ATI PN MEDICAL-SURGICAL
FINAL EXAMINATION
VERIFIED VERSION
120 Questions | 11 System-Based Sections
NCLEX-PN Test Plan Aligned
ATI Content Mastery Series
2026/2027 Edition
Practical Nursing Education
Medical-Surgical Nursing Practice
Time Limit: 4 Hours
Total Questions: 120
,ATI PN Medical-Surgical Final Exam 2026/2027 (Verified Version) Page 2
EXAM INSTRUCTIONS
• Total Questions: 120 multiple-choice questions across 11 sections covering all major body systems and pharmacology.
• Cognitive Distribution: 20% recall (knowledge), 50% application (clinical scenarios), 30% analysis (prioritization and
clinical reasoning).
• Question Style: Approximately 80% of items are scenario-based clinical case questions; 20% are direct knowledge
items.
• Special Inclusions: 15 priority-setting questions, 15 pharmacology questions, 15 assessment-and-intervention questions
distributed across all sections.
• Answer Format: Each question has four options (A, B, C, D) with exactly ONE correct answer. The correct answer is
marked with *[CORRECT]* and is followed by a rationale citing ATI PN Medical-Surgical Nursing standards and the
NCLEX-PN Test Plan.
• Time Allocation: 4 hours total; approximately 2 minutes per question.
• Testing Strategy: Use the airway-breathing-circulation (ABC) framework, Maslow hierarchy of needs, and nursing
process to prioritize. Identify assessment before intervention. Use safety and infection control principles for all questions.
• Passing Standard: Aligned with the NCLEX-PN passing standard for safe, effective entry-level practical nursing
practice.
EXAM STRUCTURE OVERVIEW
Section Topic Question Range # of Q
Section 1 Cardiovascular System Disorders Q1-Q15 15
Section 2 Respiratory System Disorders Q16-Q30 15
Section 3 Gastrointestinal System Disorders Q31-Q42 12
Section 4 Genitourinary & Renal Disorders Q43-Q52 10
Section 5 Endocrine System Disorders Q53-Q64 12
Section 6 Neurological System Disorders Q65-Q74 10
Section 7 Musculoskeletal Disorders Q75-Q82 8
Section 8 Integumentary System Disorders Q83-Q90 8
Section 9 Hematological & Immunological Disorders Q91-Q100 10
Section 10 Perioperative & Postoperative Care Q101-Q110 10
Section 11 Pharmacology & Medication Administration Q111-Q120 10
TOTAL 120
NCLEX-PN Test Plan Aligned | ATI Content Mastery Series | 2026/2027 Edition
,ATI PN Medical-Surgical Final Exam 2026/2027 (Verified Version) Page 3
Section 1: Cardiovascular System Disorders
Q1: The nurse is caring for four patients on a telemetry unit. Which patient should the nurse assess FIRST?
A patient with heart failure reporting dyspnea that increased overnight from 1 to 3 pillows
*[CORRECT]*
A patient with a permanent pacemaker whose apical pulse is 72 and regular
A patient with stable angina reporting chest pain 2/10 after nitroglycerin administration
A patient three days post-MI whose temperature is 99.2°F (37.3°C)
Correct Answer: A
Rationale: Increasing orthopnea in a heart failure patient signals worsening pulmonary congestion and possible acute
decompensation requiring immediate assessment and intervention (ATI PN Medical-Surgical: Heart Failure). The
pacemaker patient is stable, the angina patient responded to nitroglycerin, and a low-grade fever post-MI is common.
NCLEX-PN prioritization uses the airway-breathing-circulation (ABC) framework, and dyspnea escalation is the
highest-priority cue.
Q2: A patient with heart failure is being discharged home. Which statement by the patient indicates that
discharge teaching about daily weights has been effective?
I will weigh myself once a week at the same time of day.
I will weigh myself every morning before breakfast after emptying my bladder. *[CORRECT]*
I will weigh myself at bedtime to capture the day's full intake.
I will only weigh myself if I notice swelling in my ankles.
