ATI PN ADULT MEDICAL-SURGICAL PROCTORED EXAM QUESTIONS
AND VERIFIED ANSWERS | 100% CORRECT | GRADE A+
CORE DOMAINS
• NGN Unfolding Case Studies: Clinical Judgment
• Cardiovascular & Hematologic Disorders
• Respiratory Disorders
• Neurological & Sensory Disorders
• Gastrointestinal & Hepatic Disorders
• Renal & Urinary Disorders
• Endocrine & Metabolic Disorders
• Musculoskeletal & Integumentary Disorders
• Perioperative & Critical Care Nursing
• Foundations of Adult Medical-Surgical Nursing
INTRODUCTION
This comprehensive examination is designed for practical nursing students
preparing for the ATI PN Adult Medical-Surgical Proctored Exam. It
contains verified questions with correct answers and detailed rationales
covering the core domains of adult medical-surgical nursing. The
examination mirrors the actual ATI proctored exam format, including Next
Generation NCLEX (NGN) style unfolding case studies that assess clinical
judgment. Each question is accompanied by a detailed rationale to
reinforce understanding of medical-surgical nursing concepts and safe
clinical decision-making.
SECTION ONE: NGN UNFOLDING CASE STUDIES (QUESTIONS 1–20)
1. A 68-year-old male patient is admitted with community-acquired
pneumonia. Vital signs: temperature 38.9°C (102°F), heart rate 102
bpm, respiratory rate 24/min, oxygen saturation 88% on room air. He
,is confused and coughing productive yellow sputum. Highlight the
findings that require immediate intervention.
A. Temperature 38.9°C (102°F)
B. Heart rate 102 bpm
C. Respiratory rate 24/min
D. Oxygen saturation 88%
E. Confusion
F. Productive cough
D and E
RATIONALE: Oxygen saturation of 88% indicates hypoxemia requiring
immediate oxygen therapy. Confusion in an older adult may indicate
hypoxia, hypercapnia, or sepsis. These are life-threatening priorities. Fever,
tachycardia, tachypnea, and productive cough are important but not
immediate priorities .
2. The patient's condition improves and oxygen is weaned to nasal
cannula at 2 L/min. The nurse notes new-onset confusion and
decreased responsiveness. What is the most likely cause?
A. Carbon dioxide narcosis
B. Hypoglycemia
C. Stroke
D. Medication side effect
A. Carbon dioxide narcosis
RATIONALE: Patients with COPD or chronic hypoventilation may rely
on a hypoxic drive. Oxygen therapy can reduce this drive, causing CO₂
retention (hypercapnia) and CO₂ narcosis with confusion and decreased
responsiveness. This is a medical emergency .
3. The provider orders an arterial blood gas. Results: pH 7.30, PaCO₂
58 mm Hg, PaO₂ 70 mm Hg. Which acid-base imbalance is present?
A. Metabolic acidosis
B. Metabolic alkalosis
,C. Respiratory acidosis
D. Respiratory alkalosis
C. Respiratory acidosis
RATIONALE: Respiratory acidosis is pH <7.35 with PaCO₂ >45 mm Hg.
The pH is 7.30 (acidotic) and PaCO₂ is 58 mm Hg (elevated), indicating
carbon dioxide retention as the cause of acidosis .
4. A client with heart failure is receiving furosemide and digoxin. The
nurse is monitoring laboratory values. Which finding requires
immediate intervention?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 138 mEq/L
C. Serum digoxin level 1.2 ng/mL
D. BUN 18 mg/dL
A. Serum potassium 3.1 mEq/L
RATIONALE: Furosemide is a loop diuretic that causes potassium loss.
Hypokalemia increases the risk of digoxin toxicity and cardiac
dysrhythmias. A potassium level of 3.1 mEq/L is critically low and requires
immediate intervention .
5. The client reports nausea and visual disturbances, seeing yellow-
green halos around lights. Which action should the nurse take first?
