ATI Medical-Surgical Nursing Exam 2026/2027 |
ACTUAL-Style Practice Questions & Answers,
Med-Surg Nursing, Adult Health Disorders,
Clinical Judgment, Pharmacology, and Detailed
Rationales
Question 1: A nurse is assessing a client who has been admitted with
acute exacerbation of heart failure. Which of the following findings
should the nurse expect to observe?
A. Bradycardia and hypertension
B. Jugular venous distention and crackles in the lungs
C. Dry mucous membranes and poor skin turgor
D. Decreased respiratory rate and peripheral edema
CORRECT ANSWER: B. Jugular venous distention and crackles in the
lungs
Rationale: In acute heart failure exacerbation, fluid backs up into the
pulmonary circulation, causing crackles, and increased venous pressure
leads to jugular venous distention. Bradycardia and hypertension are not
typical; tachycardia and hypotension may occur. Dry mucous membranes
indicate dehydration, not fluid overload. Decreased respiratory rate is not
expected; dyspnea and tachypnea are common.
Question 2: A nurse is caring for a client who is postoperative following
abdominal surgery. Which of the following assessment findings should
the nurse report to the provider immediately?
A. Serosanguineous drainage on the dressing
B. Temperature of 37.8°C (100.0°F)
C. Dehiscence with evisceration
D. Mild incisional pain controlled with analgesics
CORRECT ANSWER: C. Dehiscence with evisceration
Rationale: Evisceration is a surgical emergency requiring immediate
intervention to prevent infection and further organ exposure.
Serosanguineous drainage is a normal finding. A low-grade fever may be
expected postoperatively. Mild incisional pain controlled with medication is
an expected outcome.
,Question 3: A nurse is assessing a client who has a new diagnosis of
type 1 diabetes mellitus. Which of the following findings indicates the
client is experiencing hypoglycemia?
A. Blood glucose 245 mg/dL
B. Polyuria and polydipsia
C. Shakiness and diaphoresis
D. Kussmaul respirations
CORRECT ANSWER: C. Shakiness and diaphoresis
Rationale: Hypoglycemia manifests with adrenergic symptoms such as
tremors, diaphoresis, palpitations, and anxiety. Blood glucose of 245 mg/dL
indicates hyperglycemia. Polyuria and polydipsia are classic signs of
hyperglycemia. Kussmaul respirations are associated with diabetic
ketoacidosis, a hyperglycemic emergency.
Question 4: A nurse is caring for a client who has chronic obstructive
pulmonary disease (COPD). Which of the following oxygen delivery
methods should the nurse anticipate using?
A. Non-rebreather mask at 10 L/min
B. Venturi mask at 2 to 4 L/min
C. Simple face mask at 8 L/min
D. Partial rebreather mask at 12 L/min
CORRECT ANSWER: B. Venturi mask at 2 to 4 L/min
Rationale: Clients with COPD retain carbon dioxide and require controlled
low-flow oxygen to avoid suppressing the hypoxic drive. A Venturi mask
delivers precise low concentrations. Non-rebreather, simple face masks,
and partial rebreather masks deliver higher oxygen concentrations that
may be harmful.
Question 5: A nurse is assessing a client who has a suspected deep
vein thrombosis (DVT) in the left leg. Which of the following findings
should the nurse expect?
A. Unilateral calf pain and swelling
B. Bilateral pitting edema
C. Cool, pale extremity with absent pulses
D. Erythema and warmth in both lower extremities
,CORRECT ANSWER: A. Unilateral calf pain and swelling
Rationale: DVT typically presents with unilateral leg swelling, pain, warmth,
and erythema due to venous obstruction. Bilateral edema suggests
systemic causes such as heart failure. Cool, pale extremity with absent
pulses indicates arterial occlusion. Bilateral erythema and warmth suggest
cellulitis or other systemic conditions.
Question 6: A nurse is preparing to administer digoxin to a client who
has heart failure. Which of the following findings should the nurse
identify as a contraindication to administering the medication?
A. Heart rate 88/min
B. Serum potassium 4.0 mEq/L
C. Heart rate 52/min
D. Blood pressure 118/76 mm Hg
CORRECT ANSWER: C. Heart rate 52/min
Rationale: Digoxin slows the heart rate and is withheld if the apical pulse is
below 60/min in adults. A heart rate of 52/min is bradycardic and
administering digoxin could further slow the rate, leading to serious
complications. The other values are within normal limits and do not
contraindicate administration.
Question 7: A nurse is assessing a client who has acute pancreatitis.
