ATI RN Med Surg Proctored / RN Med Surg 2026
Proctored RN Actual Exam New Latest Version
With All Questions And Correct Answers With
Rationale | Medical-Surgical Nursing Assessment
Q001: A 68-year-old male with a history of COPD and chronic kidney disease (stage 3) is
admitted with acute decompensated heart failure. His current medications include metoprolol,
furosemide, and inhaled tiotropium. On assessment, he has bibasilar crackles, a BP of 98/62
mm Hg, HR 110 bpm, and urine output 15 mL/hr. Serum creatinine has risen from 1.4 to 2.1
mg/dL in 24 h. Which intervention is the priority?
Options:
A. Increase metoprolol dose to reduce heart rate
B. Administer a 500 mL normal saline bolus
C. Hold furosemide and initiate a nesiritide infusion - CORRECT
D. Start dobutamine drip at 5 mcg/kg/min
(Correct Answer: C)
Q002: A 72-year-old female post right lower lobectomy develops sudden onset dyspnea and
pleuritic chest pain. ABG reveals PaO₂ 58 mm Hg on 4 L NC, PaCO₂ 48 mm Hg, pH 7.32. SpO₂
is 88 %. Which action should the nurse implement first?
Options:
A. Increase O₂ to 6 L via simple face mask
B. Obtain an immediate chest x-ray
C. Switch to high-flow nasal cannula and notify provider - CORRECT
D. Coach patient in pursed-lip breathing
(Correct Answer: C)
Q003: A 55-year-old male with acute pancreatitis (Ranson score 4) has severe epigastric pain,
BP 84/50 mm Hg, HR 122 bpm, and urine output 20 mL/hr. Hematocrit is 52 %. Which order
should the nurse anticipate?
Options:
A. Start dopamine 10 mcg/kg/min IV
B. Administer 2 L D5NS over 2 h
C. Initiate norepinephrine 0.1 mcg/kg/min IV - CORRECT
D. Give furosemide 40 mg IV push
(Correct Answer: C)
Q004: A 62-year-old female with Type 2 DM on insulin glargine is NPO for upper endoscopy at
0800. Morning glucose is 310 mg/dL, urine negative for ketones. Which action is appropriate?
Options:
A. Hold all insulin and recheck in 2 h
B. Administer 6 units regular insulin IV now - CORRECT
C. Start D5½NS with 10 units regular insulin
D. Give rapid-acting insulin per sliding scale orally
, (Correct Answer: B)
Q005: A 48-year-old male with decompensated cirrhosis develops black stools and BP 88/60
mm Hg. Which ordered intervention should the nurse complete first?
Options:
A. Insert a nasogastric tube for lavage
B. Establish two 18-gauge IVs and begin fluid resuscitation - CORRECT
C. Administer pantoprazole 80 mg IV
D. Place on high-flow O₂ via non-rebreather
(Correct Answer: B)
Q006: A 70-year-old male with chronic AF on warfarin develops hematuria. INR is 6.8,
creatinine 1.3 mg/dL, BP 110/70 mm Hg. Which medication should the nurse prepare?
Options:
A. Vitamin K 10 mg IV push - CORRECT
B. Protamine sulfate IV
C. Fresh frozen plasma 2 units
D. Tranexamic acid 1 g IV
(Correct Answer: A)
Q007: A 60-year-old female with MS on ocrelizumab presents with fever 38.5 °C, cough, and
oxygen saturation 90 % on room air. Chest CT shows bilateral ground-glass opacities. Which
initial action is priority?
Options:
A. Start broad-spectrum antibiotics immediately
B. Obtain sputum culture and blood cultures - CORRECT
C. Administer high-dose methylprednisolone
D. Initiate non-invasive ventilation
(Correct Answer: B)
Q008: A 45-year-old male with acute kidney injury (urine output 200 mL/8 h, K⁺ 5.8 mEq/L, ECG
peaked T waves) is ordered kayexalate. Which additional order should the nurse anticipate?
Options:
A. 20 units regular insulin + 1 ampule D50 IV - CORRECT
B. Sodium bicarbonate 50 mEq IV push
C. Calcium gluconate 1 g PO
D. Furosemide 80 mg IV push
(Correct Answer: A)
Q009: A 38-year-old female post-traumatic brain injury has ICP 18 mm Hg, MAP 65 mm Hg,
PaCO₂ 32 mm Hg. Which prescribed intervention should the nurse question?
