2026 ATI RN Adult Medical-Surgical
Practice Exam Questions with Answers
and Detailed Rationales
Question 1
A nurse is caring for a client who has acute decompensated
heart failure and develops severe dyspnea, pink frothy
sputum, and diffuse crackles. Which intervention should the
nurse implement first?
A. Administer IV furosemide
B. Place the client in high-Fowler's position
C. Restrict the client's oral fluid intake
D. Obtain a daily body weight
Rationale: The client's findings indicate acute pulmonary
edema, which is a life-threatening complication of left-sided
heart failure. Placing the client in high-Fowler's position
immediately improves lung expansion and reduces venous
return to the heart, helping decrease pulmonary congestion.
IV diuretics are also important but should follow immediate
positioning and stabilization measures.
Question 2
,A client with a history of chronic kidney disease has a
potassium level of 6.8 mEq/L and peaked T waves on the ECG.
Which prescription should the nurse implement first?
A. Administer sodium polystyrene sulfonate
B. Restrict dietary potassium
C. Administer IV calcium gluconate
D. Administer oral furosemide
Rationale: Severe hyperkalemia with ECG changes places the
client at immediate risk for lethal dysrhythmias. IV calcium
gluconate stabilizes the cardiac membrane and reduces the
risk of ventricular arrhythmias. It does not lower serum
potassium, so additional therapies are required, but cardiac
stabilization is the priority.
Question 3
A nurse is assessing a client who has a suspected pulmonary
embolism. Which finding requires the nurse to intervene
immediately?
A. Respiratory rate of 24/min
B. Pleuritic chest pain
C. Oxygen saturation of 91%
D. Sudden onset of severe dyspnea and hypotension
Rationale: Sudden severe dyspnea accompanied by
hypotension suggests a massive pulmonary embolism causing
significant obstruction of pulmonary blood flow and
cardiovascular collapse. This is an immediate life-threatening
emergency requiring rapid oxygenation, hemodynamic
,support, and anticoagulation or reperfusion therapy as
indicated.
Question 4
A client with diabetic ketoacidosis is receiving IV regular
insulin. Which laboratory finding best indicates that
treatment is effective?
A. Serum glucose decreases from 600 to 250 mg/dL
B. Urine ketones become negative
C. Serum bicarbonate increases from 10 to 18 mEq/L
D. Serum potassium decreases from 5.8 to 4.0 mEq/L
Rationale: DKA is characterized by metabolic acidosis caused
by ketone accumulation. Resolution of DKA is demonstrated
by correction of the metabolic acidosis, reflected by
increasing serum bicarbonate and closure of the anion gap.
Glucose improvement alone does not confirm resolution
because ketoacidosis may persist after glucose normalizes.
Question 5
A nurse is caring for a client who has SIADH. Which laboratory
finding should the nurse anticipate?
A. Serum sodium 152 mEq/L
B. Serum osmolality 310 mOsm/kg
C. Serum sodium 118 mEq/L
D. Urine specific gravity 1.001
, Rationale: SIADH causes excessive secretion of antidiuretic
hormone, resulting in water retention, dilutional
hyponatremia, low serum osmolality, and concentrated urine.
A sodium level of 118 mEq/L represents severe hyponatremia
and places the client at risk for neurologic complications,
including seizures.
Question 6
A client receiving a continuous heparin infusion has a platelet
count that decreases from 220,000/mm³ to 92,000/mm³.
Which action should the nurse take?
A. Increase the heparin infusion rate
B. Administer vitamin K
C. Stop the heparin infusion and notify the provider
D. Administer aspirin
Rationale: A significant platelet decline during heparin
therapy suggests heparin-induced thrombocytopenia (HIT),
particularly when the decrease exceeds 50% from baseline.
Heparin must be discontinued, and an alternative non-
heparin anticoagulant is generally initiated. HIT is strongly
associated with thrombosis despite thrombocytopenia.
Question 7
A client with cirrhosis is receiving lactulose for hepatic
encephalopathy. Which finding indicates that the medication
is producing the desired therapeutic effect?
