CMS (ATI ADULT MEDICAL SURGICAL) QUESTIONs,
Answers & Detailed Rationales (2026/2027)
QUESTION 1
A nurse is caring for a client who has heart failure and is receiving a loop
diuretic. Which of the following findings indicates that the client is
experiencing hypokalemia?
• A. Hyperactive bowel sounds and muscle twitching
• B. Muscle weakness and cardiac dysrhythmias
• C. Pitting peripheral edema and hypertension
• D. Decreased urine output and bradypnea
Correct Answer: B. Muscle weakness and cardiac dysrhythmias
Detailed Rationale: Loop diuretics increase potassium excretion,
leading to hypokalemia. Clinical manifestations of hypokalemia include
muscle weakness, fatigue, leg cramps, and cardiac dysrhythmias due to
altered electrical conduction in the heart. Hyperactive bowel sounds are
associated with hypokalemia, but muscle twitching is more
characteristic of hypocalcemia. Pitting edema and hypertension are
fluid overload indicators, not potassium imbalances.
QUESTION 2
A nurse is caring for a client who has a chest tube connected to a
closed-water seal drainage system. Which of the following findings
should the nurse expect?
• A. Continuous bubbling in the water-seal chamber
, • B. Fluctuating water level in the water-seal chamber with
respiration
• C. Constant bubbling in the suction control chamber
• D. Absence of fluid in the collection chamber tubing
Correct Answer: B. Fluctuating water level in the water-seal chamber
with respiration
Detailed Rationale: Tidaling (fluctuation of the water level in the water-
seal chamber with inspiration and expiration) is expected and indicates
patent system function. Continuous bubbling in the water-seal chamber
indicates an air leak. Constant bubbling in the suction control chamber
is normal when suction is applied. Fluid or drainage should be visible in
the collection tubing as it drains from the pleural space.
QUESTION 3
A nurse is assessing a client who has diabetic ketoacidosis (DKA). Which
of the following laboratory findings should the nurse expect?
• A. Blood glucose 150 mg/dL
• B. Serum pH 7.42
• C. Serum bicarbonate 14 mEq/L
• D. Negative urine ketones
Correct Answer: C. Serum bicarbonate 14 mEq/L
Detailed Rationale: DKA is characterized by uncontrolled hyperglycemia
(blood glucose typically greater than 250 mg/dL), metabolic acidosis
(serum pH less than 7.30, serum bicarbonate less than 18 mEq/L), and
,positive urine and serum ketones. A serum pH of 7.42 and blood
glucose of 150 mg/dL are within normal limits.
QUESTION 4
A nurse is caring for a client who has cirrhosis and is scheduled for a
paracentesis. Which of the following actions should the nurse take prior
to the procedure?
• A. Place the client in a supine position with legs elevated.
• B. Instruct the client to void.
• C. Administer an enema to empty the bowel.
• D. Maintain strict bed rest for 4 hr post-procedure.
Correct Answer: B. Instruct the client to void.
Detailed Rationale: The client must void immediately before a
paracentesis to reduce the risk of accidental bladder perforation during
needle insertion. The client should be positioned in an upright or semi-
Fowler's position during the procedure. Post-procedure monitoring
includes assessing for hypovolemia and checking the dressing for
leakage.
QUESTION 5
A nurse is preparing a client who has chronic kidney disease (CKD) for
hemodialysis. Which of the following clinical manifestations should the
nurse expect due to the client's condition?
• A. Hypercalcemia and hypophosphatemia
• B. Metabolic alkalosis
• C. Uremic frost and pruritus
, • D. Polyuria and hypotension
Correct Answer: C. Uremic frost and pruritus
Detailed Rationale: CKD leads to the accumulation of urea and
nitrogenous wastes in the blood (uremia), which can cause uremic frost
(crystallized urea deposits on the skin) and severe pruritus (itching).
CKD typically causes hypocalcemia, hyperphosphatemia, metabolic
acidosis, and hypertension.
QUESTION 6
A nurse is caring for a client who has increased intracranial pressure
(ICP) following a traumatic brain injury. Which of the following
interventions should the nurse implement?
• A. Position the client with the neck in a neutral, midline position.
• B. Suction the client's endotracheal tube every hour routinely.
• C. Encourage the client to perform isometric exercises in bed.
• D. Maintain the head of the bed flat.
Correct Answer: A. Position the client with the neck in a neutral,
midline position.
Detailed Rationale: Maintaining the client's head and neck in a neutral,
midline position prevents jugular venous compression, which can
increase intracranial pressure. The head of the bed should be elevated
30 degrees. Routine or unnecessary suctioning and isometric exercises
increase intra-thoracic and intra-abdominal pressure, raising ICP.
