ATI Med-Surg Proctored Exam 2026: REAL EXAM QUESTIONS & VERIFIED ANSWERS - PASS FIRST ATTEMPT GUARANTEED UPDATED QUESTIONS AND 100% ACCURATE ANSWERS | HIGH-LEVEL EXIT EXAM

A nurse is assessing a client who is near the end of life following a traumatic head injury. The client has alternating periods of hyperpnea (rapid, deep breathing) and apnea. The nurse should document this finding as which of the following respiratory patterns? A. Biot's respirations B. Hypoventilatory respirations C. Kussmaul respirations D. Cheyne-Stokes respirations Correct Answer: D Rationale: Cheyne-Stokes respirations are characterized by a rhythmic crescendo-decrescendo pattern of breathing that alternates between deep, rapid breaths and periods of total apnea. This pattern occurs due to a decreased sensitivity of the respiratory center to carbon dioxide levels, commonly seen in patients with increased intracranial pressure (ICP), severe cerebral hypoxia, or those near the end of life. (Note: Biot's respirations also involve apnea but consist of completely irregular, shallow breaths rather than a smooth, cyclical waxing and waning pattern, typically indicating a direct brainstem injury). Question 2 A nurse is preparing to administer a unit of packed red blood cells (RBCs) to a client and notes that there are several small clots floating in the IV bag. Which of the following actions should the nurse take? A. Inject 5,000 units of heparin directly into the unit of packed RBCs. B. Place the unit of packed RBCs in a blood-warming unit for 5 minutes. C. Return the unit of packed RBCs to the blood bank. D. Dilute the unit of packed RBCs using 50 mL of Lactated Ringer's solution. Correct Answer: C Rationale: The presence of clots floating in a blood component indicates inadequate anticoagulation during collection, improper storage, or expiration. The nurse must never alter or inject medications into blood components, nor use unverified warmth to dissolve clots. Blood products must only ever be co-infused with 0.9% Normal Saline, as Lactated Ringer's contains calcium which will cause the blood to clot in the tubing. Returning the unit is the only safe intervention. Question 3 A nurse in a provider's office is teaching a client about the self-management of gastroesophageal reflux disease (GERD). Which of the following instructions should the nurse include? A. "Eat a light meal 1 hour before bedtime." B. "Lie down for 30 minutes immediately after each meal." C. "Increase your daily caloric intake by 250 calories per day." D. "Elevate the head of your bed 6 inches using blocks." Correct Answer: D Rationale: Elevating the head of the bed 6 to 8 inches utilizing bed frame blocks employs gravity to naturally keep gastric acid and stomach contents from refluxing up into the lower esophagus while sleeping. Clients with GERD must remain upright for at least 2 to 3 hours after eating and avoid consuming meals or snacks close to bedtime. Question 4 A nurse is providing teaching to a client and their partner about performing peritoneal dialysis at home. When discussing peritonitis, which of the following manifestations should the nurse identify as the earliest clinical indication of this complication? A. Generalized abdominal pain B. Cloudy dialysate effluent C. Fever D. Increased heart rate Correct Answer: C Rationale: Peritonitis is a severe, common complication of peritoneal dialysis. A systemic fever accompanied by localized abdominal tenderness is typically the earliest manifestation of the inflammatory/infectious process. While a cloudy or turbid dialysate effluent drain bag is a definitive classic diagnostic sign of peritonitis, it manifests slightly later as white blood cells accumulate in the fluid. Question 5 A nurse is caring for a client who is receiving enteral nutrition via a feeding tube. Which of the following interventions should the nurse perform to prevent aspiration? A. Check the gastric aspirate pH immediately following bolus feedings. B. Place the client in a supine position before initiating continuous feedings. C. Instruct the client to perform the Valsalva maneuver after feedings. D. Measure gastric residual volume prior to administering bolus feedings. Correct Answer: D Rationale: Measuring gastric residual volumes (GRVs) prior to intermittent bolus feedings allows the nurse to identify delayed gastric emptying. Excessive residual volumes signal that fluid is pooling in the stomach, which drastically increases the risk of regurgitation and pulmonary aspiration. During feedings, the head