ATI MED SURG
Proctored Exam — Complete Q&A Study Guide
86 Questions with Verified Answers & Clinical Rationale | 2026
PROFESSOR'S STUDY GUIDE — HOW TO USE
Each Q (navy) row presents the clinical scenario as it appears on the ATI proctored exam. Cover the ANS
(teal) row to self-test before reading the answer. The Rationale explains the clinical reasoning behind each
correct answer — essential for NCLEX-style application. Definition cards are included for pharmacological and
physiological terms.
SECTION 1: ENDOCRINE & METABOLIC DISORDERS
Diabetes · DKA · Cushing's · Addison's · SIADH
A nurse is caring for a client who has diabetes insipidus. Which of the following
Q1
medications should the nurse plan to administer?
ANSWER
Desmopressin (Vasopressin analog)
ANS
Rationale: Diabetes insipidus results from decreased ADH secretion. Desmopressin/Vasopressin
replaces ADH, reduces excessive urination, and restores fluid balance.
DEFINITION | Desmopressin
A synthetic analog of antidiuretic hormone (ADH). Used to treat diabetes insipidus and nocturnal enuresis
(bedwetting). Reduces urine output by promoting water reabsorption in the kidneys.
A nurse is planning care for a client who has Cushing's syndrome due to chronic
Q2 corticosteroid use. Which of the following actions should the nurse involve in the plan of
care?
ANSWER
Check the client's urine specific gravity.
ANS
Rationale: Urine specific gravity assesses for fluid volume overload — a hallmark complication of
Cushing's syndrome caused by excess cortisol promoting sodium and water retention.
DEFINITION | Addison's Disease
Occurs when the adrenal glands do not produce sufficient cortisol or aldosterone. Results in
hyponatremia, hyperkalemia, hypoglycemia, and hypotension. Requires a diet HIGH in protein,
carbohydrates, and sodium; LOW in potassium.
, A nurse is providing teaching to a client who has Addison's disease about healthy snack
Q3 foods. Which of the following food choices by the client indicates an understanding of
the teaching?
ANSWER
Turkey and cheese sandwich.
ANS
Rationale: This choice is high in protein, carbohydrates, and sodium — all required for Addison's
disease management. Addison's patients need to avoid high-potassium foods.
A nurse is reviewing laboratory values of a client who has diabetic ketoacidosis (DKA).
Q4
Which of the following laboratory values is consistent with DKA?
ANSWER
Bicarbonate level of 12 mEq/L (below normal).
ANS Rationale: DKA causes metabolic acidosis. Bicarbonate levels below 15 mEq/L (normal: 22–26)
indicate severe acid buildup. Other DKA findings: fruity breath odor, blood glucose >250 mg/dL,
ketonuria.
A nurse is caring for a client who has type 2 diabetes mellitus and is displaying
Q5 manifestations of hyperglycemia. Which finding should indicate to the nurse that the
client has hyperglycemia?
ANSWER
Increased urination (polyuria).
ANS
Rationale: Hyperglycemia causes osmotic diuresis — excess glucose in the filtrate pulls water into the
urine, resulting in polyuria, polydipsia, and polyphagia (the classic 3 P's).
A nurse is caring for a client who has type 1 diabetes mellitus and reports hunger and
Q6 weakness. The client's blood glucose is 50 mg/dL. Which of the following actions should
the nurse take?
ANSWER
Have the client drink a glass of milk.
ANS
Rationale: Blood glucose of 50 mg/dL is hypoglycemia (<70 mg/dL). For a conscious patient, give 15 g
of fast-acting carbohydrate (e.g., milk, juice, glucose tablets). Recheck glucose in 15 minutes.
A nurse is collecting data from a client who has diabetes mellitus and a blood glucose
Q7
level of 61 mg/dL. Which of the following findings should the nurse expect?
ANSWER
Difficulty contracting muscles (muscle weakness from hypoglycemia).
ANS
Rationale: Hypoglycemia deprives muscles and the brain of glucose for energy. Symptoms include
weakness, shakiness, diaphoresis, confusion, and difficulty with motor tasks.
