ATI Medical Surgical Nursing Comprehensive Study Guide,
ATI Med Surg Exam Prep Notes, Practice Questions &
Rationales, ATI Med Surg Proctored Exam Review, Nursing
Med Surg ATI Study Bundle for RN & Nursing Students
Success
Question 1: A nurse is caring for a client with heart failure who is prescribed furosemide 40
mg IV push. Which assessment finding requires immediate intervention before
administration?
A. Blood pressure 110/70 mmHg
B. Serum potassium 3.2 mEq/L
C. Urine output 30 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium excretion, and a serum
potassium level of 3.2 mEq/L indicates hypokalemia. Administering furosemide without
addressing this electrolyte imbalance could worsen hypokalemia, increasing the risk of life-
threatening cardiac dysrhythmias. The nurse should notify the provider and anticipate
potassium replacement before administration. Blood pressure of 110/70 mmHg is acceptable,
urine output of 30 mL/hr meets minimum thresholds, and weight gain is an expected finding in
heart failure that furosemide is intended to address.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
via nasal cannula at 2 L/min. The nurse notes the client is increasingly confused and has a
headache. Which action should the nurse take first?
A. Increase oxygen to 4 L/min
B. Obtain an arterial blood gas
C. Notify the health care provider
D. Decrease oxygen to 1 L/min
CORRECT ANSWER: B. Obtain an arterial blood gas
Rationale: In clients with COPD, excessive oxygen can suppress the hypoxic drive to breathe,
leading to carbon dioxide retention and respiratory acidosis, manifested by confusion and
headache. Before adjusting oxygen therapy, the nurse must assess the client's acid-base status
via arterial blood gas to determine if hypercapnia is present. Increasing oxygen could worsen
CO2 retention, while decreasing oxygen without assessment could cause hypoxemia. Notifying
the provider is important but obtaining objective data first guides appropriate intervention.
Question 3: A nurse is preparing to administer enoxaparin to a client following total knee
arthroplasty. Which finding in the client's history requires clarification with the provider
before administration?
A. History of peptic ulcer disease
B. Platelet count of 150,000/mm³
C. INR of 1.2
D. Recent epidural catheter removal 2 hours ago
CORRECT ANSWER: D. Recent epidural catheter removal 2 hours ago
,Rationale: Enoxaparin, a low-molecular-weight heparin, increases bleeding risk. Administering
anticoagulants too soon after epidural catheter removal increases the risk of epidural
hematoma, which can cause spinal cord compression and permanent neurological damage.
Guidelines recommend waiting at least 2-4 hours after catheter removal before initiating
thromboprophylaxis. Peptic ulcer disease requires monitoring but is not an absolute
contraindication; platelet count and INR are within normal limits and do not preclude
administration.
Question 4: A client with type 1 diabetes mellitus reports shakiness, sweating, and
palpitations. Blood glucose is 58 mg/dL. Which intervention should the nurse implement
first?
A. Administer 15 grams of fast-acting carbohydrate
B. Recheck blood glucose in 15 minutes
C. Provide a snack with protein and complex carbohydrate
D. Notify the health care provider
CORRECT ANSWER: A. Administer 15 grams of fast-acting carbohydrate
Rationale: The client is experiencing symptomatic hypoglycemia with a blood glucose of 58
mg/dL. The immediate priority is to raise blood glucose quickly using the "15-15 rule":
administer 15 grams of fast-acting carbohydrate (e.g., 4 oz fruit juice, glucose tablets) and
recheck in 15 minutes. Rechecking glucose or providing a snack occurs after initial treatment.
Notifying the provider is unnecessary for a single, treatable hypoglycemic episode unless the
client becomes unresponsive or episodes are recurrent.
Question 5: A nurse is assessing a client 24 hours after abdominal surgery. Which finding
indicates a potential complication requiring immediate notification of the provider?
A. Temperature 38.1°C (100.6°F)
B. Serosanguineous drainage on dressing
C. Absent bowel sounds in all quadrants
D. Pain rating of 6/10 with movement
CORRECT ANSWER: C. Absent bowel sounds in all quadrants
Rationale: While low-grade fever, serosanguineous drainage, and moderate pain with
movement are expected findings within 24 hours postoperatively, absent bowel sounds in all
quadrants may indicate paralytic ileus or bowel obstruction, which are serious complications
requiring prompt evaluation. Bowel sounds typically return within 24-48 hours after abdominal
surgery; persistent absence warrants assessment for distension, nausea, vomiting, and provider
notification.
Question 6: A client with acute kidney injury has a serum potassium level of 6.8 mEq/L.
Which electrocardiogram change should the nurse anticipate?
