ATI Med-Surg Proctored Exam
Test Bank 2026 | 400 High-Yield
MCQs with Verified Rationales |
Medical-Surgical Nursing NCLEX
Preparation Study Guide (Instant
Download)
Ace your upcoming proctored assessment with this
comprehensive, premium test bank containing 400
meticulously crafted multiple-choice questions
specifically modeled after the 2026 ATI Medical-
Surgical blueprint. Each highly searched nursing
concept features an explicitly clear correct answer
paired with a deeply detailed, verified clinical
rationale to ensure rapid mastery of complex
pathophysiology, fluid and electrolyte imbalances,
and critical pharmacology interventions. Perfectly
formatted with professional spacing and styled visual
anchors, this high-yield document is the ultimate
resource for students seeking to guarantee a Level 3
score and excel in their NCLEX-RN preparation.
,Q1. A nurse is caring for a client who is 24 hours postoperative following a total
thyroidectomy. Which of the following findings is the priority for the nurse to
report to the provider?
A) Laryngeal stridor
B) Incisional pain rating 6 on a scale of 0 to 10
C) Mild swelling of the neck tissue
D) Client reporting a sore throat when swallowing
Answer: A) Laryngeal stridor
Rationale: Laryngeal stridor is a harsh, high-pitched respiratory sound that indicates
acute airway obstruction, which can occur post-thyroidectomy due to laryngeal nerve
damage, edema, or hypocalcemic tetany. Using the ABC (Airway, Breathing,
Circulation) priority framework, this requires immediate intervention. [1]
Q2. A nurse is assessing a client who has a chest tube connected to a water-seal
drainage system. The nurse notes continuous bubbling in the water-seal
chamber. Which of the following actions should the nurse take first?
A) Turn up the suction wall pressure.
B) Check the system for an air leak.
C) Document this as an expected finding.
D) Obtain a replacement drainage unit. [1, 2]
Answer: B) Check the system for an air leak.
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak
somewhere in the system, which prevents the re-expansion of the lung. Intermittent
bubbling is expected during expiration or coughing, but continuous bubbling requires
immediate troubleshooting from the insertion site down to the drainage unit.
Q3. A nurse is reviewing the laboratory results of a client who is receiving a
continuous intravenous heparin infusion for a deep vein thrombosis (DVT). The
client's current activated partial thromboplastin time (aPTT) is 98 seconds. Which
of the following actions should the nurse anticipate?
A) Increase the hourly heparin infusion rate.
B) Stop the infusion and prepare to administer protamine sulfate.
C) Maintain the current infusion rate and recheck the aPTT in 4 hours.
D) Hold the infusion for 1 hour and decrease the infusion rate per protocol. [1, 2]
Answer: D) Hold the infusion for 1 hour and decrease the infusion rate per
protocol. [1]
Rationale: A normal reference aPTT is 30 to 40 seconds, making a therapeutic aPTT
range (1.5 to 2.5 times the control) roughly 45 to 80 seconds. An aPTT of 98 seconds
puts the client at high risk for bleeding, necessitating a temporary hold and a rate
reduction. Protamine sulfate is reserved for severe, life-threatening hemorrhage.
,Q4. A nurse is assessing a client who has a history of liver cirrhosis and is
presenting with severe hepatic encephalopathy. Which of the following laboratory
findings should the nurse expect?
A) Elevated serum albumin
B) Elevated serum ammonia
C) Decreased serum bilirubin
D) Decreased prothrombin time (PT) [1]
Answer: B) Elevated serum ammonia
Rationale: Hepatic encephalopathy is caused by the liver's inability to convert toxic
ammonia (a byproduct of protein metabolism) into urea. The accumulation of ammonia
crosses the blood-brain barrier, causing altered mental status and neuromuscular
changes. Clients with cirrhosis typically have low albumin and prolonged PT.
