1
ATI RN ADULT MEDICAL SURGICAL ACTUAL EXAM ASSESSMENT
TECHNOLOGIES INSTITUTE ACADEMIC YEAR 2026-2027 FULL
PACKAGE QUESTIONS ANSWERS AND RATIONALES $
LATEST UPDATED VERSION
The ATI RN Adult Medical Surgical Actual Exam is the definitive proctored assessment for nursing
students preparing for professional practice. Administered by Assessment Technologies Institute
(ATI), this rigorous examination validates a candidate's mastery of medical-surgical nursing across the
adult lifespan, emphasizing clinical judgment, prioritization, and safe intervention selection. The
exam is critical because it serves as a benchmark for NCLEX-RN readiness, assessing the ability to
apply the nursing process to complex, multisystem patient scenarios. The assessment spans eight
core domains with a cognitive distribution of 25% recall, 55% application, and 20% analysis, featuring
80% scenario-based questions and 20% direct recall/medication calculation formats. This question
bank has been meticulously crafted to simulate the advanced, application-level difficulty of the
actual assessment. By working through these 200 scenario-driven questions covering cardiovascular,
respiratory, neurological, gastrointestinal, renal, endocrine, hematologic, musculoskeletal, and
oncologic disorders, you will develop the clinical reasoning and prioritization skills needed to pass on
your first attempt.
CORE DOMAINS TESTED
1. Medical-Surgical Nursing Fundamentals – Health assessment, vital signs, fluid and
electrolyte balance, acid-base interpretation, perioperative care, and patient safety.
2. Cardiovascular & Respiratory Disorders – Heart failure, myocardial infarction, hypertension,
arrhythmias, COPD, asthma, pneumonia, and pulmonary embolism.
3. Gastrointestinal & Renal Systems – Peptic ulcer disease, inflammatory bowel disease,
hepatitis, pancreatitis, acute kidney injury, chronic kidney disease, and dialysis.
4. Endocrine & Hematologic Conditions – Diabetes mellitus, thyroid disorders, adrenal
insufficiency, SIADH, anemia, leukemia, and chemotherapy complications.
5. Neurological & Musculoskeletal Alterations – Stroke, seizures, increased intracranial
pressure, neurodegenerative diseases, fractures, osteoarthritis, and pressure injuries.
6. Oncology & Immune System Disorders – Cancer staging, chemotherapy side effects,
HIV/AIDS, sepsis, and infection control.
7. Pharmacological Therapies – High-alert medications, safe administration, monitoring
parameters, and dosage calculations.
8. Patient Safety & Quality Improvement – Restraints, fall prevention, infection control, and
evidence-based practice.
,2
QUESTIONS 1-200
Q1: A 68-year-old patient is scheduled for an elective total knee
replacement. During the preoperative assessment, the nurse notes
the patient takes warfarin 5 mg daily for atrial fibrillation. Which
action by the nurse is most appropriate?
A) Hold the warfarin on the morning of surgery and administer
vitamin K as ordered
B) Continue the warfarin through the morning of surgery to prevent
stroke
C) Hold the warfarin 5 days prior to surgery per the surgeon's
protocol and document the last dose taken
D) Switch the patient to aspirin 81 mg daily until the day of surgery
Rationale: The correct answer is C because warfarin has a long half-
life and requires approximately 5 days to clear from the system, so
holding it before surgery reduces bleeding risk. Option A is incorrect
because vitamin K is only given in emergencies or specific protocols.
Option B is incorrect because continuing warfarin increases surgical
bleeding risk. Option D is incorrect because switching to aspirin does
not eliminate bleeding risk and may not prevent thromboembolism.
Q2: During the immediate postoperative period, a patient who had
abdominal surgery reports severe pain at the incision site rated 9/10.
The nurse notes the patient is guarding the abdomen and has
shallow respirations. Which nursing intervention takes priority?
A) Encourage the patient to use the incentive spirometer every hour
B) Administer the prescribed PRN opioid analgesic and reassess in
30 minutes
C) Apply a warm compress to the incision site to promote comfort
D) Reposition the patient to a side-lying position to reduce tension on
the incision
,3
Rationale: The correct answer is B because uncontrolled
postoperative pain leads to shallow breathing, which increases the
risk of atelectasis and pneumonia. Option A is incorrect because the
patient cannot effectively use the incentive spirometer while in severe
pain. Option C is incorrect because warm compresses are not the
priority for acute incisional pain. Option D is incorrect because
repositioning alone will not address severe pain.
