1
ATI Medical-Surgical Proctored Assessment
Questions and Answers with Rationales
2025/2026 | Comprehensive Review |
Capstone | Predictor | Pass Guarantee
ASSESSMENT 1 – CAPSTONE MED-SURG FORM A (50 items)
A-1.1 (MCQ)
The nurse is caring for a client with acute decompensated heart failure who is
receiving IV furosemide 80 mg BID.
Which finding best indicates the medication is effective?
A. Weight loss of 1.5 kg in 24 h
B. Serum potassium 3.0 mEq/L
C. Blood pressure 88/50 mm Hg
D. Urine specific gravity 1.035
Answer: A
Rationale: 1 kg wt ≈ 1 L fluid; 1.5 kg diuresis shows effective volume removal.
Hypokalemia (B) is adverse effect; low BP (C) may signal over-diuresis; high
USG (D) indicates dehydration but not therapeutic efficacy.
A-1.2 (MCQ)
A client with COPD is receiving 28 % Venturi mask.
The nurse should intervene immediately if which value is noted?
A. PaO₂ 58 mm Hg
B. SaO₂ 89 %
C. PaCO₂ 68 mm Hg
D. pH 7.38
Answer: C
Rationale: PaCO₂ >60 mm Hg with pH <7.35 indicates acute hypercapnic
respiratory failure; may need NIV or intubation. SaO₂ 89 % on 28 % is acceptable
for COPD to avoid blunting hypoxic drive.
, 2
A-1.3 (MCQ)
Four hours after a thyroidectomy the client reports perioral numbness.
Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Check ionized calcium level
C. Administer oral calcium gluconate
D. Start IV magnesium sulfate
Answer: B
Rationale: Perioral numbness is early sign of hypocalcemia secondary to
parathyroid trauma; confirm with lab before treating.
A-1.4 (MCQ)
The nurse is assessing a client with a below-knee cast who reports severe deep pain
unrelieved by morphine.
Priority nursing action?
A. Re-position the extremity
B. Administer additional opioid
C. Perform neurovascular assessment
D. Apply ice around cast
Answer: C
Rationale: Classic red flag for compartment syndrome; neurovascular compromise
(6 P’s) requires immediate evaluation and possible fasciotomy.
A-1.5 (MCQ)
A client with T1DM on an insulin pump is admitted with DKA.
Which blood gas result indicates the DKA has resolved?
A. pH 7.36, HCO₃ 22 mEq/L, AG 10
B. pH 7.28, HCO₃ 16 mEq/L, AG 18
C. pH 7.32, HCO₃ 18 mEq/L, AG 20
D. pH 7.48, HCO₃ 28 mEq/L, AG 8
Answer: A
Rationale: Resolution defined as pH ≥7.30, HCO₃ ≥18, anion gap ≤12, and β -
hydroxybutyrate <0.6 mmol/L.
A-1.6 (MCQ)
A client with acute pancreatitis has a pain score 9/10.
, 3
Which medication is most appropriate?
A. Morphine 2 mg IV
B. Meperidine 50 mg IV
C. Ketorolac 30 mg IV
D. Fentanyl 25 mcg IV
Answer: D
Rationale: Fentanyl provides rapid, potent analgesia without sphincter of Oddi
spasm seen with morphine; meperidine avoided (neurotoxic metabolite).
A-1.7 (MCQ)
The nurse is evaluating a client receiving heparin for PE.
Which lab value indicates therapeutic effect?
A. aPTT 1.5–2.5 × control
B. aPTT 0.5 × control
C. INR 2.0–3.0
D. Anti-Xa 0.1–0.2 IU/mL
Answer: A
Rationale: 2025 ACCP guidelines maintain aPTT ratio 1.5–2.5 × baseline for UFH;
anti-Xa 0.3–0.7 IU/mL also acceptable but not listed.
A-1.8 (MCQ)
A client with cirrhosis has a serum ammonia of 110 µmol/L and is confused.
Which dietary order is most appropriate?
A. High-protein diet to promote healing
B. Moderate protein 1.2 g/kg with vegetable source emphasis
C. NPO until alert
D. High-fat diet to spare protein
Answer: B
Rationale: Moderate protein (1.2 g/kg) with high branched-chain and vegetable
sources lowers ammonia and prevents catabolism.
A-1.9 (MCQ)
A client with acute kidney injury (oliguric) has K⁺ 6.2 mEq/L and ECG peaked T
waves.
Which medication should the nurse prepare first?
