ATI PROCTORED MEDICAL-SURGICAL RESPIRATORY EXAM (2026/2027)
ATI Proctored Medical-Surgical Nursing: Respiratory System Examination | Core Domains:
Respiratory Assessment & Diagnostic Procedures, Upper & Lower Airway Disorders, Obstructive
Pulmonary Diseases (COPD, Asthma), Restrictive Pulmonary Diseases, Infectious Respiratory
Conditions (Pneumonia, TB), Pulmonary Vascular Disorders (PE, Pulmonary Hypertension),
Respiratory Failure & Mechanical Ventilation, and Thoracic Surgery & Chest Trauma Management |
Respiratory Nursing Competency Focus | Specialty-Focused Proctored Exam Format
Exam Structure
The ATI Proctored Medical-Surgical Respiratory Exam for the 2026/2027 academic cycle is a
60-question, multiple-choice question (MCQ) examination.
Introduction
This ATI Proctored Medical-Surgical Respiratory Exam guide for the 2026/2027 cycle prepares nursing
students for the high-stakes, proctored assessment focused exclusively on respiratory system disorders.
The content evaluates clinical judgment, application of respiratory assessment techniques,
pathophysiology understanding, and evidence-based management of acute and chronic pulmonary
conditions essential for safe nursing practice in medical-surgical settings.
Answer Format
All correct answers and respiratory nursing interventions must be presented in bold and green,
followed by detailed rationales that interpret respiratory assessment findings (e.g., breath sounds, ABGs,
oximetry), explain obstructive vs. restrictive pathophysiology, justify pharmacological treatments
(bronchodilators, corticosteroids, antimicrobials), prioritize care for respiratory emergencies, and apply
principles of oxygen therapy and ventilator management.
Questions (60 Total)
1. A client with COPD has an oxygen saturation of 88% on room air. The provider orders oxygen at 2
L/min via nasal cannula. Why not higher flow?
A. To prevent oxygen toxicity
B. To avoid suppressing the hypoxic drive to breathe
C. To reduce cost
D. To prevent drying of mucous membranes
Rationale: In chronic CO₂ retainers (e.g., COPD), the primary respiratory drive shifts from CO₂ to low
O₂ (hypoxic drive). High-flow oxygen can eliminate this drive, causing apnea. Low-flow oxygen (1–2
L/min) maintains SpO₂ 88–92% without suppressing respiration.
,2. A client with asthma presents with severe respiratory distress: RR 48/min, HR 140 bpm, SpO₂ 86% on
room air, audible wheezing, and intercostal retractions. Albuterol nebulizer was given en route with
minimal improvement. What is the priority intervention?
A. Oral prednisone
B. Continuous albuterol nebulizer and supplemental oxygen
C. Chest X-ray
D. Discharge with inhaler education
Rationale: Severe asthma exacerbation with poor response to initial bronchodilator requires
continuous beta-agonist therapy to reverse bronchospasm. Oxygen improves gas exchange. Wheezing
may disappear if fatigue sets in (“silent chest”), indicating impending respiratory failure—making
immediate intervention critical.
3. A client with pneumonia has a temperature of 102.5°F, productive cough with green sputum, and
crackles in the right lower lobe. What is the priority nursing action?
A. Administer antipyretic only
B. Obtain blood cultures and start prescribed antibiotics within 1 hour
C. Encourage bed rest
D. Provide humidified oxygen
Rationale: Community-acquired pneumonia requires prompt antibiotic administration per IDSA/ATS
guidelines. Blood cultures should be drawn before antibiotics if possible, but never delay antibiotics.
Early treatment reduces mortality and hospital length of stay.
4. A client with suspected pulmonary embolism (PE) has sudden dyspnea, tachycardia, and pleuritic chest
pain. What diagnostic test is most definitive?
A. D-dimer
B. CT pulmonary angiography (CTPA)
C. Chest X-ray
D. ECG
Rationale: CTPA is the gold standard for diagnosing PE—it visualizes filling defects in pulmonary
arteries. D-dimer is sensitive but not specific; elevated in many conditions. Chest X-ray and ECG are
supportive but not diagnostic.
, 5. A client with ARDS is on mechanical ventilation with PEEP of 10 cm H₂O. The nurse notes decreased
breath sounds on the left and tracheal deviation to the right. What complication is suspected?
A. Atelectasis
B. Tension pneumothorax
C. Pulmonary edema
D. Mucus plugging
Rationale: Tension pneumothorax is a life-threatening emergency caused by air accumulation under
pressure, collapsing the lung and shifting the mediastinum. Immediate needle decompression at the 2nd
intercostal space, midclavicular line is required before chest tube insertion.
6. A client with tuberculosis (TB) is placed on airborne precautions. Which action by the nurse is correct?
A. Wear a surgical mask when entering the room
B. Wear an N95 respirator when entering the room
C. Keep the door open for ventilation
D. Allow visitors without masks
Rationale: TB requires airborne precautions: negative-pressure room, N95 or higher-level respirator
for all entering, and door kept closed. Surgical masks do not filter airborne particles; visitors must also
wear appropriate PPE.
7. A client with emphysema has a barrel chest and pursed-lip breathing. ABG results: pH 7.36, PaCO₂ 58
mm Hg, HCO₃⁻ 32 mEq/L. This indicates:
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with renal compensation
C. Metabolic alkalosis
D. Normal ABG
Rationale: Elevated PaCO₂ with normal pH and elevated HCO₃⁻ indicates chronic respiratory
acidosis—common in stable COPD. Kidneys compensate by retaining bicarbonate over days. Acute
respiratory acidosis would show low pH and normal HCO₃⁻.
8. A client returns from thoracotomy with a chest tube to water seal drainage. The nurse notes bubbling in
the water seal chamber. What does this indicate?
