ATI RN MED SURG PROCTORED RETAKE 2 EXAM PRACTICE | COMPREHENSIVE
STUDY GUIDE | ADVANCED TESTBANK WITH PRACTICE QUESTIONS & ANSWERS
| LATEST UPDATE 2026/2027
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Oxygenation
iii. Neurologic Disorders and Acute Deterioration
iv. Renal, Fluid, Electrolyte, and Acid-Base Disorders
v. Endocrine and Metabolic Disorders
vi. Gastrointestinal and Hepatobiliary Disorders
vii. Hematologic and Oncologic Conditions
viii. Infection Prevention, Sepsis, and Clinical Prioritization
ix. Perioperative and Postoperative Management
x. Complex Clinical Judgment and Medication Safety
INTRODUCTION
This advanced ATI RN Med Surg Proctored Retake 2 practice set emphasizes clinical
judgment, prioritization, pathophysiology, medication safety, interpretation of
assessment findings, and recognition of rapidly changing patient conditions. The
questions are designed for high-level review of adult medical-surgical nursing
concepts, with emphasis on distinguishing expected findings from complications
requiring immediate intervention. Students should expect scenario-based problems
involving cardiovascular, respiratory, neurologic, renal, endocrine, gastrointestinal,
hematologic, infectious, and postoperative conditions. Rather than relying on
memorization, the questions require analysis of clinical data, identification of the
highest-priority intervention, evaluation of treatment effectiveness, and application
of nursing principles to complex patient situations.
Question 1
A nurse is caring for a client admitted with acute decompensated heart failure who
has severe dyspnea, bilateral crackles, an oxygen saturation of 86%, and pink, frothy
sputum. Which action should the nurse take first?
,A. Administer the prescribed IV loop diuretic.
B. Place the client in high-Fowler's position and apply supplemental oxygen.
C. Obtain a daily weight before administering medications.
D. Restrict the client's oral fluid intake.
🔴 Correct Answer: B. Place the client in high-Fowler's position and apply
supplemental oxygen.
🔵 Explanation: The findings indicate acute pulmonary edema with impaired
oxygenation. Airway and breathing take immediate priority. Positioning the client
upright improves lung expansion and reduces venous return, while supplemental
oxygen addresses severe hypoxemia. IV diuretics are important but should follow
immediate stabilization of oxygenation.
Question 2
A client receiving a heparin infusion for an acute pulmonary embolism has an aPTT
that is substantially above the therapeutic range and develops bleeding from the
gums. Which action should the nurse take first?
A. Increase the infusion rate to prevent additional thrombus formation.
B. Administer the next scheduled dose of an oral anticoagulant.
C. Stop the heparin infusion and notify the provider.
D. Encourage the client to increase oral fluid intake.
🔴 Correct Answer: C. Stop the heparin infusion and notify the provider.
🔵 Explanation: Active bleeding combined with excessive anticoagulation requires
immediate intervention. The heparin infusion should be stopped according to the
prescribed protocol, and the provider should be notified for further management,
which can include administration of protamine when clinically indicated.
Question 3
A client with COPD is receiving oxygen at 2 L/min by nasal cannula. The client
becomes increasingly somnolent and difficult to arouse. Respirations are 8/min and
shallow. Which action is the nurse's priority?
A. Increase oxygen flow to 6 L/min.
B. Encourage the client to cough and deep breathe.
,C. Assess ventilation and prepare for assisted ventilatory support.
D. Administer a prescribed sedative to reduce anxiety.
🔴 Correct Answer: C. Assess ventilation and prepare for assisted ventilatory
support.
🔵 Explanation: Marked somnolence and respiratory depression indicate inadequate
ventilation and possible hypercapnic respiratory failure. Increasing oxygen alone does
not correct hypoventilation and can delay definitive respiratory support. The nurse
should immediately assess respiratory status and prepare for interventions such as
noninvasive or invasive ventilatory support.
Question 4
A client with diabetic ketoacidosis has received IV fluids and an insulin infusion. The
serum potassium decreases from 5.8 mEq/L to 3.1 mEq/L. Which intervention is
most appropriate?
A. Continue insulin at the current rate without modification.
B. Anticipate potassium replacement and evaluate the need to temporarily hold
insulin.
C. Administer sodium bicarbonate immediately.
D. Restrict IV fluids until the potassium normalizes.
🔴 Correct Answer: B. Anticipate potassium replacement and evaluate the need
to temporarily hold insulin.
