ATI MEDICAL-SURGICAL NURSING PRACTICE
EXAMINATION – STUDY GUIDE | LATEST UPDATE
2026/2027 | ACTUAL EXAM | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for nursing students
preparing for the ATI Medical-Surgical Nursing assessment and the NCLEX-RN®. It
integrates Next Generation NCLEX (NGN) clinical judgment concepts and covers
the full breadth of adult medical-surgical nursing: cardiovascular, respiratory,
neurological, gastrointestinal, renal, endocrine, musculoskeletal, oncological, and
perioperative care. The 100 advanced-level multiple-choice questions challenge
your ability to apply pathophysiological principles to complex clinical scenarios,
prioritize care, interpret laboratory data, and make sound evidence-based
decisions. Each item reflects the rigor of the ATI proctored medical-surgical exam,
with a strong emphasis on the nursing process, patient safety, and clinical
reasoning. Detailed rationales accompany every answer, explaining why the
correct choice is optimal and why alternatives fall short. Use this study guide to
assess your mastery of medical-surgical nursing, identify knowledge gaps, and
build the confidence and competence essential for success on the ATI
Medical-Surgical Nursing examination and the NCLEX-RN.
Table of Contents
1. Cardiovascular and Hemodynamic Nursing
2. Respiratory and Oxygenation
3. Neurological and Sensory Disorders
4. Gastrointestinal and Hepatic Disorders
5. Renal and Genitourinary Disorders
6. Endocrine and Metabolic Disorders
7. Musculoskeletal and Connective Tissue Disorders
8. Oncology and Hematologic Disorders
9. Shock, Burns, and Emergency Nursing
10. Perioperative and Postoperative Nursing
,11. Fluid, Electrolyte, and Acid-Base Balance
12. Professional Issues and Prioritization
1. A client with an acute myocardial infarction is receiving alteplase (tPA). The
nurse should monitor for which adverse effect?
A) Hypoglycemia
B) Bleeding
C) Hypertension
D) Seizures
Correct Answer: B
Alteplase is a thrombolytic agent that dissolves clots; the major adverse effect is
bleeding, including intracranial hemorrhage. Blood pressure must be strictly
controlled to reduce bleeding risk. Hypoglycemia (A) is not a direct effect.
Hypertension (C) is a contraindication, not an adverse effect. Seizures (D) can occur
with stroke but are not directly caused by alteplase.
2. A client with left-sided heart failure is admitted with worsening dyspnea
and an SpO₂ of 87% on room air. The nurse auscultates crackles in all lung
fields. Which action should the nurse take first?
A) Administer furosemide IV as prescribed.
B) Place the client in high Fowler’s position.
C) Obtain an arterial blood gas.
D) Apply a 100% non-rebreather mask.
Correct Answer: B
Positioning the client in high Fowler’s position reduces venous return and
pulmonary congestion, improving ventilation and oxygenation. This low-risk,
high-priority action can be done immediately. Oxygen (D) and diuretics (A) are also
important but positioning should be done first to maximize ventilation. ABG (C) is
not the first action.
, 3. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 4 L/min via nasal cannula. The nurse should monitor for:
A) Hypocapnia
B) Oxygen toxicity
C) Carbon dioxide narcosis
D) Respiratory alkalosis
Correct Answer: C
Clients with COPD, especially those with chronic CO₂ retention, may rely on hypoxic
drive to breathe. High-flow oxygen can suppress this drive, leading to
hypoventilation, CO₂ retention, and narcosis. Oxygen toxicity (B) is a concern with
prolonged high concentrations but not at 4 L/min. Hypocapnia (A) and respiratory
alkalosis (D) would occur with hyperventilation, not hypoventilation.
4. A client with a suspected pulmonary embolism suddenly develops severe
dyspnea, tachypnea, and a loud systolic murmur at the left sternal border.
