1|Page
ATI RN MEDICAL SURGICAL RETAKE LATEST 2026
ACTUAL EXAM| RN MED-SURG PROCTORED
ASSESSMENT II (RETAKE) WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
Following cardiac surgery, a client becomes restless and dyspneic.
Assessment reveals muffled heart sounds, jugular venous distention, BP
78/50 mm Hg, and narrowing pulse pressure. Which complication is
most likely?
A. Cardiac tamponade
B. Left-sided heart failure
C. Pulmonary embolism
D. Tension pneumothorax - Correct Answer - A. Cardiac tamponade
Hypotension, JVD, muffled heart sounds, and narrowed pulse pressure
are classic findings of obstructive shock from cardiac tamponade.
A client receiving unfractionated heparin for a pulmonary embolism has
a platelet count that decreases from 218,000/mm³ to 92,000/mm³ over 5
days. What is the nurse's priority action?
A. Administer the next heparin dose
B. Apply pressure to the previous injection site
C. Stop the heparin infusion
D. Administer prescribed vitamin K - Correct Answer - C. Stop the
heparin infusion
pg. 1
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A substantial platelet decline after heparin exposure suggests heparin-
induced thrombocytopenia (HIT), which requires immediate
discontinuation of heparin and further evaluation.
A client with severe COPD develops increasing respiratory distress.
ABGs show pH 7.21, PaCO₂ 72 mm Hg, HCO₃⁻ 29 mEq/L, and PaO₂ 48
mm Hg. The client is increasingly somnolent. Which intervention should
the nurse anticipate?
A. Encourage incentive spirometry
B. Initiate noninvasive positive-pressure ventilation
C. Restrict oral fluids
D. Administer a sedative - Correct Answer - B. Initiate noninvasive
positive-pressure ventilation
Severe hypercapnic respiratory acidosis with hypoxemia and increasing
somnolence indicates ventilatory failure requiring ventilatory support.
A client with pneumonia suddenly develops severe dyspnea. The client
is receiving mechanical ventilation with a high-pressure alarm sounding
repeatedly. Breath sounds are markedly decreased on the right. What
should the nurse do first?
A. Silence the alarm
B. Increase the tidal volume
C. Assess for pneumothorax and notify the provider
D. Lower the oxygen concentration - Correct Answer - C. Assess for
pneumothorax and notify the provider
Sudden unilateral decreased breath sounds with increased airway
pressure suggests pneumothorax, a potentially life-threatening ventilator
complication.
pg. 2
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A client with ARDS is mechanically ventilated. The oxygen saturation
remains 86% despite high oxygen concentrations. Which intervention is
most consistent with lung-protective ventilation?
A. Increase tidal volume substantially
B. Use lower tidal volumes based on predicted body weight
C. Eliminate PEEP
D. Maintain PaCO₂ below 25 mm Hg - Correct Answer - B. Use lower
tidal volumes based on predicted body weight
Lung-protective ventilation uses low tidal volumes to reduce ventilator-
induced lung injury; adequate PEEP may also be required for
oxygenation.
A client with infective endocarditis develops sudden left-sided weakness
and difficulty speaking. Which complication should the nurse suspect?
A. Septic embolization
B. Hypoglycemia
C. Pulmonary edema
D. Pericarditis - Correct Answer - A. Septic embolization
Vegetations from infective endocarditis can embolize systemically and
cause acute ischemic stroke.
A client with chronic kidney disease reports muscle weakness. ECG
findings show a widened QRS complex and tall, peaked T waves. Serum
potassium is 7.1 mEq/L. Which medication should the nurse expect to
administer first to stabilize the myocardium?
A. IV calcium gluconate
B. Oral potassium chloride
pg. 3
, 4|Page
C. Spironolactone
D. Magnesium sulfate - Correct Answer - A. IV calcium gluconate
IV calcium stabilizes the cardiac membrane during severe hyperkalemia.
It does not remove potassium but reduces immediate cardiac risk.
A client with severe liver disease develops oozing from IV sites.
Laboratory results include prolonged PT, prolonged aPTT,
thrombocytopenia, elevated D-dimer, and low fibrinogen. Which
condition is suspected?
A. DIC
B. HIT
C. Polycythemia
D. Iron-deficiency anemia - Correct Answer - A. DIC
Simultaneous clotting-factor consumption, thrombocytopenia, elevated
D-dimer, and low fibrinogen are characteristic of disseminated
intravascular coagulation.
A client with myasthenia gravis develops increasing weakness after
receiving several doses of pyridostigmine. The client has excessive
salivation, diarrhea, and muscle fasciculations. Which complication is
suspected?
A. Myasthenic crisis
B. Cholinergic crisis
C. Thyroid storm
D. Serotonin syndrome - Correct Answer - B. Cholinergic crisis
Excess acetylcholinesterase inhibitor can cause cholinergic toxicity,
characterized by weakness plus muscarinic symptoms such as salivation
and diarrhea.
pg. 4
ATI RN MEDICAL SURGICAL RETAKE LATEST 2026
ACTUAL EXAM| RN MED-SURG PROCTORED
ASSESSMENT II (RETAKE) WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
Following cardiac surgery, a client becomes restless and dyspneic.
