ATI Med-Surg Proctored Exam 2026 Ultimate Level 3 Prep — 300+ Verified Q&A,
Rationales & Priority Cheat Sheets
Achieve Level 3 proficiency with this comprehensive ATI Med-Surg 2026/2027 prep guide
featuring over 300 verified practice questions and detailed rationales. This resource
provides high-yield summaries of critical body systems, fluid and electrolyte imbalances,
and the prioritization strategies needed to tackle complex NGN-style case studies. Fully
updated for the latest testing cycle, this bundle serves as the ultimate remediation tool to
ensure you pass your proctored assessment and build a solid foundation for the NCLEX.
A nurse is assessing a client who has a sodium level of 116 mEq/L. Which of the
following is the priority nursing intervention?
A. Administer a 0.45% Sodium Chloride IV bolus.
B. Initiate seizure precautions.
C. Restrict oral water intake.
D. Encourage the intake of high-sodium foods.
Answer: B. Initiate seizure precautions.
Rationale: Severe hyponatremia (below 120) puts the client at high risk for
cerebral edema and seizures. Safety is the priority.
A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.50,
PaCO2 32, HCO3 24. What is the interpretation?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: D. Respiratory alkalosis
Rationale: The pH is high (alkaline) and the CO2 is low (alkaline). According to
R.O.M.E., when pH and CO2 move in opposite directions, it is respiratory.
A nurse is caring for a client with a chest tube. The nurse notes the water seal
chamber is tidaling. Which action should the nurse take?
A. Notify the provider of a potential air leak.
B. Clamp the chest tube immediately.
C. Document the finding as normal.
D. Check the tubing for a kink.
, Answer: C. Document the finding as normal.
Rationale: Tidaling (the rise and fall of water with breathing) indicates the system
is patent and working. Continuous bubbling would indicate a leak.
A nurse is teaching a client about a new prescription for Warfarin. Which of the
following should the nurse include?
A. "I will increase my intake of spinach and kale."
B. "I will use a straight-edge razor for shaving."
C. "I will have my aPTT levels checked weekly."
D. "I will report any black, tarry stools to my doctor."
Answer: D. "I will report any black, tarry stools to my doctor."
Rationale: Black, tarry stools indicate GI bleeding. Spinach (Vitamin K) should be
kept consistent, not increased, and PT/INR is used to monitor Warfarin, not
aPTT.
A nurse is caring for a client who is 12 hours postoperative following a total
thyroidectomy. Which equipment is the priority to have at the bedside?
A. Tracheostomy tray
B. Incentive spirometer
C. Suction machine
D. Spare IV pump
Answer: A. Tracheostomy tray
Rationale: Post-thyroidectomy patients are at risk for airway obstruction due to
swelling or laryngeal nerve damage. Emergency airway equipment is the priority.
A nurse is assessing a client with Cushing’s Syndrome. Which of the following is an
expected finding?
A. Weight loss and hypotension.
B. Hyperpigmentation of the skin.
C. Moon face and truncal obesity.
D. High potassium and low sodium levels.
Answer: C. Moon face and truncal obesity.
Rationale: Excess cortisol leads to fat redistribution (moon face, buffalo hump),
hyperglycemia, and hypertension.
A nurse is caring for a client in the compensatory stage of shock. Which of the
following findings is expected?
A. Bradycardia
B. Tachycardia
C. Hypotension
, D. Decreased respiratory rate
Answer: B. Tachycardia
Rationale: In the compensatory stage, the body attempts to maintain cardiac
output by increasing the heart rate.
A nurse is monitoring a client who is receiving a blood transfusion. The client reports
lower back pain and chills. What is the nurse's first action?
A. Slow the infusion rate.
B. Stop the transfusion.
C. Administer diphenhydramine.
D. Check the client's temperature.
Answer: B. Stop the transfusion.
Rationale: Low back pain and chills are signs of a hemolytic reaction. The blood
must be stopped immediately to prevent kidney failure or death.
A nurse is assessing a client with Left-sided Heart Failure. Which finding is
expected?
A. Jugular venous distention
B. Dependent edema
C. Crackles in the lungs
D. Enlarged liver
Answer: C. Crackles in the lungs
Rationale: Left-sided failure causes fluid to back up into the lungs (pulmonary
edema). Options A, B, and D are signs of Right-sided failure.
A nurse is caring for a client with a history of seizures. Which of the following is a
non-essential item at the bedside?