🔵 Explanation: Insulin shifts potassium into cells, potentially causing dangerous
hypokalemia. A potassium level of 3.1 mEq/L creates significant dysrhythmia risk.
Potassium replacement is generally required, and insulin may need to be temporarily
withheld until potassium is safely corrected according to the treatment protocol.
Question 5
A client with an acute ischemic stroke develops sudden worsening headache,
vomiting, declining level of consciousness, and a new unequal pupil assessment
several hours after admission. Which complication should the nurse suspect?
A. Recurrent transient ischemic attack
B. Increased intracranial pressure
, C. Hypoglycemia caused by immobility
D. Peripheral neuropathy
🔴 Correct Answer: B. Increased intracranial pressure
🔵 Explanation: A worsening headache, vomiting, decreased consciousness, and
pupillary asymmetry are concerning for increasing intracranial pressure and possible
cerebral edema or hemorrhagic transformation. This represents an acute neurologic
deterioration requiring immediate evaluation and intervention.
Question 6
A client with chronic kidney disease has a potassium level of 6.7 mEq/L and reports
generalized muscle weakness. The cardiac monitor shows peaked T waves. Which
prescribed intervention should the nurse anticipate as the immediate priority?
A. Oral potassium supplementation
B. IV calcium administration
C. Increased dietary potassium intake
D. Administration of a potassium-sparing diuretic
🔴 Correct Answer: B. IV calcium administration
🔵 Explanation: Severe hyperkalemia with ECG changes is an emergency. IV calcium
stabilizes the cardiac membrane and reduces the immediate risk of fatal
dysrhythmias. Additional therapies are then used to shift potassium intracellularly or
remove potassium from the body.
Question 7
A client with SIADH has a serum sodium concentration of 118 mEq/L and develops
confusion followed by a generalized seizure. Which intervention is the priority?
A. Encourage free-water intake.
B. Initiate seizure precautions and prepare for prescribed hypertonic saline therapy.
C. Administer hypotonic IV fluids.
D. Encourage a low-sodium diet.
🔴 Correct Answer: B. Initiate seizure precautions and prepare for prescribed
hypertonic saline therapy.
STUDY GUIDE | ADVANCED TESTBANK WITH PRACTICE QUESTIONS & ANSWERS
| LATEST UPDATE 2026/2027
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Oxygenation
iii. Neurologic Disorders and Acute Deterioration
iv. Renal, Fluid, Electrolyte, and Acid-Base Disorders
v. Endocrine and Metabolic Disorders
vi. Gastrointestinal and Hepatobiliary Disorders
vii. Hematologic and Oncologic Conditions
viii. Infection Prevention, Sepsis, and Clinical Prioritization
ix. Perioperative and Postoperative Management
x. Complex Clinical Judgment and Medication Safety
INTRODUCTION
This advanced ATI RN Med Surg Proctored Retake 2 practice set emphasizes clinical
judgment, prioritization, pathophysiology, medication safety, interpretation of
assessment findings, and recognition of rapidly changing patient conditions. The
questions are designed for high-level review of adult medical-surgical nursing
concepts, with emphasis on distinguishing expected findings from complications
requiring immediate intervention. Students should expect scenario-based problems
involving cardiovascular, respiratory, neurologic, renal, endocrine, gastrointestinal,
hematologic, infectious, and postoperative conditions. Rather than relying on
memorization, the questions require analysis of clinical data, identification of the
highest-priority intervention, evaluation of treatment effectiveness, and application
of nursing principles to complex patient situations.
Question 1
A nurse is caring for a client admitted with acute decompensated heart failure who
has severe dyspnea, bilateral crackles, an oxygen saturation of 86%, and pink, frothy
sputum. Which action should the nurse take first?
,A. Administer the prescribed IV loop diuretic.
B. Place the client in high-Fowler's position and apply supplemental oxygen.
C. Obtain a daily weight before administering medications.
D. Restrict the client's oral fluid intake.
🔴 Correct Answer: B. Place the client in high-Fowler's position and apply
supplemental oxygen.
🔵 Explanation: The findings indicate acute pulmonary edema with impaired
oxygenation. Airway and breathing take immediate priority. Positioning the client
upright improves lung expansion and reduces venous return, while supplemental
oxygen addresses severe hypoxemia. IV diuretics are important but should follow
immediate stabilization of oxygenation.
