ATI RN ADULT MEDICAL SURGICAL PROCTORED STUDY GUIDE
WITH QUESTIONS AND VERIFIED ANSWERS 2026/27
1. A client with diabetes mellitus presents with blood glucose of 48 mg/dL. The client is conscious
but confused and diaphoretic. What is the nurse's priority action?
A. Administer 15g of rapid-acting carbohydrate orally
B. Administer 1mg glucagon intramuscularly
C. Start an IV infusion of 50% dextrose
D. Monitor blood glucose every 15 minutes
Correct Answer: A
Explanation: For a conscious client with hypoglycemia, the 15-15 rule applies: give 15g rapid-
acting carbohydrate orally and recheck glucose in 15 minutes. Glucagon (B) is for unconscious
clients. IV dextrose (C) is reserved for severe cases when oral intake isn't possible. Monitoring
alone (D) delays treatment.
2. A postoperative client following abdominal surgery has a wound dehiscence with evisceration.
What is the nurse's first action?
A. Apply a sterile dry dressing to the wound
B. Cover the protruding organs with sterile saline-soaked gauze
C. Push the organs back into the abdominal cavity
D. Notify the surgeon immediately
Correct Answer: B
Explanation: Evisceration requires immediate coverage with sterile saline-soaked gauze to
prevent drying of organs. Pushing organs back (C) can cause severe damage. While notifying the
surgeon (D) is critical, protecting the organs comes first. A dry dressing (A) would cause organ
desiccation.
3. Which assessment finding in a client with chronic obstructive pulmonary disease (COPD)
requires immediate intervention?
A. Oxygen saturation of 91% on room air
B. Use of accessory muscles during respiration
C. PaCO2 of 55 mm Hg
D. Barrel chest appearance
Correct Answer: B
Explanation: Accessory muscle use indicates increased work of breathing and respiratory distress
requiring immediate intervention. COPD clients typically have baseline hypoxemia (A) and
hypercapnia (C). Barrel chest (D) is a chronic finding.
4. A client with heart failure is prescribed furosemide 40 mg daily. Which laboratory value should
the nurse monitor most closely?
, A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B
Explanation: Furosemide is a loop diuretic that causes significant potassium loss, leading to
hypokalemia. While sodium, calcium, and magnesium can also be affected, potassium is the
most critical due to risk of cardiac arrhythmias.
5. A client with a new tracheostomy tube is being discharged. Which instruction should the nurse
include in discharge teaching?
A. Change the tracheostomy ties using a square knot
B. Clean the stoma site with hydrogen peroxide daily
C. Use sterile technique when suctioning at home
D. Humidify the air to prevent secretion thickening
Correct Answer: D
Explanation: Humidification prevents secretion thickening and crusting. Tracheostomy ties
should use a bow knot (not square knot) for quick release. Normal saline, not hydrogen peroxide,
should clean the stoma. Clean technique is sufficient for home suctioning, not sterile.
6. Which finding indicates effective treatment for a client with diabetic ketoacidosis (DKA)?
A. Blood glucose decreased from 550 to 280 mg/dL
B. Serum pH increased from 7.1 to 7.32
C. Serum ketones are still positive
D. Potassium level decreased from 5.8 to 4.2 mEq/L
Correct Answer: B
Explanation: pH improvement toward normal (7.35-7.45) indicates resolution of acidosis, the
primary concern in DKA. While glucose reduction (A) is important, pH correction is the key
indicator of DKA resolution. Persistent ketones (C) indicate ongoing DKA. Potassium changes (D)
require monitoring but don't indicate DKA resolution.
7. A client with acute kidney injury has a potassium level of 6.2 mEq/L. Which medication should
the nurse anticipate administering?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Insulin and dextrose
D. Calcium gluconate
Correct Answer: C
Explanation: Insulin and dextrose rapidly shift potassium into cells, providing immediate
reduction in hyperkalemia. Calcium gluconate (D) protects the heart but doesn't lower
, potassium. Sodium polystyrene sulfonate (B) works slowly. Furosemide (A) may not be effective
in AKI.
8. Which assessment finding in a client with myocardial infarction requires immediate notification
of the healthcare provider?
A. ST-segment elevation on ECG
B. New onset ventricular tachycardia
C. troponin level of 4.5 ng/mL
D. Mild nausea and vomiting
Correct Answer: B
Explanation: New ventricular tachycardia indicates life-threatening arrhythmia requiring
immediate intervention. ST elevation (A) and elevated troponin (C) are expected with MI. Nausea
(D) is common but not immediately life-threatening.
9. A client with severe pneumonia has oxygen saturation of 86% on 2L nasal cannula. What is the
nurse's next action?
A. Increase oxygen to 4L nasal cannula
B. Place the client in high Fowler's position
C. Obtain arterial blood gases
D. Prepare for intubation
Correct Answer: A
Explanation: Increasing oxygen is the immediate priority to improve saturation. Positioning (B)
helps but doesn't address hypoxemia as directly. ABGs (C) provide information but don't treat.
Intubation (D) may be needed later but isn't the first step.
10. Which finding indicates a complication of total parenteral nutrition (TPN)?
A. Blood glucose of 140 mg/dL
B. Temperature of 38.9°C (102°F)
C. Weight gain of 1 kg in 24 hours
D. Serum triglycerides of 200 mg/dL
Correct Answer: B
Explanation: Fever indicates possible catheter-related bloodstream infection, a serious TPN
complication. Mild glucose elevation (A) is common with TPN. Small weight gain (C) may be fluid.
Triglycerides up to 400 mg/dL (D) are acceptable.
11. A client with cirrhosis has an ammonia level of 180 mcg/dL. Which medication should the nurse
administer?
