ATI RN Medical Surgical Proctored Exam
Study Guide Practice Questions Answers
2026/ 2027
Neurological System
1. A nurse is caring for a client who has a new onset of seizures. Which of the following
actions should the nurse take first?
A. Administer the prescribed anticonvulsant medication.
B. Place a padded tongue blade in the client's mouth.
C. Position the client to maintain a patent airway.
D. Document the time and characteristics of the seizure.
Correct Answer: C. Position the client to maintain a patent airway.
Rationale: The priority during a seizure is safety, with a focus on maintaining a patent
airway. Turning the client to the side (recovery position) helps prevent aspiration of secretions
and vomitus. Option A is important but is not the first action. Option B is incorrect and
dangerous, as it can cause injury to the client's mouth and teeth. Option D is done after the
seizure has ended.
2. A nurse is assessing a client who has increased intracranial pressure (ICP). Which of the
following findings is an early indicator of increasing ICP?
A. Decreased level of consciousness.
B. Decerebrate posturing.
C. Fixed, dilated pupils.
D. Bradycardia with a widened pulse pressure.
Correct Answer: A. Decreased level of consciousness.
Rationale: A change in the level of consciousness (LOC) is the earliest and most sensitive
indicator of increased ICP. As ICP continues to rise, it can lead to Cushing's triad (bradycardia,
hypertension with widened pulse pressure, and bradypnea), decerebrate posturing, and fixed,
dilated pupils, but these are later, more ominous signs.
3. A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis
(MG). Which of the following statements by the client indicates an understanding of the
teaching?
A. "I should take my medication, pyridostigmine, with meals."
,B. "I will plan my activities for the evening when I have more energy."
C. "I should report any difficulty swallowing or chewing to my provider."
D. "I will take a nap in the afternoon to help with my fatigue."
Correct Answer: C. "I should report any difficulty swallowing or chewing to my provider."
Rationale: Difficulty swallowing (dysphagia) and chewing are signs of a myasthenic crisis, a
life-threatening exacerbation of MG. This must be reported immediately. Pyridostigmine is
typically taken 30-60 minutes before meals to improve swallowing and chewing strength, not
with meals. Muscle strength is usually best in the morning, so activities should be planned for
that time. While rest is important, a nap is a general measure; reporting signs of a crisis is a
specific, critical teaching point.
4. A nurse is caring for a client who has had a stroke (CVA) and is experiencing right-sided
hemiplegia. The nurse should expect the client to also exhibit which of the following deficits?
A. Aphasia.
B. Impulsivity and poor judgment.
C. Left-sided visual field deficit.
D. Difficulty with spatial-perceptual tasks.
Correct Answer: B. Impulsivity and poor judgment.
Rationale: Right-sided hemiplegia indicates a stroke in the left hemisphere. Left-hemisphere
strokes typically cause deficits in language (aphasia), math skills, and analytical thinking. Clients
may also exhibit impulsive behavior and poor judgment. A stroke in the right hemisphere
(causing left-sided hemiplegia) would more likely cause spatial-perceptual deficits, left-sided
neglect, and a left visual field deficit.
5. A nurse is caring for a client who is post-operative day one following a craniotomy. The
nurse notes clear fluid is leaking from the client's nose. Which of the following actions should
the nurse take?
A. Have the client blow their nose gently.
B. Apply a sterile gauze dressing under the nose.
C. Test the fluid for glucose using a Dextrostix.
D. Place the client in a supine position.
Correct Answer: C. Test the fluid for glucose using a Dextrostix.
Rationale: Clear fluid leaking from the nose or ear after a craniotomy is a potential sign of
cerebrospinal fluid (CSF) leak. CSF contains glucose, so testing the fluid with a Dextrostix (or
testing for a halo sign) can help confirm the presence of CSF. The client should be instructed not
to blow their nose. A sterile gauze should be placed loosely under the nose to collect the fluid
for observation, not to plug it. The head of the bed should be elevated, not placed supine.
