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 & Infectious
Disorders, Pharmacology, Laboratory Values, Patient
Assessment, Prioritization, Delegation, Patient Safety &
NGN-Style Clinical Judgment
Question 1: A client with heart failure is prescribed furosemide. Which
assessment finding indicates that the medication is having the desired
therapeutic effect?
A. Increased jugular venous distension
B. Weight gain of 2 kg in 24 hours
C. Clear breath sounds and decreased peripheral edema
D. Blood pressure increase from 110/70 to 140/90 mmHg
CORRECT ANSWER: C. Clear breath sounds and decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired effect is the reduction of pulmonary congestion and peripheral
edema. Clear breath sounds indicate decreased pulmonary fluid, and reduced edema
signifies effective diuresis. Weight gain, increased JVD, and hypertension are signs of
worsening fluid overload or ineffective treatment.
Question 2: A post-operative client develops a fever and reports chest pain
that worsens with deep breathing. Which condition should the nurse suspect
first?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Wound infection
CORRECT ANSWER: C. Pneumonia
Rationale: Fever, chest pain worsened by deep breathing (pleuritic), and post-operative
status are classic signs of pneumonia. While atelectasis can cause fever, it is usually
accompanied by decreased breath sounds, not pleuritic pain. Pulmonary embolism
presents with sudden dyspnea and pleuritic pain, but fever is less common. A wound
infection would present with localized signs.
Question 3: A client with diabetes mellitus type 2 is prescribed metformin. The
nurse should monitor for which severe adverse effect?
A. Hypoglycemia
B. Lactic acidosis
,C. Weight gain
D. Hyperkalemia
CORRECT ANSWER: B. Lactic acidosis
Rationale: Metformin is associated with a rare but serious adverse effect called lactic
acidosis, especially in clients with renal impairment, liver disease, or hypoxia.
Hypoglycemia is uncommon with metformin monotherapy. Weight gain is not typically
an adverse effect, and hyperkalemia is not directly associated with metformin.
Question 4: The nurse is caring for a client with an exacerbation of chronic
obstructive pulmonary disease (COPD). Which arterial blood gas (ABG) finding
is most consistent with this condition?
A. pH 7.38, PaCO2 58 mmHg, HCO3- 32 mEq/L
B. pH 7.46, PaCO2 30 mmHg, HCO3- 22 mEq/L
C. pH 7.32, PaCO2 40 mmHg, HCO3- 18 mEq/L
D. pH 7.42, PaCO2 38 mmHg, HCO3- 24 mEq/L
CORRECT ANSWER: A. pH 7.38, PaCO2 58 mmHg, HCO3- 32 mEq/L
Rationale: In COPD exacerbation, clients retain carbon dioxide, leading to respiratory
acidosis with renal compensation. Option A shows a slightly acidotic pH, elevated
PaCO2 (above 45 mmHg), and elevated bicarbonate due to metabolic compensation.
Option B indicates respiratory alkalosis. Option C suggests metabolic acidosis, and D is
within normal limits.
Question 5: A client with a history of myocardial infarction is prescribed
clopidogrel. The nurse should monitor for which primary adverse effect?
A. Hypertension
B. Bradycardia
C. Bleeding
D. Hyperglycemia
CORRECT ANSWER: C. Bleeding
Rationale: Clopidogrel is an antiplatelet agent that inhibits platelet aggregation, thereby
increasing the risk of bleeding. The nurse should monitor for signs such as petechiae,
ecchymosis, gastrointestinal bleeding, and increased bleeding from wounds.
Hypertension, bradycardia, and hyperglycemia are not primary effects of clopidogrel.
Question 6: The nurse is assessing a client with suspected appendicitis. Which
assessment finding is most indicative of this condition?
A. Rebound tenderness at McBurney's point
B. Right upper quadrant pain radiating to the right shoulder
C. Left lower quadrant pain with guarding
D. Diffuse abdominal pain that decreases with movement
CORRECT ANSWER: A. Rebound tenderness at McBurney's point
,Rationale: Rebound tenderness at McBurney's point (located between the umbilicus and
the anterior iliac crest) is a classic sign of appendicitis. Right upper quadrant pain
radiating to the shoulder is more suggestive of cholecystitis. Left lower quadrant pain
may indicate diverticulitis. Diffuse pain that decreases with movement is not a typical
sign.
