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ATI RN ADULT MEDICAL-SURGICAL
(MED-SURG) PRACTICE EXAM 2026 —
100 NGN-STYLE QUESTIONS WITH
ANSWERS AND RATIONALES
Exam overview
This 100-question practice bank is designed to help nursing students prepare for adult medical-
surgical nursing assessments. It covers clinical judgment, prioritization, patient safety,
pharmacology, and common acute and chronic conditions using multiple-choice questions,
including Next Generation NCLEX (NGN)-inspired clinical scenarios.
Instructions: Choose the single best answer for each question. The correct answer and a brief
rationale follow each question.
Content areas
Content area Questions
Cardiovascular nursing 1–15
Respiratory nursing 16–27
Endocrine nursing 28–38
Renal and urinary nursing 39–48
Neurological nursing 49–58
Gastrointestinal nursing 59–68
Musculoskeletal nursing 69–76
Hematology and oncology 77–84
Infection control and perioperative care 85–92
Emergency care and clinical judgment 93–100
Section 1: Cardiovascular Nursing (Questions 1–15)
Question 1
A nurse is caring for a client experiencing an acute myocardial infarction (MI). Which finding
requires immediate intervention?
A. Anxiety and restlessness B. Chest pain rated 5/10 C. Oxygen saturation of 97% on room air
D. New-onset ventricular fibrillation
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Correct answer: D. New-onset ventricular fibrillation
Rationale: Ventricular fibrillation causes ineffective cardiac output and can rapidly lead to death.
Immediate cardiopulmonary resuscitation and defibrillation are indicated.
Question 2
A client with heart failure reports worsening shortness of breath when lying flat. Which
assessment finding is most concerning?
A. Bilateral crackles and severe respiratory distress B. Mild ankle edema at the end of the day C.
Weight gain of 0.2 kg over one week D. Heart rate of 78/min
Correct answer: A. Bilateral crackles and severe respiratory distress
Rationale: These findings suggest pulmonary congestion and possible acute decompensated heart
failure, requiring immediate assessment and intervention.
Question 3
A nurse is administering digoxin to a client with heart failure. The client's apical pulse is 52/min.
What should the nurse do?
A. Administer the medication with food B. Withhold the medication and notify the provider C.
Give half the prescribed dose D. Administer the medication and reassess in one hour
Correct answer: B. Withhold the medication and notify the provider
Rationale: Digoxin can slow the heart rate. Bradycardia may indicate an unsafe response or
toxicity. The nurse should follow the prescribed hold parameters and notify the provider.
Question 4
A client taking warfarin has an international normalized ratio (INR) of 6.0 and reports bleeding
gums. Which action is appropriate?
A. Administer the next dose as scheduled B. Encourage increased intake of leafy vegetables as
the only intervention C. Withhold warfarin and urgently notify the provider D. Administer
aspirin for discomfort
Correct answer: C. Withhold warfarin and urgently notify the provider
Rationale: An elevated INR with active bleeding indicates increased hemorrhage risk. Further
treatment, including possible vitamin K depending on severity and clinical circumstances,
requires prompt evaluation.
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Question 5
A client arrives with suspected acute MI. Which diagnostic test should be obtained promptly to
assess for ischemic changes?
A. Electrocardiogram (ECG) B. Colonoscopy C. Pulmonary function test D. Bone density scan
Correct answer: A. Electrocardiogram (ECG)
Rationale: A 12-lead ECG should be obtained promptly, generally within 10 minutes of arrival
when acute coronary syndrome is suspected.
Question 6
A nurse is teaching a client with hypertension about lifestyle modifications. Which statement
indicates understanding?
A. “I should increase my sodium intake.” B. “I should stop exercising permanently.” C. “I will
follow a heart-healthy diet and limit sodium.” D. “I can stop my medication once my blood
pressure improves.”
Correct answer: C. “I will follow a heart-healthy diet and limit sodium.”
Rationale: A heart-healthy dietary pattern, sodium reduction, physical activity, and prescribed
medications can help control blood pressure.
Question 7
A client with peripheral arterial disease reports leg pain while walking that improves with rest.
How should the nurse interpret this finding?
