ATI Med Surg Proctored Retake 2 Study Guide: Practice Questions, Answer Key, and
Test-Taking Strategies for RN Nursing Students
&
NCLEX Next Gen Clinical Case Study: Septic Shock Secondary to Community-
Acquired Pneumonia | Interactive Nursing Assessment, Prioritization, Interventions,
Medication Decisions, and Evaluation with Detailed Rationales (2026 Study Guide)
Question 1
A nurse is caring for a client admitted with acute decompensated heart failure. The client
reports increasing shortness of breath, has bilateral crackles, jugular venous distention, and
3+ pitting edema of both lower extremities. Which provider prescription should the nurse
implement first?
A. Administer IV furosemide.
B. Encourage oral fluids to improve renal perfusion.
C. Obtain a routine 12-lead ECG.
D. Educate the client about a low-sodium diet.
Answer: A. Administer IV furosemide.
Rationale: The client has evidence of fluid volume overload causing impaired oxygenation.
IV furosemide rapidly reduces preload and pulmonary congestion, improving breathing.
Although an ECG and education are appropriate, they are not the highest priority.
Increasing oral fluids would worsen fluid overload.
,Question 2
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 6 L/min
via nasal cannula. Thirty minutes later, the client becomes drowsy and difficult to arouse.
Which action should the nurse take first?
A. Increase oxygen to 8 L/min.
B. Notify the respiratory therapist.
C. Assess respiratory rate and oxygen saturation.
D. Prepare for immediate discharge.
Answer: C. Assess respiratory rate and oxygen saturation.
Rationale: Assessment comes first. Clients with advanced COPD may retain carbon
dioxide, and excessive oxygen administration can contribute to worsening hypercapnia in
some patients. The nurse should immediately assess respiratory status before
implementing additional interventions.
Question 3
A client with diabetic ketoacidosis (DKA) is receiving IV insulin therapy. Which laboratory
value requires the nurse's most immediate attention?
A. Blood glucose 240 mg/dL
B. Sodium 133 mEq/L
C. Potassium 2.9 mEq/L
D. BUN 28 mg/dL
Answer: C. Potassium 2.9 mEq/L.
,Rationale: Insulin drives potassium into cells, increasing the risk of life-threatening
hypokalemia. A potassium level of 2.9 mEq/L significantly increases the risk for
dysrhythmias and requires prompt correction.
Question 4
A postoperative client suddenly develops shortness of breath, chest pain, tachycardia, and
anxiety. Which complication should the nurse suspect first?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Pleural effusion
Answer: B. Pulmonary embolism.
Rationale: The sudden onset of dyspnea, pleuritic chest pain, tachycardia, and anxiety in a
postoperative client strongly suggests pulmonary embolism. Immediate assessment and
provider notification are indicated.
Question 5
The nurse is caring for a client receiving a blood transfusion. Fifteen minutes after the
transfusion begins, the client reports chills, low back pain, and chest tightness. What is the
nurse's priority action?
A. Slow the transfusion rate.
B. Stop the transfusion immediately.
, C. Administer acetaminophen.
D. Continue monitoring the client.
Answer: B. Stop the transfusion immediately.
Rationale: These findings are consistent with an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately while maintaining IV access with normal saline
using new tubing, followed by notification of the provider and blood bank.
Question 6
A client with chronic kidney disease has a serum potassium level of 6.4 mEq/L. Which ECG
finding would the nurse expect?
A. Flattened T waves
B. Prominent U waves
C. Tall, peaked T waves
D. Shortened PR interval
Answer: C. Tall, peaked T waves.
Rationale: Hyperkalemia commonly produces tall, peaked T waves and may progress to
widened QRS complexes and life-threatening dysrhythmias if untreated.
Question 7
A nurse is assessing a client admitted with suspected bacterial meningitis. Which finding
requires immediate implementation of droplet precautions?
Test-Taking Strategies for RN Nursing Students
&
NCLEX Next Gen Clinical Case Study: Septic Shock Secondary to Community-
Acquired Pneumonia | Interactive Nursing Assessment, Prioritization, Interventions,
Medication Decisions, and Evaluation with Detailed Rationales (2026 Study Guide)
Question 1
A nurse is caring for a client admitted with acute decompensated heart failure. The client
reports increasing shortness of breath, has bilateral crackles, jugular venous distention, and
3+ pitting edema of both lower extremities. Which provider prescription should the nurse
implement first?
A. Administer IV furosemide.
B. Encourage oral fluids to improve renal perfusion.
C. Obtain a routine 12-lead ECG.
D. Educate the client about a low-sodium diet.
Answer: A. Administer IV furosemide.
Rationale: The client has evidence of fluid volume overload causing impaired oxygenation.
IV furosemide rapidly reduces preload and pulmonary congestion, improving breathing.
Although an ECG and education are appropriate, they are not the highest priority.
Increasing oral fluids would worsen fluid overload.
,Question 2
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 6 L/min
via nasal cannula. Thirty minutes later, the client becomes drowsy and difficult to arouse.
Which action should the nurse take first?
A. Increase oxygen to 8 L/min.
B. Notify the respiratory therapist.
C. Assess respiratory rate and oxygen saturation.
D. Prepare for immediate discharge.
Answer: C. Assess respiratory rate and oxygen saturation.
Rationale: Assessment comes first. Clients with advanced COPD may retain carbon
dioxide, and excessive oxygen administration can contribute to worsening hypercapnia in
some patients. The nurse should immediately assess respiratory status before
implementing additional interventions.
Question 3
A client with diabetic ketoacidosis (DKA) is receiving IV insulin therapy. Which laboratory
value requires the nurse's most immediate attention?
A. Blood glucose 240 mg/dL
B. Sodium 133 mEq/L
C. Potassium 2.9 mEq/L
D. BUN 28 mg/dL
Answer: C. Potassium 2.9 mEq/L.
,Rationale: Insulin drives potassium into cells, increasing the risk of life-threatening
hypokalemia. A potassium level of 2.9 mEq/L significantly increases the risk for
dysrhythmias and requires prompt correction.
Question 4
A postoperative client suddenly develops shortness of breath, chest pain, tachycardia, and
anxiety. Which complication should the nurse suspect first?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Pleural effusion
Answer: B. Pulmonary embolism.
Rationale: The sudden onset of dyspnea, pleuritic chest pain, tachycardia, and anxiety in a
postoperative client strongly suggests pulmonary embolism. Immediate assessment and
provider notification are indicated.
Question 5
The nurse is caring for a client receiving a blood transfusion. Fifteen minutes after the
transfusion begins, the client reports chills, low back pain, and chest tightness. What is the
nurse's priority action?
A. Slow the transfusion rate.
B. Stop the transfusion immediately.
, C. Administer acetaminophen.
D. Continue monitoring the client.
Answer: B. Stop the transfusion immediately.
Rationale: These findings are consistent with an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately while maintaining IV access with normal saline
using new tubing, followed by notification of the provider and blood bank.
Question 6
A client with chronic kidney disease has a serum potassium level of 6.4 mEq/L. Which ECG
finding would the nurse expect?
A. Flattened T waves
B. Prominent U waves
C. Tall, peaked T waves
D. Shortened PR interval
Answer: C. Tall, peaked T waves.
Rationale: Hyperkalemia commonly produces tall, peaked T waves and may progress to
widened QRS complexes and life-threatening dysrhythmias if untreated.
Question 7
A nurse is assessing a client admitted with suspected bacterial meningitis. Which finding
requires immediate implementation of droplet precautions?
