ATI Med-Surg Proctored Exam Test Bank 2026-2027 |
Medical-Surgical Nursing, NCLEX Preparation
1. A nurse is preparing to administer a unit of packed RBCs to a client. Which of
the following actions should the nurse take?
A) Obtain the client's first set of vital signs 1 hour after the infusion starts
B) Initiate venous access with a 21-gauge needle
C) Administer the unit of packed RBCs over 1 hour
D) Use Y tubing with 0.9% sodium chloride when administering the blood
*D) Use Y tubing with 0.9% sodium chloride when administering the blood *
Rationale: Y tubing with 0.9% sodium chloride (normal saline) is the only solution
compatible with blood products. Dextrose solutions or lactated Ringer's can cause
hemolysis. A 20-gauge or larger needle is preferred for blood administration .
2. A client with heart failure reports a sudden weight gain of 2 kg (4.4 lb) in 2 days.
What is the nurse's priority action?
A) Encourage ambulation
B) Restrict fluids
C) Notify the provider
D) Administer potassium
*C) Notify the provider *
Rationale: Rapid weight gain indicates fluid overload and a possible exacerbation of heart
failure, requiring immediate provider intervention for diuretic adjustment or other medical
management .
3. A client with type 1 diabetes mellitus presents with lethargy, fruity breath odor,
and Kussmaul respirations. The nurse anticipates which ABG result?
,A) pH 7.48, PaCO₂ 30, HCO₃ 24
B) pH 7.32, PaCO₂ 50, HCO₃ 26
C) pH 7.28, PaCO₂ 30, HCO₃ 16
D) pH 7.36, PaCO₂ 40, HCO₃ 22
*C) pH 7.28, PaCO₂ 30, HCO₃ 16 *
Rationale: This client is presenting with diabetic ketoacidosis (DKA), which causes
metabolic acidosis (low pH, low HCO₃). The low PaCO₂ indicates respiratory compensation
(Kussmaul respirations) .
4. A client with acute respiratory distress syndrome (ARDS) is on volume-
controlled ventilation with FiO2 0.8, PEEP 12 cm H2O, and plateau pressure 30 cm
H2O. Arterial blood gas shows pH 7.25, PaCO2 50 mm Hg, PaO2 55 mm Hg. Which
intervention should the nurse anticipate?
A) Increase tidal volume to 10 mL/kg
B) Increase PEEP by 2-3 cm H2O
C) Decrease FiO2 to 0.6
D) Decrease PEEP to 8 cm H2O
*B) Increase PEEP by 2-3 cm H2O *
Rationale: In ARDS, the goal is to achieve an SpO2 > 90% or PaO2 > 60 mmHg with the
lowest FiO2 and PEEP. This patient is still hypoxemic despite an FiO2 of 0.8. Increasing
PEEP is the appropriate next step to recruit alveoli and improve oxygenation .
5. A client receiving IV heparin has a platelet count of 80,000/mm³. What should
the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase heparin dose
D) Administer vitamin K
*B) Hold heparin and notify the provider *
,Rationale: Thrombocytopenia may indicate heparin-induced thrombocytopenia (HIT);
heparin must be held and the provider notified immediately .
6. A 65-year-old client with heart failure taking furosemide and digoxin is
admitted with nausea, vomiting, and diarrhea for 3 days. Vital signs: BP 100/58,
HR 110 (irregular). The client is lethargic and complains of severe muscle weakness
and cramping. Which lab finding is of most concern?
A) Serum sodium 150 mEq/L
B) Serum potassium 2.9 mEq/L
C) Serum creatinine 1.1 mg/dL
D) Blood glucose 140 mg/dL
*B) Serum potassium 2.9 mEq/L *
Rationale: This client is at high risk for hypokalemia due to GI losses and furosemide use.
When combined with digoxin therapy, hypokalemia dramatically increases the risk of
digoxin toxicity and life-threatening cardiac dysrhythmias .
7. A nurse is caring for a client who has diabetes insipidus. Which medication
should the nurse plan to administer?
A) Regular insulin
B) Furosemide
C) Desmopressin
D) Lithium carbonate
*C) Desmopressin *
Rationale: Diabetes insipidus is caused by a deficiency of antidiuretic hormone (ADH).
Desmopressin is a synthetic analog of ADH used to replace the hormone and reduce
excessive urine output .
, 8. A client with cirrhosis has ascites, jaundice, and spider angiomas. The client is
confused and drowsy. Which treatment is essential?
A) Lactulose
B) Furosemide
C) Spironolactone
D) Paracentesis
*A) Lactulose *
Rationale: The client is showing signs of hepatic encephalopathy. Lactulose is the first-line
treatment to reduce ammonia levels .
9. A client with a chest tube has 200 mL of bright red drainage in the collection
chamber in 1 hour. What is the priority action?
A) Document the finding
B) Increase chest tube suction
C) Notify the provider
D) Milk the tubing
*C) Notify the provider *
Rationale: Chest tube output > 200 mL/hr indicates active bleeding (hemorrhage). The
provider should be notified immediately .
10. A client with a stroke has left-sided weakness and aphasia. Which cerebral
artery is most likely affected?
A) Right middle cerebral artery
B) Left middle cerebral artery
C) Right anterior cerebral artery
D) Left posterior cerebral artery
*B) Left middle cerebral artery *
Rationale: The left middle cerebral artery supplies the left hemisphere, which is dominant
for language in most individuals. Left-sided stroke can cause aphasia (language
impairment) and right-sided weakness .