ATI Proctored Medical-Surgical Nursing: Respiratory System Examination | Core Domains:
Respiratory Assessment & Diagnostic Procedures, Upper & Lower Airway Disorders, Obstructive
Pulmonary Diseases (COPD, Asthma), Restrictive Pulmonary Diseases, Infectious Respiratory
Conditions (Pneumonia, TB), Pulmonary Vascular Disorders (PE, Pulmonary Hypertension),
Respiratory Failure & Mechanical Ventilation, and Thoracic Surgery & Chest Trauma Management |
Respiratory Nursing Competency Focus | Specialty-Focused Proctored Exam Format
Exam Structure
The ATI Proctored Medical-Surgical Respiratory Exam for the 2026/2027 academic cycle is a
60-question, multiple-choice question (MCQ) examination.
Introduction
This ATI Proctored Medical-Surgical Respiratory Exam guide for the 2026/2027 cycle prepares nursing
students for the high-stakes, proctored assessment focused exclusively on respiratory system disorders.
The content evaluates clinical judgment, application of respiratory assessment techniques,
pathophysiology understanding, and evidence-based management of acute and chronic pulmonary
conditions essential for safe nursing practice in medical-surgical settings.
Answer Format
All correct answers and respiratory nursing interventions must be presented in bold and green,
followed by detailed rationales that interpret respiratory assessment findings (e.g., breath sounds, ABGs,
oximetry), explain obstructive vs. restrictive pathophysiology, justify pharmacological treatments
(bronchodilators, corticosteroids, antimicrobials), prioritize care for respiratory emergencies, and apply
principles of oxygen therapy and ventilator management.
Questions (60 Total)
1. A client with COPD has an oxygen saturation of 88% on room air. The provider orders oxygen at 2
L/min via nasal cannula. Why not higher flow?
A. To prevent oxygen toxicity
B. To avoid suppressing the hypoxic drive to breathe
C. To reduce cost
D. To prevent drying of mucous membranes
Rationale: In chronic CO₂ retainers (e.g., COPD), the primary respiratory drive shifts from CO₂ to low
O₂ (hypoxic drive). High-flow oxygen can eliminate this drive, causing apnea. Low-flow oxygen (1–2
L/min) maintains SpO₂ 88–92% without suppressing respiration.
,2. A client with asthma presents with severe respiratory distress: RR 48/min, HR 140 bpm, SpO₂ 86% on
room air, audible wheezing, and intercostal retractions. Albuterol nebulizer was given en route with
minimal improvement. What is the priority intervention?
A. Oral prednisone
B. Continuous albuterol nebulizer and supplemental oxygen
C. Chest X-ray
D. Discharge with inhaler education
Rationale: Severe asthma exacerbation with poor response to initial bronchodilator requires
continuous beta-agonist therapy to reverse bronchospasm. Oxygen improves gas exchange. Wheezing
may disappear if fatigue sets in (“silent chest”), indicating impending respiratory failure—making
immediate intervention critical.
3. A client with pneumonia has a temperature of 102.5°F, productive cough with green sputum, and
crackles in the right lower lobe. What is the priority nursing action?
A. Administer antipyretic only
B. Obtain blood cultures and start prescribed antibiotics within 1 hour
C. Encourage bed rest
D. Provide humidified oxygen
Rationale: Community-acquired pneumonia requires prompt antibiotic administration per IDSA/ATS
guidelines. Blood cultures should be drawn before antibiotics if possible, but never delay antibiotics.
Early treatment reduces mortality and hospital length of stay.
4. A client with suspected pulmonary embolism (PE) has sudden dyspnea, tachycardia, and pleuritic chest
pain. What diagnostic test is most definitive?
A. D-dimer
B. CT pulmonary angiography (CTPA)
C. Chest X-ray
D. ECG
Rationale: CTPA is the gold standard for diagnosing PE—it visualizes filling defects in pulmonary
arteries. D-dimer is sensitive but not specific; elevated in many conditions. Chest X-ray and ECG are
supportive but not diagnostic.
, 5. A client with ARDS is on mechanical ventilation with PEEP of 10 cm H₂O. The nurse notes decreased
breath sounds on the left and tracheal deviation to the right. What complication is suspected?
A. Atelectasis
B. Tension pneumothorax
C. Pulmonary edema
D. Mucus plugging
Rationale: Tension pneumothorax is a life-threatening emergency caused by air accumulation under
pressure, collapsing the lung and shifting the mediastinum. Immediate needle decompression at the 2nd
intercostal space, midclavicular line is required before chest tube insertion.
6. A client with tuberculosis (TB) is placed on airborne precautions. Which action by the nurse is correct?
A. Wear a surgical mask when entering the room
B. Wear an N95 respirator when entering the room
C. Keep the door open for ventilation
D. Allow visitors without masks
Rationale: TB requires airborne precautions: negative-pressure room, N95 or higher-level respirator
for all entering, and door kept closed. Surgical masks do not filter airborne particles; visitors must also
wear appropriate PPE.
7. A client with emphysema has a barrel chest and pursed-lip breathing. ABG results: pH 7.36, PaCO₂ 58
mm Hg, HCO₃⁻ 32 mEq/L. This indicates:
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with renal compensation
C. Metabolic alkalosis
D. Normal ABG
Rationale: Elevated PaCO₂ with normal pH and elevated HCO₃⁻ indicates chronic respiratory
acidosis—common in stable COPD. Kidneys compensate by retaining bicarbonate over days. Acute
respiratory acidosis would show low pH and normal HCO₃⁻.
8. A client returns from thoracotomy with a chest tube to water seal drainage. The nurse notes bubbling in
the water seal chamber. What does this indicate?