A. Prominent U waves
B. Prolonged QT interval
C. Tall, peaked T waves
D. ST segment depression
CORRECT ANSWER: C. Tall, peaked T waves
,Rationale: Hyperkalemia (potassium >5.0 mEq/L) causes characteristic ECG changes beginning
with tall, peaked T waves due to altered cardiac repolarization. As potassium rises further,
findings may include widened QRS complex, prolonged PR interval, and eventually sine wave
pattern leading to cardiac arrest. Prominent U waves and ST depression are associated with
hypokalemia; prolonged QT interval is seen with hypocalcemia or certain medications.
Question 7: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Tidaling in the water-seal chamber with respiration
B. Continuous bubbling in the water-seal chamber
C. 50 mL of serosanguineous drainage in the collection chamber
D. Fluctuation of fluid level in the water-seal chamber
CORRECT ANSWER: B. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system,
which could represent a disconnection, loose connection, or persistent pneumothorax. This
requires immediate assessment and intervention to maintain system integrity and prevent
tension pneumothorax. Tidaling and fluctuation are normal findings indicating proper system
function. Serosanguineous drainage of 50 mL is expected in the initial post-insertion period.
Question 8: A client with pancreatitis is prescribed nothing by mouth (NPO) status and total
parenteral nutrition (TPN). Which laboratory value should the nurse monitor most closely to
evaluate TPN effectiveness?
A. Serum amylase
B. Prealbumin
C. Blood urea nitrogen
D. Serum lipase
CORRECT ANSWER: B. Prealbumin
Rationale: Prealbumin has a short half-life (2-3 days) and is a sensitive indicator of nutritional
status and protein repletion, making it ideal for monitoring TPN effectiveness. Serum amylase
and lipase assess pancreatic inflammation but do not reflect nutritional status. Blood urea
nitrogen evaluates renal function and hydration. While all may be monitored in pancreatitis,
prealbumin specifically evaluates the nutritional intervention of TPN.
Question 9: A nurse is administering a blood transfusion to a client. Fifteen minutes after
initiation, the client reports chills, low back pain, and dyspnea. Which action should the nurse
take first?
A. Obtain vital signs
B. Stop the transfusion
C. Notify the blood bank
D. Administer diphenhydramine
CORRECT ANSWER: B. Stop the transfusion
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction (chills, back
pain, dyspnea), which is a medical emergency. The immediate priority is to stop the transfusion
to prevent further infusion of incompatible blood. After stopping the transfusion, the nurse
should maintain IV access with normal saline, obtain vital signs, notify the provider and blood
, bank, and send the blood bag and tubing for analysis. Administering medications occurs after
stopping the transfusion and assessing the client.
Question 10: A client with a traumatic brain injury has a sudden increase in intracranial
pressure. Which triad of findings should the nurse recognize as Cushing's triad?
A. Hypertension, bradycardia, irregular respirations
B. Hypotension, tachycardia, tachypnea
C. Fever, hypertension, pupillary dilation
D. Headache, vomiting, papilledema
CORRECT ANSWER: A. Hypertension, bradycardia, irregular respirations
Rationale: Cushing's triad is a late sign of increased intracranial pressure and consists of systolic
hypertension with widening pulse pressure, bradycardia, and irregular respirations (Cheyne-
Stokes or ataxic breathing). These findings indicate brainstem herniation and require
immediate intervention. Hypotension and tachycardia suggest hypovolemic shock. Fever,
headache, vomiting, and papilledema are associated with increased ICP but do not constitute
Cushing's triad.
Question 11: A nurse is caring for a client with a new diagnosis of deep vein thrombosis (DVT)
in the left leg. Which intervention is contraindicated?
A. Elevating the affected leg
B. Applying warm compresses
C. Massaging the affected leg
D. Administering prescribed anticoagulants
CORRECT ANSWER: C. Massaging the affected leg
Rationale: Massaging a leg with suspected or confirmed DVT is contraindicated because it may
dislodge the thrombus, causing a pulmonary embolism. Elevation promotes venous return and
reduces edema. Warm compresses may improve comfort and circulation. Anticoagulants are
the cornerstone of DVT treatment to prevent thrombus extension and embolization. The nurse
should also avoid vigorous range-of-motion exercises on the affected extremity.
Question 12: A client with myasthenia gravis is experiencing increased muscle weakness,
ptosis, and difficulty swallowing. Which medication should the nurse anticipate
administering?
A. Atropine
B. Edrophonium
C. Neostigmine
D. Dopamine
CORRECT ANSWER: C. Neostigmine
Rationale: Neostigmine is an acetylcholinesterase inhibitor that increases acetylcholine
availability at the neuromuscular junction, improving muscle strength in myasthenia gravis.
Edrophonium is used diagnostically (Tensilon test) but has a very short duration. Atropine is an
anticholinergic that would worsen symptoms. Dopamine is a vasopressor used for shock. The
nurse should administer neostigmine as prescribed and monitor for cholinergic crisis, which can
mimic myasthenic crisis.
