Comprehensive ATI RN Medical-Surgical Assessment and
Clinical Judgment Examination 2026/2027 EDITION
WITH QUESTIONS AND VERIFIED ANSWERS ALREADY
GRADED A
Question 1
A 72-year-old patient with a history of heart failure is admitted with acute pulmonary edema.
The patient is extremely dyspneic, anxious, and has pink, frothy sputum. The nurse auscultates
coarse crackles throughout all lung fields. The patient’s blood pressure is 168/92 mm Hg, heart
rate is 118 bpm, and oxygen saturation is 88% on a 100% non-rebreather mask. The provider
has just written a series of STAT orders. Which order should the nurse implement first?
A) Administer furosemide 80 mg IV push.
B) Administer morphine sulfate 4 mg IV push.
C) Administer nitroglycerin 0.4 mg sublingual.
D) Position the patient in a high-Fowler's position with legs dangling.
ANSWER: D
Explanation: The immediate, priority intervention for a patient in acute pulmonary edema is to
position them in high-Fowler's position with their legs dangling. This position uses gravity to
reduce venous return (preload) to the heart, decreasing the volume of blood returning to the
pulmonary circulation and thereby alleviating pulmonary congestion and dyspnea. This is a
classic, immediate nursing action that does not require a provider's order and should be done
simultaneously while preparing to administer medications. While furosemide, morphine, and
nitroglycerin are all critical pharmacological interventions for pulmonary edema, they all require
preparation and administration time. Positioning the patient is the fastest, most direct
intervention to reduce preload and improve ventilation-perfusion mismatch. Options A, B, and C
are important but are secondary to the immediate life-saving measure of positioning.
Question 2
A nurse is caring for a patient immediately following a coronary artery bypass graft (CABG)
surgery. The patient has a mediastinal chest tube in place to water-seal drainage with low
continuous suction. Which assessment finding requires the nurse's most immediate action?
A) 150 mL of sanguineous drainage in the first hour post-op.
B) Continuous gentle bubbling in the suction control chamber.
,C) Intermittent bubbling in the water-seal chamber during exhalation.
D) A small air leak that is heard as a puff of air from the patient's neck.
ANSWER: A
Explanation: Drainage of 150 mL in the first hour following CABG is a significant and potentially
dangerous finding. This amount of sanguineous drainage, especially in the first few hours post-
operatively, indicates active, rapid bleeding (hemorrhage) and can quickly lead to cardiac
tamponade or hypovolemic shock. The nurse should immediately notify the surgeon and
prepare for the possibility of a return to the operating room. Continuous gentle bubbling in the
suction control chamber is the expected and appropriate function of the suction mechanism.
Intermittent bubbling in the water-seal chamber during exhalation is an expected finding
indicating an air leak from the lung or pleural space, which is also normal and resolves as the
lung re-expands. A small subcutaneous air leak (crepitus) is common post-CABG and requires
monitoring, but is not an immediate life-threatening emergency compared to the massive
hemorrhage indicated by the drainage volume.
Question 3
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via a Venturi
mask at 40%. The patient’s arterial blood gas (ABG) results are: pH 7.32, PaCO2 58 mm Hg,
HCO3- 32 mEq/L, and PaO2 65 mm Hg. Which interpretation of these results is most accurate?
A) Uncompensated respiratory acidosis.
B) Compensated respiratory acidosis.
C) Partially compensated respiratory acidosis.
D) Uncompensated metabolic acidosis.
ANSWER: C
Explanation: The ABG shows a pH below the normal range of 7.35-7.45 (7.32, acidotic), a PaCO2
above the normal range of 35-45 mm Hg (58 mm Hg, indicating respiratory acidosis), and an
HCO3- above the normal range of 22-26 mEq/L (32 mEq/L). The pH is acidotic, so the primary
problem is acidosis. The PaCO2 is elevated, establishing the primary problem as respiratory. The
HCO3- is elevated, which represents a metabolic (renal) compensation mechanism where the
kidneys are retaining bicarbonate to try to buffer the acid. Because the pH is still abnormal, the
compensation is not complete. This is a classic finding in a patient with COPD who has chronic
hypercapnia, demonstrating partial compensation. Uncompensated would have a normal HCO3-
. Compensated would have a normal pH. Metabolic acidosis would be indicated by a low HCO3-.
