ATI PN Adult Medical Surgical (Adult Med-
Surg) 2026 Level 3 Proctored Exam
Assessment Package | Actual and Retake 3
Versions
1. A nurse is caring for a client who has a new diagnosis of type 1 diabetes
mellitus. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I will need to take oral medication for the rest of my life."
B. "I should check my blood sugar only when I feel dizzy."
C. "I will rotate my insulin injection sites to prevent tissue damage."
D. "I can skip my insulin dose if I am not eating."
C. "I will rotate my insulin injection sites to prevent tissue damage."
Rationale: Rotating injection sites is crucial to prevent lipohypertrophy
(thickening of fat tissue) or lipoatrophy (wasting of fat tissue), which can affect
insulin absorption. Option A is incorrect because type 1 diabetes requires insulin,
not oral medication. Option B is incorrect as blood glucose should be monitored
regularly, not just when symptomatic. Option D is incorrect because insulin is
needed even when not eating to manage basal blood glucose levels.
2. A client is admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). Which of the following acid-base imbalances should
the nurse anticipate?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
D. Respiratory acidosis
Rationale: In COPD, air trapping and impaired gas exchange lead to carbon
,dioxide retention (hypercapnia). This increase in PaCO2 causes a decrease in pH,
resulting in respiratory acidosis. The kidneys will attempt to compensate by
retaining bicarbonate, but in an acute exacerbation, the primary imbalance is
respiratory acidosis.
3. A nurse is assessing a client who has heart failure and is taking furosemide.
Which of the following findings is the priority for the nurse to report?
A. Blood pressure of 110/70 mm Hg
B. A 2 kg (4.4 lb) weight loss in one week
C. Muscle weakness and leg cramps
D. Urine output of 50 mL/hr
C. Muscle weakness and leg cramps
Rationale: Furosemide is a loop diuretic that can cause hypokalemia. Muscle
weakness, leg cramps, and cardiac dysrhythmias are signs of low potassium, which
can be life-threatening. This finding should be reported immediately. The other
options are either expected findings or not as immediately dangerous.
4. A nurse is providing teaching to a client who is scheduled for a colonoscopy.
Which of the following instructions should the nurse include?
A. "You will need to drink a clear liquid diet for 24 hours before the procedure."
B. "You can have a light breakfast on the morning of the procedure."
C. "You should stop taking all your medications one week before."
D. "You will be able to drive yourself home after the procedure."
A. "You will need to drink a clear liquid diet for 24 hours before the
procedure."
Rationale: A clear liquid diet is required before a colonoscopy to ensure the
bowel is clean for proper visualization. Option B is incorrect as the client must be
NPO after midnight. Option C is too broad; only specific medications like blood
thinners may need to be held. Option D is incorrect because sedation is used, so
the client cannot drive.
5. A client is experiencing a tonic-clonic seizure. Which of the following actions
should the nurse take first?
,A. Insert a padded tongue blade into the client's mouth.
B. Restrain the client's arms and legs.
C. Protect the client's head and turn them to the side.
D. Administer the prescribed anticonvulsant medication.
C. Protect the client's head and turn them to the side.
Rationale: The priority during a seizure is safety. Protecting the head from
injury and turning the client to the side (to maintain a patent airway and prevent
aspiration) are the most important immediate actions. Never insert anything into
the mouth or restrain the client, as this can cause injury.
6. A nurse is caring for a client following a thyroidectomy. Which of the following
findings indicates that the client is experiencing a complication?
A. A blood pressure of 110/70 mm Hg
B. A heart rate of 88/min
C. A positive Chvostek's sign
D. A temperature of 37.2°C (99°F)
C. A positive Chvostek's sign
Rationale: A positive Chvostek's sign (facial muscle twitching when tapping the
facial nerve) indicates hypocalcemia, a common complication following
thyroidectomy due to accidental removal or damage to the parathyroid glands.
This can lead to tetany and seizures and must be reported.
7. A client who has a new cast on their left arm reports severe pain, and the
nurse notes that the fingers are pale and cool. Which of the following actions
should the nurse take?
A. Elevate the arm above the level of the heart.
B. Apply ice packs to the cast.
C. Administer the prescribed pain medication.
D. Notify the provider immediately.
D. Notify the provider immediately.
Rationale: Severe pain, pallor, and coolness are signs of compartment
syndrome, a medical emergency. The provider must be notified immediately for a
, possible bivalving of the cast or fasciotomy. Elevating the arm and applying ice can
worsen the condition by reducing arterial blood flow. Pain medication will not
resolve the underlying issue.
8. A nurse is teaching a client who has gastroesophageal reflux disease (GERD)
about dietary modifications. Which of the following foods should the client be
instructed to avoid?
A. Bananas
B. Chocolate
C. Oatmeal
D. Broiled chicken
B. Chocolate
Rationale: Chocolate contains methylxanthines, which can relax the lower
esophageal sphincter (LES) and increase gastric acid secretion, worsening GERD
symptoms. Other common triggers include caffeine, alcohol, spicy foods, and fatty
foods.
9. A client is prescribed digoxin. Which of the following findings should the
nurse identify as a sign of digoxin toxicity?
A. Heart rate of 58/min
B. Blood pressure of 110/70 mm Hg
C. Nausea and vomiting
D. Increased urine output
C. Nausea and vomiting
Rationale: Nausea, vomiting, and anorexia are common early signs of digoxin
toxicity. Other signs include visual disturbances (yellow-green halos), bradycardia,
and dysrhythmias. While bradycardia can be a sign, nausea and vomiting are more
specific early indicators. A heart rate below 60/min should be held and reported.
10. A nurse is caring for a client who has a chest tube following a pneumothorax.
Which of the following findings indicates that the system is functioning
correctly?
