ATI Adult Medical Surgical Proctored Exam

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Sample questions from ATI Adult Medical Surgical Proctored Exam

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client in the emergency department has crushing chest pain, diaphoresis, and nausea. Blood pressure is 86/54 mm Hg, heart rate is 112/min, and ECG shows ST elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Administer sublingual nitroglycerin
   • B.Establish IV access and notify the cardiac catheterization team
   • C.Obtain a fasting lipid panel
   • D.Place the client in a chair and encourage slow breathing

   Rationale: The client has an acute inferior STEMI with hypotension, so rapid reperfusion preparation and IV access are priorities. Nitroglycerin can worsen hypotension, making option A unsafe. A lipid panel is appropriate later but does not address the immediate threat, and breathing exercises do not treat the infarction. In suspected STEMI, prioritize stabilization and timely reperfusion.

2. 2.A 74-year-old client on a medical unit has sudden dyspnea and pleuritic chest pain 2 days after hip surgery. Oxygen saturation is 84% on room air, heart rate is 126/min, and blood pressure is 104/68 mm Hg. Which action should the nurse take first?

   • A.Apply oxygen and activate the rapid response system
   • B.Massage the operative leg to reduce discomfort
   • C.Encourage the client to walk to improve circulation
   • D.Obtain a sputum culture before intervening

   Rationale: Acute hypoxemia and tachycardia after surgery suggest pulmonary embolism, so oxygen and urgent escalation are required. Massaging the leg could dislodge a thrombus. Ambulation is unsafe during acute respiratory distress, and a sputum culture does not address the immediate problem. Stabilize breathing and summon help before pursuing diagnostics.

3. 3.A 59-year-old client with type 1 diabetes is admitted with vomiting and abdominal pain. Glucose is 486 mg/dL, pH is 7.18, potassium is 5.6 mEq/L, and serum ketones are positive. After initiating isotonic IV fluids, which prescription should the nurse anticipate?

   • A.IV regular insulin infusion with frequent potassium monitoring
   • B.IV potassium chloride bolus before insulin
   • C.Subcutaneous long-acting insulin as the only treatment
   • D.Sodium bicarbonate for every client with this pH

   Rationale: The findings indicate diabetic ketoacidosis, treated with fluids and IV regular insulin while closely monitoring potassium. A potassium bolus is not appropriate with an initially elevated serum potassium and requires repeat laboratory guidance. Long-acting subcutaneous insulin alone is inadequate for acute DKA, and bicarbonate is not routine at this pH. DKA treatment requires coordinated fluid, insulin, and electrolyte management.

4. 4.A 72-year-old client with chronic kidney disease reports weakness and palpitations. The ECG shows peaked T waves; potassium is 6.8 mEq/L. Which prescribed medication should the nurse administer first?

   • A.Sodium polystyrene sulfonate by mouth
   • B.IV calcium gluconate
   • C.Oral potassium chloride
   • D.IV furosemide

   Answer and rationale are in the full material.

5. 5.A 66-year-old client with COPD is admitted for an exacerbation and is drowsy but arousable. Respiratory rate is 10/min, oxygen saturation is 86% on room air, and arterial blood gas shows pH 7.29, PaCO2 68 mm Hg, and PaO2 54 mm Hg. Which action should the nurse take?

   • A.Apply controlled oxygen and notify the provider about possible ventilatory support
   • B.Withhold oxygen until the PaCO2 returns to normal
   • C.Place the client flat to conserve energy
   • D.Give a sedative to reduce respiratory effort

   Answer and rationale are in the full material.