit (hypovolemia).
Question 7: A nurse is teaching a client with a new diagnosis of asthma about
using a peak flow meter. Which of the following statements by the client
indicates a need for further teaching?
A. "I will use the meter before taking my bronchodilator."
B. "I will stand up while taking the measurement."
C. "I will take a deep breath and blow out as hard and fast as possible."
D. "I will record the lowest of three readings."
CORRECT ANSWER: D. I will record the lowest of three readings.
Rationale: The client should record the highest of three readings, not the lowest. The
peak expiratory flow rate measures the maximum airflow during a forced exhalation.
The highest value best represents the client’s true airway function. The other statements
are correct regarding timing (pre-bronchodilator), posture (standing), and technique
(forceful exhalation).
Question 8: A nurse is caring for a client who is 2 days post-operative
following a total hip arthroplasty. Which of the following actions should the
nurse take to prevent dislocation?
A. Place a pillow between the client's legs when turning
B. Instruct the client to flex the hip to 90 degrees when sitting
C. Keep the client's affected leg in adduction
D. Position the client in a low Fowler's position
CORRECT ANSWER: A. Place a pillow between the client's legs when turning
Rationale: To prevent dislocation of a new hip prosthesis, the hip must be kept in
abduction and neutral rotation. Placing an abduction pillow between the legs prevents
adduction past the midline, which is the most common mechanism of posterior
dislocation. Flexion should not exceed 90 degrees, adduction is restricted, and high
Fowler's is preferred for sitting.
Question 9: A nurse is assessing a client who has a history of myocardial
infarction and is complaining of epigastric pain, nausea, and diaphoresis.
Which of the following is the priority action?
A. Administer an antacid
B. Obtain a 12-lead EKG
C. Administer a PRN antiemetic
D. Offer a light snack
, CORRECT ANSWER: B. Obtain a 12-lead EKG
Rationale: Atypical symptoms of MI (epigastric pain, nausea, diaphoresis) are common,
especially in women and older adults. The priority is to obtain a 12-lead EKG
immediately to rule out or confirm an acute cardiac event. Time is muscle; delaying
EKG for symptomatic relief could be fatal.
Question 10: A nurse is providing discharge teaching to a client who has a
permanent pacemaker. Which of the following statements indicates an
understanding of the teaching?
A. "I can no longer use my microwave oven."
B. "I will avoid lifting my arm above my shoulder for a few weeks."
C. "I should take my pulse daily and call if it is below 50."
D. "I can hold my cellular phone on the same side as my pacemaker."
CORRECT ANSWER: B. I will avoid lifting my arm above my shoulder for a few
weeks.
Rationale: To prevent dislodgement of the leads while the pacemaker site heals, the
client should avoid lifting the arm on the affected side above the shoulder. Microwaves
are safe; pulse targets are set by a cardiologist; and cell phones should be kept on the
opposite side or more than 6 inches away from the device.
Question 11: A nurse is preparing a client for a liver biopsy. Which of the
following positions will the nurse assist the client into?
A. Supine with the right arm raised above the head
B. Left lateral decubitus with the right arm over the head
C. Prone with the arms extended
D. High Fowler's with the knees bent
CORRECT ANSWER: B. Left lateral decubitus with the right arm over the head
Rationale: A liver biopsy is typically performed with the client in the left lateral
decubitus position. This exposes the lower ribs on the right side and allows for optimal
access to the liver. The right arm is raised to open the intercostal spaces for needle
insertion.
Question 12: A nurse is monitoring a client with a head injury for signs of
increased intracranial pressure (ICP). Which of the following is an early sign of
increased ICP?
A. Decorticate posturing
B. Ipsilateral pupil dilation
C. Restlessness and confusion
D. Cheyne-Stokes respirations
CORRECT ANSWER: C. Restlessness and confusion
2026/2027 Study Guide | ATI Adult Med-Surg
Proctored Exam Prep | NGN Clinical Judgment
Practice Questions & Answers, Detailed Rationales,
SATA, Case Studies, Adult Health Nursing &
Comprehensive NCLEX-RN Review
Question 1: A nurse is assessing a client who is 24 hours post-operative
following an abdominal aortic aneurysm repair. Which of the following
findings is the earliest indicator of graft occlusion?
