ATI RN Medical-Surgical Retake Examination 2026/2027:
Comprehensive Practice Questions and correct
ANSWERs with Rationales already graded A
Question 1
A nurse is caring for a client who is 2 hours postoperative following a total hip arthroplasty. The
client reports sudden onset of shortness of breath and chest pain. The nurse notes the client's
oxygen saturation is 88% on room air, heart rate is 112/min, respiratory rate is 26/min, and
blood pressure is 148/92 mm Hg. Which of the following actions should the nurse take first?
A. Administer oxygen via nonrebreather mask at 15 L/min
B. Position the client in high-Fowler's position
C. Notify the provider immediately
D. Prepare for administration of anticoagulant therapy
ANSWER: B
Explanation: The client is exhibiting signs of a pulmonary embolism (PE), which is a life-
threatening complication following orthopedic surgery. The first action the nurse should take is
to position the client in high-Fowler's position to maximize lung expansion and improve
ventilation-perfusion matching. While administering oxygen and notifying the provider are
important interventions, positioning the client to optimize respiratory status is the immediate
priority action before other interventions can be implemented. High-Fowler's position facilitates
diaphragmatic descent and improves oxygenation, which is critical while awaiting further
assessment and treatment. Anticoagulant therapy may be indicated but requires provider order
and should not be administered until diagnosis is confirmed.
Question 2
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who has been
receiving oxygen therapy at 2 L/min via nasal cannula. The client's arterial blood gas results
show: pH 7.31, PaCO2 68 mm Hg, HCO3- 32 mEq/L, and PaO2 70 mm Hg. Which of the following
interpretations of these findings is correct?
A. The client is experiencing acute respiratory acidosis with metabolic compensation
B. The client is experiencing chronic respiratory acidosis with metabolic compensation
,C. The client is experiencing acute respiratory alkalosis with metabolic compensation
D. The client is experiencing mixed respiratory and metabolic acidosis
ANSWER: B
Explanation: These ABG results indicate chronic respiratory acidosis with metabolic
compensation. The pH is below normal (7.35-7.45), indicating acidosis. The PaCO2 is elevated
above 45 mm Hg, confirming a respiratory cause. The HCO3- is elevated above 26 mEq/L,
indicating metabolic compensation that has been occurring over time. In chronic respiratory
acidosis, the kidneys retain bicarbonate to compensate for the elevated CO2, resulting in a
bicarbonate level that is elevated but the pH remains below normal because the compensation
is incomplete. Option A is incorrect because in acute respiratory acidosis, the bicarbonate would
be normal since renal compensation takes 24-48 hours. Option C is incorrect because the pH is
acidotic, not alkalotic. Option D is incorrect because the bicarbonate is elevated in response to
the respiratory acidosis rather than representing a primary metabolic acidosis.
Question 3
A nurse is preparing to administer a blood transfusion to a client with anemia. Which of the
following actions should the nurse take to prevent a transfusion reaction?
A. Administer the blood product within 2 hours of removing it from the blood bank refrigerator
B. Infuse the blood product through a Y-tubing set with 0.9% sodium chloride
C. Prime the blood tubing with lactated Ringer's solution prior to starting the transfusion
D. Check the client's vital signs 30 minutes after the transfusion has begun
ANSWER: B
Explanation: The correct action is to infuse the blood product through a Y-tubing set with 0.9%
sodium chloride (normal saline). This is the only IV solution compatible with blood products; it
prevents hemolysis and allows for simultaneous infusion of blood and saline if needed. Option A
is incorrect because blood should be administered within 4 hours of removal from the blood
bank, not 2 hours; in fact, 2 hours is too restrictive and not the standard. Option C is incorrect
because lactated Ringer's solution contains calcium, which can cause clotting in the blood
tubing and is incompatible with blood products. Option D is incorrect because vital signs should
be checked before the transfusion begins, 15 minutes after the start, and then hourly, not at 30
minutes alone; the 15-minute check is critical for early detection of transfusion reactions.
