ATI RN Med Surg Proctored / RN Med Surg 2026 Proctored
RN Exam New Latest Version With All Questions And Correct
Answers With Rationale | Medical-Surgical Nursing
Assessment
Q001: A 62-year-old male with a history of STEMI treated with PCI 18 months ago
presents to telemetry with new-onset chest discomfort and frequent ventricular ectopy
on the monitor. Vital signs: BP 98/62, HR 118 irregular, SpO₂ 94 % RA. He is diaphoretic
and states he “feels like I’m going to pass out.” Which immediate nursing action is
priority?
Options:
A. Obtain a 12-lead ECG and call the rapid-response team
B. Administer SL nitroglycerin 0.4 mg
C. Start amiodarone 150 mg IV bolus
D. Place the patient supine and initiate large-bore IV access - CORRECT
(Correct Answer: D)
Q002: A 58-year-old female with decompensated HF (EF 25 %) on continuous
dobutamine 5 mcg/kg/min develops sudden dyspnea and coughs up pink frothy
sputum. BP 180/110, HR 128, RR 32, SpO₂ 84 % on 6 L NC. Which intervention should
the nurse implement first?
Options:
A. Increase dobutamine to 10 mcg/kg/min
B. Administer furosemide 80 mg IV push - CORRECT
C. Apply BiPAP and start 100 % O₂
D. Give morphine 4 mg IV
,(Correct Answer: B)
Q003: A 72-hour post-op AAA repair patient has a sudden rise in serum creatinine from
1.1 to 2.4 mg/dL and urine output 15 mL/h × 3 h. Urine sediment shows muddy-brown
casts. Which order should the nurse question?
Options:
A. Start normal saline 500 mL bolus
B. Continue metformin 1000 mg PO BID - CORRECT
C. Insert Foley and monitor hourly output
D. Stop ACE inhibitor
(Correct Answer: B)
Q004: A 45-year-old with alcoholic cirrhosis is admitted with hematemesis. After
emergent EGD and banding of esophageal varices, which nursing action best prevents
re-bleeding?
Options:
A. Restrict all PO intake for 48 h
B. Administer octreotide 50 mcg IV bolus followed by 50 mcg/h - CORRECT
C. Give propranolol 20 mg PO daily
D. Place nasogastric tube to low suction
(Correct Answer: B)
Q005: A 38-year-old female with Graves’ disease presents with fever 103 °F, HR 150, and
delirium 2 weeks after starting methimazole. TSH is <0.01; free T4 is 8 ng/dL. Which
prescribed intervention is priority?
Options:
A. Give methimazole 30 mg PO now
B. Start propylthiouracil 300 mg PO q8h
,C. Initiate hydrocortisone 200 mg IV q8h - CORRECT
D. Administer propranolol 2 mg IV q5 min
(Correct Answer: C)
Q006: A 67-year-old with COPD (FEV₁ 35 %) is on BiPAP for hypercapnia (pH 7.28, PaCO₂
70). He becomes agitated and tries to remove the mask. Which immediate nursing
action is indicated?
Options:
A. Sedate with midazolam 2 mg IV
B. Check mask fit and synchronize settings - CORRECT
C. Switch to high-flow nasal cannula
D. Increase FiO₂ to 100 %
(Correct Answer: B)
Q007: A 55-year-old with T2DM and CKD stage 4 receives NPH insulin 20 units SC qHS.
Morning glucose is 420 mg/dL, but serum creatinine is 3.2 mg/dL. Which adjustment
should the nurse anticipate?
Options:
A. Hold insulin and give regular insulin 8 units IV now
B. Increase NPH to 30 units SC - CORRECT
C. Start insulin drip 5 units/h
D. Give 10 units regular SC now and resume NPH tonight
(Correct Answer: B)
Q008: A 70-year-old with right hip ORIF 6 h ago reports sudden severe dyspnea and
pleuritic chest pain. HR 110, RR 28, SpO₂ 88 % on 4 L NC. Which order should the nurse
implement first?
, Options:
A. Stat chest X-ray
B. Start heparin 80 units/kg IV bolus - CORRECT
C. Obtain V/Q scan
D. Administer albuterol nebulizer
(Correct Answer: B)
Q009: A 60-year-old with CLL develops tumor lysis syndrome after first cycle of
venetoclax. K⁺ 6.2, Ca²⁺ 7.8, PO₄ 7.5, uric acid 14 mg/dL. Which medication should the
nurse prepare first?
Options:
A. Calcium gluconate 1 g IV over 10 min - CORRECT
B. Regular insulin 10 units + D50W amp
C. Sodium polystyrene sulfonate 30 g PO
D. Rasburicase 6 mg IV
(Correct Answer: A)
Q010: A 48-year-old with MS on interferon-β presents with urinary retention and bilateral
lower-extremity weakness. MRI shows T6 lesion enhancement. Which nursing
intervention is priority?
