ATI Medical-Surgical Proctored Exam – ATI Med-Surg
Nursing Study Guide, Original Practice Questions &
Answers, Comprehensive ATI Adult Medical-Surgical
Assessment Preparation, Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine,
Musculoskeletal & Integumentary Disorders,
Pharmacology, Lab Values, Patient Assessment, Nursing
Interventions, Prioritization, Safety & NGN-Style Clinical
Judgment
Question 1: A client with end-stage renal disease is scheduled for
hemodialysis. Which assessment finding is the most important to report to the
nephrologist before the procedure?
A. Serum potassium level of 5.8 mEq/L
B. Blood urea nitrogen (BUN) level of 85 mg/dL
C. Creatinine level of 6.2 mg/dL
D. Hemoglobin level of 9.2 g/dL
CORRECT ANSWER: A. Serum potassium level of 5.8 mEq/L
Rationale: A potassium level of 5.8 mEq/L is a critical finding that can lead to life-
threatening cardiac arrhythmias. While elevated BUN, creatinine, and anemia are
expected findings in ESRD, a rapidly rising or severely elevated potassium level requires
immediate intervention, often including emergent dialysis. The nephrologist must be
notified to prioritize the dialysis session and consider the need for a potassium-lowering
protocol before or during treatment.
Question 2: A nurse is caring for a client who is 24 hours post-hemicolectomy.
The client reports sudden, sharp abdominal pain and has a rigid, board-like
abdomen. Which action should the nurse take first?
A. Administer prescribed pain medication
B. Assess bowel sounds
C. Notify the healthcare provider
D. Place the client in a supine position
CORRECT ANSWER: C. Notify the healthcare provider
Rationale: Sudden sharp pain with a rigid, board-like abdomen is a classic sign of
peritonitis, often indicating an anastomotic leak, perforation, or hemorrhage. This is a
surgical emergency. The nurse's priority is to notify the healthcare provider immediately.
Pain medication should be withheld until a definitive diagnosis is made, as it can mask
symptoms. Placing the client supine may increase abdominal wall tension and pain.
Question 3: A client with chronic heart failure is prescribed digoxin. Which
assessment finding indicates a potential toxic effect of this medication?
,A. Heart rate of 62 beats per minute
B. Serum digoxin level of 1.2 ng/mL
C. Anorexia and nausea
D. Peripheral edema in the lower extremities
CORRECT ANSWER: C. Anorexia and nausea
Rationale: Anorexia and nausea are classic early signs of digoxin toxicity. A heart rate of
62 bpm is within the normal range and a therapeutic effect. A serum digoxin level of 1.2
ng/mL is within the therapeutic range (0.8-2.0 ng/mL). Peripheral edema is a sign of
worsening heart failure, not a toxic effect of digoxin.
Question 4: The nurse is planning care for a client with a new tracheostomy.
Which intervention is essential to prevent a life-threatening complication?
A. Suctioning the tracheostomy tube every 2 hours
B. Maintaining sterile technique when changing the inner cannula
C. Keeping a tracheostomy obturator and a spare tube at the bedside
D. Applying a sterile dressing around the tracheostomy site
CORRECT ANSWER: C. Keeping a tracheostomy obturator and a spare tube at
the bedside
Rationale: A tracheostomy obturator and a spare tube of the same size must be kept at
the bedside at all times. This is essential to re-establish the airway if the tube is
accidentally dislodged or becomes blocked, which is a life-threatening emergency. While
suctioning, sterile technique, and dressing changes are important, they are not the most
critical intervention for this specific, life-threatening risk.
Question 5: A client is receiving IV heparin for a deep vein thrombosis. The
nurse notes that the client's activated partial thromboplastin time (aPTT) is 98
seconds. What is the priority nursing action?
A. Increase the heparin infusion rate
B. Continue to monitor the client
C. Administer Vitamin K
D. Stop the heparin infusion
CORRECT ANSWER: D. Stop the heparin infusion
Rationale: The therapeutic aPTT for a client on heparin is typically 1.5 to 2.5 times the
normal control value. If the normal control is approximately 30 seconds, the therapeutic
range is 45-75 seconds. An aPTT of 98 seconds is significantly elevated and indicates a
high risk for bleeding. The priority action is to stop the heparin infusion to prevent
hemorrhage. Vitamin K is the antidote for warfarin, not heparin.
