ATI Med Surg 2 | ATI Medical-Surgical Nursing 2 Study
Guide & Exam Prep 2026/2027 | ATI Adult Medical
Surgical Review, Med-Surg II Practice Questions,
Advanced Disease Management, Cardiovascular,
Respiratory, Neurological, Renal, Endocrine,
Gastrointestinal, Hematologic, Musculoskeletal,
Immune & Infectious Disorders, Pharmacology,
Prioritization, Clinical Judgment, Answers & Detailed
Rationales
Question 1: A patient with chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea and a productive cough with thick, green
sputum. Which finding is the earliest and most sensitive indicator of an acute
exacerbation requiring immediate intervention?
A. A decrease in forced expiratory volume in 1 second (FEV1)
B. An increase in the anteroposterior (AP) chest diameter
C. A change in the patient's sputum color from white to green
D. A significant drop in pulse oximetry from 92% to 88%
CORRECT ANSWER: A. A decrease in forced expiratory volume in 1 second
(FEV1)
Rationale: A decline in FEV1 is the most sensitive and objective indicator of an acute
exacerbation of COPD, often detectable before significant changes in oxygenation or
clinical symptoms become apparent. While a drop in SpO2 is a critical finding, it can be
a later sign, and the patient may be a poor historian. Changes in sputum color (C) are a
sign of infection but are not the most sensitive indicator for the onset of an
exacerbation. An increased AP diameter (B) is a chronic finding of hyperinflation (barrel
chest) and does not indicate an acute change.
Question 2: When caring for a patient immediately after a total laryngectomy,
what is the priority nursing action to maintain the potency of the airway?
A. Encourage the patient to cough and deep breathe every 2 hours
B. Keep the head of the bed flat to reduce tension on the suture line
C. Suction the tracheostomy tube as needed and maintain the patency of the stoma
D. Administer prescribed opioids liberally to manage severe postoperative pain
CORRECT ANSWER: C. Suction the tracheostomy tube as needed and maintain
the patency of the stoma
Rationale: The priority after a total laryngectomy is to establish and maintain a patent
airway. The patient will have a permanent tracheostomy stoma, and the nurse's primary
responsibility is to ensure this airway is free from secretions by suctioning as needed.
Encouraging coughing (A) is important but less effective without an effective cough
reflex due to the anatomic change. Keeping the head of the bed flat (B) increases the
risk of aspiration and edema, which can compromise the airway; the head of the bed
,should be elevated. Administering opioids liberally (D) can cause respiratory depression
and is contraindicated without careful monitoring.
Question 3: A patient with a diagnosis of heart failure is prescribed furosemide
and digoxin. Which of the following electrolyte imbalances would place the
patient at the highest risk for digoxin toxicity?
A. Hypercalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia
CORRECT ANSWER: C. Hypokalemia
Rationale: Digoxin toxicity is potentiated by hypokalemia because potassium and
digoxin compete for binding sites on the sodium-potassium ATPase pump. Low serum
potassium increases the likelihood of digoxin binding and resultant cardiotoxicity.
Hypercalcemia (A) can also increase the risk of digoxin toxicity, but the effect of
hypokalemia is more pronounced and clinically significant. Hyponatremia (B) and
hypermagnesemia (D) are not primary potentiators of digoxin toxicity.
Question 4: A patient with type 1 diabetes mellitus is receiving continuous
subcutaneous insulin infusion (insulin pump). Which instruction is most
important for the nurse to teach regarding sick day management?
A. "If you are unable to eat, stop the insulin infusion to prevent hypoglycemia."
B. "Drink at least 8 ounces of sugar-free liquid every hour to prevent dehydration."
C. "Check your blood glucose and urine ketones every 3 to 4 hours."
D. "Take an extra bolus of insulin for every episode of vomiting."
CORRECT ANSWER: C. "Check your blood glucose and urine ketones every 3
to 4 hours."
