1|Page
ATI RN CMS COMPREHENSIVE
PRACTICE EXAM 2026–2027 [QUESTION
1-100] AND ANSWERS UPDATED
2026/2027 | DETAILED RATIONALES – A+
GRADED | INSTANT DOWNLOAD
INTRODUCTION
The ATI RN CMS Comprehensive Practice Exam 2026–2027 is designed as an intensive review
resource for nursing students preparing for comprehensive medical-surgical assessments, ATI-
style examinations, and NCLEX-RN clinical judgment questions. The practice bank integrates
major adult health concepts and emphasizes prioritization, safety, assessment, pharmacology,
laboratory interpretation, patient education, delegation, and recognition of complications.
Rather than focusing on simple memorization, the questions require students to analyze clinical
findings, identify the most urgent problem, interpret trends, anticipate complications, and select
the safest nursing intervention. The scenarios are intentionally challenging and cover multiple
body systems to simulate the type of integrated reasoning expected on comprehensive nursing
examinations.
Each question contains four answer choices with one best answer, followed by a detailed
rationale explaining the correct decision and why the alternatives are less appropriate. The
resource is intended to help students identify knowledge gaps, strengthen clinical judgment, and
develop a systematic approach to difficult questions before taking a comprehensive examination.
CONTENT AREA OVERVIEW
Approx.
Content Area Questions Key Topics
Weight
ACS, heart failure, dysrhythmias,
Cardiovascular Disorders 1–14 14%
hypertension, shock
COPD, asthma, pneumonia, PE,
Respiratory Disorders 15–27 13%
respiratory failure
Stroke, seizures, ICP, spinal disorders,
Neurologic Disorders 28–39 12%
neurologic emergencies
Endocrine & Metabolic Diabetes, DKA, thyroid, adrenal,
40–51 12%
Disorders electrolyte disorders
,2|Page
Approx.
Content Area Questions Key Topics
Weight
AKI, CKD, dialysis, fluid balance,
Renal & Urinary Disorders 52–61 10%
urinary disorders
Gastrointestinal & Hepatic GI bleeding, liver disease, pancreatitis,
62–70 9%
Disorders bowel disorders
Hematologic & Immune Anemia, transfusion reactions,
71–77 7%
Disorders anticoagulation, infection
Musculoskeletal & Fractures, burns, pressure injuries,
78–83 6%
Integumentary Disorders infection
Cancer complications, sepsis, shock,
Oncology & Emergency Care 84–89 6%
emergencies
Clinical Judgment, Safety & ABCs, delegation, medication safety,
90–100 11%
Prioritization escalation of care
Integrated adult medical-surgical
TOTAL 100 100%
nursing
QUESTIONS 1–100
CARDIOVASCULAR DISORDERS
Q1:
A client with a history of coronary artery disease reports crushing substernal chest pressure
radiating to the jaw that began 20 minutes ago. The client is pale and diaphoretic. BP is 88/54
mm Hg and HR is 112/min. Which action should the nurse take first?
A) Administer sublingual nitroglycerin
B) Assess airway and breathing while initiating emergency cardiac evaluation
C) Encourage the client to ambulate
D) Administer an oral antihypertensive
Rationale: The client has manifestations of acute coronary syndrome with hypotension. Initial
management prioritizes airway, breathing, circulation, rapid assessment, and emergency
treatment. Nitroglycerin can worsen hypotension and should not be given when systolic pressure
is severely low. Ambulation increases myocardial oxygen demand, and an antihypertensive
would further lower blood pressure.
Q2:
A client with acute heart failure suddenly develops severe dyspnea, crackles throughout both
lungs, and pink frothy sputum. Which intervention has the highest priority?
,3|Page
A) Encourage oral fluids
B) Position the client upright and administer oxygen as prescribed
C) Place the client flat
D) Encourage ambulation
Rationale: The findings indicate acute pulmonary edema. Upright positioning improves lung
expansion and decreases venous return, while oxygen supports impaired gas exchange.
Additional oral fluids and lying flat can worsen pulmonary congestion.
Q3:
A client taking digoxin for heart failure reports nausea, anorexia, and seeing yellow-green halos.
The apical pulse is 48/min. What should the nurse do?
A) Administer the scheduled dose
B) Withhold digoxin and notify the provider
C) Give an additional potassium-wasting diuretic
D) Encourage strenuous exercise
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic findings
associated with digoxin toxicity. The medication should be withheld and the provider notified.
Administering additional digoxin could worsen toxicity.
Q4:
A client with atrial fibrillation is prescribed an anticoagulant. Which assessment finding requires
immediate follow-up?
