1|Page
ATI MEDICAL SURGICAL PROCTORED EXAM 2025-2026 WITH
NGN QUESTIONS AND CORRECT ANSWERS 100% Top Score,
ALREADY GRADED A+
Q1. A patient with diabetic ketoacidosis (DKA) presents with deep, rapid
respirations, fruity breath odor, and confusion. Which acid-base disturbance
is most consistent with these findings?
A. Metabolic alkalosis with respiratory compensation
B. Respiratory acidosis from hypoventilation
C. Metabolic acidosis with an increased anion gap
D. Normal anion gap metabolic acidosis
Rationale: DKA is characterized by accumulation of ketoacids causing
metabolic acidosis and an increased anion gap; the body compensates with
Kussmaul respirations (deep, rapid breathing) and fruity (acetone) breath.
Respiratory acidosis results from hypoventilation, not hyperventilation, and
metabolic alkalosis is the opposite disturbance. Normal anion gap metabolic
acidosis (hyperchloremic) is typically due to bicarbonate losses, not ketoacid
,2|Page
accumulation, so the clinical picture here fits metabolic acidosis with an
increased anion gap.
Q2. Which electrolyte abnormality most commonly causes peaked T waves
and widened QRS complexes on ECG when severe?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Rationale: Severe hyperkalemia affects cardiac conduction and
repolarization, producing classic ECG changes such as peaked (tall, narrow)
T waves and progressive widening of the QRS complex, which can progress
to ventricular fibrillation. Hypokalemia causes flattened T waves and U
waves. Calcium and sodium disturbances have different ECG correlates;
hypernatremia does not classically cause these specific ECG findings.
Q3. A 65-year-old smoker develops progressive dyspnea and a barrel-
shaped chest. Pulmonary function testing shows increased total lung
capacity and increased residual volume. Which diagnosis is most likely?
A. Pulmonary fibrosis
B. Emphysema (COPD - emphysematous phenotype)
,3|Page
C. Pulmonary embolism
D. Acute bronchitis
Rationale: Emphysema produces airspace enlargement and loss of elastic
recoil, creating air trapping and hyperinflation with increased total lung
capacity and increased residual volume; the classic barrel chest and
progressive dyspnea fit emphysema. Pulmonary fibrosis would show
reduced lung volumes (restrictive pattern). Pulmonary embolism causes
acute dyspnea and perfusion defects but not chronic hyperinflation. Acute
bronchitis is transient and does not produce those chronic PFT changes.
Q4. Which mechanism best explains peripheral edema in right-sided heart
failure?
A. Increased oncotic pressure in capillaries
B. Decreased interstitial hydrostatic pressure
C. Elevated systemic venous hydrostatic pressure leading to fluid
transudation
D. Increased lymphatic drainage
Rationale: Right-sided heart failure causes blood to back up into the
systemic venous circulation, increasing venous and capillary hydrostatic
pressure and forcing fluid into the interstitium, producing peripheral edema.
, 4|Page
Increased oncotic pressure or increased lymphatic drainage would reduce
edema. Decreased interstitial hydrostatic pressure would not favor fluid
accumulation.
Q5. Which lab value pattern is most typical of primary hypothyroidism?
A. Low TSH, high free T4
B. High TSH, low free T4
C. Low TSH, low free T4
D. High TSH, high free T4
Rationale: In primary hypothyroidism the dysfunctional thyroid gland
produces insufficient T4/T3, leading to low free T4 levels; the pituitary
responds by increasing TSH secretion, so the typical pattern is high TSH and
low free T4. Low TSH with low free T4 would suggest secondary/central
hypothyroidism. High TSH and high free T4 are inconsistent with
hypothyroidism.
Q6. A patient with chronic kidney disease develops fatigue, pallor, and a
hemoglobin of 8 g/dL. Which pathophysiologic mechanism most likely
explains the anemia?
