MIDTERM EXAM 2026
QUESTIONS AND ANSWERS WITH
RATIONALES
, ATI MED-SURG COMPREHENSIVE PREDICTOR MIDTERM EXAM (2026) | 200
PRACTICE QUESTIONS WITH VERIFIED ANSWERS & RATIONALES
1. Cardiac — Heart Failure
A client with chronic heart failure reports a 3-lb weight gain in 2 days, increased ankle
swelling, and shortness of breath when lying flat. Which action should the nurse take
first?
A. Encourage the client to increase oral fluid intake
B. Notify the healthcare provider
C. Document findings and reassess in 4 hours
D. Instruct the client to restrict sodium to 1 g/day starting immediately
Answer: B
Rationale: A rapid weight gain (>2–3 lb in 1–2 days), worsening edema, and orthopnea
indicate fluid overload/worsening heart failure. This requires prompt provider notification
for possible diuretic adjustment. Increasing fluids (A) would worsen the problem.
Waiting to reassess (C) delays needed intervention. Sodium restriction (D) is
appropriate long-term teaching but not the first action for acute worsening symptoms.
2. Respiratory — COPD
A nurse is caring for a client with severe COPD who is receiving oxygen therapy. Which
finding requires immediate follow-up?
A. Oxygen saturation of 90% on room air baseline
B. Respiratory rate of 22/min
C. Client is drowsy and difficult to arouse
D. Client reports mild dyspnea with exertion
,Answer: C
Rationale: Drowsiness and difficulty arousing in a COPD client can indicate CO2
narcosis from oxygen-induced hypoventilation (common if O2 is delivered at too high a
flow rate in a chronic CO2 retainer). This is an emergent finding. The other findings (A,
B, D) are consistent with baseline COPD status and don't indicate acute deterioration.
3. Endocrine — DKA
A client is admitted with diabetic ketoacidosis (DKA). Blood glucose is 480 mg/dL, and
the client is tachypneic with fruity-smelling breath. Which prescribed intervention should
the nurse anticipate implementing first?
A. Subcutaneous insulin injection
B. IV isotonic fluid administration
C. IV sodium bicarbonate
D. Oral potassium supplementation
Answer: B
Rationale: In DKA, the priority is fluid resuscitation with isotonic saline (0.9% NaCl) to
correct dehydration and improve perfusion before insulin therapy begins. IV (not
subcutaneous) regular insulin is used, and it is started after initial fluid replacement.
Bicarbonate is not routinely used unless pH is severely low. Potassium must be
corrected and monitored carefully, but fluids come first.
4. Renal — AKI
A client with acute kidney injury has a serum potassium of 6.4 mEq/L. Which ECG
change should the nurse anticipate?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST segment depression
, Answer: B
Rationale: Hyperkalemia classically produces peaked, narrow T waves early on,
progressing to widened QRS and eventual sine-wave pattern if untreated. U waves and
ST depression are more associated with hypokalemia. Prolonged QT is linked to
hypocalcemia/hypomagnesemia, not primarily hyperkalemia.
5. Neuro — Stroke
A client arrives at the emergency department with sudden left-sided facial droop, slurred
speech, and left arm weakness that began 90 minutes ago. Which action is the priority?
A. Obtain a non-contrast CT scan of the head
B. Administer aspirin
C. Draw blood for coagulation studies
D. Perform a full neurological assessment using the NIH Stroke Scale
Answer: A
Rationale: A non-contrast CT scan must be obtained immediately to rule out
hemorrhagic stroke before any thrombolytic or antiplatelet therapy can be considered —
this is the priority given the narrow tPA treatment window (typically within 3–4.5 hours of
symptom onset). Coagulation studies and NIHSS assessment happen in parallel but do
not take priority over ruling out hemorrhage first.
6. GI — Pancreatitis
A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which position should the nurse recommend to help relieve pain?
