ATI RN Med Surg Proctored Exam Study Guide 2026 | 100%
Verified Q&A with Rationales | Level 3 Booster LATEST
UPDATE THIS YEAR.pdf
This document features highly targeted, multiple-choice questions meticulously structured across two
comprehensive batches. Every single question directly aligns with the newest ATI CMS blueprint and
integrates vital Next-Generation NCLEX (NGN) clinical judgment concepts.
What is Included in This Study Guide?
Actual Practice Questions: Curated to mirror the exact difficulty, tone, and formatting of the proctored
exam.
Bolded & Italicized Correct Answers: Designed for rapid scanning, active recall, and quick-review
sessions.
In-Depth, Italicized Rationales: Comprehensive explanations for why the correct choice is right and why
the distractors are wrong. Learn the exact critical thinking paths ATI expects you to use.
Core Topics Covered:
Fluid, Electrolytes, & Acid-Base: Potassium/Sodium imbalances, EKG correlations, and uncompensated
ABG interpretation.
Cardiovascular & Respiratory: STEMI protocols, lethal dysrhythmias, chest tube management, and
COPD oxygen titration.
Endocrine & Metabolic: DKA vs. HHS differences, Addisonian crisis, Cushing's, and Thyroid Storm
emergencies.
Renal & Gastrointestinal: AKI phases, TURP/CBI troubleshooting, cirrhosis complications, and dumping
syndrome dietary interventions.
Neurological & Musculoskeletal: Autonomic dysreflexia protocols, GCS scoring, compartment syndrome
detection, and hip arthroplasty safety.
Perioperative, Immunology, & Oncology: Informed consent boundaries, malignant hyperthermia
treatment, Parkland burn formula calculations, and neutropenic precautions.
Fluid, Electrolytes, and Acid-Base Balance
1. A nurse is assessing a client with a potassium level of 2.8 mEq/L. Which of the
following findings should the nurse expect?
A) Peaked T waves on the ECG
B) Hyperactive bowel sounds
C) Prominent U waves on the ECG
, D) Positive Trousseau's sign
Explanation: A potassium level of 2.8 mEq/L indicates hypokalemia. Expected
cardiovascular manifestations include flat or inverted T waves, ST-segment
depression, and the appearance of prominent U waves. Peaked T waves and
hyperactive bowel sounds occur with hyperkalemia. A positive Trousseau's sign
indicates hypocalcemia.
2. A nurse is caring for a client who has a serum sodium level of 118 mEq/L. Which of
the following interventions is the priority?
A) Encourage increased oral fluid intake.
B) Initiate seizure precautions.
C) Administer low-dose loop diuretics.
D) Infuse a 0.45% sodium chloride IV solution.
Explanation: Severe hyponatremia (below 120 mEq/L) places the client at extreme
risk for cerebral edema, seizures, coma, and death. Ensuring client safety via
seizure precautions is the highest priority. Increasing oral fluids or infusing hypotonic
solutions (0.45% NaCl) will further dilute serum sodium and worsen the condition.
3. A nurse reviews the arterial blood gas (ABG) results for a client with severe diarrhea:
pH 7.31, PaCO2 36 mm Hg, HCO3- 16 mEq/L. Which of the following acid-base
imbalances is present?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Explanation: The pH is low (less than 7.35), indicating acidosis. The bicarbonate
(HCO3-) is low (less than 22 mEq/L), which matches the acidic pH direction, while
the PaCO2 is within the normal range (35-45 mm Hg). This confirms an
, uncompensated metabolic acidosis, a common result of severe diarrhea due to
intestinal loss of base.
4. A nurse is caring for a client with acute kidney injury who has a potassium level of
6.2 mEq/L. Which of the following medications should the nurse anticipate
administering first to stabilize the cardiac membrane?
A) Sodium polystyrene sulfonate
B) Calcium gluconate
C) Regular insulin and dextrose
D) Furosemide
Explanation: Calcium gluconate does not lower serum potassium levels, but it
immediately stabilizes the myocardial cell membrane to prevent lethal dysrhythmias
associated with severe hyperkalemia. Insulin/dextrose and sodium polystyrene
sulfonate lower potassium levels but take longer to work.
