Med-Surg CMS Proctored Exam - 2026/2027
Update | 100% Correct Key | Grade A | ATI Exam
Prep
SECTION 1 – MANAGEMENT OF CARE (22 Qs)
Q1
A 78-year-old client is admitted with acute confusion, UTI, and a history of heart failure.
The client’s adult child, who has durable power of attorney (DPOA) for health care,
requests that no urinary catheter be placed. The primary provider writes an order for an
indwelling catheter to obtain accurate intake and output.
Which action should the nurse take FIRST?
A. Insert the catheter as ordered and document the child’s disagreement
B. Call the provider to clarify the DPOA’s refusal of the invasive procedure
C. Obtain a second provider’s signature to override the refusal
D. Ask the client to sign an informed-consent form for the catheter
Correct Answer: B
,Rationale: The DPOA’s directive is legally binding; the nurse advocates by clarifying the
conflict with the provider (CMS & ANA Code of Ethics). A & C violate client rights; D is
invalid because the client is presently confused.
Q2
The nurse is assigned the following clients on a medical floor:
1. 58-year-old post-PCI on heparin drip with ACT q2h
2. 34-year-old 2 hours post-thyroidectomy reporting tingling toes
3. 70-year-old with new-onset AF on amiodarone drip
4. 65-year-old 24 hours post-laparoscopic cholecystectomy requesting pain med
Which client should the nurse see FIRST?
A. Post-PCI client (1)
B. Post-thyroidectomy client (2) – possible hypocalcemia/airway compromise
C. New AF client (3)
D. Post-cholecystectomy client (4)
Correct Answer: B
Rationale: Tingling after thyroidectomy signals potential laryngeal stridor from
hypocalcemia—an emergent airway issue. Other clients are stable or routine
monitoring.
,Q3
The charge nurse is making shift assignments. Which client is MOST appropriate to
assign to a licensed practical nurse (LPN) working under supervision?
A. A client 12 hours post-motorcycle accident with unstable pelvis and external fixator
needing morphine PCA teaching
B. A client with MG in crisis on continuous neostigmine infusion
C. A client 2 days post partial colectomy with colostomy learning irrigation
D. A client with DKA on an insulin drip with hourly blood glucose checks
Correct Answer: C
Rationale: LPN scope allows basic colostomy teaching & stable post-op care. A, B, D
require RN-level assessment, titration, or teaching of complex equipment.
Q4
A client is being transferred from ICU to the medical floor after NSTEMI. The ICU nurse
gives report that the dobutamine drip was discontinued 30 minutes ago. The receiving
nurse notes BP 88/50, HR 110, client cool/clammy.
, What is the nurse’s PRIORITY action?
A. Page the provider for a fluid bolus order
B. Re-start the dobutamine per ICU protocol
C. Place client in Trendelenburg and call rapid-response
D. Increase nasal cannula to 6 L/min
Correct Answer: C
Rationale: Suggests cardiogenic shock; rapid-response brings resources while
Trendelenburg temporarily augments preload. RN cannot restart dobutamine without
order (B).
Q5
A client with COPD has a living will stating “no intubation.” ABGs show acute respiratory
acidosis with pH 7.22. The client tells the nurse, “I changed my mind—help me
breathe.”
Which action is BEST?
A. Notify respiratory therapy for BiPAP set-up
B. Clarify that the living will is still valid
Update | 100% Correct Key | Grade A | ATI Exam
Prep
SECTION 1 – MANAGEMENT OF CARE (22 Qs)
Q1
A 78-year-old client is admitted with acute confusion, UTI, and a history of heart failure.
The client’s adult child, who has durable power of attorney (DPOA) for health care,
requests that no urinary catheter be placed. The primary provider writes an order for an
indwelling catheter to obtain accurate intake and output.
Which action should the nurse take FIRST?
A. Insert the catheter as ordered and document the child’s disagreement
B. Call the provider to clarify the DPOA’s refusal of the invasive procedure
C. Obtain a second provider’s signature to override the refusal
D. Ask the client to sign an informed-consent form for the catheter
Correct Answer: B
,Rationale: The DPOA’s directive is legally binding; the nurse advocates by clarifying the
conflict with the provider (CMS & ANA Code of Ethics). A & C violate client rights; D is
invalid because the client is presently confused.
Q2
The nurse is assigned the following clients on a medical floor:
1. 58-year-old post-PCI on heparin drip with ACT q2h
2. 34-year-old 2 hours post-thyroidectomy reporting tingling toes
3. 70-year-old with new-onset AF on amiodarone drip
4. 65-year-old 24 hours post-laparoscopic cholecystectomy requesting pain med
Which client should the nurse see FIRST?
A. Post-PCI client (1)
B. Post-thyroidectomy client (2) – possible hypocalcemia/airway compromise
C. New AF client (3)
D. Post-cholecystectomy client (4)
Correct Answer: B
Rationale: Tingling after thyroidectomy signals potential laryngeal stridor from
hypocalcemia—an emergent airway issue. Other clients are stable or routine
monitoring.
,Q3
The charge nurse is making shift assignments. Which client is MOST appropriate to
assign to a licensed practical nurse (LPN) working under supervision?
A. A client 12 hours post-motorcycle accident with unstable pelvis and external fixator
needing morphine PCA teaching
B. A client with MG in crisis on continuous neostigmine infusion
C. A client 2 days post partial colectomy with colostomy learning irrigation
D. A client with DKA on an insulin drip with hourly blood glucose checks
Correct Answer: C
Rationale: LPN scope allows basic colostomy teaching & stable post-op care. A, B, D
require RN-level assessment, titration, or teaching of complex equipment.
Q4
A client is being transferred from ICU to the medical floor after NSTEMI. The ICU nurse
gives report that the dobutamine drip was discontinued 30 minutes ago. The receiving
nurse notes BP 88/50, HR 110, client cool/clammy.
, What is the nurse’s PRIORITY action?
A. Page the provider for a fluid bolus order
B. Re-start the dobutamine per ICU protocol
C. Place client in Trendelenburg and call rapid-response
D. Increase nasal cannula to 6 L/min
Correct Answer: C
Rationale: Suggests cardiogenic shock; rapid-response brings resources while
Trendelenburg temporarily augments preload. RN cannot restart dobutamine without
order (B).
Q5
A client with COPD has a living will stating “no intubation.” ABGs show acute respiratory
acidosis with pH 7.22. The client tells the nurse, “I changed my mind—help me
breathe.”
Which action is BEST?
A. Notify respiratory therapy for BiPAP set-up
B. Clarify that the living will is still valid