Rationale: During illness, the patient's insulin requirements often increase due to
counter-regulatory hormones, leading to hyperglycemia and ketone production.
Frequent monitoring of blood glucose and urine or blood ketones is essential to adjust
insulin therapy appropriately. The insulin infusion should never be completely stopped
(A), as this can precipitate diabetic ketoacidosis. Sugar-free liquids (B) are not
recommended because the patient needs calories to prevent starvation ketosis;
carbohydrate-containing liquids are preferred. Taking an extra bolus for vomiting (D) is
unsafe and inappropriate, as the patient may not retain the calories, leading to
hypoglycemia.
Question 5: A nurse is assessing a client who has a chest tube in place
following a left pneumonectomy. The nurse notes continuous bubbling in the
water seal chamber of the drainage system. What is the nurse's most
appropriate initial action?
,A. Clamp the chest tube immediately to prevent air from entering the pleural space
B. Document the finding as normal for a pneumonectomy
C. Assess the chest tube system for an air leak
D. Increase the suction pressure to resolve the bubbling
CORRECT ANSWER: C. Assess the chest tube system for an air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
system (e.g., at the insertion site, in the tubing, or within the drainage device). The nurse
must first assess the entire system to locate the source of the leak. Clamping the tube
(A) is dangerous and could lead to a tension pneumothorax. Continuous bubbling is not
a normal finding for any chest tube system (B), including after a pneumonectomy where
the drainage is typically tidaling. Increasing suction (D) will not resolve an air leak and
may worsen the situation.
Question 6: A patient is receiving IV heparin therapy for a deep vein
thrombosis. Which of the following laboratory values is the best indicator that
the heparin is within the therapeutic range?
A. Activated partial thromboplastin time (aPTT) 1.5 to 2.5 times the normal control
B. International normalized ratio (INR) of 2.0 to 3.0
C. Platelet count of 150,000 to 400,000 cells/mcL
D. Prothrombin time (PT) 1.5 to 2.0 times the normal control
CORRECT ANSWER: A. Activated partial thromboplastin time (aPTT) 1.5 to 2.5
times the normal control
Rationale: Heparin's therapeutic effect is monitored by the aPTT, with the goal of
achieving a ratio of 1.5 to 2.5 times the patient's baseline or normal control value. The
INR (B) is the standard for monitoring warfarin therapy. The platelet count (C) is
monitored to assess for heparin-induced thrombocytopenia (HIT), not therapeutic
efficacy. The PT (D) is used to monitor warfarin therapy and the extrinsic pathway.
Question 7: A patient with cirrhosis and ascites is receiving spironolactone.
Which assessment finding is most important to report to the healthcare
provider?
A. Serum potassium level of 5.2 mEq/L
B. Serum sodium level of 135 mEq/L
C. Weight loss of 1 kg in 24 hours
D. Urine output of 30 mL per hour
CORRECT ANSWER: A. Serum potassium level of 5.2 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic. A serum potassium level of
5.2 mEq/L is above the normal range (3.5-5.0 mEq/L) and indicates hyperkalemia,
which can lead to life-threatening cardiac arrhythmias. The nurse must report this
immediately to prevent further potassium retention. A serum sodium of 135 mEq/L (B)
is within normal limits. A weight loss of 1 kg in 24 hours (C) is therapeutic and indicates
, the diuretic is working effectively (1 kg weight loss approximates 1 liter of fluid). A urine
output of 30 mL/hr (D) is at the lower limit of normal and, while requiring monitoring, is
not as immediately critical as hyperkalemia.
Question 8: The nurse is providing teaching to a patient with a new diagnosis
of angina who is prescribed sublingual nitroglycerin. Which statement by the
patient indicates a correct understanding of the medication's use?
A. "I can take up to three tablets, one every 10 minutes, and if I still have pain, I should
go to the ER."