A. Decreased urine output
B. Absent dorsalis pedis pulses
C. Severe, sudden back pain
D. Hypertension
CORRECT ANSWER: B. Absent dorsalis pedis pulses
Rationale: Graft occlusion is a critical complication following AAA repair. The earliest
clinical sign is the loss of palpable distal pulses (e.g., dorsalis pedis or posterior tibial)
due to thrombus formation at the graft site. This precedes other signs like pain, pallor, or
paresthesia. While decreased urine output and pain can occur, they are later signs of
ischemia or renal compromise. Hypertension is a risk factor, not an indicator of acute
occlusion.
Question 2: A nurse is providing dietary teaching to a client with acute
pancreatitis. Which of the following food choices by the client indicates an
understanding of the teaching?
A. A grilled cheese sandwich with tomato soup
B. A bagel with cream cheese and a banana
C. A salad with avocado, eggs, and ranch dressing
D. A cup of broth with crackers
CORRECT ANSWER: B. A bagel with cream cheese and a banana
Rationale: Acute pancreatitis requires a low-fat diet to reduce stimulation of the
pancreas. A bagel is a complex carbohydrate, cream cheese is low-fat (if used sparingly),
and a banana is a fruit; this meal is the lowest in fat among the options. The grilled
cheese, avocado/eggs, and ranch dressing are all high in fat, which would exacerbate
pain and stimulate pancreatic enzyme release.
Question 3: A nurse is caring for a client with heart failure who is receiving
furosemide. Which of the following assessment findings indicates the
medication is effective?
A. Decreased peripheral edema and clear breath sounds
B. Increased urine output and blood pressure
C. Weight gain of 1 kg in 24 hours
D. Increased jugular venous distention
,CORRECT ANSWER: A. Decreased peripheral edema and clear breath sounds
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. Effectiveness is evidenced by a reduction in symptoms of fluid overload, such as
peripheral edema, pulmonary congestion (clear breath sounds), and decreased dyspnea.
Increased blood pressure and weight gain would indicate fluid retention, while JVD is a
sign of worsening right-sided heart failure.
Question 4: A nurse is preparing to administer a blood transfusion to a client.
Which of the following actions should the nurse take first?
A. Verify the client's identity using two identifiers
B. Obtain the client's baseline vital signs
C. Check the blood product for discoloration
D. Prime the IV tubing with 0.9% sodium chloride
CORRECT ANSWER: A. Verify the client's identity using two identifiers
Rationale: According to the "Rights" of medication and blood administration, client
identification is the most critical step to prevent a transfusion reaction. The nurse must
verify the client's identity using at least two unique identifiers (e.g., name and date of
birth) against the blood product tag. While baseline vitals and checking the product are
important, they occur after identification.
Question 5: A nurse is caring for a client with a chest tube connected to a
water seal drainage system. Which of the following findings requires
immediate intervention?
A. Tidaling in the water seal chamber with respiration
B. Bubbling in the suction control chamber
C. Continuous bubbling in the water seal chamber
D. Drainage of 50 mL in the first hour
CORRECT ANSWER: C. Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which
could be from the client, the tubing, or the connection site. This compromises the
negative pressure in the pleural space and must be investigated immediately. Tidaling is
normal, bubbling in the suction chamber is expected, and 50 mL drainage is within
acceptable limits.
Question 6: A nurse is assessing a client with chronic kidney disease who is on
a fluid restriction. Which of the following findings is a sign of fluid volume
excess?
A. Postural hypotension
B. Dry mucous membranes
C. Crackles in the lung bases
D. Poor skin turgor
,CORRECT ANSWER: C. Crackles in the lung bases
Rationale: Fluid volume excess (hypervolemia) is common in CKD due to impaired
excretion. Crackles in the lung bases indicate pulmonary congestion from fluid overload.