The nurse suspects:
A) Myocardial infarction
B) Cardiac tamponade
C) Acute right ventricular failure
D) Papillary muscle rupture
Correct Answer: C
A pulmonary embolism increases pulmonary vascular resistance, leading to right
ventricular strain and failure. A new murmur (tricuspid regurgitation) can be heard
due to right ventricular dilation. Myocardial infarction (A) presents with chest pain
and ECG changes. Cardiac tamponade (B) presents with muffled heart sounds and
hypotension. Papillary muscle rupture (D) is a complication of MI.
5. A client with chronic kidney disease has a serum potassium level of 6.8
mEq/L. The nurse should prepare to administer:
A) Sodium polystyrene sulfonate (Kayexalate)
B) Potassium chloride IV
C) Spironolactone
D) Furosemide
, Correct Answer: A
Kayexalate removes potassium from the body through the GI tract and is used for
hyperkalemia. Potassium chloride (B) would worsen the condition. Spironolactone
(C) is a potassium-sparing diuretic. Furosemide (D) may be used to excrete
potassium, but Kayexalate is more specific for acute hyperkalemia.
6. The nurse is caring for a client with a chest tube to water-seal drainage. The
nurse notes continuous bubbling in the water-seal chamber. This finding
indicates:
A) The lung has fully re-expanded.
B) An air leak in the system.
C) Normal fluctuation of pleural pressure.
D) The suction is working properly.
Correct Answer: B
Continuous bubbling in the water-seal chamber indicates an air leak. The nurse
should assess the system for disconnections or leaks. Tidaling (fluctuation with
respiration) is normal. Bubbling in the suction control chamber indicates suction is
functioning. Absence of fluctuation may indicate lung re-expansion or obstruction.
7. A client with an acute asthma exacerbation is receiving albuterol via
nebulizer. Which assessment finding indicates improvement?
A) Decreased wheezing after treatment
B) Diminished breath sounds throughout all lung fields
C) Increased heart rate
D) Use of accessory muscles
Correct Answer: A
Decreased wheezing after bronchodilator treatment indicates improved airflow.
Diminished breath sounds (B) could indicate a worsening condition with severe
obstruction (“silent chest”). Increased heart rate (C) and accessory muscle use (D)
indicate respiratory distress.
8. A client with a tracheostomy requires suctioning. Which technique is
correct?
EXAMINATION – STUDY GUIDE | LATEST UPDATE
2026/2027 | ACTUAL EXAM | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for nursing students
preparing for the ATI Medical-Surgical Nursing assessment and the NCLEX-RN®. It
integrates Next Generation NCLEX (NGN) clinical judgment concepts and covers
the full breadth of adult medical-surgical nursing: cardiovascular, respiratory,
neurological, gastrointestinal, renal, endocrine, musculoskeletal, oncological, and
perioperative care. The 100 advanced-level multiple-choice questions challenge
your ability to apply pathophysiological principles to complex clinical scenarios,
prioritize care, interpret laboratory data, and make sound evidence-based
decisions. Each item reflects the rigor of the ATI proctored medical-surgical exam,
with a strong emphasis on the nursing process, patient safety, and clinical
reasoning. Detailed rationales accompany every answer, explaining why the
correct choice is optimal and why alternatives fall short. Use this study guide to
assess your mastery of medical-surgical nursing, identify knowledge gaps, and
build the confidence and competence essential for success on the ATI
Medical-Surgical Nursing examination and the NCLEX-RN.
Table of Contents
1. Cardiovascular and Hemodynamic Nursing
2. Respiratory and Oxygenation
3. Neurological and Sensory Disorders
4. Gastrointestinal and Hepatic Disorders
5. Renal and Genitourinary Disorders
6. Endocrine and Metabolic Disorders
7. Musculoskeletal and Connective Tissue Disorders
8. Oncology and Hematologic Disorders
9. Shock, Burns, and Emergency Nursing
10. Perioperative and Postoperative Nursing
,11. Fluid, Electrolyte, and Acid-Base Balance
12. Professional Issues and Prioritization
1. A client with an acute myocardial infarction is receiving alteplase (tPA). The
nurse should monitor for which adverse effect?
A) Hypoglycemia
B) Bleeding
C) Hypertension
D) Seizures
Correct Answer: B
Alteplase is a thrombolytic agent that dissolves clots; the major adverse effect is
bleeding, including intracranial hemorrhage. Blood pressure must be strictly
controlled to reduce bleeding risk. Hypoglycemia (A) is not a direct effect.