Question 4
,A nurse is caring for a client with heart failure who is receiving furosemide 40 mg IV daily. Which
of the following findings indicates the medication is having the desired therapeutic effect?
A. Decreased peripheral edema and weight loss of 1.5 kg in 24 hours
B. Serum potassium level of 3.2 mEq/L
C. Increase in blood pressure from 142/88 to 158/92 mm Hg
D. Urine output of 400 mL in the last 8 hours
ANSWER: A
Explanation: Furosemide is a loop diuretic used in heart failure to reduce fluid overload. The
desired therapeutic effect is evidenced by decreased peripheral edema and weight loss,
indicating successful diuresis and reduction of extracellular fluid volume. A weight loss of 1.5 kg
in 24 hours is consistent with adequate fluid removal (1 kg equals approximately 1 L of fluid).
Option B indicates an adverse effect of furosemide (hypokalemia) rather than a therapeutic
effect; normal potassium is 3.5-5.0 mEq/L. Option C shows worsening hypertension, which is
not a therapeutic effect since furosemide should lower blood pressure by reducing fluid volume.
Option D represents inadequate urine output; expected output is at least 30 mL/hr, so 400 mL
in 8 hours (50 mL/hr) is actually adequate but doesn't specifically indicate therapeutic effect of
the medication.
Question 5
A nurse is assessing a client who has sustained a head injury. The nurse notes a Glasgow Coma
Scale (GCS) score of 9. Which of the following interpretations of this score is correct?
A. The client has mild brain injury and requires routine monitoring
B. The client has moderate brain injury and requires frequent neurologic assessments
C. The client has severe brain injury and requires immediate neurosurgical intervention
D. The client is in a vegetative state with no meaningful neurologic function
ANSWER: B
Explanation: A GCS score of 9 falls within the moderate brain injury category (GCS 9-12). Clients
with moderate brain injury require frequent neurologic assessments and close monitoring for
deterioration. Option A is incorrect because mild brain injury is classified as GCS 13-15. Option C
is incorrect because severe brain injury is classified as GCS 3-8; while these clients may require
neurosurgical intervention, this is not the immediate interpretation of a score of 9. Option D is
incorrect because a vegetative state is not defined solely by GCS score; GCS of 3 is the lowest
possible score and indicates deep coma, not a vegetative state diagnosis.
, Question 6
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
notes that the client's serum glucose is 560 mg/dL, serum potassium is 5.2 mEq/L, and arterial
pH is 7.20. Which of the following interventions should the nurse anticipate administering first?
A. IV regular insulin
B. IV sodium bicarbonate
C. IV potassium replacement
D. IV 0.9% sodium chloride
ANSWER: D
Explanation: The initial priority in DKA management is fluid resuscitation with IV 0.9% sodium
chloride to restore circulating volume, improve tissue perfusion, and correct dehydration. Fluid
replacement helps dilute serum glucose and facilitates renal glucose excretion. While insulin is
essential for treating DKA, it is typically started after fluid resuscitation has begun. Sodium
bicarbonate is generally not recommended for DKA unless the pH is below 7.0 due to risks of
paradoxical cerebrospinal fluid acidosis. Although the potassium level appears elevated (5.2
mEq/L), this is likely due to acidosis shifting potassium out of cells; as insulin is administered and
acidosis corrects, potassium will shift back into cells, potentially causing hypokalemia, so
potassium replacement will be needed but not as the first intervention.
Question 7
A nurse is providing discharge teaching to a client who has undergone a thyroidectomy for
hyperthyroidism. The client asks about signs of complications that should be reported
immediately to the healthcare provider. Which of the following manifestations should the nurse
include in the teaching?
