ATI RN MEDICAL SURGICAL RETAKE LATEST
2026/2027 ACTUAL EXAM| RN MED-SURG
PROCTORED ASSESSMENT II (RETAKE) WITH
COMPLETE REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ ALREADY GRADED A+
Core Domains
• Cardiovascular and Hematologic Systems*
• Respiratory and Oxygenation*
• Neurological and Sensory Systems*
• Renal and Genitourinary Systems*
• Gastrointestinal and Hepatobiliary Systems*
• Endocrine and Metabolic Systems*
• Musculoskeletal and Integumentary Systems*
• Perioperative and Emergency Nursing*
• Pharmacology and Parenteral Therapies*
• Safety, Ethics, and Professional Standards*
Introduction
This comprehensive assessment evaluates the clinical judgment and applied medical-surgical nursing
knowledge required for safe, effective practice. It measures competency across foundational theory,
professional standards, regulatory compliance, and ethical decision-making. The examination uses
multiple-choice and scenario-based items that reflect realistic patient encounters across acute, chronic,
and emergent settings. Emphasis is placed on clinical reasoning, prioritization, delegation, and outcome
evaluation. Candidates must demonstrate the ability to interpret assessment data, identify
complications, implement appropriate interventions, and evaluate patient responses within the scope of
professional nursing practice.
SECTION ONE: QUESTIONS 1–100
Question 1
A nurse is assessing a client who is 24 hours postoperative following an open cholecystectomy. The
client reports right shoulder pain. Which of the following is the most appropriate nursing action?
,A. Administer a prescribed opioid analgesic
B. Position the client flat in bed
C. Apply a heating pad to the abdomen
D. Encourage the client to splint the incision
A. Administer a prescribed opioid analgesic
RATIONALE: Right shoulder pain after abdominal surgery is typically referred pain from
diaphragmatic irritation caused by residual carbon dioxide used during laparoscopy or from peritoneal
irritation. Administering the prescribed analgesic is the priority intervention to manage the client's pain.
Question 2
A nurse is caring for a client with a new tracheostomy. Which of the following actions should the nurse
take first?
A. Deflate the cuff to check for air leak
B. Suction the tracheostomy
C. Auscultate bilateral breath sounds
D. Change the tracheostomy ties
C. Auscultate bilateral breath sounds
RATIONALE: The priority assessment after tracheostomy placement is to verify effective airway
patency and ventilation by auscultating bilateral breath sounds. This determines whether the airway is
functioning properly before other interventions.
Question 3
A nurse is reviewing laboratory results for a client receiving heparin therapy. Which of the following
values should the nurse monitor to evaluate therapeutic effectiveness?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
C. Activated partial thromboplastin time (aPTT)
RATIONALE: Unfractionated heparin therapy is monitored using the aPTT, which should be
maintained at 1.5 to 2.5 times the control value. PT and INR are used to monitor warfarin therapy.
Question 4
,A nurse is caring for a client with acute pancreatitis. Which of the following laboratory findings should
the nurse expect?
A. Decreased serum amylase
B. Increased serum lipase
C. Decreased serum glucose
D. Increased serum calcium
B. Increased serum lipase
RATIONALE: Acute pancreatitis causes release of pancreatic enzymes, leading to elevated serum
lipase and amylase levels. Lipase is more specific and remains elevated longer than amylase.
Question 5
A nurse is teaching a client with type 1 diabetes mellitus about sick-day management. Which statement
by the client indicates understanding?
A. "I will stop taking my insulin if I cannot eat."
B. "I will check my blood glucose every 4 hours."
C. "I will drink only water and avoid all carbohydrates."
D. "I will take my usual insulin dose even if I am not eating."
B. "I will check my blood glucose every 4 hours."
RATIONALE: During illness, blood glucose should be monitored every 3 to 4 hours because stress
hormones increase glucose levels. Insulin should never be withheld during illness, even if the client is
not eating, to prevent diabetic ketoacidosis.
