ATI RN Adult Medical Surgical 2026
Proctored Exam Study Guide | Med-Surg
Test Bank & Practice Questions with
Detailed Rationales (Verified Level 3
Concept Review)
1. A nurse is caring for a client with heart failure who reports increasing shortness
of breath and difficulty sleeping flat. Which assessment finding requires the nurse's
immediate attention?
A. 1+ bilateral ankle edema
B. Weight gain of 1 kg in 1 week
C. Oxygen saturation of 86% on room air
D. Heart rate of 92/min
Answer: _C. Oxygen saturation of 86% on room air_
An oxygen saturation of 86% indicates significant hypoxemia and requires
immediate intervention. The nurse should assess respiratory status, apply oxygen
as prescribed, and notify the provider as indicated.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. Which oxygen saturation target is generally appropriate for a
client at risk for chronic carbon dioxide retention?
A. 70%–75%
B. 80%–84%
C. 88%–92%
D. 98%–100%
Answer: _C. 88%–92%_
,Clients with COPD who are susceptible to hypercapnia are commonly maintained
at an oxygen saturation of approximately 88%–92%, unless a different target is
prescribed.
3. A nurse is assessing a client who has a suspected myocardial infarction. Which
finding is most concerning?
A. Mild fatigue
B. Chest pressure radiating to the left arm
C. Blood pressure of 128/76 mm Hg
D. Respiratory rate of 18/min
Answer: _B. Chest pressure radiating to the left arm_
Chest pressure with radiation to the arm is a classic manifestation of myocardial
ischemia and requires rapid assessment and treatment.
4. A client taking digoxin has a potassium level of 2.8 mEq/L. Which action should
the nurse take?
A. Administer digoxin as prescribed
B. Hold digoxin and notify the provider
C. Restrict dietary potassium
D. Administer an additional dose of digoxin
Answer: _B. Hold digoxin and notify the provider_
Hypokalemia increases the risk of digoxin toxicity. The nurse should withhold the
medication and notify the provider for further evaluation and potassium
replacement as appropriate.
5. Which finding in a client receiving a blood transfusion requires the nurse to stop
the transfusion immediately?
A. Temperature increase of 0.2°C
B. Mild hunger
C. Sudden chills and low back pain
D. Heart rate of 82/min
Answer: _C. Sudden chills and low back pain_
,Chills and low back pain can indicate an acute hemolytic transfusion reaction. The
transfusion should be stopped immediately, the IV maintained with appropriate
solution, and emergency protocols initiated.
6. A client with pneumonia has an oxygen saturation of 89%, respiratory rate of
30/min, and increasing confusion. Which action is the priority?
A. Encourage oral fluids
B. Administer prescribed oxygen
C. Obtain a sputum specimen tomorrow
D. Assist the client with ambulation
Answer: _B. Administer prescribed oxygen_
Hypoxemia accompanied by tachypnea and confusion indicates impaired
oxygenation. Supporting oxygenation is the priority.
7. A client with diabetes mellitus is diaphoretic, trembling, and confused. Which
action should the nurse take first?
A. Administer long-acting insulin
B. Check the client's blood glucose
C. Encourage exercise
D. Restrict carbohydrates
Answer: _B. Check the client's blood glucose_
The manifestations suggest hypoglycemia. Blood glucose should be checked
promptly, followed by rapid treatment with glucose if the client is hypoglycemic
and able to safely receive it.
8. Which laboratory result should the nurse expect in a client with chronic kidney
disease?
A. Decreased serum creatinine
B. Increased serum creatinine
C. Decreased blood urea nitrogen
D. Increased glomerular filtration rate
Answer: _B. Increased serum creatinine_
, Reduced kidney function decreases the body's ability to eliminate creatinine,
resulting in an elevated serum creatinine level.
9. A client with acute kidney injury has a potassium level of 6.7 mEq/L. Which
ECG change should the nurse anticipate?
A. Peaked T waves
B. Prolonged QT interval only
C. ST elevation from myocardial infarction
D. Absent P waves caused by hypoglycemia
Answer: _A. Peaked T waves_
Hyperkalemia commonly causes tall, peaked T waves and can progress to
widening of the QRS complex and life-threatening dysrhythmias.
10. A nurse is caring for a client after thyroidectomy. Which finding requires
immediate intervention?
A. Mild incisional discomfort
B. Hoarse voice immediately after surgery
C. Stridor and difficulty breathing
D. Small amount of incisional swelling
Answer: _C. Stridor and difficulty breathing_
Stridor can indicate airway obstruction from swelling or bleeding and is an
emergency requiring immediate intervention.
11. A client with Addison disease is at risk for which electrolyte abnormality?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
Answer: _B. Hyperkalemia_
Decreased aldosterone secretion in Addison disease promotes sodium loss and
potassium retention, increasing the risk of hyperkalemia.
