ATI Medical-Surgical Proctored Exam – ATI RN Adult
Medical-Surgical Nursing Study Guide, Original Practice
Questions & Answers, Comprehensive 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 patient with chronic kidney disease (CKD) is receiving
erythropoietin therapy. Which laboratory value should the nurse monitor most
closely to evaluate the effectiveness of this treatment?
A. Serum creatinine level
B. Blood urea nitrogen (BUN) level
C. Hemoglobin and hematocrit levels
D. Serum potassium level
CORRECT ANSWER: C. Hemoglobin and hematocrit levels
Rationale: Erythropoietin is administered to stimulate red blood cell production in the
bone marrow. The effectiveness of this therapy is directly reflected by an increase in
hemoglobin and hematocrit levels, which indicate improved erythropoiesis and
management of anemia associated with CKD.
Question 2: A nurse is caring for a client who is 24 hours post-operative
following a total hip arthroplasty. Which intervention is most important to
prevent dislocation of the new joint?
A. Maintain the client in a low Fowler's position.
B. Keep the client's legs in an abducted position using a pillow.
C. Encourage the client to cross their legs at the ankles.
D. Elevate the head of the bed to 90 degrees.
CORRECT ANSWER: B. Keep the client's legs in an abducted position using a
pillow.
Rationale: Following a total hip arthroplasty, the hip is at high risk for dislocation.
Maintaining abduction (legs spread apart) with an abductor pillow prevents adduction,
which could cause the prosthetic head to dislocate from the acetabulum. Crossing legs
or excessive flexion should be avoided.
Question 3: The nurse is assessing a patient with a diagnosis of heart failure
who reports shortness of breath and awakens at night gasping for air. Which
finding is the most indicative of worsening heart failure?
,A. Decreased jugular venous pressure
B. Presence of a productive cough with frothy pink sputum
C. A decrease in blood pressure and heart rate
D. Increased urine output during the day
CORRECT ANSWER: B. Presence of a productive cough with frothy pink
sputum
Rationale: Frothy pink sputum is a classic sign of acute pulmonary edema, a severe
complication of left-sided heart failure. It indicates that fluid has accumulated in the
alveoli, leading to impaired gas exchange. This is a critical finding that requires
immediate intervention.
Question 4: A patient with severe diabetic ketoacidosis (DKA) is receiving an
insulin infusion. Which electrolyte imbalance is the priority to monitor and
treat to prevent a fatal cardiac dysrhythmia?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
CORRECT ANSWER: C. Hypokalemia
Rationale: Insulin drives potassium back into the cells, which can rapidly lead to severe
hypokalemia. Since potassium is critical for cardiac conduction, a sudden drop can
cause fatal arrhythmias. Therefore, potassium levels must be closely monitored and
replaced as ordered during DKA treatment.
Question 5: The nurse is preparing to administer a blood transfusion to a
client. After obtaining the blood from the blood bank, what is the most
appropriate initial action?
A. Begin the transfusion immediately to prevent the blood from warming.
B. Have the client sign the informed consent for the transfusion.
C. Verify the blood product with another licensed nurse at the bedside.
D. Prime the administration set with 0.9% normal saline.
CORRECT ANSWER: C. Verify the blood product with another licensed nurse at
the bedside.
Rationale: The most critical step to prevent a fatal transfusion reaction is the bedside
verification of the blood product. The two-nurse verification process ensures the correct
blood type, patient identification, and expiration date. This is a mandatory safety
procedure before starting the infusion.
,Question 6: A patient with angina pectoris is prescribed sublingual
nitroglycerin. Which instruction is essential for the nurse to include in the
discharge teaching?
A. Take a tablet every 5 minutes until chest pain subsides, up to three tablets.
B. Store the tablets in the refrigerator to maintain potency.
C. Swallow the tablet with a full glass of water for faster absorption.
D. Expect to feel a tingling sensation under the tongue as the drug dissolves.
CORRECT ANSWER: A. Take a tablet every 5 minutes until chest pain
subsides, up to three tablets.
Rationale: The standard protocol for sublingual nitroglycerin is to take one tablet at the
onset of pain, then another every 5 minutes up to a maximum of three tablets. If pain
persists after three tablets, emergency services must be called. A tingling sensation is an
expected side effect, not a criterion for efficacy.
Question 7: A client with an acute exacerbation of chronic obstructive
pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal cannula.
The nurse assesses the client and notes a decrease in respiratory rate and
lethargy. What is the nurse's priority action?
A. Increase the oxygen flow to 4 L/min to improve oxygenation.
B. Place the client in a supine position to promote rest.
C. Keep the oxygen at 2 L/min and continue to monitor.
D. Prepare to assist with intubation and mechanical ventilation.
CORRECT ANSWER: D. Prepare to assist with intubation and mechanical
ventilation.