Assessment reveals muffled heart sounds, jugular venous distention, BP
78/50 mm Hg, and narrowing pulse pressure. Which complication is
most likely?
A. Cardiac tamponade
B. Left-sided heart failure
C. Pulmonary embolism
D. Tension pneumothorax - Correct Answer - A. Cardiac tamponade
Hypotension, JVD, muffled heart sounds, and narrowed pulse pressure
are classic findings of obstructive shock from cardiac tamponade.
A client receiving unfractionated heparin for a pulmonary embolism has
a platelet count that decreases from 218,000/mm³ to 92,000/mm³ over 5
days. What is the nurse's priority action?
A. Administer the next heparin dose
B. Apply pressure to the previous injection site
C. Stop the heparin infusion
D. Administer prescribed vitamin K - Correct Answer - C. Stop the
heparin infusion
pg. 1
,2|Page
A substantial platelet decline after heparin exposure suggests heparin-
induced thrombocytopenia (HIT), which requires immediate
discontinuation of heparin and further evaluation.
A client with severe COPD develops increasing respiratory distress.
ABGs show pH 7.21, PaCO₂ 72 mm Hg, HCO₃⁻ 29 mEq/L, and PaO₂ 48
mm Hg. The client is increasingly somnolent. Which intervention should
the nurse anticipate?
A. Encourage incentive spirometry
B. Initiate noninvasive positive-pressure ventilation
C. Restrict oral fluids
D. Administer a sedative - Correct Answer - B. Initiate noninvasive
positive-pressure ventilation
Severe hypercapnic respiratory acidosis with hypoxemia and increasing
somnolence indicates ventilatory failure requiring ventilatory support.
A client with pneumonia suddenly develops severe dyspnea. The client
is receiving mechanical ventilation with a high-pressure alarm sounding
repeatedly. Breath sounds are markedly decreased on the right. What
should the nurse do first?
A. Silence the alarm
B. Increase the tidal volume
C. Assess for pneumothorax and notify the provider
D. Lower the oxygen concentration - Correct Answer - C. Assess for
pneumothorax and notify the provider
Sudden unilateral decreased breath sounds with increased airway
pressure suggests pneumothorax, a potentially life-threatening ventilator
complication.
pg. 2
,3|Page
A client with ARDS is mechanically ventilated. The oxygen saturation
remains 86% despite high oxygen concentrations. Which intervention is
most consistent with lung-protective ventilation?
A. Increase tidal volume substantially
B. Use lower tidal volumes based on predicted body weight
C. Eliminate PEEP
D. Maintain PaCO₂ below 25 mm Hg - Correct Answer - B. Use lower
tidal volumes based on predicted body weight
Lung-protective ventilation uses low tidal volumes to reduce ventilator-
induced lung injury; adequate PEEP may also be required for
oxygenation.
A client with infective endocarditis develops sudden left-sided weakness
and difficulty speaking. Which complication should the nurse suspect?
A. Septic embolization
B. Hypoglycemia
C. Pulmonary edema
D. Pericarditis - Correct Answer - A. Septic embolization
Vegetations from infective endocarditis can embolize systemically and
cause acute ischemic stroke.
A client with chronic kidney disease reports muscle weakness. ECG
findings show a widened QRS complex and tall, peaked T waves. Serum
potassium is 7.1 mEq/L. Which medication should the nurse expect to
administer first to stabilize the myocardium?
A. IV calcium gluconate
B. Oral potassium chloride
pg. 3
, 4|Page
C. Spironolactone
D. Magnesium sulfate - Correct Answer - A. IV calcium gluconate
IV calcium stabilizes the cardiac membrane during severe hyperkalemia.
It does not remove potassium but reduces immediate cardiac risk.
A client with severe liver disease develops oozing from IV sites.
Laboratory results include prolonged PT, prolonged aPTT,
thrombocytopenia, elevated D-dimer, and low fibrinogen. Which
condition is suspected?
A. DIC
B. HIT
C. Polycythemia
D. Iron-deficiency anemia - Correct Answer - A. DIC
Simultaneous clotting-factor consumption, thrombocytopenia, elevated
D-dimer, and low fibrinogen are characteristic of disseminated
intravascular coagulation.
A client with myasthenia gravis develops increasing weakness after
receiving several doses of pyridostigmine. The client has excessive
salivation, diarrhea, and muscle fasciculations. Which complication is
suspected?
A. Myasthenic crisis
B. Cholinergic crisis
C. Thyroid storm
D. Serotonin syndrome - Correct Answer - B. Cholinergic crisis
Excess acetylcholinesterase inhibitor can cause cholinergic toxicity,
characterized by weakness plus muscarinic symptoms such as salivation
and diarrhea.
pg. 4
