MEDICAL SURGICAL PROCTORED ATI EXAM 2
2026 ACTUAL QUESTION AND CORRECT
DETAILED ANSWERS WITH RATIONALES RATED A
GRADE.
QUESTION 1
A nurse is reviewing the medical record for an older adult client who is
experiencing nausea and vomiting. Based on the client data provided in
the exhibit, which of the following actions should the nurse take?
(Click on the "Exhibit" button for additional client information. There are
three tabs that contain separate categories of data.)
Exhibit 1: Diagnosis Results: Sodium 142 mEq/L, Potassium 4.2 mEq/L,
BUN 36 mg/dL, Creatinine 1.4 mg/dL
Exhibit 2: Nurses' Notes 1200: Alert and oriented x3, Lungs clear to
auscultation, Decreased skin turgor, Dry mucous membranes
Exhibit 3: Graphic Record: Temperature 0800: 37.7° C (99.9° F), 1200:
37.2° C (99.0° F); Pulse 0800: 96/min, 1200:105/min; Respiratory rate
0800: 18/min, 1200: 20/min; Blood pressure 0800; 118/62 mmHg, 1200:
104/65 mm Hg
a. Encourage the client to ambulate.
b. Administer an antipyretic medication.
c. Notify the charge nurse of the client's BUN level.
d. Keep the temperature in the client's room warm.
CORRECT ANS: c. Notify the charge nurse of the client's BUN level
EXPERT RATIONALE
The client's BUN (Blood Urea Nitrogen) level of 36 mg/dL is significantly
above the expected reference range of 10 to 20 mg/dL, indicating
dehydration and impaired renal function. The client's clinical
,presentation, including decreased skin turgor, dry mucous membranes,
tachycardia, and hypotension, further supports the diagnosis of
dehydration due to nausea and vomiting. The nurse should notify the
charge nurse of this abnormal laboratory finding and anticipate
interventions to restore the client's fluid volume, such as initiating
intravenous fluid therapy. Encouraging ambulation would be
inappropriate for a dehydrated client who may be at risk for falls.
Administering an antipyretic medication is not indicated, as the client's
temperature has decreased and is within normal limits. Keeping the
room warm would be inappropriate as it could exacerbate fluid loss
through diaphoresis.
QUESTION 2
A nurse is preparing to insert a double-lumen gastric (Salem) sump tube
for a client who has peptic ulcer disease and has developed
gastrointestinal bleeding. Which of the following images indicates the
tube that the nurse should select?
(Images are described in the rationale.)
a. A tube with a clear portion and a blue "pig tail" portion
b. A tube with a small disc or bolster at the insertion site
c. A single-lumen tube with a smooth tip
d. A tube with two balloons and multiple lumens
CORRECT ANS: a. A tube with a clear portion and a blue "pig tail"
portion
EXPERT RATIONALE
In a double-lumen gastric (Salem) sump tube, the clear portion of the
tube allows for aspiration of stomach contents, while the blue portion of
the tube, known as the "pig tail," vents the tube to the atmosphere. This
,venting mechanism prevents the tube from becoming lodged against
the wall of the stomach and protects the gastric mucosa from damage
during aspiration. Option B describes a percutaneous endoscopic
gastrostomy (PEG) feeding tube, which is surgically inserted through the
abdomen into the stomach for long-term enteral feeding. Option C
describes a Levin tube, which is a single-lumen nasogastric tube used
for gastric decompression but carries a higher risk of gastric mucosal
damage during aspiration. Option D describes a Sengstaken-Blakemore
tube, which is used specifically for the treatment of bleeding esophageal
varices and has multiple lumens and balloons. The Salem sump tube is
the correct choice for this client with gastrointestinal bleeding requiring
gastric decompression.
QUESTION 3
A nurse is reinforcing teaching with an older adult client who has
osteoporosis. Which of the following instructions should the nurse
include in the teaching?
a. "Place throw rugs on wooden floors at home."
b. "Supplement your diet with vitamin E."
c. "Swim laps for 20 minutes twice per week."
d. "Take calcium supplements with meals."
CORRECT ANS: d. "Take calcium supplements with meals."
EXPERT RATIONALE
The nurse should instruct the client to take calcium carbonate
supplements with or immediately following meals to increase
absorption and effectiveness. Calcium carbonate requires the acidic
environment of the stomach for optimal absorption, and taking it with
food stimulates gastric acid secretion. Option A is incorrect because
, throw rugs increase the risk of falls, which can lead to fractures in clients
with osteoporosis. Option B is incorrect because vitamin E does not play
a significant role in bone health; vitamin D and calcium are the primary
supplements for osteoporosis. Option C is incorrect because while
swimming is a low-impact exercise, weight-bearing exercises such as
walking or strength training are more beneficial for maintaining bone
density.
QUESTION 4
A nurse is reviewing the medication record of a client who is taking
digoxin. Which of the following medications should the nurse identify as
increasing the risk for the client to develop digoxin toxicity?
a. Potassium chloride
b. Famotidine
c. Levothyroxine
d. Furosemide
CORRECT ANS: d. Furosemide
EXPERT RATIONALE
Loop diuretics, such as furosemide, increase the urinary excretion of
potassium, which can lead to hypokalemia. Hypokalemia increases the
risk for the development of digoxin toxicity because digoxin binds to
the same receptor site on the sodium-potassium ATPase pump as
potassium. When potassium levels are low, more digoxin binding sites
are available, leading to increased digoxin effect and potential toxicity.
Potassium chloride would actually help prevent hypokalemia and reduce
the risk of toxicity. Famotidine and levothyroxine do not significantly
affect digoxin levels or the risk of toxicity.