Which of the following findings should the nurse expect?
A. Left upper quadrant pain radiating to the back
B. Right lower quadrant pain with rebound tenderness
C. Substernal chest pain relieved by nitroglycerin
D. Periumbilical pain that migrates to the right lower quadrant
CORRECT ANSWER: A. Left upper quadrant pain radiating to the back
Rationale: Acute pancreatitis classically presents with severe epigastric or
left upper quadrant pain that radiates to the back and is often relieved by
leaning forward. Right lower quadrant pain with rebound tenderness
suggests appendicitis. Substernal chest pain relieved by nitroglycerin
suggests angina. Periumbilical pain migrating to the right lower quadrant is
classic for appendicitis.
, Question 8: A nurse is caring for a client who has a new colostomy.
Which of the following actions should the nurse take when changing
the ostomy appliance?
A. Cleanse the stoma with alcohol-based wipes
B. Measure the stoma diameter and cut the wafer to fit
C. Apply the new pouch immediately without skin protection
D. Change the appliance every 24 hours regardless of output
CORRECT ANSWER: B. Measure the stoma diameter and cut the wafer
to fit
Rationale: The wafer must be cut to fit the stoma precisely to prevent skin
breakdown and leakage. Alcohol-based wipes can irritate the stoma and
peristomal skin. Skin protection should be applied before the new pouch.
The appliance is typically changed every 3 to 7 days, not daily, unless
leaking.
Question 9: A nurse is assessing a client who has a head injury. Which
of the following findings should the nurse report immediately?
A. GCS score of 15
B. Clear fluid leaking from the nose
C. Complaint of mild headache
D. Pupils equal and reactive to light
CORRECT ANSWER: B. Clear fluid leaking from the nose
Rationale: Clear fluid leaking from the nose (rhinorrhea) may indicate
cerebrospinal fluid leak, which requires immediate medical evaluation due
to risk of meningitis. A GCS of 15 is normal. Mild headache is common after
head injury. Equal and reactive pupils are a normal finding.
Question 10: A nurse is caring for a client who is receiving a blood
transfusion. Which of the following findings indicates an acute
hemolytic reaction?
A. Urticaria and itching
B. Fever and chills
C. Low back pain and dark urine
D. Crackles and dyspnea
CORRECT ANSWER: C. Low back pain and dark urine
ACTUAL-Style Practice Questions & Answers,
Med-Surg Nursing, Adult Health Disorders,
Clinical Judgment, Pharmacology, and Detailed
Rationales
Question 1: A nurse is assessing a client who has been admitted with
acute exacerbation of heart failure. Which of the following findings
should the nurse expect to observe?
A. Bradycardia and hypertension
B. Jugular venous distention and crackles in the lungs
C. Dry mucous membranes and poor skin turgor
D. Decreased respiratory rate and peripheral edema
CORRECT ANSWER: B. Jugular venous distention and crackles in the
lungs
Rationale: In acute heart failure exacerbation, fluid backs up into the
pulmonary circulation, causing crackles, and increased venous pressure
leads to jugular venous distention. Bradycardia and hypertension are not
typical; tachycardia and hypotension may occur. Dry mucous membranes
indicate dehydration, not fluid overload. Decreased respiratory rate is not
expected; dyspnea and tachypnea are common.
Question 2: A nurse is caring for a client who is postoperative following
abdominal surgery. Which of the following assessment findings should
the nurse report to the provider immediately?
A. Serosanguineous drainage on the dressing
B. Temperature of 37.8°C (100.0°F)
C. Dehiscence with evisceration
D. Mild incisional pain controlled with analgesics
CORRECT ANSWER: C. Dehiscence with evisceration
Rationale: Evisceration is a surgical emergency requiring immediate
intervention to prevent infection and further organ exposure.
Serosanguineous drainage is a normal finding. A low-grade fever may be
expected postoperatively. Mild incisional pain controlled with medication is
an expected outcome.
,Question 3: A nurse is assessing a client who has a new diagnosis of
type 1 diabetes mellitus. Which of the following findings indicates the
client is experiencing hypoglycemia?
A. Blood glucose 245 mg/dL
B. Polyuria and polydipsia
C. Shakiness and diaphoresis
D. Kussmaul respirations
CORRECT ANSWER: C. Shakiness and diaphoresis
Rationale: Hypoglycemia manifests with adrenergic symptoms such as
tremors, diaphoresis, palpitations, and anxiety. Blood glucose of 245 mg/dL
indicates hyperglycemia. Polyuria and polydipsia are classic signs of
hyperglycemia. Kussmaul respirations are associated with diabetic
ketoacidosis, a hyperglycemic emergency.