A. Intermittent claudication B. Venous stasis ulceration C. Acute compartment syndrome D.
Peripheral neuropathy
Correct answer: A. Intermittent claudication
Rationale: Intermittent claudication is exertional muscle pain caused by inadequate arterial blood
flow that typically improves with rest.
Question 8
A client with heart failure has a sudden weight gain of 2 kg (4.4 lb) over two days. What should
the nurse suspect?
A. Improved nutritional status B. Fluid retention C. Dehydration D. Resolution of heart failure
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Correct answer: B. Fluid retention
Rationale: Rapid weight gain can indicate fluid accumulation. The client should report this
change promptly according to their heart failure action plan.
Question 9
A nurse is assessing a client with suspected deep vein thrombosis (DVT). Which finding is most
suggestive?
A. Bilateral cool feet without swelling B. Unilateral leg swelling and warmth C. Symmetrical
arm weakness D. Slow capillary refill in both hands only
Correct answer: B. Unilateral leg swelling and warmth
Rationale: Unilateral swelling, warmth, and pain may indicate DVT. Avoid massaging the leg;
arrange prompt evaluation.
Question 10
A client develops sudden chest pain, severe dyspnea, and hypotension after surgery. The nurse
suspects pulmonary embolism. What is the priority action?
A. Encourage ambulation B. Offer oral fluids C. Activate emergency assistance and support
oxygenation D. Apply a heating pad to the affected leg
Correct answer: C. Activate emergency assistance and support oxygenation
Rationale: A pulmonary embolism can obstruct pulmonary blood flow and cause cardiovascular
collapse. Immediate emergency assessment and respiratory and circulatory support are essential.
Question 11
A client with atrial fibrillation is prescribed apixaban. Which instruction is most important?
A. Double the next dose if one dose is missed B. Report unusual bleeding or black, tarry stools
C. Take aspirin routinely without consulting the provider D. Stop the medication whenever
bruising occurs
Correct answer: B. Report unusual bleeding or black, tarry stools
Rationale: Apixaban increases bleeding risk. Signs of internal bleeding require prompt
evaluation. Missed doses and medication changes should be handled according to prescribing
instructions.
Question 12
ATI RN ADULT MEDICAL-SURGICAL
(MED-SURG) PRACTICE EXAM 2026 —
100 NGN-STYLE QUESTIONS WITH
ANSWERS AND RATIONALES
Exam overview
This 100-question practice bank is designed to help nursing students prepare for adult medical-
surgical nursing assessments. It covers clinical judgment, prioritization, patient safety,
pharmacology, and common acute and chronic conditions using multiple-choice questions,
including Next Generation NCLEX (NGN)-inspired clinical scenarios.
Instructions: Choose the single best answer for each question. The correct answer and a brief
rationale follow each question.
Content areas
Content area Questions
Cardiovascular nursing 1–15
Respiratory nursing 16–27
Endocrine nursing 28–38
Renal and urinary nursing 39–48
Neurological nursing 49–58
Gastrointestinal nursing 59–68
Musculoskeletal nursing 69–76
Hematology and oncology 77–84
Infection control and perioperative care 85–92
Emergency care and clinical judgment 93–100
Section 1: Cardiovascular Nursing (Questions 1–15)
Question 1
A nurse is caring for a client experiencing an acute myocardial infarction (MI). Which finding
requires immediate intervention?
A. Anxiety and restlessness B. Chest pain rated 5/10 C. Oxygen saturation of 97% on room air
D. New-onset ventricular fibrillation
,2|Page
Correct answer: D. New-onset ventricular fibrillation
Rationale: Ventricular fibrillation causes ineffective cardiac output and can rapidly lead to death.
Immediate cardiopulmonary resuscitation and defibrillation are indicated.
Question 2
A client with heart failure reports worsening shortness of breath when lying flat. Which
assessment finding is most concerning?
A. Bilateral crackles and severe respiratory distress B. Mild ankle edema at the end of the day C.
Weight gain of 0.2 kg over one week D. Heart rate of 78/min
Correct answer: A. Bilateral crackles and severe respiratory distress
Rationale: These findings suggest pulmonary congestion and possible acute decompensated heart
failure, requiring immediate assessment and intervention.
Question 3
A nurse is administering digoxin to a client with heart failure. The client's apical pulse is 52/min.
