ATI RN Med Surg Proctored / RN Med Surg 2026
Proctored RN Exam New Latest Version With All
Questions And Correct Answers With Rationale |
Medical-Surgical Nursing Assessment
Q001: A 58-year-old male with STEMI receives alteplase and is now 18 hours
post-completion. He develops sudden severe flank pain and a drop in hematocrit from
40 % to 28 %. BP 90/60, HR 110, RR 26. Which action is most critical?
Options:
A. Infuse 1 L 0.9 % saline over 30 minutes
B. Apply abdominal binder and keep NPO
C. Stop all anticoagulants, obtain stat abdominal CT, type & cross 4 units PRBCs
D. Administer morphine 2 mg IV and repeat CBC in 4 hours
(Correct Answer: C)
Q002: A 72-year-old female post-TURP for BPH has continuous bladder irrigation. Over 2
hours, output fluid turns bright red and increases from 50 mL to 250 mL/hr with clots.
Which nursing action is priority?
Options:
A. Increase irrigation rate to 250 mL/hr
B. Stop irrigation and notify provider immediately
C. Manually irrigate with 50 mL sterile saline using piston syringe
D. Milk tubing, check balloon traction, and prepare for possible cystoscopy
(Correct Answer: D)
Q003: A 34-year-old with cystic fibrosis on high-flow nasal cannula 50 L/min, FiO2 0.5,
has SpO2 89 %, RR 32, accessory muscle use, and PaCO2 55 mmHg. Which intervention
is most appropriate?
Options:
A. Increase FiO2 to 0.8
B. Initiate non-invasive bilevel ventilation
C. Switch to simple face mask at 10 L/min
D. Administer 2 L via nasal cannula to avoid CO2 retention
(Correct Answer: B)
,Q004: A 67-year-old with cirrhosis and esophageal varices receives octreotide 50
mcg/hr. After 6 hours, repeat EGD shows active bleeding. BP 80/50, HR 120. Which
collaborative order is anticipated next?
Options:
A. Increase octreotide to 100 mcg/hr
B. Prepare for emergent transjugular intrahepatic portosystemic shunt (TIPS)
C. Administer vitamin K 10 mg IV push
D. Start pantoprazole 80 mg IV bolus
(Correct Answer: B)
Q005: A 45-year-old with diabetic gastroparesis has a newly placed jejunal feeding tube.
After 4 hours at 40 mL/hr, the patient reports nausea and residual volume is 220 mL.
Which action is best?
Options:
A. Decrease rate to 20 mL/hr and continue
B. Stop feed, check tube position, and consider prokinetic agent
C. Switch to bolus feeding 250 mL q6h
D. Raise head of bed to 60° and resume previous rate
(Correct Answer: B)
Q006: A 29-year-old with sickle cell crisis on morphine PCA delivers 15 doses/hr,
respiratory rate 8/min, SpO2 94 %. Which immediate nursing action is essential?
Options:
A. Apply oxygen via non-rebreather
B. Stop PCA, administer naloxone 0.4 mg IV, and call provider
C. Decrease morphine basal rate by 50 %
D. Encourage incentive spirometry q30min
(Correct Answer: B)
Q007: A 55-year-old post right lower lobectomy has chest tube output 400 mL
serosanguinous fluid in 4 hours with oscillation absent and tidaling lost. Which
interpretation guides next action?
Options:
A. Normal postoperative finding; continue monitoring hourly
B. Possible re-accumulation of pneumothorax; assess for air leak and notify provider
C. Indicates clot obstruction; milk tubing aggressively
D. Sign of hemorrhage; prepare for OR
(Correct Answer: B)
, Q008: A 62-year-old on hemodialysis via left upper-arm AVF complains of numbness
and inability to flex fingers during dialysis. Which complication should the nurse suspect
first?
Options:
A. Steal syndrome
B. Infection at needle site
C. Hyperkalemia-induced paralysis
D. Disequilibrium syndrome
(Correct Answer: A)
Q009: A 50-year-old with acute severe ulcerative colitis on high-dose IV steroids
develops abdominal distension, fever 39 °C, and WBC 24 k. Which intervention is
priority?
Options:
A. Start infliximab infusion
B. Obtain abdominal X-ray and prepare for possible colectomy
C. Increase steroid dose to 2 mg/kg/day
D. Initiate probiotics per rectum
(Correct Answer: B)
Q010: A 38-year-old with myasthenia gravis on pyridostigmine 60 mg q6h presents with
sudden dysphagia, respiratory rate 28, and peak inspiratory pressure –20 cmH2O.
Which medication is contraindicated?
Options:
A. Prednisone 60 mg PO daily
B. Piperacillin-tazobactam 3.375 g IV q6h
C. Gentamicin 5 mg/kg IV daily
D. IVIG 1 g/kg × 2 days
(Correct Answer: C)
Q011: A 70-year-old with aortic stenosis (mean gradient 50 mmHg) is scheduled for
TAVR. Which pre-procedure lab value most increases mortality risk?