Hypertension (C) is a contraindication, not an adverse effect. Seizures (D) can occur
with stroke but are not directly caused by alteplase.
2. A client with left-sided heart failure is admitted with worsening dyspnea
and an SpO₂ of 87% on room air. The nurse auscultates crackles in all lung
fields. Which action should the nurse take first?
A) Administer furosemide IV as prescribed.
B) Place the client in high Fowler’s position.
C) Obtain an arterial blood gas.
D) Apply a 100% non-rebreather mask.
Correct Answer: B
Positioning the client in high Fowler’s position reduces venous return and
pulmonary congestion, improving ventilation and oxygenation. This low-risk,
high-priority action can be done immediately. Oxygen (D) and diuretics (A) are also
important but positioning should be done first to maximize ventilation. ABG (C) is
not the first action.
, 3. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 4 L/min via nasal cannula. The nurse should monitor for:
A) Hypocapnia
B) Oxygen toxicity
C) Carbon dioxide narcosis
D) Respiratory alkalosis
Correct Answer: C
Clients with COPD, especially those with chronic CO₂ retention, may rely on hypoxic
drive to breathe. High-flow oxygen can suppress this drive, leading to
hypoventilation, CO₂ retention, and narcosis. Oxygen toxicity (B) is a concern with
prolonged high concentrations but not at 4 L/min. Hypocapnia (A) and respiratory
alkalosis (D) would occur with hyperventilation, not hypoventilation.
4. A client with a suspected pulmonary embolism suddenly develops severe
dyspnea, tachypnea, and a loud systolic murmur at the left sternal border.
The nurse suspects:
A) Myocardial infarction
B) Cardiac tamponade
C) Acute right ventricular failure
D) Papillary muscle rupture
Correct Answer: C
A pulmonary embolism increases pulmonary vascular resistance, leading to right
ventricular strain and failure. A new murmur (tricuspid regurgitation) can be heard
due to right ventricular dilation. Myocardial infarction (A) presents with chest pain
and ECG changes. Cardiac tamponade (B) presents with muffled heart sounds and
hypotension. Papillary muscle rupture (D) is a complication of MI.
5. A client with chronic kidney disease has a serum potassium level of 6.8
mEq/L. The nurse should prepare to administer:
A) Sodium polystyrene sulfonate (Kayexalate)
B) Potassium chloride IV
C) Spironolactone
D) Furosemide
, Correct Answer: A
Kayexalate removes potassium from the body through the GI tract and is used for
hyperkalemia. Potassium chloride (B) would worsen the condition. Spironolactone
(C) is a potassium-sparing diuretic. Furosemide (D) may be used to excrete
potassium, but Kayexalate is more specific for acute hyperkalemia.
6. The nurse is caring for a client with a chest tube to water-seal drainage. The
nurse notes continuous bubbling in the water-seal chamber. This finding
indicates:
A) The lung has fully re-expanded.
B) An air leak in the system.
C) Normal fluctuation of pleural pressure.
D) The suction is working properly.
Correct Answer: B
Continuous bubbling in the water-seal chamber indicates an air leak. The nurse
should assess the system for disconnections or leaks. Tidaling (fluctuation with
respiration) is normal. Bubbling in the suction control chamber indicates suction is
functioning. Absence of fluctuation may indicate lung re-expansion or obstruction.
7. A client with an acute asthma exacerbation is receiving albuterol via
nebulizer. Which assessment finding indicates improvement?
A) Decreased wheezing after treatment
B) Diminished breath sounds throughout all lung fields
C) Increased heart rate
D) Use of accessory muscles
Correct Answer: A
Decreased wheezing after bronchodilator treatment indicates improved airflow.
Diminished breath sounds (B) could indicate a worsening condition with severe
obstruction (“silent chest”). Increased heart rate (C) and accessory muscle use (D)
indicate respiratory distress.
8. A client with a tracheostomy requires suctioning. Which technique is
correct?