Rationale: A client with COPD who is a chronic CO2 retainer relies on a hypoxic drive to
breathe. High oxygen concentrations can depress this drive, leading to hypoventilation,
respiratory acidosis, and decreased level of consciousness. A decreasing respiratory rate
and lethargy are signs of impending respiratory failure, and intubation may be
necessary.
Question 8: The nurse is caring for a patient who has a chest tube connected to
a three-chamber drainage system. The nurse notes continuous bubbling in the
water seal chamber. What is the most appropriate interpretation of this
finding?
A. The suction pressure is too high and needs to be decreased.
B. The chest tube is functioning normally and draining air from the pleural space.
C. There is an air leak in the system that needs to be investigated.
D. The patient requires a new chest tube as the current one is occluded.
, CORRECT ANSWER: C. There is an air leak in the system that needs to be
investigated.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
nurse should assess for external leaks at the insertion site, connecting tubes, or drainage
system connections. If no external leak is found, it indicates an internal air leak from the
lung, which requires prompt medical evaluation.
Question 9: A patient with cirrhosis of the liver is exhibiting confusion,
asterixis, and a flapping tremor. Which dietary modification is most
appropriate for this patient's current condition?
A. High protein diet to promote liver regeneration.
B. Low sodium diet to reduce ascites formation.
C. Low protein diet to reduce ammonia production.
D. High carbohydrate diet to provide energy for healing.
CORRECT ANSWER: C. Low protein diet to reduce ammonia production.
Rationale: The patient's symptoms are indicative of hepatic encephalopathy, which is
caused by elevated serum ammonia levels from the liver's inability to metabolize
protein. A low-protein diet is implemented to reduce the substrate for ammonia
production, thereby alleviating neurological symptoms.
Question 10: The nurse is preparing a client for a cardiac catheterization.
Which allergy information is most critical to ascertain from the client to
prevent a serious complication?
A. Allergy to penicillin
B. Allergy to shellfish or iodine
C. Allergy to codeine
D. Allergy to acetaminophen
CORRECT ANSWER: B. Allergy to shellfish or iodine
Rationale: The contrast dye used during cardiac catheterization is iodine-based. Clients
with allergies to shellfish, iodine, or contrast media are at an increased risk for a severe
anaphylactic reaction. A history of such allergies should be reported to the provider, and
pre-medication with antihistamines or corticosteroids may be ordered.
Question 11: A client with a new diagnosis of diabetes mellitus type 2 is being
taught about foot care. Which statement by the client indicates a need for
further teaching?
Medical-Surgical Nursing Study Guide, Original Practice
Questions & Answers, Comprehensive 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 patient with chronic kidney disease (CKD) is receiving
erythropoietin therapy. Which laboratory value should the nurse monitor most
closely to evaluate the effectiveness of this treatment?
A. Serum creatinine level
B. Blood urea nitrogen (BUN) level
C. Hemoglobin and hematocrit levels
D. Serum potassium level
CORRECT ANSWER: C. Hemoglobin and hematocrit levels
Rationale: Erythropoietin is administered to stimulate red blood cell production in the
bone marrow. The effectiveness of this therapy is directly reflected by an increase in
hemoglobin and hematocrit levels, which indicate improved erythropoiesis and
management of anemia associated with CKD.
Question 2: A nurse is caring for a client who is 24 hours post-operative
following a total hip arthroplasty. Which intervention is most important to
prevent dislocation of the new joint?
A. Maintain the client in a low Fowler's position.
B. Keep the client's legs in an abducted position using a pillow.
C. Encourage the client to cross their legs at the ankles.
D. Elevate the head of the bed to 90 degrees.
CORRECT ANSWER: B. Keep the client's legs in an abducted position using a
pillow.
Rationale: Following a total hip arthroplasty, the hip is at high risk for dislocation.
Maintaining abduction (legs spread apart) with an abductor pillow prevents adduction,
which could cause the prosthetic head to dislocate from the acetabulum. Crossing legs
or excessive flexion should be avoided.
Question 3: The nurse is assessing a patient with a diagnosis of heart failure
who reports shortness of breath and awakens at night gasping for air. Which
finding is the most indicative of worsening heart failure?
,A. Decreased jugular venous pressure
B. Presence of a productive cough with frothy pink sputum
C. A decrease in blood pressure and heart rate
D. Increased urine output during the day
CORRECT ANSWER: B. Presence of a productive cough with frothy pink
sputum
Rationale: Frothy pink sputum is a classic sign of acute pulmonary edema, a severe
complication of left-sided heart failure. It indicates that fluid has accumulated in the
alveoli, leading to impaired gas exchange. This is a critical finding that requires
immediate intervention.
