ATI RN Medical-Surgical Retake FINAL Exam Prep –
Comprehensive Practice Assessment 2026/2027
EDITION WITH QUESTIONS AND VERIFIED ANSWERS
ALREADY GRADED A
Question 1
A 68-year-old male patient with a history of hypertension and type 2 diabetes is admitted to the
post-anesthesia care unit (PACU) following an open reduction and internal fixation (ORIF) of a
fractured right hip. His vital signs upon arrival are: heart rate 112 bpm, blood pressure 88/54
mmHg, respiratory rate 22/min, and SpO2 93% on 4L nasal cannula. The surgical incision is dry
and intact. Which assessment finding should the PACU nurse prioritize as the most immediate
indicator of a potentially life-threatening complication?
A. The patient's blood glucose level of 180 mg/dL, requiring a sliding-scale insulin dose
B. The patient's moderate incisional pain rated as 6/10, indicating a need for PRN analgesics
C. The patient's urinary output of 20 mL over the last hour, suggesting early hypovolemic shock
D. The patient's pedal pulses being weakly palpable bilaterally, consistent with baseline
peripheral vascular disease
ANSWER: C
Explanation: In the immediate post-operative period following major orthopedic surgery,
especially in an elderly patient with pre-existing diabetes and hypertension, the most critical
concern is hemorrhage (either internal or occult) leading to hypovolemic shock. A urinary
output of less than 30 mL/hr is a sensitive, early indicator of inadequate renal perfusion due to
a decreased circulating blood volume. The tachycardia and hypotension already present strongly
support this trajectory. While hyperglycemia (A) is concerning and can impair wound healing, it
is not an immediate life-threatening emergency in this context. Pain (B) is important but a low
priority compared to hemodynamic instability. Weakly palpable pulses (D) are a concern for
peripheral vascular disease but are not an emergent indicator of active hemorrhagic shock and
align with a common comorbidity.
Question 2
,The nurse is caring for a patient who just returned from the operating room after a left total
knee arthroplasty. The patient has a continuous passive motion (CPM) machine in place and a
patient-controlled analgesia (PCA) pump. Which action by the nurse is the highest priority
during the initial post-operative assessment?
A. Teaching the patient how to use the incentive spirometer and assessing lung sounds
B. Checking the CPM machine settings to ensure it is set to the prescribed range of motion
C. Assessing the surgical dressing for fresh, bright red bleeding and neurovascular status of the
foot
D. Evaluating the effectiveness of the PCA pump by asking the patient to rate their pain on a 0-
10 scale
ANSWER: A
Explanation: While all options are important aspects of post-operative care, the highest priority
immediately following surgery is to prevent pulmonary complications such as atelectasis or
pneumonia. General anesthesia, positioning, and post-operative pain reduce tidal volume and
functional residual capacity. Assessing lung sounds and reinforcing the use of an incentive
spirometer is the most critical action to prevent respiratory compromise, which poses the
greatest immediate threat to life compared to local joint complications or pain management.
Neurovascular assessments (C) are extremely high priority for the extremity itself, but airway
and breathing (the 'A' and 'B' of the ABCs) always take precedence.
Question 3
A patient is receiving a continuous infusion of normal saline at 150 mL/hr via a peripheral IV in
the left forearm. During the 0800 assessment, the nurse notes that the IV site is cool to the
touch, mildly edematous, and the infusion pump is beeping with an "occlusion" alarm. What is
the most appropriate immediate nursing action?
A. Palpate the site for a fluid thrill and flush the IV line with 3 mL of sterile saline
B. Discontinue the IV site and restart the line in the opposite arm
C. Elevate the arm on a pillow and apply a warm, moist compress to the site
D. Slow the infusion rate to 50 mL/hr and apply a transparent dressing
ANSWER: B
Explanation: The assessment findings—coolness, edema, and occlusion—are classic signs of IV
infiltration. The solution has escaped into the interstitial tissue, causing the alarm to sound
because the pressure is back-feeding. The most appropriate action is to discontinue the current
IV access to prevent further tissue damage from the crystalloid solution and to restart the IV in a
,different location (preferably the opposite arm) to ensure the patient continues to receive their
prescribed fluids. Flushing (A) is incorrect as it would exacerbate the infiltration by pushing
more fluid into the tissue. Warm compresses (C) are often used for phlebitis, not acute
infiltration. Slowing the rate (D) will not resolve the occlusion or prevent further tissue damage.