Q3: A nurse is caring for a postoperative patient on the second day
after a laparoscopic cholecystectomy. The patient has not had a
bowel movement since before surgery and reports mild abdominal
bloating. The patient's vital signs are stable, and bowel sounds are
present in all four quadrants. What is the nurse's best initial action?
A) Administer a Fleet enema to stimulate peristalsis
B) Encourage ambulation and increase oral fluid intake
C) Contact the provider to request an abdominal X-ray
D) Place the patient on NPO status until bowel function returns
Rationale: The correct answer is B because postoperative ileus is
common and typically resolves with conservative measures like early
ambulation and hydration. Option A is incorrect because enemas are
invasive and not the first-line intervention. Option C is incorrect
because imaging is not indicated for mild bloating with stable vital
signs. Option D is incorrect because NPO status is unnecessary when
bowel sounds are present.
Q4: A patient is recovering from spinal surgery and is on strict bed
rest with a flat bed position as ordered. The nurse is performing a
skin assessment and notes a reddened area on the patient's sacrum
that blanches with fingertip pressure. How should the nurse
document this finding?
, 4
A) Stage 1 pressure injury
B) Blanchable erythema
C) Stage 2 pressure injury
D) Deep tissue injury
Rationale: The correct answer is B because blanchable erythema is
not a pressure injury; it indicates reactive hyperemia that resolves
with pressure relief. Option A is incorrect because a Stage 1 pressure
injury is non-blanchable erythema. Option C is incorrect because
Stage 2 involves partial-thickness skin loss. Option D is incorrect
because deep tissue injury presents as purple or maroon
discoloration.
Q5: When caring for a client in restraints, the nurse understands that
the restraint order must be renewed:
A) Every 7 days
B) Every 24 hours
C) Every 4 hours
D) Every shift
Rationale: The correct answer is B because restraint orders must be
renewed every 24 hours for adults. Option A is incorrect because 7
days is the maximum duration for an order. Option C is incorrect
because 4 hours is the renewal interval for children. Option D is
incorrect because every shift is not the standard renewal interval.
Q6: A client consumed 240 mL of juice, 120 mL of coffee, and 300 mL
of water with medication, and received 500 mL of intravenous fluid
during the shift. The total intake to record is:
A) 660 mL
B) 1,260 mL
ATI RN ADULT MEDICAL SURGICAL ACTUAL EXAM ASSESSMENT
TECHNOLOGIES INSTITUTE ACADEMIC YEAR 2026-2027 FULL
PACKAGE QUESTIONS ANSWERS AND RATIONALES $
LATEST UPDATED VERSION
The ATI RN Adult Medical Surgical Actual Exam is the definitive proctored assessment for nursing
students preparing for professional practice. Administered by Assessment Technologies Institute
(ATI), this rigorous examination validates a candidate's mastery of medical-surgical nursing across the
adult lifespan, emphasizing clinical judgment, prioritization, and safe intervention selection. The
exam is critical because it serves as a benchmark for NCLEX-RN readiness, assessing the ability to
apply the nursing process to complex, multisystem patient scenarios. The assessment spans eight
core domains with a cognitive distribution of 25% recall, 55% application, and 20% analysis, featuring
80% scenario-based questions and 20% direct recall/medication calculation formats. This question
bank has been meticulously crafted to simulate the advanced, application-level difficulty of the
actual assessment. By working through these 200 scenario-driven questions covering cardiovascular,
respiratory, neurological, gastrointestinal, renal, endocrine, hematologic, musculoskeletal, and
oncologic disorders, you will develop the clinical reasoning and prioritization skills needed to pass on
your first attempt.
CORE DOMAINS TESTED
1. Medical-Surgical Nursing Fundamentals – Health assessment, vital signs, fluid and
electrolyte balance, acid-base interpretation, perioperative care, and patient safety.
2. Cardiovascular & Respiratory Disorders – Heart failure, myocardial infarction, hypertension,
arrhythmias, COPD, asthma, pneumonia, and pulmonary embolism.
3. Gastrointestinal & Renal Systems – Peptic ulcer disease, inflammatory bowel disease,
hepatitis, pancreatitis, acute kidney injury, chronic kidney disease, and dialysis.
4. Endocrine & Hematologic Conditions – Diabetes mellitus, thyroid disorders, adrenal
insufficiency, SIADH, anemia, leukemia, and chemotherapy complications.
5. Neurological & Musculoskeletal Alterations – Stroke, seizures, increased intracranial
pressure, neurodegenerative diseases, fractures, osteoarthritis, and pressure injuries.
