ATI
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
, ATI MED-SURG MIDTERM EXAM REVIEW | 2026 PRACTICE
TEST
Question 1: Bowtie (Cardiovascular)
Scenario: A 72-year-old male is admitted to the medical-surgical unit with a 5-lb weight gain
over the past 3 days, dyspnea on exertion, and a persistent cough. Upon assessment, the nurse
notes 3+ pitting edema in the bilateral lower extremities, jugular venous distention (JVD), and
coarse crackles in the bilateral lung bases. The client’s oxygen saturation is 89% on room air.
Task: Based on the assessment findings, select the Condition the client is most likely
experiencing, two Actions the nurse should take, and three Parameters to Monitor to evaluate
the client's progress.
Options:
• Potential Conditions: Pulmonary Embolism | Acute Decompensated Heart Failure |
Pneumonia | Diabetic Ketoacidosis
• Potential Actions: Administer IV 0.9% Normal Saline Bolus | Administer IV Furosemide |
Elevate Head of Bed to 45 degrees | Encourage 3L of oral fluids daily | Administer
Metoprolol
• Parameters to Monitor: Daily weights | Intake and Output | Serum Potassium levels |
Temperature every 4 hours | Hemoglobin A1C
Answer & Rationale
• Condition: Acute Decompensated Heart Failure
o Rationale: Weight gain, JVD, pitting edema, and crackles are classic signs of fluid
volume overload secondary to heart failure.
• Actions: Administer IV Furosemide AND Elevate Head of Bed to 45 degrees
, o Rationale: Furosemide is a loop diuretic that reduces fluid volume overload
(preload). Elevating the HOB promotes lung expansion and reduces venous
return to the heart, easing dyspnea. IV fluids (Normal Saline) would worsen fluid
overload.
• Parameters to Monitor: Daily weights, Intake and Output, AND Serum Potassium
levels
o Rationale: Daily weights (taken at the same time, same scale) are the most
accurate indicator of fluid status. I&O tracks fluid balance. Furosemide is a
potassium-wasting diuretic; therefore, monitoring potassium is critical to
prevent hypokalemia and subsequent cardiac dysrhythmias.
Question 2: Matrix / Multiple Response (Respiratory)
Scenario: A nurse is caring for a 65-year-old client with a history of Chronic Obstructive
Pulmonary Disease (COPD) who is admitted with an acute exacerbation and suspected
pneumonia. The client is lethargic, using accessory muscles to breathe, and has a productive
cough with thick, yellow-green sputum. Arterial Blood Gas (ABG) results: pH 7.28, PaCO2 58 mm
Hg, HCO3 32 mEq/L, PaO2 60 mm Hg. SpO2 is 87%.
Task: For each nursing intervention below, click to indicate if the intervention is Indicated,
Contraindicated, or Non-Essential for this client.
Non-
Nursing Intervention Indicated Contraindicated
Essential
1. Administer oxygen via nasal cannula to maintain
[] [] []
SpO2 at 88%-92%.
2. Administer high-flow oxygen via a non-rebreather
[] [] []
mask at 15 L/min.
, Non-
Nursing Intervention Indicated Contraindicated
Essential
3. Encourage the use of an incentive spirometer every
[] [] []
1-2 hours.
4. Administer a codeine-based antitussive (cough
[] [] []
suppressant) before bed.
5. Instruct the client on pursed-lip breathing
[] [] []
techniques.
Answer & Rationale
1. Indicated: COPD clients often rely on a "hypoxic drive" to breathe. Targeting SpO2 88-
92% provides adequate oxygenation without knocking out their respiratory drive.
2. Contraindicated: High-flow oxygen can suppress the hypoxic drive in a chronic CO2
retainer, leading to severe respiratory depression and CO2 narcosis.
3. Indicated: Incentive spirometry promotes lung expansion, prevents atelectasis, and
helps clear secretions.
4. Contraindicated: Cough suppressants prevent the clearance of thick secretions (yellow-
green sputum), which can worsen the pneumonia and airway obstruction. Furthermore,
codeine suppresses the respiratory drive.
5. Indicated: Pursed-lip breathing prolongs exhalation, prevents airway collapse, and helps
blow off trapped CO2.