A nurse is collecting data from a client who has diabetic ketoacidosis. Which of the
Q8
following findings should the nurse expect?
, ANSWER
Fruity breath odor.
ANS
Rationale: Fruity (acetone) breath results from ketone bodies produced during fat metabolism in the
absence of insulin. It is a classic, hallmark sign of DKA.
A nurse is collecting data from a client who has a new diagnosis of pheochromocytoma.
Q9
Which of the following findings should the nurse expect?
ANSWER
Hypertension.
ANS
Rationale: Pheochromocytoma is a benign adrenal medulla tumor that secretes excess epinephrine
and norepinephrine, causing severe hypertension, headache, diaphoresis, and tachycardia.
DEFINITION | Pheochromocytoma
A benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine (and
norepinephrine), resulting in episodic or sustained hypertension, headache, palpitations, and diaphoresis.
A nurse is collecting data from a client who has a sodium level of 128 mEq/L. Which of
Q 10
the following findings should the nurse expect?
ANSWER
Mental confusion.
ANS Rationale: Normal sodium: 135–145 mEq/L. Hyponatremia (<135) causes neurological symptoms:
confusion, lethargy, seizures, and — in severe cases — coma. The brain is especially sensitive to
osmotic shifts.
A nurse is reinforcing teaching about foods high in calcium with a client who has
Q 11 hypocalcemia. Which of the following foods should the nurse recommend as containing
the most calcium?
ANSWER
3 oz canned salmon (with bones).
ANS
Rationale: Canned salmon with bones is rich in bioavailable calcium. Other high-calcium foods: dairy
products, sardines, fortified cereals, and dark leafy greens (kale, bok choy).
A nurse is reinforcing teaching with a 73-year-old female client about preventing
Q 12
osteoporosis. Which of the following information should the nurse include?
ANSWER
Take 2,000 international units (IU) of Vitamin D daily.
ANS
Rationale: Vitamin D enhances calcium absorption from the GI tract — essential for bone density.
Postmenopausal women are at highest risk for osteoporosis due to estrogen loss.
Proctored Exam — Complete Q&A Study Guide
86 Questions with Verified Answers & Clinical Rationale | 2026
PROFESSOR'S STUDY GUIDE — HOW TO USE
Each Q (navy) row presents the clinical scenario as it appears on the ATI proctored exam. Cover the ANS
(teal) row to self-test before reading the answer. The Rationale explains the clinical reasoning behind each
correct answer — essential for NCLEX-style application. Definition cards are included for pharmacological and
physiological terms.
SECTION 1: ENDOCRINE & METABOLIC DISORDERS
Diabetes · DKA · Cushing's · Addison's · SIADH
A nurse is caring for a client who has diabetes insipidus. Which of the following
Q1
medications should the nurse plan to administer?
ANSWER
Desmopressin (Vasopressin analog)
ANS
Rationale: Diabetes insipidus results from decreased ADH secretion. Desmopressin/Vasopressin
replaces ADH, reduces excessive urination, and restores fluid balance.
DEFINITION | Desmopressin
A synthetic analog of antidiuretic hormone (ADH). Used to treat diabetes insipidus and nocturnal enuresis
(bedwetting). Reduces urine output by promoting water reabsorption in the kidneys.
A nurse is planning care for a client who has Cushing's syndrome due to chronic
Q2 corticosteroid use. Which of the following actions should the nurse involve in the plan of
care?
ANSWER
Check the client's urine specific gravity.
ANS
Rationale: Urine specific gravity assesses for fluid volume overload — a hallmark complication of
Cushing's syndrome caused by excess cortisol promoting sodium and water retention.
DEFINITION | Addison's Disease
Occurs when the adrenal glands do not produce sufficient cortisol or aldosterone. Results in
hyponatremia, hyperkalemia, hypoglycemia, and hypotension. Requires a diet HIGH in protein,
carbohydrates, and sodium; LOW in potassium.
, A nurse is providing teaching to a client who has Addison's disease about healthy snack
Q3 foods. Which of the following food choices by the client indicates an understanding of
the teaching?
