ATI RN ADULT MEDICAL SURGICAL
2026/2027 COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A nurse is caring for a client who is 24 hours postoperative following a thyroidectomy.
Which of the following findings is the priority to report to the provider?
A. Tingling in the fingers and toes
B. Hoarseness and a weak voice
C. Pain at the incision site rated 4 on a 1-10 scale
D. Serosanguinous drainage on the dressing
Answer: A
Conceptual Explanation: Tingling in the fingers and toes (paresthesia) is a sign of
hypocalcemia, which can occur if the parathyroid glands are accidentally damaged or
removed during a thyroidectomy. This is a medical emergency that can lead to tetany and
laryngospasm.
,2. A nurse is assessing a client who has a chest tube connected to a water-seal drainage
system. The nurse notes continuous bubbling in the water-seal chamber. Which of the
following actions should the nurse take?
A. Milk the tubing to clear a possible clot
B. Decrease the suction pressure
C. Document this as an expected finding
D. Check the system for an air leak
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system. Intermittent bubbling is expected with expiration or coughing, but
continuous bubbling requires investigation.
3. A nurse is providing teaching to a client who has chronic kidney disease and a new
prescription for epoetin alfa. Which of the following statements by the client indicates an
understanding of the teaching?
A. I will take this medication to help my body build up its store of white blood cells.
B. I will need to have my blood pressure monitored regularly while taking this medication.
C. I should expect my energy levels to increase within 24 hours of my first dose.
D. I will limit my intake of iron-rich foods while on this medication.
Answer: B
, Conceptual Explanation: Epoetin alfa can cause hypertension. It stimulates red blood cell
production, which increases blood viscosity. Clients should be monitored for increased
blood pressure and risk of cardiovascular events.
4. A nurse is reviewing the arterial blood gas (ABG) results for a client who has COPD: pH
7.32, PaCO2 58 mmHg, HCO3 30 mEq/L. The nurse should interpret these results as which of
the following?
A. Partially compensated respiratory acidosis
B. Fully compensated respiratory acidosis
C. Uncompensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Answer: A
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory origin),
and the HCO3 is high (compensatory mechanism attempting to buffer). Since the pH is not
within the normal range, it is partially compensated.
5. A nurse is caring for a client who has a serum potassium level of 6.8 mEq/L. Which of the
following medications should the nurse expect to administer first?
A. Regular insulin and 50% dextrose
B. Sodium polystyrene sulfonate
C. Furosemide
2026/2027 COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A nurse is caring for a client who is 24 hours postoperative following a thyroidectomy.
Which of the following findings is the priority to report to the provider?
A. Tingling in the fingers and toes
B. Hoarseness and a weak voice
C. Pain at the incision site rated 4 on a 1-10 scale
D. Serosanguinous drainage on the dressing
Answer: A
Conceptual Explanation: Tingling in the fingers and toes (paresthesia) is a sign of
hypocalcemia, which can occur if the parathyroid glands are accidentally damaged or
removed during a thyroidectomy. This is a medical emergency that can lead to tetany and
laryngospasm.
,2. A nurse is assessing a client who has a chest tube connected to a water-seal drainage
system. The nurse notes continuous bubbling in the water-seal chamber. Which of the
following actions should the nurse take?
A. Milk the tubing to clear a possible clot
B. Decrease the suction pressure
C. Document this as an expected finding
D. Check the system for an air leak
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system. Intermittent bubbling is expected with expiration or coughing, but
continuous bubbling requires investigation.
3. A nurse is providing teaching to a client who has chronic kidney disease and a new
prescription for epoetin alfa. Which of the following statements by the client indicates an
understanding of the teaching?
A. I will take this medication to help my body build up its store of white blood cells.
B. I will need to have my blood pressure monitored regularly while taking this medication.
C. I should expect my energy levels to increase within 24 hours of my first dose.
D. I will limit my intake of iron-rich foods while on this medication.
Answer: B
, Conceptual Explanation: Epoetin alfa can cause hypertension. It stimulates red blood cell
production, which increases blood viscosity. Clients should be monitored for increased
blood pressure and risk of cardiovascular events.
4. A nurse is reviewing the arterial blood gas (ABG) results for a client who has COPD: pH
7.32, PaCO2 58 mmHg, HCO3 30 mEq/L. The nurse should interpret these results as which of
the following?
A. Partially compensated respiratory acidosis
B. Fully compensated respiratory acidosis
C. Uncompensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Answer: A
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory origin),
and the HCO3 is high (compensatory mechanism attempting to buffer). Since the pH is not
within the normal range, it is partially compensated.
5. A nurse is caring for a client who has a serum potassium level of 6.8 mEq/L. Which of the
following medications should the nurse expect to administer first?
A. Regular insulin and 50% dextrose
B. Sodium polystyrene sulfonate
C. Furosemide
