ATI RN MEDICAL SURGICAL EXAM COMPREHENSIVE
GUIDE 2026/27 EDITION Q&A
1. A nurse is caring for a client with heart failure who has
crackles in both lung bases, an ejection fraction of 35%, and
a recent weight gain of 3 kg in 3 days. Which medication
should the nurse anticipate administering first?
A. Metoprolol
B. Digoxin
, C. Furosemide
D. Spironolactone
Correct Answer: C
Explanation: Furosemide is a loop diuretic that rapidly reduces
preload and relieves pulmonary congestion in acute
decompensated heart failure. Metoprolol is a beta-blocker
used for chronic management. Digoxin improves contractility
but does not address fluid overload quickly. Spironolactone is
a potassium-sparing diuretic used in chronic HF, not for acute
decompensation.
2. A client with chronic obstructive pulmonary disease (COPD)
has a respiratory rate of 28, oxygen saturation of 88% on
room air, and an arterial blood gas (ABG) showing pH 7.32,
PaCO2 58 mm Hg, and HCO3 30 mEq/L. Which intervention
should the nurse implement first?
A. Administer bronchodilators
B. Apply non-invasive positive pressure ventilation (NIPPV)
C. Provide oxygen via Venturi mask at 24%
D. Prepare for endotracheal intubation
Correct Answer: C
*Explanation: The ABG shows chronic respiratory acidosis
with compensation. Oxygen should be titrated carefully in
COPD to avoid suppressing hypoxic drive; a Venturi mask at
24% provides precise low-concentration oxygen.
Bronchodilators are important but not the first step. NIPPV
may be used later if oxygenation fails. Intubation is not
indicated initially given the compensated state.*
,3. A postoperative client develops sudden chest pain, dyspnea,
and tachycardia 24 hours after total knee replacement
surgery. The nurse notes an oxygen saturation of 89% on 2 L
nasal cannula. Which action should the nurse take first?
A. Administer subcutaneous heparin
B. Obtain a stat chest x-ray
C. Apply supplemental oxygen at 100%
D. Elevate the head of the bed to 90 degrees
Correct Answer: D
*Explanation: Elevating the head of the bed improves
ventilation and reduces orthopnea. Administering 100%
oxygen is also critical, but positioning is an immediate
nursing action that requires no equipment. Heparin may be
ordered after suspected pulmonary embolism, but it is not a
first action. Chest x-ray is diagnostic but not the priority over
airway and breathing.*
4. A client with diabetes mellitus is receiving continuous enteral
nutrition. The blood glucose level is 280 mg/dL. Which action
should the nurse take?
A. Stop the enteral feeding immediately
B. Administer regular insulin per sliding scale
C. Change the enteral formula to a diabetes-specific formula
D. Check for ketones in the urine
Correct Answer: B
Explanation: Hyperglycemia during enteral feeding is
, common; sliding-scale insulin addresses the immediate
elevation. Stopping the feeding can cause hypoglycemia later
and is not indicated. Changing formula may help chronically
but not emergently. Urine ketones are less relevant without
signs of DKA; blood ketones would be more accurate.
5. A client with cirrhosis has ascites and is on spironolactone.
The nurse assesses a serum potassium of 5.8 mEq/L. Which
dietary choice should the nurse question?
A. Baked potato with skin
B. White rice with steamed carrots
C. Apple slices
D. White bread with butter
Correct Answer: A
*Explanation: Baked potato with skin is high in potassium,
which is dangerous with hyperkalemia (K >5.5).
Spironolactone is potassium-sparing, further increasing risk.
The other options are low-potassium choices appropriate for
this client.*
6. A nurse is monitoring a client receiving a blood transfusion.
Fifteen minutes after initiation, the client reports low back
pain and chills. Vital signs: BP 90/50, HR 110, temperature
38.5°C (101.3°F). Which action should the nurse take first?
