ATI MEDICAL-SURGICAL NURSING PRACTICE
EXAMINATION 2026–2027 — COMPREHENSIVE
STUDY GUIDE | LATEST UPDATE 2026/2027 | ACTUAL
EXAM PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS
This advanced practice examination is tailored for nursing students and graduate
nurses preparing for the ATI Medical-Surgical Nursing assessment and the NCLEX-
RN®. The 100-item test delivers a rigorous evaluation of medical-surgical nursing
across body systems, emphasizing critical thinking, clinical judgment, and safe,
evidence-based practice. Questions span cardiovascular, respiratory, endocrine,
gastrointestinal, renal, neurological, musculoskeletal, integumentary, hematologic,
and oncologic disorders, as well as perioperative care, emergency nursing, and
professional responsibilities. Each item is constructed to mirror the complexity of a
high-stakes certification or licensure examination, incorporating unfolding
scenarios, laboratory interpretation, pharmacologic principles, and delegation
priorities. Detailed rationales reinforce core content and clarify incorrect options.
This 2026–2027 edition integrates the latest practice guidelines and patient safety
standards to ensure candidates are fully prepared to demonstrate entry-level
competency in medical-surgical nursing. Use this review tool to self-assess
knowledge deficits and solidify your readiness for ATI, NCLEX, and clinical practice.
Table of Contents
I. Cardiovascular and Hematologic Disorders
II. Respiratory and Acid-Base Balance
III. Endocrine and Metabolic Disorders
IV. Gastrointestinal and Hepatic Disorders
V. Renal, Urinary, and Fluid/Electrolyte Imbalances
VI. Neurological and Sensory Disorders
VII. Musculoskeletal and Integumentary Disorders
VIII. Oncology and Immunologic Disorders
,IX. Perioperative, Emergency, and Disaster Nursing
X. Pharmacology and Intravenous Therapy
XI. Professional Roles, Delegation, and Quality Improvement
1. A client with acute decompensated heart failure is receiving dobutamine
intravenously. Which hemodynamic parameter is the best indicator that the
drug is achieving its intended effect?
A) Decrease in pulmonary artery wedge pressure
B) Increase in central venous pressure
C) Decrease in systemic vascular resistance
D) Increase in cardiac index
Correct Answer: D
Dobutamine is a positive inotrope that primarily increases cardiac output,
reflected by a rise in cardiac index. A decrease in wedge pressure (A) is a
secondary effect of improved forward flow but not the direct therapeutic goal.
Central venous pressure (B) may actually decrease as stroke volume improves.
Systemic vascular resistance (C) is more affected by vasodilators.
2. A client with chronic obstructive pulmonary disease develops confusion,
asterixis, and a bounding pulse. Arterial blood gases on 2 L/min oxygen: pH
7.32, PaCO₂ 68 mm Hg, HCO₃⁻ 34 mEq/L. Which interpretation is correct?
A) Chronic respiratory acidosis with acute hypoxemia
B) Acute respiratory acidosis with incomplete renal compensation
C) Fully compensated respiratory acidosis with superimposed metabolic
alkalosis
D) Acute respiratory acidosis on chronic respiratory acidosis
,Correct Answer: D
The pH of 7.32 indicates an acute acidemia, while the elevated HCO₃⁻ (34)
suggests chronic compensatory metabolic alkalosis. An acute rise in CO₂ on top of
chronic retention creates an acute-on-chronic picture. Option A does not capture
the acute decompensation. Option B would show a lower HCO₃⁻. Option C is
incorrect because the pH is not normal.
3. After a total thyroidectomy, a client reports tingling around the mouth and
has a positive Chvostek’s sign. The nurse anticipates an order for which
intravenous electrolyte replacement?
A) Magnesium sulfate
B) Calcium gluconate
C) Potassium chloride
D) Sodium bicarbonate
Correct Answer: B
These findings indicate hypocalcemia due to possible parathyroid gland removal or
damage. Intravenous calcium is needed to correct the deficit and prevent tetany.
Magnesium (A) is not the primary deficiency. Potassium (C) and sodium
bicarbonate (D) are unrelated.
4. A client with cirrhosis and esophageal varices presents with brisk, bright red
hematemesis. Vital signs: BP 88/52 mm Hg, HR 118 bpm. Which
intervention should the nurse anticipate first?
