, ACTUAL ATI Med-Surg Proctored Exam Test Bank 2026 |
Medical-Surgical Nursing, NCLEX Preparation | Multiple
Choice Questions and Answers with Verified Rationales|Grade
A+. EXAM COVERAGE
1. Cardiovascular System Disorders and Hemodynamic Monitoring
2. Respiratory System Disorders and Ventilatory Management
3. Endocrine and Metabolic Disorders
4. Renal and Urological Disorders
5. Gastrointestinal and Hepatobiliary Disorders
6. Neurological and Musculoskeletal Disorders
7. Oncology, Immunology, and Hematological Disorders
8. Perioperative Care and Emergency Medical-Surgical Nursing
1. A nurse is caring for a client with heart failure who is receiving digoxin (Lanoxin) 0.25 mg daily.
Which of the following findings indicates digoxin toxicity?
A. Heart rate of 62 bpm
B. Blood pressure of 118/76 mmHg
C. Nausea and yellow-tinged vision
D. Urine output of 50 mL/hour
CORRECT ANSWER : C
Rationale: Classic signs of digoxin toxicity include gastrointestinal symptoms like nausea and
visual disturbances such as yellow-green halos or blurred vision. A heart rate of 62 bpm and
, blood pressure of 118/76 mmHg are within normal ranges, and urine output of 50 mL/hr is
adequate. Hypokalemia increases susceptibility to toxicity, making symptom recognition vital.
2. A nurse is assessing a client with chronic heart failure. Which of the following physical findings
is the earliest indicator of left-sided heart failure?
A. Peripheral dependent edema
B. Jugular venous distention (JVD)
C. Dyspnea on exertion
D. Hepatomegaly with right upper quadrant tenderness
CORRECT ANSWER : C
Rationale: Dyspnea on exertion is the earliest sign of left-sided heart failure due to pulmonary
congestion resulting from the left ventricle's inability to pump blood forward. Peripheral edema,
JVD, and hepatomegaly are classic clinical manifestations of right-sided heart failure.
3. A client with chronic obstructive pulmonary disease (COPD) has an arterial blood gas (ABG)
report showing pH 7.30, PaCO2 58 mmHg, and HCO3 26 mEq/L. The nurse should interpret
these results as:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER : C
Rationale: Respiratory acidosis is characterized by a decreased pH below 7.35 and an elevated
PaCO2 above 45 mmHg due to alveolar hypoventilation. The normal bicarbonate level indicates
that renal compensation has not yet occurred. COPD clients frequently retain carbon dioxide,
driving this acid-base imbalance.
4. A nurse is planning care for a client who has a newly inserted chest tube connected to a water-
seal drainage system. Which of the following nursing interventions is appropriate to include in
the plan?
A. Strip or milk the chest tubing every 2 hours to maintain patency.
B. Clamp the chest tube whenever the client is ambulating outside of bed.
, C. Ensure that the water-seal chamber exhibits tidaling with spontaneous respirations.
D. Add sterile water to the suction control chamber if bubbling completely ceases.
CORRECT ANSWER : C
Rationale: Tidaling (fluctuation of fluid in the water-seal chamber with breathing) indicates a
patent pleural system and should be present. Stripping or milking chest tubes creates excessive
negative pressure and is contraindicated. Clamping chest tubes can cause tension
pneumothorax, and bubbling in the suction control chamber depends on suction source
attachment, not water loss.
5. A nurse is assessing a client who has type 1 diabetes mellitus and presents with deep, rapid
respirations, fruity breath odor, and a serum glucose of 450 mg/dL. Which acid-base imbalance
should the nurse expect?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
CORRECT ANSWER : C
Rationale: Diabetic ketoacidosis (DKA) results in the accumulation of ketone bodies, leading to
metabolic acidosis characterized by low pH and low bicarbonate levels. Kussmaul respirations
represent the respiratory system's compensatory mechanism to blow off carbon dioxide.
6. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central
line. The next bag is temporarily unavailable from the pharmacy. Which of the following
solutions should the nurse infuse while waiting?