Question 4: A nurse is caring for a client who has chronic obstructive
pulmonary disease (COPD). Which of the following oxygen delivery
methods should the nurse anticipate using?
A. Non-rebreather mask at 10 L/min
B. Venturi mask at 2 to 4 L/min
C. Simple face mask at 8 L/min
D. Partial rebreather mask at 12 L/min
CORRECT ANSWER: B. Venturi mask at 2 to 4 L/min
Rationale: Clients with COPD retain carbon dioxide and require controlled
low-flow oxygen to avoid suppressing the hypoxic drive. A Venturi mask
delivers precise low concentrations. Non-rebreather, simple face masks,
and partial rebreather masks deliver higher oxygen concentrations that
may be harmful.
Question 5: A nurse is assessing a client who has a suspected deep
vein thrombosis (DVT) in the left leg. Which of the following findings
should the nurse expect?
A. Unilateral calf pain and swelling
B. Bilateral pitting edema
C. Cool, pale extremity with absent pulses
D. Erythema and warmth in both lower extremities
,CORRECT ANSWER: A. Unilateral calf pain and swelling
Rationale: DVT typically presents with unilateral leg swelling, pain, warmth,
and erythema due to venous obstruction. Bilateral edema suggests
systemic causes such as heart failure. Cool, pale extremity with absent
pulses indicates arterial occlusion. Bilateral erythema and warmth suggest
cellulitis or other systemic conditions.
Question 6: A nurse is preparing to administer digoxin to a client who
has heart failure. Which of the following findings should the nurse
identify as a contraindication to administering the medication?
A. Heart rate 88/min
B. Serum potassium 4.0 mEq/L
C. Heart rate 52/min
D. Blood pressure 118/76 mm Hg
CORRECT ANSWER: C. Heart rate 52/min
Rationale: Digoxin slows the heart rate and is withheld if the apical pulse is
below 60/min in adults. A heart rate of 52/min is bradycardic and
administering digoxin could further slow the rate, leading to serious
complications. The other values are within normal limits and do not
contraindicate administration.
Question 7: A nurse is assessing a client who has acute pancreatitis.
Which of the following findings should the nurse expect?
A. Left upper quadrant pain radiating to the back
B. Right lower quadrant pain with rebound tenderness
C. Substernal chest pain relieved by nitroglycerin
D. Periumbilical pain that migrates to the right lower quadrant
CORRECT ANSWER: A. Left upper quadrant pain radiating to the back
Rationale: Acute pancreatitis classically presents with severe epigastric or
left upper quadrant pain that radiates to the back and is often relieved by
leaning forward. Right lower quadrant pain with rebound tenderness
suggests appendicitis. Substernal chest pain relieved by nitroglycerin
suggests angina. Periumbilical pain migrating to the right lower quadrant is
classic for appendicitis.
, Question 8: A nurse is caring for a client who has a new colostomy.
Which of the following actions should the nurse take when changing
the ostomy appliance?
A. Cleanse the stoma with alcohol-based wipes
B. Measure the stoma diameter and cut the wafer to fit
C. Apply the new pouch immediately without skin protection
D. Change the appliance every 24 hours regardless of output
CORRECT ANSWER: B. Measure the stoma diameter and cut the wafer
to fit
Rationale: The wafer must be cut to fit the stoma precisely to prevent skin
breakdown and leakage. Alcohol-based wipes can irritate the stoma and
peristomal skin. Skin protection should be applied before the new pouch.
The appliance is typically changed every 3 to 7 days, not daily, unless
leaking.
Question 9: A nurse is assessing a client who has a head injury. Which
of the following findings should the nurse report immediately?
A. GCS score of 15
B. Clear fluid leaking from the nose
C. Complaint of mild headache
D. Pupils equal and reactive to light
CORRECT ANSWER: B. Clear fluid leaking from the nose
Rationale: Clear fluid leaking from the nose (rhinorrhea) may indicate
cerebrospinal fluid leak, which requires immediate medical evaluation due
to risk of meningitis. A GCS of 15 is normal. Mild headache is common after
head injury. Equal and reactive pupils are a normal finding.
Question 10: A nurse is caring for a client who is receiving a blood
transfusion. Which of the following findings indicates an acute
hemolytic reaction?
A. Urticaria and itching
B. Fever and chills
C. Low back pain and dark urine
D. Crackles and dyspnea
CORRECT ANSWER: C. Low back pain and dark urine
