ATI Med-Surg Proctored Exam 2026/2027: Ultimate Level 3 Prep — 300+ Verified Q&A,
Rationales & Priority Cheat Sheets
Achieve Level 3 proficiency with this comprehensive ATI Med-Surg 2026/2027 prep guide
featuring over 300 verified practice questions and detailed rationales. This resource
provides high-yield summaries of critical body systems, fluid and electrolyte imbalances,
and the prioritization strategies needed to tackle complex NGN-style case studies. Fully
updated for the latest testing cycle, this bundle serves as the ultimate remediation tool to
ensure you pass your proctored assessment and build a solid foundation for the NCLEX.
A nurse is assessing a client with a chest tube. The nurse notes continuous bubbling
in the water-seal chamber. What does this indicate?
A) Normal operation.
B) The system is ready to be removed.
C) An air leak in the system.
D) The suction is too high.
C) An air leak in the system
Rationale: Intermittent bubbling is normal during expiration/coughing, but
continuous bubbling indicates a leak that must be addressed.
A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which action should the nurse take?
A) Maintain the client's legs in an adducted position.
B) Place an abduction pillow between the client's legs.
C) Encourage the client to cross their legs when sitting.
D) Keep the client's hip flexed at 110 degrees.
B) Place an abduction pillow between the client's legs
Rationale: Abduction prevents dislocation of the new prosthesis. Adduction
and extreme flexion (>90 degrees) are contraindicated.
A client has a potassium level of 6.5 mEq/L. Which medication should the nurse expect
to administer first?
A) Furosemide
B) Sodium polystyrene sulfonate (Kayexalate)
C) Calcium gluconate
, D) Spironolactone
C) Calcium gluconate
Rationale: While Kayexalate removes potassium, calcium gluconate is the
priority to stabilize the cardiac membrane and prevent dysrhythmias.
A nurse is teaching a client with Type 1 Diabetes about foot care. Which instruction
should be included?
A) "Soak your feet in hot water daily to improve circulation."
B) "Apply lotion between your toes to prevent cracking."
C) "Wear well-fitting, closed-toe shoes at all times."
D) "Cut your toenails in a rounded shape."
C) "Wear well-fitting, closed-toe shoes at all times"
Rationale: Soaking is drying; lotion between toes causes maceration; and
nails should be cut straight across to prevent ingrowns.
A client is experiencing autonomic dysreflexia. What is the nurse's first action?
A) Administer antihypertensive medication.
B) Check the client for a distended bladder.
C) Raise the head of the bed to a high-Fowler's position.
D) Notify the provider.
C) Raise the head of the bed to a high-Fowler's position
Rationale: This is the first action to help lower blood pressure via orthostatic
effect before finding the trigger (usually a full bladder).
A nurse is assessing a client with Cushing's Syndrome. Which finding is expected?
A) Weight loss and hypotension.
B) Truncal obesity and "moon face."
C) Hyponatremia and hyperkalemia.
D) Increased skin thickness.
B) Truncal obesity and "moon face"
Rationale: Cushing's is an overproduction of cortisol, leading to fat
redistribution and fluid retention.
A nurse is caring for a client with a newly applied plaster cast. Which action is
appropriate?
A) Cover the cast with a heavy blanket to keep it warm.
, B) Use the palms of the hands when handling the wet cast.
C) Use a hairdryer on high heat to speed up drying.
D) Petal the edges only after the cast is dry.
B) Use the palms of the hands when handling the wet cast
Rationale: Using fingertips can cause indentations that lead to pressure
points and skin breakdown.
A client is receiving a blood transfusion and reports chills and back pain. What is the
priority nursing action?
A) Slow the infusion rate.
B) Administer diphenhydramine.
C) Stop the transfusion.
D) Check the client's vital signs.
C) Stop the transfusion
Rationale: These are signs of a hemolytic reaction. The infusion must be
stopped immediately to prevent further reaction.
What is the priority assessment for a client with a T6 spinal cord injury?
A) Deep vein thrombosis.
B) Urinary retention.
C) Respiratory rate and rhythm.
D) Skin integrity.