Options:
A. Mannitol 1 g/kg IV over 20 min
B. Maintain head-of-bed at 30°
C. Initiate dexmedetomidine infusion at 1.5 mcg/kg/h - CORRECT
D. Target PaCO₂ 30–35 mm Hg
(Correct Answer: C)
Proctored RN Actual Exam New Latest Version
With All Questions And Correct Answers With
Rationale | Medical-Surgical Nursing Assessment
Q001: A 68-year-old male with a history of COPD and chronic kidney disease (stage 3) is
admitted with acute decompensated heart failure. His current medications include metoprolol,
furosemide, and inhaled tiotropium. On assessment, he has bibasilar crackles, a BP of 98/62
mm Hg, HR 110 bpm, and urine output 15 mL/hr. Serum creatinine has risen from 1.4 to 2.1
mg/dL in 24 h. Which intervention is the priority?
Options:
A. Increase metoprolol dose to reduce heart rate
B. Administer a 500 mL normal saline bolus
C. Hold furosemide and initiate a nesiritide infusion - CORRECT
D. Start dobutamine drip at 5 mcg/kg/min
(Correct Answer: C)
Q002: A 72-year-old female post right lower lobectomy develops sudden onset dyspnea and
pleuritic chest pain. ABG reveals PaO₂ 58 mm Hg on 4 L NC, PaCO₂ 48 mm Hg, pH 7.32. SpO₂
is 88 %. Which action should the nurse implement first?
Options:
A. Increase O₂ to 6 L via simple face mask
B. Obtain an immediate chest x-ray
C. Switch to high-flow nasal cannula and notify provider - CORRECT
D. Coach patient in pursed-lip breathing
(Correct Answer: C)
Q003: A 55-year-old male with acute pancreatitis (Ranson score 4) has severe epigastric pain,
BP 84/50 mm Hg, HR 122 bpm, and urine output 20 mL/hr. Hematocrit is 52 %. Which order
should the nurse anticipate?
Options:
A. Start dopamine 10 mcg/kg/min IV
B. Administer 2 L D5NS over 2 h
C. Initiate norepinephrine 0.1 mcg/kg/min IV - CORRECT
D. Give furosemide 40 mg IV push
(Correct Answer: C)
Q004: A 62-year-old female with Type 2 DM on insulin glargine is NPO for upper endoscopy at
0800. Morning glucose is 310 mg/dL, urine negative for ketones. Which action is appropriate?
Options:
A. Hold all insulin and recheck in 2 h
B. Administer 6 units regular insulin IV now - CORRECT
C. Start D5½NS with 10 units regular insulin
D. Give rapid-acting insulin per sliding scale orally
, (Correct Answer: B)
Q005: A 48-year-old male with decompensated cirrhosis develops black stools and BP 88/60
mm Hg. Which ordered intervention should the nurse complete first?
Options:
A. Insert a nasogastric tube for lavage
B. Establish two 18-gauge IVs and begin fluid resuscitation - CORRECT
C. Administer pantoprazole 80 mg IV
D. Place on high-flow O₂ via non-rebreather
(Correct Answer: B)
Q006: A 70-year-old male with chronic AF on warfarin develops hematuria. INR is 6.8,
creatinine 1.3 mg/dL, BP 110/70 mm Hg. Which medication should the nurse prepare?
Options:
A. Vitamin K 10 mg IV push - CORRECT
B. Protamine sulfate IV
C. Fresh frozen plasma 2 units
D. Tranexamic acid 1 g IV
(Correct Answer: A)
Q007: A 60-year-old female with MS on ocrelizumab presents with fever 38.5 °C, cough, and
oxygen saturation 90 % on room air. Chest CT shows bilateral ground-glass opacities. Which
initial action is priority?
Options:
A. Start broad-spectrum antibiotics immediately
B. Obtain sputum culture and blood cultures - CORRECT
C. Administer high-dose methylprednisolone
D. Initiate non-invasive ventilation
(Correct Answer: B)
Q008: A 45-year-old male with acute kidney injury (urine output 200 mL/8 h, K⁺ 5.8 mEq/L, ECG
peaked T waves) is ordered kayexalate. Which additional order should the nurse anticipate?
Options:
A. 20 units regular insulin + 1 ampule D50 IV - CORRECT
B. Sodium bicarbonate 50 mEq IV push
C. Calcium gluconate 1 g PO
D. Furosemide 80 mg IV push
(Correct Answer: A)
Q009: A 38-year-old female post-traumatic brain injury has ICP 18 mm Hg, MAP 65 mm Hg,
PaCO₂ 32 mm Hg. Which prescribed intervention should the nurse question?
Options:
A. Mannitol 1 g/kg IV over 20 min
B. Maintain head-of-bed at 30°
C. Initiate dexmedetomidine infusion at 1.5 mcg/kg/h - CORRECT
D. Target PaCO₂ 30–35 mm Hg
(Correct Answer: C)