ATI Med Surg Exam Prep Notes, Practice Questions &
Rationales, ATI Med Surg Proctored Exam Review, Nursing
Med Surg ATI Study Bundle for RN & Nursing Students
Success
Question 1: A nurse is caring for a client with heart failure who is prescribed furosemide 40
mg IV push. Which assessment finding requires immediate intervention before
administration?
A. Blood pressure 110/70 mmHg
B. Serum potassium 3.2 mEq/L
C. Urine output 30 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium excretion, and a serum
potassium level of 3.2 mEq/L indicates hypokalemia. Administering furosemide without
addressing this electrolyte imbalance could worsen hypokalemia, increasing the risk of life-
threatening cardiac dysrhythmias. The nurse should notify the provider and anticipate
potassium replacement before administration. Blood pressure of 110/70 mmHg is acceptable,
urine output of 30 mL/hr meets minimum thresholds, and weight gain is an expected finding in
heart failure that furosemide is intended to address.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
via nasal cannula at 2 L/min. The nurse notes the client is increasingly confused and has a
headache. Which action should the nurse take first?
A. Increase oxygen to 4 L/min
B. Obtain an arterial blood gas
C. Notify the health care provider
D. Decrease oxygen to 1 L/min
CORRECT ANSWER: B. Obtain an arterial blood gas
Rationale: In clients with COPD, excessive oxygen can suppress the hypoxic drive to breathe,
leading to carbon dioxide retention and respiratory acidosis, manifested by confusion and
headache. Before adjusting oxygen therapy, the nurse must assess the client's acid-base status
via arterial blood gas to determine if hypercapnia is present. Increasing oxygen could worsen
CO2 retention, while decreasing oxygen without assessment could cause hypoxemia. Notifying
the provider is important but obtaining objective data first guides appropriate intervention.
Question 3: A nurse is preparing to administer enoxaparin to a client following total knee
arthroplasty. Which finding in the client's history requires clarification with the provider
before administration?
A. History of peptic ulcer disease
B. Platelet count of 150,000/mm³
C. INR of 1.2
D. Recent epidural catheter removal 2 hours ago
CORRECT ANSWER: D. Recent epidural catheter removal 2 hours ago
,Rationale: Enoxaparin, a low-molecular-weight heparin, increases bleeding risk. Administering
anticoagulants too soon after epidural catheter removal increases the risk of epidural
hematoma, which can cause spinal cord compression and permanent neurological damage.
Guidelines recommend waiting at least 2-4 hours after catheter removal before initiating
thromboprophylaxis. Peptic ulcer disease requires monitoring but is not an absolute
contraindication; platelet count and INR are within normal limits and do not preclude
administration.
Question 4: A client with type 1 diabetes mellitus reports shakiness, sweating, and
palpitations. Blood glucose is 58 mg/dL. Which intervention should the nurse implement
first?
A. Administer 15 grams of fast-acting carbohydrate
B. Recheck blood glucose in 15 minutes
C. Provide a snack with protein and complex carbohydrate
D. Notify the health care provider
CORRECT ANSWER: A. Administer 15 grams of fast-acting carbohydrate
Rationale: The client is experiencing symptomatic hypoglycemia with a blood glucose of 58
mg/dL. The immediate priority is to raise blood glucose quickly using the "15-15 rule":
administer 15 grams of fast-acting carbohydrate (e.g., 4 oz fruit juice, glucose tablets) and
recheck in 15 minutes. Rechecking glucose or providing a snack occurs after initial treatment.
Notifying the provider is unnecessary for a single, treatable hypoglycemic episode unless the
client becomes unresponsive or episodes are recurrent.
Question 5: A nurse is assessing a client 24 hours after abdominal surgery. Which finding
indicates a potential complication requiring immediate notification of the provider?
A. Temperature 38.1°C (100.6°F)
B. Serosanguineous drainage on dressing
C. Absent bowel sounds in all quadrants
D. Pain rating of 6/10 with movement
CORRECT ANSWER: C. Absent bowel sounds in all quadrants
Rationale: While low-grade fever, serosanguineous drainage, and moderate pain with
movement are expected findings within 24 hours postoperatively, absent bowel sounds in all
quadrants may indicate paralytic ileus or bowel obstruction, which are serious complications
requiring prompt evaluation. Bowel sounds typically return within 24-48 hours after abdominal
surgery; persistent absence warrants assessment for distension, nausea, vomiting, and provider
notification.
Question 6: A client with acute kidney injury has a serum potassium level of 6.8 mEq/L.
Which electrocardiogram change should the nurse anticipate?