A) Mild bruising at an injection site
B) Heart rate of 88/min
C) Sudden severe headache and new unilateral weakness
D) INR within the prescribed therapeutic range
Rationale: Sudden severe headache and unilateral weakness may indicate intracranial
hemorrhage or stroke and require immediate emergency evaluation. Mild bruising may occur
with anticoagulation, while a controlled heart rate and therapeutic INR are expected treatment
findings.
Q5:
A client with heart failure has gained 2.5 kg (5.5 lb) in 3 days. Which finding most strongly
supports fluid retention?
A) Dry oral mucosa
B) New bilateral crackles and dependent edema
, 4|Page
C) Decreased jugular venous pressure
D) Increased urine output
Rationale: Rapid weight gain with crackles and dependent edema indicates fluid accumulation.
Dry mucosa and decreased jugular venous pressure suggest volume depletion rather than
overload.
Q6:
A client with an inferior myocardial infarction has a BP of 82/50 mm Hg after receiving
prescribed nitroglycerin. Which action is most appropriate?
A) Administer another nitroglycerin dose
B) Withhold additional nitroglycerin and notify the provider immediately
C) Encourage the client to stand
D) Give a diuretic
Rationale: Nitroglycerin causes vasodilation and can worsen significant hypotension. The
medication should be withheld and urgent cardiovascular reassessment performed.
Q7:
A client with peripheral arterial disease reports severe calf pain when walking that resolves with
rest. Which teaching is most appropriate?
A) Keep the legs elevated above the heart continuously
B) Follow the prescribed walking program and avoid tobacco exposure
C) Apply heating pads directly to the feet
D) Wear tight compression garments without evaluation
Rationale: Intermittent claudication is characteristic of arterial insufficiency. Structured walking
can improve functional circulation, while smoking cessation reduces vascular injury. Extreme
heat can cause burns, and compression may be inappropriate in significant arterial disease.
Q8:
A client with a new diagnosis of hypertension asks which lifestyle change has the greatest
general benefit for cardiovascular risk reduction. Which response is appropriate?
A) Eliminate all physical activity
B) Follow an individualized plan addressing sodium intake, weight, activity, diet, and
tobacco use
C) Increase processed-food intake
D) Stop prescribed medications once BP improves
ATI RN CMS COMPREHENSIVE
PRACTICE EXAM 2026–2027 [QUESTION
1-100] AND ANSWERS UPDATED
2026/2027 | DETAILED RATIONALES – A+
GRADED | INSTANT DOWNLOAD
INTRODUCTION
The ATI RN CMS Comprehensive Practice Exam 2026–2027 is designed as an intensive review
resource for nursing students preparing for comprehensive medical-surgical assessments, ATI-
style examinations, and NCLEX-RN clinical judgment questions. The practice bank integrates
major adult health concepts and emphasizes prioritization, safety, assessment, pharmacology,
laboratory interpretation, patient education, delegation, and recognition of complications.
Rather than focusing on simple memorization, the questions require students to analyze clinical
findings, identify the most urgent problem, interpret trends, anticipate complications, and select
the safest nursing intervention. The scenarios are intentionally challenging and cover multiple
body systems to simulate the type of integrated reasoning expected on comprehensive nursing
examinations.
Each question contains four answer choices with one best answer, followed by a detailed
rationale explaining the correct decision and why the alternatives are less appropriate. The
resource is intended to help students identify knowledge gaps, strengthen clinical judgment, and
develop a systematic approach to difficult questions before taking a comprehensive examination.
CONTENT AREA OVERVIEW
Approx.
Content Area Questions Key Topics
Weight
ACS, heart failure, dysrhythmias,
Cardiovascular Disorders 1–14 14%
hypertension, shock
COPD, asthma, pneumonia, PE,
Respiratory Disorders 15–27 13%
respiratory failure
Stroke, seizures, ICP, spinal disorders,
Neurologic Disorders 28–39 12%
neurologic emergencies
Endocrine & Metabolic Diabetes, DKA, thyroid, adrenal,
40–51 12%
Disorders electrolyte disorders
,2|Page
Approx.
