ATI MED-SURG COMPREHENSIVE
PREDICTOR 2026 – PRACTICE QUESTIONS,
VERIFIED ANSWERS & DETAILED
RATIONALES
ATI MED-SURG COMPREHENSIVE PREDICTOR 2026 – PRACTICE QUESTIONS
DOCUMENT OVERVIEW
• This comprehensive predictor contains 200 verified, detailed exam-style questions
aligned with ATI Medical-Surgical Nursing standards, designed to assess mastery
across all major clinical domains and prepare you for success on the actual exam.
• Study this material by completing 20-25 questions per session, reviewing
rationales carefully for both correct and incorrect options, and focusing on areas
where you score below 80% for targeted remediation.
1. A 62-year-old client with a history of hypertension and hyperlipidemia is
admitted with chest pain radiating to the left arm and shortness of breath.
The nurse notes diaphoresis and anxiety. What is the priority nursing action?
A) Administer sublingual nitroglycerin and assess pain relief
B) Obtain a 12-lead ECG and establish IV access
C) Provide reassurance and position the client in semi-Fowler's
D) Administer oxygen and obtain vital signs
E) Call the client's family and inform them of admission
CORRECT ANSWER: B) Obtain a 12-lead ECG and establish IV access
RATIONALE: A 12-lead ECG must be obtained within 10 minutes of arrival to rule out
myocardial infarction. Establishing IV access allows for rapid medication
administration and blood draws. While oxygen, nitroglycerin, and reassurance are
also important, the ECG is the diagnostic priority in suspected acute coronary
,syndrome. The ECG provides critical information about myocardial injury and
guides treatment decisions.
2. A client receiving chemotherapy for breast cancer develops severe nausea
and vomiting 4 hours post-infusion. Which antiemetic agent would be most
effective?
A) Metoclopramide given orally
B) Ondansetron IV given 30 minutes before and after chemotherapy
C) Diphenhydramine IM for breakthrough nausea
D) Prochlorperazine rectal suppository
E) Ginger supplements as a complementary therapy
CORRECT ANSWER: B) Ondansetron IV given 30 minutes before and after
chemotherapy
RATIONALE: 5-HT3 receptor antagonists like ondansetron are the gold standard for
preventing and managing acute and delayed chemotherapy-induced nausea and
vomiting (CINV). Administering before and after chemotherapy provides optimal
prevention. Metoclopramide is less effective for CINV. While other agents may help
with breakthrough symptoms, ondansetron's proven efficacy and timing make it
the best choice for this scenario.
3. A 58-year-old male client has a new diagnosis of type 2 diabetes mellitus. He
asks the nurse about dietary modifications. What should the nurse
emphasize?
A) Eliminate all refined carbohydrates and focus only on protein intake
B) Follow a consistent carbohydrate intake with balanced meals containing fiber,
protein, and healthy fats
C) Increase fruit juice consumption as a healthy carbohydrate source
D) Restrict total caloric intake to below 1000 calories daily
,E) Avoid eating after 6 PM to prevent blood sugar spikes
CORRECT ANSWER: B) Follow a consistent carbohydrate intake with balanced
meals containing fiber, protein, and healthy fats
RATIONALE: Consistent carbohydrate intake helps maintain stable blood glucose
levels. Balanced meals with complex carbohydrates (high fiber), lean proteins, and
healthy fats promote satiety, slow glucose absorption, and reduce blood sugar
fluctuations. Complete elimination of carbohydrates is unnecessary and
unsustainable. Fruit juice is high in simple sugars. Extreme caloric restriction is
contraindicated and potentially harmful. Meal timing alone does not prevent
hyperglycemia.
4. A client admitted with acute pancreatitis reports severe epigastric pain
radiating to the back. Which medication would provide the most appropriate
pain management?
A) Morphine IV
B) Aspirin oral
C) Ketorolac IV
D) Meperidine IM
E) Ibuprofen oral
CORRECT ANSWER: A) Morphine IV
RATIONALE: Morphine is the preferred opioid for acute pancreatitis pain
management. While meperidine was historically used, morphine is now considered
superior and does not increase pancreatic duct pressure as previously thought.