Question 6
A nurse is assessing a client with heart failure who reports increased shortness of breath when lying flat.
Which of the following terms should the nurse document?
A. Orthopnea
B. Dyspnea
C. Paroxysmal nocturnal dyspnea
D. Tachypnea
A. Orthopnea
RATIONALE: Orthopnea is shortness of breath that occurs when lying flat and is relieved by sitting
upright. It is a common manifestation of left-sided heart failure due to pulmonary congestion.
Question 7
, A nurse is caring for a client who is receiving total parenteral nutrition. Which of the following actions is
the priority?
A. Weigh the client daily
B. Monitor blood glucose levels
C. Change the central line dressing every 72 hours
D. Administer the TPN solution via gravity infusion
B. Monitor blood glucose levels
RATIONALE: TPN contains high concentrations of dextrose, which can cause hyperglycemia.
Monitoring blood glucose levels is the priority to detect and prevent complications such as
hyperglycemic hyperosmolar state.
Question 8
A nurse is assessing a client with a suspected pulmonary embolism. Which of the following findings
should the nurse expect?
A. Bradycardia
B. Sudden pleuritic chest pain
C. Productive cough with green sputum
D. Hypertension with bounding pulses
B. Sudden pleuritic chest pain
RATIONALE: Pulmonary embolism typically presents with sudden onset of pleuritic chest pain,
dyspnea, tachycardia, and anxiety. The pain worsens with inspiration due to pleural irritation.
Question 9
A nurse is preparing to administer digoxin to a client with heart failure. Which of the following findings
should the nurse report before administering the medication?
A. Heart rate of 58 beats per minute
B. Blood pressure of 128/76 mm Hg
C. Serum potassium level of 4.2 mEq/L
D. Weight loss of 1 kg since admission
A. Heart rate of 58 beats per minute
RATIONALE: Digoxin should be withheld if the apical pulse is below 60 beats per minute in adults.
Digoxin slows the heart rate, and administering it to a client with bradycardia could worsen the
condition.
2026/2027 ACTUAL EXAM| RN MED-SURG
PROCTORED ASSESSMENT II (RETAKE) WITH
COMPLETE REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ ALREADY GRADED A+
Core Domains
• Cardiovascular and Hematologic Systems*
• Respiratory and Oxygenation*
• Neurological and Sensory Systems*
• Renal and Genitourinary Systems*
• Gastrointestinal and Hepatobiliary Systems*
• Endocrine and Metabolic Systems*
• Musculoskeletal and Integumentary Systems*
• Perioperative and Emergency Nursing*
• Pharmacology and Parenteral Therapies*
• Safety, Ethics, and Professional Standards*
Introduction
This comprehensive assessment evaluates the clinical judgment and applied medical-surgical nursing
knowledge required for safe, effective practice. It measures competency across foundational theory,
professional standards, regulatory compliance, and ethical decision-making. The examination uses
multiple-choice and scenario-based items that reflect realistic patient encounters across acute, chronic,
and emergent settings. Emphasis is placed on clinical reasoning, prioritization, delegation, and outcome
evaluation. Candidates must demonstrate the ability to interpret assessment data, identify
complications, implement appropriate interventions, and evaluate patient responses within the scope of
professional nursing practice.
SECTION ONE: QUESTIONS 1–100
Question 1
A nurse is assessing a client who is 24 hours postoperative following an open cholecystectomy. The
client reports right shoulder pain. Which of the following is the most appropriate nursing action?
,A. Administer a prescribed opioid analgesic
B. Position the client flat in bed
C. Apply a heating pad to the abdomen
D. Encourage the client to splint the incision
A. Administer a prescribed opioid analgesic
RATIONALE: Right shoulder pain after abdominal surgery is typically referred pain from
diaphragmatic irritation caused by residual carbon dioxide used during laparoscopy or from peritoneal
irritation. Administering the prescribed analgesic is the priority intervention to manage the client's pain.
