ATI Med-Surg Proctored Exam Prep (200
Questions & Correct Answers with Rationales
Already Graded A+) | Next-Gen NCLEX (NGN)
Case Studies | 2026 Updated
Pass your ATI Adult Medical-Surgical Proctored Exam with a Level 2 or 3 using
this ultimate study pack! Includes 200 high-yield practice questions spanning
critical systems: Cardiovascular, Respiratory, Endocrine, GI, and Renal. Master
the Next-Generation NCLEX (NGN) format with detailed clinical case studies.
Each question features clear, in-depth rationales based on priority frameworks
like ABCs and Maslow’s hierarchy. Perfect for quick reviews and breaking
through testing anxiety!
,Question 1
A nurse is reviewing the ECG of a client experiencing an acute myocardial infarction. Which of
the following ECG changes indicates myocardial injury?
A) ST segment depression
B) T wave inversion
C) ST segment elevation
D) Pathological Q wave
Rationale: ST segment elevation is a primary indicator of myocardial injury. ST depression and
T wave inversion indicate ischemia. A pathological Q wave indicates old tissue death or
necrosis.
Question 2
A nurse is assessing a client with left-sided heart failure. Which of the following assessment
findings should the nurse expect?
A) Dependent edema
B) Jugular vein distention
C) Frothy, blood-tinged sputum
D) Hepatomegaly
Rationale: Left-sided heart failure causes fluid to back up into the lungs. This leads to
pulmonary edema, which causes frothy, blood-tinged sputum. Edema, jugular vein distention,
and hepatomegaly are signs of right-sided heart failure.
Question 3
A nurse is providing discharge teaching to a client prescribed lisinopril. Which of the following
instructions should the nurse include in the teaching?
A) "Avoid foods high in potassium while taking this medication."
B) "Change positions slowly when getting out of bed."
C) "Take the medication with an antacid to prevent stomach upset."
D) "Monitor your heart rate and do not take if it is below 60."
Rationale: Lisinopril is an ACE inhibitor. It can cause orthostatic hypotension. Clients must
change positions slowly to prevent dizziness. It can also cause high potassium levels, so clients
should not avoid it without reason. Digoxin or beta-blockers require checking the pulse.
Question 4
,A nurse is caring for a client who just had a permanent pacemaker inserted. Which of the
following interventions is the priority for the nurse?
A) Encourage range-of-motion exercises for the affected arm.
B) "Assess the insertion site for bleeding and hematoma."
C) Apply a heating pad to the incision site for pain relief.
D) Instruct the client to never use a microwave.
Rationale: Checking the site for bleeding is the priority to catch bleeding issues early. Moving
the arm too much can pull out the pacemaker wires. Modern pacemakers are safe around
microwaves.
Question 5
A nurse is assessing a client with peripheral arterial disease (PAD). Which of the following
findings should the nurse expect?
A) Brownish discoloration of the lower extremities
B) Brawny edema around the ankles
C) Thick, leathery skin
D) Intermittent claudication
Rationale: Intermittent claudication is muscle pain that happens during walk or exercise and
goes away with rest. It is a classic sign of PAD due to poor blood flow. The other options are
signs of venous disease.
Question 6
A nurse is caring for a client with infective endocarditis. Which of the following findings is a
priority to report to the provider?
A) Fever
B) Joint pain
C) New or changing heart murmur
D) Splinter hemorrhages on the nail beds
Rationale: A new or changing heart murmur means the infection is damaging the heart
valves. This is a critical issue that must be reported. Fever, joint pain, and nail streaks are
expected with this infection.
Question 7
A nurse is teaching a client with angina about administering sublingual nitroglycerin tablets.
Which of the following client statements indicates an understanding of the teaching?
A) "I should take a tablet every 5 minutes for up to five doses."
B) "I should swallow the tablet whole with a glass of water."
, C) "I will keep the tablets in a clear plastic bag in my purse."
D) "If the first tablet does not relieve the pain, I will call emergency services after taking a
second tablet."
Rationale: The proper steps are to take one tablet. If pain stays after 5 minutes, call
emergency services and take a second tablet. Do not take more than three tablets total. The
pills must dissolve under the tongue and stay in a dark glass bottle to work.
Respiratory System
Question 8
A nurse is caring for a client who has a chest tube connected to a water-seal drainage system.
The nurse notes continuous bubbling in the water-seal chamber. Which of the following actions
should the nurse take?
A) Check the system for an air leak.
B) Turn up the suction wall gauge.
C) Check the system for an air leak.
D) Milk the chest tube to clear clots.
Rationale: Continuous bubbling in the water-seal chamber means there is an air leak in the
system. Intermittent bubbling is normal during breathing out or coughing. Turning up the
suction or milking the tube will not fix an air leak.
Question 9
A nurse is assessing a client who has a new diagnosis of acute respiratory distress syndrome
(ARDS). Which of the following clinical findings should the nurse expect?
A) Refractory hypoxemia
B) Increased lung compliance
C) Respiratory alkalosis on early ABGs
D) Decreased pulmonary artery pressure
Rationale: Refractory hypoxemia means low oxygen levels that do not improve even when
giving high levels of oxygen. This is the main sign of ARDS. Lung compliance drops as lungs
get stiff.
Question 10
A nurse is planning care for a client who is postoperative following a total laryngectomy. Which
of the following interventions is the priority?
