ATI RN Adult Medical-Surgical 2026 Update | 70 Actual NGN Questions Comprehensive Practice Exam
ATI RN ADULT MEDICAL SURGICAL
2026 Update with Actual NGN Questions and
Answers
100% Correct | 2026/2027 Updated Edition
Comprehensive Practice Examination Aligned with ATI RN Adult Medical-Surgical CMS
Proctored Exam Standards & Next Generation NCLEX (NGN) Clinical Judgment
Components
Section Content Domain Questions
1 Respiratory System Disorders Q1–Q12
2 Cardiovascular System Disorders Q13–Q24
3 Neurological System Disorders Q25–Q34
4 Gastrointestinal System Disorders Q35–Q42
5 Renal, Urinary, & Endocrine Disorders Q43–Q50
6 MSK, Immune, Hematologic, & Oncologic Q51–Q56
7 Medical-Surgical Emergencies & Perioperative Q57–Q62
8 NGN Clinical Judgment Integration (SATA, Bowtie, Case) Q63–Q70
TOTAL 70 Questions
Cognitive Level Distribution: 25% Recall | 50% Application | 25% Analysis
Question Format (Sections 1–7): 75% Scenario-Based | 20% Prioritization/Clinical Judgment | 5% Recall
NGN Clinical Judgment Model: Recognize Cues → Analyze Cues → Prioritize Hypotheses → Generate Solutions →
Take Action → Evaluate Outcomes
Special Formats (Section 8): SATA with partial-credit scoring (Q63–65), Bowtie condition-intervention-evaluation
(Q66), Extended Case Studies with full CJMM walkthrough (Q67–70).
Scope: RN-level clinical judgment with comprehensive scenarios spanning all body systems, perioperative care,
emergencies, and oncologic complications.
ATI RN Adult Medical-Surgical CMS Preparation Page 1
,ATI RN Adult Medical-Surgical 2026 Update | 70 Actual NGN Questions Comprehensive Practice Exam
Examination Begins on Next Page →
ATI RN Adult Medical-Surgical CMS Preparation Page 2
, ATI RN Adult Medical-Surgical 2026 Update | 70 Actual NGN Questions Comprehensive Practice Exam
SECTION 1 — Respiratory System Disorders (Q1–Q12)
COPD, Asthma, Pneumonia, Pulmonary Embolism, Tuberculosis, ARDS, Mechanical Ventilation, & Thoracic Surgery.
Q1. A client with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse notes the client is
lethargic, confused, and has a respiratory rate of 10 breaths/min. Arterial blood gases reveal pH 7.28, PaCO₂
68 mmHg, PaO₂ 92 mmHg. Which action should the nurse take first?
A. Increase the oxygen flow to 6 L/min to improve oxygenation.
B. Decrease the oxygen flow to 2 L/min and prepare for noninvasive ventilation (BiPAP). [CORRECT]
C. Administer a bronchodilator treatment immediately.
D. Suction the airway to remove secretions.
Correct Answer: B
Rationale:
The client is experiencing CO₂ narcosis from excessive oxygen delivery. Clients with severe COPD rely on a hypoxic drive to
breathe; high-flow oxygen suppresses this drive, causing CO₂ retention, respiratory acidosis (pH 7.28, PaCO₂ 68), and altered
mental status. The nurse lowers the oxygen to 2 L/min (target SpO₂ 88–92% for COPD) and prepares for BiPAP, which improves
ventilation and reduces work of breathing. Increasing oxygen (A) worsens hypercapnia. Bronchodilators (C) do not reverse CO₂
narcosis. Suctioning (D) does not address the underlying drive suppression.
Q2. A client with asthma is prescribed albuterol (a SABA) and fluticasone (an inhaled corticosteroid). Which
statement by the client indicates the need for further teaching?
A. I will use the albuterol inhaler when I feel short of breath.
B. I will rinse my mouth after using the fluticasone inhaler.
C. I will use the fluticasone inhaler at the first sign of an asthma attack. [CORRECT]
D. I will use the albuterol inhaler 15 minutes before exercise to prevent symptoms.
Correct Answer: C
Rationale:
Fluticasone is an inhaled corticosteroid used for long-term control and prevention of asthma symptoms — NOT for acute attacks.
The client should use albuterol (a SABA) for acute bronchospasm. Rinsing the mouth after fluticasone (B) prevents oral
candidiasis (thrush). Using albuterol before exercise (D) is appropriate for exercise-induced asthma. The nurse reinforces the
difference between "rescue" (albuterol) and "controller" (fluticasone) medications.
Q3. A client with asthma presents to the emergency department with severe dyspnea, inability to speak in full
sentences, and peak expiratory flow at 40% of personal best. Which assessment finding indicates a
life-threatening deterioration requiring immediate intubation?
A. Loud, audible wheezing throughout all lung fields.
B. Silent chest with markedly diminished breath sounds. [CORRECT]
C. Heart rate of 110 bpm.
D. Productive cough with small amounts of clear sputum.
Correct Answer: B
Rationale:
Absence of wheezing with diminished breath sounds is a "silent chest" — indicating severe airway obstruction with insufficient
airflow to generate wheezing. This is a life-threatening sign of impending respiratory failure requiring immediate intubation.
