ATI MEDICAL SURGICAL
CMS PROCTORED EXAM
2024 ACTUAL EXAM
COMPLETE ACCURATE
EXAM QUESTIONS WITH
DETAILED VERIFIED
ANSWERS /ALREADY
GRADED A+
1. A client who had a total hip arthroplasty is being discharged. Which
instruction should the nurse include in the discharge teaching?
● A. "Avoid lying on the operative side."
● B. "Cross your legs at the knees only when sitting."
● C. "Bend at the waist only when tying your shoes."
● D. "Do not sit in low chairs."
Answer: D. "Do not sit in low chairs."
Explanation: Clients who have undergone total hip arthroplasty should avoid sitting in low
chairs to prevent hip flexion beyond 90 degrees, which could cause dislocation of the
prosthesis. Sitting in low chairs places the hip at a flexed angle, increasing the risk of injury.
,2. A client with pneumonia is receiving oxygen therapy. Which finding
indicates that the therapy is effective?
● A. Respiratory rate of 22 breaths per minute
● B. PaO2 of 88 mm Hg
● C. SaO2 of 90%
● D. Use of accessory muscles to breathe
Answer: B. PaO2 of 88 mm Hg
Explanation: The PaO2 (partial pressure of oxygen in arterial blood) should be within a normal
range of 80 to 100 mm Hg for an adult. This indicates that the oxygen therapy is improving the
client’s oxygenation. The SaO2 value should ideally be above 95%, so 90% is lower than
expected. Use of accessory muscles indicates increased effort to breathe and is not a sign of
effective oxygen therapy.
3. A nurse is caring for a client who has cirrhosis with ascites. Which
dietary instruction should the nurse provide?
● A. Increase your protein intake.
● B. Consume 4 g of sodium daily.
● C. Decrease your caloric intake.
● D. Limit your fluid intake to 1,500 mL/day.
Answer: D. Limit your fluid intake to 1,500 mL/day.
Explanation: Clients with cirrhosis and ascites are typically instructed to limit fluid intake to
prevent worsening of the ascites. Sodium intake is also restricted (usually less than 2 g/day) to
reduce fluid retention. Increasing protein may be contraindicated depending on liver function
and risk of hepatic encephalopathy.
4. A nurse is assessing a client who has fluid volume overload. Which of
the following findings should the nurse expect?
● A. Hypotension
● B. Bradycardia
● C. Crackles in the lungs
● D. Flat neck veins
Answer: C. Crackles in the lungs
Explanation: Fluid volume overload causes excess fluid to accumulate in the lungs, leading to
crackles, dyspnea, and potential pulmonary edema. Other signs include hypertension,
tachycardia, and distended neck veins.
,5. A nurse is caring for a client who has deep-vein thrombosis (DVT).
Which of the following interventions should the nurse implement?
● A. Massage the affected extremity.
● B. Apply warm compresses to the extremity.
● C. Place the client in a prone position.
● D. Encourage the client to ambulate frequently.
Answer: B. Apply warm compresses to the extremity.
Explanation: Warm compresses promote circulation and reduce swelling in a client with DVT.
Massaging the affected extremity is contraindicated as it may dislodge the clot and cause a
pulmonary embolism. Bed rest with leg elevation is typically recommended during the acute
phase, followed by gradual ambulation as the condition improves.
6. A nurse is teaching a client with heart failure about the purpose of taking
furosemide. Which of the following statements by the client indicates an
understanding of the teaching?
● A. "This medication helps my heart pump better."
● B. "This medication helps reduce my blood pressure."
● C. "This medication reduces extra fluid in my lungs."
● D. "This medication lowers my potassium level."
Answer: C. "This medication reduces extra fluid in my lungs."
Explanation: Furosemide is a loop diuretic that helps remove excess fluid from the body, which
can accumulate in the lungs in clients with heart failure. This reduces symptoms like dyspnea. It
does lower blood pressure but the main goal in heart failure is reducing fluid overload.
7. A client is being discharged after treatment for a myocardial infarction
(MI). Which of the following instructions should the nurse include?
● A. Engage in physical activity to the point of discomfort.
● B. Begin cardiac rehabilitation at home.
● C. Report any chest pain that does not subside with rest.
● D. Increase sodium intake to prevent hypotension.
Answer: C. Report any chest pain that does not subside with rest.
Explanation: Clients recovering from an MI should immediately report chest pain that does not
subside with rest or is relieved by nitroglycerin. This could indicate another ischemic event.
