150 Comprehensive Questions with Detailed Rationales |
Comprehensive Med-Surg Mastery
Exam: ATI RN Adult Medical-Surgical CMS Proctored Exam 2026/2027
Format: 100-150 Questions (Practice Version), Multiple Choice, NGN-Style Items
Content Areas: Cardiovascular, Respiratory, GI, Renal/Genitourinary, Endocrine,
Neurological, Hematology/Oncology, Musculoskeletal, Perioperative, Pain & Safety
Administration: Proctored (ATI Live Proctoring or CAT)
1. A nurse in the emergency department is assessing a client. Which action should
the nurse take FIRST?
a) Obtain a sputum sample for culture
b) Administer ondansetron for nausea
c) Initiate airborne precautions
d) Prepare the client for a chest x-ray
Rationale: The priority is to initiate airborne precautions to protect healthcare
workers and other patients from potential airborne transmission. According to the
ABCs and safety principles, staff and patient safety must be established before
other interventions .
,2. A nurse is caring for a client who is postoperative and has a prescription for
fentanyl PRN. In the event the client develops respiratory depression, which
medication should the nurse ensure is available?
a) Naloxone
b) Atropine
c) Flumazenil
d) Acetylcysteine
Rationale: Naloxone (Narcan) is an opioid antagonist that reverses the effects of
fentanyl and other opioids, including respiratory depression. This is a critical
reversal agent that should be readily available whenever opioids are
administered .
3. A nurse in an emergency department is assessing a client. Which finding
suggests a tension pneumothorax?
a) Absent breath sounds on the affected side with tracheal deviation
b) Rhonchi throughout all lung fields
c) Crackles in bilateral lung bases
d) Wheezing on expiration
Rationale: Tension pneumothorax causes absent breath sounds on the affected
side, hyperresonance, and tracheal deviation away from the affected side. This is a
medical emergency requiring immediate needle decompression .
4. A nurse is caring for a client who has a central venous access device and notes
the tubing has become disconnected. The client develops dyspnea and
tachycardia. Which action should the nurse take FIRST?
a) Perform an ECG
b) Obtain ABG values
c) Turn the client to the left side
d) Clamp the catheter
,Rationale: Air embolism is a life-threatening complication. The nurse should turn
the client to the left side (Durant's maneuver) and clamp the catheter to prevent
further air from entering the circulation .
5. A client with salicylate (aspirin) toxicity initially presents with what acid-base
imbalance?
a) Metabolic alkalosis
b) Respiratory acidosis
c) Metabolic acidosis
d) Respiratory alkalosis
Rationale: Salicylate toxicity initially causes respiratory alkalosis due to central
nervous system stimulation (hyperventilation). As toxicity progresses, metabolic
acidosis develops due to accumulation of organic acids .
6. A client reports chest pain. After administering sublingual nitroglycerin, which
vital sign change requires immediate intervention?
a) Heart rate from 80 to 90 bpm
b) Blood pressure from 120/80 to 90/60 mm Hg
c) Respiratory rate from 16 to 20/min
d) Temperature from 37.0°C to 37.2°C
Rationale: Nitroglycerin causes vasodilation and can cause significant
hypotension. A drop to 90/60 mm Hg requires holding further doses and notifying
the provider .
7. A nurse is caring for a client who had a left lower lobectomy for lung cancer.
Which factor will have the most significant impact on the plan of care?
a) Lung cancer usually metastasizes before the client presents with symptoms
b) The client will require lifelong oxygen therapy
, c) The client will be unable to ambulate independently
d) Pain management is rarely needed after thoracic surgery
Rationale: Lung cancer typically metastasizes before symptoms appear. The nurse
must assess for metastatic spread (brain, bone, liver) even after surgical resection .
8. A nurse is preparing to administer a unit of packed RBCs. Identify the correct
sequence of steps.
a) Obtain venous access → Obtain blood from bank → Verify compatibility → Initiate
transfusion → Remain with client for first 15-30 minutes
b) Verify compatibility → Obtain venous access → Obtain blood → Initiate transfusion →
Remain with client
c) Obtain blood → Verify compatibility → Obtain venous access → Initiate transfusion →
Remain with client
d) Obtain venous access → Verify compatibility → Obtain blood → Initiate transfusion →
Remain with client
Rationale: The correct sequence is: obtain venous access, verify compatibility with
another nurse, obtain blood from the blood bank, initiate transfusion slowly, and
remain with the client for the first 15-30 minutes to monitor for transfusion
reactions .
9. A client with acute myocardial infarction reports chest pain rated 8/10. Which is
the nurse's priority action?
a) Administer prescribed nitroglycerin and reassess
b) Document the pain
c) Offer a snack
d) Call family
Rationale: Chest pain in MI indicates ongoing myocardial ischemia, which is life-
threatening. Administering prescribed nitroglycerin addresses myocardial ischemia
directly. Documentation alone does not treat the patient .
