ATI MED SURG PROCTORED 2025
COMPLETE REVIEW & STUDY PREP
MANUAL || LATEST EDITION
Medical-Surgical Nursing: 20 Foundational Practice Questions & Rationales
Instructions: Study each question and select the best answer. The correct answer is marked
with .
1. A client with chronic obstructive pulmonary disease (COPD) is prescribed long-term oxygen
therapy at 2 L/min via nasal cannula. The nurse's priority teaching point should be:
A. "You can adjust the flow rate up to 4 L/min if you feel more short of breath."
B. "It is safe to be around open flames while using your oxygen."
C. "The goal of this therapy is to maintain your oxygen saturation above 90%."
D. "You only need to use the oxygen when you are experiencing symptoms."
Rationale: For patients with COPD, the goal of long-term O2 therapy is to maintain SpO2 ≥ 90%
to prevent tissue hypoxia and cor pulmonale. Flow rates should never be self-adjusted (A).
Oxygen supports combustion (B is dangerous). Therapy is prescribed for continuous or specific-
use periods, not just PRN symptoms (D).
2. When assessing a client who is 24 hours post-operative total hip replacement, which
finding requires immediate intervention?
A. Pain rated 4/10 at the surgical site.
B. Left foot is warm with palpable pedal pulse.
C. The affected leg is shortened, adducted, and externally rotated.
D. Serosanguineous drainage on the dressing.
Rationale: Findings in (C) are classic signs of a prosthetic hip dislocation, a surgical emergency.
(A) is expected pain. (B) indicates good perfusion. (D) is expected drainage.
3. A client with heart failure is started on furosemide 40 mg IV. Which electrolyte imbalance is
the nurse most vigilant for?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Rationale: Loop diuretics like furosemide cause significant potassium loss in the urine, leading
to hypokalemia. This can precipitate dangerous dysrhythmias, especially in patients on digoxin.
,4. The nurse is caring for a client with a new diagnosis of type 2 diabetes mellitus. Which
statement by the client indicates a need for further teaching?
A. "I will rotate the sites where I give my insulin."
B. "I should carry a fast-acting sugar with me at all times in case of low blood sugar."
C. "If I feel shaky and sweaty, I should check my blood sugar."
D. "Since my medication is a pill, I don't need to worry about hypoglycemia."
Rationale: Oral hypoglycemics (e.g., sulfonylureas) can absolutely cause hypoglycemia. (D) is a
dangerous misconception. (A, B, C) are correct self-management strategies.
5. A client with cirrhosis has significant ascites. The nurse anticipates the HCP will prescribe
which medication to reduce fluid accumulation?
A. Spironolactone
B. Furosemide alone
C. Hydrochlorothiazide
D. Metolazone
Rationale: Spironolactone, an aldosterone antagonist, is the potassium-sparing diuretic of
choice in cirrhosis as it counteracts the hyperaldosteronism common in liver disease. It is often
used with a loop diuretic but rarely a loop diuretic alone initially.
6. Four hours after a colonoscopy, a client reports severe, constant abdominal pain and
distention. The nurse's first action should be to:
A. Medicate for pain as ordered.
B. Assess vital signs and notify the provider immediately.
C. Encourage ambulation to pass gas.
D. Provide a warm beverage.
Rationale: Severe, constant pain after a scope procedure is a red flag for potential perforation.
Assessing for signs of shock (vital signs) and notifying the provider is the priority to prevent
peritonitis and sepsis.
7. For a client with an acute exacerbation of ulcerative colitis, which dietary order should the
nurse question?
A. Clear liquids
B. High-fiber bran cereal
C. Oral electrolyte solution
D. Applesauce
Rationale: During an acute flare, the goal is to put the bowel at rest and avoid irritation. High-
fiber foods (B) are contraindicated as they increase bulk and motility. Low-residue, easily
digested foods or NPO status are typical.