Content Area Questions Key Topics
Weight
AKI, CKD, dialysis, fluid balance,
Renal & Urinary Disorders 52–61 10%
urinary disorders
Gastrointestinal & Hepatic GI bleeding, liver disease, pancreatitis,
62–70 9%
Disorders bowel disorders
Hematologic & Immune Anemia, transfusion reactions,
71–77 7%
Disorders anticoagulation, infection
Musculoskeletal & Fractures, burns, pressure injuries,
78–83 6%
Integumentary Disorders infection
Cancer complications, sepsis, shock,
Oncology & Emergency Care 84–89 6%
emergencies
Clinical Judgment, Safety & ABCs, delegation, medication safety,
90–100 11%
Prioritization escalation of care
Integrated adult medical-surgical
TOTAL 100 100%
nursing
QUESTIONS 1–100
CARDIOVASCULAR DISORDERS
Q1:
A client with a history of coronary artery disease reports crushing substernal chest pressure
radiating to the jaw that began 20 minutes ago. The client is pale and diaphoretic. BP is 88/54
mm Hg and HR is 112/min. Which action should the nurse take first?
A) Administer sublingual nitroglycerin
B) Assess airway and breathing while initiating emergency cardiac evaluation
C) Encourage the client to ambulate
D) Administer an oral antihypertensive
Rationale: The client has manifestations of acute coronary syndrome with hypotension. Initial
management prioritizes airway, breathing, circulation, rapid assessment, and emergency
treatment. Nitroglycerin can worsen hypotension and should not be given when systolic pressure
is severely low. Ambulation increases myocardial oxygen demand, and an antihypertensive
would further lower blood pressure.
Q2:
A client with acute heart failure suddenly develops severe dyspnea, crackles throughout both
lungs, and pink frothy sputum. Which intervention has the highest priority?
,3|Page
A) Encourage oral fluids
B) Position the client upright and administer oxygen as prescribed
C) Place the client flat
D) Encourage ambulation
Rationale: The findings indicate acute pulmonary edema. Upright positioning improves lung
expansion and decreases venous return, while oxygen supports impaired gas exchange.
Additional oral fluids and lying flat can worsen pulmonary congestion.
Q3:
A client taking digoxin for heart failure reports nausea, anorexia, and seeing yellow-green halos.
The apical pulse is 48/min. What should the nurse do?
A) Administer the scheduled dose
B) Withhold digoxin and notify the provider
C) Give an additional potassium-wasting diuretic
D) Encourage strenuous exercise
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic findings
associated with digoxin toxicity. The medication should be withheld and the provider notified.
Administering additional digoxin could worsen toxicity.
Q4:
A client with atrial fibrillation is prescribed an anticoagulant. Which assessment finding requires
immediate follow-up?
A) Mild bruising at an injection site
B) Heart rate of 88/min
C) Sudden severe headache and new unilateral weakness
D) INR within the prescribed therapeutic range
Rationale: Sudden severe headache and unilateral weakness may indicate intracranial
hemorrhage or stroke and require immediate emergency evaluation. Mild bruising may occur
with anticoagulation, while a controlled heart rate and therapeutic INR are expected treatment
findings.
Q5:
A client with heart failure has gained 2.5 kg (5.5 lb) in 3 days. Which finding most strongly
supports fluid retention?
A) Dry oral mucosa
B) New bilateral crackles and dependent edema
, 4|Page
C) Decreased jugular venous pressure
D) Increased urine output
Rationale: Rapid weight gain with crackles and dependent edema indicates fluid accumulation.
Dry mucosa and decreased jugular venous pressure suggest volume depletion rather than
overload.
Q6:
A client with an inferior myocardial infarction has a BP of 82/50 mm Hg after receiving
prescribed nitroglycerin. Which action is most appropriate?
A) Administer another nitroglycerin dose
B) Withhold additional nitroglycerin and notify the provider immediately
C) Encourage the client to stand
D) Give a diuretic
Rationale: Nitroglycerin causes vasodilation and can worsen significant hypotension. The
medication should be withheld and urgent cardiovascular reassessment performed.
Q7:
A client with peripheral arterial disease reports severe calf pain when walking that resolves with
rest. Which teaching is most appropriate?
A) Keep the legs elevated above the heart continuously
B) Follow the prescribed walking program and avoid tobacco exposure
C) Apply heating pads directly to the feet
D) Wear tight compression garments without evaluation
Rationale: Intermittent claudication is characteristic of arterial insufficiency. Structured walking
can improve functional circulation, while smoking cessation reduces vascular injury. Extreme
heat can cause burns, and compression may be inappropriate in significant arterial disease.
Q8:
A client with a new diagnosis of hypertension asks which lifestyle change has the greatest
general benefit for cardiovascular risk reduction. Which response is appropriate?
A) Eliminate all physical activity
B) Follow an individualized plan addressing sodium intake, weight, activity, diet, and
tobacco use
C) Increase processed-food intake
D) Stop prescribed medications once BP improves