A. Supine with legs extended
B. Sitting upright, leaning forward with knees drawn to chest
C. Left lateral (Sims') position
D. High Fowler's with legs extended
QUESTIONS AND ANSWERS WITH
RATIONALES
, ATI MED-SURG COMPREHENSIVE PREDICTOR MIDTERM EXAM (2026) | 200
PRACTICE QUESTIONS WITH VERIFIED ANSWERS & RATIONALES
1. Cardiac — Heart Failure
A client with chronic heart failure reports a 3-lb weight gain in 2 days, increased ankle
swelling, and shortness of breath when lying flat. Which action should the nurse take
first?
A. Encourage the client to increase oral fluid intake
B. Notify the healthcare provider
C. Document findings and reassess in 4 hours
D. Instruct the client to restrict sodium to 1 g/day starting immediately
Answer: B
Rationale: A rapid weight gain (>2–3 lb in 1–2 days), worsening edema, and orthopnea
indicate fluid overload/worsening heart failure. This requires prompt provider notification
for possible diuretic adjustment. Increasing fluids (A) would worsen the problem.
Waiting to reassess (C) delays needed intervention. Sodium restriction (D) is
appropriate long-term teaching but not the first action for acute worsening symptoms.
2. Respiratory — COPD
A nurse is caring for a client with severe COPD who is receiving oxygen therapy. Which
finding requires immediate follow-up?
A. Oxygen saturation of 90% on room air baseline
B. Respiratory rate of 22/min
C. Client is drowsy and difficult to arouse
D. Client reports mild dyspnea with exertion
,Answer: C
Rationale: Drowsiness and difficulty arousing in a COPD client can indicate CO2
narcosis from oxygen-induced hypoventilation (common if O2 is delivered at too high a
flow rate in a chronic CO2 retainer). This is an emergent finding. The other findings (A,
B, D) are consistent with baseline COPD status and don't indicate acute deterioration.
3. Endocrine — DKA
A client is admitted with diabetic ketoacidosis (DKA). Blood glucose is 480 mg/dL, and
the client is tachypneic with fruity-smelling breath. Which prescribed intervention should
the nurse anticipate implementing first?
A. Subcutaneous insulin injection
B. IV isotonic fluid administration
C. IV sodium bicarbonate
D. Oral potassium supplementation
Answer: B
Rationale: In DKA, the priority is fluid resuscitation with isotonic saline (0.9% NaCl) to
correct dehydration and improve perfusion before insulin therapy begins. IV (not
subcutaneous) regular insulin is used, and it is started after initial fluid replacement.
Bicarbonate is not routinely used unless pH is severely low. Potassium must be
corrected and monitored carefully, but fluids come first.
4. Renal — AKI
A client with acute kidney injury has a serum potassium of 6.4 mEq/L. Which ECG
change should the nurse anticipate?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST segment depression
, Answer: B
Rationale: Hyperkalemia classically produces peaked, narrow T waves early on,
progressing to widened QRS and eventual sine-wave pattern if untreated. U waves and
ST depression are more associated with hypokalemia. Prolonged QT is linked to
hypocalcemia/hypomagnesemia, not primarily hyperkalemia.
5. Neuro — Stroke
A client arrives at the emergency department with sudden left-sided facial droop, slurred
speech, and left arm weakness that began 90 minutes ago. Which action is the priority?
A. Obtain a non-contrast CT scan of the head
B. Administer aspirin
C. Draw blood for coagulation studies
D. Perform a full neurological assessment using the NIH Stroke Scale
Answer: A
Rationale: A non-contrast CT scan must be obtained immediately to rule out
hemorrhagic stroke before any thrombolytic or antiplatelet therapy can be considered —
this is the priority given the narrow tPA treatment window (typically within 3–4.5 hours of
symptom onset). Coagulation studies and NIHSS assessment happen in parallel but do
not take priority over ruling out hemorrhage first.
6. GI — Pancreatitis
A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which position should the nurse recommend to help relieve pain?
A. Supine with legs extended
B. Sitting upright, leaning forward with knees drawn to chest
C. Left lateral (Sims') position
D. High Fowler's with legs extended