A. Hoarseness that resolves within 24 hours
B. Tingling around the mouth and fingers
C. Incisional pain that is relieved by acetaminophen
D. Difficulty swallowing liquids for the first 2 days
ANSWER: B
Explanation: Tingling around the mouth and fingers (paresthesia) is a sign of hypocalcemia,
which can occur following thyroidectomy due to accidental removal or damage to the
parathyroid glands. This is a critical complication that requires immediate reporting and
Comprehensive Practice Questions and correct
ANSWERs with Rationales already graded A
Question 1
A nurse is caring for a client who is 2 hours postoperative following a total hip arthroplasty. The
client reports sudden onset of shortness of breath and chest pain. The nurse notes the client's
oxygen saturation is 88% on room air, heart rate is 112/min, respiratory rate is 26/min, and
blood pressure is 148/92 mm Hg. Which of the following actions should the nurse take first?
A. Administer oxygen via nonrebreather mask at 15 L/min
B. Position the client in high-Fowler's position
C. Notify the provider immediately
D. Prepare for administration of anticoagulant therapy
ANSWER: B
Explanation: The client is exhibiting signs of a pulmonary embolism (PE), which is a life-
threatening complication following orthopedic surgery. The first action the nurse should take is
to position the client in high-Fowler's position to maximize lung expansion and improve
ventilation-perfusion matching. While administering oxygen and notifying the provider are
important interventions, positioning the client to optimize respiratory status is the immediate
priority action before other interventions can be implemented. High-Fowler's position facilitates
diaphragmatic descent and improves oxygenation, which is critical while awaiting further
assessment and treatment. Anticoagulant therapy may be indicated but requires provider order
and should not be administered until diagnosis is confirmed.
Question 2
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who has been
receiving oxygen therapy at 2 L/min via nasal cannula. The client's arterial blood gas results
show: pH 7.31, PaCO2 68 mm Hg, HCO3- 32 mEq/L, and PaO2 70 mm Hg. Which of the following
interpretations of these findings is correct?
A. The client is experiencing acute respiratory acidosis with metabolic compensation
B. The client is experiencing chronic respiratory acidosis with metabolic compensation
,C. The client is experiencing acute respiratory alkalosis with metabolic compensation
D. The client is experiencing mixed respiratory and metabolic acidosis
ANSWER: B
Explanation: These ABG results indicate chronic respiratory acidosis with metabolic
compensation. The pH is below normal (7.35-7.45), indicating acidosis. The PaCO2 is elevated
above 45 mm Hg, confirming a respiratory cause. The HCO3- is elevated above 26 mEq/L,
indicating metabolic compensation that has been occurring over time. In chronic respiratory
acidosis, the kidneys retain bicarbonate to compensate for the elevated CO2, resulting in a
bicarbonate level that is elevated but the pH remains below normal because the compensation
is incomplete. Option A is incorrect because in acute respiratory acidosis, the bicarbonate would
be normal since renal compensation takes 24-48 hours. Option C is incorrect because the pH is
acidotic, not alkalotic. Option D is incorrect because the bicarbonate is elevated in response to
the respiratory acidosis rather than representing a primary metabolic acidosis.
Question 3
A nurse is preparing to administer a blood transfusion to a client with anemia. Which of the
following actions should the nurse take to prevent a transfusion reaction?
A. Administer the blood product within 2 hours of removing it from the blood bank refrigerator
B. Infuse the blood product through a Y-tubing set with 0.9% sodium chloride
C. Prime the blood tubing with lactated Ringer's solution prior to starting the transfusion
D. Check the client's vital signs 30 minutes after the transfusion has begun
ANSWER: B
Explanation: The correct action is to infuse the blood product through a Y-tubing set with 0.9%
sodium chloride (normal saline). This is the only IV solution compatible with blood products; it
prevents hemolysis and allows for simultaneous infusion of blood and saline if needed. Option A
is incorrect because blood should be administered within 4 hours of removal from the blood
bank, not 2 hours; in fact, 2 hours is too restrictive and not the standard. Option C is incorrect
because lactated Ringer's solution contains calcium, which can cause clotting in the blood
tubing and is incompatible with blood products. Option D is incorrect because vital signs should
be checked before the transfusion begins, 15 minutes after the start, and then hourly, not at 30
minutes alone; the 15-minute check is critical for early detection of transfusion reactions.