Question 7: A client with chronic kidney disease (CKD) has a potassium level
of 6.5 mEq/L. Which intervention should the nurse anticipate?
A. Administration of oral potassium supplements
B. Intravenous sodium polystyrene sulfonate (Kayexalate)
C. Encouraging a high-potassium diet
D. Restricting calcium intake
CORRECT ANSWER: B. Intravenous sodium polystyrene sulfonate (Kayexalate)
Rationale: Hyperkalemia (potassium >5.0 mEq/L) is a life-threatening complication of
CKD. Sodium polystyrene sulfonate is a cation-exchange resin that binds potassium in
the gastrointestinal tract, promoting its excretion. Oral or IV potassium and a high-
potassium diet would worsen hyperkalemia. Calcium restriction is not the primary
treatment for hyperkalemia.
Question 8: The nurse is educating a client with asthma on the use of a
metered-dose inhaler (MDI). Which statement indicates a need for further
teaching?
A. "I will shake the inhaler well before each use."
B. "I will inhale and press the canister at the same time."
C. "I will hold my breath for 10 seconds after inhaling the medication."
D. "I will exhale completely after taking the medication."
CORRECT ANSWER: D. "I will exhale completely after taking the medication."
Rationale: The client should exhale completely before, not after, inhaling the medication.
The correct steps include shaking the inhaler, exhaling fully, placing the mouthpiece,
inhaling while pressing the canister, and holding breath for up to 10 seconds. Exhaling
after inhaling will expel the medication, reducing efficacy.
Question 9: A client with cirrhosis is exhibiting asterixis. The nurse should
assess for which complication?
A. Portal hypertension
B. Hepatic encephalopathy
C. Ascites
D. Esophageal varices
CORRECT ANSWER: B. Hepatic encephalopathy
Rationale: Asterixis, or "liver flap," is a flapping tremor of the hands when the wrists are
extended, and it is a hallmark sign of hepatic encephalopathy, caused by the
, accumulation of ammonia and other toxins in the blood. Portal hypertension, ascites,
and esophageal varices are also complications of cirrhosis but are not directly
associated with asterixis.
Question 10: A client is receiving a blood transfusion and develops chills, back
pain, and hypotension. Which action should the nurse take first?
A. Stop the transfusion and keep the IV line open with normal saline.
B. Slow the transfusion and monitor the client's vital signs.
C. Administer diphenhydramine (Benadryl) as prescribed.
D. Notify the healthcare provider.
CORRECT ANSWER: A. Stop the transfusion and keep the IV line open with
normal saline.
Rationale: These symptoms indicate a possible acute hemolytic transfusion reaction.
The priority action is to stop the transfusion immediately to prevent further reaction,
then keep the line open with normal saline to maintain IV access. The healthcare
provider should be notified after stopping the infusion, and further interventions, such as
administering antihistamines, may be prescribed.
Question 11: The nurse is teaching a client about a low-sodium diet for
hypertension. Which food selection indicates the client understands the
teaching?
A. Canned vegetable soup
B. A dill pickle
C. Fresh apple slices
D. Salted pretzels
CORRECT ANSWER: C. Fresh apple slices
Rationale: Fresh fruits like apples are naturally low in sodium and are an appropriate
choice for a low-sodium diet. Canned soup, pickles, and salted pretzels are highly
processed and contain large amounts of sodium, which should be avoided.
Question 12: A client with a pulmonary embolism is receiving heparin therapy.
The nurse should monitor for which laboratory finding to evaluate therapeutic
effectiveness?
A. Activated partial thromboplastin time (aPTT) 60 seconds
B. Prothrombin time (PT) 20 seconds
C. International normalized ratio (INR) 3.5
D. Platelet count 100,000/mm³
CORRECT ANSWER: A. Activated partial thromboplastin time (aPTT) 60
seconds
Rationale: Heparin's therapeutic effect is monitored by aPTT. The goal is typically 1.5 to
2.5 times the control value (usually 25-35 seconds), so an aPTT of 60 seconds is
Medical-Surgical Nursing Study Guide, Original Practice
Questions & Answers, Comprehensive ATI Med-Surg
Assessment Preparation, Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine,
Musculoskeletal, Integumentary, Immune & Infectious
Disorders, Pharmacology, Laboratory Values, Patient
Assessment, Prioritization, Delegation, Patient Safety &
NGN-Style Clinical Judgment
Question 1: A client with heart failure is prescribed furosemide. Which
assessment finding indicates that the medication is having the desired
therapeutic effect?
