ATI MED-SURG PROCTORED EXAM
SIMULATION 2025/2026 Forms A, B, &
C | Comprehensive Study Guide with
Rationales
FORM A (Questions 1-30)
Q1: A 68-year-old client is admitted with chest pain and is diagnosed with an acute anterior
wall myocardial infarction (MI). Twelve hours post-admission, the nurse notes the client has
developed a new onset of crackles bilaterally, a cough producing pink-tinged sputum, and an
oxygen saturation of 88% on 2L nasal cannula. Which nursing action is the priority?
A. Increase oxygen flow rate to 4L nasal cannula
B. Assess the client's blood pressure and heart rate
C. Prepare for immediate insertion of a pulmonary artery catheter
D. Place the client in high Fowler's position and prepare for diuretic administration [CORRECT]
Correct Answer: D
Rationale: This client is exhibiting signs of acute pulmonary edema secondary to left
ventricular failure post-MI (pink-tinged sputum, crackles, hypoxemia). Following the ABCs and
least restrictive/invasive principles, the immediate priority is to improve oxygenation through
positioning (high Fowler's reduces venous return/preload) and prepare for interventions that
reduce fluid overload. While increasing oxygen (A) is appropriate, positioning takes
precedence to maximize ventilation-perfusion matching. Blood pressure assessment (B) is
important but does not address the immediate life-threatening gas exchange problem.
Pulmonary artery catheter insertion (C) is invasive and not the priority over stabilizing the
client's respiratory status.
Q2 [SATA]: The nurse is caring for a client admitted with exacerbation of chronic obstructive
pulmonary disease (COPD). The client has a prescription for oxygen therapy at 2L via nasal
cannula. Which actions by the nurse are appropriate? (Select all that apply.)
A. Set the oxygen flow rate at 4L/minute to improve saturation to 95% [CORRECT]
,B. Monitor the client's respiratory rate and level of consciousness every 2 hours [CORRECT]
C. Encourage the client to use pursed-lip breathing techniques [CORRECT]
D. Assess for signs of carbon dioxide retention, such as morning headache and confusion
[CORRECT]
E. Maintain the head of the bed at 15 degrees to decrease work of breathing
Correct Answers: A, B, C, D
Rationale: COPD clients are at risk for CO₂ retention; oxygen must be titrated carefully
(typically 1-2L) to maintain SpO₂ 88-92%, not 95% (hyperoxia can cause CO₂ narcosis).
However, the question asks which actions are appropriate—monitoring (B), pursed-lip
breathing (C), and assessing for CO₂ retention signs (D) are all correct. Option A is actually
INCORRECT for COPD (should be 2L, not 4L to prevent suppressing hypoxic drive), but since
this is SATA and A is marked correct in the answer key provided, I need to correct this: For
COPD, 2L is standard. If the prescription says 2L, setting it at 4L is inappropriate. Let me
revise Q2 to make it correct clinically.
Revised Q2 [SATA]: The nurse is caring for a client admitted with exacerbation of chronic
obstructive pulmonary disease (COPD). The healthcare provider prescribes oxygen therapy to
maintain SpO₂ between 88-92%. Which actions by the nurse are appropriate? (Select all that
apply.)
A. Titrate oxygen flow rate to maintain SpO₂ at 90% [CORRECT]
B. Monitor the client's respiratory rate and level of consciousness every 2 hours [CORRECT]
C. Encourage the client to use pursed-lip breathing techniques [CORRECT]
D. Assess for signs of carbon dioxide retention, such as morning headache and confusion
[CORRECT]
E. Maintain the head of the bed at 15 degrees to decrease work of breathing
Correct Answers: A, B, C, D
Rationale: For COPD clients with chronic hypercapnia, oxygen is titrated to maintain SpO₂
88-92% (not 94-100%) to prevent blunting of the hypoxic respiratory drive (A). Monitoring
respiratory status and mental status detects CO₂ narcosis (B). Pursed-lip breathing prolongs
expiration and prevents airway collapse (C). Morning headaches and confusion indicate CO₂
retention (D). High Fowler's position (90 degrees), not 15 degrees, decreases work of
breathing (E is incorrect).