Question 4
The nurse is preparing to administer a blood transfusion of one unit of packed red blood cells
(PRBCs) to a patient with a hemoglobin level of 7.2 g/dL. The patient has a history of heart
failure. The patient's baseline vital signs are: HR 88, BP 142/78, RR 18, SpO2 96%. The nurse has
acquired the blood unit and completed the patient identification verification. Prior to initiating
the transfusion, which action by the nurse is most critical?
A. Administering furosemide (Lasix) 40 mg IV push as prescribed
B. Ensuring that baseline vital signs are documented in the electronic health record
C. Obtaining an informed consent for the transfusion from the patient
D. Priming the blood administration tubing with 0.9% normal saline
ANSWER: A
Explanation: This patient has a history of heart failure and is receiving a blood product. Blood
transfusions have a high volume and solute load that can precipitate fluid volume overload and
worsening heart failure. Administering a loop diuretic like furosemide, as prescribed, prior to or
during the transfusion is a critical intervention to mitigate this risk. While documenting baseline
vitals (B) is a standard nursing action, it is not the most critical specific intervention for this high-
risk patient. Informed consent (C) should ideally be obtained before the patient is brought to
the unit or at the very beginning of the shift, but the most acute action is preparing the
patient's cardiac system for the volume load. Priming with NS (D) is a standard step for blood
administration, but is a technical task, whereas the pharmacological preparation is a proactive,
medically necessary step for managing co-morbidities.
Question 5
A patient arrives in the emergency department with severe, tearing chest pain radiating to the
back. The blood pressure is significantly different between the right arm (190/100 mmHg) and
the left arm (110/70 mmHg). The nurse suspects an acute aortic dissection. What is the priority
nursing action?
, A. Administer a sublingual nitroglycerin tablet and prepare for thrombolytic therapy
B. Start two large-bore IV lines and prepare to administer IV beta-blockers (e.g., esmolol)
C. Position the patient flat, log-roll the patient, and prepare for a lumbar puncture
D. Apply a non-rebreather mask at 15 L/min and prepare for immediate intubation
ANSWER: B
Explanation: The immediate medical management of an acute aortic dissection focuses on
reducing the force of myocardial contraction (dP/dt) and lowering systolic blood pressure to
minimize the shearing force on the aortic wall. Beta-blockers, such as esmolol, are the first-line
agents to reduce heart rate and contractility. Starting large-bore IVs is essential to administer
these medications and to prepare for possible massive transfusion if the aorta ruptures.
Nitroglycerin and thrombolytics (A) are contraindicated; thrombolytics would be catastrophic in
a dissection. A lumbar puncture (C) is for suspected meningitis or subarachnoid hemorrhage,
not a dissection. While high-flow oxygen (D) is appropriate, intubation is not the immediate
priority unless the patient is in respiratory failure or so hemodynamically unstable that they are
obtunded.
Question 6
A 72-year-old female patient is admitted to the medical-surgical unit with acute exacerbation of
chronic obstructive pulmonary disease (COPD). She is receiving oxygen at 2 L/min via nasal
cannula. Her arterial blood gas (ABG) results are: pH 7.31, PaCO2 68 mmHg, HCO3- 32 mEq/L,
and PaO2 72 mmHg. Which interpretation of these ABG results is correct, and what is the most
appropriate nursing action?
A. Uncompensated metabolic acidosis; administer sodium bicarbonate as prescribed
B. Partially compensated respiratory acidosis; continue current oxygen therapy and monitor for
changes in mental status
C. Fully compensated metabolic alkalosis; prepare for mechanical ventilation
D. Uncompensated respiratory alkalosis; decrease oxygen flow rate to 1 L/min
ANSWER: B
Explanation: The ABG shows a low pH (7.31) indicating acidosis, elevated PaCO2 (68 mmHg)
indicating a respiratory cause, and elevated HCO3- (32 mEq/L) indicating renal compensation.