Q5. A nurse is providing discharge teaching to a client who has a new
prescription for sublingual nitroglycerin tablets for stable angina pectoris. Which
of the following instructions should the nurse include?
A) Swallow the tablet with a full glass of water if chest pain occurs.
B) Take up to five tablets, spaced 2 minutes apart, before calling emergency services.
C) Store the tablets in their original dark glass bottle at room temperature.
D) Discard the bottle and get a refill every 12 months. [1, 2]
Answer: C) Store the tablets in their original dark glass bottle at room
temperature. [1]
Rationale: Nitroglycerin is highly sensitive to light, heat, and moisture, and must be
stored in its original amber glass container to maintain potency. Clients should place the
tablet under the tongue, take a maximum of three doses 5 minutes apart, and call
emergency services if pain is not relieved after the first dose. Tablets typically expire 3
to 6 months after opening.
Q6. A nurse is caring for a client who is in the compensatory stage of
hypovolemic shock. Which of the following clinical manifestations should the
nurse expect to assess?
A) Cool, clammy skin and tachycardia
B) Bradycardia and profound hypotension
C) Lethargy and a respiratory rate of 8/min
D) Increased urine output and bounding peripheral pulses
Answer: A) Cool, clammy skin and tachycardia [1]
Rationale: During the compensatory stage of shock, the sympathetic nervous system
triggers the fight-or-flight response. This causes vasoconstriction (resulting in cool,
clammy skin) and an increased heart rate (tachycardia) to maintain cardiac output and
perfusion to vital organs. Hypotension and lethargy signal the progressive or refractory
stages.
Q7. A nurse is managing the care of a client with acute pancreatitis. Which of the
following provider prescriptions should the nurse implement first?
, A) Administer hydromorphone IV bolus for pain.
B) Maintain the client on strict NPO status.
C) Insert a nasogastric (NG) tube to low intermittent suction.
D) Start a continuous intravenous infusion of lactated Ringer's.
Answer: B) Maintain the client on strict NPO status.
Rationale: The primary pathophysiological mechanism of acute pancreatitis is the
autodigestion of the pancreas by its own enzymes. Keeping the client NPO is the
absolute priority because it stops the stimulation of pancreatic secretions, resting the
organ and preventing further pancreatic tissue destruction and severe pain.
Q8. A nurse is teaching a client who has chronic kidney disease (CKD) about a
newly prescribed low-potassium diet. Which of the following food choices by the
client indicates an understanding of the teaching?
A) One medium baked potato with skin
B) A snack cup of applesauce
C) A fresh banana
D) One cup of cooked spinach
Answer: B) A snack cup of applesauce
Rationale: Applesauce is a low-potassium food choice, making it safe for a client with
CKD who needs to avoid hyperkalemia. Potatoes, bananas, and spinach are all
exceptionally high in potassium and must be restricted to prevent lethal cardiac
dysrhythmias. [1]
Q9. A nurse is monitoring a client who is receiving a blood transfusion of packed
red blood cells. Fifteen minutes into the transfusion, the client develops chills,
lower back pain, and a fever. Which of the following actions must the nurse take
first?
A) Stop the transfusion immediately.
B) Notify the hospital blood bank.
C) Administer diphenhydramine IV.
D) Run normal saline through the blood tubing. [1]
Answer: A) Stop the transfusion immediately.
Rationale: Chills, fever, and lower back pain are classic symptoms of an acute
hemolytic transfusion reaction, which can be fatal. The first and most critical action is to
stop the transfusion immediately to prevent further administration of incompatible blood.
The nurse should then disconnect the blood tubing and flush the line with fresh normal
saline using completely new tubing. [1]
Q10. A nurse is reviewing the arterial blood gas (ABG) results for a client with
severe chronic obstructive pulmonary disease (COPD). The results are: pH 7.31,
PaCO2 52 mmHg, HCO3 25 mEq/L, PaCO2 78 mmHg. How should the nurse
interpret these findings?
