ATI RN Adult Medical Surgical Proctored Exam | ATI RN Adult Medical-
Surgical Proctored Assessment Study Guide & Exam Prep 2026–2027 | ATI
Adult Med Surg Nursing Review | Cardiovascular, Respiratory, Neurological,
Gastrointestinal, Renal, Endocrine, Musculoskeletal, Immune &
Integumentary Disorders | Patient Assessment, Clinical Manifestations,
Nursing Interventions, Pharmacology, Complications, Prioritization, Safety &
Clinical Judgment | Practice Questions, NGN-Style Case Studies & Detailed
Rationales
Question 1: A nurse is caring for a client who has heart failure and is receiving
furosemide. Which laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia. Hypokalemia can precipitate cardiac dysrhythmias, especially in
clients taking digoxin. Serum potassium should be monitored closely and replaced
as needed.
Question 2: A nurse is assessing a client who has unstable angina. Which finding
should the nurse expect?
A. Chest pain that is relieved by rest and nitroglycerin
B. Chest pain that occurs at rest and is not relieved by nitroglycerin
C. Chest pain that is worse with deep inspiration
D. Chest pain that radiates to the right shoulder
CORRECT ANSWER: B. Chest pain that occurs at rest and is not relieved by
nitroglycerin
Rationale: Unstable angina is characterized by chest pain that occurs at rest or
with minimal exertion and is not readily relieved by nitroglycerin. This indicates an
acute coronary syndrome requiring immediate medical evaluation.
,Question 3: A nurse is preparing to administer digoxin to a client who has heart
failure. Which assessment finding indicates the need to withhold the
medication?
A. Heart rate 58 bpm
B. Blood pressure 110/70 mmHg
C. Respiratory rate 18 breaths/min
D. Serum potassium 4.0 mEq/L
CORRECT ANSWER: A. Heart rate 58 bpm
Rationale: Digoxin should be withheld if the heart rate is less than 60 bpm in
adults. The healthcare provider should be notified. Blood pressure, respiratory
rate, and potassium level are within normal limits.
Question 4: A nurse is providing teaching to a client who has a new prescription
for warfarin. Which statement by the client indicates a need for further
teaching?
A. "I will avoid eating large amounts of leafy green vegetables"
B. "I will report any bleeding or bruising to my provider"
C. "I will take ibuprofen for headaches"
D. "I will have my blood tested regularly"
CORRECT ANSWER: C. "I will take ibuprofen for headaches"
Rationale: Ibuprofen and other NSAIDs increase the risk of bleeding when taken
with warfarin. The client should use acetaminophen for pain. Consistent vitamin K
intake (leafy greens) is important, not avoidance. Bleeding and regular INR
monitoring are appropriate.
Question 5: A nurse is assessing a client who has an acute myocardial infarction.
Which finding is most concerning?
A. Chest pain rated 6 on a scale of 0-10
B. Jugular venous distention
,C. Crackles heard in the lung bases
D. New-onset heart block
CORRECT ANSWER: D. New-onset heart block
Rationale: New-onset heart block following an acute myocardial infarction
indicates ischemia of the conduction system and can progress to complete heart
block or asystole. This requires immediate intervention. While the other findings
require attention, conduction disturbances are the most life-threatening.
Question 6: A nurse is caring for a client who has a new prescription for
sublingual nitroglycerin. Which instruction should the nurse include?
A. "Take the medication while standing to enhance absorption"
B. "Lie down when you take this medication"
C. "Discontinue the medication if you develop a headache"
D. "You can take up to five tablets in 15 minutes before seeking help"
CORRECT ANSWER: B. "Lie down when you take this medication"
Rationale: Sublingual nitroglycerin can cause hypotension and dizziness. The client
should lie down to minimize fall risk. Headache is an expected side effect and
does not indicate the need to discontinue. The client should take up to three
tablets, five minutes apart, before seeking emergency help.
Question 7: A nurse is caring for a client who has heart failure and is receiving
dobutamine. Which finding indicates a potential complication?
A. Heart rate increase from 88 to 102 bpm
B. Urine output of 180 mL over 4 hours
C. Blood pressure decrease from 142/88 to 108/64 mmHg
D. Crackles in bilateral lung bases
CORRECT ANSWER: C. Blood pressure decrease from 142/88 to 108/64 mmHg
Rationale: A systolic BP below 110 mmHg in a client receiving dobutamine
suggests inadequate perfusion and potential cardiogenic shock. Dobutamine can
, cause hypotension due to beta-2 mediated vasodilation. This finding requires
immediate intervention.
Question 8: A client receiving heparin develops an aPTT of 120 seconds, new-
onset confusion, oliguria, and petechiae. Which laboratory value is most
important to assess immediately?
A. Platelet count
B. INR
C. Serum creatinine
D. Hemoglobin and hematocrit
CORRECT ANSWER: A. Platelet count
Rationale: The triad of supratherapeutic aPTT, new confusion, oliguria, and
petechiae suggests heparin-induced thrombocytopenia (HIT). Platelet count
should be assessed immediately. HIT is a life-threatening complication requiring
immediate discontinuation of heparin.
Question 9: A nurse is assessing a client who has peripheral arterial disease.
Which finding should the nurse expect?
A. Edema on the ankle
B. Hair loss distal to the calves
C. Leg pain relieved by elevation
D. Warm extremities
CORRECT ANSWER: B. Hair loss distal to the calves
Rationale: Peripheral arterial disease causes decreased blood flow to the
extremities, resulting in hair loss, cool extremities, and pain that worsens with
elevation. Venous disorders cause edema and pain relieved by elevation.
