ATI Medical-Surgical Proctored Exam – ATI RN
Adult Medical-Surgical Nursing Study Guide,
Original Practice Questions & Answers,
Comprehensive ATI Med-Surg Assessment
Preparation, Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine,
Musculoskeletal, Integumentary & Immune
Disorders, Pharmacology, Laboratory Values,
Patient Safety, Prioritization, Delegation & NGN
Clinical Judgment
Question 1: A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment finding
indicates a potential complication of this therapy?
A. Respiratory rate of 22 breaths per minute
B. Pulse oximetry reading of 89%
C. Patient reporting a headache and confusion
D. Productive cough with green sputum
CORRECT ANSWER: C. Patient reporting a headache and confusion
Rationale: In patients with COPD, oxygen administration can lead to hypoventilation due
to a decreased hypoxic drive. Headache and confusion are early signs of hypercapnia,
which can result from this reduced respiratory effort. A respiratory rate of 22 is slightly
elevated but not a direct complication of oxygen therapy. An SpO2 of 89% indicates the
oxygen is not effective, and productive cough indicates an infection, not a complication
of oxygen therapy.
Question 2: A nurse is caring for a patient with heart failure who has crackles
in the lung bases and peripheral edema. Which prescribed medication should
the nurse administer first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
CORRECT ANSWER: B. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting fluid
excretion, alleviating pulmonary congestion and edema. While Digoxin, Metoprolol, and
Lisinopril are important for heart failure management, they do not provide immediate
relief of fluid overload symptoms. The priority is to reduce fluid volume to improve
oxygenation and decrease workload on the heart.
,Question 3: A patient is 2 hours post-operative from a total hip arthroplasty.
Which finding requires immediate notification of the healthcare provider?
A. Pain rated 5 out of 10 at the surgical site
B. Blood pressure of 148/88 mmHg
C. Pulse oximetry of 91% on room air
D. Urinary output of 40 mL in the last hour
CORRECT ANSWER: C. Pulse oximetry of 91% on room air
Rationale: An SpO2 of 91% is concerning for hypoxemia, which could indicate a
pulmonary embolism, a significant risk after hip surgery. Pain at the site and elevated
blood pressure are expected post-operative findings that can be managed. Urinary
output of 40 mL/hr is adequate (greater than 30 mL/hr).
Question 4: A nurse is providing teaching to a patient with a new diagnosis of
Type 1 diabetes mellitus. Which statement by the patient indicates a need for
further teaching?
A. "I will rotate my insulin injection sites to prevent lipodystrophy."
B. "I should check my blood sugar before each meal and at bedtime."
C. "If I feel shaky and sweaty, I need to eat a quick source of sugar."
D. "I can skip my insulin if I am not going to eat breakfast."
CORRECT ANSWER: D. "I can skip my insulin if I am not going to eat
breakfast."
Rationale: Patients with Type 1 diabetes require exogenous insulin at all times, even
when not eating, to prevent diabetic ketoacidosis (DKA). Skipping insulin is dangerous.
The other options are correct statements regarding self-management.
Question 5: A patient with acute pancreatitis is reporting severe abdominal
pain. Which position should the nurse encourage to help alleviate the
discomfort?
A. Supine with legs extended
B. Prone position
C. Side-lying with knees flexed to the chest
D. High-Fowler's position
CORRECT ANSWER: C. Side-lying with knees flexed to the chest
Rationale: The fetal position (side-lying with knees flexed) helps reduce tension on the
abdominal muscles and pancreas, which can decrease pain. The prone and supine
,positions often increase pain due to stretching of the peritoneum. High-Fowler's is useful
for respiratory issues but not specifically for pancreatic pain.
Question 6: The nurse is assessing a patient with cirrhosis of the liver. Which
finding is most indicative of portal hypertension?
A. Ascites
B. Jaundice
C. Spider angiomas
D. Palmar erythema
CORRECT ANSWER: A. Ascites
Rationale: Ascites is a direct consequence of increased hydrostatic pressure in the portal
venous system, leading to fluid accumulation in the peritoneal cavity. Jaundice, spider
angiomas, and palmar erythema are related to hepatic dysfunction and altered estrogen
metabolism but are not direct indicators of portal hypertension.
Question 7: A patient is receiving a blood transfusion of packed red blood
cells. Fifteen minutes after the start of the infusion, the patient reports low
back pain and chills. What is the nurse's priority action?
A. Slow the infusion rate
B. Administer an antihistamine
C. Stop the transfusion immediately
D. Obtain a urine sample
CORRECT ANSWER: C. Stop the transfusion immediately
Rationale: Low back pain and chills are classic signs of an acute hemolytic transfusion
reaction, which is a medical emergency. The priority is to stop the transfusion to prevent
further complications, then maintain IV access with normal saline and notify the
provider. Slowing the infusion would be dangerous.