Correct Answer: B
Rationale: Daily weights must be taken every morning, after voiding, before eating, and with similar clothing to detect
fluid retention early; a gain of 2-3 lb in 24 hours or 5 lb in a week must be reported (ATI PN: Heart Failure patient
education). Weekly weights, bedtime weights, or weighing only when symptomatic delay recognition of
decompensation. NCLEX-PN evaluation of learning requires identifying the correct technique.
Q3: Which assessment finding is MOST characteristic of an acute myocardial infarction (MI)?
Substernal chest pain that improves with rest and lasts less than 5 minutes
Sudden, tearing chest pain radiating to the back between the shoulder blades
Crushing substernal chest pain lasting more than 15 minutes, unrelieved by nitroglycerin
*[CORRECT]*
Sharp, stabbing chest pain that worsens with deep inspiration
Correct Answer: C
Rationale: An acute MI typically presents as crushing substernal chest pain lasting longer than 15 minutes, unrelieved
by rest or nitroglycerin, often radiating to the jaw, left arm, or back (ATI PN: Coronary Artery Disease). Pain
improving with rest describes stable angina; tearing pain suggests aortic dissection; pleuritic pain suggests pericarditis
or pulmonary embolism. NCLEX-PN cognitive level: recall of classic presentations.
NCLEX-PN Test Plan Aligned | ATI Content Mastery Series | 2026/2027 Edition
, ATI PN Medical-Surgical Final Exam 2026/2027 (Verified Version) Page 4
Q4: A 56-year-old male patient with coronary artery disease (CAD) asks the nurse how he can reduce his risk
of further cardiac events. Which response by the nurse is MOST appropriate?
Limit alcohol intake to no more than three drinks per day.
Continue smoking if you have cut back to less than half a pack daily.
Engage in moderate aerobic exercise for at least 30 minutes most days of the week. *[CORRECT]*
Maintain a diet high in saturated fats to keep your cholesterol stable.
Correct Answer: C
Rationale: Moderate aerobic exercise (such as brisk walking) for at least 30 minutes most days of the week is a strong
evidence-based recommendation for secondary prevention in CAD (ATI PN: CAD Lifestyle Modifications). Alcohol
intake should be limited to no more than one drink per day for women and two for men; smoking must be eliminated
entirely; saturated fats should be reduced. NCLEX-PN application of teaching principles.
Q5: A patient with a history of stable angina is admitted with chest pain. Which finding would lead the nurse
to suspect the pain is due to an acute MI rather than stable angina?
The pain is relieved by one sublingual nitroglycerin tablet within 5 minutes.
The pain occurs predictably with exertion and resolves with rest.
The pain is accompanied by diaphoresis, nausea, and dyspnea and is unrelieved by nitroglycerin.
*[CORRECT]*
The pain is described as mild and pressure-like in quality.
Correct Answer: C
Rationale: An acute MI is differentiated from stable angina by pain that is unrelieved by nitroglycerin, is more severe
and prolonged, and is accompanied by autonomic symptoms such as diaphoresis, nausea, vomiting, and dyspnea (ATI
PN: ACS differentiation). Stable angina is predictable with exertion, relieved by rest or nitroglycerin, and lacks these
systemic signs. NCLEX-PN cognitive level: analysis of clinical findings.
Q6: A patient with suspected peripheral vascular disease (PVD) is being assessed. Which finding is consistent
with arterial insufficiency rather than venous insufficiency?
Brownish discoloration of the lower legs with edema
Ulcers located near the medial malleolus with moderate drainage
Cool, pale skin with diminished or absent peripheral pulses and pain that worsens with elevation
*[CORRECT]*
3+ pitting edema with warm, darkened skin and ulcers at the ankle
Correct Answer: C
Rationale: Arterial insufficiency presents with cool, pale or cyanotic skin, diminished or absent pulses, and pain that
worsens with elevation and improves with dependency (ATI PN: Peripheral Vascular Disease). Brownish discoloration,
medial malleolar ulcers, edema, and warm skin characterize venous insufficiency. NCLEX-PN cognitive level:
application of assessment differentiation.
