ATI Med-Surg Practice Exam Pack 2026-2027
Verified Questions, Answers & Explanations
(Professional & clear)
1. A nurse is reviewing the arterial blood gas (ABG) results for a client with a history of
severe chronic obstructive pulmonary disease (COPD) who is admitted with an acute
respiratory infection. The results are: pH 7.32, PaCO₂ 68 mm Hg, HCO₃⁻ 32 mEq/L,
, PaO₂ 58 mm Hg. Which of the following acid-base imbalances is this client
experiencing?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Partially compensated metabolic acidosis
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO₂ is elevated (>45 mm
Hg), which matches the acidotic state (respiratory origin). The HCO₃⁻ is also elevated
(>26 mEq/L), indicating that the kidneys are attempting to compensate by retaining
bicarbonate. Because the pH has not yet returned to the normal range, the
compensation is partially compensated.
2. A nurse is caring for a client with an acute kidney injury who has a serum potassium
level of 6.8 mEq/L. The nurse notes peaked T waves and a widened QRS complex on
the cardiac monitor. Which of the following prescriptions should the nurse implement
first?
A. Administer oral sodium polystyrene sulfonate 15 g.
B. Administer intravenous 10% calcium gluconate over 5 min.
C. Initiate an intravenous infusion of regular insulin and 50% dextrose.
D. Obtain a 12-lead electrocardiogram (ECG).
Rationale: Severe hyperkalemia with cardiac changes is a medical emergency.
Administering calcium gluconate is the highest priority because it stabilizes the
myocardial cell membrane, reducing the risk of lethal dysrhythmias. While
insulin/dextrose shifts potassium into cells and sodium polystyrene sulfonate removes it
from the body, they do not work as quickly to protect the heart.
3. A nurse is assessing a client who has a serum calcium level of 7.2 mg/dL. Which of
the following findings should the nurse expect? (Select All That Apply.)
A. Positive Trousseau's sign
B. Depressed deep tendon reflexes
C. Circumoral numbness and tingling
D. Hyperactive bowel sounds
, E. Constipation
Rationale: Hypocalcemia (<8.5 mg/dL) increases neuromuscular excitability. Expected
signs include a positive Trousseau's sign (carpopedal spasm induced by inflating a BP
cuff), circumoral paresthesia, hyperactive deep tendon reflexes (not depressed), and
hyperactive smooth muscle manifestations like abdominal cramping and diarrhea (not
constipation).
4. A nurse is planning care for a client who is prescribed a continuous intravenous
infusion of 3% sodium chloride to treat severe symptomatic hyponatremia. Which of the
following interventions should the nurse include?
A. Infuse the solution rapidly via a peripheral intravenous line.
B. Assess neurological status every 1 to 2 hours.
C. Encourage the client to increase oral fluid intake.
D. Monitor for clinical manifestations of hypovolemic shock.
Rationale: 3% sodium chloride is a highly hypertonic solution that must be infused
slowly and carefully (typically via a central line) to avoid osmotic demyelination
syndrome. Rapid shifts can cause severe brain damage. Frequent neurological checks
are required to assess response and screen for complications like cerebral edema or
fluid volume excess. Fluid restriction, rather than increased intake, is typically indicated
for hyponatremia.
5. A nurse is evaluating a client who has been undergoing continuous nasogastric (NG)
tube suctioning for 4 days following an intestinal resection. Which of the following acid-
base imbalances should the nurse monitor for?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Rationale: Nasogastric suctioning removes highly acidic gastric secretions (hydrochloric
acid). The loss of hydrogen ions and chloride results in an excess of base in the
systemic circulation, predisposing the client to metabolic alkalosis.
, 6. A nurse is reviewing the electrolyte panel for a client who has chronic alcohol use
disorder and malnutrition. Which of the following electrolyte imbalances is this client at
the highest risk for developing?
A. Hypernatremia
B. Hypomagnesemia
C. Hypercalcemia
D. Hypokalemia
Rationale: Chronic alcoholism leads to significant renal wasting of magnesium, poor
dietary intake, and impaired gastrointestinal absorption, making hypomagnesemia a
classic, high-yield complication.
7. A nurse is calculating the fluid resuscitation volume for a client using the Parkland
formula. The client weighs 75 kg and has sustained deep partial-thickness burns to 36%
of their total body surface area (TBSA). How many milliliters of Lactated Ringer's should
the nurse administer during the first 8 hours of fluid resuscitation?
A. 10,800 mL
B. 5,400 mL
C. 2,700 mL
D. 1,350 mL
Rationale: The Parkland formula is: 4 mL × weight in kg × % TBSA.
Total 24-hour volume = 4 × 75 × 36 = 10,800 mL.
The standard protocol dictates giving half of the total volume over the first 8 hours:
10,800 ÷ 2 = 5,400 mL.
8. A nurse is assessing a client with severe dehydration. Which of the following
laboratory values should the nurse anticipate?