,Question 6: A client with type 1 diabetes mellitus is experiencing nausea,
vomiting, and a blood glucose level of 320 mg/dL. The client's breath has a
fruity odor. Which intervention should the nurse anticipate?
A. Administering glucagon subcutaneously
B. Initiating a continuous insulin infusion
C. Encouraging oral intake of clear liquids
D. Administering a bolus of 50% dextrose
CORRECT ANSWER: B. Initiating a continuous insulin infusion
Rationale: The client is presenting with signs of diabetic ketoacidosis (DKA):
hyperglycemia, nausea, vomiting, and fruity breath (acetone). The primary treatment for
DKA is IV fluids and a continuous insulin infusion to lower blood glucose and correct
metabolic acidosis. Glucagon is used for hypoglycemia. Oral intake is contraindicated if
the client is vomiting. Dextrose is given when blood glucose begins to drop too low
during DKA treatment, not as an initial intervention.
Question 7: A client is diagnosed with a pulmonary embolism. Which finding is
most indicative of this condition?
A. Bradypnea and bradycardia
B. Wheezing and productive cough
C. Sudden pleuritic chest pain and dyspnea
D. Hypertension and bounding pulses
CORRECT ANSWER: C. Sudden pleuritic chest pain and dyspnea
Rationale: A pulmonary embolism (PE) often presents with the sudden onset of pleuritic
chest pain (sharp pain that worsens with inspiration) and dyspnea (shortness of breath).
Tachypnea and tachycardia are more common than bradypnea and bradycardia.
Wheezing and productive cough are more characteristic of asthma or pneumonia.
Hypotension and tachycardia are more common than hypertension.
Question 8: The nurse is teaching a client with coronary artery disease about
dietary modifications. Which statement by the client indicates a need for
further teaching?
A. "I will choose lean cuts of meat and remove the skin from poultry."
B. "I can eat as much shellfish and organ meats as I want."
C. "I should use olive oil instead of butter."
D. "I will increase my intake of whole grains and vegetables."
CORRECT ANSWER: B. "I can eat as much shellfish and organ meats as I
want."
, Rationale: Shellfish and organ meats are high in cholesterol and should be limited in a
heart-healthy diet. The other statements are correct: lean meats, olive oil, whole grains,
and vegetables are recommended. This client requires further teaching about limiting
foods high in dietary cholesterol.
Question 9: A client with liver cirrhosis has ascites. Which nursing
intervention is most effective in managing this condition?
A. Maintaining a high-sodium diet
B. Administering a loop diuretic
C. Encouraging a high-protein diet
D. Restricting oral fluid intake to 500 mL/day
CORRECT ANSWER: B. Administering a loop diuretic
Rationale: Ascites is the accumulation of fluid in the peritoneal cavity. Management
includes sodium restriction and diuretics, such as spironolactone and/or loop diuretics
(e.g., furosemide), to promote fluid excretion. A low-sodium diet is essential, not a high-
sodium diet. Fluid restriction is often used but is usually secondary to sodium restriction
and diuretics. Protein intake is managed based on the client's status, but a high-protein
diet is not the primary management for ascites.
Question 10: The nurse is caring for a client with a chest tube connected to a
closed-chest drainage system. Which finding requires immediate intervention?
A. Continuous bubbling in the suction control chamber
B. Gentle bubbling in the water seal chamber with expiration
C. Absence of tidaling in the water seal chamber
D. 100 mL of sanguineous drainage in the first hour
CORRECT ANSWER: D. 100 mL of sanguineous drainage in the first hour
Rationale: Drainage of more than 70-100 mL/hr of sanguineous fluid is a sign of active
hemorrhage and requires immediate notification of the healthcare provider. Continuous
bubbling in the suction control chamber is expected (unless it's dry suction). Gentle
bubbling in the water seal chamber on expiration is normal for a client with a
pneumothorax. Absence of tidaling can be normal if the lung has re-expanded or if the
tube is clamped.
Question 11: A client with a history of chronic obstructive pulmonary disease
(COPD) is receiving oxygen via nasal cannula at 2 L/min. The nurse assesses
the client and finds them lethargic and confused. Which is the most likely
cause?