ATI RN Adult Medical-Surgical CMS Preparation Page 3
ATI RN ADULT MEDICAL SURGICAL
2026 Update with Actual NGN Questions and
Answers
100% Correct | 2026/2027 Updated Edition
Comprehensive Practice Examination Aligned with ATI RN Adult Medical-Surgical CMS
Proctored Exam Standards & Next Generation NCLEX (NGN) Clinical Judgment
Components
Section Content Domain Questions
1 Respiratory System Disorders Q1–Q12
2 Cardiovascular System Disorders Q13–Q24
3 Neurological System Disorders Q25–Q34
4 Gastrointestinal System Disorders Q35–Q42
5 Renal, Urinary, & Endocrine Disorders Q43–Q50
6 MSK, Immune, Hematologic, & Oncologic Q51–Q56
7 Medical-Surgical Emergencies & Perioperative Q57–Q62
8 NGN Clinical Judgment Integration (SATA, Bowtie, Case) Q63–Q70
TOTAL 70 Questions
Cognitive Level Distribution: 25% Recall | 50% Application | 25% Analysis
Question Format (Sections 1–7): 75% Scenario-Based | 20% Prioritization/Clinical Judgment | 5% Recall
NGN Clinical Judgment Model: Recognize Cues → Analyze Cues → Prioritize Hypotheses → Generate Solutions →
Take Action → Evaluate Outcomes
Special Formats (Section 8): SATA with partial-credit scoring (Q63–65), Bowtie condition-intervention-evaluation
(Q66), Extended Case Studies with full CJMM walkthrough (Q67–70).
Scope: RN-level clinical judgment with comprehensive scenarios spanning all body systems, perioperative care,
emergencies, and oncologic complications.
ATI RN Adult Medical-Surgical CMS Preparation Page 1
,ATI RN Adult Medical-Surgical 2026 Update | 70 Actual NGN Questions Comprehensive Practice Exam
Examination Begins on Next Page →
ATI RN Adult Medical-Surgical CMS Preparation Page 2
, ATI RN Adult Medical-Surgical 2026 Update | 70 Actual NGN Questions Comprehensive Practice Exam
SECTION 1 — Respiratory System Disorders (Q1–Q12)
COPD, Asthma, Pneumonia, Pulmonary Embolism, Tuberculosis, ARDS, Mechanical Ventilation, & Thoracic Surgery.
Q1. A client with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse notes the client is
lethargic, confused, and has a respiratory rate of 10 breaths/min. Arterial blood gases reveal pH 7.28, PaCO₂
68 mmHg, PaO₂ 92 mmHg. Which action should the nurse take first?
A. Increase the oxygen flow to 6 L/min to improve oxygenation.
B. Decrease the oxygen flow to 2 L/min and prepare for noninvasive ventilation (BiPAP). [CORRECT]
C. Administer a bronchodilator treatment immediately.
D. Suction the airway to remove secretions.
Correct Answer: B
Rationale:
The client is experiencing CO₂ narcosis from excessive oxygen delivery. Clients with severe COPD rely on a hypoxic drive to
breathe; high-flow oxygen suppresses this drive, causing CO₂ retention, respiratory acidosis (pH 7.28, PaCO₂ 68), and altered
mental status. The nurse lowers the oxygen to 2 L/min (target SpO₂ 88–92% for COPD) and prepares for BiPAP, which improves
ventilation and reduces work of breathing. Increasing oxygen (A) worsens hypercapnia. Bronchodilators (C) do not reverse CO₂
narcosis. Suctioning (D) does not address the underlying drive suppression.
Q2. A client with asthma is prescribed albuterol (a SABA) and fluticasone (an inhaled corticosteroid). Which
statement by the client indicates the need for further teaching?
A. I will use the albuterol inhaler when I feel short of breath.
B. I will rinse my mouth after using the fluticasone inhaler.
C. I will use the fluticasone inhaler at the first sign of an asthma attack. [CORRECT]
D. I will use the albuterol inhaler 15 minutes before exercise to prevent symptoms.
Correct Answer: C
Rationale:
Fluticasone is an inhaled corticosteroid used for long-term control and prevention of asthma symptoms — NOT for acute attacks.
The client should use albuterol (a SABA) for acute bronchospasm. Rinsing the mouth after fluticasone (B) prevents oral
candidiasis (thrush). Using albuterol before exercise (D) is appropriate for exercise-induced asthma. The nurse reinforces the
difference between "rescue" (albuterol) and "controller" (fluticasone) medications.
Q3. A client with asthma presents to the emergency department with severe dyspnea, inability to speak in full
sentences, and peak expiratory flow at 40% of personal best. Which assessment finding indicates a
life-threatening deterioration requiring immediate intubation?
A. Loud, audible wheezing throughout all lung fields.
B. Silent chest with markedly diminished breath sounds. [CORRECT]
C. Heart rate of 110 bpm.
D. Productive cough with small amounts of clear sputum.
Correct Answer: B
Rationale:
Absence of wheezing with diminished breath sounds is a "silent chest" — indicating severe airway obstruction with insufficient
airflow to generate wheezing. This is a life-threatening sign of impending respiratory failure requiring immediate intubation.
ATI RN Adult Medical-Surgical CMS Preparation Page 3
