ATI MED-SURG PROCTORED EXAM 2026
Form B | Medical-Surgical Nursing Practice
Academic Year 2026/2027
75 Questions | Graded A+ | 100% Verified
Instructions:
1. This examination consists of 75 multiple-choice questions covering 10 med-surg domains.
2. Each question has four options (A, B, C, D). Select the BEST answer for each question.
3. Correct answers appear in bold cyan with clinical rationales referencing ATI/NCSBN test plans.
4. Apply clinical judgment frameworks: ABCs, Maslow's Hierarchy, and Nursing Process.
5. Total time: 120 minutes. Passing score: 75% (56/75 correct).
Score Summary
Domain Q# Pts Total
I. Clinical Judgment & Nursing Process 1-8 1 8
II. Respiratory & Cardiac Disorders 9-16 1 8
III. GI & Endocrine Management 17-24 1 8
IV. Neurological & Musculoskeletal Care 25-32 1 8
V. Renal & Genitourinary Conditions 33-40 1 8
VI. Perioperative & Wound Care 41-48 1 8
VII. Pharmacology & IV Therapy 49-56 1 8
VIII. Infection Control & Safety 57-64 1 8
IX. Patient Education & Discharge 65-70 1 6
X. NCLEX-RN Prioritization Strategies 71-75 1 5
TOTAL 75 - 75
1
,SECTION I: CLINICAL JUDGMENT & NURSING PROCESS
1. A nurse is caring for a patient admitted with dehydration. Which assessment finding requires IMMEDIATE
nursing intervention?
A. Dry mucous membranes and decreased skin turgor B. Blood pressure of 86/54 mmHg with heart rate
of 118 bpm
C. Urine output of 800 mL in the past 8 hours D. Patient reports feeling mildly thirsty
Rationale: A blood pressure of 86/54 mmHg with tachycardia indicates hypovolemic shock, requiring immediate
intervention to restore intravascular volume. While dry mucous membranes, decreased skin turgor, and thirst are
expected findings in dehydration, hypotension with compensatory tachycardia signals progression to a life-threatening
state requiring rapid fluid resuscitation and continuous hemodynamic monitoring.
2. A nurse is using the nursing process to care for a patient with chronic obstructive pulmonary disease (COPD).
Which step of the nursing process involves establishing patient-centered, measurable goals?
A. Assessment B. Diagnosis
C. Planning D. Evaluation
Rationale: The planning phase of the nursing process involves establishing patient-centered, measurable, and time-bound
goals/outcomes and selecting appropriate nursing interventions. Assessment involves data collection, diagnosis involves
clinical judgment about patient responses, and evaluation involves comparing patient responses to established goals to
determine effectiveness.
3. A patient with type 2 diabetes mellitus has a blood glucose level of 48 mg/dL. Which nursing action should
the nurse take FIRST?
A. Administer the scheduled dose of insulin as B. Provide 15-20 grams of fast-acting
prescribed carbohydrate and recheck glucose in 15 minutes
C. Document the finding and continue routine D. Notify the healthcare provider before taking any
monitoring action
Rationale: Hypoglycemia (blood glucose below 70 mg/dL) requires immediate treatment with 15-20 grams of fast-acting
carbohydrates (e.g., 4 oz juice, glucose tablets). The 'Rule of 15' recommends rechecking glucose after 15 minutes and
repeating treatment if still below 70 mg/dL. Administering insulin would worsen hypoglycemia, and delaying treatment to
notify the provider could result in seizure or loss of consciousness.
4. Which statement by a nurse demonstrates the use of clinical judgment rather than critical thinking alone?
A. The nurse follows the facility protocol for fall B. The nurse identifies a subtle change in the
prevention patient's neurological status and anticipates the
need for emergency intervention
C. The nurse administers the prescribed medication at D. The nurse accurately documents the patient's vital
the scheduled time signs in the electronic health record
Rationale: Clinical judgment extends beyond critical thinking by integrating knowledge, experience, and contextual
understanding to make decisions about patient care. Identifying a subtle neurological change and anticipating the need
for intervention demonstrates the synthesis of assessment data, pattern recognition, and anticipatory decision-making that
characterizes clinical judgment.
2
, 5. A nurse receives report on four patients. Which patient should the nurse assess FIRST using the ABC
(Airway-Breathing-Circulation) priority framework?
A. A patient scheduled for surgery in 2 hours B. A patient with a new tracheostomy who is
requiring pre-operative teaching experiencing blood-tinged secretions and
increased respiratory effort
C. A patient requesting pain medication for chronic D. A patient with a wound dressing that needs to be
arthritis changed
Rationale: Using the ABC priority framework, airway and breathing take highest precedence. A patient with a new
tracheostomy experiencing blood-tinged secretions and increased respiratory effort may have airway obstruction,
hemorrhage, or dislodgment—any of which can rapidly become life-threatening. The nurse must assess this patient first to
ensure airway patency and adequate oxygenation.