Question 8: The nurse is caring for a patient with a chest tube inserted for a
pneumothorax. The chest tube is accidentally disconnected from the drainage
system. What should the nurse do first?
A. Clamp the chest tube immediately
B. Place the end of the tube in sterile water
C. Call the healthcare provider
D. Reconnect the tube to the drainage system
CORRECT ANSWER: B. Place the end of the tube in sterile water
, Rationale: If a chest tube is disconnected, the priority is to prevent air from entering the
pleural space, which could cause a tension pneumothorax. Placing the end of the tube in
sterile water creates a water seal, preventing air entry while allowing air to escape.
Clamping can cause a tension pneumothorax.
Question 9: A patient with chronic kidney disease (CKD) has a serum
potassium of 6.2 mEq/L. Which finding is most concerning?
A. Fatigue
B. Constipation
C. ECG changes with peaked T-waves
D. Nausea
CORRECT ANSWER: C. ECG changes with peaked T-waves
Rationale: A serum potassium of 6.2 mEq/L is hyperkalemia. Peaked T-waves are an
early and classic ECG change that can progress to ventricular fibrillation or cardiac
arrest. This is a life-threatening finding requiring immediate intervention. Fatigue and
nausea are non-specific, and constipation is more associated with hypercalcemia.
Question 10: A nurse is preparing to administer heparin subcutaneously to a
patient. Which action is correct for this administration?
A. Aspirate before injecting the medication
B. Massage the injection site after administration
C. Insert the needle at a 90-degree angle into a skin fold
D. Use a 21-gauge needle for injection
CORRECT ANSWER: C. Insert the needle at a 90-degree angle into a skin fold
Rationale: Heparin is administered subcutaneously, and the correct technique involves
pinching a skin fold and inserting the needle at a 90-degree angle. Aspiration is not
recommended as it can cause bruising. Massaging the site can cause hematoma
formation. A 21-gauge needle is too large; a small gauge (25-26) is used.
Question 11: The nurse is monitoring a patient with a head injury for signs of
increased intracranial pressure (ICP). Which sign is a late finding of increased
ICP?
A. Headache
B. Vomiting
C. Decerebrate posturing
D. Restlessness
CORRECT ANSWER: C. Decerebrate posturing
Adult Medical-Surgical Nursing Study Guide,
Original Practice Questions & Answers,
Comprehensive ATI Med-Surg Assessment
Preparation, Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine,
Musculoskeletal, Integumentary & Immune
Disorders, Pharmacology, Laboratory Values,
Patient Safety, Prioritization, Delegation & NGN
Clinical Judgment
Question 1: A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment finding
indicates a potential complication of this therapy?
A. Respiratory rate of 22 breaths per minute
B. Pulse oximetry reading of 89%
C. Patient reporting a headache and confusion
D. Productive cough with green sputum
CORRECT ANSWER: C. Patient reporting a headache and confusion
Rationale: In patients with COPD, oxygen administration can lead to hypoventilation due
to a decreased hypoxic drive. Headache and confusion are early signs of hypercapnia,
which can result from this reduced respiratory effort. A respiratory rate of 22 is slightly
elevated but not a direct complication of oxygen therapy. An SpO2 of 89% indicates the
oxygen is not effective, and productive cough indicates an infection, not a complication
of oxygen therapy.
Question 2: A nurse is caring for a patient with heart failure who has crackles
in the lung bases and peripheral edema. Which prescribed medication should
the nurse administer first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
CORRECT ANSWER: B. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting fluid
excretion, alleviating pulmonary congestion and edema. While Digoxin, Metoprolol, and
Lisinopril are important for heart failure management, they do not provide immediate
relief of fluid overload symptoms. The priority is to reduce fluid volume to improve
oxygenation and decrease workload on the heart.
,Question 3: A patient is 2 hours post-operative from a total hip arthroplasty.
Which finding requires immediate notification of the healthcare provider?
A. Pain rated 5 out of 10 at the surgical site
B. Blood pressure of 148/88 mmHg
C. Pulse oximetry of 91% on room air
D. Urinary output of 40 mL in the last hour
CORRECT ANSWER: C. Pulse oximetry of 91% on room air
Rationale: An SpO2 of 91% is concerning for hypoxemia, which could indicate a
pulmonary embolism, a significant risk after hip surgery. Pain at the site and elevated
blood pressure are expected post-operative findings that can be managed. Urinary
output of 40 mL/hr is adequate (greater than 30 mL/hr).
Question 4: A nurse is providing teaching to a patient with a new diagnosis of
Type 1 diabetes mellitus. Which statement by the patient indicates a need for
further teaching?