,6. A nurse is teaching a client who has Parkinson's disease about a new prescription for
carbidopa-levodopa. Which of the following instructions should the nurse include?
A. "Take the medication with a high-protein meal."
B. "You may experience a darkening of your urine."
C. "Notify your provider if you experience a persistent cough."
D. "This medication will cure your disease."
Correct Answer: B. "You may experience a darkening of your urine."
Rationale: Carbidopa-levodopa can cause darkening of urine and sweat, which is a harmless
but important side effect to teach the client about. High-protein meals can interfere with the
absorption of levodopa. A persistent cough is not a common side effect. The medication
manages symptoms but does not cure the disease.
7. A nurse is assessing a client who has Guillain-Barré syndrome (GBS). Which of the following
findings is the priority for the nurse to report?
A. Loss of deep tendon reflexes in the lower extremities.
B. A decrease in vital capacity.
C. Paresthesia in the hands and feet.
D. An ascending pattern of muscle weakness.
Correct Answer: B. A decrease in vital capacity.
Rationale: The priority for a client with GBS is monitoring for respiratory compromise. The
ascending paralysis can affect the diaphragm and intercostal muscles, leading to respiratory
failure. A decreasing vital capacity is a critical indicator of impending respiratory failure and
must be reported immediately. Options A, C, and D are all expected findings in GBS.
8. A nurse is reviewing the medical record of a client who has a new prescription for a
phenytoin. The nurse should identify which of the following findings as a contraindication to
this medication?
A. History of hypertension.
B. History of a seizure disorder.
C. History of a sinus bradycardia.
D. History of diabetes mellitus.
Correct Answer: C. History of a sinus bradycardia.
Rationale: Phenytoin can cause cardiac dysrhythmias, including bradycardia and heart
block. Therefore, it is contraindicated in clients with a history of sinus bradycardia, sinoatrial
block, or second- and third-degree atrioventricular block. A history of hypertension, seizure
disorder, or diabetes is not a contraindication.
, 9. A nurse is caring for a client who is 24 hours post-operative following a lumbar
laminectomy. Which of the following actions should the nurse take?
A. Logroll the client when turning.
B. Place the client in a high-Fowler's position.
C. Encourage the client to sit up in a chair for 2 hours.
D. Perform passive range-of-motion exercises for the legs.
Correct Answer: A. Logroll the client when turning.
Rationale: After a lumbar laminectomy, the client's spine must be kept in alignment to
prevent injury and promote healing. The nurse should use the logrolling technique to turn the
client, keeping the spine straight. High-Fowler's position can increase stress on the surgical site.
Prolonged sitting is also discouraged initially. Passive ROM of the legs can cause stress on the
lower back.
10. A nurse is assessing a client who has a head injury and is exhibiting a decrease in level of
consciousness. Which of the following is the priority action?
A. Check the client's pupillary response.
B. Perform a Glasgow Coma Scale assessment.
C. Ensure the client has a patent airway.
D. Obtain a prescription for a CT scan.
Correct Answer: C. Ensure the client has a patent airway.
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the airway is
always the first priority. A decreasing level of consciousness can lead to loss of protective
reflexes, putting the client at risk for airway obstruction and aspiration. While the other
assessments and interventions are important, ensuring a patent airway is the immediate
priority.
11. A nurse is providing teaching to a client who has multiple sclerosis (MS) and is
experiencing ataxia. Which of the following instructions should the nurse include?
A. "Use a cane or walker for ambulation."
B. "Take a hot bath to relax your muscles."
C. "Increase your intake of foods high in potassium."
D. "Perform vigorous exercise to build strength."
Correct Answer: A. "Use a cane or walker for ambulation."
Rationale: Ataxia is a lack of muscle coordination that can affect gait and balance. Using an
assistive device like a cane or walker is a key safety measure to prevent falls. Hot baths can
exacerbate MS symptoms (Uhthoff's phenomenon). While a healthy diet is important,
Study Guide Practice Questions Answers
2026/ 2027
Neurological System
1. A nurse is caring for a client who has a new onset of seizures. Which of the following
actions should the nurse take first?