A. 0.9% sodium chloride with 20 mEq KCl
B. 10% dextrose in water (D10W)
C. 0.45% sodium chloride
D. Lactated Ringer's solution
CORRECT ANSWER : B
Medical-Surgical Nursing, NCLEX Preparation | Multiple
Choice Questions and Answers with Verified Rationales|Grade
A+. EXAM COVERAGE
1. Cardiovascular System Disorders and Hemodynamic Monitoring
2. Respiratory System Disorders and Ventilatory Management
3. Endocrine and Metabolic Disorders
4. Renal and Urological Disorders
5. Gastrointestinal and Hepatobiliary Disorders
6. Neurological and Musculoskeletal Disorders
7. Oncology, Immunology, and Hematological Disorders
8. Perioperative Care and Emergency Medical-Surgical Nursing
1. A nurse is caring for a client with heart failure who is receiving digoxin (Lanoxin) 0.25 mg daily.
Which of the following findings indicates digoxin toxicity?
A. Heart rate of 62 bpm
B. Blood pressure of 118/76 mmHg
C. Nausea and yellow-tinged vision
D. Urine output of 50 mL/hour
CORRECT ANSWER : C
Rationale: Classic signs of digoxin toxicity include gastrointestinal symptoms like nausea and
visual disturbances such as yellow-green halos or blurred vision. A heart rate of 62 bpm and
, blood pressure of 118/76 mmHg are within normal ranges, and urine output of 50 mL/hr is
adequate. Hypokalemia increases susceptibility to toxicity, making symptom recognition vital.
2. A nurse is assessing a client with chronic heart failure. Which of the following physical findings
is the earliest indicator of left-sided heart failure?
A. Peripheral dependent edema
B. Jugular venous distention (JVD)
C. Dyspnea on exertion
D. Hepatomegaly with right upper quadrant tenderness
CORRECT ANSWER : C
Rationale: Dyspnea on exertion is the earliest sign of left-sided heart failure due to pulmonary
congestion resulting from the left ventricle's inability to pump blood forward. Peripheral edema,
JVD, and hepatomegaly are classic clinical manifestations of right-sided heart failure.
3. A client with chronic obstructive pulmonary disease (COPD) has an arterial blood gas (ABG)
report showing pH 7.30, PaCO2 58 mmHg, and HCO3 26 mEq/L. The nurse should interpret
these results as:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER : C
Rationale: Respiratory acidosis is characterized by a decreased pH below 7.35 and an elevated
PaCO2 above 45 mmHg due to alveolar hypoventilation. The normal bicarbonate level indicates
that renal compensation has not yet occurred. COPD clients frequently retain carbon dioxide,
driving this acid-base imbalance.
4. A nurse is planning care for a client who has a newly inserted chest tube connected to a water-
seal drainage system. Which of the following nursing interventions is appropriate to include in
the plan?
A. Strip or milk the chest tubing every 2 hours to maintain patency.
B. Clamp the chest tube whenever the client is ambulating outside of bed.
, C. Ensure that the water-seal chamber exhibits tidaling with spontaneous respirations.
D. Add sterile water to the suction control chamber if bubbling completely ceases.
CORRECT ANSWER : C
Rationale: Tidaling (fluctuation of fluid in the water-seal chamber with breathing) indicates a
patent pleural system and should be present. Stripping or milking chest tubes creates excessive
negative pressure and is contraindicated. Clamping chest tubes can cause tension
pneumothorax, and bubbling in the suction control chamber depends on suction source
attachment, not water loss.
5. A nurse is assessing a client who has type 1 diabetes mellitus and presents with deep, rapid
respirations, fruity breath odor, and a serum glucose of 450 mg/dL. Which acid-base imbalance
should the nurse expect?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
CORRECT ANSWER : C
Rationale: Diabetic ketoacidosis (DKA) results in the accumulation of ketone bodies, leading to
metabolic acidosis characterized by low pH and low bicarbonate levels. Kussmaul respirations
represent the respiratory system's compensatory mechanism to blow off carbon dioxide.
6. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central
line. The next bag is temporarily unavailable from the pharmacy. Which of the following
solutions should the nurse infuse while waiting?
A. 0.9% sodium chloride with 20 mEq KCl
B. 10% dextrose in water (D10W)
C. 0.45% sodium chloride
D. Lactated Ringer's solution
CORRECT ANSWER : B
