ATI
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
, ATI MED-SURG MIDTERM REVIEW GUIDE COMPREHENSIVE PREDICTOR-STYLE
PRACTICE EXAM — 2026 EDITION
1. Cardiovascular
Q1. A client with heart failure has new-onset crackles in both lung bases, weight
gain of 3 lb in 2 days, and dyspnea on exertion. Which finding requires the most
immediate intervention?
A. Weight gain of 3 lb in 2 days
B. Bibasilar crackles
C. Oxygen saturation of 88% on room air
D. Dyspnea on exertion
Answer: C. Oxygen saturation of 88% on room air
Rationale: Airway/breathing/oxygenation always takes priority using the ABC
framework. An SpO₂ of 88% indicates inadequate gas exchange and requires
immediate action. The weight gain and crackles support fluid overload, while
dyspnea on exertion is not as immediately life-threatening.
Q2. The nurse is teaching a client newly prescribed digoxin. Which statement
indicates a need for further teaching?
A. "I will take my pulse before each dose and hold it if below 60."
B. "I can take an antacid at the same time as my digoxin if my stomach is upset."
C. "I will report nausea, visual changes, or fatigue to my provider."
D. "I will have my potassium level checked periodically."
,Answer: B. "I can take an antacid at the same time as my digoxin if my stomach
is upset."
Rationale: Antacids can decrease digoxin absorption and should be separated
from digoxin administration. Monitoring pulse, reporting possible toxicity
symptoms, and monitoring potassium levels are appropriate.
Q3. A client post-MI is started on a beta-blocker. Which assessment finding
would cause the nurse to withhold the medication and notify the provider?
A. Heart rate 58 bpm, BP 110/70
B. Heart rate 52 bpm, BP 88/54
C. Heart rate 68 bpm, BP 124/78
D. Heart rate 74 bpm, BP 130/82
Answer: B. Heart rate 52 bpm, BP 88/54
Rationale: Significant bradycardia combined with hypotension indicates poor
tolerance of the beta-blocker and requires withholding the medication and
notifying the provider.
Q4. Which client is at greatest risk for developing a venous thromboembolism
(VTE)?
A. 24-year-old post-appendectomy, ambulating independently
B. 68-year-old on bedrest after hip replacement, not wearing SCDs
C. 45-year-old with a fractured wrist, discharged home
D. 30-year-old with a sprained ankle, using crutches
Answer: B. 68-year-old on bedrest after hip replacement, not wearing SCDs
, Rationale: Major orthopedic surgery, immobility, advanced age, and lack of
mechanical prophylaxis substantially increase VTE risk.
Q5. A client in cardiogenic shock is started on a dobutamine infusion. What is
the expected therapeutic effect?
A. Decreased heart rate and myocardial oxygen demand
B. Increased contractility and cardiac output
C. Peripheral vasoconstriction to raise blood pressure
D. Diuresis to reduce preload
Answer: B. Increased contractility and cardiac output
Rationale: Dobutamine is primarily a beta-1 agonist that increases myocardial
contractility and cardiac output, making it useful in cardiogenic shock.
2. Respiratory
Q6. A client with COPD has an ABG of pH 7.32, PaCO₂ 58, HCO₃ 30. How should
the nurse interpret this?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis, compensated
D. Respiratory alkalosis, uncompensated
Answer: B. Partially compensated respiratory acidosis
Rationale: The pH is low, PaCO₂ is elevated, and HCO₃ is elevated as renal
compensation. Because the pH remains abnormal, compensation is partial.
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
, ATI MED-SURG MIDTERM REVIEW GUIDE COMPREHENSIVE PREDICTOR-STYLE
PRACTICE EXAM — 2026 EDITION
1. Cardiovascular
Q1. A client with heart failure has new-onset crackles in both lung bases, weight
gain of 3 lb in 2 days, and dyspnea on exertion. Which finding requires the most
immediate intervention?
A. Weight gain of 3 lb in 2 days
B. Bibasilar crackles
C. Oxygen saturation of 88% on room air
D. Dyspnea on exertion
Answer: C. Oxygen saturation of 88% on room air
Rationale: Airway/breathing/oxygenation always takes priority using the ABC
framework. An SpO₂ of 88% indicates inadequate gas exchange and requires
immediate action. The weight gain and crackles support fluid overload, while
dyspnea on exertion is not as immediately life-threatening.
Q2. The nurse is teaching a client newly prescribed digoxin. Which statement
indicates a need for further teaching?
A. "I will take my pulse before each dose and hold it if below 60."
B. "I can take an antacid at the same time as my digoxin if my stomach is upset."
C. "I will report nausea, visual changes, or fatigue to my provider."
D. "I will have my potassium level checked periodically."
,Answer: B. "I can take an antacid at the same time as my digoxin if my stomach
is upset."
Rationale: Antacids can decrease digoxin absorption and should be separated
from digoxin administration. Monitoring pulse, reporting possible toxicity
symptoms, and monitoring potassium levels are appropriate.
Q3. A client post-MI is started on a beta-blocker. Which assessment finding
would cause the nurse to withhold the medication and notify the provider?
A. Heart rate 58 bpm, BP 110/70
B. Heart rate 52 bpm, BP 88/54
C. Heart rate 68 bpm, BP 124/78
D. Heart rate 74 bpm, BP 130/82
Answer: B. Heart rate 52 bpm, BP 88/54
Rationale: Significant bradycardia combined with hypotension indicates poor
tolerance of the beta-blocker and requires withholding the medication and
notifying the provider.
Q4. Which client is at greatest risk for developing a venous thromboembolism
(VTE)?
A. 24-year-old post-appendectomy, ambulating independently
B. 68-year-old on bedrest after hip replacement, not wearing SCDs
C. 45-year-old with a fractured wrist, discharged home
D. 30-year-old with a sprained ankle, using crutches
Answer: B. 68-year-old on bedrest after hip replacement, not wearing SCDs
, Rationale: Major orthopedic surgery, immobility, advanced age, and lack of
mechanical prophylaxis substantially increase VTE risk.
Q5. A client in cardiogenic shock is started on a dobutamine infusion. What is
the expected therapeutic effect?
A. Decreased heart rate and myocardial oxygen demand
B. Increased contractility and cardiac output
C. Peripheral vasoconstriction to raise blood pressure
D. Diuresis to reduce preload
Answer: B. Increased contractility and cardiac output
Rationale: Dobutamine is primarily a beta-1 agonist that increases myocardial
contractility and cardiac output, making it useful in cardiogenic shock.
2. Respiratory
Q6. A client with COPD has an ABG of pH 7.32, PaCO₂ 58, HCO₃ 30. How should
the nurse interpret this?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis, compensated
D. Respiratory alkalosis, uncompensated
Answer: B. Partially compensated respiratory acidosis
Rationale: The pH is low, PaCO₂ is elevated, and HCO₃ is elevated as renal
compensation. Because the pH remains abnormal, compensation is partial.