A. Suction equipment
B. Oxygen flow meter
C. Padded side rails
D. Padded tongue blade
Answer: D. Padded tongue blade
Rationale: Tongue blades should never be inserted into a seizing client's mouth
as they can cause injury. Suction and oxygen are vital for the postictal phase.
A nurse is caring for a client with a potassium level of 6.5 mEq/L. Which medication
should the nurse anticipate administering?
A. Potassium Chloride
B. Sodium Polystyrene Sulfonate
C. Furosemide
, D. Spironolactone
Answer: B. Sodium Polystyrene Sulfonate (Kayexalate)
Rationale: This medication exchanges sodium for potassium in the gut to
facilitate potassium excretion via stool.
A nurse is assessing a client with a suspected hip fracture. Which of the following is
a classic manifestation?
A. Internal rotation of the affected leg.
B. External rotation and shortening of the affected leg.
C. Lengthening of the affected leg.
D. Ability to bear weight on the affected leg.
Answer: B. External rotation and shortening of the affected leg.
Rationale: These are hallmark signs of a displaced hip fracture.
A nurse is teaching a client who has a new diagnosis of Type 1 Diabetes. When
should the nurse instruct the client to check for ketones in the urine?
A. Every morning before breakfast.
B. When blood glucose is greater than 240 mg/dL.
C. Only if they are planning to exercise.
D. If they have had a large meal.
Answer: B. When blood glucose is greater than 240 mg/dL.
Rationale: Elevated glucose levels increase the risk of Diabetic Ketoacidosis
(DKA); ketones should be checked during illness or hyperglycemia.
A nurse is caring for a client with Addison’s disease. Which of the following lab
values is expected?
A. Sodium 150 mEq/L
B. Potassium 5.6 mEq/L
C. Glucose 110 mg/dL
D. Calcium 9.0 mg/dL
Answer: B. Potassium 5.6 mEq/L
Rationale: Addison's (adrenal insufficiency) causes sodium loss (hyponatremia)
and potassium retention (hyperkalemia).
A nurse is assessing a client for Autonomic Dysreflexia. Which of the following
findings is common?
A. Hypotension and tachycardia.
B. Severe headache and hypertension.
C. Flushed skin below the level of injury.
D. Diaphoresis below the level of injury.
Rationales & Priority Cheat Sheets
Achieve Level 3 proficiency with this comprehensive ATI Med-Surg 2026/2027 prep guide
featuring over 300 verified practice questions and detailed rationales. This resource
provides high-yield summaries of critical body systems, fluid and electrolyte imbalances,
and the prioritization strategies needed to tackle complex NGN-style case studies. Fully
updated for the latest testing cycle, this bundle serves as the ultimate remediation tool to
ensure you pass your proctored assessment and build a solid foundation for the NCLEX.
A nurse is assessing a client who has a sodium level of 116 mEq/L. Which of the
following is the priority nursing intervention?
A. Administer a 0.45% Sodium Chloride IV bolus.
B. Initiate seizure precautions.
C. Restrict oral water intake.
D. Encourage the intake of high-sodium foods.
Answer: B. Initiate seizure precautions.
Rationale: Severe hyponatremia (below 120) puts the client at high risk for
cerebral edema and seizures. Safety is the priority.
A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.50,
PaCO2 32, HCO3 24. What is the interpretation?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: D. Respiratory alkalosis
Rationale: The pH is high (alkaline) and the CO2 is low (alkaline). According to
R.O.M.E., when pH and CO2 move in opposite directions, it is respiratory.
A nurse is caring for a client with a chest tube. The nurse notes the water seal
chamber is tidaling. Which action should the nurse take?
A. Notify the provider of a potential air leak.
B. Clamp the chest tube immediately.
C. Document the finding as normal.
D. Check the tubing for a kink.
, Answer: C. Document the finding as normal.
Rationale: Tidaling (the rise and fall of water with breathing) indicates the system
is patent and working. Continuous bubbling would indicate a leak.
A nurse is teaching a client about a new prescription for Warfarin. Which of the
following should the nurse include?
A. "I will increase my intake of spinach and kale."
B. "I will use a straight-edge razor for shaving."
C. "I will have my aPTT levels checked weekly."
D. "I will report any black, tarry stools to my doctor."
Answer: D. "I will report any black, tarry stools to my doctor."