Cardiac rehabilitation should be supervised, and sodium intake is typically restricted to manage
blood pressure and fluid retention.
, 8. A nurse is caring for a client with end-stage renal disease (ESRD)
receiving hemodialysis. Which dietary restriction should the nurse
reinforce?
● A. Increase calcium intake.
● B. Limit phosphorus intake.
● C. Increase potassium intake.
● D. Limit protein intake.
Answer: B. Limit phosphorus intake.
Explanation: Clients with ESRD should limit their phosphorus intake because their kidneys
cannot adequately excrete it, leading to hyperphosphatemia. High phosphorus levels can cause
calcium to leach from bones, leading to bone disease. Potassium and protein intake are also
restricted, but phosphorus restriction is crucial due to its impact on bone health.
9. A client is admitted with exacerbation of chronic obstructive pulmonary
disease (COPD). Which arterial blood gas (ABG) results would the nurse
expect?
● A. pH 7.30, PaCO2 60 mm Hg, HCO3 26 mEq/L
● B. pH 7.48, PaCO2 32 mm Hg, HCO3 24 mEq/L
● C. pH 7.45, PaCO2 40 mm Hg, HCO3 22 mEq/L
● D. pH 7.35, PaCO2 45 mm Hg, HCO3 28 mEq/L
Answer: A. pH 7.30, PaCO2 60 mm Hg, HCO3 26 mEq/L
Explanation: Clients with COPD often have respiratory acidosis due to CO2 retention, as they
cannot effectively eliminate CO2. A low pH and elevated PaCO2 (above 45 mm Hg) indicate
acidosis. The bicarbonate (HCO3) level may be normal or slightly elevated as compensation.
10. A nurse is caring for a client with a new diagnosis of diabetes mellitus.
Which of the following should the nurse teach the client regarding insulin
administration?
● A. Inject insulin into a muscle for faster absorption.
● B. Rotate injection sites to prevent lipodystrophy.
● C. Administer insulin when blood glucose is less than 70 mg/dL.
● D. Shake the insulin vial before withdrawing a dose.
Answer: B. Rotate injection sites to prevent lipodystrophy.
Explanation: Rotating injection sites helps prevent lipodystrophy, a condition where the skin
becomes hardened or develops lumps due to repeated insulin injections in the same spot.
CMS PROCTORED EXAM
2024 ACTUAL EXAM
COMPLETE ACCURATE
EXAM QUESTIONS WITH
DETAILED VERIFIED
ANSWERS /ALREADY
GRADED A+
1. A client who had a total hip arthroplasty is being discharged. Which
instruction should the nurse include in the discharge teaching?
● A. "Avoid lying on the operative side."
● B. "Cross your legs at the knees only when sitting."
● C. "Bend at the waist only when tying your shoes."
● D. "Do not sit in low chairs."
Answer: D. "Do not sit in low chairs."
Explanation: Clients who have undergone total hip arthroplasty should avoid sitting in low
chairs to prevent hip flexion beyond 90 degrees, which could cause dislocation of the
prosthesis. Sitting in low chairs places the hip at a flexed angle, increasing the risk of injury.
,2. A client with pneumonia is receiving oxygen therapy. Which finding
indicates that the therapy is effective?
● A. Respiratory rate of 22 breaths per minute
● B. PaO2 of 88 mm Hg
● C. SaO2 of 90%
● D. Use of accessory muscles to breathe
Answer: B. PaO2 of 88 mm Hg
Explanation: The PaO2 (partial pressure of oxygen in arterial blood) should be within a normal
range of 80 to 100 mm Hg for an adult. This indicates that the oxygen therapy is improving the
client’s oxygenation. The SaO2 value should ideally be above 95%, so 90% is lower than
expected. Use of accessory muscles indicates increased effort to breathe and is not a sign of
effective oxygen therapy.
3. A nurse is caring for a client who has cirrhosis with ascites. Which
dietary instruction should the nurse provide?
● A. Increase your protein intake.
● B. Consume 4 g of sodium daily.
● C. Decrease your caloric intake.
● D. Limit your fluid intake to 1,500 mL/day.
Answer: D. Limit your fluid intake to 1,500 mL/day.
Explanation: Clients with cirrhosis and ascites are typically instructed to limit fluid intake to
prevent worsening of the ascites. Sodium intake is also restricted (usually less than 2 g/day) to
reduce fluid retention. Increasing protein may be contraindicated depending on liver function
and risk of hepatic encephalopathy.