Because the pH is still abnormal, this is a partially compensated respiratory acidosis. The best
nursing action is to continue the prescribed low-flow oxygen and monitor the patient for signs
of decreased level of consciousness (CO2 narcosis), as the elevated PaCO2 can lead to
respiratory depression. Sodium bicarbonate (A) is not indicated because this is a respiratory, not
Comprehensive Practice Assessment 2026/2027
EDITION WITH QUESTIONS AND VERIFIED ANSWERS
ALREADY GRADED A
Question 1
A 68-year-old male patient with a history of hypertension and type 2 diabetes is admitted to the
post-anesthesia care unit (PACU) following an open reduction and internal fixation (ORIF) of a
fractured right hip. His vital signs upon arrival are: heart rate 112 bpm, blood pressure 88/54
mmHg, respiratory rate 22/min, and SpO2 93% on 4L nasal cannula. The surgical incision is dry
and intact. Which assessment finding should the PACU nurse prioritize as the most immediate
indicator of a potentially life-threatening complication?
A. The patient's blood glucose level of 180 mg/dL, requiring a sliding-scale insulin dose
B. The patient's moderate incisional pain rated as 6/10, indicating a need for PRN analgesics
C. The patient's urinary output of 20 mL over the last hour, suggesting early hypovolemic shock
D. The patient's pedal pulses being weakly palpable bilaterally, consistent with baseline
peripheral vascular disease
ANSWER: C
Explanation: In the immediate post-operative period following major orthopedic surgery,
especially in an elderly patient with pre-existing diabetes and hypertension, the most critical
concern is hemorrhage (either internal or occult) leading to hypovolemic shock. A urinary
output of less than 30 mL/hr is a sensitive, early indicator of inadequate renal perfusion due to
a decreased circulating blood volume. The tachycardia and hypotension already present strongly
support this trajectory. While hyperglycemia (A) is concerning and can impair wound healing, it
is not an immediate life-threatening emergency in this context. Pain (B) is important but a low
priority compared to hemodynamic instability. Weakly palpable pulses (D) are a concern for
peripheral vascular disease but are not an emergent indicator of active hemorrhagic shock and
align with a common comorbidity.
Question 2
,The nurse is caring for a patient who just returned from the operating room after a left total
knee arthroplasty. The patient has a continuous passive motion (CPM) machine in place and a
patient-controlled analgesia (PCA) pump. Which action by the nurse is the highest priority
during the initial post-operative assessment?
A. Teaching the patient how to use the incentive spirometer and assessing lung sounds
B. Checking the CPM machine settings to ensure it is set to the prescribed range of motion
C. Assessing the surgical dressing for fresh, bright red bleeding and neurovascular status of the
foot
D. Evaluating the effectiveness of the PCA pump by asking the patient to rate their pain on a 0-
10 scale
ANSWER: A
Explanation: While all options are important aspects of post-operative care, the highest priority
immediately following surgery is to prevent pulmonary complications such as atelectasis or
pneumonia. General anesthesia, positioning, and post-operative pain reduce tidal volume and
functional residual capacity. Assessing lung sounds and reinforcing the use of an incentive
spirometer is the most critical action to prevent respiratory compromise, which poses the
greatest immediate threat to life compared to local joint complications or pain management.
Neurovascular assessments (C) are extremely high priority for the extremity itself, but airway
and breathing (the 'A' and 'B' of the ABCs) always take precedence.
Question 3
A patient is receiving a continuous infusion of normal saline at 150 mL/hr via a peripheral IV in
the left forearm. During the 0800 assessment, the nurse notes that the IV site is cool to the
touch, mildly edematous, and the infusion pump is beeping with an "occlusion" alarm. What is
the most appropriate immediate nursing action?
A. Palpate the site for a fluid thrill and flush the IV line with 3 mL of sterile saline
B. Discontinue the IV site and restart the line in the opposite arm
C. Elevate the arm on a pillow and apply a warm, moist compress to the site
D. Slow the infusion rate to 50 mL/hr and apply a transparent dressing
ANSWER: B
Explanation: The assessment findings—coolness, edema, and occlusion—are classic signs of IV
infiltration. The solution has escaped into the interstitial tissue, causing the alarm to sound
because the pressure is back-feeding. The most appropriate action is to discontinue the current
IV access to prevent further tissue damage from the crystalloid solution and to restart the IV in a
,different location (preferably the opposite arm) to ensure the patient continues to receive their
prescribed fluids. Flushing (A) is incorrect as it would exacerbate the infiltration by pushing
more fluid into the tissue. Warm compresses (C) are often used for phlebitis, not acute
infiltration. Slowing the rate (D) will not resolve the occlusion or prevent further tissue damage.