NCLEX-PN Test Plan Aligned | ATI Content Mastery Series | 2026/2027 Edition
FINAL EXAMINATION
VERIFIED VERSION
120 Questions | 11 System-Based Sections
NCLEX-PN Test Plan Aligned
ATI Content Mastery Series
2026/2027 Edition
Practical Nursing Education
Medical-Surgical Nursing Practice
Time Limit: 4 Hours
Total Questions: 120
,ATI PN Medical-Surgical Final Exam 2026/2027 (Verified Version) Page 2
EXAM INSTRUCTIONS
• Total Questions: 120 multiple-choice questions across 11 sections covering all major body systems and pharmacology.
• Cognitive Distribution: 20% recall (knowledge), 50% application (clinical scenarios), 30% analysis (prioritization and
clinical reasoning).
• Question Style: Approximately 80% of items are scenario-based clinical case questions; 20% are direct knowledge
items.
• Special Inclusions: 15 priority-setting questions, 15 pharmacology questions, 15 assessment-and-intervention questions
distributed across all sections.
• Answer Format: Each question has four options (A, B, C, D) with exactly ONE correct answer. The correct answer is
marked with *[CORRECT]* and is followed by a rationale citing ATI PN Medical-Surgical Nursing standards and the
NCLEX-PN Test Plan.
• Time Allocation: 4 hours total; approximately 2 minutes per question.
• Testing Strategy: Use the airway-breathing-circulation (ABC) framework, Maslow hierarchy of needs, and nursing
process to prioritize. Identify assessment before intervention. Use safety and infection control principles for all questions.
• Passing Standard: Aligned with the NCLEX-PN passing standard for safe, effective entry-level practical nursing
practice.
EXAM STRUCTURE OVERVIEW
Section Topic Question Range # of Q
Section 1 Cardiovascular System Disorders Q1-Q15 15
Section 2 Respiratory System Disorders Q16-Q30 15
Section 3 Gastrointestinal System Disorders Q31-Q42 12
Section 4 Genitourinary & Renal Disorders Q43-Q52 10
Section 5 Endocrine System Disorders Q53-Q64 12
Section 6 Neurological System Disorders Q65-Q74 10
Section 7 Musculoskeletal Disorders Q75-Q82 8
Section 8 Integumentary System Disorders Q83-Q90 8
Section 9 Hematological & Immunological Disorders Q91-Q100 10
Section 10 Perioperative & Postoperative Care Q101-Q110 10
Section 11 Pharmacology & Medication Administration Q111-Q120 10
TOTAL 120
NCLEX-PN Test Plan Aligned | ATI Content Mastery Series | 2026/2027 Edition
,ATI PN Medical-Surgical Final Exam 2026/2027 (Verified Version) Page 3
Section 1: Cardiovascular System Disorders
Q1: The nurse is caring for four patients on a telemetry unit. Which patient should the nurse assess FIRST?
A patient with heart failure reporting dyspnea that increased overnight from 1 to 3 pillows
*[CORRECT]*
A patient with a permanent pacemaker whose apical pulse is 72 and regular
A patient with stable angina reporting chest pain 2/10 after nitroglycerin administration
A patient three days post-MI whose temperature is 99.2°F (37.3°C)
Correct Answer: A
Rationale: Increasing orthopnea in a heart failure patient signals worsening pulmonary congestion and possible acute
decompensation requiring immediate assessment and intervention (ATI PN Medical-Surgical: Heart Failure). The
pacemaker patient is stable, the angina patient responded to nitroglycerin, and a low-grade fever post-MI is common.
NCLEX-PN prioritization uses the airway-breathing-circulation (ABC) framework, and dyspnea escalation is the
highest-priority cue.
Q2: A patient with heart failure is being discharged home. Which statement by the patient indicates that
discharge teaching about daily weights has been effective?
I will weigh myself once a week at the same time of day.
I will weigh myself every morning before breakfast after emptying my bladder. *[CORRECT]*
I will weigh myself at bedtime to capture the day's full intake.
I will only weigh myself if I notice swelling in my ankles.