5. A nurse is assessing a client who has hypocalcemia. Which of the following
techniques should the nurse use to check for Trousseau's sign?
A) Tap the client's face just below the temple.
B) Inflate a blood pressure cuff on the upper arm.
C) Depress the abdomen gently over the right lower quadrant.
D) Ask the client to hyperextend their wrist.
Explanation: Trousseau's sign is assessed by inflating a blood pressure cuff on the
client's upper arm above the systolic pressure for 2 to 3 minutes. A positive sign is
indicated by carpopedal spasm (flexion of the wrist and metacarpophalangeal joints).
Tapping the facial nerve tests for Chvostek's sign.
Cardiovascular System
, 6. A nurse is caring for a client in the emergency department who reports crushing
chest pain. The ECG reveals ST-segment elevation in leads II, III, and aVF. Which of
the following actions should the nurse take first?
A) Obtain a 12-lead ECG.
B) Administer morphine IV.
C) Administer oxygen if saturation is below 90%.
D) Draw blood for troponin levels.
Explanation: Following the initial emergency protocols for an acute myocardial
infarction (STEMI), initial priorities include addressing oxygenation if the client is
hypoxemic (SaO2 < 90%) alongside immediate administration of chewed aspirin.
While morphine and lab draws are essential, ensuring adequate oxygenation to
ischemic myocardial tissues is a primary immediate intervention.
7. A nurse is monitoring a client's cardiac rhythm and notes a sudden absence of P
waves, replaced by rapid, irregular f-waves, and an irregular ventricular response.
The nurse should identify this rhythm as which of the following?
A) Ventricular tachycardia
B) Atrial fibrillation
C) First-degree AV block
D) Premature ventricular contractions
Explanation: Atrial fibrillation is characterized by the total absence of distinct P
waves, replaced by rapid, chaotic fibrillatory (f) waves, and a characteristically
irregular R-R interval (irregularly irregular ventricular rate).
8. A nurse is providing discharge teaching to a client with a new diagnosis of heart
failure who is prescribed digoxin and furosemide. Which of the following instructions
is critical to include?
A) Report any changes in vision or yellow-green halos immediately.
Verified Q&A with Rationales | Level 3 Booster LATEST
UPDATE THIS YEAR.pdf
This document features highly targeted, multiple-choice questions meticulously structured across two
comprehensive batches. Every single question directly aligns with the newest ATI CMS blueprint and
integrates vital Next-Generation NCLEX (NGN) clinical judgment concepts.
What is Included in This Study Guide?
Actual Practice Questions: Curated to mirror the exact difficulty, tone, and formatting of the proctored
exam.
Bolded & Italicized Correct Answers: Designed for rapid scanning, active recall, and quick-review
sessions.
In-Depth, Italicized Rationales: Comprehensive explanations for why the correct choice is right and why
the distractors are wrong. Learn the exact critical thinking paths ATI expects you to use.
Core Topics Covered:
Fluid, Electrolytes, & Acid-Base: Potassium/Sodium imbalances, EKG correlations, and uncompensated
ABG interpretation.
Cardiovascular & Respiratory: STEMI protocols, lethal dysrhythmias, chest tube management, and
COPD oxygen titration.
Endocrine & Metabolic: DKA vs. HHS differences, Addisonian crisis, Cushing's, and Thyroid Storm
emergencies.
Renal & Gastrointestinal: AKI phases, TURP/CBI troubleshooting, cirrhosis complications, and dumping
syndrome dietary interventions.
Neurological & Musculoskeletal: Autonomic dysreflexia protocols, GCS scoring, compartment syndrome
detection, and hip arthroplasty safety.
Perioperative, Immunology, & Oncology: Informed consent boundaries, malignant hyperthermia
treatment, Parkland burn formula calculations, and neutropenic precautions.
Fluid, Electrolytes, and Acid-Base Balance
1. A nurse is assessing a client with a potassium level of 2.8 mEq/L. Which of the
following findings should the nurse expect?