A. "I will rotate my insulin injection sites to prevent lipodystrophy."
B. "I should check my blood sugar before each meal and at bedtime."
C. "If I feel shaky and sweaty, I need to eat a quick source of sugar."
D. "I can skip my insulin if I am not going to eat breakfast."
CORRECT ANSWER: D. "I can skip my insulin if I am not going to eat
breakfast."
Rationale: Patients with Type 1 diabetes require exogenous insulin at all times, even
when not eating, to prevent diabetic ketoacidosis (DKA). Skipping insulin is dangerous.
The other options are correct statements regarding self-management.
Question 5: A patient with acute pancreatitis is reporting severe abdominal
pain. Which position should the nurse encourage to help alleviate the
discomfort?
A. Supine with legs extended
B. Prone position
C. Side-lying with knees flexed to the chest
D. High-Fowler's position
CORRECT ANSWER: C. Side-lying with knees flexed to the chest
Rationale: The fetal position (side-lying with knees flexed) helps reduce tension on the
abdominal muscles and pancreas, which can decrease pain. The prone and supine
,positions often increase pain due to stretching of the peritoneum. High-Fowler's is useful
for respiratory issues but not specifically for pancreatic pain.
Question 6: The nurse is assessing a patient with cirrhosis of the liver. Which
finding is most indicative of portal hypertension?
A. Ascites
B. Jaundice
C. Spider angiomas
D. Palmar erythema
CORRECT ANSWER: A. Ascites
Rationale: Ascites is a direct consequence of increased hydrostatic pressure in the portal
venous system, leading to fluid accumulation in the peritoneal cavity. Jaundice, spider
angiomas, and palmar erythema are related to hepatic dysfunction and altered estrogen
metabolism but are not direct indicators of portal hypertension.
Question 7: A patient is receiving a blood transfusion of packed red blood
cells. Fifteen minutes after the start of the infusion, the patient reports low
back pain and chills. What is the nurse's priority action?
A. Slow the infusion rate
B. Administer an antihistamine
C. Stop the transfusion immediately
D. Obtain a urine sample
CORRECT ANSWER: C. Stop the transfusion immediately
Rationale: Low back pain and chills are classic signs of an acute hemolytic transfusion
reaction, which is a medical emergency. The priority is to stop the transfusion to prevent
further complications, then maintain IV access with normal saline and notify the
provider. Slowing the infusion would be dangerous.
Question 8: The nurse is caring for a patient with a chest tube inserted for a
pneumothorax. The chest tube is accidentally disconnected from the drainage
system. What should the nurse do first?
A. Clamp the chest tube immediately
B. Place the end of the tube in sterile water
C. Call the healthcare provider
D. Reconnect the tube to the drainage system
CORRECT ANSWER: B. Place the end of the tube in sterile water
, Rationale: If a chest tube is disconnected, the priority is to prevent air from entering the
pleural space, which could cause a tension pneumothorax. Placing the end of the tube in
sterile water creates a water seal, preventing air entry while allowing air to escape.
Clamping can cause a tension pneumothorax.
Question 9: A patient with chronic kidney disease (CKD) has a serum
potassium of 6.2 mEq/L. Which finding is most concerning?
A. Fatigue
B. Constipation
C. ECG changes with peaked T-waves
D. Nausea
CORRECT ANSWER: C. ECG changes with peaked T-waves
Rationale: A serum potassium of 6.2 mEq/L is hyperkalemia. Peaked T-waves are an
early and classic ECG change that can progress to ventricular fibrillation or cardiac
arrest. This is a life-threatening finding requiring immediate intervention. Fatigue and
nausea are non-specific, and constipation is more associated with hypercalcemia.
Question 10: A nurse is preparing to administer heparin subcutaneously to a
patient. Which action is correct for this administration?
A. Aspirate before injecting the medication
B. Massage the injection site after administration
C. Insert the needle at a 90-degree angle into a skin fold
D. Use a 21-gauge needle for injection
CORRECT ANSWER: C. Insert the needle at a 90-degree angle into a skin fold
Rationale: Heparin is administered subcutaneously, and the correct technique involves
pinching a skin fold and inserting the needle at a 90-degree angle. Aspiration is not
recommended as it can cause bruising. Massaging the site can cause hematoma
formation. A 21-gauge needle is too large; a small gauge (25-26) is used.
Question 11: The nurse is monitoring a patient with a head injury for signs of
increased intracranial pressure (ICP). Which sign is a late finding of increased
ICP?
A. Headache
B. Vomiting
C. Decerebrate posturing
D. Restlessness
CORRECT ANSWER: C. Decerebrate posturing
