ATI RN TARGETED MEDICAL-SURGICAL
EXAM QUESTIONS AND ANSWERS WITH
RATIONALES LATEST EXAM UPDATE
.
1. A nurse is collecting data from a client who has emphysema. Which of the following
findings should the nurse expect? (Select all that apply.)
A. Dyspnea
B. Barrel chest
C. Clubbing of the fingers
D. Shallow respirations
E. Bradycardia
Answer: A, B, C, D
Rationale: In emphysema, dyspnea, barrel chest, clubbing of the fingers, and shallow
respirations are expected. Tachycardia, not bradycardia, occurs as the heart compensates for
low oxygen levels .
2. A nurse is caring for a client with pneumonia who has been receiving IV antibiotics.
Which assessment finding indicates treatment is effective?
A. Diminished breath sounds in all lung fields
B. Client reports increased dyspnea
C. Client reports improvement in cough and energy levels
D. Chest x-ray shows increased infiltrates
Page 1 of 39
,Answer: C. Client reports improvement in cough and energy levels
Rationale: Subjective improvement in symptoms such as cough and energy levels indicates a
positive response to antibiotic therapy. Objective data should also show improved breath sounds
and clearing of infiltrates .
3. A nurse is interpreting arterial blood gas (ABG) results for a client. Which values
indicate respiratory acidosis?
A. pH 7.50, PaCO2 30, HCO3 24 B.
pH 7.30, PaCO2 50, HCO3 24
C. pH 7.35, PaCO2 45, HCO3 28
D. pH 7.25, PaCO2 40, HCO3 15
Answer: B. pH 7.30, PaCO2 50, HCO3 24
Rationale: Respiratory acidosis is indicated by a low pH (<7.35) and an elevated PaCO2 (>45).
HCO3 remains normal in the acute phase .
4. A nurse is caring for a client with a pulmonary embolism. Which finding should the
nurse report immediately? A. Heart rate of 100/min
B. Respiratory rate of 24/min
C. Oxygen saturation of 91% on room air
D. Sudden onset of chest pain and dyspnea
Answer: D. Sudden onset of chest pain and dyspnea
Rationale: Sudden chest pain and dyspnea indicate worsening of the pulmonary embolism and
potential hemodynamic compromise. This requires immediate intervention.
5. A nurse is providing postural drainage for a client with bronchiectasis. Which action
should the nurse take?
A. Perform treatment immediately after meals
B. Schedule treatment 1 hour before meals or 3 hours after meals
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,C. Limit treatment to 5 minutes per position
D. Place client in supine position for all drainage
Answer: B. Schedule treatment 1 hour before meals or 3 hours after meals *Rationale:
Postural drainage should be scheduled away from mealtimes to prevent nausea, vomiting, and
aspiration. It's typically done before meals or at least 1-2 hours after eating.*
6. A nurse is assessing a client with suspected tuberculosis. Which finding is most
significant?
A. Night sweats
B. Persistent cough with blood-tinged sputum
C. Low-grade fever
D. Weight gain
Answer: B. Persistent cough with blood-tinged sputum
Rationale: While all symptoms may be present, a persistent cough with hemoptysis (bloodtinged
sputum) is a classic and concerning finding that warrants further investigation for TB.
7. A nurse is caring for a client receiving oxygen at 6 L/min via nasal cannula.
Which finding indicates adequate oxygenation?
A. Oxygen saturation of 88%
B. Oxygen saturation of 94%
C. Respiratory rate of 28/min
D. Use of accessory muscles
Answer: B. Oxygen saturation of 94%
Rationale: Oxygen saturation should generally be maintained at 94% or higher for most clients.
88% is too low, and tachypnea with accessory muscle use indicates respiratory distress.
Page 3 of 39
, 8. A nurse is teaching a client with asthma how to use a metered-dose inhaler (MDI)
with a spacer. Which step is correct? A. Inhale quickly and forcefully
B. Hold breath for 10 seconds after inhalation
C. Exhale into the spacer
D. Activate the inhaler at the end of exhalation
Answer: B. Hold breath for 10 seconds after inhalation
Rationale: Holding the breath for up to 10 seconds allows the medication to deposit in the
airways. Inhalation should be slow and deep, and the inhaler is activated at the beginning of
inspiration .
9. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which
intervention should the nurse prioritize? A. Administer intravenous regular
insulin
B. Encourage the client to drink oral fluids
C. Begin intravenous fluids with normal saline
D. Provide oxygen via nasal cannula
Answer: C. Begin intravenous fluids with normal saline
Rationale: The first priority in DKA management is fluid replacement to correct dehydration and
restore perfusion. Once fluids are initiated, insulin therapy can safely follow .
10. A nurse is monitoring a client who had a thyroidectomy. The client suddenly develops
stridor, difficulty breathing, and restlessness. Which action should the nurse take first?
A. Administer calcium gluconate
B. Prepare for emergency tracheostomy
C. Place the client in high-Fowler's position
D. Notify the healthcare provider immediately
Answer: B. Prepare for emergency tracheostomy
Page 4 of 39
EXAM QUESTIONS AND ANSWERS WITH
RATIONALES LATEST EXAM UPDATE
.
