ATI
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
, ATI MEDICAL-SURGICAL NURSING MIDTERM SUCCESS BUNDLE (2026) | 100% EXAM
PREPARATION QUESTIONS AND ANSWERS WITH RATIONALES
1. Cardiovascular System: Heart Failure
Question: A nurse is assessing a client admitted with acute decompensated heart failure. Which
assessment finding requires immediate intervention?
• A) Bilateral 2+ pitting edema in the lower extremities.
• B) Oxygen saturation of 88% on room air.
• C) Weight gain of 3 lbs over the past 3 days.
• D) Fine crackles heard in the bilateral lower lung bases.
Answer: B
• Rationale: An oxygen saturation of 88% indicates severe hypoxia and potential
respiratory failure, which is a life-threatening emergency requiring immediate oxygen
therapy and medical intervention.
• Why others are wrong: Edema (A), weight gain (C), and crackles (D) are expected
findings in fluid volume overload associated with heart failure. While they require
treatment (diuretics), they are not as immediately life-threatening as severe hypoxia.
2. Endocrine System: Diabetic Ketoacidosis (DKA)
Question: A client with type 1 diabetes mellitus is admitted to the emergency department with
diabetic ketoacidosis (DKA). Which laboratory finding should the nurse expect?
• A) Blood pH of 7.48
• B) Serum bicarbonate of 26 mEq/L
• C) Serum potassium of 5.8 mEq/L
• D) Blood glucose of 145 mg/dL
,Answer: C
• Rationale: In DKA, acidosis causes potassium to shift from the intracellular space to the
extracellular space to maintain acid-base balance, leading to hyperkalemia (high serum
potassium), even if total body potassium is depleted.
• Why others are wrong: DKA causes metabolic acidosis, so the pH would be low (<7.35)
and bicarbonate would be low (<22 mEq/L) as the body attempts to buffer the acid.
Blood glucose is typically significantly elevated (usually >250 mg/dL).
3. Respiratory System: Chronic Obstructive Pulmonary Disease (COPD)
Question: A nurse is providing dietary teaching to a client with severe COPD who is
experiencing fatigue. Which instruction should the nurse include?
• A) Consume a high-carbohydrate, low-fat diet.
• B) Drink 1 to 2 liters of fluid during each meal to stay hydrated.
• C) Eat three large, nutrient-dense meals per day to conserve energy.
• D) Consume a high-protein, high-calorie diet with small, frequent meals.
Answer: D
• Rationale: Clients with severe COPD have high caloric requirements due to the
increased energy expended on the work of breathing. A high-protein, high-calorie diet
prevents malnutrition. Small, frequent meals prevent abdominal distention, which can
restrict diaphragmatic excursion and increase shortness of breath.
• Why others are wrong: High-carbohydrate diets increase carbon dioxide production,
which can worsen respiratory acidosis in COPD patients. Fluids should be consumed
between meals rather than during meals to prevent early satiety and gastric fullness.
Large meals require more energy to digest and can push against the diaphragm.
4. Renal System: Acute Kidney Injury (AKI)
, Question: A nurse is reviewing the laboratory results of a client in the oliguric phase of acute
kidney injury (AKI). Which finding is the most concerning?
• A) Serum creatinine of 1.3 mg/dL
• B) Blood urea nitrogen (BUN) of 30 mg/dL
• C) Serum potassium of 6.4 mEq/L
• D) Urine specific gravity of 1.010
Answer: C
• Rationale: Hyperkalemia is a life-threatening complication of the oliguric phase of AKI
because the kidneys are unable to excrete potassium. A level of 6.4 mEq/L puts the
client at immediate risk for fatal cardiac dysrhythmias (e.g., ventricular fibrillation) and
requires immediate intervention (e.g., calcium gluconate, insulin/glucose, Kayexalate, or
dialysis).
• Why others are wrong: Elevated creatinine and BUN are expected in AKI. A specific
gravity of 1.010 (fixed specific gravity) is a classic finding in intrinsic renal failure,
indicating the kidneys have lost the ability to concentrate urine.
5. Gastrointestinal System: Bowel Obstruction
Question: A nurse is assessing a client suspected of having a mechanical small bowel
obstruction. Which assessment finding is most consistent with the early stages of this
condition?
