ATI RN Medical-Surgical Proctored Exam — Study Guide, 2026 Exam & 2023 Exam

Perioperative Care

Pre-operative teaching, informed consent verification, post-operative assessment (airway, pain, wound, complications like atelectasis or DVT), and early ambulation all fall here. Questions often ask you to sequence care — what to check first after a patient returns from surgery, or which finding needs to be reported immediately versus documented and monitored.

Cardiovascular & Respiratory Disorders

This is one of the highest-yield domains: chest pain and MI recognition, cardiac biomarkers (like Troponin I), heart failure, dysrhythmias, and respiratory conditions including COPD, chest tubes, and oxygen therapy. Expect questions that give you an assessment finding and ask what it means or what to do next.

Endocrine & Metabolic Disorders

Diabetes management (including recognizing hypoglycemia vs. hyperglycemia), thyroid disorders, and adrenal conditions are tested here. A recurring pattern: a patient presents with a vague symptom (confused, clammy, unconscious) and you have to identify assessment as the first action before treating.

Renal, GI & Fluid/Electrolyte Balance

Electrolyte imbalances (especially potassium and sodium), acute kidney injury, GI bleeding, and fluid volume disorders show up constantly. Know the normal lab ranges cold and the classic signs of each imbalance — these questions reward pattern recognition more than memorization.

Emergency & Critical Care Priorities

Shock (hypovolemic, septic, cardiogenic), airway emergencies, and rapid clinical deterioration are tested through prioritization questions — which patient do you see first, what's the first action, what finding is most concerning. These use the same ABC/priority framework as Fundamentals, applied to more complex medical-surgical scenarios.

How many questions are on the ATI Medical-Surgical proctored exam?

ATI's official Medical-Surgical proctored exam typically runs 60–70 scored multiple-choice and Next Generation NCLEX-style items, though your nursing program sets the exact count, time limit, and number of unscored pretest items — check your course syllabus or ATI Learning System for your cohort's specific format.

What score do I need to pass ATI Medical-Surgical?

ATI reports results as proficiency levels (Level 1, 2, or 3) rather than a single passing percentage, and each nursing program sets its own required level for the course. Ask your instructor what level your program requires before test day.

Is this the same test as ATI's official proctored exam?

No. This is an independent, original study resource written to cover the same content areas and question style as ATI's Medical-Surgical content-mastery exam. It is not affiliated with, endorsed by, or a reproduction of Assessment Technologies Institute's proprietary exam content.

How is this different from the practice assessments inside my school's ATI account?

Your school's ATI Learning System practice assessments are the official ones and should be your primary prep. This site is a free, unlimited supplement — one question at a time with an instant rationale, no login or institutional access required — useful for extra reps between official practice attempts.

What should I study first if I'm running out of time?

Prioritize cardiovascular and respiratory content first — it's the highest-yield domain — then electrolyte imbalances, since both show up repeatedly in slightly different clinical wrappers and reward pattern recognition over memorization.

Cardiac (13 questions)

• Early Signs of Hypovolemic Shock
• Most Specific Lab Test for a Heart Attack
• The Priority Concern With a Potassium of 6.2
• Right-Sided Heart Failure: What the Nurse Should Expect
• The Late Vital Sign Change in Rising Intracranial Pressure
• DVT Patient With Sudden Chest Pain and Dyspnea
• The Medication Chewed Immediately During a Heart Attack
• Heart Failure Patient on Digoxin and Lasix: What to Watch
• What Pulsus Paradoxus Signals
• Protecting the Heart During Severe Hyperkalemia
• EKG Changes With a Potassium of 6.2 in Renal Failure
• EKG Findings With a Potassium of 2.8
• What Beck's Triad Diagnoses

Respiratory (11 questions)

• Why COPD Patients Need Low-Flow Oxygen
• Chest Tube Water-Seal Bubbling: Air Leak or Normal?
• When Chest Tube Drainage Signals a Problem
• The Gold-Standard Test for a Pulmonary Embolism
• Interpreting an ABG in a COPD Exacerbation
• What a V/Q Scan Actually Measures
• Chest Tube 'Tidaling' in the Water-Seal Chamber
• Subcutaneous Emphysema Around a Chest Tube Site
• Assessment Findings in a Tension Pneumothorax
• Barrel Chest and Clubbed Fingers: What They Signal
• The Condition Most Linked to Barrel Chest

Endocrine (11 questions)

• Recognizing the Signs of Hypoglycemia
• First Action for an Unconscious, Clammy Diabetic Patient
• Expected Vital Signs in Graves' Disease
• Reading an ABG in Diabetic Ketoacidosis
• The Standard Treatment for Diabetes Insipidus
• Protecting the Eyes in Graves' Disease Exophthalmos
• Diabetes Insipidus After a Head Injury: Expected Findings
• The Hallmark Sign of Thyroid Storm
• Expected Lab Finding in Addisonian Crisis
• Blood Pressure in an Addisonian Crisis
• The Electrolyte Risk With Hyperparathyroidism

Renal & Electrolytes (7 questions)

• Furosemide and Potassium Loss
• Managing High Phosphorus in Chronic Renal Failure
• What Chvostek's Sign Reveals About Calcium
• High Magnesium in Renal Failure: What to Monitor
• Positive Trousseau's Sign: What It Means
• Why Anemia Is Common in Chronic Renal Failure
• Defining the Oliguric Phase of Acute Renal Failure

GI & Hepatic (7 questions)

• Treating High Ammonia Levels in Cirrhosis
• The Most Common Trigger for Autonomic Dysreflexia
• Monitoring Fluid Status in a Patient With Ascites
• What Cullen's Sign Points To
• Where Turner's Sign Appears in Pancreatitis
• What 'Borborygmi' Sounds Actually Are
• Positive Murphy's Sign: What It Diagnoses

Neurological (12 questions)

• Interpreting a Glasgow Coma Scale Score of 7
• The Most Sensitive Sign of Neurological Change
• Testing Clear Nasal Drainage After a Head Injury
• The 'Halo Sign' After a Head Injury
• What a Positive Kernig's Sign Means
• Positive Babinski Sign in an Adult
• Positive Brudzinski's Sign: The Nurse's Immediate Action
• A Halo Sign on the Bedsheet: What Comes Next
• Recognizing Decerebrate Posturing
• Recognizing Decorticate Posturing
• The Primary Danger of a C4 Spinal Cord Injury
• Clear Drainage From the Ear After a Head Injury

Musculoskeletal & Perfusion (9 questions)

• The Real Purpose of Buck's Traction
• The Earliest Sign of Compartment Syndrome
• Cold, Blue Toes in a Casted Leg: What to Do First
• Confusion and Petechiae After a Femur Fracture
• What Homans' Sign Used to Screen For
• The Classic Leg Position With a Hip Fracture
• Why Nurses No Longer Perform Homans' Sign
• What Phalen's Test Diagnoses
• Confirming Carpal Tunnel With Phalen's Test