6. Oncology & Immune System Disorders – Cancer staging, chemotherapy side effects,
HIV/AIDS, sepsis, and infection control.
7. Pharmacological Therapies – High-alert medications, safe administration, monitoring
parameters, and dosage calculations.
8. Patient Safety & Quality Improvement – Restraints, fall prevention, infection control, and
evidence-based practice.
,2
QUESTIONS 1-200
Q1: A 68-year-old patient is scheduled for an elective total knee
replacement. During the preoperative assessment, the nurse notes
the patient takes warfarin 5 mg daily for atrial fibrillation. Which
action by the nurse is most appropriate?
A) Hold the warfarin on the morning of surgery and administer
vitamin K as ordered
B) Continue the warfarin through the morning of surgery to prevent
stroke
C) Hold the warfarin 5 days prior to surgery per the surgeon's
protocol and document the last dose taken
D) Switch the patient to aspirin 81 mg daily until the day of surgery
Rationale: The correct answer is C because warfarin has a long half-
life and requires approximately 5 days to clear from the system, so
holding it before surgery reduces bleeding risk. Option A is incorrect
because vitamin K is only given in emergencies or specific protocols.
Option B is incorrect because continuing warfarin increases surgical
bleeding risk. Option D is incorrect because switching to aspirin does
not eliminate bleeding risk and may not prevent thromboembolism.
Q2: During the immediate postoperative period, a patient who had
abdominal surgery reports severe pain at the incision site rated 9/10.
The nurse notes the patient is guarding the abdomen and has
shallow respirations. Which nursing intervention takes priority?
A) Encourage the patient to use the incentive spirometer every hour
B) Administer the prescribed PRN opioid analgesic and reassess in
30 minutes
C) Apply a warm compress to the incision site to promote comfort
D) Reposition the patient to a side-lying position to reduce tension on
the incision
,3
Rationale: The correct answer is B because uncontrolled
postoperative pain leads to shallow breathing, which increases the
risk of atelectasis and pneumonia. Option A is incorrect because the
patient cannot effectively use the incentive spirometer while in severe
pain. Option C is incorrect because warm compresses are not the
priority for acute incisional pain. Option D is incorrect because
repositioning alone will not address severe pain.
Q3: A nurse is caring for a postoperative patient on the second day
after a laparoscopic cholecystectomy. The patient has not had a
bowel movement since before surgery and reports mild abdominal
bloating. The patient's vital signs are stable, and bowel sounds are
present in all four quadrants. What is the nurse's best initial action?
A) Administer a Fleet enema to stimulate peristalsis
B) Encourage ambulation and increase oral fluid intake
C) Contact the provider to request an abdominal X-ray
D) Place the patient on NPO status until bowel function returns
Rationale: The correct answer is B because postoperative ileus is
common and typically resolves with conservative measures like early
ambulation and hydration. Option A is incorrect because enemas are
invasive and not the first-line intervention. Option C is incorrect
because imaging is not indicated for mild bloating with stable vital
signs. Option D is incorrect because NPO status is unnecessary when
bowel sounds are present.
Q4: A patient is recovering from spinal surgery and is on strict bed
rest with a flat bed position as ordered. The nurse is performing a
skin assessment and notes a reddened area on the patient's sacrum
that blanches with fingertip pressure. How should the nurse
document this finding?
, 4
A) Stage 1 pressure injury
B) Blanchable erythema
C) Stage 2 pressure injury
D) Deep tissue injury
Rationale: The correct answer is B because blanchable erythema is
not a pressure injury; it indicates reactive hyperemia that resolves
with pressure relief. Option A is incorrect because a Stage 1 pressure
injury is non-blanchable erythema. Option C is incorrect because
Stage 2 involves partial-thickness skin loss. Option D is incorrect
because deep tissue injury presents as purple or maroon
discoloration.
Q5: When caring for a client in restraints, the nurse understands that
the restraint order must be renewed:
A) Every 7 days
B) Every 24 hours
C) Every 4 hours
D) Every shift
Rationale: The correct answer is B because restraint orders must be
renewed every 24 hours for adults. Option A is incorrect because 7
days is the maximum duration for an order. Option C is incorrect
because 4 hours is the renewal interval for children. Option D is
incorrect because every shift is not the standard renewal interval.
Q6: A client consumed 240 mL of juice, 120 mL of coffee, and 300 mL
of water with medication, and received 500 mL of intravenous fluid
during the shift. The total intake to record is:
A) 660 mL
B) 1,260 mL