2026 ACTUAL QUESTION AND CORRECT
DETAILED ANSWERS WITH RATIONALES RATED A
GRADE.
QUESTION 1
A nurse is reviewing the medical record for an older adult client who is
experiencing nausea and vomiting. Based on the client data provided in
the exhibit, which of the following actions should the nurse take?
(Click on the "Exhibit" button for additional client information. There are
three tabs that contain separate categories of data.)
Exhibit 1: Diagnosis Results: Sodium 142 mEq/L, Potassium 4.2 mEq/L,
BUN 36 mg/dL, Creatinine 1.4 mg/dL
Exhibit 2: Nurses' Notes 1200: Alert and oriented x3, Lungs clear to
auscultation, Decreased skin turgor, Dry mucous membranes
Exhibit 3: Graphic Record: Temperature 0800: 37.7° C (99.9° F), 1200:
37.2° C (99.0° F); Pulse 0800: 96/min, 1200:105/min; Respiratory rate
0800: 18/min, 1200: 20/min; Blood pressure 0800; 118/62 mmHg, 1200:
104/65 mm Hg
a. Encourage the client to ambulate.
b. Administer an antipyretic medication.
c. Notify the charge nurse of the client's BUN level.
d. Keep the temperature in the client's room warm.
CORRECT ANS: c. Notify the charge nurse of the client's BUN level
EXPERT RATIONALE
The client's BUN (Blood Urea Nitrogen) level of 36 mg/dL is significantly
above the expected reference range of 10 to 20 mg/dL, indicating
dehydration and impaired renal function. The client's clinical
,presentation, including decreased skin turgor, dry mucous membranes,
tachycardia, and hypotension, further supports the diagnosis of
dehydration due to nausea and vomiting. The nurse should notify the
charge nurse of this abnormal laboratory finding and anticipate
interventions to restore the client's fluid volume, such as initiating
intravenous fluid therapy. Encouraging ambulation would be
inappropriate for a dehydrated client who may be at risk for falls.
Administering an antipyretic medication is not indicated, as the client's
temperature has decreased and is within normal limits. Keeping the
room warm would be inappropriate as it could exacerbate fluid loss
through diaphoresis.
QUESTION 2
A nurse is preparing to insert a double-lumen gastric (Salem) sump tube
for a client who has peptic ulcer disease and has developed
gastrointestinal bleeding. Which of the following images indicates the
tube that the nurse should select?
(Images are described in the rationale.)
a. A tube with a clear portion and a blue "pig tail" portion
b. A tube with a small disc or bolster at the insertion site
c. A single-lumen tube with a smooth tip
d. A tube with two balloons and multiple lumens
CORRECT ANS: a. A tube with a clear portion and a blue "pig tail"
portion
EXPERT RATIONALE
In a double-lumen gastric (Salem) sump tube, the clear portion of the
tube allows for aspiration of stomach contents, while the blue portion of
the tube, known as the "pig tail," vents the tube to the atmosphere. This
,venting mechanism prevents the tube from becoming lodged against
the wall of the stomach and protects the gastric mucosa from damage
during aspiration. Option B describes a percutaneous endoscopic
gastrostomy (PEG) feeding tube, which is surgically inserted through the
abdomen into the stomach for long-term enteral feeding. Option C
describes a Levin tube, which is a single-lumen nasogastric tube used
for gastric decompression but carries a higher risk of gastric mucosal
damage during aspiration. Option D describes a Sengstaken-Blakemore
tube, which is used specifically for the treatment of bleeding esophageal
varices and has multiple lumens and balloons. The Salem sump tube is
the correct choice for this client with gastrointestinal bleeding requiring
gastric decompression.
QUESTION 3
A nurse is reinforcing teaching with an older adult client who has
osteoporosis. Which of the following instructions should the nurse
include in the teaching?
a. "Place throw rugs on wooden floors at home."
b. "Supplement your diet with vitamin E."
c. "Swim laps for 20 minutes twice per week."
d. "Take calcium supplements with meals."
CORRECT ANS: d. "Take calcium supplements with meals."
EXPERT RATIONALE
The nurse should instruct the client to take calcium carbonate
supplements with or immediately following meals to increase
absorption and effectiveness. Calcium carbonate requires the acidic
environment of the stomach for optimal absorption, and taking it with
food stimulates gastric acid secretion. Option A is incorrect because
, throw rugs increase the risk of falls, which can lead to fractures in clients
with osteoporosis. Option B is incorrect because vitamin E does not play
a significant role in bone health; vitamin D and calcium are the primary
supplements for osteoporosis. Option C is incorrect because while
swimming is a low-impact exercise, weight-bearing exercises such as
walking or strength training are more beneficial for maintaining bone
density.
QUESTION 4
A nurse is reviewing the medication record of a client who is taking
digoxin. Which of the following medications should the nurse identify as
increasing the risk for the client to develop digoxin toxicity?
a. Potassium chloride
b. Famotidine
c. Levothyroxine
d. Furosemide
CORRECT ANS: d. Furosemide
EXPERT RATIONALE
Loop diuretics, such as furosemide, increase the urinary excretion of
potassium, which can lead to hypokalemia. Hypokalemia increases the
risk for the development of digoxin toxicity because digoxin binds to
the same receptor site on the sodium-potassium ATPase pump as
potassium. When potassium levels are low, more digoxin binding sites
are available, leading to increased digoxin effect and potential toxicity.
Potassium chloride would actually help prevent hypokalemia and reduce
the risk of toxicity. Famotidine and levothyroxine do not significantly
affect digoxin levels or the risk of toxicity.
