ATI MED-SURG PROCTORED EXAM –
COMPREHENSIVE STUDY GUIDE
EXAM OVERVIEW
| Component | Details |
|--||
| Exam | ATI RN Medical-Surgical Proctored Exam (NGN format) |
| Format | Multiple choice, SATA, NGN case studies (bow-tie, cloze, enhanced hot spot) |
| Key Content Areas | Cardiovascular, Respiratory, Gastrointestinal, Renal, Endocrine,
Neurological, Musculoskeletal, Infection Control, Pharmacology, Perioperative Care |
| Scoring | Level 1 = 56-67%, Level 2 = 68-77%, Level 3 = 78-100% |
| Time | Approximately 3 hours |
SECTION 1: CARDIOVASCULAR DISORDERS
Q1. A nurse is caring for a client with heart failure who has a weight gain of 4 lbs in 24 hours.
What is the priority action?
A) Increase the furosemide dose
B) Assess for edema and crackles and notify the provider
C) Restrict fluids to 1 L/day
D) Document and continue monitoring
Correct Answer: B
Rationale: Weight gain of 2-3 lbs in 24 hours suggests fluid overload. The nurse should assess
the client (edema, lung sounds, JVD) and notify the provider. Do not change the dose without an
order.
Q2. A client with COPD and CO2 retention is prescribed home oxygen. Which flow rate is
typically prescribed?
A) High flow (6-10 L/min)
,B) Low flow (1-3 L/min) via nasal cannula
C) Non-rebreather mask
D) Oxygen is contraindicated
Correct Answer: B
Rationale: Clients with chronic hypercapnia risk CO2 narcosis with high O2. Low flow (1-3
L/min) titrated to SpO2 88-92% is used. Hypoxia is more dangerous than withholding O2.
Q3. Which finding indicates decreased cardiac output?
A) Shivering
B) Oliguria
C) Bradypnea
D) Constricted pupils
Correct Answer: B
Rationale: Decreased cardiac output reduces renal perfusion, causing oliguria (urine output <0.5
mL/kg/hr). This is a sensitive indicator of inadequate perfusion.
Q4. A client's ECG shows tall peaked T waves. This finding is consistent with which electrolyte
imbalance?
A) Hypercalcemia
B) Hyperkalemia
C) Hypokalemia
D) Hyponatremia
Correct Answer: B
Rationale: Peaked T waves indicate life-threatening hyperkalemia. Prepare for calcium
gluconate and insulin/glucose. This is a medical emergency.
Q5. A client with angina is prescribed nitroglycerin. Which instruction is most important?
A) "Take one tablet every 15 minutes for up to 3 doses"
B) "Take one tablet sublingually when chest pain occurs"
, C) "Store the tablets in the refrigerator"
D) "Chew the tablet for faster absorption"
Correct Answer: B
Rationale: Nitroglycerin should be taken sublingually (under the tongue) when chest pain
occurs. If pain persists after 5 minutes, call 911 and take a second dose. Tablets should be
stored in a dark, cool, dry place.
Q6. A client with heart failure is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 72 bpm
B) Nausea, vomiting, and yellow vision
C) Blood pressure 130/80 mm Hg
D) Urine output 60 mL/hr
Correct Answer: B
Rationale: Nausea, vomiting, and yellow/green halos around lights are classic signs of digoxin
toxicity. Hypokalemia increases the risk.
Q7. A client with a deep vein thrombosis (DVT) is on heparin. Which finding suggests a
complication?
A) Bruising at IV site
B) New chest pain and shortness of breath
C) Hemoglobin 12 g/dL
D) Mild headache
Correct Answer: B
Rationale: Chest pain + dyspnea in a DVT patient suggests pulmonary embolism — a medical
emergency. Report immediately.
Q8. A client receiving a blood transfusion reports low back pain and chills 15 minutes after
initiation. What is the priority action?