Medical-Surgical Nursing, NCLEX Preparation
1. A nurse is preparing to administer a unit of packed RBCs to a client. Which of
the following actions should the nurse take?
A) Obtain the client's first set of vital signs 1 hour after the infusion starts
B) Initiate venous access with a 21-gauge needle
C) Administer the unit of packed RBCs over 1 hour
D) Use Y tubing with 0.9% sodium chloride when administering the blood
*D) Use Y tubing with 0.9% sodium chloride when administering the blood *
Rationale: Y tubing with 0.9% sodium chloride (normal saline) is the only solution
compatible with blood products. Dextrose solutions or lactated Ringer's can cause
hemolysis. A 20-gauge or larger needle is preferred for blood administration .
2. A client with heart failure reports a sudden weight gain of 2 kg (4.4 lb) in 2 days.
What is the nurse's priority action?
A) Encourage ambulation
B) Restrict fluids
C) Notify the provider
D) Administer potassium
*C) Notify the provider *
Rationale: Rapid weight gain indicates fluid overload and a possible exacerbation of heart
failure, requiring immediate provider intervention for diuretic adjustment or other medical
management .
3. A client with type 1 diabetes mellitus presents with lethargy, fruity breath odor,
and Kussmaul respirations. The nurse anticipates which ABG result?
,A) pH 7.48, PaCO₂ 30, HCO₃ 24
B) pH 7.32, PaCO₂ 50, HCO₃ 26
C) pH 7.28, PaCO₂ 30, HCO₃ 16
D) pH 7.36, PaCO₂ 40, HCO₃ 22
*C) pH 7.28, PaCO₂ 30, HCO₃ 16 *
Rationale: This client is presenting with diabetic ketoacidosis (DKA), which causes
metabolic acidosis (low pH, low HCO₃). The low PaCO₂ indicates respiratory compensation
(Kussmaul respirations) .
4. A client with acute respiratory distress syndrome (ARDS) is on volume-
controlled ventilation with FiO2 0.8, PEEP 12 cm H2O, and plateau pressure 30 cm
H2O. Arterial blood gas shows pH 7.25, PaCO2 50 mm Hg, PaO2 55 mm Hg. Which
intervention should the nurse anticipate?
A) Increase tidal volume to 10 mL/kg
B) Increase PEEP by 2-3 cm H2O
C) Decrease FiO2 to 0.6
D) Decrease PEEP to 8 cm H2O
*B) Increase PEEP by 2-3 cm H2O *
Rationale: In ARDS, the goal is to achieve an SpO2 > 90% or PaO2 > 60 mmHg with the
lowest FiO2 and PEEP. This patient is still hypoxemic despite an FiO2 of 0.8. Increasing
PEEP is the appropriate next step to recruit alveoli and improve oxygenation .
5. A client receiving IV heparin has a platelet count of 80,000/mm³. What should
the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase heparin dose
D) Administer vitamin K
*B) Hold heparin and notify the provider *
,Rationale: Thrombocytopenia may indicate heparin-induced thrombocytopenia (HIT);
heparin must be held and the provider notified immediately .
6. A 65-year-old client with heart failure taking furosemide and digoxin is
admitted with nausea, vomiting, and diarrhea for 3 days. Vital signs: BP 100/58,
HR 110 (irregular). The client is lethargic and complains of severe muscle weakness
and cramping. Which lab finding is of most concern?
A) Serum sodium 150 mEq/L
B) Serum potassium 2.9 mEq/L
C) Serum creatinine 1.1 mg/dL
D) Blood glucose 140 mg/dL
*B) Serum potassium 2.9 mEq/L *
Rationale: This client is at high risk for hypokalemia due to GI losses and furosemide use.
When combined with digoxin therapy, hypokalemia dramatically increases the risk of
digoxin toxicity and life-threatening cardiac dysrhythmias .
7. A nurse is caring for a client who has diabetes insipidus. Which medication
should the nurse plan to administer?
A) Regular insulin
B) Furosemide
C) Desmopressin
D) Lithium carbonate
*C) Desmopressin *
Rationale: Diabetes insipidus is caused by a deficiency of antidiuretic hormone (ADH).
Desmopressin is a synthetic analog of ADH used to replace the hormone and reduce
excessive urine output .
, 8. A client with cirrhosis has ascites, jaundice, and spider angiomas. The client is
confused and drowsy. Which treatment is essential?
A) Lactulose
B) Furosemide
C) Spironolactone
D) Paracentesis
*A) Lactulose *
Rationale: The client is showing signs of hepatic encephalopathy. Lactulose is the first-line
treatment to reduce ammonia levels .
9. A client with a chest tube has 200 mL of bright red drainage in the collection
chamber in 1 hour. What is the priority action?
A) Document the finding
B) Increase chest tube suction
C) Notify the provider
D) Milk the tubing
*C) Notify the provider *
Rationale: Chest tube output > 200 mL/hr indicates active bleeding (hemorrhage). The
provider should be notified immediately .
10. A client with a stroke has left-sided weakness and aphasia. Which cerebral
artery is most likely affected?
A) Right middle cerebral artery
B) Left middle cerebral artery
C) Right anterior cerebral artery
D) Left posterior cerebral artery
*B) Left middle cerebral artery *
Rationale: The left middle cerebral artery supplies the left hemisphere, which is dominant
for language in most individuals. Left-sided stroke can cause aphasia (language
impairment) and right-sided weakness .