A. Spironolactone
B. Lactulose
C. Propranolol
WITH QUESTIONS AND VERIFIED ANSWERS 2026/27
1. A client with diabetes mellitus presents with blood glucose of 48 mg/dL. The client is conscious
but confused and diaphoretic. What is the nurse's priority action?
A. Administer 15g of rapid-acting carbohydrate orally
B. Administer 1mg glucagon intramuscularly
C. Start an IV infusion of 50% dextrose
D. Monitor blood glucose every 15 minutes
Correct Answer: A
Explanation: For a conscious client with hypoglycemia, the 15-15 rule applies: give 15g rapid-
acting carbohydrate orally and recheck glucose in 15 minutes. Glucagon (B) is for unconscious
clients. IV dextrose (C) is reserved for severe cases when oral intake isn't possible. Monitoring
alone (D) delays treatment.
2. A postoperative client following abdominal surgery has a wound dehiscence with evisceration.
What is the nurse's first action?
A. Apply a sterile dry dressing to the wound
B. Cover the protruding organs with sterile saline-soaked gauze
C. Push the organs back into the abdominal cavity
D. Notify the surgeon immediately
Correct Answer: B
Explanation: Evisceration requires immediate coverage with sterile saline-soaked gauze to
prevent drying of organs. Pushing organs back (C) can cause severe damage. While notifying the
surgeon (D) is critical, protecting the organs comes first. A dry dressing (A) would cause organ
desiccation.
3. Which assessment finding in a client with chronic obstructive pulmonary disease (COPD)
requires immediate intervention?
A. Oxygen saturation of 91% on room air
B. Use of accessory muscles during respiration
C. PaCO2 of 55 mm Hg
D. Barrel chest appearance
Correct Answer: B
Explanation: Accessory muscle use indicates increased work of breathing and respiratory distress
requiring immediate intervention. COPD clients typically have baseline hypoxemia (A) and
hypercapnia (C). Barrel chest (D) is a chronic finding.
4. A client with heart failure is prescribed furosemide 40 mg daily. Which laboratory value should
the nurse monitor most closely?
, A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B
Explanation: Furosemide is a loop diuretic that causes significant potassium loss, leading to
hypokalemia. While sodium, calcium, and magnesium can also be affected, potassium is the
most critical due to risk of cardiac arrhythmias.
5. A client with a new tracheostomy tube is being discharged. Which instruction should the nurse
include in discharge teaching?
A. Change the tracheostomy ties using a square knot
B. Clean the stoma site with hydrogen peroxide daily
C. Use sterile technique when suctioning at home
D. Humidify the air to prevent secretion thickening
Correct Answer: D
Explanation: Humidification prevents secretion thickening and crusting. Tracheostomy ties
should use a bow knot (not square knot) for quick release. Normal saline, not hydrogen peroxide,
should clean the stoma. Clean technique is sufficient for home suctioning, not sterile.
6. Which finding indicates effective treatment for a client with diabetic ketoacidosis (DKA)?
A. Blood glucose decreased from 550 to 280 mg/dL
B. Serum pH increased from 7.1 to 7.32
C. Serum ketones are still positive
D. Potassium level decreased from 5.8 to 4.2 mEq/L
Correct Answer: B
Explanation: pH improvement toward normal (7.35-7.45) indicates resolution of acidosis, the
primary concern in DKA. While glucose reduction (A) is important, pH correction is the key
indicator of DKA resolution. Persistent ketones (C) indicate ongoing DKA. Potassium changes (D)
require monitoring but don't indicate DKA resolution.
7. A client with acute kidney injury has a potassium level of 6.2 mEq/L. Which medication should
the nurse anticipate administering?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Insulin and dextrose
D. Calcium gluconate
Correct Answer: C
Explanation: Insulin and dextrose rapidly shift potassium into cells, providing immediate
reduction in hyperkalemia. Calcium gluconate (D) protects the heart but doesn't lower
, potassium. Sodium polystyrene sulfonate (B) works slowly. Furosemide (A) may not be effective
in AKI.
8. Which assessment finding in a client with myocardial infarction requires immediate notification
of the healthcare provider?
A. ST-segment elevation on ECG
B. New onset ventricular tachycardia
C. troponin level of 4.5 ng/mL
D. Mild nausea and vomiting
Correct Answer: B
Explanation: New ventricular tachycardia indicates life-threatening arrhythmia requiring
immediate intervention. ST elevation (A) and elevated troponin (C) are expected with MI. Nausea
(D) is common but not immediately life-threatening.
9. A client with severe pneumonia has oxygen saturation of 86% on 2L nasal cannula. What is the
nurse's next action?
A. Increase oxygen to 4L nasal cannula
B. Place the client in high Fowler's position
C. Obtain arterial blood gases
D. Prepare for intubation
Correct Answer: A
Explanation: Increasing oxygen is the immediate priority to improve saturation. Positioning (B)
helps but doesn't address hypoxemia as directly. ABGs (C) provide information but don't treat.
Intubation (D) may be needed later but isn't the first step.
10. Which finding indicates a complication of total parenteral nutrition (TPN)?
A. Blood glucose of 140 mg/dL
B. Temperature of 38.9°C (102°F)
C. Weight gain of 1 kg in 24 hours
D. Serum triglycerides of 200 mg/dL
Correct Answer: B
Explanation: Fever indicates possible catheter-related bloodstream infection, a serious TPN
complication. Mild glucose elevation (A) is common with TPN. Small weight gain (C) may be fluid.
Triglycerides up to 400 mg/dL (D) are acceptable.
11. A client with cirrhosis has an ammonia level of 180 mcg/dL. Which medication should the nurse
administer?
A. Spironolactone
B. Lactulose
C. Propranolol