B. "I should take a tablet with a full glass of water to ensure it dissolves properly."
C. "I should expect to feel a slight headache, which indicates the medication is working."
D. "I can store the tablets in the bathroom cabinet for easy access."
CORRECT ANSWER: A. "I can take up to three tablets, one every 10 minutes,
and if I still have pain, I should go to the ER."
Rationale: The standard regimen for sublingual nitroglycerin is to take one tablet at the
onset of angina, followed by a second in 5 minutes and a third in another 5 minutes if
pain persists. Total of three tablets is the maximum, and if the pain is not relieved, the
patient must call 911 or go to the ER. Sublingual tablets should be dissolved under the
tongue, not swallowed with water (B). A headache is a common side effect but does not
indicate therapeutic effect (C). Tablets should be stored in their original, dark container
and not in the bathroom (D) due to heat and moisture.
Question 9: A patient is admitted with acute pancreatitis. The patient is NPO
and has a nasogastric (NG) tube in place. Which finding is most indicative of a
worsening condition and potential paralytic ileus?
A. Abdominal guarding
B. Absent bowel sounds in all four quadrants
C. Serum amylase level of 180 U/L
D. Pain radiating to the back
CORRECT ANSWER: B. Absent bowel sounds in all four quadrants
Rationale: Paralytic ileus is a common complication of acute pancreatitis. Absent bowel
sounds, especially when combined with abdominal distension and vomiting, is a classic
sign of a non-functioning gastrointestinal tract. Abdominal guarding (A) and radiating
pain (D) are typical findings of acute pancreatitis but don't specifically indicate a
paralytic ileus. A serum amylase level of 180 U/L (C) is only slightly elevated (normal
30-120 U/L), which may indicate pancreatic inflammation but is not specific for ileus.
Question 10: A patient on hemodialysis reports experiencing muscle cramps
during the dialysis session. What is the most likely cause and appropriate
nursing intervention?
A. Hyperkalemia; administer insulin and dextrose
B. Hypovolemia; slow the rate of fluid removal
Guide & Exam Prep 2026/2027 | ATI Adult Medical
Surgical Review, Med-Surg II Practice Questions,
Advanced Disease Management, Cardiovascular,
Respiratory, Neurological, Renal, Endocrine,
Gastrointestinal, Hematologic, Musculoskeletal,
Immune & Infectious Disorders, Pharmacology,
Prioritization, Clinical Judgment, Answers & Detailed
Rationales
Question 1: A patient with chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea and a productive cough with thick, green
sputum. Which finding is the earliest and most sensitive indicator of an acute
exacerbation requiring immediate intervention?
A. A decrease in forced expiratory volume in 1 second (FEV1)
B. An increase in the anteroposterior (AP) chest diameter
C. A change in the patient's sputum color from white to green
D. A significant drop in pulse oximetry from 92% to 88%
CORRECT ANSWER: A. A decrease in forced expiratory volume in 1 second
(FEV1)
Rationale: A decline in FEV1 is the most sensitive and objective indicator of an acute
exacerbation of COPD, often detectable before significant changes in oxygenation or
clinical symptoms become apparent. While a drop in SpO2 is a critical finding, it can be
a later sign, and the patient may be a poor historian. Changes in sputum color (C) are a
sign of infection but are not the most sensitive indicator for the onset of an
exacerbation. An increased AP diameter (B) is a chronic finding of hyperinflation (barrel
chest) and does not indicate an acute change.
Question 2: When caring for a patient immediately after a total laryngectomy,
what is the priority nursing action to maintain the potency of the airway?
A. Encourage the patient to cough and deep breathe every 2 hours
B. Keep the head of the bed flat to reduce tension on the suture line
C. Suction the tracheostomy tube as needed and maintain the patency of the stoma
D. Administer prescribed opioids liberally to manage severe postoperative pain
CORRECT ANSWER: C. Suction the tracheostomy tube as needed and maintain
the patency of the stoma
Rationale: The priority after a total laryngectomy is to establish and maintain a patent
airway. The patient will have a permanent tracheostomy stoma, and the nurse's primary
responsibility is to ensure this airway is free from secretions by suctioning as needed.