A) Metabolic acidosis
B) Respiratory alkalosis
Test Bank 2026 | 400 High-Yield
MCQs with Verified Rationales |
Medical-Surgical Nursing NCLEX
Preparation Study Guide (Instant
Download)
Ace your upcoming proctored assessment with this
comprehensive, premium test bank containing 400
meticulously crafted multiple-choice questions
specifically modeled after the 2026 ATI Medical-
Surgical blueprint. Each highly searched nursing
concept features an explicitly clear correct answer
paired with a deeply detailed, verified clinical
rationale to ensure rapid mastery of complex
pathophysiology, fluid and electrolyte imbalances,
and critical pharmacology interventions. Perfectly
formatted with professional spacing and styled visual
anchors, this high-yield document is the ultimate
resource for students seeking to guarantee a Level 3
score and excel in their NCLEX-RN preparation.
,Q1. A nurse is caring for a client who is 24 hours postoperative following a total
thyroidectomy. Which of the following findings is the priority for the nurse to
report to the provider?
A) Laryngeal stridor
B) Incisional pain rating 6 on a scale of 0 to 10
C) Mild swelling of the neck tissue
D) Client reporting a sore throat when swallowing
Answer: A) Laryngeal stridor
Rationale: Laryngeal stridor is a harsh, high-pitched respiratory sound that indicates
acute airway obstruction, which can occur post-thyroidectomy due to laryngeal nerve
damage, edema, or hypocalcemic tetany. Using the ABC (Airway, Breathing,
Circulation) priority framework, this requires immediate intervention. [1]
Q2. A nurse is assessing a client who has a chest tube connected to a water-seal
drainage system. The nurse notes continuous bubbling in the water-seal
chamber. Which of the following actions should the nurse take first?
A) Turn up the suction wall pressure.
B) Check the system for an air leak.
C) Document this as an expected finding.
D) Obtain a replacement drainage unit. [1, 2]
Answer: B) Check the system for an air leak.
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak
somewhere in the system, which prevents the re-expansion of the lung. Intermittent
bubbling is expected during expiration or coughing, but continuous bubbling requires
immediate troubleshooting from the insertion site down to the drainage unit.
Q3. A nurse is reviewing the laboratory results of a client who is receiving a
continuous intravenous heparin infusion for a deep vein thrombosis (DVT). The
client's current activated partial thromboplastin time (aPTT) is 98 seconds. Which
of the following actions should the nurse anticipate?
A) Increase the hourly heparin infusion rate.
B) Stop the infusion and prepare to administer protamine sulfate.
C) Maintain the current infusion rate and recheck the aPTT in 4 hours.
D) Hold the infusion for 1 hour and decrease the infusion rate per protocol. [1, 2]
Answer: D) Hold the infusion for 1 hour and decrease the infusion rate per
protocol. [1]
Rationale: A normal reference aPTT is 30 to 40 seconds, making a therapeutic aPTT
range (1.5 to 2.5 times the control) roughly 45 to 80 seconds. An aPTT of 98 seconds
puts the client at high risk for bleeding, necessitating a temporary hold and a rate
reduction. Protamine sulfate is reserved for severe, life-threatening hemorrhage.
,Q4. A nurse is assessing a client who has a history of liver cirrhosis and is
presenting with severe hepatic encephalopathy. Which of the following laboratory
findings should the nurse expect?
A) Elevated serum albumin
B) Elevated serum ammonia
C) Decreased serum bilirubin
D) Decreased prothrombin time (PT) [1]
Answer: B) Elevated serum ammonia
Rationale: Hepatic encephalopathy is caused by the liver's inability to convert toxic
ammonia (a byproduct of protein metabolism) into urea. The accumulation of ammonia
crosses the blood-brain barrier, causing altered mental status and neuromuscular
changes. Clients with cirrhosis typically have low albumin and prolonged PT.
Q5. A nurse is providing discharge teaching to a client who has a new
prescription for sublingual nitroglycerin tablets for stable angina pectoris. Which
of the following instructions should the nurse include?
