ATI MED-SURG PROCTORED EXAM TEST
BANK 2026 - 2027 MEDICAL-SURGICAL
NURSING, NCLEX PREP QUESTIONS AND
ANSWERS WITH VERIFIED RATIONALES
GRADED A+
This premium study resource features 200 high-yield medical-surgical
multiple-choice questions meticulously designed to mirror the actual
2026 ATI Proctored Exam and NCLEX-RN blueprint. Every question
includes clear answers and in-depth, verified rationales to bridge
critical knowledge gaps and elevate your clinical judgment. Perfect
for active revision, this high-utility test bank ensures you master core
concepts, recognize emergency prioritization frameworks, and secure
a top-tier score.
Question 1
A nurse is caring for a client who is 4 hours postoperative following a
subtotal thyroidectomy. The nurse notes that the client is experiencing
muscle spasms and tingling around the mouth. Which of the following
medications should the nurse prepare to administer?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: B. Calcium gluconate
Rationale: Hypocalcemia is a potential complication of thyroid
surgery due to accidental removal or injury to the parathyroid glands.
Symptoms include circumoral paresthesia, muscle spasms, and
,positive Trousseau's or Chvostek's signs. Calcium gluconate is
administered intravenously to correct acute hypocalcemia.
Question 2
A nurse is reviewing the arterial blood gas (ABG) results of a client with
severe chronic obstructive pulmonary disease (COPD). The results are: pH
7.31, PaCO2 52 mmHg, HCO3- 28 mEq/L, and PaO2 65 mmHg. Which of
the following acid-base imbalances is the client experiencing?
A. Uncompensated metabolic acidosis
B. Partially compensated respiratory alkalosis
C. Partially compensated respiratory acidosis
D. Fully compensated metabolic alkalosis
Answer: C. Partially compensated respiratory acidosis
Rationale: A pH below 7.35 indicates acidosis. The PaCO2 is elevated
above 45 mmHg, pointing to a respiratory cause. The HCO3- is
elevated above 26 mEq/L, indicating that the kidneys are retaining
bicarbonate to compensate for the respiratory acidosis. Because the
pH has not yet returned to the normal range, the compensation is
partial.
Question 3
A nurse is assessing a client who has been taking high-dose prednisone for
the treatment of rheumatoid arthritis. Which of the following findings should
the nurse identify as an adverse effect of this medication?
A. Hypoglycemia
B. Fluid volume deficit
C. Osteoporosis
D. Hypotension
Answer: C. Osteoporosis
Rationale: Long-term or high-dose corticosteroid therapy suppresses
bone formation, accelerates bone resorption, and reduces intestinal
,absorption of calcium, leading to osteoporosis. Other common side
effects include hyperglycemia, fluid retention, weight gain,
hypertension, and increased susceptibility to infection.
Question 4
A nurse is planning care for a client who is scheduled for an
electrocardiogram (ECG) and has a prescription for a continuous
intravenous heparin infusion. Which of the following laboratory values must
the nurse monitor to adjust the heparin dosage?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Answer: C. Activated partial thromboplastin time (aPTT)
Rationale: The aPTT test evaluates the intrinsic pathway of
coagulation and is used specifically to monitor and titrate
unfractionated heparin therapy. PT and INR are utilized to monitor oral
anticoagulant therapy, such as warfarin. While platelets should be
checked to monitor for heparin-induced thrombocytopenia (HIT),
aPTT dictates the dosage adjustments.
Question 5
A nurse is assessing a client who has a history of left-sided heart failure.
Which of the following clinical manifestations should the nurse expect to
observe?
A. Jugular venous distention
B. Dependent pitting edema
C. Hepatomegaly
D. Dyspnea and wheezing
Answer: D. Dyspnea and wheezing
Rationale: Left-sided heart failure causes blood to back up into the
, pulmonary circulation, resulting in pulmonary congestion. Clinical
manifestations include dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, crackles, and wheezing. Jugular venous distention,
dependent edema, and hepatomegaly are signs of right-sided heart
failure.
Question 6
A nurse in the emergency department is caring for a client who reports
severe, crushing chest pain radiating to the left jaw. The nurse should
immediately perform which of the following actions first?
A. Obtain a 12-lead electrocardiogram (ECG)
B. Administer a high-calorie fluid snack
C. Insert an indwelling urinary catheter
D. Auscultate bowel sounds in all quadrants
Answer: A. Obtain a 12-lead electrocardiogram (ECG)
Rationale: The client's symptoms are highly suggestive of an acute
myocardial infarction (MI). Obtaining a 12-lead ECG is the priority
diagnostic action to confirm myocardial ischemia, injury, or infarction,
enabling prompt initiation of reperfusion therapy.
Question 7
A nurse is reinforcing discharge teaching with a client who has been
diagnosed with stable angina and is prescribed sublingual nitroglycerin
tablets. Which of the following instructions should the nurse include?
A. Swallow the tablet with a full glass of water.
B. Take one tablet every 5 minutes up to a maximum of 3 doses if chest
pain occurs.
C. Store the medication in a clear plastic container on a window sill.
D. Discard the medication if it produces a burning sensation under the
tongue.