Encouraging coughing (A) is important but less effective without an effective cough
reflex due to the anatomic change. Keeping the head of the bed flat (B) increases the
risk of aspiration and edema, which can compromise the airway; the head of the bed
,should be elevated. Administering opioids liberally (D) can cause respiratory depression
and is contraindicated without careful monitoring.
Question 3: A patient with a diagnosis of heart failure is prescribed furosemide
and digoxin. Which of the following electrolyte imbalances would place the
patient at the highest risk for digoxin toxicity?
A. Hypercalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia
CORRECT ANSWER: C. Hypokalemia
Rationale: Digoxin toxicity is potentiated by hypokalemia because potassium and
digoxin compete for binding sites on the sodium-potassium ATPase pump. Low serum
potassium increases the likelihood of digoxin binding and resultant cardiotoxicity.
Hypercalcemia (A) can also increase the risk of digoxin toxicity, but the effect of
hypokalemia is more pronounced and clinically significant. Hyponatremia (B) and
hypermagnesemia (D) are not primary potentiators of digoxin toxicity.
Question 4: A patient with type 1 diabetes mellitus is receiving continuous
subcutaneous insulin infusion (insulin pump). Which instruction is most
important for the nurse to teach regarding sick day management?
A. "If you are unable to eat, stop the insulin infusion to prevent hypoglycemia."
B. "Drink at least 8 ounces of sugar-free liquid every hour to prevent dehydration."
C. "Check your blood glucose and urine ketones every 3 to 4 hours."
D. "Take an extra bolus of insulin for every episode of vomiting."
CORRECT ANSWER: C. "Check your blood glucose and urine ketones every 3
to 4 hours."
Rationale: During illness, the patient's insulin requirements often increase due to
counter-regulatory hormones, leading to hyperglycemia and ketone production.
Frequent monitoring of blood glucose and urine or blood ketones is essential to adjust
insulin therapy appropriately. The insulin infusion should never be completely stopped
(A), as this can precipitate diabetic ketoacidosis. Sugar-free liquids (B) are not
recommended because the patient needs calories to prevent starvation ketosis;
carbohydrate-containing liquids are preferred. Taking an extra bolus for vomiting (D) is
unsafe and inappropriate, as the patient may not retain the calories, leading to
hypoglycemia.
Question 5: A nurse is assessing a client who has a chest tube in place
following a left pneumonectomy. The nurse notes continuous bubbling in the
water seal chamber of the drainage system. What is the nurse's most
appropriate initial action?
,A. Clamp the chest tube immediately to prevent air from entering the pleural space
B. Document the finding as normal for a pneumonectomy
C. Assess the chest tube system for an air leak
D. Increase the suction pressure to resolve the bubbling
CORRECT ANSWER: C. Assess the chest tube system for an air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
system (e.g., at the insertion site, in the tubing, or within the drainage device). The nurse
must first assess the entire system to locate the source of the leak. Clamping the tube
(A) is dangerous and could lead to a tension pneumothorax. Continuous bubbling is not
a normal finding for any chest tube system (B), including after a pneumonectomy where
the drainage is typically tidaling. Increasing suction (D) will not resolve an air leak and
may worsen the situation.
Question 6: A patient is receiving IV heparin therapy for a deep vein
thrombosis. Which of the following laboratory values is the best indicator that
the heparin is within the therapeutic range?