A) Slow the infusion rate to 50 mL/hour
COMPREHENSIVE STUDY GUIDE
EXAM OVERVIEW
| Component | Details |
|--||
| Exam | ATI RN Medical-Surgical Proctored Exam (NGN format) |
| Format | Multiple choice, SATA, NGN case studies (bow-tie, cloze, enhanced hot spot) |
| Key Content Areas | Cardiovascular, Respiratory, Gastrointestinal, Renal, Endocrine,
Neurological, Musculoskeletal, Infection Control, Pharmacology, Perioperative Care |
| Scoring | Level 1 = 56-67%, Level 2 = 68-77%, Level 3 = 78-100% |
| Time | Approximately 3 hours |
SECTION 1: CARDIOVASCULAR DISORDERS
Q1. A nurse is caring for a client with heart failure who has a weight gain of 4 lbs in 24 hours.
What is the priority action?
A) Increase the furosemide dose
B) Assess for edema and crackles and notify the provider
C) Restrict fluids to 1 L/day
D) Document and continue monitoring
Correct Answer: B
Rationale: Weight gain of 2-3 lbs in 24 hours suggests fluid overload. The nurse should assess
the client (edema, lung sounds, JVD) and notify the provider. Do not change the dose without an
order.
Q2. A client with COPD and CO2 retention is prescribed home oxygen. Which flow rate is
typically prescribed?
A) High flow (6-10 L/min)
,B) Low flow (1-3 L/min) via nasal cannula
C) Non-rebreather mask
D) Oxygen is contraindicated
Correct Answer: B
Rationale: Clients with chronic hypercapnia risk CO2 narcosis with high O2. Low flow (1-3
L/min) titrated to SpO2 88-92% is used. Hypoxia is more dangerous than withholding O2.
Q3. Which finding indicates decreased cardiac output?
A) Shivering
B) Oliguria
C) Bradypnea
D) Constricted pupils
Correct Answer: B
Rationale: Decreased cardiac output reduces renal perfusion, causing oliguria (urine output <0.5
mL/kg/hr). This is a sensitive indicator of inadequate perfusion.
Q4. A client's ECG shows tall peaked T waves. This finding is consistent with which electrolyte
imbalance?
A) Hypercalcemia
B) Hyperkalemia
C) Hypokalemia
D) Hyponatremia
Correct Answer: B
Rationale: Peaked T waves indicate life-threatening hyperkalemia. Prepare for calcium
gluconate and insulin/glucose. This is a medical emergency.
Q5. A client with angina is prescribed nitroglycerin. Which instruction is most important?
A) "Take one tablet every 15 minutes for up to 3 doses"
B) "Take one tablet sublingually when chest pain occurs"
, C) "Store the tablets in the refrigerator"
D) "Chew the tablet for faster absorption"
Correct Answer: B
Rationale: Nitroglycerin should be taken sublingually (under the tongue) when chest pain
occurs. If pain persists after 5 minutes, call 911 and take a second dose. Tablets should be
stored in a dark, cool, dry place.
Q6. A client with heart failure is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 72 bpm
B) Nausea, vomiting, and yellow vision
C) Blood pressure 130/80 mm Hg
D) Urine output 60 mL/hr
Correct Answer: B
Rationale: Nausea, vomiting, and yellow/green halos around lights are classic signs of digoxin
toxicity. Hypokalemia increases the risk.
Q7. A client with a deep vein thrombosis (DVT) is on heparin. Which finding suggests a
complication?
A) Bruising at IV site
B) New chest pain and shortness of breath
C) Hemoglobin 12 g/dL
D) Mild headache
Correct Answer: B
Rationale: Chest pain + dyspnea in a DVT patient suggests pulmonary embolism — a medical
emergency. Report immediately.
Q8. A client receiving a blood transfusion reports low back pain and chills 15 minutes after
initiation. What is the priority action?
A) Slow the infusion rate to 50 mL/hour