A. 10 % calcium gluconate 10 mL IV over 2 min
ATI Medical-Surgical Proctored Assessment
Questions and Answers with Rationales
2025/2026 | Comprehensive Review |
Capstone | Predictor | Pass Guarantee
ASSESSMENT 1 – CAPSTONE MED-SURG FORM A (50 items)
A-1.1 (MCQ)
The nurse is caring for a client with acute decompensated heart failure who is
receiving IV furosemide 80 mg BID.
Which finding best indicates the medication is effective?
A. Weight loss of 1.5 kg in 24 h
B. Serum potassium 3.0 mEq/L
C. Blood pressure 88/50 mm Hg
D. Urine specific gravity 1.035
Answer: A
Rationale: 1 kg wt ≈ 1 L fluid; 1.5 kg diuresis shows effective volume removal.
Hypokalemia (B) is adverse effect; low BP (C) may signal over-diuresis; high
USG (D) indicates dehydration but not therapeutic efficacy.
A-1.2 (MCQ)
A client with COPD is receiving 28 % Venturi mask.
The nurse should intervene immediately if which value is noted?
A. PaO₂ 58 mm Hg
B. SaO₂ 89 %
C. PaCO₂ 68 mm Hg
D. pH 7.38
Answer: C
Rationale: PaCO₂ >60 mm Hg with pH <7.35 indicates acute hypercapnic
respiratory failure; may need NIV or intubation. SaO₂ 89 % on 28 % is acceptable
for COPD to avoid blunting hypoxic drive.
, 2
A-1.3 (MCQ)
Four hours after a thyroidectomy the client reports perioral numbness.
Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Check ionized calcium level
C. Administer oral calcium gluconate
D. Start IV magnesium sulfate
Answer: B
Rationale: Perioral numbness is early sign of hypocalcemia secondary to
parathyroid trauma; confirm with lab before treating.
A-1.4 (MCQ)
The nurse is assessing a client with a below-knee cast who reports severe deep pain
unrelieved by morphine.
Priority nursing action?
A. Re-position the extremity
B. Administer additional opioid
C. Perform neurovascular assessment
D. Apply ice around cast
Answer: C
Rationale: Classic red flag for compartment syndrome; neurovascular compromise
(6 P’s) requires immediate evaluation and possible fasciotomy.
A-1.5 (MCQ)
A client with T1DM on an insulin pump is admitted with DKA.
Which blood gas result indicates the DKA has resolved?
A. pH 7.36, HCO₃ 22 mEq/L, AG 10
B. pH 7.28, HCO₃ 16 mEq/L, AG 18
C. pH 7.32, HCO₃ 18 mEq/L, AG 20
D. pH 7.48, HCO₃ 28 mEq/L, AG 8
Answer: A
Rationale: Resolution defined as pH ≥7.30, HCO₃ ≥18, anion gap ≤12, and β -
hydroxybutyrate <0.6 mmol/L.
A-1.6 (MCQ)
A client with acute pancreatitis has a pain score 9/10.
, 3
Which medication is most appropriate?
A. Morphine 2 mg IV
B. Meperidine 50 mg IV
C. Ketorolac 30 mg IV
D. Fentanyl 25 mcg IV
Answer: D
Rationale: Fentanyl provides rapid, potent analgesia without sphincter of Oddi
spasm seen with morphine; meperidine avoided (neurotoxic metabolite).
A-1.7 (MCQ)
The nurse is evaluating a client receiving heparin for PE.
Which lab value indicates therapeutic effect?
A. aPTT 1.5–2.5 × control
B. aPTT 0.5 × control
C. INR 2.0–3.0
D. Anti-Xa 0.1–0.2 IU/mL
Answer: A
Rationale: 2025 ACCP guidelines maintain aPTT ratio 1.5–2.5 × baseline for UFH;
anti-Xa 0.3–0.7 IU/mL also acceptable but not listed.
A-1.8 (MCQ)
A client with cirrhosis has a serum ammonia of 110 µmol/L and is confused.
Which dietary order is most appropriate?
A. High-protein diet to promote healing
B. Moderate protein 1.2 g/kg with vegetable source emphasis
C. NPO until alert
D. High-fat diet to spare protein
Answer: B
Rationale: Moderate protein (1.2 g/kg) with high branched-chain and vegetable
sources lowers ammonia and prevents catabolism.
A-1.9 (MCQ)
A client with acute kidney injury (oliguric) has K⁺ 6.2 mEq/L and ECG peaked T
waves.
Which medication should the nurse prepare first?
A. 10 % calcium gluconate 10 mL IV over 2 min