A) Prepare for endoscopic variceal ligation
B) Start an octreotide infusion
C) Insert a Sengstaken-Blakemore tube
D) Administer intravenous vasopressin and nitroglycerin
Correct Answer: B
Octreotide (a somatostatin analog) reduces portal pressure and is first-line
pharmacotherapy for acute variceal bleeding, along with volume resuscitation.
Endoscopic ligation (A) follows hemodynamic stabilization. Balloon tamponade (C)
is a rescue therapy. Vasopressin (D) is less preferred due to ischemic side effects.
, 5. The nurse receives a client from the operating room after a transsphenoidal
hypophysectomy. Which finding requires the most immediate action?
A) Urine output of 250 mL/hr for two consecutive hours
B) Clear drainage on the nasal drip pad that tests positive for glucose
C) Serum sodium of 148 mEq/L
D) Report of a mild frontal headache
Correct Answer: B
Clear nasal drainage with glucose is cerebrospinal fluid (CSF), indicating a possible
CSF leak and risk for meningitis. This takes priority over diabetes insipidus (A),
hypernatremia (C), or headache (D), which are expected or manageable
postoperatively.
6. An 84-year-old client with community-acquired pneumonia has a CURB-65
score of 3 (confusion, BUN 22 mg/dL, respiratory rate 32, BP 90/60). What
does this score indicate?
A) Outpatient oral antibiotic therapy is safe
B) Consider outpatient management with close follow-up
C) The client requires intensive care unit admission
D) The client should be hospitalized for intravenous antibiotics
Correct Answer: D
A CURB-65 score of 3 indicates severe pneumonia with a mortality risk that
warrants inpatient management and usually IV antibiotics. ICU admission (C) is
considered for scores of 4–5. Outpatient treatment (A, B) is for scores of 0–1.
7. The nurse is preparing to administer a unit of packed red blood cells. The
client’s pretransfusion temperature is 98.4°F (36.9°C). Fifteen minutes into
the infusion, the client develops a temperature of 100.6°F (38.1°C) and
reports chills but no flank pain, dyspnea, or urticaria. What is the most
appropriate nursing action?
A) Stop the transfusion and administer diphenhydramine
B) Slow the infusion rate and reassess in 15 minutes
C) Continue the infusion and monitor for worsening symptoms
D) Stop the transfusion, administer an antipyretic, and restart slowly
EXAMINATION 2026–2027 — COMPREHENSIVE
STUDY GUIDE | LATEST UPDATE 2026/2027 | ACTUAL
EXAM PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS
This advanced practice examination is tailored for nursing students and graduate
nurses preparing for the ATI Medical-Surgical Nursing assessment and the NCLEX-
RN®. The 100-item test delivers a rigorous evaluation of medical-surgical nursing
across body systems, emphasizing critical thinking, clinical judgment, and safe,
evidence-based practice. Questions span cardiovascular, respiratory, endocrine,
gastrointestinal, renal, neurological, musculoskeletal, integumentary, hematologic,
and oncologic disorders, as well as perioperative care, emergency nursing, and
professional responsibilities. Each item is constructed to mirror the complexity of a
high-stakes certification or licensure examination, incorporating unfolding
scenarios, laboratory interpretation, pharmacologic principles, and delegation
priorities. Detailed rationales reinforce core content and clarify incorrect options.
This 2026–2027 edition integrates the latest practice guidelines and patient safety
standards to ensure candidates are fully prepared to demonstrate entry-level
competency in medical-surgical nursing. Use this review tool to self-assess
knowledge deficits and solidify your readiness for ATI, NCLEX, and clinical practice.
Table of Contents
I. Cardiovascular and Hematologic Disorders
II. Respiratory and Acid-Base Balance
III. Endocrine and Metabolic Disorders
IV. Gastrointestinal and Hepatic Disorders
V. Renal, Urinary, and Fluid/Electrolyte Imbalances
VI. Neurological and Sensory Disorders
VII. Musculoskeletal and Integumentary Disorders
VIII. Oncology and Immunologic Disorders
,IX. Perioperative, Emergency, and Disaster Nursing
X. Pharmacology and Intravenous Therapy
XI. Professional Roles, Delegation, and Quality Improvement
1. A client with acute decompensated heart failure is receiving dobutamine
intravenously. Which hemodynamic parameter is the best indicator that the
drug is achieving its intended effect?