Comprehensive Med-Surg Mastery
Exam: ATI RN Adult Medical-Surgical CMS Proctored Exam 2026/2027
Format: 100-150 Questions (Practice Version), Multiple Choice, NGN-Style Items
Content Areas: Cardiovascular, Respiratory, GI, Renal/Genitourinary, Endocrine,
Neurological, Hematology/Oncology, Musculoskeletal, Perioperative, Pain & Safety
Administration: Proctored (ATI Live Proctoring or CAT)
1. A nurse in the emergency department is assessing a client. Which action should
the nurse take FIRST?
a) Obtain a sputum sample for culture
b) Administer ondansetron for nausea
c) Initiate airborne precautions
d) Prepare the client for a chest x-ray
Rationale: The priority is to initiate airborne precautions to protect healthcare
workers and other patients from potential airborne transmission. According to the
ABCs and safety principles, staff and patient safety must be established before
other interventions .
,2. A nurse is caring for a client who is postoperative and has a prescription for
fentanyl PRN. In the event the client develops respiratory depression, which
medication should the nurse ensure is available?
a) Naloxone
b) Atropine
c) Flumazenil
d) Acetylcysteine
Rationale: Naloxone (Narcan) is an opioid antagonist that reverses the effects of
fentanyl and other opioids, including respiratory depression. This is a critical
reversal agent that should be readily available whenever opioids are
administered .
3. A nurse in an emergency department is assessing a client. Which finding
suggests a tension pneumothorax?
a) Absent breath sounds on the affected side with tracheal deviation
b) Rhonchi throughout all lung fields
c) Crackles in bilateral lung bases
d) Wheezing on expiration
Rationale: Tension pneumothorax causes absent breath sounds on the affected
side, hyperresonance, and tracheal deviation away from the affected side. This is a
medical emergency requiring immediate needle decompression .
4. A nurse is caring for a client who has a central venous access device and notes
the tubing has become disconnected. The client develops dyspnea and
tachycardia. Which action should the nurse take FIRST?
a) Perform an ECG
b) Obtain ABG values
c) Turn the client to the left side
d) Clamp the catheter
,Rationale: Air embolism is a life-threatening complication. The nurse should turn
the client to the left side (Durant's maneuver) and clamp the catheter to prevent
further air from entering the circulation .
5. A client with salicylate (aspirin) toxicity initially presents with what acid-base
imbalance?
a) Metabolic alkalosis
b) Respiratory acidosis
c) Metabolic acidosis
d) Respiratory alkalosis
Rationale: Salicylate toxicity initially causes respiratory alkalosis due to central
nervous system stimulation (hyperventilation). As toxicity progresses, metabolic
acidosis develops due to accumulation of organic acids .
6. A client reports chest pain. After administering sublingual nitroglycerin, which
vital sign change requires immediate intervention?
a) Heart rate from 80 to 90 bpm
b) Blood pressure from 120/80 to 90/60 mm Hg
c) Respiratory rate from 16 to 20/min
d) Temperature from 37.0°C to 37.2°C
Rationale: Nitroglycerin causes vasodilation and can cause significant
hypotension. A drop to 90/60 mm Hg requires holding further doses and notifying
the provider .
7. A nurse is caring for a client who had a left lower lobectomy for lung cancer.
Which factor will have the most significant impact on the plan of care?
a) Lung cancer usually metastasizes before the client presents with symptoms
b) The client will require lifelong oxygen therapy
, c) The client will be unable to ambulate independently
d) Pain management is rarely needed after thoracic surgery
Rationale: Lung cancer typically metastasizes before symptoms appear. The nurse
must assess for metastatic spread (brain, bone, liver) even after surgical resection .
8. A nurse is preparing to administer a unit of packed RBCs. Identify the correct
sequence of steps.
a) Obtain venous access → Obtain blood from bank → Verify compatibility → Initiate
transfusion → Remain with client for first 15-30 minutes
b) Verify compatibility → Obtain venous access → Obtain blood → Initiate transfusion →
Remain with client
c) Obtain blood → Verify compatibility → Obtain venous access → Initiate transfusion →
Remain with client
d) Obtain venous access → Verify compatibility → Obtain blood → Initiate transfusion →
Remain with client
Rationale: The correct sequence is: obtain venous access, verify compatibility with
another nurse, obtain blood from the blood bank, initiate transfusion slowly, and
remain with the client for the first 15-30 minutes to monitor for transfusion
reactions .
9. A client with acute myocardial infarction reports chest pain rated 8/10. Which is
the nurse's priority action?
a) Administer prescribed nitroglycerin and reassess
b) Document the pain
c) Offer a snack
d) Call family
Rationale: Chest pain in MI indicates ongoing myocardial ischemia, which is life-
threatening. Administering prescribed nitroglycerin addresses myocardial ischemia
directly. Documentation alone does not treat the patient .