A. Activated partial thromboplastin time (aPTT) 1.5 to 2.5 times the normal control
B. International normalized ratio (INR) of 2.0 to 3.0
C. Platelet count of 150,000 to 400,000 cells/mcL
D. Prothrombin time (PT) 1.5 to 2.0 times the normal control
CORRECT ANSWER: A. Activated partial thromboplastin time (aPTT) 1.5 to 2.5
times the normal control
Rationale: Heparin's therapeutic effect is monitored by the aPTT, with the goal of
achieving a ratio of 1.5 to 2.5 times the patient's baseline or normal control value. The
INR (B) is the standard for monitoring warfarin therapy. The platelet count (C) is
monitored to assess for heparin-induced thrombocytopenia (HIT), not therapeutic
efficacy. The PT (D) is used to monitor warfarin therapy and the extrinsic pathway.
Question 7: A patient with cirrhosis and ascites is receiving spironolactone.
Which assessment finding is most important to report to the healthcare
provider?
A. Serum potassium level of 5.2 mEq/L
B. Serum sodium level of 135 mEq/L
C. Weight loss of 1 kg in 24 hours
D. Urine output of 30 mL per hour
CORRECT ANSWER: A. Serum potassium level of 5.2 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic. A serum potassium level of
5.2 mEq/L is above the normal range (3.5-5.0 mEq/L) and indicates hyperkalemia,
which can lead to life-threatening cardiac arrhythmias. The nurse must report this
immediately to prevent further potassium retention. A serum sodium of 135 mEq/L (B)
is within normal limits. A weight loss of 1 kg in 24 hours (C) is therapeutic and indicates
, the diuretic is working effectively (1 kg weight loss approximates 1 liter of fluid). A urine
output of 30 mL/hr (D) is at the lower limit of normal and, while requiring monitoring, is
not as immediately critical as hyperkalemia.
Question 8: The nurse is providing teaching to a patient with a new diagnosis
of angina who is prescribed sublingual nitroglycerin. Which statement by the
patient indicates a correct understanding of the medication's use?
A. "I can take up to three tablets, one every 10 minutes, and if I still have pain, I should
go to the ER."
B. "I should take a tablet with a full glass of water to ensure it dissolves properly."
C. "I should expect to feel a slight headache, which indicates the medication is working."
D. "I can store the tablets in the bathroom cabinet for easy access."
CORRECT ANSWER: A. "I can take up to three tablets, one every 10 minutes,
and if I still have pain, I should go to the ER."
Rationale: The standard regimen for sublingual nitroglycerin is to take one tablet at the
onset of angina, followed by a second in 5 minutes and a third in another 5 minutes if
pain persists. Total of three tablets is the maximum, and if the pain is not relieved, the
patient must call 911 or go to the ER. Sublingual tablets should be dissolved under the
tongue, not swallowed with water (B). A headache is a common side effect but does not
indicate therapeutic effect (C). Tablets should be stored in their original, dark container
and not in the bathroom (D) due to heat and moisture.
Question 9: A patient is admitted with acute pancreatitis. The patient is NPO
and has a nasogastric (NG) tube in place. Which finding is most indicative of a
worsening condition and potential paralytic ileus?
A. Abdominal guarding
B. Absent bowel sounds in all four quadrants
C. Serum amylase level of 180 U/L
D. Pain radiating to the back
CORRECT ANSWER: B. Absent bowel sounds in all four quadrants
Rationale: Paralytic ileus is a common complication of acute pancreatitis. Absent bowel
sounds, especially when combined with abdominal distension and vomiting, is a classic
sign of a non-functioning gastrointestinal tract. Abdominal guarding (A) and radiating
pain (D) are typical findings of acute pancreatitis but don't specifically indicate a
paralytic ileus. A serum amylase level of 180 U/L (C) is only slightly elevated (normal
30-120 U/L), which may indicate pancreatic inflammation but is not specific for ileus.
Question 10: A patient on hemodialysis reports experiencing muscle cramps
during the dialysis session. What is the most likely cause and appropriate
nursing intervention?
A. Hyperkalemia; administer insulin and dextrose
B. Hypovolemia; slow the rate of fluid removal