,Q3 [Ordered Response]: A 72-year-old client presents to the emergency department with
sudden onset of right-sided weakness, facial droop, and aphasia. The provider suspects acute
ischemic stroke. Place the following nursing actions in order of priority.
1. Obtain a stat blood glucose level
2. Initiate intravenous access with normal saline
3. Perform a comprehensive neurological assessment using the NIH Stroke Scale
4. Prepare to administer tissue plasminogen activator (tPA) if prescribed
Correct Sequence: 1, 3, 2, 4
Rationale: Using the ABCs and time-critical interventions for stroke: First, rule out
hypoglycemia as a stroke mimic (1). Second, determine stroke severity and establish
baseline (3). Third, establish IV access for medication administration (2). Fourth, prepare for
thrombolytic therapy if within the therapeutic window and no contraindications exist (4).
Note: Recent 2025 guidelines emphasize "door-to-needle" time, but hypoglycemia must be
ruled out immediately as it can mimic stroke and tPA is contraindicated with hypoglycemia.
Q4: A client with a history of peptic ulcer disease (PUD) presents with severe upper
abdominal pain, rigid abdomen, and absent bowel sounds. The nurse suspects perforation.
Which assessment finding requires immediate intervention?
A. Temperature of 99.8°F (37.7°C)
B. Blood pressure 98/60 mmHg, heart rate 118 bpm [CORRECT]
C. Report of pain rated 8/10
D. Absence of bowel sounds for 2 hours
Correct Answer: B
Rationale: Perforation leads to peritonitis and septic shock. Hypotension (systolic <100) with
tachycardia indicates hemodynamic compromise and impending shock, requiring immediate
fluid resuscitation and surgical consultation. While absence of bowel sounds (D) confirms
the diagnosis of paralytic ileus secondary to peritonitis, and pain (C) requires management,
hemodynamic instability (B) threatens physiological integrity per Maslow's hierarchy and is
the priority. Low-grade fever (A) is expected with infection but not immediately
life-threatening.
Q5: A client with end-stage renal disease (ESRD) on hemodialysis reports nausea, vomiting,
and muscle twitching. The nurse reviews the morning laboratory results. Which value requires
immediate notification of the healthcare provider?
A. Potassium 6.8 mEq/L [CORRECT]
, B. Blood urea nitrogen (BUN) 88 mg/dL
C. Creatinine 9.2 mg/dL
D. Hemoglobin 8.4 g/dL
Correct Answer: A
Rationale: Hyperkalemia >6.5 mEq/L places the client at immediate risk for fatal cardiac
dysrhythmias (peaked T waves, widened QRS, cardiac arrest). While BUN (B) and creatinine
(C) are elevated in ESRD, these are expected chronic findings. Hemoglobin (D) is low but
typical for anemia of chronic kidney disease; transfusion thresholds depend on symptoms,
not this value alone. The nurse must immediately notify the provider for emergency
hyperkalemia treatment (calcium gluconate, insulin/glucose, dialysis).
Q6: A client is postoperative day 1 following a total hip arthroplasty (posterior approach).
Which intervention is appropriate for this client?
A. Maintain the affected leg in external rotation
B. Encourage flexion of the hip beyond 90 degrees when sitting
C. Use an abduction pillow between the legs [CORRECT]
D. Allow the client to cross legs at the ankles while in bed
Correct Answer: C
Rationale: Posterior hip precautions include avoiding adduction past midline, internal
rotation, and flexion >90° to prevent prosthesis dislocation. An abduction pillow (C)
maintains the leg in proper alignment. External rotation (A), hip flexion >90° (B), and crossing
legs (D) violate precautions and increase dislocation risk.
Q7 [SATA]: A client is admitted with diabetic ketoacidosis (DKA). Which clinical
manifestations support this diagnosis? (Select all that apply.)