of the bed must be elevated to at least 30 to 45 degrees, never flat or supine. Question 6 A nurse is assessing a client's pressure injury. Which of the following findings indicates active wound healing? A. Light yellow, foul-smelling exudate B. Wound tissue that is firm to palpation C. Dry, dark brown eschar covering the bed D. Dark red granulation tissue Correct Answer: D Rationale: Granulation tissue appears pink-to-dark red, moist, and granular. It is composed of a newly formed extracellular matrix and rich capillary budding, which indicates healthy, viable tissue and active wound healing. Yellow exudate indicates infection or slough, indurated firm tissue signals localized inflammation/stagnation, and eschar represents dead necrotic tissue that prevents healing until debrided. Question 7 A client is 6 hours postoperative following the placement of an external fixator for a tibial fracture. Which of the following actions should the nurse take? A. Palpate the dorsalis pedis and posterior tibial pulses. B. Maintain the affected lower extremity in a dependent position. C. Wrap sterile gauze over the sharp points of the fixator pins. D. Tighten or adjust loose clamps on the external fixator frame. Correct Answer: A Rationale: Postoperative orthopedic clients face severe risks of neurovascular compromise and compartment syndrome. Palpating peripheral pulses (along with assessing color, temperature, capillary refill, sensation, and motor movement) ensures microvascular perfusion is preserved. The leg should be elevated to reduce edema, and the fixator frame clamps must only be adjusted by the orthopedic surgeon. Question 8 A nurse is preparing an in-service presentation about the use of automated external defibrillators (AEDs). Which of the following instructions should the nurse include? A. "Continue performing chest compressions while the AED is analyzing the rhythm." B. "Position the client on a flat, firm surface." C. "Manually adjust the AED energy output setting to 80 joules." D. "Apply the AED immediately for a client who is in stable Atrial Fibrillation." Correct Answer: B Rationale: Placing a client on a flat, firm surface provides the resistance needed for effective manual cardiopulmonary resuscitation (CPR) and prevents artifact interference during AED rhythm processing. Compressions must stop during analysis so the machine can read the rhythm cleanly, and AEDs automatically determine energy parameters. AEDs are programmed to shock only pulseless Ventricular Fibrillation (V-fib) and pulseless Ventricular Tachycardia (V-tach). Question 9 A nurse is reviewing the laboratory results of a client and notes a serum sodium level of 120 mEq/L. Which of the following clinical findings should the nurse expect? A. Hyperreflexia B. Decreased bowel sounds C. Confusion D. Increased central venous pressure Correct Answer: C Rationale: A serum sodium level of 120 mEq/L indicates severe hyponatremia (normal range: 135–145 mEq/L). As sodium levels drop, extracellular fluid shifts into brain cells via osmosis, causing cellular swelling and cerebral edema. This presents neurologically as confusion, altered mental status, lethargy, headache, and can progress to seizures. It also typically causes hyporeflexia and hyperactive gastrointestinal cramping. Question 10 A nurse is teaching a client who has tuberculosis and a new prescription for isoniazid and rifampin. Which of the following statements by the client indicates an understanding of the teaching? A. "I will be finished with this medication regimen in about 3 months." B. "I should check the whites of my eyes regularly while taking these medications." C. "I should take my medication with an antacid if it upsets my stomach." D. "I will no longer be infectious after two consecutive negative sputum specimens." Correct Answer: B Rationale: Both isoniazid and rifampin are highly hepatotoxic medications. The client must monitor closely for early signs of drug-induced hepatitis, such as jaundice (yellowing of the sclera or skin), right upper quadrant pain, and dark urine. Tuberculosis regimens typically last 6 to 9 months, antacids containing aluminum must be avoided as they decrease absorption, and a client is considered non-infectious after three consecutive negative sputum cultures. Question 11 A nurse is caring for a client who is in septic shock. Which of the following laboratory findings indicates that the client is developing Multiple Organ Dysfunction Syndrome (MODS)? A. Arterial hypoxemia B. Decreased serum liver enzymes C. Decreased