A. Prominent U waves
B. Prolonged QT interval
C. Tall, peaked T waves
D. ST segment depression
CORRECT ANSWER: C. Tall, peaked T waves
,Rationale: Hyperkalemia (potassium >5.0 mEq/L) causes characteristic ECG changes beginning
with tall, peaked T waves due to altered cardiac repolarization. As potassium rises further,
findings may include widened QRS complex, prolonged PR interval, and eventually sine wave
pattern leading to cardiac arrest. Prominent U waves and ST depression are associated with
hypokalemia; prolonged QT interval is seen with hypocalcemia or certain medications.
Question 7: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Tidaling in the water-seal chamber with respiration
B. Continuous bubbling in the water-seal chamber
C. 50 mL of serosanguineous drainage in the collection chamber
D. Fluctuation of fluid level in the water-seal chamber
CORRECT ANSWER: B. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system,
which could represent a disconnection, loose connection, or persistent pneumothorax. This
requires immediate assessment and intervention to maintain system integrity and prevent
tension pneumothorax. Tidaling and fluctuation are normal findings indicating proper system
function. Serosanguineous drainage of 50 mL is expected in the initial post-insertion period.
Question 8: A client with pancreatitis is prescribed nothing by mouth (NPO) status and total
parenteral nutrition (TPN). Which laboratory value should the nurse monitor most closely to
evaluate TPN effectiveness?
A. Serum amylase
B. Prealbumin
C. Blood urea nitrogen
D. Serum lipase
CORRECT ANSWER: B. Prealbumin
Rationale: Prealbumin has a short half-life (2-3 days) and is a sensitive indicator of nutritional
status and protein repletion, making it ideal for monitoring TPN effectiveness. Serum amylase
and lipase assess pancreatic inflammation but do not reflect nutritional status. Blood urea
nitrogen evaluates renal function and hydration. While all may be monitored in pancreatitis,
prealbumin specifically evaluates the nutritional intervention of TPN.
Question 9: A nurse is administering a blood transfusion to a client. Fifteen minutes after
initiation, the client reports chills, low back pain, and dyspnea. Which action should the nurse
take first?
A. Obtain vital signs
B. Stop the transfusion
C. Notify the blood bank
D. Administer diphenhydramine
CORRECT ANSWER: B. Stop the transfusion
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction (chills, back
pain, dyspnea), which is a medical emergency. The immediate priority is to stop the transfusion
to prevent further infusion of incompatible blood. After stopping the transfusion, the nurse
should maintain IV access with normal saline, obtain vital signs, notify the provider and blood
, bank, and send the blood bag and tubing for analysis. Administering medications occurs after
stopping the transfusion and assessing the client.
Question 10: A client with a traumatic brain injury has a sudden increase in intracranial
pressure. Which triad of findings should the nurse recognize as Cushing's triad?
A. Hypertension, bradycardia, irregular respirations
B. Hypotension, tachycardia, tachypnea
C. Fever, hypertension, pupillary dilation
D. Headache, vomiting, papilledema
CORRECT ANSWER: A. Hypertension, bradycardia, irregular respirations
Rationale: Cushing's triad is a late sign of increased intracranial pressure and consists of systolic
hypertension with widening pulse pressure, bradycardia, and irregular respirations (Cheyne-
Stokes or ataxic breathing). These findings indicate brainstem herniation and require
immediate intervention. Hypotension and tachycardia suggest hypovolemic shock. Fever,
headache, vomiting, and papilledema are associated with increased ICP but do not constitute
Cushing's triad.
Question 11: A nurse is caring for a client with a new diagnosis of deep vein thrombosis (DVT)
in the left leg. Which intervention is contraindicated?
A. Elevating the affected leg
B. Applying warm compresses
C. Massaging the affected leg
D. Administering prescribed anticoagulants
CORRECT ANSWER: C. Massaging the affected leg
Rationale: Massaging a leg with suspected or confirmed DVT is contraindicated because it may
dislodge the thrombus, causing a pulmonary embolism. Elevation promotes venous return and
reduces edema. Warm compresses may improve comfort and circulation. Anticoagulants are
the cornerstone of DVT treatment to prevent thrombus extension and embolization. The nurse
should also avoid vigorous range-of-motion exercises on the affected extremity.
Question 12: A client with myasthenia gravis is experiencing increased muscle weakness,
ptosis, and difficulty swallowing. Which medication should the nurse anticipate
administering?
A. Atropine
B. Edrophonium
C. Neostigmine
D. Dopamine
CORRECT ANSWER: C. Neostigmine
Rationale: Neostigmine is an acetylcholinesterase inhibitor that increases acetylcholine
availability at the neuromuscular junction, improving muscle strength in myasthenia gravis.
Edrophonium is used diagnostically (Tensilon test) but has a very short duration. Atropine is an
anticholinergic that would worsen symptoms. Dopamine is a vasopressor used for shock. The
nurse should administer neostigmine as prescribed and monitor for cholinergic crisis, which can
mimic myasthenic crisis.