A. Slow the transfusion rate
B. Administer acetaminophen
GUIDE 2026/27 EDITION Q&A
1. A nurse is caring for a client with heart failure who has
crackles in both lung bases, an ejection fraction of 35%, and
a recent weight gain of 3 kg in 3 days. Which medication
should the nurse anticipate administering first?
A. Metoprolol
B. Digoxin
, C. Furosemide
D. Spironolactone
Correct Answer: C
Explanation: Furosemide is a loop diuretic that rapidly reduces
preload and relieves pulmonary congestion in acute
decompensated heart failure. Metoprolol is a beta-blocker
used for chronic management. Digoxin improves contractility
but does not address fluid overload quickly. Spironolactone is
a potassium-sparing diuretic used in chronic HF, not for acute
decompensation.
2. A client with chronic obstructive pulmonary disease (COPD)
has a respiratory rate of 28, oxygen saturation of 88% on
room air, and an arterial blood gas (ABG) showing pH 7.32,
PaCO2 58 mm Hg, and HCO3 30 mEq/L. Which intervention
should the nurse implement first?
A. Administer bronchodilators
B. Apply non-invasive positive pressure ventilation (NIPPV)
C. Provide oxygen via Venturi mask at 24%
D. Prepare for endotracheal intubation
Correct Answer: C
*Explanation: The ABG shows chronic respiratory acidosis
with compensation. Oxygen should be titrated carefully in
COPD to avoid suppressing hypoxic drive; a Venturi mask at
24% provides precise low-concentration oxygen.
Bronchodilators are important but not the first step. NIPPV
may be used later if oxygenation fails. Intubation is not
indicated initially given the compensated state.*
,3. A postoperative client develops sudden chest pain, dyspnea,
and tachycardia 24 hours after total knee replacement
surgery. The nurse notes an oxygen saturation of 89% on 2 L
nasal cannula. Which action should the nurse take first?
A. Administer subcutaneous heparin
B. Obtain a stat chest x-ray
C. Apply supplemental oxygen at 100%
D. Elevate the head of the bed to 90 degrees
Correct Answer: D
*Explanation: Elevating the head of the bed improves
ventilation and reduces orthopnea. Administering 100%
oxygen is also critical, but positioning is an immediate
nursing action that requires no equipment. Heparin may be
ordered after suspected pulmonary embolism, but it is not a
first action. Chest x-ray is diagnostic but not the priority over
airway and breathing.*
4. A client with diabetes mellitus is receiving continuous enteral
nutrition. The blood glucose level is 280 mg/dL. Which action
should the nurse take?
A. Stop the enteral feeding immediately
B. Administer regular insulin per sliding scale
C. Change the enteral formula to a diabetes-specific formula
D. Check for ketones in the urine
Correct Answer: B
Explanation: Hyperglycemia during enteral feeding is
, common; sliding-scale insulin addresses the immediate
elevation. Stopping the feeding can cause hypoglycemia later
and is not indicated. Changing formula may help chronically
but not emergently. Urine ketones are less relevant without
signs of DKA; blood ketones would be more accurate.
5. A client with cirrhosis has ascites and is on spironolactone.
The nurse assesses a serum potassium of 5.8 mEq/L. Which
dietary choice should the nurse question?
A. Baked potato with skin
B. White rice with steamed carrots
C. Apple slices
D. White bread with butter
Correct Answer: A
*Explanation: Baked potato with skin is high in potassium,
which is dangerous with hyperkalemia (K >5.5).
Spironolactone is potassium-sparing, further increasing risk.
The other options are low-potassium choices appropriate for
this client.*
6. A nurse is monitoring a client receiving a blood transfusion.
Fifteen minutes after initiation, the client reports low back
pain and chills. Vital signs: BP 90/50, HR 110, temperature
38.5°C (101.3°F). Which action should the nurse take first?
A. Slow the transfusion rate
B. Administer acetaminophen
