ATI Med-Surg Final Exam Study Guide
Complete Sequence: Questions 100–200 (101 Total Items)
NCLEX Med-Surg Master Study Guide
Comprehensive 200 Question Prep
Q1 | CARDIAC — HEART FAILURE
A client with chronic heart failure reports a 3-lb weight gain in 2 days,
increased ankle swelling, and shortness of breath when lying flat. Which
action should the nurse take first?
A. Encourage the client to increase oral fluid intake
B. Notify the healthcare provider
C. Document findings and reassess in 4 hours
D. Instruct the client to restrict sodium to 1 g/day starting immediately
Correct Answer: B
Rationale: A rapid weight gain (>2–3 lb in 1–2 days), worsening edema, and orthopnea
indicate fluid overload/worsening heart failure. This requires prompt provider notification for
possible diuretic adjustment. Increasing fluids (A) would worsen the problem. Waiting to
reassess (C) delays needed intervention. Sodium restriction (D) is appropriate long-term
teaching but not the first action for acute worsening symptoms.
Q2 | RESPIRATORY — COPD
A nurse is caring for a client with severe COPD who is receiving oxygen therapy.
Which finding requires immediate follow-up?
A. Oxygen saturation of 90% on room air baseline
B. Respiratory rate of 22/min
C. Client is drowsy and difficult to arouse
D. Client reports mild dyspnea with exertion
, E.
Correct Answer: C
Rationale: Drowsiness and difficulty arousing in a COPD client can indicate CO2 narcosis
from oxygen-induced hypoventilation (common if O2 is delivered at too high a flow rate in a
chronic CO2 retainer). This is an emergent finding. The other findings (A, B, D) are
consistent with baseline COPD status and don't indicate acute deterioration.
,Q3 | ENDOCRINE — DKA
A client is admitted with diabetic ketoacidosis (DKA). Blood glucose is 480 mg/dL,
and the client is tachypneic with fruity-smelling breath. Which
prescribed intervention should the nurse anticipate implementing first?
A. Subcutaneous insulin injection
B. IV isotonic fluid administration
C. IV sodium bicarbonate
D. Oral potassium supplementation
Correct Answer: B
Rationale: In DKA, the priority is fluid resuscitation with isotonic saline (0.9% NaCl) to
correct dehydration and improve perfusion before insulin therapy begins. IV (not
subcutaneous) regular insulin is used, and it is started after initial fluid replacement.
Bicarbonate is not routinely used unless pH is severely low. Potassium must be corrected
and monitored carefully, but fluids come first.
Q4 | RENAL — AKI
A client with acute kidney injury has a serum potassium of 6.4 mEq/L. Which ECG
change should the nurse anticipate?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST segment depression
Correct Answer: B
Rationale: Hyperkalemia classically produces peaked, narrow T waves early on,
progressing to widened QRS and eventual sine-wave pattern if untreated. U waves and ST
depression are more associated with hypokalemia. Prolonged QT is linked to hypocalcemia/
hypomagnesemia, not primarily hyperkalemia.
, Q5 | NEURO — STROKE
A client arrives at the emergency department with sudden left-sided facial droop,
slurred speech, and left arm weakness that began 90 minutes ago. Which action
is the priority?
A. Obtain a non-contrast CT scan of the head
B. Administer aspirin
C. Draw blood for coagulation studies
D. Perform a full neurological assessment using the NIH Stroke Scale
Correct Answer: A
Rationale: A non-contrast CT scan must be obtained immediately to rule out hemorrhagic
stroke before any thrombolytic or antiplatelet therapy can be considered — this is the
priority given the narrow tPA treatment window (typically within 3–4.5 hours of symptom
onset). Coagulation studies and NIHSS assessment happen in parallel but do not take
priority over ruling out hemorrhage first.
Q6 | GI — PANCREATITIS
A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which position should the nurse recommend to help relieve pain?
A. Supine with legs extended
B. Sitting upright, leaning forward with knees drawn to chest
C. Left lateral (Sims') position
D. High Fowler's with legs extended
Correct Answer: B
Rationale: Leaning forward with knees flexed toward the chest reduces tension on the
abdominal muscles and pancreas, which can decrease pain in acute pancreatitis. Lying
supine and flat typically worsens pain.