QUESTION 7
Answers & Detailed Rationales (2026/2027)
QUESTION 1
A nurse is caring for a client who has heart failure and is receiving a loop
diuretic. Which of the following findings indicates that the client is
experiencing hypokalemia?
• A. Hyperactive bowel sounds and muscle twitching
• B. Muscle weakness and cardiac dysrhythmias
• C. Pitting peripheral edema and hypertension
• D. Decreased urine output and bradypnea
Correct Answer: B. Muscle weakness and cardiac dysrhythmias
Detailed Rationale: Loop diuretics increase potassium excretion,
leading to hypokalemia. Clinical manifestations of hypokalemia include
muscle weakness, fatigue, leg cramps, and cardiac dysrhythmias due to
altered electrical conduction in the heart. Hyperactive bowel sounds are
associated with hypokalemia, but muscle twitching is more
characteristic of hypocalcemia. Pitting edema and hypertension are
fluid overload indicators, not potassium imbalances.
QUESTION 2
A nurse is caring for a client who has a chest tube connected to a
closed-water seal drainage system. Which of the following findings
should the nurse expect?
• A. Continuous bubbling in the water-seal chamber
, • B. Fluctuating water level in the water-seal chamber with
respiration
• C. Constant bubbling in the suction control chamber
• D. Absence of fluid in the collection chamber tubing
Correct Answer: B. Fluctuating water level in the water-seal chamber
with respiration
Detailed Rationale: Tidaling (fluctuation of the water level in the water-
seal chamber with inspiration and expiration) is expected and indicates
patent system function. Continuous bubbling in the water-seal chamber
indicates an air leak. Constant bubbling in the suction control chamber
is normal when suction is applied. Fluid or drainage should be visible in
the collection tubing as it drains from the pleural space.
QUESTION 3
A nurse is assessing a client who has diabetic ketoacidosis (DKA). Which
of the following laboratory findings should the nurse expect?
• A. Blood glucose 150 mg/dL
• B. Serum pH 7.42
• C. Serum bicarbonate 14 mEq/L
• D. Negative urine ketones
Correct Answer: C. Serum bicarbonate 14 mEq/L
Detailed Rationale: DKA is characterized by uncontrolled hyperglycemia
(blood glucose typically greater than 250 mg/dL), metabolic acidosis
(serum pH less than 7.30, serum bicarbonate less than 18 mEq/L), and
,positive urine and serum ketones. A serum pH of 7.42 and blood
glucose of 150 mg/dL are within normal limits.
QUESTION 4
A nurse is caring for a client who has cirrhosis and is scheduled for a
paracentesis. Which of the following actions should the nurse take prior
to the procedure?
• A. Place the client in a supine position with legs elevated.
• B. Instruct the client to void.
• C. Administer an enema to empty the bowel.
• D. Maintain strict bed rest for 4 hr post-procedure.
Correct Answer: B. Instruct the client to void.
Detailed Rationale: The client must void immediately before a
paracentesis to reduce the risk of accidental bladder perforation during
needle insertion. The client should be positioned in an upright or semi-
Fowler's position during the procedure. Post-procedure monitoring
includes assessing for hypovolemia and checking the dressing for
leakage.
QUESTION 5
A nurse is preparing a client who has chronic kidney disease (CKD) for
hemodialysis. Which of the following clinical manifestations should the
nurse expect due to the client's condition?
• A. Hypercalcemia and hypophosphatemia
• B. Metabolic alkalosis
• C. Uremic frost and pruritus
, • D. Polyuria and hypotension
Correct Answer: C. Uremic frost and pruritus
Detailed Rationale: CKD leads to the accumulation of urea and
nitrogenous wastes in the blood (uremia), which can cause uremic frost
(crystallized urea deposits on the skin) and severe pruritus (itching).
CKD typically causes hypocalcemia, hyperphosphatemia, metabolic
acidosis, and hypertension.
QUESTION 6
A nurse is caring for a client who has increased intracranial pressure
(ICP) following a traumatic brain injury. Which of the following
interventions should the nurse implement?
• A. Position the client with the neck in a neutral, midline position.
• B. Suction the client's endotracheal tube every hour routinely.
• C. Encourage the client to perform isometric exercises in bed.
• D. Maintain the head of the bed flat.
Correct Answer: A. Position the client with the neck in a neutral,
midline position.
Detailed Rationale: Maintaining the client's head and neck in a neutral,
midline position prevents jugular venous compression, which can
increase intracranial pressure. The head of the bed should be elevated
30 degrees. Routine or unnecessary suctioning and isometric exercises
increase intra-thoracic and intra-abdominal pressure, raising ICP.
QUESTION 7