4. A nurse is assessing a client who has fluid volume overload. Which of
the following findings should the nurse expect?
● A. Hypotension
● B. Bradycardia
● C. Crackles in the lungs
● D. Flat neck veins
Answer: C. Crackles in the lungs
Explanation: Fluid volume overload causes excess fluid to accumulate in the lungs, leading to
crackles, dyspnea, and potential pulmonary edema. Other signs include hypertension,
tachycardia, and distended neck veins.
,5. A nurse is caring for a client who has deep-vein thrombosis (DVT).
Which of the following interventions should the nurse implement?
● A. Massage the affected extremity.
● B. Apply warm compresses to the extremity.
● C. Place the client in a prone position.
● D. Encourage the client to ambulate frequently.
Answer: B. Apply warm compresses to the extremity.
Explanation: Warm compresses promote circulation and reduce swelling in a client with DVT.
Massaging the affected extremity is contraindicated as it may dislodge the clot and cause a
pulmonary embolism. Bed rest with leg elevation is typically recommended during the acute
phase, followed by gradual ambulation as the condition improves.
6. A nurse is teaching a client with heart failure about the purpose of taking
furosemide. Which of the following statements by the client indicates an
understanding of the teaching?
● A. "This medication helps my heart pump better."
● B. "This medication helps reduce my blood pressure."
● C. "This medication reduces extra fluid in my lungs."
● D. "This medication lowers my potassium level."
Answer: C. "This medication reduces extra fluid in my lungs."
Explanation: Furosemide is a loop diuretic that helps remove excess fluid from the body, which
can accumulate in the lungs in clients with heart failure. This reduces symptoms like dyspnea. It
does lower blood pressure but the main goal in heart failure is reducing fluid overload.
7. A client is being discharged after treatment for a myocardial infarction
(MI). Which of the following instructions should the nurse include?
● A. Engage in physical activity to the point of discomfort.
● B. Begin cardiac rehabilitation at home.
● C. Report any chest pain that does not subside with rest.
● D. Increase sodium intake to prevent hypotension.
Answer: C. Report any chest pain that does not subside with rest.
Explanation: Clients recovering from an MI should immediately report chest pain that does not
subside with rest or is relieved by nitroglycerin. This could indicate another ischemic event.
Cardiac rehabilitation should be supervised, and sodium intake is typically restricted to manage
blood pressure and fluid retention.
, 8. A nurse is caring for a client with end-stage renal disease (ESRD)
receiving hemodialysis. Which dietary restriction should the nurse
reinforce?
● A. Increase calcium intake.
● B. Limit phosphorus intake.
● C. Increase potassium intake.
● D. Limit protein intake.
Answer: B. Limit phosphorus intake.
Explanation: Clients with ESRD should limit their phosphorus intake because their kidneys
cannot adequately excrete it, leading to hyperphosphatemia. High phosphorus levels can cause
calcium to leach from bones, leading to bone disease. Potassium and protein intake are also
restricted, but phosphorus restriction is crucial due to its impact on bone health.
9. A client is admitted with exacerbation of chronic obstructive pulmonary
disease (COPD). Which arterial blood gas (ABG) results would the nurse
expect?
● A. pH 7.30, PaCO2 60 mm Hg, HCO3 26 mEq/L
● B. pH 7.48, PaCO2 32 mm Hg, HCO3 24 mEq/L
● C. pH 7.45, PaCO2 40 mm Hg, HCO3 22 mEq/L
● D. pH 7.35, PaCO2 45 mm Hg, HCO3 28 mEq/L
Answer: A. pH 7.30, PaCO2 60 mm Hg, HCO3 26 mEq/L
Explanation: Clients with COPD often have respiratory acidosis due to CO2 retention, as they
cannot effectively eliminate CO2. A low pH and elevated PaCO2 (above 45 mm Hg) indicate
acidosis. The bicarbonate (HCO3) level may be normal or slightly elevated as compensation.
10. A nurse is caring for a client with a new diagnosis of diabetes mellitus.
Which of the following should the nurse teach the client regarding insulin
administration?
● A. Inject insulin into a muscle for faster absorption.
● B. Rotate injection sites to prevent lipodystrophy.
● C. Administer insulin when blood glucose is less than 70 mg/dL.
● D. Shake the insulin vial before withdrawing a dose.
Answer: B. Rotate injection sites to prevent lipodystrophy.
Explanation: Rotating injection sites helps prevent lipodystrophy, a condition where the skin
becomes hardened or develops lumps due to repeated insulin injections in the same spot.