A. Continuous bubbling in the water seal chamber.
Surg) 2026 Level 3 Proctored Exam
Assessment Package | Actual and Retake 3
Versions
1. A nurse is caring for a client who has a new diagnosis of type 1 diabetes
mellitus. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I will need to take oral medication for the rest of my life."
B. "I should check my blood sugar only when I feel dizzy."
C. "I will rotate my insulin injection sites to prevent tissue damage."
D. "I can skip my insulin dose if I am not eating."
C. "I will rotate my insulin injection sites to prevent tissue damage."
Rationale: Rotating injection sites is crucial to prevent lipohypertrophy
(thickening of fat tissue) or lipoatrophy (wasting of fat tissue), which can affect
insulin absorption. Option A is incorrect because type 1 diabetes requires insulin,
not oral medication. Option B is incorrect as blood glucose should be monitored
regularly, not just when symptomatic. Option D is incorrect because insulin is
needed even when not eating to manage basal blood glucose levels.
2. A client is admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). Which of the following acid-base imbalances should
the nurse anticipate?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
D. Respiratory acidosis
Rationale: In COPD, air trapping and impaired gas exchange lead to carbon
,dioxide retention (hypercapnia). This increase in PaCO2 causes a decrease in pH,
resulting in respiratory acidosis. The kidneys will attempt to compensate by
retaining bicarbonate, but in an acute exacerbation, the primary imbalance is
respiratory acidosis.
3. A nurse is assessing a client who has heart failure and is taking furosemide.
Which of the following findings is the priority for the nurse to report?
A. Blood pressure of 110/70 mm Hg
B. A 2 kg (4.4 lb) weight loss in one week
C. Muscle weakness and leg cramps
D. Urine output of 50 mL/hr
C. Muscle weakness and leg cramps
Rationale: Furosemide is a loop diuretic that can cause hypokalemia. Muscle
weakness, leg cramps, and cardiac dysrhythmias are signs of low potassium, which
can be life-threatening. This finding should be reported immediately. The other
options are either expected findings or not as immediately dangerous.
4. A nurse is providing teaching to a client who is scheduled for a colonoscopy.
Which of the following instructions should the nurse include?
A. "You will need to drink a clear liquid diet for 24 hours before the procedure."
B. "You can have a light breakfast on the morning of the procedure."
C. "You should stop taking all your medications one week before."
D. "You will be able to drive yourself home after the procedure."
A. "You will need to drink a clear liquid diet for 24 hours before the
procedure."
Rationale: A clear liquid diet is required before a colonoscopy to ensure the
bowel is clean for proper visualization. Option B is incorrect as the client must be
NPO after midnight. Option C is too broad; only specific medications like blood
thinners may need to be held. Option D is incorrect because sedation is used, so
the client cannot drive.
5. A client is experiencing a tonic-clonic seizure. Which of the following actions
should the nurse take first?
,A. Insert a padded tongue blade into the client's mouth.
B. Restrain the client's arms and legs.
C. Protect the client's head and turn them to the side.
D. Administer the prescribed anticonvulsant medication.
C. Protect the client's head and turn them to the side.
Rationale: The priority during a seizure is safety. Protecting the head from
injury and turning the client to the side (to maintain a patent airway and prevent
aspiration) are the most important immediate actions. Never insert anything into
the mouth or restrain the client, as this can cause injury.
6. A nurse is caring for a client following a thyroidectomy. Which of the following
findings indicates that the client is experiencing a complication?
A. A blood pressure of 110/70 mm Hg
B. A heart rate of 88/min
C. A positive Chvostek's sign
D. A temperature of 37.2°C (99°F)
C. A positive Chvostek's sign
Rationale: A positive Chvostek's sign (facial muscle twitching when tapping the
facial nerve) indicates hypocalcemia, a common complication following
thyroidectomy due to accidental removal or damage to the parathyroid glands.
This can lead to tetany and seizures and must be reported.
7. A client who has a new cast on their left arm reports severe pain, and the
nurse notes that the fingers are pale and cool. Which of the following actions
should the nurse take?
A. Elevate the arm above the level of the heart.
B. Apply ice packs to the cast.
C. Administer the prescribed pain medication.
D. Notify the provider immediately.
D. Notify the provider immediately.
Rationale: Severe pain, pallor, and coolness are signs of compartment
syndrome, a medical emergency. The provider must be notified immediately for a
, possible bivalving of the cast or fasciotomy. Elevating the arm and applying ice can
worsen the condition by reducing arterial blood flow. Pain medication will not
resolve the underlying issue.
8. A nurse is teaching a client who has gastroesophageal reflux disease (GERD)
about dietary modifications. Which of the following foods should the client be
instructed to avoid?
A. Bananas
B. Chocolate
C. Oatmeal
D. Broiled chicken
B. Chocolate
Rationale: Chocolate contains methylxanthines, which can relax the lower
esophageal sphincter (LES) and increase gastric acid secretion, worsening GERD
symptoms. Other common triggers include caffeine, alcohol, spicy foods, and fatty
foods.
9. A client is prescribed digoxin. Which of the following findings should the
nurse identify as a sign of digoxin toxicity?
A. Heart rate of 58/min
B. Blood pressure of 110/70 mm Hg
C. Nausea and vomiting
D. Increased urine output
C. Nausea and vomiting
Rationale: Nausea, vomiting, and anorexia are common early signs of digoxin
toxicity. Other signs include visual disturbances (yellow-green halos), bradycardia,
and dysrhythmias. While bradycardia can be a sign, nausea and vomiting are more
specific early indicators. A heart rate below 60/min should be held and reported.
10. A nurse is caring for a client who has a chest tube following a pneumothorax.
Which of the following findings indicates that the system is functioning
correctly?
A. Continuous bubbling in the water seal chamber.
