MEDICAL-SURGICAL ATI PROCTORED EXAM 2019 – FULL
130+ QUESTION PRACTICE EXAM WITH ANSWERS AND
RATIONALES 2026 UPDATE| DIGITAL INSTANT PDF
DOWNLOAD
Overview:
This comprehensive exam contains 130+ medium- to long-length questions covering all major
Medical-Surgical topics, including:
Cardiovascular disorders (HF, MI, DVT, arrhythmias)
Respiratory disorders (COPD, pneumonia, pulmonary edema)
Endocrine disorders (Diabetes – DKA, HHS, hypoglycemia)
Renal disorders (CKD, electrolyte imbalances)
Hepatic disorders (Cirrhosis, hepatic encephalopathy, ascites)
Hematologic issues (anemia, anticoagulation, neutropenia)
Postoperative complications (shock, infection, hypovolemia)
Transfusion reactions
Acid-base imbalances (respiratory and metabolic)
Q1 A 68-year-old patient with chronic heart failure reports sudden weight gain of 4
pounds in 2 days, swelling in the legs, and shortness of breath when lying down.
Which nursing action should be performed first?
A. Encourage the patient to ambulate to reduce edema
B. Provide a low-sodium diet teaching session
C. Assess lung sounds and oxygen saturation
D. Notify the physician after completing routine vitals
Rationale: Rapid weight gain and dyspnea suggest fluid overload and possible
pulmonary edema; assessment is the first priority to identify immediate risks.
Q2: A patient with chronic obstructive pulmonary disease (COPD) is using
accessory muscles to breathe and has a respiratory rate of 32 breaths per minute.
The oxygen saturation is 87% on room air. What is the nurse’s priority action?
A. Encourage the patient to perform deep breathing exercises
B. Administer prescribed supplemental oxygen and monitor respiratory status
C. Wait for the physician to provide further orders
D. Encourage coughing and incentive spirometry
,Rationale: Hypoxemia is the immediate concern; administering oxygen and
monitoring are urgent interventions.
Q3: A 55-year-old patient with type 2 diabetes presents with fruity-smelling
breath, nausea, abdominal pain, and rapid, deep breathing. Which condition should
the nurse suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis (DKA)
C. Hyperosmolar hyperglycemic state (HHS)
D. Hypothyroidism
Rationale: Fruity breath and Kussmaul respirations are classic signs of DKA,
which is a medical emergency.
Q4: A patient who is receiving heparin reports new-onset bruising and nosebleeds.
Which lab value should the nurse check first?
A. INR
B. aPTT
C. Platelet count
D. Hematocrit
Rationale: Heparin therapy is monitored with aPTT to maintain therapeutic levels
and prevent excessive bleeding.
Q5: A postoperative patient develops sudden shortness of breath, chest pain, and
tachycardia. Which nursing action should be taken first?
A. Administer pain medication
B. Place the patient in high Fowler’s position only
C. Assess vital signs, oxygen saturation, and lung sounds
D. Notify the physician after completing all routine care
Rationale: These symptoms may indicate pulmonary embolism; rapid assessment
is critical to identify life-threatening complications.
,Q6: A patient with chronic kidney disease has a potassium level of 6.3 mEq/L.
Which action should the nurse perform first?
A. Encourage intake of high-potassium foods
B. Check sodium and calcium levels
C. Place the patient on a cardiac monitor and notify the physician
D. Administer phosphate binders
Rationale: Hyperkalemia can cause life-threatening cardiac arrhythmias;
monitoring and rapid intervention are priorities.
Q7: A patient with cirrhosis develops confusion, asterixis, and a sweet ammonia
odor on the breath. What complication should the nurse suspect?
A. Hypoglycemia
B. Electrolyte imbalance
C. Hepatic encephalopathy
D. Stroke
Rationale: Neurologic changes, asterixis, and fetor hepaticus are indicative of
hepatic encephalopathy.
Q8: A patient with congestive heart failure is receiving furosemide. Which
assessment finding requires immediate intervention?
A. Blood pressure 120/78 mmHg
B. Weight gain of 1 lb in a week
C. Potassium level of 2.8 mEq/L
D. Mild ankle edema
Rationale: Hypokalemia increases the risk of arrhythmias; this is a potentially life-
threatening side effect of diuretic therapy.
Q9: A patient with COPD has an ABG result of pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻
26 mEq/L. What does this indicate?
A. Metabolic acidosis
B. Respiratory alkalosis
, C. Respiratory acidosis
D. Metabolic alkalosis
Rationale: Elevated PaCO₂ and low pH indicate respiratory acidosis due to CO₂
retention.
Q10: A patient with pneumonia has a fever of 102°F, productive cough, and
confusion. Which nursing action is the priority?
A. Encourage oral fluids
B. Administer prescribed antibiotics and monitor response
C. Provide rest only
D. Schedule a follow-up visit
Rationale: Prompt administration of antibiotics is essential to treat infection and
prevent further complications, especially in an older adult.
Q11: A patient with a history of deep vein thrombosis (DVT) is prescribed
warfarin. Which lab value should the nurse monitor to ensure safe anticoagulation?
A. aPTT
B. INR
C. Platelet count
D. Hematocrit
Rationale: INR is used to monitor warfarin therapy to prevent bleeding or clotting
complications.
Q12: A patient with COPD reports increased dyspnea, wheezing, and fatigue.
Which nursing intervention is most important initially?
A. Encourage walking
B. Assess lung sounds and oxygen saturation
C. Teach pursed-lip breathing
D. Wait for the physician to see the patient
Rationale: Assessment identifies the severity of respiratory distress and guides
immediate interventions.
