ATI PN MED SURG PROCTORED Exam Test Bank:
200 Questions + Verified Answers +
Comprehensive Rationales – Pass On Your First
Attempt
Question 1
A nurse is caring for a client who is 2 days post-operative following a below-the-
knee amputation. The client reports severe pain in the toes of the affected limb.
Which of the following responses by the nurse is most appropriate?
A. "This is a sign of a complication called neuroma formation."
B. "I will re-evaluate your pain in 30 minutes."
C. "The pain you are feeling is real and is often called phantom limb pain."
D. "Let me elevate your residual limb to reduce swelling."
Correct Answer: C
Rationale: Phantom limb pain is a real and common phenomenon following
amputation where the client feels pain in the missing limb. The nurse should first
validate the client's experience. (A) Neuroma is a possible cause of residual limb
pain, but the description (pain in the toes of the missing foot) is classic for
phantom pain. (B) Delaying re-evaluation dismisses the client's pain. (D) Elevation
is for edema, not phantom pain.
Question 2
A nurse is providing teaching to a client with heart failure who has a new
prescription for furosemide. Which of the following statements by the client
indicates an understanding of the teaching?
A. "I will take this medication before I go to bed each night."
B. "I should expect to have a persistent, dry cough."
C. "I will weigh myself at the same time each morning."
1|Page
, D. "I can continue to use salt substitutes on my food."
Correct Answer: C
Rationale: Daily weights are the most sensitive indicator of fluid volume status.
Clients should weigh themselves at the same time, on the same scale, with the
same amount of clothing, preferably before breakfast. (A) Furosemide should be
taken in the morning to avoid nocturia disrupting sleep. (B) Persistent dry cough is
associated with ACE inhibitors, not loop diuretics. (D) Salt substitutes contain
potassium, and furosemide is potassium-wasting; however, clients with heart
failure are often on potassium-sparing meds or have renal issues, making this
dangerous without specific provider guidance.
Question 3
A client with chronic obstructive pulmonary disease (COPD) has a new
prescription for home oxygen therapy at 2 L/min via nasal cannula. Which of the
following statements by the client indicates a need for further teaching?
A. "I can use my electric blanket while my oxygen is on."
B. "I will check the water level in my humidifier bottle daily."
C. "I should avoid using petroleum jelly on my lips or nose."
D. "I know that smoking is the most common cause of my COPD."
Correct Answer: A
Rationale: Using an electric blanket (or any electrical appliance that can create a
spark) while oxygen is in use creates a severe fire risk. Oxygen supports
combustion. (B) Keeping the humidifier filled prevents dryness and cracking of
nasal mucosa. (C) Petroleum-based products can ignite in the presence of oxygen;
water-based lubricants are recommended. (D) This is a factual statement and
shows understanding, though not directly related to oxygen safety.
Question 4
A nurse is assessing a client who is 6 hours post-operative following an open
cholecystectomy. Which of the following findings is the highest priority to report
to the provider?
A. The client's blood pressure is 144/88 mm Hg.
2|Page
, B. The client's oxygen saturation is 89% on room air.
C. The client reports pain as a 6 on a 0-10 scale.
D. The client's urinary output is 40 mL in the past 2 hours.
Correct Answer: B
Rationale: Using the ABCs (Airway, Breathing, Circulation), an oxygen saturation
of 89% indicates hypoxemia and is the priority finding. Post-operative hypoxemia
can lead to respiratory failure, atelectasis, or pneumonia. (A) BP of 144/88 is
slightly elevated but not critical. (C) Pain is important but not life-threatening. (D)
Urinary output of 40 mL in 2 hours (20 mL/hr) is below the expected 30 mL/hr but
is a lower priority than oxygenation.
Question 5
A nurse is preparing to administer a blood transfusion of packed red blood cells
(PRBCs) to a client who has anemia. Which of the following actions should the
nurse take first?
A. Verify the client's blood type and cross-match results with another nurse.
B. Prime the blood administration tubing with 0.9% sodium chloride.
C. Ask the client to state their full name and date of birth.
D. Obtain the client's baseline vital signs.
Correct Answer: C
Rationale: Patient identification is the most critical safety step in any medication
or blood administration. The nurse should use two identifiers (e.g., name, DOB,
medical record number) per the "two-person verification" process. While all steps
are important, verification of the correct client is the first and most important
step to prevent a fatal transfusion reaction.
