ATI RN Medical-Surgical Proctored
Assessment 2026 | 100 Real Exam
Questions & Answers
1. A nurse is caring for a client who has chronic obstructive pulmonary disease
(COPD). Which finding requires immediate intervention?
A. Barrel-shaped chest
B. Oxygen saturation of 91%
C. Respiratory rate of 32/min with increasing confusion
D. Productive cough with clear sputum
Answer: C. Respiratory rate of 32/min with increasing confusion
Rationale: Tachypnea accompanied by acute confusion can indicate worsening
hypoxemia or hypercapnia and requires immediate assessment and intervention.
2. A client with heart failure is receiving IV furosemide. Which laboratory value
should the nurse monitor most closely?
A. Sodium
B. Potassium
C. Hemoglobin
D. Platelet count
Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that can cause potassium loss, increasing
the risk of dysrhythmias.
3. A nurse is assessing a client who has hypokalemia. Which finding should the
nurse expect?
,A. Muscle weakness
B. Hyperactive reflexes
C. Peaked T waves
D. Severe hypertension
Answer: A. Muscle weakness
Rationale: Hypokalemia can cause muscle weakness, fatigue, constipation, and
characteristic ECG changes such as flattened T waves and prominent U waves.
4. A client is admitted with diabetic ketoacidosis (DKA). Which prescription
should the nurse implement first?
A. Administer IV regular insulin
B. Begin isotonic IV fluid replacement
C. Administer potassium replacement
D. Give sodium bicarbonate
Answer: B. Begin isotonic IV fluid replacement
Rationale: Severe dehydration is a major problem in DKA. Initial treatment
generally focuses on restoring circulating volume with isotonic fluids before or
alongside subsequent insulin and electrolyte management.
5. A client taking warfarin has an INR of 5.8. Which action should the nurse
anticipate?
A. Administer the next scheduled dose
B. Encourage foods high in vitamin K immediately
C. Hold warfarin and notify the provider
D. Administer aspirin
Answer: C. Hold warfarin and notify the provider
Rationale: An excessively elevated INR increases bleeding risk. The medication
should be withheld and the provider notified for further management.
,6. A nurse is caring for a client who has a chest tube connected to a drainage
system. Which finding requires intervention?
A. Tidaling in the water-seal chamber
B. Intermittent bubbling with coughing shortly after insertion
C. Continuous bubbling in the water-seal chamber
D. Small amount of drainage in the collection chamber
Answer: C. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber can indicate an air
leak. The nurse should assess the system and client to locate the source.
7. A client with SIADH has a sodium level of 118 mEq/L. Which prescription
should the nurse anticipate?
A. Encourage large amounts of oral water
B. Restrict fluids
C. Administer hypotonic IV fluids
D. Encourage a low-sodium diet
Answer: B. Restrict fluids
Rationale: SIADH causes excessive water retention and dilutional hyponatremia.
Fluid restriction is commonly used to reduce free-water retention.
8. A client with acute kidney injury has a potassium level of 6.4 mEq/L. Which
finding is the priority?
A. Nausea
B. Muscle fatigue
C. Cardiac dysrhythmia
D. Decreased appetite
Answer: C. Cardiac dysrhythmia
, Rationale: Severe hyperkalemia can cause life-threatening cardiac conduction
abnormalities and dysrhythmias.
9. A nurse is teaching a client who has a new ileostomy. Which statement indicates
understanding?
A. “I should expect formed stool from the stoma.”
B. “I should report a dusky or black stoma.”
C. “I should clean the stoma with alcohol.”
D. “I should restrict fluids to prevent output.”
Answer: B. “I should report a dusky or black stoma.”
Rationale: A healthy stoma should be moist and pink to red. Dusky, purple, brown,
or black coloration can indicate impaired blood supply.
10. A client is experiencing an acute ischemic stroke. Which assessment finding is
most important to report immediately?
A. Mild headache
B. Sudden difficulty speaking
C. History of hypertension
D. Blood pressure of 148/86 mm Hg
Answer: B. Sudden difficulty speaking
Rationale: Sudden speech difficulty is a classic sign of acute stroke. Rapid
recognition and treatment are essential because some interventions are time-
dependent.
11. A nurse is caring for a client who has pneumonia. Which finding indicates
improvement?
