ATI Med-Surg Proctored Exam Prep |
200 Q&As with Verified Answers &
Rationales (2026 Edition)
Question 1
A nurse is assessing a client who has been receiving intravenous fluids at 175
mL/hr for the past 24 hours. Which of the following findings should the nurse
identify as a priority to report to the provider?
A. Distended neck veins while sitting upright
B. Weight gain of 1 lb (0.45 kg) over 24 hours
C. Serum sodium level of 136 mEq/L
D. Peripheral edema (1+) in both ankles
ANSWER: A. Distended neck veins while sitting upright
EXPLANATION: Jugular venous distention (JVD) while the client is sitting
upright is a definitive sign of fluid volume overload and increased central
venous pressure. This is a high-priority finding indicating the cardiovascular
system is failing to handle the fluid workload. A 1 lb weight gain is minor,
sodium is within the normal range (135–145 mEq/L), and mild ankle edema is
less acute than fluid backing up into the central venous system.
Question 2
, A nurse is evaluating the electrocardiogram (ECG) of a client who has a serum
potassium level of 2.8 mEq/L. Which of the following ECG changes should the
nurse expect to observe?
A. Tall, peaked T waves
B. Widened QRS complexes
C. Flattened T waves and prominent U waves
D. Shortened PR intervals
ANSWER: C. Flattened T waves and prominent U waves
EXPLANATION: A potassium level of 2.8 mEq/L represents severe
hypokalemia. Electrocardiogram changes associated with hypokalemia
include flattened or inverted T waves, ST-segment depression, and the
appearance of a prominent U wave. Peaked T waves and widened QRS
complexes are associated with hyperkalemia.
Question 3
A nurse is caring for a client with a history of chronic alcoholism who presents
with a serum magnesium level of 1.1 mEq/L. Which of the following clinical
assessments should the nurse prioritize?
A. Deep tendon reflexes
B. Skin turgor and capillary refill
C. Bowel sounds in all four quadrants
D. Pupillary response to light
ANSWER: A. Deep tendon reflexes
EXPLANATION: Normal serum magnesium is 1.3 to 2.1 mEq/L. A level of
1.1 mEq/L indicates hypomagnesemia, which causes neuromuscular
irritability. The nurse must prioritize monitoring deep tendon reflexes (DTRs),
which will be hyperactive (hyperreflexia). Clonus, tremors, and a positive
Chvostek's or Trousseau's sign may also be present.
, Question 4
A client with type 1 diabetes mellitus is admitted to the emergency department
with a blood glucose level of 480 mg/dL and a diagnosis of Diabetic
Ketoacidosis (DKA). The client's arterial blood gas (ABG) values are: pH 7.15,
PaCO2 28 mmHg, HCO3- 12 mEq/L. The nurse should interpret this asset as
which of the following?
A. Uncompensated respiratory acidosis
B. Partially compensated metabolic acidosis
C. Fully compensated metabolic acidosis
D. Uncompensated metabolic alkalosis
ANSWER: B. Partially compensated metabolic acidosis
EXPLANATION: The low pH (7.15) indicates acidosis. The low HCO3- (12
mEq/L) confirms a metabolic origin. The low PaCO2 (28 mmHg) shows that
the lungs are attempting to eliminate acid (carbon dioxide) via
hyperventilation (Kussmaul respirations) to raise the pH. Because the pH is
still abnormal, compensation is partial.
Question 5
A nurse is reviewing the laboratory results of a client with hyperparathyroidism.
Which of the following electrolyte abnormalities should the nurse expect to
find?
A. Hypocalcemia
B. Hypercalcemia
C. Hyperkalemia
D. Hypophosphatemia
ANSWER: B. Hypercalcemia
EXPLANATION: Parathyroid hormone (PTH) regulates calcium and
phosphorus. Hyperparathyroidism results in excess production of PTH, which
, causes increased bone resorption, pulling calcium out of the bones and into
the bloodstream, leading to hypercalcemia. Calcium and phosphorus have an
inverse relationship, so hypophosphatemia also occurs, but hypercalcemia is
the hallmark presentation.
Question 6
A nurse is managing a client with severe nasogastric (NG) tube suctioning. For
which of the following acid-base imbalances is this client at greatest risk?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
ANSWER: B. Metabolic alkalosis
EXPLANATION: Nasogastric suctioning removes highly acidic gastric
secretions containing large amounts of hydrochloric acid (HCl). The loss of
these hydrogen and chloride ions leaves behind an excess of base
(bicarbonate) in the blood, causing metabolic alkalosis.
Question 7
A client is admitted to the unit with a serum sodium level of 118 mEq/L. Which
of the following nursing interventions is the highest priority?
A. Encourage increased oral fluid intake
B. Implement strict seizure precautions
C. Administer intravenous hypotonic saline (0.45% NaCl)
D. Administer a prescription for oral sodium tablets
ANSWER: B. Implement strict seizure precautions
EXPLANATION: A serum sodium level below 120 mEq/L indicates severe
hyponatremia, placing the client at high risk for cerebral edema, increased
intracranial pressure, seizures, coma, and death. Safety and seizure
200 Q&As with Verified Answers &
Rationales (2026 Edition)
Question 1
A nurse is assessing a client who has been receiving intravenous fluids at 175
mL/hr for the past 24 hours. Which of the following findings should the nurse
identify as a priority to report to the provider?