, 8. A client with a head injury has clear fluid draining from the nose. The nurse should:
A. Have the client blow his nose gently.
B. Test the fluid for glucose with a dextrostick.
C. Pack the nares with gauze.
D. Suction the nostril vigorously.
Rationale: Clear drainage from the nose or ear after head injury could be cerebrospinal fluid
(CSF). CSF tests positive for glucose, while mucus does not. Having the client blow, packing, or
aggressive suctioning could increase the risk of meningitis.
9. Which client is at HIGHEST risk for developing a pulmonary embolism?
A. A 30-year-old postpartum client who had a normal vaginal delivery.
B. A 45-year-old client on bedrest for 4 days after knee arthroscopy.
C. A 68-year-old client with metastatic cancer 1 week post-abdominal surgery.
D. A 55-year-old client with osteoarthritis who walks daily.
Rationale: Virchow's Triad (stasis, hypercoagulability, vessel injury). (C) has all three: post-op
stasis, cancer-induced hypercoagulability, and surgical vessel injury. (B) has stasis but a lower-
risk profile.
10. When administering a blood transfusion, the nurse knows that the only compatible IV
fluid to run with blood products is:
A. 5% Dextrose in Water (D5W)
B. 0.9% Normal Saline (NS)
C. Lactated Ringer's (LR)
D. 5% Dextrose in 0.45% NS
Rationale: 0.9% NS is the only solution compatible with blood. Other solutions (like those
containing dextrose or calcium) can cause hemolysis or clotting in the tubing.
11. A client with acute pancreatitis has severe abdominal pain. Which position should the
nurse encourage to provide comfort?
A. Supine with legs flat.
B. Sitting upright, leaning forward.
C. Right-side lying.
D. Knee-chest position.
Rationale: Sitting upright and leaning forward helps to relieve pressure on the inflamed
pancreas from the abdominal organs, especially the stomach.
12. The nurse is teaching a client about warfarin therapy. Which statement by the client
indicates understanding?
A. "I will stop taking the medication if I see any bruising."
COMPLETE REVIEW & STUDY PREP
MANUAL || LATEST EDITION
Medical-Surgical Nursing: 20 Foundational Practice Questions & Rationales
Instructions: Study each question and select the best answer. The correct answer is marked
with .
1. A client with chronic obstructive pulmonary disease (COPD) is prescribed long-term oxygen
therapy at 2 L/min via nasal cannula. The nurse's priority teaching point should be:
A. "You can adjust the flow rate up to 4 L/min if you feel more short of breath."
B. "It is safe to be around open flames while using your oxygen."
C. "The goal of this therapy is to maintain your oxygen saturation above 90%."
D. "You only need to use the oxygen when you are experiencing symptoms."
Rationale: For patients with COPD, the goal of long-term O2 therapy is to maintain SpO2 ≥ 90%
to prevent tissue hypoxia and cor pulmonale. Flow rates should never be self-adjusted (A).
Oxygen supports combustion (B is dangerous). Therapy is prescribed for continuous or specific-
use periods, not just PRN symptoms (D).
2. When assessing a client who is 24 hours post-operative total hip replacement, which
finding requires immediate intervention?
A. Pain rated 4/10 at the surgical site.
B. Left foot is warm with palpable pedal pulse.
C. The affected leg is shortened, adducted, and externally rotated.
D. Serosanguineous drainage on the dressing.
Rationale: Findings in (C) are classic signs of a prosthetic hip dislocation, a surgical emergency.
(A) is expected pain. (B) indicates good perfusion. (D) is expected drainage.
3. A client with heart failure is started on furosemide 40 mg IV. Which electrolyte imbalance is
the nurse most vigilant for?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Rationale: Loop diuretics like furosemide cause significant potassium loss in the urine, leading
to hypokalemia. This can precipitate dangerous dysrhythmias, especially in patients on digoxin.
,4. The nurse is caring for a client with a new diagnosis of type 2 diabetes mellitus. Which
statement by the client indicates a need for further teaching?