Question 3: Trend Analysis & Drop-Down (Endocrine)
Scenario: A 24-year-old client arrives at the emergency department with a blood glucose of 580
mg/dL, fruity breath, and deep, rapid respirations (Kussmaul breathing). The provider diagnoses
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
, ATI MED-SURG MIDTERM EXAM REVIEW | 2026 PRACTICE
TEST
Question 1: Bowtie (Cardiovascular)
Scenario: A 72-year-old male is admitted to the medical-surgical unit with a 5-lb weight gain
over the past 3 days, dyspnea on exertion, and a persistent cough. Upon assessment, the nurse
notes 3+ pitting edema in the bilateral lower extremities, jugular venous distention (JVD), and
coarse crackles in the bilateral lung bases. The client’s oxygen saturation is 89% on room air.
Task: Based on the assessment findings, select the Condition the client is most likely
experiencing, two Actions the nurse should take, and three Parameters to Monitor to evaluate
the client's progress.
Options:
• Potential Conditions: Pulmonary Embolism | Acute Decompensated Heart Failure |
Pneumonia | Diabetic Ketoacidosis
• Potential Actions: Administer IV 0.9% Normal Saline Bolus | Administer IV Furosemide |
Elevate Head of Bed to 45 degrees | Encourage 3L of oral fluids daily | Administer
Metoprolol
• Parameters to Monitor: Daily weights | Intake and Output | Serum Potassium levels |
Temperature every 4 hours | Hemoglobin A1C
Answer & Rationale
• Condition: Acute Decompensated Heart Failure
o Rationale: Weight gain, JVD, pitting edema, and crackles are classic signs of fluid
volume overload secondary to heart failure.
• Actions: Administer IV Furosemide AND Elevate Head of Bed to 45 degrees
, o Rationale: Furosemide is a loop diuretic that reduces fluid volume overload
(preload). Elevating the HOB promotes lung expansion and reduces venous
return to the heart, easing dyspnea. IV fluids (Normal Saline) would worsen fluid
overload.
• Parameters to Monitor: Daily weights, Intake and Output, AND Serum Potassium
levels
o Rationale: Daily weights (taken at the same time, same scale) are the most
accurate indicator of fluid status. I&O tracks fluid balance. Furosemide is a
potassium-wasting diuretic; therefore, monitoring potassium is critical to
prevent hypokalemia and subsequent cardiac dysrhythmias.
Question 2: Matrix / Multiple Response (Respiratory)
Scenario: A nurse is caring for a 65-year-old client with a history of Chronic Obstructive
Pulmonary Disease (COPD) who is admitted with an acute exacerbation and suspected
pneumonia. The client is lethargic, using accessory muscles to breathe, and has a productive
cough with thick, yellow-green sputum. Arterial Blood Gas (ABG) results: pH 7.28, PaCO2 58 mm
Hg, HCO3 32 mEq/L, PaO2 60 mm Hg. SpO2 is 87%.
Task: For each nursing intervention below, click to indicate if the intervention is Indicated,
Contraindicated, or Non-Essential for this client.
Non-
Nursing Intervention Indicated Contraindicated
Essential
1. Administer oxygen via nasal cannula to maintain
[] [] []
SpO2 at 88%-92%.
2. Administer high-flow oxygen via a non-rebreather
[] [] []
mask at 15 L/min.
, Non-
Nursing Intervention Indicated Contraindicated
Essential
3. Encourage the use of an incentive spirometer every
[] [] []
1-2 hours.
4. Administer a codeine-based antitussive (cough
[] [] []
suppressant) before bed.
5. Instruct the client on pursed-lip breathing
[] [] []
techniques.
Answer & Rationale
1. Indicated: COPD clients often rely on a "hypoxic drive" to breathe. Targeting SpO2 88-
92% provides adequate oxygenation without knocking out their respiratory drive.
2. Contraindicated: High-flow oxygen can suppress the hypoxic drive in a chronic CO2
retainer, leading to severe respiratory depression and CO2 narcosis.
3. Indicated: Incentive spirometry promotes lung expansion, prevents atelectasis, and
helps clear secretions.
4. Contraindicated: Cough suppressants prevent the clearance of thick secretions (yellow-
green sputum), which can worsen the pneumonia and airway obstruction. Furthermore,
codeine suppresses the respiratory drive.
5. Indicated: Pursed-lip breathing prolongs exhalation, prevents airway collapse, and helps
blow off trapped CO2.
Question 3: Trend Analysis & Drop-Down (Endocrine)
Scenario: A 24-year-old client arrives at the emergency department with a blood glucose of 580
mg/dL, fruity breath, and deep, rapid respirations (Kussmaul breathing). The provider diagnoses