Question 2
A nurse is caring for a client with a new tracheostomy. Which of the following actions should the nurse
take first?
A. Deflate the cuff to check for air leak
B. Suction the tracheostomy
C. Auscultate bilateral breath sounds
D. Change the tracheostomy ties
C. Auscultate bilateral breath sounds
RATIONALE: The priority assessment after tracheostomy placement is to verify effective airway
patency and ventilation by auscultating bilateral breath sounds. This determines whether the airway is
functioning properly before other interventions.
Question 3
A nurse is reviewing laboratory results for a client receiving heparin therapy. Which of the following
values should the nurse monitor to evaluate therapeutic effectiveness?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
C. Activated partial thromboplastin time (aPTT)
RATIONALE: Unfractionated heparin therapy is monitored using the aPTT, which should be
maintained at 1.5 to 2.5 times the control value. PT and INR are used to monitor warfarin therapy.
Question 4
,A nurse is caring for a client with acute pancreatitis. Which of the following laboratory findings should
the nurse expect?
A. Decreased serum amylase
B. Increased serum lipase
C. Decreased serum glucose
D. Increased serum calcium
B. Increased serum lipase
RATIONALE: Acute pancreatitis causes release of pancreatic enzymes, leading to elevated serum
lipase and amylase levels. Lipase is more specific and remains elevated longer than amylase.
Question 5
A nurse is teaching a client with type 1 diabetes mellitus about sick-day management. Which statement
by the client indicates understanding?
A. "I will stop taking my insulin if I cannot eat."
B. "I will check my blood glucose every 4 hours."
C. "I will drink only water and avoid all carbohydrates."
D. "I will take my usual insulin dose even if I am not eating."
B. "I will check my blood glucose every 4 hours."
RATIONALE: During illness, blood glucose should be monitored every 3 to 4 hours because stress
hormones increase glucose levels. Insulin should never be withheld during illness, even if the client is
not eating, to prevent diabetic ketoacidosis.
Question 6
A nurse is assessing a client with heart failure who reports increased shortness of breath when lying flat.
Which of the following terms should the nurse document?
A. Orthopnea
B. Dyspnea
C. Paroxysmal nocturnal dyspnea
D. Tachypnea
A. Orthopnea
RATIONALE: Orthopnea is shortness of breath that occurs when lying flat and is relieved by sitting
upright. It is a common manifestation of left-sided heart failure due to pulmonary congestion.
Question 7
, A nurse is caring for a client who is receiving total parenteral nutrition. Which of the following actions is
the priority?
A. Weigh the client daily
B. Monitor blood glucose levels
C. Change the central line dressing every 72 hours
D. Administer the TPN solution via gravity infusion
B. Monitor blood glucose levels
RATIONALE: TPN contains high concentrations of dextrose, which can cause hyperglycemia.
Monitoring blood glucose levels is the priority to detect and prevent complications such as
hyperglycemic hyperosmolar state.
Question 8
A nurse is assessing a client with a suspected pulmonary embolism. Which of the following findings
should the nurse expect?
A. Bradycardia
B. Sudden pleuritic chest pain
C. Productive cough with green sputum
D. Hypertension with bounding pulses
B. Sudden pleuritic chest pain
RATIONALE: Pulmonary embolism typically presents with sudden onset of pleuritic chest pain,
dyspnea, tachycardia, and anxiety. The pain worsens with inspiration due to pleural irritation.
Question 9
A nurse is preparing to administer digoxin to a client with heart failure. Which of the following findings
should the nurse report before administering the medication?
A. Heart rate of 58 beats per minute
B. Blood pressure of 128/76 mm Hg
C. Serum potassium level of 4.2 mEq/L
D. Weight loss of 1 kg since admission
A. Heart rate of 58 beats per minute
RATIONALE: Digoxin should be withheld if the apical pulse is below 60 beats per minute in adults.
Digoxin slows the heart rate, and administering it to a client with bradycardia could worsen the
condition.