6. A nurse is developing a nursing diagnosis for a patient with heart failure who reports difficulty breathing
when lying flat. Which nursing diagnosis is MOST appropriate?
A. Impaired Gas Exchange related to alveolar- B. Decreased Cardiac Output related to altered
capillary membrane changes myocardial contractility
C. Activity Intolerance related to imbalance between D. Ineffective Breathing Pattern related to
oxygen supply and demand pulmonary congestion and orthopnea
Rationale: The patient's report of difficulty breathing when lying flat (orthopnea) is caused by pulmonary congestion due
to heart failure. Ineffective Breathing Pattern directly addresses the altered respiratory pattern associated with
orthopnea. While Impaired Gas Exchange and Decreased Cardiac Output are also applicable to heart failure, the specific
symptom described—positional dyspnea—best aligns with Ineffective Breathing Pattern.
7. A nurse is evaluating the effectiveness of a patient's pain management plan. The patient reports pain as '3 out
of 10' after receiving morphine 4 mg IV 30 minutes ago. The pre-intervention pain level was '8 out of 10.' Which
conclusion is MOST appropriate?
A. The intervention was ineffective because the B. The intervention was partially effective; pain
patient still reports pain decreased by 5 points, but further intervention
may be warranted
C. The intervention was completely effective since D. The patient's pain report is unreliable and should
pain is now mild be reassessed
Rationale: A reduction in pain from 8/10 to 3/10 represents a clinically significant decrease, indicating the intervention
was partially effective. However, the pain goal may not yet be achieved if the target was complete pain relief or a specific
score. The nurse should discuss the remaining pain with the patient and consider adjunct interventions (repositioning,
non-pharmacological measures, or additional analgesics).
8. A nurse is applying Maslow's Hierarchy of Needs to prioritize care for multiple patients. Which need takes the
HIGHEST priority according to this framework?
A. Self-esteem and achievement B. Love and belonging
C. Physiological needs and safety D. Self-actualization
Rationale: Maslow's Hierarchy of Needs prioritizes physiological needs (oxygen, nutrition, elimination) and safety above
psychosocial needs. In nursing practice, life-threatening physiological and safety concerns must be addressed before
psychological needs such as belonging, self-esteem, and self-actualization. This framework guides nursing triage and
prioritization decisions.
SECTION II: RESPIRATORY & CARDIAC DISORDERS
3
Form B | Medical-Surgical Nursing Practice
Academic Year 2026/2027
75 Questions | Graded A+ | 100% Verified
Instructions:
1. This examination consists of 75 multiple-choice questions covering 10 med-surg domains.
2. Each question has four options (A, B, C, D). Select the BEST answer for each question.
3. Correct answers appear in bold cyan with clinical rationales referencing ATI/NCSBN test plans.
4. Apply clinical judgment frameworks: ABCs, Maslow's Hierarchy, and Nursing Process.
5. Total time: 120 minutes. Passing score: 75% (56/75 correct).
Score Summary
Domain Q# Pts Total
I. Clinical Judgment & Nursing Process 1-8 1 8
II. Respiratory & Cardiac Disorders 9-16 1 8
III. GI & Endocrine Management 17-24 1 8
IV. Neurological & Musculoskeletal Care 25-32 1 8
V. Renal & Genitourinary Conditions 33-40 1 8
VI. Perioperative & Wound Care 41-48 1 8
VII. Pharmacology & IV Therapy 49-56 1 8
VIII. Infection Control & Safety 57-64 1 8
IX. Patient Education & Discharge 65-70 1 6
X. NCLEX-RN Prioritization Strategies 71-75 1 5
TOTAL 75 - 75
1
,SECTION I: CLINICAL JUDGMENT & NURSING PROCESS
1. A nurse is caring for a patient admitted with dehydration. Which assessment finding requires IMMEDIATE
nursing intervention?
A. Dry mucous membranes and decreased skin turgor B. Blood pressure of 86/54 mmHg with heart rate
of 118 bpm
C. Urine output of 800 mL in the past 8 hours D. Patient reports feeling mildly thirsty
Rationale: A blood pressure of 86/54 mmHg with tachycardia indicates hypovolemic shock, requiring immediate
intervention to restore intravascular volume. While dry mucous membranes, decreased skin turgor, and thirst are
expected findings in dehydration, hypotension with compensatory tachycardia signals progression to a life-threatening
state requiring rapid fluid resuscitation and continuous hemodynamic monitoring.
2. A nurse is using the nursing process to care for a patient with chronic obstructive pulmonary disease (COPD).
Which step of the nursing process involves establishing patient-centered, measurable goals?