C) Respiratory rate and rhythm
Rationale: ABCs are the priority. Injuries at T6 and above can compromise
respiratory function.
A nurse is caring for a client with hyperthyroidism (Grave's Disease). Which room
assignment is best?
A) A room near the nurse's station for frequent monitoring.
B) A private, quiet room away from high-traffic areas.
C) A semi-private room with a talkative roommate.
D) A room near the elevator.
B) A private, quiet room away from high-traffic areas
Rationale: Hyperthyroidism causes extreme irritability and sensitivity to
stimuli; a calm environment is therapeutic.
, A nurse is monitoring a client after a thyroidectomy. The nurse notes the client is
experiencing tingling in the fingers and a positive Trousseau's sign. Which medication
should be ready?
A) Potassium chloride
B) Calcium gluconate
C) Magnesium sulfate
D) Levothyroxine
B) Calcium gluconate
Rationale: These are signs of hypocalcemia, which can occur if the
parathyroid glands are accidentally removed/damaged during surgery.
A client has a prescription for a clear liquid diet. Which item should the nurse offer?
A) Vanilla ice cream.
B) Orange juice with pulp.
C) Apple juice.
D) Cream of mushroom soup.
C) Apple juice
Rationale: Clear liquids must be transparent. Ice cream and cream soups are
"full liquids."
A nurse is caring for a client with an NG tube for decompression. Which action should
the nurse take to verify placement before administering meds?
A) Auscultate for a "whoosh" over the stomach while injecting air.
B) Check the pH of the aspirated gastric contents.
C) Observe the color of the drainage.
D) Order a chest X-ray daily.
B) Check the pH of the aspirated gastric contents
Rationale: X-ray is the "gold standard" for the first time, but pH testing (<5) is
the best bedside method for ongoing verification.
A client is being treated for DKA (Diabetic Ketoacidosis). Which IV fluid should the
nurse expect to hang once the blood glucose drops to 250 mg/dL?
A) 0.45% Normal Saline.
B) Lactated Ringer's.
C) 5% Dextrose in 0.45% Normal Saline.
D) 3% Sodium Chloride.
Rationales & Priority Cheat Sheets
Achieve Level 3 proficiency with this comprehensive ATI Med-Surg 2026/2027 prep guide
featuring over 300 verified practice questions and detailed rationales. This resource
provides high-yield summaries of critical body systems, fluid and electrolyte imbalances,
and the prioritization strategies needed to tackle complex NGN-style case studies. Fully
updated for the latest testing cycle, this bundle serves as the ultimate remediation tool to
ensure you pass your proctored assessment and build a solid foundation for the NCLEX.
A nurse is assessing a client with a chest tube. The nurse notes continuous bubbling
in the water-seal chamber. What does this indicate?
A) Normal operation.
B) The system is ready to be removed.
C) An air leak in the system.
D) The suction is too high.
C) An air leak in the system
Rationale: Intermittent bubbling is normal during expiration/coughing, but
continuous bubbling indicates a leak that must be addressed.
A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which action should the nurse take?
A) Maintain the client's legs in an adducted position.
B) Place an abduction pillow between the client's legs.
C) Encourage the client to cross their legs when sitting.
D) Keep the client's hip flexed at 110 degrees.
B) Place an abduction pillow between the client's legs
Rationale: Abduction prevents dislocation of the new prosthesis. Adduction
and extreme flexion (>90 degrees) are contraindicated.
A client has a potassium level of 6.5 mEq/L. Which medication should the nurse expect
to administer first?
A) Furosemide
B) Sodium polystyrene sulfonate (Kayexalate)
C) Calcium gluconate
, D) Spironolactone
C) Calcium gluconate
Rationale: While Kayexalate removes potassium, calcium gluconate is the
priority to stabilize the cardiac membrane and prevent dysrhythmias.
A nurse is teaching a client with Type 1 Diabetes about foot care. Which instruction
should be included?
A) "Soak your feet in hot water daily to improve circulation."
B) "Apply lotion between your toes to prevent cracking."
C) "Wear well-fitting, closed-toe shoes at all times."