A. Iron overload from reduced excretion
B. Decreased erythropoietin production by failing kidneys
ATI MEDICAL SURGICAL PROCTORED EXAM 2025-2026 WITH
NGN QUESTIONS AND CORRECT ANSWERS 100% Top Score,
ALREADY GRADED A+
Q1. A patient with diabetic ketoacidosis (DKA) presents with deep, rapid
respirations, fruity breath odor, and confusion. Which acid-base disturbance
is most consistent with these findings?
A. Metabolic alkalosis with respiratory compensation
B. Respiratory acidosis from hypoventilation
C. Metabolic acidosis with an increased anion gap
D. Normal anion gap metabolic acidosis
Rationale: DKA is characterized by accumulation of ketoacids causing
metabolic acidosis and an increased anion gap; the body compensates with
Kussmaul respirations (deep, rapid breathing) and fruity (acetone) breath.
Respiratory acidosis results from hypoventilation, not hyperventilation, and
metabolic alkalosis is the opposite disturbance. Normal anion gap metabolic
acidosis (hyperchloremic) is typically due to bicarbonate losses, not ketoacid
,2|Page
accumulation, so the clinical picture here fits metabolic acidosis with an
increased anion gap.
Q2. Which electrolyte abnormality most commonly causes peaked T waves
and widened QRS complexes on ECG when severe?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Rationale: Severe hyperkalemia affects cardiac conduction and
repolarization, producing classic ECG changes such as peaked (tall, narrow)
T waves and progressive widening of the QRS complex, which can progress
to ventricular fibrillation. Hypokalemia causes flattened T waves and U
waves. Calcium and sodium disturbances have different ECG correlates;
hypernatremia does not classically cause these specific ECG findings.
Q3. A 65-year-old smoker develops progressive dyspnea and a barrel-
shaped chest. Pulmonary function testing shows increased total lung
capacity and increased residual volume. Which diagnosis is most likely?
A. Pulmonary fibrosis
B. Emphysema (COPD - emphysematous phenotype)
,3|Page
C. Pulmonary embolism
D. Acute bronchitis
Rationale: Emphysema produces airspace enlargement and loss of elastic
recoil, creating air trapping and hyperinflation with increased total lung
capacity and increased residual volume; the classic barrel chest and
progressive dyspnea fit emphysema. Pulmonary fibrosis would show
reduced lung volumes (restrictive pattern). Pulmonary embolism causes
acute dyspnea and perfusion defects but not chronic hyperinflation. Acute
bronchitis is transient and does not produce those chronic PFT changes.
Q4. Which mechanism best explains peripheral edema in right-sided heart
failure?
A. Increased oncotic pressure in capillaries
B. Decreased interstitial hydrostatic pressure
C. Elevated systemic venous hydrostatic pressure leading to fluid
transudation
D. Increased lymphatic drainage
Rationale: Right-sided heart failure causes blood to back up into the
systemic venous circulation, increasing venous and capillary hydrostatic
pressure and forcing fluid into the interstitium, producing peripheral edema.
, 4|Page
Increased oncotic pressure or increased lymphatic drainage would reduce
edema. Decreased interstitial hydrostatic pressure would not favor fluid
accumulation.
Q5. Which lab value pattern is most typical of primary hypothyroidism?
A. Low TSH, high free T4
B. High TSH, low free T4
C. Low TSH, low free T4
D. High TSH, high free T4
Rationale: In primary hypothyroidism the dysfunctional thyroid gland
produces insufficient T4/T3, leading to low free T4 levels; the pituitary
responds by increasing TSH secretion, so the typical pattern is high TSH and
low free T4. Low TSH with low free T4 would suggest secondary/central
hypothyroidism. High TSH and high free T4 are inconsistent with
hypothyroidism.
Q6. A patient with chronic kidney disease develops fatigue, pallor, and a
hemoglobin of 8 g/dL. Which pathophysiologic mechanism most likely
explains the anemia?
A. Iron overload from reduced excretion
B. Decreased erythropoietin production by failing kidneys
