ATI PN Med Surg Proctored Exam 2026 — Adult Medical Surgical Questions with Answers and Explanations

About the ATI PN Med Surg Proctored Exam 2026

The ATI PN Adult Medical Surgical proctored assessment measures how well practical nursing students apply med-surg knowledge to real client situations. It is less about memorizing disease definitions and more about recognizing complications, choosing safe interventions, reinforcing client teaching and knowing when a finding must be reported to the RN or provider.

Most PN programs give the exam at the end of the adult health or med-surg course. The result is often a course requirement, and it gives your program an early view of how ready you are for the PN Comprehensive Predictor and the NCLEX-PN. Because it is proctored, you take it on a secure browser under supervision, either on campus or through remote proctoring, depending on your school.

Item count, time limit and the level you need are set by ATI and your program, and they can change between versions. Check your syllabus or ATI student account for your exact requirements.

How this practice test is built

These 100 questions are original practice items modeled on the content and style of the ATI PN Adult Medical Surgical assessment. They are not actual exam questions. Each one is written for the LPN/LVN scope of practice, so answers focus on data collection, reinforcing teaching, safe care and timely reporting rather than RN-only actions such as initial assessment or independent care planning.

How the ATI Med Surg Proctored Exam Is Scored

ATI does not report a simple pass or fail. It converts your score into a proficiency level:

Your score report also breaks results down by topic and lists the areas to review. Use that list alongside the rationales in this practice test: if the report flags “fluid and electrolyte imbalances,” go back to every question in that area and reread why each wrong option is wrong.

For a full explanation of ATI levels, retakes and remediation, see our ATI proctored exam guide.

Body Systems Covered: High-Yield ATI Med Surg Topics

These are the topics that show up again and again in PN med-surg questions. For each system, the “report immediately” list covers the findings the exam most often expects you to recognize.

Respiratory

• COPD: low-flow oxygen as prescribed (often a target SpO2 of 88–92%), pursed-lip breathing, tripod positioning, small frequent high-calorie meals
• Pneumonia: coughing and deep breathing, incentive spirometer, fluids, early ambulation
• Tuberculosis: airborne precautions, N95 respirator, negative-pressure room, long-term medication adherence
• Chest tubes: tidaling in the water seal is expected; continuous bubbling in the water seal suggests an air leak; if the tube disconnects, place the end in sterile water and notify the RN

Cardiovascular

• Heart failure: daily weights at the same time with the same scale, sodium and fluid restriction, reporting a gain of more than 2–3 lb in a day or 5 lb in a week
• Myocardial infarction: chest pain that radiates, diaphoresis, nausea; women and older adults may have atypical symptoms such as fatigue
• Hypertension: correct cuff size, lifestyle teaching, orthostatic precautions with new medications
• Deep vein thrombosis: unilateral calf swelling and warmth; never massage the leg; prevention with ambulation and compression devices
• Peripheral arterial vs. venous disease: arterial means pain with walking, pale cool skin, and legs kept dependent; venous means edema, brown discoloration, and legs elevated

Endocrine

• Diabetes: blood glucose monitoring, insulin types and peak times, foot care, sick-day rules (keep taking insulin, check glucose more often)
• Hypoglycemia: shaky, sweaty, confused; follow the 15-15 rule (15 g fast-acting carbohydrate, recheck in 15 minutes)
• DKA vs. HHS: DKA involves ketones, acidosis and Kussmaul respirations; HHS involves extreme hyperglycemia and dehydration without significant ketosis
• Thyroid: hypothyroidism is slow (fatigue, cold intolerance, weight gain); hyperthyroidism is fast (tachycardia, heat intolerance, weight loss)
• Adrenal: Addison’s disease (low cortisol, risk of crisis) vs. Cushing’s syndrome (high cortisol, infection risk, hyperglycemia); never stop long-term steroids abruptly

Neurological

• Stroke: recognize signs with the FAST acronym, note the time last known well, check swallowing before any oral intake
• Increased intracranial pressure: head of bed elevated about 30 degrees, head midline, avoid hip flexion and straining; late signs include Cushing’s triad
• Seizures: side-lying position, protect the head, nothing in the mouth, do not restrain, time the seizure
• Parkinson’s disease: fall prevention, aspiration risk, medication timing
• Spinal cord injury: autonomic dysreflexia (sit the client up, find the trigger, often a full bladder)

Gastrointestinal and Hepatic

• GI bleeding: coffee-ground emesis, black tarry stools, falling blood pressure with rising heart rate
• Bowel obstruction: distension, vomiting, NPO, nasogastric tube to suction
• Ostomy care: a healthy stoma is pink or red and moist; a dusky, purple or black stoma must be reported
• Cirrhosis: bleeding risk, ascites, lactulose to lower ammonia, watching for confusion
• Pancreatitis: severe epigastric pain radiating to the back, NPO, pain control

Renal and Urinary

• Acute kidney injury and chronic kidney disease: intake and output, daily weights, fluid, potassium and phosphorus restrictions
• Dialysis access: feel for a thrill and listen for a bruit over an AV fistula; no blood pressures or needle sticks on that arm
• UTI: fluids, completing the full antibiotic course, confusion as an early sign in older adults
• Urinary catheters: keep the bag below the bladder, perineal care, remove as early as possible to prevent infection

Oncology and Immunity

• Neutropenia: private room, strict hand hygiene, no fresh flowers or raw fruits and vegetables, report a temperature of 100.4°F (38°C) or higher
• Thrombocytopenia: bleeding precautions, electric razor, soft toothbrush, no IM injections when possible
• Chemotherapy and radiation: safe handling, skin care over the radiation site, mouth care, nausea management