A. Distended neck veins while sitting upright
B. Weight gain of 1 lb (0.45 kg) over 24 hours
C. Serum sodium level of 136 mEq/L
D. Peripheral edema (1+) in both ankles
ANSWER: A. Distended neck veins while sitting upright
EXPLANATION: Jugular venous distention (JVD) while the client is sitting
upright is a definitive sign of fluid volume overload and increased central
venous pressure. This is a high-priority finding indicating the cardiovascular
system is failing to handle the fluid workload. A 1 lb weight gain is minor,
sodium is within the normal range (135–145 mEq/L), and mild ankle edema is
less acute than fluid backing up into the central venous system.
Question 2
, A nurse is evaluating the electrocardiogram (ECG) of a client who has a serum
potassium level of 2.8 mEq/L. Which of the following ECG changes should the
nurse expect to observe?
A. Tall, peaked T waves
B. Widened QRS complexes
C. Flattened T waves and prominent U waves
D. Shortened PR intervals
ANSWER: C. Flattened T waves and prominent U waves
EXPLANATION: A potassium level of 2.8 mEq/L represents severe
hypokalemia. Electrocardiogram changes associated with hypokalemia
include flattened or inverted T waves, ST-segment depression, and the
appearance of a prominent U wave. Peaked T waves and widened QRS
complexes are associated with hyperkalemia.
Question 3
A nurse is caring for a client with a history of chronic alcoholism who presents
with a serum magnesium level of 1.1 mEq/L. Which of the following clinical
assessments should the nurse prioritize?
A. Deep tendon reflexes
B. Skin turgor and capillary refill
C. Bowel sounds in all four quadrants
D. Pupillary response to light
ANSWER: A. Deep tendon reflexes
EXPLANATION: Normal serum magnesium is 1.3 to 2.1 mEq/L. A level of
1.1 mEq/L indicates hypomagnesemia, which causes neuromuscular
irritability. The nurse must prioritize monitoring deep tendon reflexes (DTRs),
which will be hyperactive (hyperreflexia). Clonus, tremors, and a positive
Chvostek's or Trousseau's sign may also be present.
, Question 4
A client with type 1 diabetes mellitus is admitted to the emergency department
with a blood glucose level of 480 mg/dL and a diagnosis of Diabetic
Ketoacidosis (DKA). The client's arterial blood gas (ABG) values are: pH 7.15,
PaCO2 28 mmHg, HCO3- 12 mEq/L. The nurse should interpret this asset as
which of the following?
A. Uncompensated respiratory acidosis
B. Partially compensated metabolic acidosis
C. Fully compensated metabolic acidosis
D. Uncompensated metabolic alkalosis
ANSWER: B. Partially compensated metabolic acidosis
EXPLANATION: The low pH (7.15) indicates acidosis. The low HCO3- (12
mEq/L) confirms a metabolic origin. The low PaCO2 (28 mmHg) shows that
the lungs are attempting to eliminate acid (carbon dioxide) via
hyperventilation (Kussmaul respirations) to raise the pH. Because the pH is
still abnormal, compensation is partial.
Question 5
A nurse is reviewing the laboratory results of a client with hyperparathyroidism.
Which of the following electrolyte abnormalities should the nurse expect to
find?
A. Hypocalcemia
B. Hypercalcemia
C. Hyperkalemia
D. Hypophosphatemia
ANSWER: B. Hypercalcemia
EXPLANATION: Parathyroid hormone (PTH) regulates calcium and
phosphorus. Hyperparathyroidism results in excess production of PTH, which
, causes increased bone resorption, pulling calcium out of the bones and into
the bloodstream, leading to hypercalcemia. Calcium and phosphorus have an
inverse relationship, so hypophosphatemia also occurs, but hypercalcemia is
the hallmark presentation.
Question 6
A nurse is managing a client with severe nasogastric (NG) tube suctioning. For
which of the following acid-base imbalances is this client at greatest risk?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
ANSWER: B. Metabolic alkalosis
EXPLANATION: Nasogastric suctioning removes highly acidic gastric
secretions containing large amounts of hydrochloric acid (HCl). The loss of
these hydrogen and chloride ions leaves behind an excess of base
(bicarbonate) in the blood, causing metabolic alkalosis.
Question 7
A client is admitted to the unit with a serum sodium level of 118 mEq/L. Which
of the following nursing interventions is the highest priority?
A. Encourage increased oral fluid intake
B. Implement strict seizure precautions
C. Administer intravenous hypotonic saline (0.45% NaCl)
D. Administer a prescription for oral sodium tablets
ANSWER: B. Implement strict seizure precautions
EXPLANATION: A serum sodium level below 120 mEq/L indicates severe
hyponatremia, placing the client at high risk for cerebral edema, increased
intracranial pressure, seizures, coma, and death. Safety and seizure
