ATI RN Adult Med-Surg Proctored
Exam 2025 – Verified Questions with
100% Correct Answers and Explanations
Medical-Surgical Questions (1–80)
1. A nurse is caring for a client with a new diagnosis of heart failure. Which
assessment finding should the nurse prioritize?
a. Elevated blood pressure
b. Crackles in the lungs
c. Bradycardia
d. Dry cough
Correct Answer: b. Crackles in the lungs
Rationale: Crackles in the lungs indicate pulmonary edema, a common complication of
heart failure due to fluid overload. This is a priority finding as it suggests worsening heart
failure requiring immediate intervention. Elevated blood pressure may be present but is
less specific, bradycardia is not typical, and a dry cough is less urgent.
2. A client with type 2 diabetes mellitus is prescribed metformin. Which statement by
the client indicates understanding of the medication?
a. “I should take this medication with a high-fat meal.”
b. “This medication helps my pancreas produce more insulin.”
c. “I need to monitor for signs of lactic acidosis.”
d. “This medication will cure my diabetes.”
Correct Answer: c. I need to monitor for signs of lactic acidosis.
Rationale: Metformin can rarely cause lactic acidosis, a serious side effect. Clients
should be aware of symptoms like muscle pain or weakness. Metformin is taken with
meals but not specifically high-fat ones, it does not stimulate insulin production, and it
does not cure diabetes.
3. A nurse is assessing a client with suspected appendicitis. Which finding should the
nurse report immediately?
a. Nausea and vomiting
b. Rebound tenderness
c. Low-grade fever
d. Anorexia
Correct Answer: b. Rebound tenderness
Rationale: Rebound tenderness is a hallmark sign of appendicitis, indicating peritoneal
irritation and potential rupture, which requires urgent surgical evaluation. Nausea,
vomiting, fever, and anorexia are common but less specific and urgent.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at
2 L/min via nasal cannula. Which arterial blood gas (ABG) result indicates the need
, for adjustment?
a. pH 7.38, PaCO₂ 40 mmHg, PaO₂ 90 mmHg
b. pH 7.30, PaCO₂ 50 mmHg, PaO₂ 85 mmHg
c. pH 7.40, PaCO₂ 42 mmHg, PaO₂ 88 mmHg
d. pH 7.42, PaCO₂ 38 mmHg, PaO₂ 92 mmHg
Correct Answer: b. pH 7.30, PaCO₂ 50 mmHg, PaO₂ 85 mmHg
Rationale: The ABG shows respiratory acidosis (low pH, high PaCO₂), common in
COPD exacerbations due to CO₂ retention. This suggests inadequate ventilation,
requiring adjustment of oxygen therapy or additional interventions. The other results are
within normal ranges.
5. A nurse is caring for a client post-thyroidectomy. Which finding indicates a
potential complication?
a. Mild throat discomfort
b. Hoarseness
c. Hypocalcemia
d. Slight swelling at the incision site
Correct Answer: c. Hypocalcemia
Rationale: Hypocalcemia is a potential complication post-thyroidectomy due to
accidental removal or damage to the parathyroid glands, leading to symptoms like tetany
or tingling. Hoarseness, mild discomfort, and slight swelling are expected post-surgery.
6. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
should the nurse monitor?
a. Platelet count
b. Prothrombin time (PT)
c. Activated partial thromboplastin time (aPTT)
d. White blood cell count
Correct Answer: b. Prothrombin time (PT)
Rationale: Warfarin’s effectiveness is monitored using PT and INR, as it affects the
extrinsic coagulation pathway. aPTT is used for heparin, and platelet count or WBC are
not directly relevant.
7. A nurse is teaching a client with gastroesophageal reflux disease (GERD). Which
recommendation should the nurse include?
a. Eat a high-carbohydrate snack before bed
b. Elevate the foot of the bed
c. Reduce caffeine intake
d. Increase protein intake
Correct Answer: c. Reduce caffeine intake
Rationale: Caffeine relaxes the lower esophageal sphincter, worsening GERD
symptoms. Elevating the head of the bed, not the foot, is recommended. High-carb snacks
and increased protein are not specific to GERD management.