Rationale: Black, tarry stools indicate GI bleeding. Spinach (Vitamin K) should be
kept consistent, not increased, and PT/INR is used to monitor Warfarin, not
aPTT.
A nurse is caring for a client who is 12 hours postoperative following a total
thyroidectomy. Which equipment is the priority to have at the bedside?
A. Tracheostomy tray
B. Incentive spirometer
C. Suction machine
D. Spare IV pump
Answer: A. Tracheostomy tray
Rationale: Post-thyroidectomy patients are at risk for airway obstruction due to
swelling or laryngeal nerve damage. Emergency airway equipment is the priority.
A nurse is assessing a client with Cushing’s Syndrome. Which of the following is an
expected finding?
A. Weight loss and hypotension.
B. Hyperpigmentation of the skin.
C. Moon face and truncal obesity.
D. High potassium and low sodium levels.
Answer: C. Moon face and truncal obesity.
Rationale: Excess cortisol leads to fat redistribution (moon face, buffalo hump),
hyperglycemia, and hypertension.
A nurse is caring for a client in the compensatory stage of shock. Which of the
following findings is expected?
A. Bradycardia
B. Tachycardia
C. Hypotension
, D. Decreased respiratory rate
Answer: B. Tachycardia
Rationale: In the compensatory stage, the body attempts to maintain cardiac
output by increasing the heart rate.
A nurse is monitoring a client who is receiving a blood transfusion. The client reports
lower back pain and chills. What is the nurse's first action?
A. Slow the infusion rate.
B. Stop the transfusion.
C. Administer diphenhydramine.
D. Check the client's temperature.
Answer: B. Stop the transfusion.
Rationale: Low back pain and chills are signs of a hemolytic reaction. The blood
must be stopped immediately to prevent kidney failure or death.
A nurse is assessing a client with Left-sided Heart Failure. Which finding is
expected?
A. Jugular venous distention
B. Dependent edema
C. Crackles in the lungs
D. Enlarged liver
Answer: C. Crackles in the lungs
Rationale: Left-sided failure causes fluid to back up into the lungs (pulmonary
edema). Options A, B, and D are signs of Right-sided failure.
A nurse is caring for a client with a history of seizures. Which of the following is a
non-essential item at the bedside?
A. Suction equipment
B. Oxygen flow meter
C. Padded side rails
D. Padded tongue blade
Answer: D. Padded tongue blade
Rationale: Tongue blades should never be inserted into a seizing client's mouth
as they can cause injury. Suction and oxygen are vital for the postictal phase.
A nurse is caring for a client with a potassium level of 6.5 mEq/L. Which medication
should the nurse anticipate administering?
A. Potassium Chloride
B. Sodium Polystyrene Sulfonate
C. Furosemide
, D. Spironolactone
Answer: B. Sodium Polystyrene Sulfonate (Kayexalate)
Rationale: This medication exchanges sodium for potassium in the gut to
facilitate potassium excretion via stool.
A nurse is assessing a client with a suspected hip fracture. Which of the following is
a classic manifestation?
A. Internal rotation of the affected leg.
B. External rotation and shortening of the affected leg.
C. Lengthening of the affected leg.
D. Ability to bear weight on the affected leg.
Answer: B. External rotation and shortening of the affected leg.
Rationale: These are hallmark signs of a displaced hip fracture.
A nurse is teaching a client who has a new diagnosis of Type 1 Diabetes. When
should the nurse instruct the client to check for ketones in the urine?
A. Every morning before breakfast.
B. When blood glucose is greater than 240 mg/dL.
C. Only if they are planning to exercise.
D. If they have had a large meal.
Answer: B. When blood glucose is greater than 240 mg/dL.
Rationale: Elevated glucose levels increase the risk of Diabetic Ketoacidosis
(DKA); ketones should be checked during illness or hyperglycemia.
A nurse is caring for a client with Addison’s disease. Which of the following lab
values is expected?
A. Sodium 150 mEq/L
B. Potassium 5.6 mEq/L
C. Glucose 110 mg/dL
D. Calcium 9.0 mg/dL
Answer: B. Potassium 5.6 mEq/L
Rationale: Addison's (adrenal insufficiency) causes sodium loss (hyponatremia)
and potassium retention (hyperkalemia).
A nurse is assessing a client for Autonomic Dysreflexia. Which of the following
findings is common?
A. Hypotension and tachycardia.
B. Severe headache and hypertension.
C. Flushed skin below the level of injury.
D. Diaphoresis below the level of injury.