NSAIDs like ketorolac and ibuprofen are contraindicated in acute pancreatitis due
to risk of complications. IV administration provides rapid and reliable pain control
essential for reducing sympathetic stimulation.
, 5. A 70-year-old client with COPD is admitted with acute exacerbation. Which
finding would indicate the client is experiencing acute respiratory distress?
A) SpO2 of 92% on room air with mild dyspnea
B) Respiratory rate of 28 with pursed-lip breathing and tripod positioning
C) Productive cough with clear sputum and wheezing
D) Alert and oriented with normal breath sounds bilaterally
E) SpO2 of 88% with use of accessory muscles and inability to speak full sentences
CORRECT ANSWER: E) SpO2 of 88% with use of accessory muscles and inability
to speak full sentences
RATIONALE: Signs of severe respiratory distress include SpO2 below 90%, use of
accessory muscles, altered speech patterns (inability to complete sentences), and
clinical signs of hypoxemia. While other findings may indicate COPD exacerbation,
this option represents true acute respiratory distress requiring immediate
intervention. A SpO2 of 92% is acceptable, and tripod positioning with pursed-lip
breathing are adaptive mechanisms, not acute distress indicators.
6. A client with peripheral arterial disease (PAD) is ambulating in the hallway
when sudden calf pain develops. The nurse should perform which action first?
A) Assist the client to sit and massage the affected leg
B) Encourage the client to continue walking through the pain
C) Assist the client to sit and elevate the affected limb
D) Obtain pain medication immediately
E) Perform ankle-brachial index (ABI) measurement
CORRECT ANSWER: C) Assist the client to sit and elevate the affected limb
RATIONALE: When claudication pain develops, the client should immediately stop
activity and sit. The affected limb should be placed in a dependent position (NOT
elevated) to increase blood flow to the muscles, but remaining seated and still
PREDICTOR 2026 – PRACTICE QUESTIONS,
VERIFIED ANSWERS & DETAILED
RATIONALES
ATI MED-SURG COMPREHENSIVE PREDICTOR 2026 – PRACTICE QUESTIONS
DOCUMENT OVERVIEW
• This comprehensive predictor contains 200 verified, detailed exam-style questions
aligned with ATI Medical-Surgical Nursing standards, designed to assess mastery
across all major clinical domains and prepare you for success on the actual exam.
• Study this material by completing 20-25 questions per session, reviewing
rationales carefully for both correct and incorrect options, and focusing on areas
where you score below 80% for targeted remediation.
1. A 62-year-old client with a history of hypertension and hyperlipidemia is
admitted with chest pain radiating to the left arm and shortness of breath.
The nurse notes diaphoresis and anxiety. What is the priority nursing action?
A) Administer sublingual nitroglycerin and assess pain relief
B) Obtain a 12-lead ECG and establish IV access
C) Provide reassurance and position the client in semi-Fowler's
D) Administer oxygen and obtain vital signs
E) Call the client's family and inform them of admission
CORRECT ANSWER: B) Obtain a 12-lead ECG and establish IV access
RATIONALE: A 12-lead ECG must be obtained within 10 minutes of arrival to rule out
myocardial infarction. Establishing IV access allows for rapid medication
administration and blood draws. While oxygen, nitroglycerin, and reassurance are
also important, the ECG is the diagnostic priority in suspected acute coronary
,syndrome. The ECG provides critical information about myocardial injury and
guides treatment decisions.
2. A client receiving chemotherapy for breast cancer develops severe nausea
and vomiting 4 hours post-infusion. Which antiemetic agent would be most
effective?