8. A client with a new colostomy reports leakage around the appliance. What should
the nurse assess first?
a. Skin integrity around the stoma
b. Type of appliance used
c. Client’s dietary intake
d. Frequency of appliance changes
, Correct Answer: a. Skin integrity around the stoma
Rationale: Leakage can cause skin breakdown, a priority due to the risk of infection and
discomfort. Assessing the appliance type, diet, or change frequency is secondary to
ensuring skin protection.
9. A nurse is caring for a client with a flail chest following a motor vehicle crash.
Which action should the nurse prioritize?
a. Administer analgesics
b. Prepare for positive pressure ventilation
c. Apply a chest binder
d. Encourage deep breathing exercises
Correct Answer: b. Prepare for positive pressure ventilation
Rationale: Flail chest causes paradoxical chest movement, impairing ventilation.
Positive pressure ventilation stabilizes the chest and ensures adequate oxygenation,
making it a priority. Analgesics and breathing exercises are secondary, and chest binders
are not typically used.
10. A client with Crohn’s disease reports abdominal pain. Which finding should the
nurse expect?
a. Bloody stools
b. Right lower quadrant pain
c. Weight gain
d. Constipation
Correct Answer: b. Right lower quadrant pain
Rationale: Crohn’s disease commonly causes pain in the right lower quadrant due to
inflammation in the ileum. Bloody stools may occur but are less specific, and weight gain
or constipation are not typical.
11. A nurse is preparing a client for a colonoscopy. Which instruction is most
important?
a. Avoid solid foods for 48 hours
b. Drink clear liquids until midnight
c. Take the bowel prep as prescribed
d. Arrive 30 minutes early
Correct Answer: c. Take the bowel prep as prescribed
Rationale: Bowel preparation is critical for a clear view during a colonoscopy.
Incomplete prep can lead to a canceled procedure. Clear liquids and fasting are important
but secondary to the prep.
12. A client with pneumonia is receiving antibiotics. Which finding indicates the
treatment is effective?
a. Increased sputum production
b. Decreased oxygen saturation
c. Resolution of fever
d. Persistent crackles
Correct Answer: c. Resolution of fever
Rationale: Resolution of fever indicates the antibiotic is addressing the infection.
Increased sputum, decreased oxygen saturation, or persistent crackles suggest ongoing
infection or complications.
Exam 2025 – Verified Questions with
100% Correct Answers and Explanations
Medical-Surgical Questions (1–80)
1. A nurse is caring for a client with a new diagnosis of heart failure. Which
assessment finding should the nurse prioritize?
a. Elevated blood pressure
b. Crackles in the lungs
c. Bradycardia
d. Dry cough
Correct Answer: b. Crackles in the lungs
Rationale: Crackles in the lungs indicate pulmonary edema, a common complication of
heart failure due to fluid overload. This is a priority finding as it suggests worsening heart
failure requiring immediate intervention. Elevated blood pressure may be present but is
less specific, bradycardia is not typical, and a dry cough is less urgent.
2. A client with type 2 diabetes mellitus is prescribed metformin. Which statement by
the client indicates understanding of the medication?
a. “I should take this medication with a high-fat meal.”
b. “This medication helps my pancreas produce more insulin.”
c. “I need to monitor for signs of lactic acidosis.”
d. “This medication will cure my diabetes.”
Correct Answer: c. I need to monitor for signs of lactic acidosis.
Rationale: Metformin can rarely cause lactic acidosis, a serious side effect. Clients
should be aware of symptoms like muscle pain or weakness. Metformin is taken with
meals but not specifically high-fat ones, it does not stimulate insulin production, and it
does not cure diabetes.
3. A nurse is assessing a client with suspected appendicitis. Which finding should the
nurse report immediately?
a. Nausea and vomiting
b. Rebound tenderness
c. Low-grade fever
d. Anorexia
Correct Answer: b. Rebound tenderness
Rationale: Rebound tenderness is a hallmark sign of appendicitis, indicating peritoneal
irritation and potential rupture, which requires urgent surgical evaluation. Nausea,
vomiting, fever, and anorexia are common but less specific and urgent.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at
2 L/min via nasal cannula. Which arterial blood gas (ABG) result indicates the need
, for adjustment?
a. pH 7.38, PaCO₂ 40 mmHg, PaO₂ 90 mmHg
b. pH 7.30, PaCO₂ 50 mmHg, PaO₂ 85 mmHg
c. pH 7.40, PaCO₂ 42 mmHg, PaO₂ 88 mmHg
d. pH 7.42, PaCO₂ 38 mmHg, PaO₂ 92 mmHg
Correct Answer: b. pH 7.30, PaCO₂ 50 mmHg, PaO₂ 85 mmHg
Rationale: The ABG shows respiratory acidosis (low pH, high PaCO₂), common in
COPD exacerbations due to CO₂ retention. This suggests inadequate ventilation,
requiring adjustment of oxygen therapy or additional interventions. The other results are
within normal ranges.