Nursing Study Guide, Original Practice Questions &
Answers, Comprehensive ATI Adult Medical-Surgical
Assessment Preparation, Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine,
Musculoskeletal & Integumentary Disorders,
Pharmacology, Lab Values, Patient Assessment, Nursing
Interventions, Prioritization, Safety & NGN-Style Clinical
Judgment
Question 1: A client with end-stage renal disease is scheduled for
hemodialysis. Which assessment finding is the most important to report to the
nephrologist before the procedure?
A. Serum potassium level of 5.8 mEq/L
B. Blood urea nitrogen (BUN) level of 85 mg/dL
C. Creatinine level of 6.2 mg/dL
D. Hemoglobin level of 9.2 g/dL
CORRECT ANSWER: A. Serum potassium level of 5.8 mEq/L
Rationale: A potassium level of 5.8 mEq/L is a critical finding that can lead to life-
threatening cardiac arrhythmias. While elevated BUN, creatinine, and anemia are
expected findings in ESRD, a rapidly rising or severely elevated potassium level requires
immediate intervention, often including emergent dialysis. The nephrologist must be
notified to prioritize the dialysis session and consider the need for a potassium-lowering
protocol before or during treatment.
Question 2: A nurse is caring for a client who is 24 hours post-hemicolectomy.
The client reports sudden, sharp abdominal pain and has a rigid, board-like
abdomen. Which action should the nurse take first?
A. Administer prescribed pain medication
B. Assess bowel sounds
C. Notify the healthcare provider
D. Place the client in a supine position
CORRECT ANSWER: C. Notify the healthcare provider
Rationale: Sudden sharp pain with a rigid, board-like abdomen is a classic sign of
peritonitis, often indicating an anastomotic leak, perforation, or hemorrhage. This is a
surgical emergency. The nurse's priority is to notify the healthcare provider immediately.
Pain medication should be withheld until a definitive diagnosis is made, as it can mask
symptoms. Placing the client supine may increase abdominal wall tension and pain.
Question 3: A client with chronic heart failure is prescribed digoxin. Which
assessment finding indicates a potential toxic effect of this medication?
,A. Heart rate of 62 beats per minute
B. Serum digoxin level of 1.2 ng/mL
C. Anorexia and nausea
D. Peripheral edema in the lower extremities
CORRECT ANSWER: C. Anorexia and nausea
Rationale: Anorexia and nausea are classic early signs of digoxin toxicity. A heart rate of
62 bpm is within the normal range and a therapeutic effect. A serum digoxin level of 1.2
ng/mL is within the therapeutic range (0.8-2.0 ng/mL). Peripheral edema is a sign of
worsening heart failure, not a toxic effect of digoxin.
Question 4: The nurse is planning care for a client with a new tracheostomy.
Which intervention is essential to prevent a life-threatening complication?
A. Suctioning the tracheostomy tube every 2 hours
B. Maintaining sterile technique when changing the inner cannula
C. Keeping a tracheostomy obturator and a spare tube at the bedside
D. Applying a sterile dressing around the tracheostomy site
CORRECT ANSWER: C. Keeping a tracheostomy obturator and a spare tube at
the bedside
Rationale: A tracheostomy obturator and a spare tube of the same size must be kept at
the bedside at all times. This is essential to re-establish the airway if the tube is
accidentally dislodged or becomes blocked, which is a life-threatening emergency. While
suctioning, sterile technique, and dressing changes are important, they are not the most
critical intervention for this specific, life-threatening risk.
Question 5: A client is receiving IV heparin for a deep vein thrombosis. The
nurse notes that the client's activated partial thromboplastin time (aPTT) is 98
seconds. What is the priority nursing action?
A. Increase the heparin infusion rate
B. Continue to monitor the client
C. Administer Vitamin K
D. Stop the heparin infusion
CORRECT ANSWER: D. Stop the heparin infusion
Rationale: The therapeutic aPTT for a client on heparin is typically 1.5 to 2.5 times the
normal control value. If the normal control is approximately 30 seconds, the therapeutic
range is 45-75 seconds. An aPTT of 98 seconds is significantly elevated and indicates a
high risk for bleeding. The priority action is to stop the heparin infusion to prevent
hemorrhage. Vitamin K is the antidote for warfarin, not heparin.