Question 2
A client receiving a heparin infusion for an acute pulmonary embolism has an aPTT
that is substantially above the therapeutic range and develops bleeding from the
gums. Which action should the nurse take first?
A. Increase the infusion rate to prevent additional thrombus formation.
B. Administer the next scheduled dose of an oral anticoagulant.
C. Stop the heparin infusion and notify the provider.
D. Encourage the client to increase oral fluid intake.
🔴 Correct Answer: C. Stop the heparin infusion and notify the provider.
🔵 Explanation: Active bleeding combined with excessive anticoagulation requires
immediate intervention. The heparin infusion should be stopped according to the
prescribed protocol, and the provider should be notified for further management,
which can include administration of protamine when clinically indicated.
Question 3
A client with COPD is receiving oxygen at 2 L/min by nasal cannula. The client
becomes increasingly somnolent and difficult to arouse. Respirations are 8/min and
shallow. Which action is the nurse's priority?
A. Increase oxygen flow to 6 L/min.
B. Encourage the client to cough and deep breathe.
,C. Assess ventilation and prepare for assisted ventilatory support.
D. Administer a prescribed sedative to reduce anxiety.
🔴 Correct Answer: C. Assess ventilation and prepare for assisted ventilatory
support.
🔵 Explanation: Marked somnolence and respiratory depression indicate inadequate
ventilation and possible hypercapnic respiratory failure. Increasing oxygen alone does
not correct hypoventilation and can delay definitive respiratory support. The nurse
should immediately assess respiratory status and prepare for interventions such as
noninvasive or invasive ventilatory support.
Question 4
A client with diabetic ketoacidosis has received IV fluids and an insulin infusion. The
serum potassium decreases from 5.8 mEq/L to 3.1 mEq/L. Which intervention is
most appropriate?
A. Continue insulin at the current rate without modification.
B. Anticipate potassium replacement and evaluate the need to temporarily hold
insulin.
C. Administer sodium bicarbonate immediately.
D. Restrict IV fluids until the potassium normalizes.
🔴 Correct Answer: B. Anticipate potassium replacement and evaluate the need
to temporarily hold insulin.
🔵 Explanation: Insulin shifts potassium into cells, potentially causing dangerous
hypokalemia. A potassium level of 3.1 mEq/L creates significant dysrhythmia risk.
Potassium replacement is generally required, and insulin may need to be temporarily
withheld until potassium is safely corrected according to the treatment protocol.
Question 5
A client with an acute ischemic stroke develops sudden worsening headache,
vomiting, declining level of consciousness, and a new unequal pupil assessment
several hours after admission. Which complication should the nurse suspect?
A. Recurrent transient ischemic attack
B. Increased intracranial pressure
, C. Hypoglycemia caused by immobility
D. Peripheral neuropathy
🔴 Correct Answer: B. Increased intracranial pressure
🔵 Explanation: A worsening headache, vomiting, decreased consciousness, and
pupillary asymmetry are concerning for increasing intracranial pressure and possible
cerebral edema or hemorrhagic transformation. This represents an acute neurologic
deterioration requiring immediate evaluation and intervention.
Question 6
A client with chronic kidney disease has a potassium level of 6.7 mEq/L and reports
generalized muscle weakness. The cardiac monitor shows peaked T waves. Which
prescribed intervention should the nurse anticipate as the immediate priority?
A. Oral potassium supplementation
B. IV calcium administration
C. Increased dietary potassium intake
D. Administration of a potassium-sparing diuretic
🔴 Correct Answer: B. IV calcium administration
🔵 Explanation: Severe hyperkalemia with ECG changes is an emergency. IV calcium
stabilizes the cardiac membrane and reduces the immediate risk of fatal
dysrhythmias. Additional therapies are then used to shift potassium intracellularly or
remove potassium from the body.
Question 7
A client with SIADH has a serum sodium concentration of 118 mEq/L and develops
confusion followed by a generalized seizure. Which intervention is the priority?
A. Encourage free-water intake.
B. Initiate seizure precautions and prepare for prescribed hypertonic saline therapy.
C. Administer hypotonic IV fluids.
D. Encourage a low-sodium diet.
🔴 Correct Answer: B. Initiate seizure precautions and prepare for prescribed
hypertonic saline therapy.