A. Increased jugular venous distension
B. Weight gain of 2 kg in 24 hours
C. Clear breath sounds and decreased peripheral edema
D. Blood pressure increase from 110/70 to 140/90 mmHg
CORRECT ANSWER: C. Clear breath sounds and decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired effect is the reduction of pulmonary congestion and peripheral
edema. Clear breath sounds indicate decreased pulmonary fluid, and reduced edema
signifies effective diuresis. Weight gain, increased JVD, and hypertension are signs of
worsening fluid overload or ineffective treatment.
Question 2: A post-operative client develops a fever and reports chest pain
that worsens with deep breathing. Which condition should the nurse suspect
first?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Wound infection
CORRECT ANSWER: C. Pneumonia
Rationale: Fever, chest pain worsened by deep breathing (pleuritic), and post-operative
status are classic signs of pneumonia. While atelectasis can cause fever, it is usually
accompanied by decreased breath sounds, not pleuritic pain. Pulmonary embolism
presents with sudden dyspnea and pleuritic pain, but fever is less common. A wound
infection would present with localized signs.
Question 3: A client with diabetes mellitus type 2 is prescribed metformin. The
nurse should monitor for which severe adverse effect?
A. Hypoglycemia
B. Lactic acidosis
,C. Weight gain
D. Hyperkalemia
CORRECT ANSWER: B. Lactic acidosis
Rationale: Metformin is associated with a rare but serious adverse effect called lactic
acidosis, especially in clients with renal impairment, liver disease, or hypoxia.
Hypoglycemia is uncommon with metformin monotherapy. Weight gain is not typically
an adverse effect, and hyperkalemia is not directly associated with metformin.
Question 4: The nurse is caring for a client with an exacerbation of chronic
obstructive pulmonary disease (COPD). Which arterial blood gas (ABG) finding
is most consistent with this condition?
A. pH 7.38, PaCO2 58 mmHg, HCO3- 32 mEq/L
B. pH 7.46, PaCO2 30 mmHg, HCO3- 22 mEq/L
C. pH 7.32, PaCO2 40 mmHg, HCO3- 18 mEq/L
D. pH 7.42, PaCO2 38 mmHg, HCO3- 24 mEq/L
CORRECT ANSWER: A. pH 7.38, PaCO2 58 mmHg, HCO3- 32 mEq/L
Rationale: In COPD exacerbation, clients retain carbon dioxide, leading to respiratory
acidosis with renal compensation. Option A shows a slightly acidotic pH, elevated
PaCO2 (above 45 mmHg), and elevated bicarbonate due to metabolic compensation.
Option B indicates respiratory alkalosis. Option C suggests metabolic acidosis, and D is
within normal limits.
Question 5: A client with a history of myocardial infarction is prescribed
clopidogrel. The nurse should monitor for which primary adverse effect?
A. Hypertension
B. Bradycardia
C. Bleeding
D. Hyperglycemia
CORRECT ANSWER: C. Bleeding
Rationale: Clopidogrel is an antiplatelet agent that inhibits platelet aggregation, thereby
increasing the risk of bleeding. The nurse should monitor for signs such as petechiae,
ecchymosis, gastrointestinal bleeding, and increased bleeding from wounds.
Hypertension, bradycardia, and hyperglycemia are not primary effects of clopidogrel.
Question 6: The nurse is assessing a client with suspected appendicitis. Which
assessment finding is most indicative of this condition?
A. Rebound tenderness at McBurney's point
B. Right upper quadrant pain radiating to the right shoulder
C. Left lower quadrant pain with guarding
D. Diffuse abdominal pain that decreases with movement
CORRECT ANSWER: A. Rebound tenderness at McBurney's point
,Rationale: Rebound tenderness at McBurney's point (located between the umbilicus and
the anterior iliac crest) is a classic sign of appendicitis. Right upper quadrant pain
radiating to the shoulder is more suggestive of cholecystitis. Left lower quadrant pain
may indicate diverticulitis. Diffuse pain that decreases with movement is not a typical
sign.