,Question 4
The nurse is caring for a patient admitted with a subdural hematoma following a fall. The
patient has become increasingly lethargic over the past hour, and the nurse notes a fixed and
dilated pupil on the right side. Which additional assessment finding should the nurse monitor
for that would indicate uncal herniation?
A) Decorticate posturing to painful stimuli.
B) A rapid increase in blood pressure and bradycardia.
C) Flaccid paralysis of all four extremities.
D) Cheyne-Stokes respirations.
ANSWER: B
Explanation: A fixed and dilated pupil on the same side as the lesion (ipsilateral) is an early sign
of uncal herniation, where the uncus of the temporal lobe is forced over the tentorium,
compressing the oculomotor nerve (CN III). If this progresses, the brainstem is compromised,
leading to the Cushing's triad: hypertension (with a widening pulse pressure), bradycardia, and
irregular respirations. This is a critical sign of increased intracranial pressure (ICP) and
impending brainstem herniation. Decorticate posturing (flexion of arms, extension of legs) is a
sign of damage above the brainstem, while decerebrate (extension of all four) is a more severe
sign of brainstem damage. Flaccid paralysis indicates a loss of motor function and is a late, grave
sign. Cheyne-Stokes respirations are a pattern of periodic breathing often seen with deep,
bilateral hemispheric damage or metabolic conditions, but not specifically indicative of uncal
herniation as the Cushing's triad is.
Question 5
A patient with a history of peptic ulcer disease (PUD) is experiencing severe abdominal pain,
vomiting, and a rigid, board-like abdomen. The patient is hypotensive and tachycardic. Which of
the following is the priority nursing intervention?
A) Administer a proton pump inhibitor (PPI) intravenously.
B) Insert a nasogastric (NG) tube to low intermittent suction.
C) Prepare the patient for an immediate upper endoscopy.
D) Administer IV fluids and prepare the patient for emergency surgery.
ANSWER: D
Explanation: The patient's presentation of a rigid, board-like abdomen with severe pain,
vomiting, and signs of hypovolemic shock (hypotension, tachycardia) is highly indicative of a
perforated ulcer, which is a surgical emergency. The priority is to stabilize the patient's
hemodynamic status by administering IV fluids and preparing the patient for emergency surgery
to repair the perforation. Perforation allows gastric contents to spill into the peritoneal cavity,
, leading to peritonitis and sepsis. While administering IV fluids is the immediate stabilizing
action, the definitive treatment is surgery. Inserting an NG tube is important to decompress the
stomach and prevent further spillage, but it is done after hemodynamic stabilization.
Administering a PPI is part of the medical management for PUD but is not the priority in this
life-threatening scenario. An upper endoscopy is contraindicated in a suspected perforation
because it could exacerbate the leak.
Question 6
A nurse is providing teaching to a patient who is newly diagnosed with type 1 diabetes mellitus.
The patient asks about the differences between hypoglycemia and diabetic ketoacidosis (DKA).
Which response by the nurse is most accurate regarding the management of severe
hypoglycemia?
A) "Severe hypoglycemia requires immediate administration of intravenous insulin."
B) "If you are unconscious from severe hypoglycemia, you should receive intravenous dextrose
or glucagon."
C) "You should eat a complex carbohydrate like a peanut butter sandwich to treat severe
hypoglycemia."
D) "Severe hypoglycemia is managed by drinking a 12-ounce can of regular soda."
ANSWER: B
Explanation: The treatment of severe hypoglycemia, where a patient is unconscious or unable
to swallow, requires emergency intervention. The priority is to rapidly increase blood glucose
levels. This is safely and effectively done by administering intravenous dextrose (D50W) or by
administering intramuscular or subcutaneous glucagon (a hormone that stimulates the liver to
release stored glycogen). Option A is incorrect because insulin would further lower blood
glucose, worsening the condition. Option C and D are incorrect because they describe
treatments for mild to moderate hypoglycemia in a conscious patient who can swallow safely. A
peanut butter sandwich contains fat and protein, which slow the absorption of sugar, making it
less effective for an acute, severe event. While regular soda has sugar, it cannot be given to an
unconscious patient due to the risk of aspiration.
Question 7
A patient with end-stage renal disease (ESRD) is undergoing hemodialysis for the first time via
an internal arteriovenous (AV) fistula in the left arm. Which of the following nursing actions is
most appropriate for the care of the AV fistula?
A) Assess for a bruit and thrill over the site every 8 hours and document.