Proctored Exam Study Guide | Med-Surg
Test Bank & Practice Questions with
Detailed Rationales (Verified Level 3
Concept Review)
1. A nurse is caring for a client with heart failure who reports increasing shortness
of breath and difficulty sleeping flat. Which assessment finding requires the nurse's
immediate attention?
A. 1+ bilateral ankle edema
B. Weight gain of 1 kg in 1 week
C. Oxygen saturation of 86% on room air
D. Heart rate of 92/min
Answer: _C. Oxygen saturation of 86% on room air_
An oxygen saturation of 86% indicates significant hypoxemia and requires
immediate intervention. The nurse should assess respiratory status, apply oxygen
as prescribed, and notify the provider as indicated.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. Which oxygen saturation target is generally appropriate for a
client at risk for chronic carbon dioxide retention?
A. 70%–75%
B. 80%–84%
C. 88%–92%
D. 98%–100%
Answer: _C. 88%–92%_
,Clients with COPD who are susceptible to hypercapnia are commonly maintained
at an oxygen saturation of approximately 88%–92%, unless a different target is
prescribed.
3. A nurse is assessing a client who has a suspected myocardial infarction. Which
finding is most concerning?
A. Mild fatigue
B. Chest pressure radiating to the left arm
C. Blood pressure of 128/76 mm Hg
D. Respiratory rate of 18/min
Answer: _B. Chest pressure radiating to the left arm_
Chest pressure with radiation to the arm is a classic manifestation of myocardial
ischemia and requires rapid assessment and treatment.
4. A client taking digoxin has a potassium level of 2.8 mEq/L. Which action should
the nurse take?
A. Administer digoxin as prescribed
B. Hold digoxin and notify the provider
C. Restrict dietary potassium
D. Administer an additional dose of digoxin
Answer: _B. Hold digoxin and notify the provider_
Hypokalemia increases the risk of digoxin toxicity. The nurse should withhold the
medication and notify the provider for further evaluation and potassium
replacement as appropriate.
5. Which finding in a client receiving a blood transfusion requires the nurse to stop
the transfusion immediately?
A. Temperature increase of 0.2°C
B. Mild hunger
C. Sudden chills and low back pain
D. Heart rate of 82/min
Answer: _C. Sudden chills and low back pain_
,Chills and low back pain can indicate an acute hemolytic transfusion reaction. The
transfusion should be stopped immediately, the IV maintained with appropriate
solution, and emergency protocols initiated.
6. A client with pneumonia has an oxygen saturation of 89%, respiratory rate of
30/min, and increasing confusion. Which action is the priority?
A. Encourage oral fluids
B. Administer prescribed oxygen
C. Obtain a sputum specimen tomorrow
D. Assist the client with ambulation
Answer: _B. Administer prescribed oxygen_
Hypoxemia accompanied by tachypnea and confusion indicates impaired
oxygenation. Supporting oxygenation is the priority.
7. A client with diabetes mellitus is diaphoretic, trembling, and confused. Which
action should the nurse take first?
A. Administer long-acting insulin
B. Check the client's blood glucose
C. Encourage exercise
D. Restrict carbohydrates
Answer: _B. Check the client's blood glucose_
The manifestations suggest hypoglycemia. Blood glucose should be checked
promptly, followed by rapid treatment with glucose if the client is hypoglycemic
and able to safely receive it.
8. Which laboratory result should the nurse expect in a client with chronic kidney
disease?
A. Decreased serum creatinine
B. Increased serum creatinine
C. Decreased blood urea nitrogen
D. Increased glomerular filtration rate
Answer: _B. Increased serum creatinine_
, Reduced kidney function decreases the body's ability to eliminate creatinine,
resulting in an elevated serum creatinine level.
9. A client with acute kidney injury has a potassium level of 6.7 mEq/L. Which
ECG change should the nurse anticipate?
A. Peaked T waves
B. Prolonged QT interval only
C. ST elevation from myocardial infarction
D. Absent P waves caused by hypoglycemia
Answer: _A. Peaked T waves_
Hyperkalemia commonly causes tall, peaked T waves and can progress to
widening of the QRS complex and life-threatening dysrhythmias.
10. A nurse is caring for a client after thyroidectomy. Which finding requires
immediate intervention?
A. Mild incisional discomfort
B. Hoarse voice immediately after surgery
C. Stridor and difficulty breathing
D. Small amount of incisional swelling
Answer: _C. Stridor and difficulty breathing_
Stridor can indicate airway obstruction from swelling or bleeding and is an
emergency requiring immediate intervention.
11. A client with Addison disease is at risk for which electrolyte abnormality?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
Answer: _B. Hyperkalemia_
Decreased aldosterone secretion in Addison disease promotes sodium loss and
potassium retention, increasing the risk of hyperkalemia.