1. A nurse is collecting data from a client who has emphysema. Which of the following
findings should the nurse expect? (Select all that apply.)
A. Dyspnea
B. Barrel chest
C. Clubbing of the fingers
D. Shallow respirations
E. Bradycardia
Answer: A, B, C, D
Rationale: In emphysema, dyspnea, barrel chest, clubbing of the fingers, and shallow
respirations are expected. Tachycardia, not bradycardia, occurs as the heart compensates for
low oxygen levels .
2. A nurse is caring for a client with pneumonia who has been receiving IV antibiotics.
Which assessment finding indicates treatment is effective?
A. Diminished breath sounds in all lung fields
B. Client reports increased dyspnea
C. Client reports improvement in cough and energy levels
D. Chest x-ray shows increased infiltrates
Page 1 of 39
,Answer: C. Client reports improvement in cough and energy levels
Rationale: Subjective improvement in symptoms such as cough and energy levels indicates a
positive response to antibiotic therapy. Objective data should also show improved breath sounds
and clearing of infiltrates .
3. A nurse is interpreting arterial blood gas (ABG) results for a client. Which values
indicate respiratory acidosis?
A. pH 7.50, PaCO2 30, HCO3 24 B.
pH 7.30, PaCO2 50, HCO3 24
C. pH 7.35, PaCO2 45, HCO3 28
D. pH 7.25, PaCO2 40, HCO3 15
Answer: B. pH 7.30, PaCO2 50, HCO3 24
Rationale: Respiratory acidosis is indicated by a low pH (<7.35) and an elevated PaCO2 (>45).
HCO3 remains normal in the acute phase .
4. A nurse is caring for a client with a pulmonary embolism. Which finding should the
nurse report immediately? A. Heart rate of 100/min
B. Respiratory rate of 24/min
C. Oxygen saturation of 91% on room air
D. Sudden onset of chest pain and dyspnea
Answer: D. Sudden onset of chest pain and dyspnea
Rationale: Sudden chest pain and dyspnea indicate worsening of the pulmonary embolism and
potential hemodynamic compromise. This requires immediate intervention.
5. A nurse is providing postural drainage for a client with bronchiectasis. Which action
should the nurse take?
A. Perform treatment immediately after meals
B. Schedule treatment 1 hour before meals or 3 hours after meals
Page 2 of 39
,C. Limit treatment to 5 minutes per position
D. Place client in supine position for all drainage
Answer: B. Schedule treatment 1 hour before meals or 3 hours after meals *Rationale:
Postural drainage should be scheduled away from mealtimes to prevent nausea, vomiting, and
aspiration. It's typically done before meals or at least 1-2 hours after eating.*
6. A nurse is assessing a client with suspected tuberculosis. Which finding is most
significant?
A. Night sweats
B. Persistent cough with blood-tinged sputum
C. Low-grade fever
D. Weight gain
Answer: B. Persistent cough with blood-tinged sputum
Rationale: While all symptoms may be present, a persistent cough with hemoptysis (bloodtinged
sputum) is a classic and concerning finding that warrants further investigation for TB.
7. A nurse is caring for a client receiving oxygen at 6 L/min via nasal cannula.
Which finding indicates adequate oxygenation?
A. Oxygen saturation of 88%
B. Oxygen saturation of 94%
C. Respiratory rate of 28/min
D. Use of accessory muscles
Answer: B. Oxygen saturation of 94%
Rationale: Oxygen saturation should generally be maintained at 94% or higher for most clients.
88% is too low, and tachypnea with accessory muscle use indicates respiratory distress.
Page 3 of 39
, 8. A nurse is teaching a client with asthma how to use a metered-dose inhaler (MDI)
with a spacer. Which step is correct? A. Inhale quickly and forcefully
B. Hold breath for 10 seconds after inhalation
C. Exhale into the spacer
D. Activate the inhaler at the end of exhalation
Answer: B. Hold breath for 10 seconds after inhalation
Rationale: Holding the breath for up to 10 seconds allows the medication to deposit in the
airways. Inhalation should be slow and deep, and the inhaler is activated at the beginning of
inspiration .
9. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which
intervention should the nurse prioritize? A. Administer intravenous regular
insulin
B. Encourage the client to drink oral fluids
C. Begin intravenous fluids with normal saline
D. Provide oxygen via nasal cannula
Answer: C. Begin intravenous fluids with normal saline
Rationale: The first priority in DKA management is fluid replacement to correct dehydration and
restore perfusion. Once fluids are initiated, insulin therapy can safely follow .
10. A nurse is monitoring a client who had a thyroidectomy. The client suddenly develops
stridor, difficulty breathing, and restlessness. Which action should the nurse take first?
A. Administer calcium gluconate
B. Prepare for emergency tracheostomy
C. Place the client in high-Fowler's position
D. Notify the healthcare provider immediately
Answer: B. Prepare for emergency tracheostomy
Page 4 of 39