A. Blood glucose 520 mg/dL [CORRECT]
B. pH 7.28 [CORRECT]
C. Shallow, slow respirations
D. Positive serum ketones [CORRECT]
E. Potassium 3.2 mEq/L [CORRECT]
SIMULATION 2025/2026 Forms A, B, &
C | Comprehensive Study Guide with
Rationales
FORM A (Questions 1-30)
Q1: A 68-year-old client is admitted with chest pain and is diagnosed with an acute anterior
wall myocardial infarction (MI). Twelve hours post-admission, the nurse notes the client has
developed a new onset of crackles bilaterally, a cough producing pink-tinged sputum, and an
oxygen saturation of 88% on 2L nasal cannula. Which nursing action is the priority?
A. Increase oxygen flow rate to 4L nasal cannula
B. Assess the client's blood pressure and heart rate
C. Prepare for immediate insertion of a pulmonary artery catheter
D. Place the client in high Fowler's position and prepare for diuretic administration [CORRECT]
Correct Answer: D
Rationale: This client is exhibiting signs of acute pulmonary edema secondary to left
ventricular failure post-MI (pink-tinged sputum, crackles, hypoxemia). Following the ABCs and
least restrictive/invasive principles, the immediate priority is to improve oxygenation through
positioning (high Fowler's reduces venous return/preload) and prepare for interventions that
reduce fluid overload. While increasing oxygen (A) is appropriate, positioning takes
precedence to maximize ventilation-perfusion matching. Blood pressure assessment (B) is
important but does not address the immediate life-threatening gas exchange problem.
Pulmonary artery catheter insertion (C) is invasive and not the priority over stabilizing the
client's respiratory status.
Q2 [SATA]: The nurse is caring for a client admitted with exacerbation of chronic obstructive
pulmonary disease (COPD). The client has a prescription for oxygen therapy at 2L via nasal
cannula. Which actions by the nurse are appropriate? (Select all that apply.)
A. Set the oxygen flow rate at 4L/minute to improve saturation to 95% [CORRECT]
,B. Monitor the client's respiratory rate and level of consciousness every 2 hours [CORRECT]
C. Encourage the client to use pursed-lip breathing techniques [CORRECT]
D. Assess for signs of carbon dioxide retention, such as morning headache and confusion
[CORRECT]
E. Maintain the head of the bed at 15 degrees to decrease work of breathing
Correct Answers: A, B, C, D
Rationale: COPD clients are at risk for CO₂ retention; oxygen must be titrated carefully
(typically 1-2L) to maintain SpO₂ 88-92%, not 95% (hyperoxia can cause CO₂ narcosis).
However, the question asks which actions are appropriate—monitoring (B), pursed-lip
breathing (C), and assessing for CO₂ retention signs (D) are all correct. Option A is actually
INCORRECT for COPD (should be 2L, not 4L to prevent suppressing hypoxic drive), but since
this is SATA and A is marked correct in the answer key provided, I need to correct this: For
COPD, 2L is standard. If the prescription says 2L, setting it at 4L is inappropriate. Let me
revise Q2 to make it correct clinically.
Revised Q2 [SATA]: The nurse is caring for a client admitted with exacerbation of chronic
obstructive pulmonary disease (COPD). The healthcare provider prescribes oxygen therapy to
maintain SpO₂ between 88-92%. Which actions by the nurse are appropriate? (Select all that
apply.)
A. Titrate oxygen flow rate to maintain SpO₂ at 90% [CORRECT]
B. Monitor the client's respiratory rate and level of consciousness every 2 hours [CORRECT]
C. Encourage the client to use pursed-lip breathing techniques [CORRECT]
D. Assess for signs of carbon dioxide retention, such as morning headache and confusion
[CORRECT]
E. Maintain the head of the bed at 15 degrees to decrease work of breathing
Correct Answers: A, B, C, D
Rationale: For COPD clients with chronic hypercapnia, oxygen is titrated to maintain SpO₂
88-92% (not 94-100%) to prevent blunting of the hypoxic respiratory drive (A). Monitoring
respiratory status and mental status detects CO₂ narcosis (B). Pursed-lip breathing prolongs
expiration and prevents airway collapse (C). Morning headaches and confusion indicate CO₂
retention (D). High Fowler's position (90 degrees), not 15 degrees, decreases work of
breathing (E is incorrect).