A. Administer the prescribed anticonvulsant medication.
B. Place a padded tongue blade in the client's mouth.
C. Position the client to maintain a patent airway.
D. Document the time and characteristics of the seizure.
Correct Answer: C. Position the client to maintain a patent airway.
Rationale: The priority during a seizure is safety, with a focus on maintaining a patent
airway. Turning the client to the side (recovery position) helps prevent aspiration of secretions
and vomitus. Option A is important but is not the first action. Option B is incorrect and
dangerous, as it can cause injury to the client's mouth and teeth. Option D is done after the
seizure has ended.
2. A nurse is assessing a client who has increased intracranial pressure (ICP). Which of the
following findings is an early indicator of increasing ICP?
A. Decreased level of consciousness.
B. Decerebrate posturing.
C. Fixed, dilated pupils.
D. Bradycardia with a widened pulse pressure.
Correct Answer: A. Decreased level of consciousness.
Rationale: A change in the level of consciousness (LOC) is the earliest and most sensitive
indicator of increased ICP. As ICP continues to rise, it can lead to Cushing's triad (bradycardia,
hypertension with widened pulse pressure, and bradypnea), decerebrate posturing, and fixed,
dilated pupils, but these are later, more ominous signs.
3. A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis
(MG). Which of the following statements by the client indicates an understanding of the
teaching?
A. "I should take my medication, pyridostigmine, with meals."
,B. "I will plan my activities for the evening when I have more energy."
C. "I should report any difficulty swallowing or chewing to my provider."
D. "I will take a nap in the afternoon to help with my fatigue."
Correct Answer: C. "I should report any difficulty swallowing or chewing to my provider."
Rationale: Difficulty swallowing (dysphagia) and chewing are signs of a myasthenic crisis, a
life-threatening exacerbation of MG. This must be reported immediately. Pyridostigmine is
typically taken 30-60 minutes before meals to improve swallowing and chewing strength, not
with meals. Muscle strength is usually best in the morning, so activities should be planned for
that time. While rest is important, a nap is a general measure; reporting signs of a crisis is a
specific, critical teaching point.
4. A nurse is caring for a client who has had a stroke (CVA) and is experiencing right-sided
hemiplegia. The nurse should expect the client to also exhibit which of the following deficits?
A. Aphasia.
B. Impulsivity and poor judgment.
C. Left-sided visual field deficit.
D. Difficulty with spatial-perceptual tasks.
Correct Answer: B. Impulsivity and poor judgment.
Rationale: Right-sided hemiplegia indicates a stroke in the left hemisphere. Left-hemisphere
strokes typically cause deficits in language (aphasia), math skills, and analytical thinking. Clients
may also exhibit impulsive behavior and poor judgment. A stroke in the right hemisphere
(causing left-sided hemiplegia) would more likely cause spatial-perceptual deficits, left-sided
neglect, and a left visual field deficit.
5. A nurse is caring for a client who is post-operative day one following a craniotomy. The
nurse notes clear fluid is leaking from the client's nose. Which of the following actions should
the nurse take?
A. Have the client blow their nose gently.
B. Apply a sterile gauze dressing under the nose.
C. Test the fluid for glucose using a Dextrostix.
D. Place the client in a supine position.
Correct Answer: C. Test the fluid for glucose using a Dextrostix.
Rationale: Clear fluid leaking from the nose or ear after a craniotomy is a potential sign of
cerebrospinal fluid (CSF) leak. CSF contains glucose, so testing the fluid with a Dextrostix (or
testing for a halo sign) can help confirm the presence of CSF. The client should be instructed not
to blow their nose. A sterile gauze should be placed loosely under the nose to collect the fluid
for observation, not to plug it. The head of the bed should be elevated, not placed supine.