A) Decrease in pulmonary artery wedge pressure
B) Increase in central venous pressure
C) Decrease in systemic vascular resistance
D) Increase in cardiac index
Correct Answer: D
Dobutamine is a positive inotrope that primarily increases cardiac output,
reflected by a rise in cardiac index. A decrease in wedge pressure (A) is a
secondary effect of improved forward flow but not the direct therapeutic goal.
Central venous pressure (B) may actually decrease as stroke volume improves.
Systemic vascular resistance (C) is more affected by vasodilators.
2. A client with chronic obstructive pulmonary disease develops confusion,
asterixis, and a bounding pulse. Arterial blood gases on 2 L/min oxygen: pH
7.32, PaCO₂ 68 mm Hg, HCO₃⁻ 34 mEq/L. Which interpretation is correct?
A) Chronic respiratory acidosis with acute hypoxemia
B) Acute respiratory acidosis with incomplete renal compensation
C) Fully compensated respiratory acidosis with superimposed metabolic
alkalosis
D) Acute respiratory acidosis on chronic respiratory acidosis
,Correct Answer: D
The pH of 7.32 indicates an acute acidemia, while the elevated HCO₃⁻ (34)
suggests chronic compensatory metabolic alkalosis. An acute rise in CO₂ on top of
chronic retention creates an acute-on-chronic picture. Option A does not capture
the acute decompensation. Option B would show a lower HCO₃⁻. Option C is
incorrect because the pH is not normal.
3. After a total thyroidectomy, a client reports tingling around the mouth and
has a positive Chvostek’s sign. The nurse anticipates an order for which
intravenous electrolyte replacement?
A) Magnesium sulfate
B) Calcium gluconate
C) Potassium chloride
D) Sodium bicarbonate
Correct Answer: B
These findings indicate hypocalcemia due to possible parathyroid gland removal or
damage. Intravenous calcium is needed to correct the deficit and prevent tetany.
Magnesium (A) is not the primary deficiency. Potassium (C) and sodium
bicarbonate (D) are unrelated.
4. A client with cirrhosis and esophageal varices presents with brisk, bright red
hematemesis. Vital signs: BP 88/52 mm Hg, HR 118 bpm. Which
intervention should the nurse anticipate first?
A) Prepare for endoscopic variceal ligation
B) Start an octreotide infusion
C) Insert a Sengstaken-Blakemore tube
D) Administer intravenous vasopressin and nitroglycerin
Correct Answer: B
Octreotide (a somatostatin analog) reduces portal pressure and is first-line
pharmacotherapy for acute variceal bleeding, along with volume resuscitation.
Endoscopic ligation (A) follows hemodynamic stabilization. Balloon tamponade (C)
is a rescue therapy. Vasopressin (D) is less preferred due to ischemic side effects.
, 5. The nurse receives a client from the operating room after a transsphenoidal
hypophysectomy. Which finding requires the most immediate action?
A) Urine output of 250 mL/hr for two consecutive hours
B) Clear drainage on the nasal drip pad that tests positive for glucose
C) Serum sodium of 148 mEq/L
D) Report of a mild frontal headache
Correct Answer: B
Clear nasal drainage with glucose is cerebrospinal fluid (CSF), indicating a possible
CSF leak and risk for meningitis. This takes priority over diabetes insipidus (A),
hypernatremia (C), or headache (D), which are expected or manageable
postoperatively.
6. An 84-year-old client with community-acquired pneumonia has a CURB-65
score of 3 (confusion, BUN 22 mg/dL, respiratory rate 32, BP 90/60). What
does this score indicate?
A) Outpatient oral antibiotic therapy is safe
B) Consider outpatient management with close follow-up
C) The client requires intensive care unit admission
D) The client should be hospitalized for intravenous antibiotics
Correct Answer: D
A CURB-65 score of 3 indicates severe pneumonia with a mortality risk that
warrants inpatient management and usually IV antibiotics. ICU admission (C) is
considered for scores of 4–5. Outpatient treatment (A, B) is for scores of 0–1.
7. The nurse is preparing to administer a unit of packed red blood cells. The
client’s pretransfusion temperature is 98.4°F (36.9°C). Fifteen minutes into
the infusion, the client develops a temperature of 100.6°F (38.1°C) and
reports chills but no flank pain, dyspnea, or urticaria. What is the most
appropriate nursing action?
A) Stop the transfusion and administer diphenhydramine
B) Slow the infusion rate and reassess in 15 minutes
C) Continue the infusion and monitor for worsening symptoms
D) Stop the transfusion, administer an antipyretic, and restart slowly