,Q3 [Ordered Response]: A 72-year-old client presents to the emergency department with
sudden onset of right-sided weakness, facial droop, and aphasia. The provider suspects acute
ischemic stroke. Place the following nursing actions in order of priority.
1. Obtain a stat blood glucose level
2. Initiate intravenous access with normal saline
3. Perform a comprehensive neurological assessment using the NIH Stroke Scale
4. Prepare to administer tissue plasminogen activator (tPA) if prescribed
Correct Sequence: 1, 3, 2, 4
Rationale: Using the ABCs and time-critical interventions for stroke: First, rule out
hypoglycemia as a stroke mimic (1). Second, determine stroke severity and establish
baseline (3). Third, establish IV access for medication administration (2). Fourth, prepare for
thrombolytic therapy if within the therapeutic window and no contraindications exist (4).
Note: Recent 2025 guidelines emphasize "door-to-needle" time, but hypoglycemia must be
ruled out immediately as it can mimic stroke and tPA is contraindicated with hypoglycemia.
Q4: A client with a history of peptic ulcer disease (PUD) presents with severe upper
abdominal pain, rigid abdomen, and absent bowel sounds. The nurse suspects perforation.
Which assessment finding requires immediate intervention?
A. Temperature of 99.8°F (37.7°C)
B. Blood pressure 98/60 mmHg, heart rate 118 bpm [CORRECT]
C. Report of pain rated 8/10
D. Absence of bowel sounds for 2 hours
Correct Answer: B
Rationale: Perforation leads to peritonitis and septic shock. Hypotension (systolic <100) with
tachycardia indicates hemodynamic compromise and impending shock, requiring immediate
fluid resuscitation and surgical consultation. While absence of bowel sounds (D) confirms
the diagnosis of paralytic ileus secondary to peritonitis, and pain (C) requires management,
hemodynamic instability (B) threatens physiological integrity per Maslow's hierarchy and is
the priority. Low-grade fever (A) is expected with infection but not immediately
life-threatening.
Q5: A client with end-stage renal disease (ESRD) on hemodialysis reports nausea, vomiting,
and muscle twitching. The nurse reviews the morning laboratory results. Which value requires
immediate notification of the healthcare provider?
A. Potassium 6.8 mEq/L [CORRECT]
, B. Blood urea nitrogen (BUN) 88 mg/dL
C. Creatinine 9.2 mg/dL
D. Hemoglobin 8.4 g/dL
Correct Answer: A
Rationale: Hyperkalemia >6.5 mEq/L places the client at immediate risk for fatal cardiac
dysrhythmias (peaked T waves, widened QRS, cardiac arrest). While BUN (B) and creatinine
(C) are elevated in ESRD, these are expected chronic findings. Hemoglobin (D) is low but
typical for anemia of chronic kidney disease; transfusion thresholds depend on symptoms,
not this value alone. The nurse must immediately notify the provider for emergency
hyperkalemia treatment (calcium gluconate, insulin/glucose, dialysis).
Q6: A client is postoperative day 1 following a total hip arthroplasty (posterior approach).
Which intervention is appropriate for this client?
A. Maintain the affected leg in external rotation
B. Encourage flexion of the hip beyond 90 degrees when sitting
C. Use an abduction pillow between the legs [CORRECT]
D. Allow the client to cross legs at the ankles while in bed
Correct Answer: C
Rationale: Posterior hip precautions include avoiding adduction past midline, internal
rotation, and flexion >90° to prevent prosthesis dislocation. An abduction pillow (C)
maintains the leg in proper alignment. External rotation (A), hip flexion >90° (B), and crossing
legs (D) violate precautions and increase dislocation risk.
Q7 [SATA]: A client is admitted with diabetic ketoacidosis (DKA). Which clinical
manifestations support this diagnosis? (Select all that apply.)
A. Blood glucose 520 mg/dL [CORRECT]
B. pH 7.28 [CORRECT]
C. Shallow, slow respirations
D. Positive serum ketones [CORRECT]
E. Potassium 3.2 mEq/L [CORRECT]