BANK 2026 - 2027 MEDICAL-SURGICAL
NURSING, NCLEX PREP QUESTIONS AND
ANSWERS WITH VERIFIED RATIONALES
GRADED A+
This premium study resource features 200 high-yield medical-surgical
multiple-choice questions meticulously designed to mirror the actual
2026 ATI Proctored Exam and NCLEX-RN blueprint. Every question
includes clear answers and in-depth, verified rationales to bridge
critical knowledge gaps and elevate your clinical judgment. Perfect
for active revision, this high-utility test bank ensures you master core
concepts, recognize emergency prioritization frameworks, and secure
a top-tier score.
Question 1
A nurse is caring for a client who is 4 hours postoperative following a
subtotal thyroidectomy. The nurse notes that the client is experiencing
muscle spasms and tingling around the mouth. Which of the following
medications should the nurse prepare to administer?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: B. Calcium gluconate
Rationale: Hypocalcemia is a potential complication of thyroid
surgery due to accidental removal or injury to the parathyroid glands.
Symptoms include circumoral paresthesia, muscle spasms, and
,positive Trousseau's or Chvostek's signs. Calcium gluconate is
administered intravenously to correct acute hypocalcemia.
Question 2
A nurse is reviewing the arterial blood gas (ABG) results of a client with
severe chronic obstructive pulmonary disease (COPD). The results are: pH
7.31, PaCO2 52 mmHg, HCO3- 28 mEq/L, and PaO2 65 mmHg. Which of
the following acid-base imbalances is the client experiencing?
A. Uncompensated metabolic acidosis
B. Partially compensated respiratory alkalosis
C. Partially compensated respiratory acidosis
D. Fully compensated metabolic alkalosis
Answer: C. Partially compensated respiratory acidosis
Rationale: A pH below 7.35 indicates acidosis. The PaCO2 is elevated
above 45 mmHg, pointing to a respiratory cause. The HCO3- is
elevated above 26 mEq/L, indicating that the kidneys are retaining
bicarbonate to compensate for the respiratory acidosis. Because the
pH has not yet returned to the normal range, the compensation is
partial.
Question 3
A nurse is assessing a client who has been taking high-dose prednisone for
the treatment of rheumatoid arthritis. Which of the following findings should
the nurse identify as an adverse effect of this medication?
A. Hypoglycemia
B. Fluid volume deficit
C. Osteoporosis
D. Hypotension
Answer: C. Osteoporosis
Rationale: Long-term or high-dose corticosteroid therapy suppresses
bone formation, accelerates bone resorption, and reduces intestinal
,absorption of calcium, leading to osteoporosis. Other common side
effects include hyperglycemia, fluid retention, weight gain,
hypertension, and increased susceptibility to infection.
Question 4
A nurse is planning care for a client who is scheduled for an
electrocardiogram (ECG) and has a prescription for a continuous
intravenous heparin infusion. Which of the following laboratory values must
the nurse monitor to adjust the heparin dosage?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Answer: C. Activated partial thromboplastin time (aPTT)
Rationale: The aPTT test evaluates the intrinsic pathway of
coagulation and is used specifically to monitor and titrate
unfractionated heparin therapy. PT and INR are utilized to monitor oral
anticoagulant therapy, such as warfarin. While platelets should be
checked to monitor for heparin-induced thrombocytopenia (HIT),
aPTT dictates the dosage adjustments.
Question 5
A nurse is assessing a client who has a history of left-sided heart failure.
Which of the following clinical manifestations should the nurse expect to
observe?
A. Jugular venous distention
B. Dependent pitting edema
C. Hepatomegaly
D. Dyspnea and wheezing
Answer: D. Dyspnea and wheezing
Rationale: Left-sided heart failure causes blood to back up into the
, pulmonary circulation, resulting in pulmonary congestion. Clinical
manifestations include dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, crackles, and wheezing. Jugular venous distention,
dependent edema, and hepatomegaly are signs of right-sided heart
failure.
Question 6
A nurse in the emergency department is caring for a client who reports
severe, crushing chest pain radiating to the left jaw. The nurse should
immediately perform which of the following actions first?
A. Obtain a 12-lead electrocardiogram (ECG)
B. Administer a high-calorie fluid snack
C. Insert an indwelling urinary catheter
D. Auscultate bowel sounds in all quadrants
Answer: A. Obtain a 12-lead electrocardiogram (ECG)
Rationale: The client's symptoms are highly suggestive of an acute
myocardial infarction (MI). Obtaining a 12-lead ECG is the priority
diagnostic action to confirm myocardial ischemia, injury, or infarction,
enabling prompt initiation of reperfusion therapy.
Question 7
A nurse is reinforcing discharge teaching with a client who has been
diagnosed with stable angina and is prescribed sublingual nitroglycerin
tablets. Which of the following instructions should the nurse include?
A. Swallow the tablet with a full glass of water.
B. Take one tablet every 5 minutes up to a maximum of 3 doses if chest
pain occurs.
C. Store the medication in a clear plastic container on a window sill.
D. Discard the medication if it produces a burning sensation under the
tongue.