Correct Answer: B
Rationale: Daily weights must be taken every morning, after voiding, before eating, and with similar clothing to detect
fluid retention early; a gain of 2-3 lb in 24 hours or 5 lb in a week must be reported (ATI PN: Heart Failure patient
education). Weekly weights, bedtime weights, or weighing only when symptomatic delay recognition of
decompensation. NCLEX-PN evaluation of learning requires identifying the correct technique.
Q3: Which assessment finding is MOST characteristic of an acute myocardial infarction (MI)?
Substernal chest pain that improves with rest and lasts less than 5 minutes
Sudden, tearing chest pain radiating to the back between the shoulder blades
Crushing substernal chest pain lasting more than 15 minutes, unrelieved by nitroglycerin
*[CORRECT]*
Sharp, stabbing chest pain that worsens with deep inspiration
Correct Answer: C
Rationale: An acute MI typically presents as crushing substernal chest pain lasting longer than 15 minutes, unrelieved
by rest or nitroglycerin, often radiating to the jaw, left arm, or back (ATI PN: Coronary Artery Disease). Pain
improving with rest describes stable angina; tearing pain suggests aortic dissection; pleuritic pain suggests pericarditis
or pulmonary embolism. NCLEX-PN cognitive level: recall of classic presentations.
NCLEX-PN Test Plan Aligned | ATI Content Mastery Series | 2026/2027 Edition
, ATI PN Medical-Surgical Final Exam 2026/2027 (Verified Version) Page 4
Q4: A 56-year-old male patient with coronary artery disease (CAD) asks the nurse how he can reduce his risk
of further cardiac events. Which response by the nurse is MOST appropriate?
Limit alcohol intake to no more than three drinks per day.
Continue smoking if you have cut back to less than half a pack daily.
Engage in moderate aerobic exercise for at least 30 minutes most days of the week. *[CORRECT]*
Maintain a diet high in saturated fats to keep your cholesterol stable.
Correct Answer: C
Rationale: Moderate aerobic exercise (such as brisk walking) for at least 30 minutes most days of the week is a strong
evidence-based recommendation for secondary prevention in CAD (ATI PN: CAD Lifestyle Modifications). Alcohol
intake should be limited to no more than one drink per day for women and two for men; smoking must be eliminated
entirely; saturated fats should be reduced. NCLEX-PN application of teaching principles.
Q5: A patient with a history of stable angina is admitted with chest pain. Which finding would lead the nurse
to suspect the pain is due to an acute MI rather than stable angina?
The pain is relieved by one sublingual nitroglycerin tablet within 5 minutes.
The pain occurs predictably with exertion and resolves with rest.
The pain is accompanied by diaphoresis, nausea, and dyspnea and is unrelieved by nitroglycerin.
*[CORRECT]*
The pain is described as mild and pressure-like in quality.
Correct Answer: C
Rationale: An acute MI is differentiated from stable angina by pain that is unrelieved by nitroglycerin, is more severe
and prolonged, and is accompanied by autonomic symptoms such as diaphoresis, nausea, vomiting, and dyspnea (ATI
PN: ACS differentiation). Stable angina is predictable with exertion, relieved by rest or nitroglycerin, and lacks these
systemic signs. NCLEX-PN cognitive level: analysis of clinical findings.
Q6: A patient with suspected peripheral vascular disease (PVD) is being assessed. Which finding is consistent
with arterial insufficiency rather than venous insufficiency?
Brownish discoloration of the lower legs with edema
Ulcers located near the medial malleolus with moderate drainage
Cool, pale skin with diminished or absent peripheral pulses and pain that worsens with elevation
*[CORRECT]*
3+ pitting edema with warm, darkened skin and ulcers at the ankle
Correct Answer: C
Rationale: Arterial insufficiency presents with cool, pale or cyanotic skin, diminished or absent pulses, and pain that
worsens with elevation and improves with dependency (ATI PN: Peripheral Vascular Disease). Brownish discoloration,
medial malleolar ulcers, edema, and warm skin characterize venous insufficiency. NCLEX-PN cognitive level:
application of assessment differentiation.
NCLEX-PN Test Plan Aligned | ATI Content Mastery Series | 2026/2027 Edition