,Question 6: A client with type 1 diabetes mellitus is experiencing nausea,
vomiting, and a blood glucose level of 320 mg/dL. The client's breath has a
fruity odor. Which intervention should the nurse anticipate?
A. Administering glucagon subcutaneously
B. Initiating a continuous insulin infusion
C. Encouraging oral intake of clear liquids
D. Administering a bolus of 50% dextrose
CORRECT ANSWER: B. Initiating a continuous insulin infusion
Rationale: The client is presenting with signs of diabetic ketoacidosis (DKA):
hyperglycemia, nausea, vomiting, and fruity breath (acetone). The primary treatment for
DKA is IV fluids and a continuous insulin infusion to lower blood glucose and correct
metabolic acidosis. Glucagon is used for hypoglycemia. Oral intake is contraindicated if
the client is vomiting. Dextrose is given when blood glucose begins to drop too low
during DKA treatment, not as an initial intervention.
Question 7: A client is diagnosed with a pulmonary embolism. Which finding is
most indicative of this condition?
A. Bradypnea and bradycardia
B. Wheezing and productive cough
C. Sudden pleuritic chest pain and dyspnea
D. Hypertension and bounding pulses
CORRECT ANSWER: C. Sudden pleuritic chest pain and dyspnea
Rationale: A pulmonary embolism (PE) often presents with the sudden onset of pleuritic
chest pain (sharp pain that worsens with inspiration) and dyspnea (shortness of breath).
Tachypnea and tachycardia are more common than bradypnea and bradycardia.
Wheezing and productive cough are more characteristic of asthma or pneumonia.
Hypotension and tachycardia are more common than hypertension.
Question 8: The nurse is teaching a client with coronary artery disease about
dietary modifications. Which statement by the client indicates a need for
further teaching?
A. "I will choose lean cuts of meat and remove the skin from poultry."
B. "I can eat as much shellfish and organ meats as I want."
C. "I should use olive oil instead of butter."
D. "I will increase my intake of whole grains and vegetables."
CORRECT ANSWER: B. "I can eat as much shellfish and organ meats as I
want."
, Rationale: Shellfish and organ meats are high in cholesterol and should be limited in a
heart-healthy diet. The other statements are correct: lean meats, olive oil, whole grains,
and vegetables are recommended. This client requires further teaching about limiting
foods high in dietary cholesterol.
Question 9: A client with liver cirrhosis has ascites. Which nursing
intervention is most effective in managing this condition?
A. Maintaining a high-sodium diet
B. Administering a loop diuretic
C. Encouraging a high-protein diet
D. Restricting oral fluid intake to 500 mL/day
CORRECT ANSWER: B. Administering a loop diuretic
Rationale: Ascites is the accumulation of fluid in the peritoneal cavity. Management
includes sodium restriction and diuretics, such as spironolactone and/or loop diuretics
(e.g., furosemide), to promote fluid excretion. A low-sodium diet is essential, not a high-
sodium diet. Fluid restriction is often used but is usually secondary to sodium restriction
and diuretics. Protein intake is managed based on the client's status, but a high-protein
diet is not the primary management for ascites.
Question 10: The nurse is caring for a client with a chest tube connected to a
closed-chest drainage system. Which finding requires immediate intervention?
A. Continuous bubbling in the suction control chamber
B. Gentle bubbling in the water seal chamber with expiration
C. Absence of tidaling in the water seal chamber
D. 100 mL of sanguineous drainage in the first hour
CORRECT ANSWER: D. 100 mL of sanguineous drainage in the first hour
Rationale: Drainage of more than 70-100 mL/hr of sanguineous fluid is a sign of active
hemorrhage and requires immediate notification of the healthcare provider. Continuous
bubbling in the suction control chamber is expected (unless it's dry suction). Gentle
bubbling in the water seal chamber on expiration is normal for a client with a
pneumothorax. Absence of tidaling can be normal if the lung has re-expanded or if the
tube is clamped.
Question 11: A client with a history of chronic obstructive pulmonary disease
(COPD) is receiving oxygen via nasal cannula at 2 L/min. The nurse assesses
the client and finds them lethargic and confused. Which is the most likely
cause?