Question 4: A patient with severe diabetic ketoacidosis (DKA) is receiving an
insulin infusion. Which electrolyte imbalance is the priority to monitor and
treat to prevent a fatal cardiac dysrhythmia?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
CORRECT ANSWER: C. Hypokalemia
Rationale: Insulin drives potassium back into the cells, which can rapidly lead to severe
hypokalemia. Since potassium is critical for cardiac conduction, a sudden drop can
cause fatal arrhythmias. Therefore, potassium levels must be closely monitored and
replaced as ordered during DKA treatment.
Question 5: The nurse is preparing to administer a blood transfusion to a
client. After obtaining the blood from the blood bank, what is the most
appropriate initial action?
A. Begin the transfusion immediately to prevent the blood from warming.
B. Have the client sign the informed consent for the transfusion.
C. Verify the blood product with another licensed nurse at the bedside.
D. Prime the administration set with 0.9% normal saline.
CORRECT ANSWER: C. Verify the blood product with another licensed nurse at
the bedside.
Rationale: The most critical step to prevent a fatal transfusion reaction is the bedside
verification of the blood product. The two-nurse verification process ensures the correct
blood type, patient identification, and expiration date. This is a mandatory safety
procedure before starting the infusion.
,Question 6: A patient with angina pectoris is prescribed sublingual
nitroglycerin. Which instruction is essential for the nurse to include in the
discharge teaching?
A. Take a tablet every 5 minutes until chest pain subsides, up to three tablets.
B. Store the tablets in the refrigerator to maintain potency.
C. Swallow the tablet with a full glass of water for faster absorption.
D. Expect to feel a tingling sensation under the tongue as the drug dissolves.
CORRECT ANSWER: A. Take a tablet every 5 minutes until chest pain
subsides, up to three tablets.
Rationale: The standard protocol for sublingual nitroglycerin is to take one tablet at the
onset of pain, then another every 5 minutes up to a maximum of three tablets. If pain
persists after three tablets, emergency services must be called. A tingling sensation is an
expected side effect, not a criterion for efficacy.
Question 7: A client with an acute exacerbation of chronic obstructive
pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal cannula.
The nurse assesses the client and notes a decrease in respiratory rate and
lethargy. What is the nurse's priority action?
A. Increase the oxygen flow to 4 L/min to improve oxygenation.
B. Place the client in a supine position to promote rest.
C. Keep the oxygen at 2 L/min and continue to monitor.
D. Prepare to assist with intubation and mechanical ventilation.
CORRECT ANSWER: D. Prepare to assist with intubation and mechanical
ventilation.
Rationale: A client with COPD who is a chronic CO2 retainer relies on a hypoxic drive to
breathe. High oxygen concentrations can depress this drive, leading to hypoventilation,
respiratory acidosis, and decreased level of consciousness. A decreasing respiratory rate
and lethargy are signs of impending respiratory failure, and intubation may be
necessary.
Question 8: The nurse is caring for a patient who has a chest tube connected to
a three-chamber drainage system. The nurse notes continuous bubbling in the
water seal chamber. What is the most appropriate interpretation of this
finding?
A. The suction pressure is too high and needs to be decreased.
B. The chest tube is functioning normally and draining air from the pleural space.
C. There is an air leak in the system that needs to be investigated.
D. The patient requires a new chest tube as the current one is occluded.
, CORRECT ANSWER: C. There is an air leak in the system that needs to be
investigated.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
nurse should assess for external leaks at the insertion site, connecting tubes, or drainage
system connections. If no external leak is found, it indicates an internal air leak from the
lung, which requires prompt medical evaluation.
Question 9: A patient with cirrhosis of the liver is exhibiting confusion,
asterixis, and a flapping tremor. Which dietary modification is most
appropriate for this patient's current condition?
A. High protein diet to promote liver regeneration.
B. Low sodium diet to reduce ascites formation.
C. Low protein diet to reduce ammonia production.
D. High carbohydrate diet to provide energy for healing.
CORRECT ANSWER: C. Low protein diet to reduce ammonia production.
Rationale: The patient's symptoms are indicative of hepatic encephalopathy, which is
caused by elevated serum ammonia levels from the liver's inability to metabolize
protein. A low-protein diet is implemented to reduce the substrate for ammonia
production, thereby alleviating neurological symptoms.
Question 10: The nurse is preparing a client for a cardiac catheterization.
Which allergy information is most critical to ascertain from the client to
prevent a serious complication?
A. Allergy to penicillin
B. Allergy to shellfish or iodine
C. Allergy to codeine
D. Allergy to acetaminophen
CORRECT ANSWER: B. Allergy to shellfish or iodine
Rationale: The contrast dye used during cardiac catheterization is iodine-based. Clients
with allergies to shellfish, iodine, or contrast media are at an increased risk for a severe
anaphylactic reaction. A history of such allergies should be reported to the provider, and
pre-medication with antihistamines or corticosteroids may be ordered.
Question 11: A client with a new diagnosis of diabetes mellitus type 2 is being
taught about foot care. Which statement by the client indicates a need for
further teaching?