A) Metoclopramide given orally
B) Ondansetron IV given 30 minutes before and after chemotherapy
C) Diphenhydramine IM for breakthrough nausea
D) Prochlorperazine rectal suppository
E) Ginger supplements as a complementary therapy
CORRECT ANSWER: B) Ondansetron IV given 30 minutes before and after
chemotherapy
RATIONALE: 5-HT3 receptor antagonists like ondansetron are the gold standard for
preventing and managing acute and delayed chemotherapy-induced nausea and
vomiting (CINV). Administering before and after chemotherapy provides optimal
prevention. Metoclopramide is less effective for CINV. While other agents may help
with breakthrough symptoms, ondansetron's proven efficacy and timing make it
the best choice for this scenario.
3. A 58-year-old male client has a new diagnosis of type 2 diabetes mellitus. He
asks the nurse about dietary modifications. What should the nurse
emphasize?
A) Eliminate all refined carbohydrates and focus only on protein intake
B) Follow a consistent carbohydrate intake with balanced meals containing fiber,
protein, and healthy fats
C) Increase fruit juice consumption as a healthy carbohydrate source
D) Restrict total caloric intake to below 1000 calories daily
,E) Avoid eating after 6 PM to prevent blood sugar spikes
CORRECT ANSWER: B) Follow a consistent carbohydrate intake with balanced
meals containing fiber, protein, and healthy fats
RATIONALE: Consistent carbohydrate intake helps maintain stable blood glucose
levels. Balanced meals with complex carbohydrates (high fiber), lean proteins, and
healthy fats promote satiety, slow glucose absorption, and reduce blood sugar
fluctuations. Complete elimination of carbohydrates is unnecessary and
unsustainable. Fruit juice is high in simple sugars. Extreme caloric restriction is
contraindicated and potentially harmful. Meal timing alone does not prevent
hyperglycemia.
4. A client admitted with acute pancreatitis reports severe epigastric pain
radiating to the back. Which medication would provide the most appropriate
pain management?
A) Morphine IV
B) Aspirin oral
C) Ketorolac IV
D) Meperidine IM
E) Ibuprofen oral
CORRECT ANSWER: A) Morphine IV
RATIONALE: Morphine is the preferred opioid for acute pancreatitis pain
management. While meperidine was historically used, morphine is now considered
superior and does not increase pancreatic duct pressure as previously thought.
NSAIDs like ketorolac and ibuprofen are contraindicated in acute pancreatitis due
to risk of complications. IV administration provides rapid and reliable pain control
essential for reducing sympathetic stimulation.
, 5. A 70-year-old client with COPD is admitted with acute exacerbation. Which
finding would indicate the client is experiencing acute respiratory distress?
A) SpO2 of 92% on room air with mild dyspnea
B) Respiratory rate of 28 with pursed-lip breathing and tripod positioning
C) Productive cough with clear sputum and wheezing
D) Alert and oriented with normal breath sounds bilaterally
E) SpO2 of 88% with use of accessory muscles and inability to speak full sentences
CORRECT ANSWER: E) SpO2 of 88% with use of accessory muscles and inability
to speak full sentences
RATIONALE: Signs of severe respiratory distress include SpO2 below 90%, use of
accessory muscles, altered speech patterns (inability to complete sentences), and
clinical signs of hypoxemia. While other findings may indicate COPD exacerbation,
this option represents true acute respiratory distress requiring immediate
intervention. A SpO2 of 92% is acceptable, and tripod positioning with pursed-lip
breathing are adaptive mechanisms, not acute distress indicators.
6. A client with peripheral arterial disease (PAD) is ambulating in the hallway
when sudden calf pain develops. The nurse should perform which action first?
A) Assist the client to sit and massage the affected leg
B) Encourage the client to continue walking through the pain
C) Assist the client to sit and elevate the affected limb
D) Obtain pain medication immediately
E) Perform ankle-brachial index (ABI) measurement
CORRECT ANSWER: C) Assist the client to sit and elevate the affected limb
RATIONALE: When claudication pain develops, the client should immediately stop
activity and sit. The affected limb should be placed in a dependent position (NOT
elevated) to increase blood flow to the muscles, but remaining seated and still