A. Increasing respiratory rate
B. Oxygen saturation increasing from 89% to 95%
Assessment 2026 | 100 Real Exam
Questions & Answers
1. A nurse is caring for a client who has chronic obstructive pulmonary disease
(COPD). Which finding requires immediate intervention?
A. Barrel-shaped chest
B. Oxygen saturation of 91%
C. Respiratory rate of 32/min with increasing confusion
D. Productive cough with clear sputum
Answer: C. Respiratory rate of 32/min with increasing confusion
Rationale: Tachypnea accompanied by acute confusion can indicate worsening
hypoxemia or hypercapnia and requires immediate assessment and intervention.
2. A client with heart failure is receiving IV furosemide. Which laboratory value
should the nurse monitor most closely?
A. Sodium
B. Potassium
C. Hemoglobin
D. Platelet count
Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that can cause potassium loss, increasing
the risk of dysrhythmias.
3. A nurse is assessing a client who has hypokalemia. Which finding should the
nurse expect?
,A. Muscle weakness
B. Hyperactive reflexes
C. Peaked T waves
D. Severe hypertension
Answer: A. Muscle weakness
Rationale: Hypokalemia can cause muscle weakness, fatigue, constipation, and
characteristic ECG changes such as flattened T waves and prominent U waves.
4. A client is admitted with diabetic ketoacidosis (DKA). Which prescription
should the nurse implement first?
A. Administer IV regular insulin
B. Begin isotonic IV fluid replacement
C. Administer potassium replacement
D. Give sodium bicarbonate
Answer: B. Begin isotonic IV fluid replacement
Rationale: Severe dehydration is a major problem in DKA. Initial treatment
generally focuses on restoring circulating volume with isotonic fluids before or
alongside subsequent insulin and electrolyte management.
5. A client taking warfarin has an INR of 5.8. Which action should the nurse
anticipate?
A. Administer the next scheduled dose
B. Encourage foods high in vitamin K immediately
C. Hold warfarin and notify the provider
D. Administer aspirin
Answer: C. Hold warfarin and notify the provider
Rationale: An excessively elevated INR increases bleeding risk. The medication
should be withheld and the provider notified for further management.
,6. A nurse is caring for a client who has a chest tube connected to a drainage
system. Which finding requires intervention?
A. Tidaling in the water-seal chamber
B. Intermittent bubbling with coughing shortly after insertion
C. Continuous bubbling in the water-seal chamber
D. Small amount of drainage in the collection chamber
Answer: C. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber can indicate an air
leak. The nurse should assess the system and client to locate the source.
7. A client with SIADH has a sodium level of 118 mEq/L. Which prescription
should the nurse anticipate?
A. Encourage large amounts of oral water
B. Restrict fluids
C. Administer hypotonic IV fluids
D. Encourage a low-sodium diet
Answer: B. Restrict fluids
Rationale: SIADH causes excessive water retention and dilutional hyponatremia.
Fluid restriction is commonly used to reduce free-water retention.
8. A client with acute kidney injury has a potassium level of 6.4 mEq/L. Which
finding is the priority?
A. Nausea
B. Muscle fatigue
C. Cardiac dysrhythmia
D. Decreased appetite
Answer: C. Cardiac dysrhythmia
, Rationale: Severe hyperkalemia can cause life-threatening cardiac conduction
abnormalities and dysrhythmias.
9. A nurse is teaching a client who has a new ileostomy. Which statement indicates
understanding?
A. “I should expect formed stool from the stoma.”
B. “I should report a dusky or black stoma.”
C. “I should clean the stoma with alcohol.”
D. “I should restrict fluids to prevent output.”
Answer: B. “I should report a dusky or black stoma.”
Rationale: A healthy stoma should be moist and pink to red. Dusky, purple, brown,
or black coloration can indicate impaired blood supply.
10. A client is experiencing an acute ischemic stroke. Which assessment finding is
most important to report immediately?
A. Mild headache
B. Sudden difficulty speaking
C. History of hypertension
D. Blood pressure of 148/86 mm Hg
Answer: B. Sudden difficulty speaking
Rationale: Sudden speech difficulty is a classic sign of acute stroke. Rapid
recognition and treatment are essential because some interventions are time-
dependent.
11. A nurse is caring for a client who has pneumonia. Which finding indicates
improvement?
A. Increasing respiratory rate
B. Oxygen saturation increasing from 89% to 95%
