ATI
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
ATI Med-Surg Midterm Review Guide — 2026 Edition
, ATI MED-SURG MIDTERM REVIEW GUIDE
COMPREHENSIVE PREDICTOR-STYLE PRACTICE
EXAM - 2026 EDITION
1. Cardiovascular
1. Cardiovascular
2. 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
Rationale: * Antacids decrease digoxin absorption and should be separated by at least 2
hours. Holding the dose for bradycardia (<60 bpm), monitoring for toxicity symptoms (nausea,
halos/visual disturbances, fatigue), and monitoring potassium (hypokalemia potentiates digoxin
toxicity) are all correct self-care behaviors.
3. 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
ATI Med-Surg Midterm Review Guide — 2026 Edition
, D. Heart rate 74 bpm, BP 130/82
Answer: B
Rationale: * Beta-blockers are typically held for HR <50-60 bpm (per facility protocol) or
symptomatic hypotension (SBP <90-100). Option B shows both significant bradycardia and
hypotension, indicating the client cannot tolerate the medication at this time. Option A is
borderline but not clearly unsafe without additional symptoms.
4. 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
Rationale: * Virchow's triad (venous stasis, hypercoagulability, endothelial damage) is
maximized in this client: major orthopedic surgery, immobility, and absence of mechanical
prophylaxis (SCDs). Age and immobility are major VTE risk factors that outweigh the others
listed.
5. 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
ATI Med-Surg Midterm Review Guide — 2026 Edition
, Rationale: * Dobutamine is a beta-1 agonist that increases myocardial contractility (positive
inotrope) and cardiac output, the primary goal in cardiogenic shock. It causes mild vasodilation
(not vasoconstriction) and has no direct diuretic effect.
2. Respiratory
6. 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
Rationale: * pH is low (acidosis), PaCO2 is high (respiratory cause), and HCO3 is elevated
above normal (kidneys retaining bicarb to compensate) - but pH has not normalized, so
compensation is partial. This is the classic chronic COPD pattern.
7. The nurse auscultates fine crackles that do not clear with coughing in a client with
pneumonia. What does this finding most likely indicate?
A. Airway obstruction by secretions
B. Fluid or exudate in the alveoli
C. Bronchospasm
D. Pleural friction rub
Answer: B
Rationale: * Crackles that persist after coughing represent fluid/exudate within the alveoli
(consistent with pneumonia), not mobile secretions in larger airways (which would often clear
ATI Med-Surg Midterm Review Guide — 2026 Edition
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
ATI Med-Surg Midterm Review Guide — 2026 Edition
, ATI MED-SURG MIDTERM REVIEW GUIDE
COMPREHENSIVE PREDICTOR-STYLE PRACTICE
EXAM - 2026 EDITION
1. Cardiovascular
1. Cardiovascular
2. 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
Rationale: * Antacids decrease digoxin absorption and should be separated by at least 2
hours. Holding the dose for bradycardia (<60 bpm), monitoring for toxicity symptoms (nausea,
halos/visual disturbances, fatigue), and monitoring potassium (hypokalemia potentiates digoxin
toxicity) are all correct self-care behaviors.
3. 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
ATI Med-Surg Midterm Review Guide — 2026 Edition
, D. Heart rate 74 bpm, BP 130/82
Answer: B
Rationale: * Beta-blockers are typically held for HR <50-60 bpm (per facility protocol) or
symptomatic hypotension (SBP <90-100). Option B shows both significant bradycardia and
hypotension, indicating the client cannot tolerate the medication at this time. Option A is
borderline but not clearly unsafe without additional symptoms.
4. 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
Rationale: * Virchow's triad (venous stasis, hypercoagulability, endothelial damage) is
maximized in this client: major orthopedic surgery, immobility, and absence of mechanical
prophylaxis (SCDs). Age and immobility are major VTE risk factors that outweigh the others
listed.
5. 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
ATI Med-Surg Midterm Review Guide — 2026 Edition
, Rationale: * Dobutamine is a beta-1 agonist that increases myocardial contractility (positive
inotrope) and cardiac output, the primary goal in cardiogenic shock. It causes mild vasodilation
(not vasoconstriction) and has no direct diuretic effect.
2. Respiratory
6. 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
Rationale: * pH is low (acidosis), PaCO2 is high (respiratory cause), and HCO3 is elevated
above normal (kidneys retaining bicarb to compensate) - but pH has not normalized, so
compensation is partial. This is the classic chronic COPD pattern.
7. The nurse auscultates fine crackles that do not clear with coughing in a client with
pneumonia. What does this finding most likely indicate?
A. Airway obstruction by secretions
B. Fluid or exudate in the alveoli
C. Bronchospasm
D. Pleural friction rub
Answer: B
Rationale: * Crackles that persist after coughing represent fluid/exudate within the alveoli
(consistent with pneumonia), not mobile secretions in larger airways (which would often clear
ATI Med-Surg Midterm Review Guide — 2026 Edition