D) "Cut your toenails in a rounded shape."
C) "Wear well-fitting, closed-toe shoes at all times"
Rationale: Soaking is drying; lotion between toes causes maceration; and
nails should be cut straight across to prevent ingrowns.
A client is experiencing autonomic dysreflexia. What is the nurse's first action?
A) Administer antihypertensive medication.
B) Check the client for a distended bladder.
C) Raise the head of the bed to a high-Fowler's position.
D) Notify the provider.
C) Raise the head of the bed to a high-Fowler's position
Rationale: This is the first action to help lower blood pressure via orthostatic
effect before finding the trigger (usually a full bladder).
A nurse is assessing a client with Cushing's Syndrome. Which finding is expected?
A) Weight loss and hypotension.
B) Truncal obesity and "moon face."
C) Hyponatremia and hyperkalemia.
D) Increased skin thickness.
B) Truncal obesity and "moon face"
Rationale: Cushing's is an overproduction of cortisol, leading to fat
redistribution and fluid retention.
A nurse is caring for a client with a newly applied plaster cast. Which action is
appropriate?
A) Cover the cast with a heavy blanket to keep it warm.
, B) Use the palms of the hands when handling the wet cast.
C) Use a hairdryer on high heat to speed up drying.
D) Petal the edges only after the cast is dry.
B) Use the palms of the hands when handling the wet cast
Rationale: Using fingertips can cause indentations that lead to pressure
points and skin breakdown.
A client is receiving a blood transfusion and reports chills and back pain. What is the
priority nursing action?
A) Slow the infusion rate.
B) Administer diphenhydramine.
C) Stop the transfusion.
D) Check the client's vital signs.
C) Stop the transfusion
Rationale: These are signs of a hemolytic reaction. The infusion must be
stopped immediately to prevent further reaction.
What is the priority assessment for a client with a T6 spinal cord injury?
A) Deep vein thrombosis.
B) Urinary retention.
C) Respiratory rate and rhythm.
D) Skin integrity.
C) Respiratory rate and rhythm
Rationale: ABCs are the priority. Injuries at T6 and above can compromise
respiratory function.
A nurse is caring for a client with hyperthyroidism (Grave's Disease). Which room
assignment is best?
A) A room near the nurse's station for frequent monitoring.
B) A private, quiet room away from high-traffic areas.
C) A semi-private room with a talkative roommate.
D) A room near the elevator.
B) A private, quiet room away from high-traffic areas
Rationale: Hyperthyroidism causes extreme irritability and sensitivity to
stimuli; a calm environment is therapeutic.
, A nurse is monitoring a client after a thyroidectomy. The nurse notes the client is
experiencing tingling in the fingers and a positive Trousseau's sign. Which medication
should be ready?
A) Potassium chloride
B) Calcium gluconate
C) Magnesium sulfate
D) Levothyroxine
B) Calcium gluconate
Rationale: These are signs of hypocalcemia, which can occur if the
parathyroid glands are accidentally removed/damaged during surgery.
A client has a prescription for a clear liquid diet. Which item should the nurse offer?
A) Vanilla ice cream.
B) Orange juice with pulp.
C) Apple juice.
D) Cream of mushroom soup.
C) Apple juice
Rationale: Clear liquids must be transparent. Ice cream and cream soups are
"full liquids."
A nurse is caring for a client with an NG tube for decompression. Which action should
the nurse take to verify placement before administering meds?
A) Auscultate for a "whoosh" over the stomach while injecting air.
B) Check the pH of the aspirated gastric contents.
C) Observe the color of the drainage.
D) Order a chest X-ray daily.
B) Check the pH of the aspirated gastric contents
Rationale: X-ray is the "gold standard" for the first time, but pH testing (<5) is
the best bedside method for ongoing verification.
A client is being treated for DKA (Diabetic Ketoacidosis). Which IV fluid should the
nurse expect to hang once the blood glucose drops to 250 mg/dL?
A) 0.45% Normal Saline.
B) Lactated Ringer's.
C) 5% Dextrose in 0.45% Normal Saline.
D) 3% Sodium Chloride.