ANSWER
Turkey and cheese sandwich.
ANS
Rationale: This choice is high in protein, carbohydrates, and sodium — all required for Addison's
disease management. Addison's patients need to avoid high-potassium foods.
A nurse is reviewing laboratory values of a client who has diabetic ketoacidosis (DKA).
Q4
Which of the following laboratory values is consistent with DKA?
ANSWER
Bicarbonate level of 12 mEq/L (below normal).
ANS Rationale: DKA causes metabolic acidosis. Bicarbonate levels below 15 mEq/L (normal: 22–26)
indicate severe acid buildup. Other DKA findings: fruity breath odor, blood glucose >250 mg/dL,
ketonuria.
A nurse is caring for a client who has type 2 diabetes mellitus and is displaying
Q5 manifestations of hyperglycemia. Which finding should indicate to the nurse that the
client has hyperglycemia?
ANSWER
Increased urination (polyuria).
ANS
Rationale: Hyperglycemia causes osmotic diuresis — excess glucose in the filtrate pulls water into the
urine, resulting in polyuria, polydipsia, and polyphagia (the classic 3 P's).
A nurse is caring for a client who has type 1 diabetes mellitus and reports hunger and
Q6 weakness. The client's blood glucose is 50 mg/dL. Which of the following actions should
the nurse take?
ANSWER
Have the client drink a glass of milk.
ANS
Rationale: Blood glucose of 50 mg/dL is hypoglycemia (<70 mg/dL). For a conscious patient, give 15 g
of fast-acting carbohydrate (e.g., milk, juice, glucose tablets). Recheck glucose in 15 minutes.
A nurse is collecting data from a client who has diabetes mellitus and a blood glucose
Q7
level of 61 mg/dL. Which of the following findings should the nurse expect?
ANSWER
Difficulty contracting muscles (muscle weakness from hypoglycemia).
ANS
Rationale: Hypoglycemia deprives muscles and the brain of glucose for energy. Symptoms include
weakness, shakiness, diaphoresis, confusion, and difficulty with motor tasks.
A nurse is collecting data from a client who has diabetic ketoacidosis. Which of the
Q8
following findings should the nurse expect?
, ANSWER
Fruity breath odor.
ANS
Rationale: Fruity (acetone) breath results from ketone bodies produced during fat metabolism in the
absence of insulin. It is a classic, hallmark sign of DKA.
A nurse is collecting data from a client who has a new diagnosis of pheochromocytoma.
Q9
Which of the following findings should the nurse expect?
ANSWER
Hypertension.
ANS
Rationale: Pheochromocytoma is a benign adrenal medulla tumor that secretes excess epinephrine
and norepinephrine, causing severe hypertension, headache, diaphoresis, and tachycardia.
DEFINITION | Pheochromocytoma
A benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine (and
norepinephrine), resulting in episodic or sustained hypertension, headache, palpitations, and diaphoresis.
A nurse is collecting data from a client who has a sodium level of 128 mEq/L. Which of
Q 10
the following findings should the nurse expect?
ANSWER
Mental confusion.
ANS Rationale: Normal sodium: 135–145 mEq/L. Hyponatremia (<135) causes neurological symptoms:
confusion, lethargy, seizures, and — in severe cases — coma. The brain is especially sensitive to
osmotic shifts.
A nurse is reinforcing teaching about foods high in calcium with a client who has
Q 11 hypocalcemia. Which of the following foods should the nurse recommend as containing
the most calcium?
ANSWER
3 oz canned salmon (with bones).
ANS
Rationale: Canned salmon with bones is rich in bioavailable calcium. Other high-calcium foods: dairy
products, sardines, fortified cereals, and dark leafy greens (kale, bok choy).
A nurse is reinforcing teaching with a 73-year-old female client about preventing
Q 12
osteoporosis. Which of the following information should the nurse include?
ANSWER
Take 2,000 international units (IU) of Vitamin D daily.
ANS
Rationale: Vitamin D enhances calcium absorption from the GI tract — essential for bone density.
Postmenopausal women are at highest risk for osteoporosis due to estrogen loss.