Postural hypotension, dry mucous membranes, and poor skin turgor are signs of fluid
volume deficit (hypovolemia).
Question 7: A nurse is teaching a client with a new diagnosis of asthma about
using a peak flow meter. Which of the following statements by the client
indicates a need for further teaching?
A. "I will use the meter before taking my bronchodilator."
B. "I will stand up while taking the measurement."
C. "I will take a deep breath and blow out as hard and fast as possible."
D. "I will record the lowest of three readings."
CORRECT ANSWER: D. I will record the lowest of three readings.
Rationale: The client should record the highest of three readings, not the lowest. The
peak expiratory flow rate measures the maximum airflow during a forced exhalation.
The highest value best represents the client’s true airway function. The other statements
are correct regarding timing (pre-bronchodilator), posture (standing), and technique
(forceful exhalation).
Question 8: A nurse is caring for a client who is 2 days post-operative
following a total hip arthroplasty. Which of the following actions should the
nurse take to prevent dislocation?
A. Place a pillow between the client's legs when turning
B. Instruct the client to flex the hip to 90 degrees when sitting
C. Keep the client's affected leg in adduction
D. Position the client in a low Fowler's position
CORRECT ANSWER: A. Place a pillow between the client's legs when turning
Rationale: To prevent dislocation of a new hip prosthesis, the hip must be kept in
abduction and neutral rotation. Placing an abduction pillow between the legs prevents
adduction past the midline, which is the most common mechanism of posterior
dislocation. Flexion should not exceed 90 degrees, adduction is restricted, and high
Fowler's is preferred for sitting.
Question 9: A nurse is assessing a client who has a history of myocardial
infarction and is complaining of epigastric pain, nausea, and diaphoresis.
Which of the following is the priority action?
A. Administer an antacid
B. Obtain a 12-lead EKG
C. Administer a PRN antiemetic
D. Offer a light snack
, CORRECT ANSWER: B. Obtain a 12-lead EKG
Rationale: Atypical symptoms of MI (epigastric pain, nausea, diaphoresis) are common,
especially in women and older adults. The priority is to obtain a 12-lead EKG
immediately to rule out or confirm an acute cardiac event. Time is muscle; delaying
EKG for symptomatic relief could be fatal.
Question 10: A nurse is providing discharge teaching to a client who has a
permanent pacemaker. Which of the following statements indicates an
understanding of the teaching?
A. "I can no longer use my microwave oven."
B. "I will avoid lifting my arm above my shoulder for a few weeks."
C. "I should take my pulse daily and call if it is below 50."
D. "I can hold my cellular phone on the same side as my pacemaker."
CORRECT ANSWER: B. I will avoid lifting my arm above my shoulder for a few
weeks.
Rationale: To prevent dislodgement of the leads while the pacemaker site heals, the
client should avoid lifting the arm on the affected side above the shoulder. Microwaves
are safe; pulse targets are set by a cardiologist; and cell phones should be kept on the
opposite side or more than 6 inches away from the device.
Question 11: A nurse is preparing a client for a liver biopsy. Which of the
following positions will the nurse assist the client into?
A. Supine with the right arm raised above the head
B. Left lateral decubitus with the right arm over the head
C. Prone with the arms extended
D. High Fowler's with the knees bent
CORRECT ANSWER: B. Left lateral decubitus with the right arm over the head
Rationale: A liver biopsy is typically performed with the client in the left lateral
decubitus position. This exposes the lower ribs on the right side and allows for optimal
access to the liver. The right arm is raised to open the intercostal spaces for needle
insertion.
Question 12: A nurse is monitoring a client with a head injury for signs of
increased intracranial pressure (ICP). Which of the following is an early sign of
increased ICP?
A. Decorticate posturing
B. Ipsilateral pupil dilation
C. Restlessness and confusion
D. Cheyne-Stokes respirations
CORRECT ANSWER: C. Restlessness and confusion