What should the nurse do?
A. Administer the medication with food B. Withhold the medication and notify the provider C.
Give half the prescribed dose D. Administer the medication and reassess in one hour
Correct answer: B. Withhold the medication and notify the provider
Rationale: Digoxin can slow the heart rate. Bradycardia may indicate an unsafe response or
toxicity. The nurse should follow the prescribed hold parameters and notify the provider.
Question 4
A client taking warfarin has an international normalized ratio (INR) of 6.0 and reports bleeding
gums. Which action is appropriate?
A. Administer the next dose as scheduled B. Encourage increased intake of leafy vegetables as
the only intervention C. Withhold warfarin and urgently notify the provider D. Administer
aspirin for discomfort
Correct answer: C. Withhold warfarin and urgently notify the provider
Rationale: An elevated INR with active bleeding indicates increased hemorrhage risk. Further
treatment, including possible vitamin K depending on severity and clinical circumstances,
requires prompt evaluation.
,3|Page
Question 5
A client arrives with suspected acute MI. Which diagnostic test should be obtained promptly to
assess for ischemic changes?
A. Electrocardiogram (ECG) B. Colonoscopy C. Pulmonary function test D. Bone density scan
Correct answer: A. Electrocardiogram (ECG)
Rationale: A 12-lead ECG should be obtained promptly, generally within 10 minutes of arrival
when acute coronary syndrome is suspected.
Question 6
A nurse is teaching a client with hypertension about lifestyle modifications. Which statement
indicates understanding?
A. “I should increase my sodium intake.” B. “I should stop exercising permanently.” C. “I will
follow a heart-healthy diet and limit sodium.” D. “I can stop my medication once my blood
pressure improves.”
Correct answer: C. “I will follow a heart-healthy diet and limit sodium.”
Rationale: A heart-healthy dietary pattern, sodium reduction, physical activity, and prescribed
medications can help control blood pressure.
Question 7
A client with peripheral arterial disease reports leg pain while walking that improves with rest.
How should the nurse interpret this finding?
A. Intermittent claudication B. Venous stasis ulceration C. Acute compartment syndrome D.
Peripheral neuropathy
Correct answer: A. Intermittent claudication
Rationale: Intermittent claudication is exertional muscle pain caused by inadequate arterial blood
flow that typically improves with rest.
Question 8
A client with heart failure has a sudden weight gain of 2 kg (4.4 lb) over two days. What should
the nurse suspect?
A. Improved nutritional status B. Fluid retention C. Dehydration D. Resolution of heart failure
, 4|Page
Correct answer: B. Fluid retention
Rationale: Rapid weight gain can indicate fluid accumulation. The client should report this
change promptly according to their heart failure action plan.
Question 9
A nurse is assessing a client with suspected deep vein thrombosis (DVT). Which finding is most
suggestive?
A. Bilateral cool feet without swelling B. Unilateral leg swelling and warmth C. Symmetrical
arm weakness D. Slow capillary refill in both hands only
Correct answer: B. Unilateral leg swelling and warmth
Rationale: Unilateral swelling, warmth, and pain may indicate DVT. Avoid massaging the leg;
arrange prompt evaluation.
Question 10
A client develops sudden chest pain, severe dyspnea, and hypotension after surgery. The nurse
suspects pulmonary embolism. What is the priority action?
A. Encourage ambulation B. Offer oral fluids C. Activate emergency assistance and support
oxygenation D. Apply a heating pad to the affected leg
Correct answer: C. Activate emergency assistance and support oxygenation
Rationale: A pulmonary embolism can obstruct pulmonary blood flow and cause cardiovascular
collapse. Immediate emergency assessment and respiratory and circulatory support are essential.
Question 11
A client with atrial fibrillation is prescribed apixaban. Which instruction is most important?
A. Double the next dose if one dose is missed B. Report unusual bleeding or black, tarry stools
C. Take aspirin routinely without consulting the provider D. Stop the medication whenever
bruising occurs
Correct answer: B. Report unusual bleeding or black, tarry stools
Rationale: Apixaban increases bleeding risk. Signs of internal bleeding require prompt
evaluation. Missed doses and medication changes should be handled according to prescribing
instructions.
Question 12