Complete Sequence: Questions 100–200 (101 Total Items)
NCLEX Med-Surg Master Study Guide
Comprehensive 200 Question Prep
Q1 | CARDIAC — HEART FAILURE
A client with chronic heart failure reports a 3-lb weight gain in 2 days,
increased ankle swelling, and shortness of breath when lying flat. Which
action should the nurse take first?
A. Encourage the client to increase oral fluid intake
B. Notify the healthcare provider
C. Document findings and reassess in 4 hours
D. Instruct the client to restrict sodium to 1 g/day starting immediately
Correct Answer: B
Rationale: A rapid weight gain (>2–3 lb in 1–2 days), worsening edema, and orthopnea
indicate fluid overload/worsening heart failure. This requires prompt provider notification for
possible diuretic adjustment. Increasing fluids (A) would worsen the problem. Waiting to
reassess (C) delays needed intervention. Sodium restriction (D) is appropriate long-term
teaching but not the first action for acute worsening symptoms.
Q2 | RESPIRATORY — COPD
A nurse is caring for a client with severe COPD who is receiving oxygen therapy.
Which finding requires immediate follow-up?
A. Oxygen saturation of 90% on room air baseline
B. Respiratory rate of 22/min
C. Client is drowsy and difficult to arouse
D. Client reports mild dyspnea with exertion
, E.
Correct Answer: C
Rationale: Drowsiness and difficulty arousing in a COPD client can indicate CO2 narcosis
from oxygen-induced hypoventilation (common if O2 is delivered at too high a flow rate in a
chronic CO2 retainer). This is an emergent finding. The other findings (A, B, D) are
consistent with baseline COPD status and don't indicate acute deterioration.
,Q3 | ENDOCRINE — DKA
A client is admitted with diabetic ketoacidosis (DKA). Blood glucose is 480 mg/dL,
and the client is tachypneic with fruity-smelling breath. Which
prescribed intervention should the nurse anticipate implementing first?
A. Subcutaneous insulin injection
B. IV isotonic fluid administration
C. IV sodium bicarbonate
D. Oral potassium supplementation
Correct Answer: B
Rationale: In DKA, the priority is fluid resuscitation with isotonic saline (0.9% NaCl) to
correct dehydration and improve perfusion before insulin therapy begins. IV (not
subcutaneous) regular insulin is used, and it is started after initial fluid replacement.
Bicarbonate is not routinely used unless pH is severely low. Potassium must be corrected
and monitored carefully, but fluids come first.
Q4 | RENAL — AKI
A client with acute kidney injury has a serum potassium of 6.4 mEq/L. Which ECG
change should the nurse anticipate?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST segment depression
Correct Answer: B
Rationale: Hyperkalemia classically produces peaked, narrow T waves early on,
progressing to widened QRS and eventual sine-wave pattern if untreated. U waves and ST
depression are more associated with hypokalemia. Prolonged QT is linked to hypocalcemia/
hypomagnesemia, not primarily hyperkalemia.
, Q5 | NEURO — STROKE
A client arrives at the emergency department with sudden left-sided facial droop,
slurred speech, and left arm weakness that began 90 minutes ago. Which action
is the priority?
A. Obtain a non-contrast CT scan of the head
B. Administer aspirin
C. Draw blood for coagulation studies
D. Perform a full neurological assessment using the NIH Stroke Scale
Correct Answer: A
Rationale: A non-contrast CT scan must be obtained immediately to rule out hemorrhagic
stroke before any thrombolytic or antiplatelet therapy can be considered — this is the
priority given the narrow tPA treatment window (typically within 3–4.5 hours of symptom
onset). Coagulation studies and NIHSS assessment happen in parallel but do not take
priority over ruling out hemorrhage first.
Q6 | GI — PANCREATITIS
A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which position should the nurse recommend to help relieve pain?
A. Supine with legs extended
B. Sitting upright, leaning forward with knees drawn to chest
C. Left lateral (Sims') position
D. High Fowler's with legs extended
Correct Answer: B
Rationale: Leaning forward with knees flexed toward the chest reduces tension on the
abdominal muscles and pancreas, which can decrease pain in acute pancreatitis. Lying
supine and flat typically worsens pain.