Perioperative Care

• Preoperative: verify consent is signed, NPO status, remove jewelry and dentures, teach incentive spirometer use
• Postoperative: airway first, vital signs, pain control, incentive spirometer about 10 times an hour while awake, early ambulation
• Wound dehiscence or evisceration: cover with sterile saline-moistened dressing, low Fowler’s position with knees bent, stay with the client and notify immediately

Musculoskeletal

• Hip replacement: hip precautions (no flexion past 90 degrees, no crossing legs, abduction pillow as ordered)
• Casts and traction: neurovascular checks (the 6 Ps), weights hang freely
• Compartment syndrome: pain out of proportion to the injury, not relieved by medication; report at once

Must-Know Lab Values for the ATI PN Med Surg Exam

ATI does not ask you to recite reference ranges, but it does ask you to interpret a result and decide what the nurse should do. Know these cold:

Study tip: for every lab in this table, ask yourself: “If the result is high, what do I do? If it is low, what do I do?” That is exactly how ATI frames the question.

High-Alert Medications You Must Know

These are the drugs that ATI tests most heavily because errors carry serious harm.

Prioritization and PN Scope of Practice

Prioritization questions are among the most commonly missed on the ATI PN Med Surg exam. The trick is to combine ABCs, Maslow and the concept of “who is most unstable?”

How to approach a prioritization question

1. Airway > Breathing > Circulation. If one option addresses an airway or breathing concern, that is almost always the priority.
2. Unstable over stable. A client whose vital signs are changing or whose condition is new takes priority over a client with expected post-operative findings.
3. Acute over chronic. New onset chest pain takes priority over a client who has had stable COPD for years.
4. Actual over risk. A client who is actively bleeding takes priority over one who is at risk for bleeding.

PN scope on ATI

On every question, the correct answer stays within LPN/LVN scope:

• The LPN collects data (vital signs, focused observations) but does not perform the initial comprehensive assessment.
• The LPN reinforces teaching that the RN has already initiated. The LPN does not create new teaching plans.
• The LPN provides care to stable clients with predictable outcomes. Unstable or newly admitted clients need the RN.
• The LPN reports changes to the RN or provider. If an answer choice says “assess the client,” check whether a simpler “collect data” or “notify the RN” option is available.

Sample Questions Explained

Each example below shows the kind of reasoning ATI expects. Read the rationale even if you get the answer right, because the exam often tests the same concept from a different angle.

Study Plans: 4 Weeks and 2 Weeks

4-week plan

2-week plan

Regardless of the plan you choose: read every rationale, even for questions you answer correctly. ATI often tests the same concept from a different angle, and the rationale explains the reasoning that transfers to unfamiliar questions.

Common Mistakes to Avoid on the ATI Med Surg Exam

1. Choosing the RN action instead of the PN action. If an option says “assess the client’s cardiac rhythm,” check whether “take the client’s vital signs and report” is also available.
2. Picking the first thing that sounds right. Read all four options before choosing. ATI designs distractors to be plausible.
3. Ignoring the word ‘first.’ When the question says “which action should the nurse take first,” more than one option may be correct eventually, but only one is the priority.
4. Mixing up lab values. Know whether a value is high or low and what the nurse does about it. Do not confuse hyper- and hypo- conditions.
5. Forgetting to report. PN-scope questions almost always have a “notify the RN” or “notify the provider” option for abnormal or unstable findings. That is usually correct.
6. Skipping the rationale. Understanding why each wrong answer is wrong builds the reasoning you need for questions you have never seen before.

Test-Day Strategies

• Pace yourself. Divide the total time by the number of questions. If you have 90 minutes for 60 questions, that is 1.5 minutes per question. If you are stuck, flag it and move on.
• Read the stem carefully. Look for keywords: “first,” “priority,” “most important,” “immediately.” These change the correct answer.
• Eliminate obviously wrong options. Even if you are unsure, removing one or two distractors sharply improves your odds.
• Do not change your answer unless you have a clear reason. First instincts are right more often than not.
• If two options look equal, pick the one that keeps the client safest. Safety is always the ATI default.
• Take your final practice run 2 days before the exam, not the night before. The last day should be light review and rest.

Med-Surg Glossary: Terms You Will See on the Exam

Orthostatic hypotension

A drop in blood pressure when moving from lying to sitting or standing, causing dizziness.

Kussmaul respirations

Deep, rapid breathing the body uses to blow off CO2 during metabolic acidosis (classic DKA sign).

Chvostek sign

Facial twitching when the cheek is tapped, indicating low calcium.

Trousseau sign

Carpal spasm when a blood pressure cuff is inflated on the arm, also indicating low calcium.

Cushing’s triad

Hypertension, bradycardia and irregular respirations, a late sign of increased intracranial pressure.

Autonomic dysreflexia

Life-threatening hypertension triggered by a stimulus below a spinal cord injury, often a full bladder.

Hematemesis

Vomiting blood. If it looks like coffee grounds, the blood has been partially digested.

Melena

Black, tarry stool caused by upper GI bleeding.

Hematuria

Blood in the urine. Can be visible (gross) or microscopic.

Diaphoresis

Profuse sweating, often seen with MI, hypoglycemia or pain.

Atelectasis

Partial lung collapse, usually post-operative. Prevented by incentive spirometer use.

Dehiscence

Wound edges separating after surgery.

Evisceration

Abdominal organs protruding through a dehisced wound. Cover with sterile saline-soaked dressing and call for help.

Related Practice Exams

Studying for more than one ATI exam? These practice tests cover related nursing content areas. Also see the 2023 PN Med Surg edition if your program still uses that version.