Question 10: A nurse is caring for a client who is postoperative following a
transurethral resection of the prostate. The nurse notes the client's urinary
Surgical Proctored Assessment Study Guide & Exam Prep 2026–2027 | ATI
Adult Med Surg Nursing Review | Cardiovascular, Respiratory, Neurological,
Gastrointestinal, Renal, Endocrine, Musculoskeletal, Immune &
Integumentary Disorders | Patient Assessment, Clinical Manifestations,
Nursing Interventions, Pharmacology, Complications, Prioritization, Safety &
Clinical Judgment | Practice Questions, NGN-Style Case Studies & Detailed
Rationales
Question 1: A nurse is caring for a client who has heart failure and is receiving
furosemide. Which laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia. Hypokalemia can precipitate cardiac dysrhythmias, especially in
clients taking digoxin. Serum potassium should be monitored closely and replaced
as needed.
Question 2: A nurse is assessing a client who has unstable angina. Which finding
should the nurse expect?
A. Chest pain that is relieved by rest and nitroglycerin
B. Chest pain that occurs at rest and is not relieved by nitroglycerin
C. Chest pain that is worse with deep inspiration
D. Chest pain that radiates to the right shoulder
CORRECT ANSWER: B. Chest pain that occurs at rest and is not relieved by
nitroglycerin
Rationale: Unstable angina is characterized by chest pain that occurs at rest or
with minimal exertion and is not readily relieved by nitroglycerin. This indicates an
acute coronary syndrome requiring immediate medical evaluation.
,Question 3: A nurse is preparing to administer digoxin to a client who has heart
failure. Which assessment finding indicates the need to withhold the
medication?
A. Heart rate 58 bpm
B. Blood pressure 110/70 mmHg
C. Respiratory rate 18 breaths/min
D. Serum potassium 4.0 mEq/L
CORRECT ANSWER: A. Heart rate 58 bpm
Rationale: Digoxin should be withheld if the heart rate is less than 60 bpm in
adults. The healthcare provider should be notified. Blood pressure, respiratory
rate, and potassium level are within normal limits.
Question 4: A nurse is providing teaching to a client who has a new prescription
for warfarin. Which statement by the client indicates a need for further
teaching?
A. "I will avoid eating large amounts of leafy green vegetables"
B. "I will report any bleeding or bruising to my provider"
C. "I will take ibuprofen for headaches"
D. "I will have my blood tested regularly"
CORRECT ANSWER: C. "I will take ibuprofen for headaches"
Rationale: Ibuprofen and other NSAIDs increase the risk of bleeding when taken
with warfarin. The client should use acetaminophen for pain. Consistent vitamin K
intake (leafy greens) is important, not avoidance. Bleeding and regular INR
monitoring are appropriate.
Question 5: A nurse is assessing a client who has an acute myocardial infarction.
Which finding is most concerning?
A. Chest pain rated 6 on a scale of 0-10
B. Jugular venous distention
,C. Crackles heard in the lung bases
D. New-onset heart block
CORRECT ANSWER: D. New-onset heart block
Rationale: New-onset heart block following an acute myocardial infarction
indicates ischemia of the conduction system and can progress to complete heart
block or asystole. This requires immediate intervention. While the other findings
require attention, conduction disturbances are the most life-threatening.
Question 6: A nurse is caring for a client who has a new prescription for
sublingual nitroglycerin. Which instruction should the nurse include?
A. "Take the medication while standing to enhance absorption"
B. "Lie down when you take this medication"
C. "Discontinue the medication if you develop a headache"
D. "You can take up to five tablets in 15 minutes before seeking help"
CORRECT ANSWER: B. "Lie down when you take this medication"
Rationale: Sublingual nitroglycerin can cause hypotension and dizziness. The client
should lie down to minimize fall risk. Headache is an expected side effect and
does not indicate the need to discontinue. The client should take up to three
tablets, five minutes apart, before seeking emergency help.
Question 7: A nurse is caring for a client who has heart failure and is receiving
dobutamine. Which finding indicates a potential complication?
A. Heart rate increase from 88 to 102 bpm
B. Urine output of 180 mL over 4 hours
C. Blood pressure decrease from 142/88 to 108/64 mmHg
D. Crackles in bilateral lung bases
CORRECT ANSWER: C. Blood pressure decrease from 142/88 to 108/64 mmHg
Rationale: A systolic BP below 110 mmHg in a client receiving dobutamine
suggests inadequate perfusion and potential cardiogenic shock. Dobutamine can
, cause hypotension due to beta-2 mediated vasodilation. This finding requires
immediate intervention.
Question 8: A client receiving heparin develops an aPTT of 120 seconds, new-
onset confusion, oliguria, and petechiae. Which laboratory value is most
important to assess immediately?
A. Platelet count
B. INR
C. Serum creatinine
D. Hemoglobin and hematocrit
CORRECT ANSWER: A. Platelet count
Rationale: The triad of supratherapeutic aPTT, new confusion, oliguria, and
petechiae suggests heparin-induced thrombocytopenia (HIT). Platelet count
should be assessed immediately. HIT is a life-threatening complication requiring
immediate discontinuation of heparin.
Question 9: A nurse is assessing a client who has peripheral arterial disease.
Which finding should the nurse expect?
A. Edema on the ankle
B. Hair loss distal to the calves
C. Leg pain relieved by elevation
D. Warm extremities
CORRECT ANSWER: B. Hair loss distal to the calves
Rationale: Peripheral arterial disease causes decreased blood flow to the
extremities, resulting in hair loss, cool extremities, and pain that worsens with
elevation. Venous disorders cause edema and pain relieved by elevation.
Question 10: A nurse is caring for a client who is postoperative following a
transurethral resection of the prostate. The nurse notes the client's urinary