A. Administer the next dose of digoxin
B. Hold the digoxin and notify the provider
C. Encourage increased fluid intake
D. Administer an antiemetic
B. Hold the digoxin and notify the provider
RATIONALE: Nausea and visual disturbances (yellow-green halos) are
classic signs of digoxin toxicity. The digoxin should be held, and the
provider notified immediately. The risk is increased by hypokalemia .
6. A client with type 1 diabetes is admitted with diabetic ketoacidosis
(DKA). Which finding is most characteristic of this condition?
, A. Blood glucose 480 mg/dL, pH 7.20, positive ketones
B. Blood glucose 480 mg/dL, pH 7.45, negative ketones
C. Blood glucose 200 mg/dL, pH 7.35, positive ketones
D. Blood glucose 80 mg/dL, pH 7.40, negative ketones
A. Blood glucose 480 mg/dL, pH 7.20, positive ketones
RATIONALE: DKA is characterized by hyperglycemia (>250 mg/dL),
metabolic acidosis (pH <7.30), and positive ketones. The combination in
option A is classic for DKA.
7. Which intervention is the priority for the client in DKA?
A. Administer intravenous insulin
B. Administer intravenous fluids (0.9% normal saline)
C. Administer sodium bicarbonate
D. Monitor serum potassium
B. Administer intravenous fluids (0.9% normal saline)
RATIONALE: The initial priority in DKA management is fluid
resuscitation with 0.9% normal saline to treat dehydration and restore
perfusion. Insulin is typically given intravenously after or during fluid
replacement. Potassium is monitored closely and replaced as needed .
8. A client is 4 hours postoperative following a thyroidectomy. Which
finding is most concerning?
A. Incisional pain rated 4/10
B. Hoarse voice
C. Stridor and increasing respiratory effort
D. Mild neck swelling
C. Stridor and increasing respiratory effort
RATIONALE: Stridor indicates airway obstruction, likely due to
laryngeal nerve damage or edema. This is a medical emergency requiring
immediate intervention. Mild pain, hoarseness, and mild swelling are
expected postoperative findings .
AND VERIFIED ANSWERS | 100% CORRECT | GRADE A+
CORE DOMAINS
• NGN Unfolding Case Studies: Clinical Judgment
• Cardiovascular & Hematologic Disorders
• Respiratory Disorders
• Neurological & Sensory Disorders
• Gastrointestinal & Hepatic Disorders
• Renal & Urinary Disorders
• Endocrine & Metabolic Disorders
• Musculoskeletal & Integumentary Disorders
• Perioperative & Critical Care Nursing
• Foundations of Adult Medical-Surgical Nursing
INTRODUCTION
This comprehensive examination is designed for practical nursing students
preparing for the ATI PN Adult Medical-Surgical Proctored Exam. It
contains verified questions with correct answers and detailed rationales
covering the core domains of adult medical-surgical nursing. The
examination mirrors the actual ATI proctored exam format, including Next
Generation NCLEX (NGN) style unfolding case studies that assess clinical
judgment. Each question is accompanied by a detailed rationale to
reinforce understanding of medical-surgical nursing concepts and safe
clinical decision-making.
SECTION ONE: NGN UNFOLDING CASE STUDIES (QUESTIONS 1–20)
1. A 68-year-old male patient is admitted with community-acquired
pneumonia. Vital signs: temperature 38.9°C (102°F), heart rate 102
bpm, respiratory rate 24/min, oxygen saturation 88% on room air. He
,is confused and coughing productive yellow sputum. Highlight the
findings that require immediate intervention.
A. Temperature 38.9°C (102°F)
B. Heart rate 102 bpm
C. Respiratory rate 24/min
D. Oxygen saturation 88%
E. Confusion
F. Productive cough
D and E
RATIONALE: Oxygen saturation of 88% indicates hypoxemia requiring
immediate oxygen therapy. Confusion in an older adult may indicate
hypoxia, hypercapnia, or sepsis. These are life-threatening priorities. Fever,
tachycardia, tachypnea, and productive cough are important but not
immediate priorities .