,6. A nurse is teaching a client who has Parkinson's disease about a new prescription for
carbidopa-levodopa. Which of the following instructions should the nurse include?
A. "Take the medication with a high-protein meal."
B. "You may experience a darkening of your urine."
C. "Notify your provider if you experience a persistent cough."
D. "This medication will cure your disease."
Correct Answer: B. "You may experience a darkening of your urine."
Rationale: Carbidopa-levodopa can cause darkening of urine and sweat, which is a harmless
but important side effect to teach the client about. High-protein meals can interfere with the
absorption of levodopa. A persistent cough is not a common side effect. The medication
manages symptoms but does not cure the disease.
7. A nurse is assessing a client who has Guillain-Barré syndrome (GBS). Which of the following
findings is the priority for the nurse to report?
A. Loss of deep tendon reflexes in the lower extremities.
B. A decrease in vital capacity.
C. Paresthesia in the hands and feet.
D. An ascending pattern of muscle weakness.
Correct Answer: B. A decrease in vital capacity.
Rationale: The priority for a client with GBS is monitoring for respiratory compromise. The
ascending paralysis can affect the diaphragm and intercostal muscles, leading to respiratory
failure. A decreasing vital capacity is a critical indicator of impending respiratory failure and
must be reported immediately. Options A, C, and D are all expected findings in GBS.
8. A nurse is reviewing the medical record of a client who has a new prescription for a
phenytoin. The nurse should identify which of the following findings as a contraindication to
this medication?
A. History of hypertension.
B. History of a seizure disorder.
C. History of a sinus bradycardia.
D. History of diabetes mellitus.
Correct Answer: C. History of a sinus bradycardia.
Rationale: Phenytoin can cause cardiac dysrhythmias, including bradycardia and heart
block. Therefore, it is contraindicated in clients with a history of sinus bradycardia, sinoatrial
block, or second- and third-degree atrioventricular block. A history of hypertension, seizure
disorder, or diabetes is not a contraindication.
, 9. A nurse is caring for a client who is 24 hours post-operative following a lumbar
laminectomy. Which of the following actions should the nurse take?
A. Logroll the client when turning.
B. Place the client in a high-Fowler's position.
C. Encourage the client to sit up in a chair for 2 hours.
D. Perform passive range-of-motion exercises for the legs.
Correct Answer: A. Logroll the client when turning.
Rationale: After a lumbar laminectomy, the client's spine must be kept in alignment to
prevent injury and promote healing. The nurse should use the logrolling technique to turn the
client, keeping the spine straight. High-Fowler's position can increase stress on the surgical site.
Prolonged sitting is also discouraged initially. Passive ROM of the legs can cause stress on the
lower back.
10. A nurse is assessing a client who has a head injury and is exhibiting a decrease in level of
consciousness. Which of the following is the priority action?
A. Check the client's pupillary response.
B. Perform a Glasgow Coma Scale assessment.
C. Ensure the client has a patent airway.
D. Obtain a prescription for a CT scan.
Correct Answer: C. Ensure the client has a patent airway.
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the airway is
always the first priority. A decreasing level of consciousness can lead to loss of protective
reflexes, putting the client at risk for airway obstruction and aspiration. While the other
assessments and interventions are important, ensuring a patent airway is the immediate
priority.
11. A nurse is providing teaching to a client who has multiple sclerosis (MS) and is
experiencing ataxia. Which of the following instructions should the nurse include?
A. "Use a cane or walker for ambulation."
B. "Take a hot bath to relax your muscles."
C. "Increase your intake of foods high in potassium."
D. "Perform vigorous exercise to build strength."
Correct Answer: A. "Use a cane or walker for ambulation."
Rationale: Ataxia is a lack of muscle coordination that can affect gait and balance. Using an
assistive device like a cane or walker is a key safety measure to prevent falls. Hot baths can
exacerbate MS symptoms (Uhthoff's phenomenon). While a healthy diet is important,