A. Assessment B. Diagnosis
C. Planning D. Evaluation
Rationale: The planning phase of the nursing process involves establishing patient-centered, measurable, and time-bound
goals/outcomes and selecting appropriate nursing interventions. Assessment involves data collection, diagnosis involves
clinical judgment about patient responses, and evaluation involves comparing patient responses to established goals to
determine effectiveness.
3. A patient with type 2 diabetes mellitus has a blood glucose level of 48 mg/dL. Which nursing action should
the nurse take FIRST?
A. Administer the scheduled dose of insulin as B. Provide 15-20 grams of fast-acting
prescribed carbohydrate and recheck glucose in 15 minutes
C. Document the finding and continue routine D. Notify the healthcare provider before taking any
monitoring action
Rationale: Hypoglycemia (blood glucose below 70 mg/dL) requires immediate treatment with 15-20 grams of fast-acting
carbohydrates (e.g., 4 oz juice, glucose tablets). The 'Rule of 15' recommends rechecking glucose after 15 minutes and
repeating treatment if still below 70 mg/dL. Administering insulin would worsen hypoglycemia, and delaying treatment to
notify the provider could result in seizure or loss of consciousness.
4. Which statement by a nurse demonstrates the use of clinical judgment rather than critical thinking alone?
A. The nurse follows the facility protocol for fall B. The nurse identifies a subtle change in the
prevention patient's neurological status and anticipates the
need for emergency intervention
C. The nurse administers the prescribed medication at D. The nurse accurately documents the patient's vital
the scheduled time signs in the electronic health record
Rationale: Clinical judgment extends beyond critical thinking by integrating knowledge, experience, and contextual
understanding to make decisions about patient care. Identifying a subtle neurological change and anticipating the need
for intervention demonstrates the synthesis of assessment data, pattern recognition, and anticipatory decision-making that
characterizes clinical judgment.
2
, 5. A nurse receives report on four patients. Which patient should the nurse assess FIRST using the ABC
(Airway-Breathing-Circulation) priority framework?
A. A patient scheduled for surgery in 2 hours B. A patient with a new tracheostomy who is
requiring pre-operative teaching experiencing blood-tinged secretions and
increased respiratory effort
C. A patient requesting pain medication for chronic D. A patient with a wound dressing that needs to be
arthritis changed
Rationale: Using the ABC priority framework, airway and breathing take highest precedence. A patient with a new
tracheostomy experiencing blood-tinged secretions and increased respiratory effort may have airway obstruction,
hemorrhage, or dislodgment—any of which can rapidly become life-threatening. The nurse must assess this patient first to
ensure airway patency and adequate oxygenation.
6. A nurse is developing a nursing diagnosis for a patient with heart failure who reports difficulty breathing
when lying flat. Which nursing diagnosis is MOST appropriate?
A. Impaired Gas Exchange related to alveolar- B. Decreased Cardiac Output related to altered
capillary membrane changes myocardial contractility
C. Activity Intolerance related to imbalance between D. Ineffective Breathing Pattern related to
oxygen supply and demand pulmonary congestion and orthopnea
Rationale: The patient's report of difficulty breathing when lying flat (orthopnea) is caused by pulmonary congestion due
to heart failure. Ineffective Breathing Pattern directly addresses the altered respiratory pattern associated with
orthopnea. While Impaired Gas Exchange and Decreased Cardiac Output are also applicable to heart failure, the specific
symptom described—positional dyspnea—best aligns with Ineffective Breathing Pattern.
7. A nurse is evaluating the effectiveness of a patient's pain management plan. The patient reports pain as '3 out
of 10' after receiving morphine 4 mg IV 30 minutes ago. The pre-intervention pain level was '8 out of 10.' Which
conclusion is MOST appropriate?
A. The intervention was ineffective because the B. The intervention was partially effective; pain
patient still reports pain decreased by 5 points, but further intervention
may be warranted
C. The intervention was completely effective since D. The patient's pain report is unreliable and should
pain is now mild be reassessed
Rationale: A reduction in pain from 8/10 to 3/10 represents a clinically significant decrease, indicating the intervention
was partially effective. However, the pain goal may not yet be achieved if the target was complete pain relief or a specific
score. The nurse should discuss the remaining pain with the patient and consider adjunct interventions (repositioning,
non-pharmacological measures, or additional analgesics).
8. A nurse is applying Maslow's Hierarchy of Needs to prioritize care for multiple patients. Which need takes the
HIGHEST priority according to this framework?
A. Self-esteem and achievement B. Love and belonging
C. Physiological needs and safety D. Self-actualization
Rationale: Maslow's Hierarchy of Needs prioritizes physiological needs (oxygen, nutrition, elimination) and safety above
psychosocial needs. In nursing practice, life-threatening physiological and safety concerns must be addressed before
psychological needs such as belonging, self-esteem, and self-actualization. This framework guides nursing triage and
prioritization decisions.
SECTION II: RESPIRATORY & CARDIAC DISORDERS
3