Practice Exam Questions with Answers
and Detailed Rationales
Question 1
A nurse is caring for a client who has acute decompensated
heart failure and develops severe dyspnea, pink frothy
sputum, and diffuse crackles. Which intervention should the
nurse implement first?
A. Administer IV furosemide
B. Place the client in high-Fowler's position
C. Restrict the client's oral fluid intake
D. Obtain a daily body weight
Rationale: The client's findings indicate acute pulmonary
edema, which is a life-threatening complication of left-sided
heart failure. Placing the client in high-Fowler's position
immediately improves lung expansion and reduces venous
return to the heart, helping decrease pulmonary congestion.
IV diuretics are also important but should follow immediate
positioning and stabilization measures.
Question 2
,A client with a history of chronic kidney disease has a
potassium level of 6.8 mEq/L and peaked T waves on the ECG.
Which prescription should the nurse implement first?
A. Administer sodium polystyrene sulfonate
B. Restrict dietary potassium
C. Administer IV calcium gluconate
D. Administer oral furosemide
Rationale: Severe hyperkalemia with ECG changes places the
client at immediate risk for lethal dysrhythmias. IV calcium
gluconate stabilizes the cardiac membrane and reduces the
risk of ventricular arrhythmias. It does not lower serum
potassium, so additional therapies are required, but cardiac
stabilization is the priority.
Question 3
A nurse is assessing a client who has a suspected pulmonary
embolism. Which finding requires the nurse to intervene
immediately?
A. Respiratory rate of 24/min
B. Pleuritic chest pain
C. Oxygen saturation of 91%
D. Sudden onset of severe dyspnea and hypotension
Rationale: Sudden severe dyspnea accompanied by
hypotension suggests a massive pulmonary embolism causing
significant obstruction of pulmonary blood flow and
cardiovascular collapse. This is an immediate life-threatening
emergency requiring rapid oxygenation, hemodynamic
,support, and anticoagulation or reperfusion therapy as
indicated.
Question 4
A client with diabetic ketoacidosis is receiving IV regular
insulin. Which laboratory finding best indicates that
treatment is effective?
A. Serum glucose decreases from 600 to 250 mg/dL
B. Urine ketones become negative
C. Serum bicarbonate increases from 10 to 18 mEq/L
D. Serum potassium decreases from 5.8 to 4.0 mEq/L
Rationale: DKA is characterized by metabolic acidosis caused
by ketone accumulation. Resolution of DKA is demonstrated
by correction of the metabolic acidosis, reflected by
increasing serum bicarbonate and closure of the anion gap.
Glucose improvement alone does not confirm resolution
because ketoacidosis may persist after glucose normalizes.
Question 5
A nurse is caring for a client who has SIADH. Which laboratory
finding should the nurse anticipate?
A. Serum sodium 152 mEq/L
B. Serum osmolality 310 mOsm/kg
C. Serum sodium 118 mEq/L
D. Urine specific gravity 1.001
, Rationale: SIADH causes excessive secretion of antidiuretic
hormone, resulting in water retention, dilutional
hyponatremia, low serum osmolality, and concentrated urine.
A sodium level of 118 mEq/L represents severe hyponatremia
and places the client at risk for neurologic complications,
including seizures.
Question 6
A client receiving a continuous heparin infusion has a platelet
count that decreases from 220,000/mm³ to 92,000/mm³.
Which action should the nurse take?
A. Increase the heparin infusion rate
B. Administer vitamin K
C. Stop the heparin infusion and notify the provider
D. Administer aspirin
Rationale: A significant platelet decline during heparin
therapy suggests heparin-induced thrombocytopenia (HIT),
particularly when the decrease exceeds 50% from baseline.
Heparin must be discontinued, and an alternative non-
heparin anticoagulant is generally initiated. HIT is strongly
associated with thrombosis despite thrombocytopenia.
Question 7
A client with cirrhosis is receiving lactulose for hepatic
encephalopathy. Which finding indicates that the medication
is producing the desired therapeutic effect?