A) Swallow the tablet with a full glass of water if chest pain occurs.
B) Take up to five tablets, spaced 2 minutes apart, before calling emergency services.
C) Store the tablets in their original dark glass bottle at room temperature.
D) Discard the bottle and get a refill every 12 months. [1, 2]
Answer: C) Store the tablets in their original dark glass bottle at room
temperature. [1]
Rationale: Nitroglycerin is highly sensitive to light, heat, and moisture, and must be
stored in its original amber glass container to maintain potency. Clients should place the
tablet under the tongue, take a maximum of three doses 5 minutes apart, and call
emergency services if pain is not relieved after the first dose. Tablets typically expire 3
to 6 months after opening.
Q6. A nurse is caring for a client who is in the compensatory stage of
hypovolemic shock. Which of the following clinical manifestations should the
nurse expect to assess?
A) Cool, clammy skin and tachycardia
B) Bradycardia and profound hypotension
C) Lethargy and a respiratory rate of 8/min
D) Increased urine output and bounding peripheral pulses
Answer: A) Cool, clammy skin and tachycardia [1]
Rationale: During the compensatory stage of shock, the sympathetic nervous system
triggers the fight-or-flight response. This causes vasoconstriction (resulting in cool,
clammy skin) and an increased heart rate (tachycardia) to maintain cardiac output and
perfusion to vital organs. Hypotension and lethargy signal the progressive or refractory
stages.
Q7. A nurse is managing the care of a client with acute pancreatitis. Which of the
following provider prescriptions should the nurse implement first?
, A) Administer hydromorphone IV bolus for pain.
B) Maintain the client on strict NPO status.
C) Insert a nasogastric (NG) tube to low intermittent suction.
D) Start a continuous intravenous infusion of lactated Ringer's.
Answer: B) Maintain the client on strict NPO status.
Rationale: The primary pathophysiological mechanism of acute pancreatitis is the
autodigestion of the pancreas by its own enzymes. Keeping the client NPO is the
absolute priority because it stops the stimulation of pancreatic secretions, resting the
organ and preventing further pancreatic tissue destruction and severe pain.
Q8. A nurse is teaching a client who has chronic kidney disease (CKD) about a
newly prescribed low-potassium diet. Which of the following food choices by the
client indicates an understanding of the teaching?
A) One medium baked potato with skin
B) A snack cup of applesauce
C) A fresh banana
D) One cup of cooked spinach
Answer: B) A snack cup of applesauce
Rationale: Applesauce is a low-potassium food choice, making it safe for a client with
CKD who needs to avoid hyperkalemia. Potatoes, bananas, and spinach are all
exceptionally high in potassium and must be restricted to prevent lethal cardiac
dysrhythmias. [1]
Q9. A nurse is monitoring a client who is receiving a blood transfusion of packed
red blood cells. Fifteen minutes into the transfusion, the client develops chills,
lower back pain, and a fever. Which of the following actions must the nurse take
first?
A) Stop the transfusion immediately.
B) Notify the hospital blood bank.
C) Administer diphenhydramine IV.
D) Run normal saline through the blood tubing. [1]
Answer: A) Stop the transfusion immediately.
Rationale: Chills, fever, and lower back pain are classic symptoms of an acute
hemolytic transfusion reaction, which can be fatal. The first and most critical action is to
stop the transfusion immediately to prevent further administration of incompatible blood.
The nurse should then disconnect the blood tubing and flush the line with fresh normal
saline using completely new tubing. [1]
Q10. A nurse is reviewing the arterial blood gas (ABG) results for a client with
severe chronic obstructive pulmonary disease (COPD). The results are: pH 7.31,
PaCO2 52 mmHg, HCO3 25 mEq/L, PaCO2 78 mmHg. How should the nurse
interpret these findings?
A) Metabolic acidosis
B) Respiratory alkalosis