Question 7: A client with chronic kidney disease (CKD) has a potassium level
of 6.5 mEq/L. Which intervention should the nurse anticipate?
A. Administration of oral potassium supplements
B. Intravenous sodium polystyrene sulfonate (Kayexalate)
C. Encouraging a high-potassium diet
D. Restricting calcium intake
CORRECT ANSWER: B. Intravenous sodium polystyrene sulfonate (Kayexalate)
Rationale: Hyperkalemia (potassium >5.0 mEq/L) is a life-threatening complication of
CKD. Sodium polystyrene sulfonate is a cation-exchange resin that binds potassium in
the gastrointestinal tract, promoting its excretion. Oral or IV potassium and a high-
potassium diet would worsen hyperkalemia. Calcium restriction is not the primary
treatment for hyperkalemia.
Question 8: The nurse is educating a client with asthma on the use of a
metered-dose inhaler (MDI). Which statement indicates a need for further
teaching?
A. "I will shake the inhaler well before each use."
B. "I will inhale and press the canister at the same time."
C. "I will hold my breath for 10 seconds after inhaling the medication."
D. "I will exhale completely after taking the medication."
CORRECT ANSWER: D. "I will exhale completely after taking the medication."
Rationale: The client should exhale completely before, not after, inhaling the medication.
The correct steps include shaking the inhaler, exhaling fully, placing the mouthpiece,
inhaling while pressing the canister, and holding breath for up to 10 seconds. Exhaling
after inhaling will expel the medication, reducing efficacy.
Question 9: A client with cirrhosis is exhibiting asterixis. The nurse should
assess for which complication?
A. Portal hypertension
B. Hepatic encephalopathy
C. Ascites
D. Esophageal varices
CORRECT ANSWER: B. Hepatic encephalopathy
Rationale: Asterixis, or "liver flap," is a flapping tremor of the hands when the wrists are
extended, and it is a hallmark sign of hepatic encephalopathy, caused by the
, accumulation of ammonia and other toxins in the blood. Portal hypertension, ascites,
and esophageal varices are also complications of cirrhosis but are not directly
associated with asterixis.
Question 10: A client is receiving a blood transfusion and develops chills, back
pain, and hypotension. Which action should the nurse take first?
A. Stop the transfusion and keep the IV line open with normal saline.
B. Slow the transfusion and monitor the client's vital signs.
C. Administer diphenhydramine (Benadryl) as prescribed.
D. Notify the healthcare provider.
CORRECT ANSWER: A. Stop the transfusion and keep the IV line open with
normal saline.
Rationale: These symptoms indicate a possible acute hemolytic transfusion reaction.
The priority action is to stop the transfusion immediately to prevent further reaction,
then keep the line open with normal saline to maintain IV access. The healthcare
provider should be notified after stopping the infusion, and further interventions, such as
administering antihistamines, may be prescribed.
Question 11: The nurse is teaching a client about a low-sodium diet for
hypertension. Which food selection indicates the client understands the
teaching?
A. Canned vegetable soup
B. A dill pickle
C. Fresh apple slices
D. Salted pretzels
CORRECT ANSWER: C. Fresh apple slices
Rationale: Fresh fruits like apples are naturally low in sodium and are an appropriate
choice for a low-sodium diet. Canned soup, pickles, and salted pretzels are highly
processed and contain large amounts of sodium, which should be avoided.
Question 12: A client with a pulmonary embolism is receiving heparin therapy.
The nurse should monitor for which laboratory finding to evaluate therapeutic
effectiveness?
A. Activated partial thromboplastin time (aPTT) 60 seconds
B. Prothrombin time (PT) 20 seconds
C. International normalized ratio (INR) 3.5
D. Platelet count 100,000/mm³
CORRECT ANSWER: A. Activated partial thromboplastin time (aPTT) 60
seconds
Rationale: Heparin's therapeutic effect is monitored by aPTT. The goal is typically 1.5 to
2.5 times the control value (usually 25-35 seconds), so an aPTT of 60 seconds is