blood urea nitrogen (BUN) D. Hypoglycemia Correct Answer: A Rationale: Multiple Organ Dysfunction Syndrome (MODS) results from widespread endothelial damage and microvascular clotting, causing systemic hypoperfusion. In the lungs, this leads to acute respiratory distress syndrome (ARDS), which manifests as severe arterial hypoxemia ($PaO_2$ low despite oxygen delivery). Organ failure in MODS would cause elevated liver enzymes (ALT/AST) and elevated kidney markers (BUN/Creatinine), along with early hyperglycemia due to stress-induced glycogenolysis. Question 12 A nurse is reviewing a client's laboratory values and notes a potassium level of 2.8 mEq/L. Which of the following findings should the nurse expect? A. Hyperactive bowel sounds B. Increased blood pressure C. Irregular pulse D. Exaggerated deep tendon reflexes Correct Answer: C Rationale: A potassium level of 2.8 mEq/L represents severe hypokalemia (normal range: 3.5– 5.0 mEq/L). Potassium is essential for cardiac electrical conduction; low levels alter myocardial repolarization, causing PVCs, a weak/irregular pulse, flat T-waves, and prominent U-waves on an EKG. Hypokalemia causes hypoactive bowel sounds (paralytic ileus), muscle weakness, hypotension, and decreased reflexes. Question 13 A nurse is caring for a client who is admitted to the medical-surgical unit with a seizure disorder. Which of the following interventions should the nurse include in the plan of care? A. Teach assistive personnel how to apply physical restraints during a seizure. B. Keep all four side rails in a down position to prevent entrapment. C. Keep a padded tongue blade taped to the wall at the client's bedside. D. Maintain patent peripheral IV access. Correct Answer: D Rationale: Maintaining a functional, patent peripheral IV line is critical for seizure safety protocols, allowing rapid access to administer emergency IV anticonvulsants (such as lorazepam or diazepam) if status epilepticus occurs. Restraints and tongue blades are strictly contraindicated because they cause fractures or airway trauma. Side rails should be raised and padded to protect the client. Question 14 A nurse is collecting a medical history from an older adult client who has hypertension and a new prescription for nadolol. Which of the following conditions in the client's history should the nurse report to the provider? A. Cataracts B. Gastroesophageal reflux disease (GERD) C. Asthma D. Hypothyroidism Correct Answer: C Rationale: Nadolol is a non-selective beta-adrenergic blocker. It blocks both $beta_1$ receptors (in the heart) and $beta_2$ receptors (in the bronchial smooth muscle). Blocking $beta_2$ receptors can cause bronchoconstriction and trigger life-threatening bronchospasms in clients with underlying reactive airway diseases like asthma or COPD. Question 15 A nurse is preparing to administer thrombolytic therapy (tPA) to a client who is experiencing an acute ischemic stroke. Which of the following is an appropriate nursing action? A. Start the thrombolytic therapy within 8 hours of symptom onset. B. Insert an indwelling urinary catheter immediately after therapy begins. C. Monitor the client's blood pressure every 30 minutes during the infusion. D. Elevate the head of the bed between 25 and 30 degrees. Correct Answer: D Rationale: Elevating the head of the bed between 25 and 30 degrees optimizes cerebral venous drainage, reduces intracranial pressure, and minimizes the risk of aspiration. Thrombolytics must typically be given within 3 to 4.5 hours of symptom onset. Invasive procedures like urinary catheter insertions must be completed prior to starting tPA due to the profound risk of systemic bleeding, and blood pressure is monitored every 15 minutes during the infusion. Question 16 A nurse is teaching a client about the proper use of an incentive spirometer. Which of the following instructions should the nurse include? A. Place your hands tightly on your upper abdomen during inhalation. B. Exhale slowly and forcefully through pursed lips into the mouthpiece. C. Hold your breath for about 3 to 5 seconds at the peak of inhalation before exhaling. D. Position the mouthpiece exactly 2.5 cm (1 inch) away from your open mouth. Correct Answer: C Rationale: Holding the breath for 3 to 5 seconds at the end of maximal inspiration allows the alveolar sacs to fully re-expand, preventing or treating atelectasis. The client must place their lips in a tight seal around the mouthpiece and perform a slow, deep, sustained inhalation, rather than exhaling into the device.