Options:
A. Start high-dose methylprednisolone 1 g IV daily - CORRECT
B. Insert indwelling urinary catheter
C. Begin plasmapheresis
D. Administer oxybutynin 5 mg PO
RN Exam New Latest Version With All Questions And Correct
Answers With Rationale | Medical-Surgical Nursing
Assessment
Q001: A 62-year-old male with a history of STEMI treated with PCI 18 months ago
presents to telemetry with new-onset chest discomfort and frequent ventricular ectopy
on the monitor. Vital signs: BP 98/62, HR 118 irregular, SpO₂ 94 % RA. He is diaphoretic
and states he “feels like I’m going to pass out.” Which immediate nursing action is
priority?
Options:
A. Obtain a 12-lead ECG and call the rapid-response team
B. Administer SL nitroglycerin 0.4 mg
C. Start amiodarone 150 mg IV bolus
D. Place the patient supine and initiate large-bore IV access - CORRECT
(Correct Answer: D)
Q002: A 58-year-old female with decompensated HF (EF 25 %) on continuous
dobutamine 5 mcg/kg/min develops sudden dyspnea and coughs up pink frothy
sputum. BP 180/110, HR 128, RR 32, SpO₂ 84 % on 6 L NC. Which intervention should
the nurse implement first?
Options:
A. Increase dobutamine to 10 mcg/kg/min
B. Administer furosemide 80 mg IV push - CORRECT
C. Apply BiPAP and start 100 % O₂
D. Give morphine 4 mg IV
,(Correct Answer: B)
Q003: A 72-hour post-op AAA repair patient has a sudden rise in serum creatinine from
1.1 to 2.4 mg/dL and urine output 15 mL/h × 3 h. Urine sediment shows muddy-brown
casts. Which order should the nurse question?
Options:
A. Start normal saline 500 mL bolus
B. Continue metformin 1000 mg PO BID - CORRECT
C. Insert Foley and monitor hourly output
D. Stop ACE inhibitor
(Correct Answer: B)
Q004: A 45-year-old with alcoholic cirrhosis is admitted with hematemesis. After
emergent EGD and banding of esophageal varices, which nursing action best prevents
re-bleeding?
Options:
A. Restrict all PO intake for 48 h
B. Administer octreotide 50 mcg IV bolus followed by 50 mcg/h - CORRECT
C. Give propranolol 20 mg PO daily
D. Place nasogastric tube to low suction
(Correct Answer: B)
Q005: A 38-year-old female with Graves’ disease presents with fever 103 °F, HR 150, and
delirium 2 weeks after starting methimazole. TSH is <0.01; free T4 is 8 ng/dL. Which
prescribed intervention is priority?
Options:
A. Give methimazole 30 mg PO now
B. Start propylthiouracil 300 mg PO q8h
,C. Initiate hydrocortisone 200 mg IV q8h - CORRECT
D. Administer propranolol 2 mg IV q5 min
(Correct Answer: C)
Q006: A 67-year-old with COPD (FEV₁ 35 %) is on BiPAP for hypercapnia (pH 7.28, PaCO₂
70). He becomes agitated and tries to remove the mask. Which immediate nursing
action is indicated?
Options:
A. Sedate with midazolam 2 mg IV
B. Check mask fit and synchronize settings - CORRECT
C. Switch to high-flow nasal cannula
D. Increase FiO₂ to 100 %
(Correct Answer: B)
Q007: A 55-year-old with T2DM and CKD stage 4 receives NPH insulin 20 units SC qHS.
Morning glucose is 420 mg/dL, but serum creatinine is 3.2 mg/dL. Which adjustment
should the nurse anticipate?
Options:
A. Hold insulin and give regular insulin 8 units IV now
B. Increase NPH to 30 units SC - CORRECT
C. Start insulin drip 5 units/h
D. Give 10 units regular SC now and resume NPH tonight
(Correct Answer: B)
Q008: A 70-year-old with right hip ORIF 6 h ago reports sudden severe dyspnea and
pleuritic chest pain. HR 110, RR 28, SpO₂ 88 % on 4 L NC. Which order should the nurse
implement first?
, Options:
A. Stat chest X-ray
B. Start heparin 80 units/kg IV bolus - CORRECT
C. Obtain V/Q scan
D. Administer albuterol nebulizer
(Correct Answer: B)
Q009: A 60-year-old with CLL develops tumor lysis syndrome after first cycle of
venetoclax. K⁺ 6.2, Ca²⁺ 7.8, PO₄ 7.5, uric acid 14 mg/dL. Which medication should the
nurse prepare first?
Options:
A. Calcium gluconate 1 g IV over 10 min - CORRECT
B. Regular insulin 10 units + D50W amp
C. Sodium polystyrene sulfonate 30 g PO
D. Rasburicase 6 mg IV
(Correct Answer: A)
Q010: A 48-year-old with MS on interferon-β presents with urinary retention and bilateral
lower-extremity weakness. MRI shows T6 lesion enhancement. Which nursing
intervention is priority?
Options:
A. Start high-dose methylprednisolone 1 g IV daily - CORRECT
B. Insert indwelling urinary catheter
C. Begin plasmapheresis
D. Administer oxybutynin 5 mg PO