A) Peaked T waves on the ECG
B) Hyperactive bowel sounds
C) Prominent U waves on the ECG
, D) Positive Trousseau's sign
Explanation: A potassium level of 2.8 mEq/L indicates hypokalemia. Expected
cardiovascular manifestations include flat or inverted T waves, ST-segment
depression, and the appearance of prominent U waves. Peaked T waves and
hyperactive bowel sounds occur with hyperkalemia. A positive Trousseau's sign
indicates hypocalcemia.
2. A nurse is caring for a client who has a serum sodium level of 118 mEq/L. Which of
the following interventions is the priority?
A) Encourage increased oral fluid intake.
B) Initiate seizure precautions.
C) Administer low-dose loop diuretics.
D) Infuse a 0.45% sodium chloride IV solution.
Explanation: Severe hyponatremia (below 120 mEq/L) places the client at extreme
risk for cerebral edema, seizures, coma, and death. Ensuring client safety via
seizure precautions is the highest priority. Increasing oral fluids or infusing hypotonic
solutions (0.45% NaCl) will further dilute serum sodium and worsen the condition.
3. A nurse reviews the arterial blood gas (ABG) results for a client with severe diarrhea:
pH 7.31, PaCO2 36 mm Hg, HCO3- 16 mEq/L. Which of the following acid-base
imbalances is present?
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Explanation: The pH is low (less than 7.35), indicating acidosis. The bicarbonate
(HCO3-) is low (less than 22 mEq/L), which matches the acidic pH direction, while
the PaCO2 is within the normal range (35-45 mm Hg). This confirms an
, uncompensated metabolic acidosis, a common result of severe diarrhea due to
intestinal loss of base.
4. A nurse is caring for a client with acute kidney injury who has a potassium level of
6.2 mEq/L. Which of the following medications should the nurse anticipate
administering first to stabilize the cardiac membrane?
A) Sodium polystyrene sulfonate
B) Calcium gluconate
C) Regular insulin and dextrose
D) Furosemide
Explanation: Calcium gluconate does not lower serum potassium levels, but it
immediately stabilizes the myocardial cell membrane to prevent lethal dysrhythmias
associated with severe hyperkalemia. Insulin/dextrose and sodium polystyrene
sulfonate lower potassium levels but take longer to work.
5. A nurse is assessing a client who has hypocalcemia. Which of the following
techniques should the nurse use to check for Trousseau's sign?
A) Tap the client's face just below the temple.
B) Inflate a blood pressure cuff on the upper arm.
C) Depress the abdomen gently over the right lower quadrant.
D) Ask the client to hyperextend their wrist.
Explanation: Trousseau's sign is assessed by inflating a blood pressure cuff on the
client's upper arm above the systolic pressure for 2 to 3 minutes. A positive sign is
indicated by carpopedal spasm (flexion of the wrist and metacarpophalangeal joints).
Tapping the facial nerve tests for Chvostek's sign.
Cardiovascular System
, 6. A nurse is caring for a client in the emergency department who reports crushing
chest pain. The ECG reveals ST-segment elevation in leads II, III, and aVF. Which of
the following actions should the nurse take first?
A) Obtain a 12-lead ECG.
B) Administer morphine IV.
C) Administer oxygen if saturation is below 90%.
D) Draw blood for troponin levels.
Explanation: Following the initial emergency protocols for an acute myocardial
infarction (STEMI), initial priorities include addressing oxygenation if the client is
hypoxemic (SaO2 < 90%) alongside immediate administration of chewed aspirin.
While morphine and lab draws are essential, ensuring adequate oxygenation to
ischemic myocardial tissues is a primary immediate intervention.
7. A nurse is monitoring a client's cardiac rhythm and notes a sudden absence of P
waves, replaced by rapid, irregular f-waves, and an irregular ventricular response.
The nurse should identify this rhythm as which of the following?
A) Ventricular tachycardia
B) Atrial fibrillation
C) First-degree AV block
D) Premature ventricular contractions
Explanation: Atrial fibrillation is characterized by the total absence of distinct P
waves, replaced by rapid, chaotic fibrillatory (f) waves, and a characteristically
irregular R-R interval (irregularly irregular ventricular rate).
8. A nurse is providing discharge teaching to a client with a new diagnosis of heart
failure who is prescribed digoxin and furosemide. Which of the following instructions
is critical to include?
A) Report any changes in vision or yellow-green halos immediately.