Question 4
The nurse is preparing to administer a blood transfusion of one unit of packed red blood cells
(PRBCs) to a patient with a hemoglobin level of 7.2 g/dL. The patient has a history of heart
failure. The patient's baseline vital signs are: HR 88, BP 142/78, RR 18, SpO2 96%. The nurse has
acquired the blood unit and completed the patient identification verification. Prior to initiating
the transfusion, which action by the nurse is most critical?
A. Administering furosemide (Lasix) 40 mg IV push as prescribed
B. Ensuring that baseline vital signs are documented in the electronic health record
C. Obtaining an informed consent for the transfusion from the patient
D. Priming the blood administration tubing with 0.9% normal saline
ANSWER: A
Explanation: This patient has a history of heart failure and is receiving a blood product. Blood
transfusions have a high volume and solute load that can precipitate fluid volume overload and
worsening heart failure. Administering a loop diuretic like furosemide, as prescribed, prior to or
during the transfusion is a critical intervention to mitigate this risk. While documenting baseline
vitals (B) is a standard nursing action, it is not the most critical specific intervention for this high-
risk patient. Informed consent (C) should ideally be obtained before the patient is brought to
the unit or at the very beginning of the shift, but the most acute action is preparing the
patient's cardiac system for the volume load. Priming with NS (D) is a standard step for blood
administration, but is a technical task, whereas the pharmacological preparation is a proactive,
medically necessary step for managing co-morbidities.
Question 5
A patient arrives in the emergency department with severe, tearing chest pain radiating to the
back. The blood pressure is significantly different between the right arm (190/100 mmHg) and
the left arm (110/70 mmHg). The nurse suspects an acute aortic dissection. What is the priority
nursing action?
, A. Administer a sublingual nitroglycerin tablet and prepare for thrombolytic therapy
B. Start two large-bore IV lines and prepare to administer IV beta-blockers (e.g., esmolol)
C. Position the patient flat, log-roll the patient, and prepare for a lumbar puncture
D. Apply a non-rebreather mask at 15 L/min and prepare for immediate intubation
ANSWER: B
Explanation: The immediate medical management of an acute aortic dissection focuses on
reducing the force of myocardial contraction (dP/dt) and lowering systolic blood pressure to
minimize the shearing force on the aortic wall. Beta-blockers, such as esmolol, are the first-line
agents to reduce heart rate and contractility. Starting large-bore IVs is essential to administer
these medications and to prepare for possible massive transfusion if the aorta ruptures.
Nitroglycerin and thrombolytics (A) are contraindicated; thrombolytics would be catastrophic in
a dissection. A lumbar puncture (C) is for suspected meningitis or subarachnoid hemorrhage,
not a dissection. While high-flow oxygen (D) is appropriate, intubation is not the immediate
priority unless the patient is in respiratory failure or so hemodynamically unstable that they are
obtunded.
Question 6
A 72-year-old female patient is admitted to the medical-surgical unit with acute exacerbation of
chronic obstructive pulmonary disease (COPD). She is receiving oxygen at 2 L/min via nasal
cannula. Her arterial blood gas (ABG) results are: pH 7.31, PaCO2 68 mmHg, HCO3- 32 mEq/L,
and PaO2 72 mmHg. Which interpretation of these ABG results is correct, and what is the most
appropriate nursing action?
A. Uncompensated metabolic acidosis; administer sodium bicarbonate as prescribed
B. Partially compensated respiratory acidosis; continue current oxygen therapy and monitor for
changes in mental status
C. Fully compensated metabolic alkalosis; prepare for mechanical ventilation
D. Uncompensated respiratory alkalosis; decrease oxygen flow rate to 1 L/min
ANSWER: B
Explanation: The ABG shows a low pH (7.31) indicating acidosis, elevated PaCO2 (68 mmHg)
indicating a respiratory cause, and elevated HCO3- (32 mEq/L) indicating renal compensation.
Because the pH is still abnormal, this is a partially compensated respiratory acidosis. The best
nursing action is to continue the prescribed low-flow oxygen and monitor the patient for signs
of decreased level of consciousness (CO2 narcosis), as the elevated PaCO2 can lead to
respiratory depression. Sodium bicarbonate (A) is not indicated because this is a respiratory, not