Question 4
,A nurse is caring for a client with heart failure who is receiving furosemide 40 mg IV daily. Which
of the following findings indicates the medication is having the desired therapeutic effect?
A. Decreased peripheral edema and weight loss of 1.5 kg in 24 hours
B. Serum potassium level of 3.2 mEq/L
C. Increase in blood pressure from 142/88 to 158/92 mm Hg
D. Urine output of 400 mL in the last 8 hours
ANSWER: A
Explanation: Furosemide is a loop diuretic used in heart failure to reduce fluid overload. The
desired therapeutic effect is evidenced by decreased peripheral edema and weight loss,
indicating successful diuresis and reduction of extracellular fluid volume. A weight loss of 1.5 kg
in 24 hours is consistent with adequate fluid removal (1 kg equals approximately 1 L of fluid).
Option B indicates an adverse effect of furosemide (hypokalemia) rather than a therapeutic
effect; normal potassium is 3.5-5.0 mEq/L. Option C shows worsening hypertension, which is
not a therapeutic effect since furosemide should lower blood pressure by reducing fluid volume.
Option D represents inadequate urine output; expected output is at least 30 mL/hr, so 400 mL
in 8 hours (50 mL/hr) is actually adequate but doesn't specifically indicate therapeutic effect of
the medication.
Question 5
A nurse is assessing a client who has sustained a head injury. The nurse notes a Glasgow Coma
Scale (GCS) score of 9. Which of the following interpretations of this score is correct?
A. The client has mild brain injury and requires routine monitoring
B. The client has moderate brain injury and requires frequent neurologic assessments
C. The client has severe brain injury and requires immediate neurosurgical intervention
D. The client is in a vegetative state with no meaningful neurologic function
ANSWER: B
Explanation: A GCS score of 9 falls within the moderate brain injury category (GCS 9-12). Clients
with moderate brain injury require frequent neurologic assessments and close monitoring for
deterioration. Option A is incorrect because mild brain injury is classified as GCS 13-15. Option C
is incorrect because severe brain injury is classified as GCS 3-8; while these clients may require
neurosurgical intervention, this is not the immediate interpretation of a score of 9. Option D is
incorrect because a vegetative state is not defined solely by GCS score; GCS of 3 is the lowest
possible score and indicates deep coma, not a vegetative state diagnosis.
, Question 6
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
notes that the client's serum glucose is 560 mg/dL, serum potassium is 5.2 mEq/L, and arterial
pH is 7.20. Which of the following interventions should the nurse anticipate administering first?
A. IV regular insulin
B. IV sodium bicarbonate
C. IV potassium replacement
D. IV 0.9% sodium chloride
ANSWER: D
Explanation: The initial priority in DKA management is fluid resuscitation with IV 0.9% sodium
chloride to restore circulating volume, improve tissue perfusion, and correct dehydration. Fluid
replacement helps dilute serum glucose and facilitates renal glucose excretion. While insulin is
essential for treating DKA, it is typically started after fluid resuscitation has begun. Sodium
bicarbonate is generally not recommended for DKA unless the pH is below 7.0 due to risks of
paradoxical cerebrospinal fluid acidosis. Although the potassium level appears elevated (5.2
mEq/L), this is likely due to acidosis shifting potassium out of cells; as insulin is administered and
acidosis corrects, potassium will shift back into cells, potentially causing hypokalemia, so
potassium replacement will be needed but not as the first intervention.
Question 7
A nurse is providing discharge teaching to a client who has undergone a thyroidectomy for
hyperthyroidism. The client asks about signs of complications that should be reported
immediately to the healthcare provider. Which of the following manifestations should the nurse
include in the teaching?
A. Hoarseness that resolves within 24 hours
B. Tingling around the mouth and fingers
C. Incisional pain that is relieved by acetaminophen
D. Difficulty swallowing liquids for the first 2 days
ANSWER: B
Explanation: Tingling around the mouth and fingers (paresthesia) is a sign of hypocalcemia,
which can occur following thyroidectomy due to accidental removal or damage to the
parathyroid glands. This is a critical complication that requires immediate reporting and