A. "I will rotate the sites where I give my insulin."
B. "I should carry a fast-acting sugar with me at all times in case of low blood sugar."
C. "If I feel shaky and sweaty, I should check my blood sugar."
D. "Since my medication is a pill, I don't need to worry about hypoglycemia."
Rationale: Oral hypoglycemics (e.g., sulfonylureas) can absolutely cause hypoglycemia. (D) is a
dangerous misconception. (A, B, C) are correct self-management strategies.
5. A client with cirrhosis has significant ascites. The nurse anticipates the HCP will prescribe
which medication to reduce fluid accumulation?
A. Spironolactone
B. Furosemide alone
C. Hydrochlorothiazide
D. Metolazone
Rationale: Spironolactone, an aldosterone antagonist, is the potassium-sparing diuretic of
choice in cirrhosis as it counteracts the hyperaldosteronism common in liver disease. It is often
used with a loop diuretic but rarely a loop diuretic alone initially.
6. Four hours after a colonoscopy, a client reports severe, constant abdominal pain and
distention. The nurse's first action should be to:
A. Medicate for pain as ordered.
B. Assess vital signs and notify the provider immediately.
C. Encourage ambulation to pass gas.
D. Provide a warm beverage.
Rationale: Severe, constant pain after a scope procedure is a red flag for potential perforation.
Assessing for signs of shock (vital signs) and notifying the provider is the priority to prevent
peritonitis and sepsis.
7. For a client with an acute exacerbation of ulcerative colitis, which dietary order should the
nurse question?
A. Clear liquids
B. High-fiber bran cereal
C. Oral electrolyte solution
D. Applesauce
Rationale: During an acute flare, the goal is to put the bowel at rest and avoid irritation. High-
fiber foods (B) are contraindicated as they increase bulk and motility. Low-residue, easily
digested foods or NPO status are typical.
, 8. A client with a head injury has clear fluid draining from the nose. The nurse should:
A. Have the client blow his nose gently.
B. Test the fluid for glucose with a dextrostick.
C. Pack the nares with gauze.
D. Suction the nostril vigorously.
Rationale: Clear drainage from the nose or ear after head injury could be cerebrospinal fluid
(CSF). CSF tests positive for glucose, while mucus does not. Having the client blow, packing, or
aggressive suctioning could increase the risk of meningitis.
9. Which client is at HIGHEST risk for developing a pulmonary embolism?
A. A 30-year-old postpartum client who had a normal vaginal delivery.
B. A 45-year-old client on bedrest for 4 days after knee arthroscopy.
C. A 68-year-old client with metastatic cancer 1 week post-abdominal surgery.
D. A 55-year-old client with osteoarthritis who walks daily.
Rationale: Virchow's Triad (stasis, hypercoagulability, vessel injury). (C) has all three: post-op
stasis, cancer-induced hypercoagulability, and surgical vessel injury. (B) has stasis but a lower-
risk profile.
10. When administering a blood transfusion, the nurse knows that the only compatible IV
fluid to run with blood products is:
A. 5% Dextrose in Water (D5W)
B. 0.9% Normal Saline (NS)
C. Lactated Ringer's (LR)
D. 5% Dextrose in 0.45% NS
Rationale: 0.9% NS is the only solution compatible with blood. Other solutions (like those
containing dextrose or calcium) can cause hemolysis or clotting in the tubing.
11. A client with acute pancreatitis has severe abdominal pain. Which position should the
nurse encourage to provide comfort?
A. Supine with legs flat.
B. Sitting upright, leaning forward.
C. Right-side lying.
D. Knee-chest position.
Rationale: Sitting upright and leaning forward helps to relieve pressure on the inflamed
pancreas from the abdominal organs, especially the stomach.
12. The nurse is teaching a client about warfarin therapy. Which statement by the client
indicates understanding?
A. "I will stop taking the medication if I see any bruising."