5. A nurse is caring for a client post-thyroidectomy. Which finding indicates a
potential complication?
a. Mild throat discomfort
b. Hoarseness
c. Hypocalcemia
d. Slight swelling at the incision site
Correct Answer: c. Hypocalcemia
Rationale: Hypocalcemia is a potential complication post-thyroidectomy due to
accidental removal or damage to the parathyroid glands, leading to symptoms like tetany
or tingling. Hoarseness, mild discomfort, and slight swelling are expected post-surgery.
6. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
should the nurse monitor?
a. Platelet count
b. Prothrombin time (PT)
c. Activated partial thromboplastin time (aPTT)
d. White blood cell count
Correct Answer: b. Prothrombin time (PT)
Rationale: Warfarin’s effectiveness is monitored using PT and INR, as it affects the
extrinsic coagulation pathway. aPTT is used for heparin, and platelet count or WBC are
not directly relevant.
7. A nurse is teaching a client with gastroesophageal reflux disease (GERD). Which
recommendation should the nurse include?
a. Eat a high-carbohydrate snack before bed
b. Elevate the foot of the bed
c. Reduce caffeine intake
d. Increase protein intake
Correct Answer: c. Reduce caffeine intake
Rationale: Caffeine relaxes the lower esophageal sphincter, worsening GERD
symptoms. Elevating the head of the bed, not the foot, is recommended. High-carb snacks
and increased protein are not specific to GERD management.
8. A client with a new colostomy reports leakage around the appliance. What should
the nurse assess first?
a. Skin integrity around the stoma
b. Type of appliance used
c. Client’s dietary intake
d. Frequency of appliance changes
, Correct Answer: a. Skin integrity around the stoma
Rationale: Leakage can cause skin breakdown, a priority due to the risk of infection and
discomfort. Assessing the appliance type, diet, or change frequency is secondary to
ensuring skin protection.
9. A nurse is caring for a client with a flail chest following a motor vehicle crash.
Which action should the nurse prioritize?
a. Administer analgesics
b. Prepare for positive pressure ventilation
c. Apply a chest binder
d. Encourage deep breathing exercises
Correct Answer: b. Prepare for positive pressure ventilation
Rationale: Flail chest causes paradoxical chest movement, impairing ventilation.
Positive pressure ventilation stabilizes the chest and ensures adequate oxygenation,
making it a priority. Analgesics and breathing exercises are secondary, and chest binders
are not typically used.
10. A client with Crohn’s disease reports abdominal pain. Which finding should the
nurse expect?
a. Bloody stools
b. Right lower quadrant pain
c. Weight gain
d. Constipation
Correct Answer: b. Right lower quadrant pain
Rationale: Crohn’s disease commonly causes pain in the right lower quadrant due to
inflammation in the ileum. Bloody stools may occur but are less specific, and weight gain
or constipation are not typical.
11. A nurse is preparing a client for a colonoscopy. Which instruction is most
important?
a. Avoid solid foods for 48 hours
b. Drink clear liquids until midnight
c. Take the bowel prep as prescribed
d. Arrive 30 minutes early
Correct Answer: c. Take the bowel prep as prescribed
Rationale: Bowel preparation is critical for a clear view during a colonoscopy.
Incomplete prep can lead to a canceled procedure. Clear liquids and fasting are important
but secondary to the prep.
12. A client with pneumonia is receiving antibiotics. Which finding indicates the
treatment is effective?
a. Increased sputum production
b. Decreased oxygen saturation
c. Resolution of fever
d. Persistent crackles
Correct Answer: c. Resolution of fever
Rationale: Resolution of fever indicates the antibiotic is addressing the infection.
Increased sputum, decreased oxygen saturation, or persistent crackles suggest ongoing
infection or complications.