A. Decreased urine specific gravity
B. Increased hematocrit
C. Decreased blood urea nitrogen (BUN)
D. Decreased serum osmolality
Verified Questions, Answers & Explanations
(Professional & clear)
1. A nurse is reviewing the arterial blood gas (ABG) results for a client with a history of
severe chronic obstructive pulmonary disease (COPD) who is admitted with an acute
respiratory infection. The results are: pH 7.32, PaCO₂ 68 mm Hg, HCO₃⁻ 32 mEq/L,
, PaO₂ 58 mm Hg. Which of the following acid-base imbalances is this client
experiencing?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Partially compensated metabolic acidosis
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO₂ is elevated (>45 mm
Hg), which matches the acidotic state (respiratory origin). The HCO₃⁻ is also elevated
(>26 mEq/L), indicating that the kidneys are attempting to compensate by retaining
bicarbonate. Because the pH has not yet returned to the normal range, the
compensation is partially compensated.
2. A nurse is caring for a client with an acute kidney injury who has a serum potassium
level of 6.8 mEq/L. The nurse notes peaked T waves and a widened QRS complex on
the cardiac monitor. Which of the following prescriptions should the nurse implement
first?
A. Administer oral sodium polystyrene sulfonate 15 g.
B. Administer intravenous 10% calcium gluconate over 5 min.
C. Initiate an intravenous infusion of regular insulin and 50% dextrose.
D. Obtain a 12-lead electrocardiogram (ECG).
Rationale: Severe hyperkalemia with cardiac changes is a medical emergency.
Administering calcium gluconate is the highest priority because it stabilizes the
myocardial cell membrane, reducing the risk of lethal dysrhythmias. While
insulin/dextrose shifts potassium into cells and sodium polystyrene sulfonate removes it
from the body, they do not work as quickly to protect the heart.
3. A nurse is assessing a client who has a serum calcium level of 7.2 mg/dL. Which of
the following findings should the nurse expect? (Select All That Apply.)
A. Positive Trousseau's sign
B. Depressed deep tendon reflexes
C. Circumoral numbness and tingling
D. Hyperactive bowel sounds
, E. Constipation
Rationale: Hypocalcemia (<8.5 mg/dL) increases neuromuscular excitability. Expected
signs include a positive Trousseau's sign (carpopedal spasm induced by inflating a BP
cuff), circumoral paresthesia, hyperactive deep tendon reflexes (not depressed), and
hyperactive smooth muscle manifestations like abdominal cramping and diarrhea (not
constipation).
4. A nurse is planning care for a client who is prescribed a continuous intravenous
infusion of 3% sodium chloride to treat severe symptomatic hyponatremia. Which of the
following interventions should the nurse include?
A. Infuse the solution rapidly via a peripheral intravenous line.
B. Assess neurological status every 1 to 2 hours.
C. Encourage the client to increase oral fluid intake.
D. Monitor for clinical manifestations of hypovolemic shock.
Rationale: 3% sodium chloride is a highly hypertonic solution that must be infused
slowly and carefully (typically via a central line) to avoid osmotic demyelination
syndrome. Rapid shifts can cause severe brain damage. Frequent neurological checks
are required to assess response and screen for complications like cerebral edema or
fluid volume excess. Fluid restriction, rather than increased intake, is typically indicated
for hyponatremia.
5. A nurse is evaluating a client who has been undergoing continuous nasogastric (NG)
tube suctioning for 4 days following an intestinal resection. Which of the following acid-
base imbalances should the nurse monitor for?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Rationale: Nasogastric suctioning removes highly acidic gastric secretions (hydrochloric
acid). The loss of hydrogen ions and chloride results in an excess of base in the
systemic circulation, predisposing the client to metabolic alkalosis.
, 6. A nurse is reviewing the electrolyte panel for a client who has chronic alcohol use
disorder and malnutrition. Which of the following electrolyte imbalances is this client at
the highest risk for developing?
A. Hypernatremia
B. Hypomagnesemia
C. Hypercalcemia
D. Hypokalemia
Rationale: Chronic alcoholism leads to significant renal wasting of magnesium, poor
dietary intake, and impaired gastrointestinal absorption, making hypomagnesemia a
classic, high-yield complication.
7. A nurse is calculating the fluid resuscitation volume for a client using the Parkland
formula. The client weighs 75 kg and has sustained deep partial-thickness burns to 36%
of their total body surface area (TBSA). How many milliliters of Lactated Ringer's should
the nurse administer during the first 8 hours of fluid resuscitation?
A. 10,800 mL
B. 5,400 mL
C. 2,700 mL
D. 1,350 mL
Rationale: The Parkland formula is: 4 mL × weight in kg × % TBSA.
Total 24-hour volume = 4 × 75 × 36 = 10,800 mL.
The standard protocol dictates giving half of the total volume over the first 8 hours:
10,800 ÷ 2 = 5,400 mL.
8. A nurse is assessing a client with severe dehydration. Which of the following
laboratory values should the nurse anticipate?
A. Decreased urine specific gravity
B. Increased hematocrit
C. Decreased blood urea nitrogen (BUN)
D. Decreased serum osmolality