A) Place the client in a semi-Fowler's position.
Questions & Correct Answers with Rationales
Already Graded A+) | Next-Gen NCLEX (NGN)
Case Studies | 2026 Updated
Pass your ATI Adult Medical-Surgical Proctored Exam with a Level 2 or 3 using
this ultimate study pack! Includes 200 high-yield practice questions spanning
critical systems: Cardiovascular, Respiratory, Endocrine, GI, and Renal. Master
the Next-Generation NCLEX (NGN) format with detailed clinical case studies.
Each question features clear, in-depth rationales based on priority frameworks
like ABCs and Maslow’s hierarchy. Perfect for quick reviews and breaking
through testing anxiety!
,Question 1
A nurse is reviewing the ECG of a client experiencing an acute myocardial infarction. Which of
the following ECG changes indicates myocardial injury?
A) ST segment depression
B) T wave inversion
C) ST segment elevation
D) Pathological Q wave
Rationale: ST segment elevation is a primary indicator of myocardial injury. ST depression and
T wave inversion indicate ischemia. A pathological Q wave indicates old tissue death or
necrosis.
Question 2
A nurse is assessing a client with left-sided heart failure. Which of the following assessment
findings should the nurse expect?
A) Dependent edema
B) Jugular vein distention
C) Frothy, blood-tinged sputum
D) Hepatomegaly
Rationale: Left-sided heart failure causes fluid to back up into the lungs. This leads to
pulmonary edema, which causes frothy, blood-tinged sputum. Edema, jugular vein distention,
and hepatomegaly are signs of right-sided heart failure.
Question 3
A nurse is providing discharge teaching to a client prescribed lisinopril. Which of the following
instructions should the nurse include in the teaching?
A) "Avoid foods high in potassium while taking this medication."
B) "Change positions slowly when getting out of bed."
C) "Take the medication with an antacid to prevent stomach upset."
D) "Monitor your heart rate and do not take if it is below 60."
Rationale: Lisinopril is an ACE inhibitor. It can cause orthostatic hypotension. Clients must
change positions slowly to prevent dizziness. It can also cause high potassium levels, so clients
should not avoid it without reason. Digoxin or beta-blockers require checking the pulse.
Question 4
,A nurse is caring for a client who just had a permanent pacemaker inserted. Which of the
following interventions is the priority for the nurse?
A) Encourage range-of-motion exercises for the affected arm.
B) "Assess the insertion site for bleeding and hematoma."
C) Apply a heating pad to the incision site for pain relief.
D) Instruct the client to never use a microwave.
Rationale: Checking the site for bleeding is the priority to catch bleeding issues early. Moving
the arm too much can pull out the pacemaker wires. Modern pacemakers are safe around
microwaves.
Question 5
A nurse is assessing a client with peripheral arterial disease (PAD). Which of the following
findings should the nurse expect?
A) Brownish discoloration of the lower extremities
B) Brawny edema around the ankles
C) Thick, leathery skin
D) Intermittent claudication
Rationale: Intermittent claudication is muscle pain that happens during walk or exercise and
goes away with rest. It is a classic sign of PAD due to poor blood flow. The other options are
signs of venous disease.
Question 6
A nurse is caring for a client with infective endocarditis. Which of the following findings is a
priority to report to the provider?
A) Fever
B) Joint pain
C) New or changing heart murmur
D) Splinter hemorrhages on the nail beds
Rationale: A new or changing heart murmur means the infection is damaging the heart
valves. This is a critical issue that must be reported. Fever, joint pain, and nail streaks are
expected with this infection.
Question 7
A nurse is teaching a client with angina about administering sublingual nitroglycerin tablets.
Which of the following client statements indicates an understanding of the teaching?
A) "I should take a tablet every 5 minutes for up to five doses."
B) "I should swallow the tablet whole with a glass of water."
, C) "I will keep the tablets in a clear plastic bag in my purse."
D) "If the first tablet does not relieve the pain, I will call emergency services after taking a
second tablet."
Rationale: The proper steps are to take one tablet. If pain stays after 5 minutes, call
emergency services and take a second tablet. Do not take more than three tablets total. The
pills must dissolve under the tongue and stay in a dark glass bottle to work.
Respiratory System
Question 8
A nurse is caring for a client who has a chest tube connected to a water-seal drainage system.
The nurse notes continuous bubbling in the water-seal chamber. Which of the following actions
should the nurse take?
A) Check the system for an air leak.
B) Turn up the suction wall gauge.
C) Check the system for an air leak.
D) Milk the chest tube to clear clots.
Rationale: Continuous bubbling in the water-seal chamber means there is an air leak in the
system. Intermittent bubbling is normal during breathing out or coughing. Turning up the
suction or milking the tube will not fix an air leak.
Question 9
A nurse is assessing a client who has a new diagnosis of acute respiratory distress syndrome
(ARDS). Which of the following clinical findings should the nurse expect?
A) Refractory hypoxemia
B) Increased lung compliance
C) Respiratory alkalosis on early ABGs
D) Decreased pulmonary artery pressure
Rationale: Refractory hypoxemia means low oxygen levels that do not improve even when
giving high levels of oxygen. This is the main sign of ARDS. Lung compliance drops as lungs
get stiff.
Question 10
A nurse is planning care for a client who is postoperative following a total laryngectomy. Which
of the following interventions is the priority?
A) Place the client in a semi-Fowler's position.