Question 6
A client with type 2 diabetes mellitus is admitted with a blood glucose level of 650
mg/dL. The nurse notes the client is drowsy, has dry mucous membranes, and has
a fruity odor to their breath. Which of the following acid-base imbalances should
the nurse expect?
A. Respiratory acidosis
3|Page
, B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The scenario describes hyperglycemia with fruity breath (ketones),
indicating diabetic ketoacidosis (DKA). Ketones are weak acids that overwhelm
the body's buffering system, leading to a fall in blood pH, which is metabolic
acidosis. (A) Respiratory acidosis involves high CO2 due to hypoventilation. (C)
Respiratory alkalosis involves low CO2 due to hyperventilation (which can occur
as compensation for metabolic acidosis but is not the primary imbalance). (D)
Metabolic alkalosis occurs from vomiting or excessive antacid use.
Question 7
A nurse is caring for a client with a new ileostomy. Which of the following ostomy
outputs would the nurse expect to see as the client's bowel function returns?
A. Formed, brown stool every 1-2 days
B. Semi-formed, brown stool passed with gas
C. Semi-liquid, yellow-green to brown liquid
D. Liquid, dark brown output with a strong odor
Correct Answer: C
Rationale: An ileostomy is located in the small intestine (ileum). The small
intestine does not reabsorb water as efficiently as the colon, so output is
continuously semi-liquid to liquid. The color is often yellow-green (due to bile) to
brown. (A) Formed stool is typical of a sigmoid colostomy. (B) Semi-formed is
typical of a descending colostomy. (D) Liquid dark brown output with strong odor
can occur, but the hallmark of an ileostomy is the presence of digestive enzymes
and bile.
Question 8
A nurse is assessing a client who has benign prostatic hyperplasia (BPH). Which of
the following findings should the nurse expect?
A. Stress incontinence
4|Page
200 Questions + Verified Answers +
Comprehensive Rationales – Pass On Your First
Attempt
Question 1
A nurse is caring for a client who is 2 days post-operative following a below-the-
knee amputation. The client reports severe pain in the toes of the affected limb.
Which of the following responses by the nurse is most appropriate?
A. "This is a sign of a complication called neuroma formation."
B. "I will re-evaluate your pain in 30 minutes."
C. "The pain you are feeling is real and is often called phantom limb pain."
D. "Let me elevate your residual limb to reduce swelling."
Correct Answer: C
Rationale: Phantom limb pain is a real and common phenomenon following
amputation where the client feels pain in the missing limb. The nurse should first
validate the client's experience. (A) Neuroma is a possible cause of residual limb
pain, but the description (pain in the toes of the missing foot) is classic for
phantom pain. (B) Delaying re-evaluation dismisses the client's pain. (D) Elevation
is for edema, not phantom pain.
Question 2
A nurse is providing teaching to a client with heart failure who has a new
prescription for furosemide. Which of the following statements by the client
indicates an understanding of the teaching?
A. "I will take this medication before I go to bed each night."
B. "I should expect to have a persistent, dry cough."
C. "I will weigh myself at the same time each morning."
1|Page
, D. "I can continue to use salt substitutes on my food."
Correct Answer: C
Rationale: Daily weights are the most sensitive indicator of fluid volume status.
Clients should weigh themselves at the same time, on the same scale, with the
same amount of clothing, preferably before breakfast. (A) Furosemide should be
taken in the morning to avoid nocturia disrupting sleep. (B) Persistent dry cough is
associated with ACE inhibitors, not loop diuretics. (D) Salt substitutes contain
potassium, and furosemide is potassium-wasting; however, clients with heart
failure are often on potassium-sparing meds or have renal issues, making this
dangerous without specific provider guidance.
Question 3
A client with chronic obstructive pulmonary disease (COPD) has a new
prescription for home oxygen therapy at 2 L/min via nasal cannula. Which of the
following statements by the client indicates a need for further teaching?