2. The patient's condition improves and oxygen is weaned to nasal
cannula at 2 L/min. The nurse notes new-onset confusion and
decreased responsiveness. What is the most likely cause?
A. Carbon dioxide narcosis
B. Hypoglycemia
C. Stroke
D. Medication side effect
A. Carbon dioxide narcosis
RATIONALE: Patients with COPD or chronic hypoventilation may rely
on a hypoxic drive. Oxygen therapy can reduce this drive, causing CO₂
retention (hypercapnia) and CO₂ narcosis with confusion and decreased
responsiveness. This is a medical emergency .
3. The provider orders an arterial blood gas. Results: pH 7.30, PaCO₂
58 mm Hg, PaO₂ 70 mm Hg. Which acid-base imbalance is present?
A. Metabolic acidosis
B. Metabolic alkalosis
,C. Respiratory acidosis
D. Respiratory alkalosis
C. Respiratory acidosis
RATIONALE: Respiratory acidosis is pH <7.35 with PaCO₂ >45 mm Hg.
The pH is 7.30 (acidotic) and PaCO₂ is 58 mm Hg (elevated), indicating
carbon dioxide retention as the cause of acidosis .
4. A client with heart failure is receiving furosemide and digoxin. The
nurse is monitoring laboratory values. Which finding requires
immediate intervention?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 138 mEq/L
C. Serum digoxin level 1.2 ng/mL
D. BUN 18 mg/dL
A. Serum potassium 3.1 mEq/L
RATIONALE: Furosemide is a loop diuretic that causes potassium loss.
Hypokalemia increases the risk of digoxin toxicity and cardiac
dysrhythmias. A potassium level of 3.1 mEq/L is critically low and requires
immediate intervention .
5. The client reports nausea and visual disturbances, seeing yellow-
green halos around lights. Which action should the nurse take first?
A. Administer the next dose of digoxin
B. Hold the digoxin and notify the provider
C. Encourage increased fluid intake
D. Administer an antiemetic
B. Hold the digoxin and notify the provider
RATIONALE: Nausea and visual disturbances (yellow-green halos) are
classic signs of digoxin toxicity. The digoxin should be held, and the
provider notified immediately. The risk is increased by hypokalemia .
6. A client with type 1 diabetes is admitted with diabetic ketoacidosis
(DKA). Which finding is most characteristic of this condition?
, A. Blood glucose 480 mg/dL, pH 7.20, positive ketones
B. Blood glucose 480 mg/dL, pH 7.45, negative ketones
C. Blood glucose 200 mg/dL, pH 7.35, positive ketones
D. Blood glucose 80 mg/dL, pH 7.40, negative ketones
A. Blood glucose 480 mg/dL, pH 7.20, positive ketones
RATIONALE: DKA is characterized by hyperglycemia (>250 mg/dL),
metabolic acidosis (pH <7.30), and positive ketones. The combination in
option A is classic for DKA.
7. Which intervention is the priority for the client in DKA?
A. Administer intravenous insulin
B. Administer intravenous fluids (0.9% normal saline)
C. Administer sodium bicarbonate
D. Monitor serum potassium
B. Administer intravenous fluids (0.9% normal saline)
RATIONALE: The initial priority in DKA management is fluid
resuscitation with 0.9% normal saline to treat dehydration and restore
perfusion. Insulin is typically given intravenously after or during fluid
replacement. Potassium is monitored closely and replaced as needed .
8. A client is 4 hours postoperative following a thyroidectomy. Which
finding is most concerning?
A. Incisional pain rated 4/10
B. Hoarse voice
C. Stridor and increasing respiratory effort
D. Mild neck swelling
C. Stridor and increasing respiratory effort
RATIONALE: Stridor indicates airway obstruction, likely due to
laryngeal nerve damage or edema. This is a medical emergency requiring
immediate intervention. Mild pain, hoarseness, and mild swelling are
expected postoperative findings .