130+ QUESTION PRACTICE EXAM WITH ANSWERS AND
RATIONALES 2026 UPDATE| DIGITAL INSTANT PDF
DOWNLOAD
Overview:
This comprehensive exam contains 130+ medium- to long-length questions covering all major
Medical-Surgical topics, including:
Cardiovascular disorders (HF, MI, DVT, arrhythmias)
Respiratory disorders (COPD, pneumonia, pulmonary edema)
Endocrine disorders (Diabetes – DKA, HHS, hypoglycemia)
Renal disorders (CKD, electrolyte imbalances)
Hepatic disorders (Cirrhosis, hepatic encephalopathy, ascites)
Hematologic issues (anemia, anticoagulation, neutropenia)
Postoperative complications (shock, infection, hypovolemia)
Transfusion reactions
Acid-base imbalances (respiratory and metabolic)
Q1 A 68-year-old patient with chronic heart failure reports sudden weight gain of 4
pounds in 2 days, swelling in the legs, and shortness of breath when lying down.
Which nursing action should be performed first?
A. Encourage the patient to ambulate to reduce edema
B. Provide a low-sodium diet teaching session
C. Assess lung sounds and oxygen saturation
D. Notify the physician after completing routine vitals
Rationale: Rapid weight gain and dyspnea suggest fluid overload and possible
pulmonary edema; assessment is the first priority to identify immediate risks.
Q2: A patient with chronic obstructive pulmonary disease (COPD) is using
accessory muscles to breathe and has a respiratory rate of 32 breaths per minute.
The oxygen saturation is 87% on room air. What is the nurse’s priority action?
A. Encourage the patient to perform deep breathing exercises
B. Administer prescribed supplemental oxygen and monitor respiratory status
C. Wait for the physician to provide further orders
D. Encourage coughing and incentive spirometry
,Rationale: Hypoxemia is the immediate concern; administering oxygen and
monitoring are urgent interventions.
Q3: A 55-year-old patient with type 2 diabetes presents with fruity-smelling
breath, nausea, abdominal pain, and rapid, deep breathing. Which condition should
the nurse suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis (DKA)
C. Hyperosmolar hyperglycemic state (HHS)
D. Hypothyroidism
Rationale: Fruity breath and Kussmaul respirations are classic signs of DKA,
which is a medical emergency.
Q4: A patient who is receiving heparin reports new-onset bruising and nosebleeds.
Which lab value should the nurse check first?
A. INR
B. aPTT
C. Platelet count
D. Hematocrit
Rationale: Heparin therapy is monitored with aPTT to maintain therapeutic levels
and prevent excessive bleeding.
Q5: A postoperative patient develops sudden shortness of breath, chest pain, and
tachycardia. Which nursing action should be taken first?
A. Administer pain medication
B. Place the patient in high Fowler’s position only
C. Assess vital signs, oxygen saturation, and lung sounds
D. Notify the physician after completing all routine care
Rationale: These symptoms may indicate pulmonary embolism; rapid assessment
is critical to identify life-threatening complications.
,Q6: A patient with chronic kidney disease has a potassium level of 6.3 mEq/L.
Which action should the nurse perform first?
A. Encourage intake of high-potassium foods
B. Check sodium and calcium levels
C. Place the patient on a cardiac monitor and notify the physician
D. Administer phosphate binders
Rationale: Hyperkalemia can cause life-threatening cardiac arrhythmias;
monitoring and rapid intervention are priorities.
Q7: A patient with cirrhosis develops confusion, asterixis, and a sweet ammonia
odor on the breath. What complication should the nurse suspect?
A. Hypoglycemia
B. Electrolyte imbalance
C. Hepatic encephalopathy
D. Stroke
Rationale: Neurologic changes, asterixis, and fetor hepaticus are indicative of
hepatic encephalopathy.
Q8: A patient with congestive heart failure is receiving furosemide. Which
assessment finding requires immediate intervention?
A. Blood pressure 120/78 mmHg
B. Weight gain of 1 lb in a week
C. Potassium level of 2.8 mEq/L
D. Mild ankle edema
Rationale: Hypokalemia increases the risk of arrhythmias; this is a potentially life-
threatening side effect of diuretic therapy.
Q9: A patient with COPD has an ABG result of pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻
26 mEq/L. What does this indicate?
A. Metabolic acidosis
B. Respiratory alkalosis
, C. Respiratory acidosis
D. Metabolic alkalosis
Rationale: Elevated PaCO₂ and low pH indicate respiratory acidosis due to CO₂
retention.
Q10: A patient with pneumonia has a fever of 102°F, productive cough, and
confusion. Which nursing action is the priority?
A. Encourage oral fluids
B. Administer prescribed antibiotics and monitor response
C. Provide rest only
D. Schedule a follow-up visit
Rationale: Prompt administration of antibiotics is essential to treat infection and
prevent further complications, especially in an older adult.
Q11: A patient with a history of deep vein thrombosis (DVT) is prescribed
warfarin. Which lab value should the nurse monitor to ensure safe anticoagulation?
A. aPTT
B. INR
C. Platelet count
D. Hematocrit
Rationale: INR is used to monitor warfarin therapy to prevent bleeding or clotting
complications.
Q12: A patient with COPD reports increased dyspnea, wheezing, and fatigue.
Which nursing intervention is most important initially?
A. Encourage walking
B. Assess lung sounds and oxygen saturation
C. Teach pursed-lip breathing
D. Wait for the physician to see the patient
Rationale: Assessment identifies the severity of respiratory distress and guides
immediate interventions.