Clinical Judgment Examination 2026/2027 EDITION
WITH QUESTIONS AND VERIFIED ANSWERS ALREADY
GRADED A
Question 1
A 72-year-old patient with a history of heart failure is admitted with acute pulmonary edema.
The patient is extremely dyspneic, anxious, and has pink, frothy sputum. The nurse auscultates
coarse crackles throughout all lung fields. The patient’s blood pressure is 168/92 mm Hg, heart
rate is 118 bpm, and oxygen saturation is 88% on a 100% non-rebreather mask. The provider
has just written a series of STAT orders. Which order should the nurse implement first?
A) Administer furosemide 80 mg IV push.
B) Administer morphine sulfate 4 mg IV push.
C) Administer nitroglycerin 0.4 mg sublingual.
D) Position the patient in a high-Fowler's position with legs dangling.
ANSWER: D
Explanation: The immediate, priority intervention for a patient in acute pulmonary edema is to
position them in high-Fowler's position with their legs dangling. This position uses gravity to
reduce venous return (preload) to the heart, decreasing the volume of blood returning to the
pulmonary circulation and thereby alleviating pulmonary congestion and dyspnea. This is a
classic, immediate nursing action that does not require a provider's order and should be done
simultaneously while preparing to administer medications. While furosemide, morphine, and
nitroglycerin are all critical pharmacological interventions for pulmonary edema, they all require
preparation and administration time. Positioning the patient is the fastest, most direct
intervention to reduce preload and improve ventilation-perfusion mismatch. Options A, B, and C
are important but are secondary to the immediate life-saving measure of positioning.
Question 2
A nurse is caring for a patient immediately following a coronary artery bypass graft (CABG)
surgery. The patient has a mediastinal chest tube in place to water-seal drainage with low
continuous suction. Which assessment finding requires the nurse's most immediate action?
A) 150 mL of sanguineous drainage in the first hour post-op.
B) Continuous gentle bubbling in the suction control chamber.
,C) Intermittent bubbling in the water-seal chamber during exhalation.
D) A small air leak that is heard as a puff of air from the patient's neck.
ANSWER: A
Explanation: Drainage of 150 mL in the first hour following CABG is a significant and potentially
dangerous finding. This amount of sanguineous drainage, especially in the first few hours post-
operatively, indicates active, rapid bleeding (hemorrhage) and can quickly lead to cardiac
tamponade or hypovolemic shock. The nurse should immediately notify the surgeon and
prepare for the possibility of a return to the operating room. Continuous gentle bubbling in the
suction control chamber is the expected and appropriate function of the suction mechanism.
Intermittent bubbling in the water-seal chamber during exhalation is an expected finding
indicating an air leak from the lung or pleural space, which is also normal and resolves as the
lung re-expands. A small subcutaneous air leak (crepitus) is common post-CABG and requires
monitoring, but is not an immediate life-threatening emergency compared to the massive
hemorrhage indicated by the drainage volume.
Question 3
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via a Venturi
mask at 40%. The patient’s arterial blood gas (ABG) results are: pH 7.32, PaCO2 58 mm Hg,
HCO3- 32 mEq/L, and PaO2 65 mm Hg. Which interpretation of these results is most accurate?
A) Uncompensated respiratory acidosis.
B) Compensated respiratory acidosis.
C) Partially compensated respiratory acidosis.
D) Uncompensated metabolic acidosis.
ANSWER: C
Explanation: The ABG shows a pH below the normal range of 7.35-7.45 (7.32, acidotic), a PaCO2
above the normal range of 35-45 mm Hg (58 mm Hg, indicating respiratory acidosis), and an
HCO3- above the normal range of 22-26 mEq/L (32 mEq/L). The pH is acidotic, so the primary
problem is acidosis. The PaCO2 is elevated, establishing the primary problem as respiratory. The
HCO3- is elevated, which represents a metabolic (renal) compensation mechanism where the
kidneys are retaining bicarbonate to try to buffer the acid. Because the pH is still abnormal, the
compensation is not complete. This is a classic finding in a patient with COPD who has chronic
hypercapnia, demonstrating partial compensation. Uncompensated would have a normal HCO3-
. Compensated would have a normal pH. Metabolic acidosis would be indicated by a low HCO3-.