A. "I can use my electric blanket while my oxygen is on."
B. "I will check the water level in my humidifier bottle daily."
C. "I should avoid using petroleum jelly on my lips or nose."
D. "I know that smoking is the most common cause of my COPD."
Correct Answer: A
Rationale: Using an electric blanket (or any electrical appliance that can create a
spark) while oxygen is in use creates a severe fire risk. Oxygen supports
combustion. (B) Keeping the humidifier filled prevents dryness and cracking of
nasal mucosa. (C) Petroleum-based products can ignite in the presence of oxygen;
water-based lubricants are recommended. (D) This is a factual statement and
shows understanding, though not directly related to oxygen safety.
Question 4
A nurse is assessing a client who is 6 hours post-operative following an open
cholecystectomy. Which of the following findings is the highest priority to report
to the provider?
A. The client's blood pressure is 144/88 mm Hg.
2|Page
, B. The client's oxygen saturation is 89% on room air.
C. The client reports pain as a 6 on a 0-10 scale.
D. The client's urinary output is 40 mL in the past 2 hours.
Correct Answer: B
Rationale: Using the ABCs (Airway, Breathing, Circulation), an oxygen saturation
of 89% indicates hypoxemia and is the priority finding. Post-operative hypoxemia
can lead to respiratory failure, atelectasis, or pneumonia. (A) BP of 144/88 is
slightly elevated but not critical. (C) Pain is important but not life-threatening. (D)
Urinary output of 40 mL in 2 hours (20 mL/hr) is below the expected 30 mL/hr but
is a lower priority than oxygenation.
Question 5
A nurse is preparing to administer a blood transfusion of packed red blood cells
(PRBCs) to a client who has anemia. Which of the following actions should the
nurse take first?
A. Verify the client's blood type and cross-match results with another nurse.
B. Prime the blood administration tubing with 0.9% sodium chloride.
C. Ask the client to state their full name and date of birth.
D. Obtain the client's baseline vital signs.
Correct Answer: C
Rationale: Patient identification is the most critical safety step in any medication
or blood administration. The nurse should use two identifiers (e.g., name, DOB,
medical record number) per the "two-person verification" process. While all steps
are important, verification of the correct client is the first and most important
step to prevent a fatal transfusion reaction.
Question 6
A client with type 2 diabetes mellitus is admitted with a blood glucose level of 650
mg/dL. The nurse notes the client is drowsy, has dry mucous membranes, and has
a fruity odor to their breath. Which of the following acid-base imbalances should
the nurse expect?
A. Respiratory acidosis
3|Page
, B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The scenario describes hyperglycemia with fruity breath (ketones),
indicating diabetic ketoacidosis (DKA). Ketones are weak acids that overwhelm
the body's buffering system, leading to a fall in blood pH, which is metabolic
acidosis. (A) Respiratory acidosis involves high CO2 due to hypoventilation. (C)
Respiratory alkalosis involves low CO2 due to hyperventilation (which can occur
as compensation for metabolic acidosis but is not the primary imbalance). (D)
Metabolic alkalosis occurs from vomiting or excessive antacid use.
Question 7
A nurse is caring for a client with a new ileostomy. Which of the following ostomy
outputs would the nurse expect to see as the client's bowel function returns?
A. Formed, brown stool every 1-2 days
B. Semi-formed, brown stool passed with gas
C. Semi-liquid, yellow-green to brown liquid
D. Liquid, dark brown output with a strong odor
Correct Answer: C
Rationale: An ileostomy is located in the small intestine (ileum). The small
intestine does not reabsorb water as efficiently as the colon, so output is
continuously semi-liquid to liquid. The color is often yellow-green (due to bile) to
brown. (A) Formed stool is typical of a sigmoid colostomy. (B) Semi-formed is
typical of a descending colostomy. (D) Liquid dark brown output with strong odor
can occur, but the hallmark of an ileostomy is the presence of digestive enzymes
and bile.
Question 8
A nurse is assessing a client who has benign prostatic hyperplasia (BPH). Which of
the following findings should the nurse expect?
A. Stress incontinence
4|Page