Options:
A. Hemoglobin 9.8 g/dL
B. Creatinine 2.3 mg/dL
C. INR 1.6
D. BNP 350 pg/mL
(Correct Answer: B)
Proctored RN Exam New Latest Version With All
Questions And Correct Answers With Rationale |
Medical-Surgical Nursing Assessment
Q001: A 58-year-old male with STEMI receives alteplase and is now 18 hours
post-completion. He develops sudden severe flank pain and a drop in hematocrit from
40 % to 28 %. BP 90/60, HR 110, RR 26. Which action is most critical?
Options:
A. Infuse 1 L 0.9 % saline over 30 minutes
B. Apply abdominal binder and keep NPO
C. Stop all anticoagulants, obtain stat abdominal CT, type & cross 4 units PRBCs
D. Administer morphine 2 mg IV and repeat CBC in 4 hours
(Correct Answer: C)
Q002: A 72-year-old female post-TURP for BPH has continuous bladder irrigation. Over 2
hours, output fluid turns bright red and increases from 50 mL to 250 mL/hr with clots.
Which nursing action is priority?
Options:
A. Increase irrigation rate to 250 mL/hr
B. Stop irrigation and notify provider immediately
C. Manually irrigate with 50 mL sterile saline using piston syringe
D. Milk tubing, check balloon traction, and prepare for possible cystoscopy
(Correct Answer: D)
Q003: A 34-year-old with cystic fibrosis on high-flow nasal cannula 50 L/min, FiO2 0.5,
has SpO2 89 %, RR 32, accessory muscle use, and PaCO2 55 mmHg. Which intervention
is most appropriate?
Options:
A. Increase FiO2 to 0.8
B. Initiate non-invasive bilevel ventilation
C. Switch to simple face mask at 10 L/min
D. Administer 2 L via nasal cannula to avoid CO2 retention
(Correct Answer: B)
,Q004: A 67-year-old with cirrhosis and esophageal varices receives octreotide 50
mcg/hr. After 6 hours, repeat EGD shows active bleeding. BP 80/50, HR 120. Which
collaborative order is anticipated next?
Options:
A. Increase octreotide to 100 mcg/hr
B. Prepare for emergent transjugular intrahepatic portosystemic shunt (TIPS)
C. Administer vitamin K 10 mg IV push
D. Start pantoprazole 80 mg IV bolus
(Correct Answer: B)
Q005: A 45-year-old with diabetic gastroparesis has a newly placed jejunal feeding tube.
After 4 hours at 40 mL/hr, the patient reports nausea and residual volume is 220 mL.
Which action is best?
Options:
A. Decrease rate to 20 mL/hr and continue
B. Stop feed, check tube position, and consider prokinetic agent
C. Switch to bolus feeding 250 mL q6h
D. Raise head of bed to 60° and resume previous rate
(Correct Answer: B)
Q006: A 29-year-old with sickle cell crisis on morphine PCA delivers 15 doses/hr,
respiratory rate 8/min, SpO2 94 %. Which immediate nursing action is essential?
Options:
A. Apply oxygen via non-rebreather
B. Stop PCA, administer naloxone 0.4 mg IV, and call provider
C. Decrease morphine basal rate by 50 %
D. Encourage incentive spirometry q30min
(Correct Answer: B)
Q007: A 55-year-old post right lower lobectomy has chest tube output 400 mL
serosanguinous fluid in 4 hours with oscillation absent and tidaling lost. Which
interpretation guides next action?
Options:
A. Normal postoperative finding; continue monitoring hourly
B. Possible re-accumulation of pneumothorax; assess for air leak and notify provider
C. Indicates clot obstruction; milk tubing aggressively
D. Sign of hemorrhage; prepare for OR
(Correct Answer: B)
, Q008: A 62-year-old on hemodialysis via left upper-arm AVF complains of numbness
and inability to flex fingers during dialysis. Which complication should the nurse suspect
first?
Options:
A. Steal syndrome
B. Infection at needle site
C. Hyperkalemia-induced paralysis
D. Disequilibrium syndrome
(Correct Answer: A)
Q009: A 50-year-old with acute severe ulcerative colitis on high-dose IV steroids
develops abdominal distension, fever 39 °C, and WBC 24 k. Which intervention is
priority?
Options:
A. Start infliximab infusion
B. Obtain abdominal X-ray and prepare for possible colectomy
C. Increase steroid dose to 2 mg/kg/day
D. Initiate probiotics per rectum
(Correct Answer: B)
Q010: A 38-year-old with myasthenia gravis on pyridostigmine 60 mg q6h presents with
sudden dysphagia, respiratory rate 28, and peak inspiratory pressure –20 cmH2O.
Which medication is contraindicated?
Options:
A. Prednisone 60 mg PO daily
B. Piperacillin-tazobactam 3.375 g IV q6h
C. Gentamicin 5 mg/kg IV daily
D. IVIG 1 g/kg × 2 days
(Correct Answer: C)
Q011: A 70-year-old with aortic stenosis (mean gradient 50 mmHg) is scheduled for
TAVR. Which pre-procedure lab value most increases mortality risk?
Options:
A. Hemoglobin 9.8 g/dL
B. Creatinine 2.3 mg/dL
C. INR 1.6
D. BNP 350 pg/mL
(Correct Answer: B)