,Question 4
The nurse is caring for a patient admitted with a subdural hematoma following a fall. The
patient has become increasingly lethargic over the past hour, and the nurse notes a fixed and
dilated pupil on the right side. Which additional assessment finding should the nurse monitor
for that would indicate uncal herniation?
A) Decorticate posturing to painful stimuli.
B) A rapid increase in blood pressure and bradycardia.
C) Flaccid paralysis of all four extremities.
D) Cheyne-Stokes respirations.
ANSWER: B
Explanation: A fixed and dilated pupil on the same side as the lesion (ipsilateral) is an early sign
of uncal herniation, where the uncus of the temporal lobe is forced over the tentorium,
compressing the oculomotor nerve (CN III). If this progresses, the brainstem is compromised,
leading to the Cushing's triad: hypertension (with a widening pulse pressure), bradycardia, and
irregular respirations. This is a critical sign of increased intracranial pressure (ICP) and
impending brainstem herniation. Decorticate posturing (flexion of arms, extension of legs) is a
sign of damage above the brainstem, while decerebrate (extension of all four) is a more severe
sign of brainstem damage. Flaccid paralysis indicates a loss of motor function and is a late, grave
sign. Cheyne-Stokes respirations are a pattern of periodic breathing often seen with deep,
bilateral hemispheric damage or metabolic conditions, but not specifically indicative of uncal
herniation as the Cushing's triad is.
Question 5
A patient with a history of peptic ulcer disease (PUD) is experiencing severe abdominal pain,
vomiting, and a rigid, board-like abdomen. The patient is hypotensive and tachycardic. Which of
the following is the priority nursing intervention?
A) Administer a proton pump inhibitor (PPI) intravenously.
B) Insert a nasogastric (NG) tube to low intermittent suction.
C) Prepare the patient for an immediate upper endoscopy.
D) Administer IV fluids and prepare the patient for emergency surgery.
ANSWER: D
Explanation: The patient's presentation of a rigid, board-like abdomen with severe pain,
vomiting, and signs of hypovolemic shock (hypotension, tachycardia) is highly indicative of a
perforated ulcer, which is a surgical emergency. The priority is to stabilize the patient's
hemodynamic status by administering IV fluids and preparing the patient for emergency surgery
to repair the perforation. Perforation allows gastric contents to spill into the peritoneal cavity,
, leading to peritonitis and sepsis. While administering IV fluids is the immediate stabilizing
action, the definitive treatment is surgery. Inserting an NG tube is important to decompress the
stomach and prevent further spillage, but it is done after hemodynamic stabilization.
Administering a PPI is part of the medical management for PUD but is not the priority in this
life-threatening scenario. An upper endoscopy is contraindicated in a suspected perforation
because it could exacerbate the leak.
Question 6
A nurse is providing teaching to a patient who is newly diagnosed with type 1 diabetes mellitus.
The patient asks about the differences between hypoglycemia and diabetic ketoacidosis (DKA).
Which response by the nurse is most accurate regarding the management of severe
hypoglycemia?
A) "Severe hypoglycemia requires immediate administration of intravenous insulin."
B) "If you are unconscious from severe hypoglycemia, you should receive intravenous dextrose
or glucagon."
C) "You should eat a complex carbohydrate like a peanut butter sandwich to treat severe
hypoglycemia."
D) "Severe hypoglycemia is managed by drinking a 12-ounce can of regular soda."
ANSWER: B
Explanation: The treatment of severe hypoglycemia, where a patient is unconscious or unable
to swallow, requires emergency intervention. The priority is to rapidly increase blood glucose
levels. This is safely and effectively done by administering intravenous dextrose (D50W) or by
administering intramuscular or subcutaneous glucagon (a hormone that stimulates the liver to
release stored glycogen). Option A is incorrect because insulin would further lower blood
glucose, worsening the condition. Option C and D are incorrect because they describe
treatments for mild to moderate hypoglycemia in a conscious patient who can swallow safely. A
peanut butter sandwich contains fat and protein, which slow the absorption of sugar, making it
less effective for an acute, severe event. While regular soda has sugar, it cannot be given to an
unconscious patient due to the risk of aspiration.
Question 7
A patient with end-stage renal disease (ESRD) is undergoing hemodialysis for the first time via
an internal arteriovenous (AV) fistula in the left arm. Which of the following nursing actions is
most appropriate for the care of the AV fistula?
A) Assess for a bruit and thrill over the site every 8 hours and document.