• A) Ribbon-like, liquid stools
• B) High-pitched, hyperactive, or "tinkling" bowel sounds
• C) Absent bowel sounds in all four quadrants
• D) Significant abdominal distention with no pain
Answer: B
NURSING
QUESTIONS & ANSWERS WITH
RATIONALES
, ATI MEDICAL-SURGICAL NURSING MIDTERM SUCCESS BUNDLE (2026) | 100% EXAM
PREPARATION QUESTIONS AND ANSWERS WITH RATIONALES
1. Cardiovascular System: Heart Failure
Question: A nurse is assessing a client admitted with acute decompensated heart failure. Which
assessment finding requires immediate intervention?
• A) Bilateral 2+ pitting edema in the lower extremities.
• B) Oxygen saturation of 88% on room air.
• C) Weight gain of 3 lbs over the past 3 days.
• D) Fine crackles heard in the bilateral lower lung bases.
Answer: B
• Rationale: An oxygen saturation of 88% indicates severe hypoxia and potential
respiratory failure, which is a life-threatening emergency requiring immediate oxygen
therapy and medical intervention.
• Why others are wrong: Edema (A), weight gain (C), and crackles (D) are expected
findings in fluid volume overload associated with heart failure. While they require
treatment (diuretics), they are not as immediately life-threatening as severe hypoxia.
2. Endocrine System: Diabetic Ketoacidosis (DKA)
Question: A client with type 1 diabetes mellitus is admitted to the emergency department with
diabetic ketoacidosis (DKA). Which laboratory finding should the nurse expect?
• A) Blood pH of 7.48
• B) Serum bicarbonate of 26 mEq/L
• C) Serum potassium of 5.8 mEq/L
• D) Blood glucose of 145 mg/dL
,Answer: C
• Rationale: In DKA, acidosis causes potassium to shift from the intracellular space to the
extracellular space to maintain acid-base balance, leading to hyperkalemia (high serum
potassium), even if total body potassium is depleted.
• Why others are wrong: DKA causes metabolic acidosis, so the pH would be low (<7.35)
and bicarbonate would be low (<22 mEq/L) as the body attempts to buffer the acid.
Blood glucose is typically significantly elevated (usually >250 mg/dL).
3. Respiratory System: Chronic Obstructive Pulmonary Disease (COPD)
Question: A nurse is providing dietary teaching to a client with severe COPD who is
experiencing fatigue. Which instruction should the nurse include?
• A) Consume a high-carbohydrate, low-fat diet.
• B) Drink 1 to 2 liters of fluid during each meal to stay hydrated.
• C) Eat three large, nutrient-dense meals per day to conserve energy.
• D) Consume a high-protein, high-calorie diet with small, frequent meals.
Answer: D
• Rationale: Clients with severe COPD have high caloric requirements due to the
increased energy expended on the work of breathing. A high-protein, high-calorie diet
prevents malnutrition. Small, frequent meals prevent abdominal distention, which can
restrict diaphragmatic excursion and increase shortness of breath.
• Why others are wrong: High-carbohydrate diets increase carbon dioxide production,
which can worsen respiratory acidosis in COPD patients. Fluids should be consumed
between meals rather than during meals to prevent early satiety and gastric fullness.
Large meals require more energy to digest and can push against the diaphragm.
4. Renal System: Acute Kidney Injury (AKI)
, Question: A nurse is reviewing the laboratory results of a client in the oliguric phase of acute
kidney injury (AKI). Which finding is the most concerning?
• A) Serum creatinine of 1.3 mg/dL
• B) Blood urea nitrogen (BUN) of 30 mg/dL
• C) Serum potassium of 6.4 mEq/L
• D) Urine specific gravity of 1.010
Answer: C
• Rationale: Hyperkalemia is a life-threatening complication of the oliguric phase of AKI
because the kidneys are unable to excrete potassium. A level of 6.4 mEq/L puts the
client at immediate risk for fatal cardiac dysrhythmias (e.g., ventricular fibrillation) and
requires immediate intervention (e.g., calcium gluconate, insulin/glucose, Kayexalate, or
dialysis).
• Why others are wrong: Elevated creatinine and BUN are expected in AKI. A specific
gravity of 1.010 (fixed specific gravity) is a classic finding in intrinsic renal failure,
indicating the kidneys have lost the ability to concentrate urine.
5. Gastrointestinal System: Bowel Obstruction
Question: A nurse is assessing a client suspected of having a mechanical small bowel
obstruction. Which assessment finding is most consistent with the early stages of this
condition?
• A) Ribbon-like, liquid stools
• B) High-pitched, hyperactive, or "tinkling" bowel sounds
• C) Absent bowel sounds in all four quadrants
• D) Significant abdominal distention with no pain
Answer: B
