ATI ADULT MEDICAL-SURGICAL PROCTORED EXAM 2026/2027 - NGN
FORMAT - 400 VERIFIED QUESTIONS WITH ANSWERS A, B, C, D MIXED &
DETAILED RATIONALES | A+ GRADED | LEVEL 3
Course: ATI Adult Medical Surgical CMS Proctored 2026/2027 | 400 Questions | NGN | Answers Mixed
A/B/C/D (Not All A) | 2026/2027 Edition
Coverage: Cardiovascular, Respiratory, GI, Endocrine, Renal, Fluids/Electrolytes, Neuro, Musculoskeletal, Oncology, Perioperative,
Hematology, Immunology - All NGN Clinical Judgment Model with Bow-tie, Matrix, Case Studies
Original 2026/2027 content based on ATI Med-Surg standards, Lewis Medical-Surgical Nursing, Saunders NCLEX, NCSBN CJMM. Author-created, mixed answer
keys for exam realism. Not copied from official ATI.
1. Left-sided heart failure pulmonary edema signs? (2026/2027 Variant 1)
A. Nocturia only
B. Weight loss
C. Dyspnea, crackles, frothy sputum, tachypnea, orthopnea
D. Peripheral edema only
Correct Answer: C
Rationale: Left HF backs up to lungs -> pulmonary congestion: dyspnea, crackles, cough frothy sputum, tachypnea, orthopnea, PND.
2. Right-sided heart failure signs? (2026/2027 Variant 2)
A. Dry cough
B. Frothy sputum
C. Peripheral edema, JVD, ascites, weight gain, hepatomegaly
D. Lung crackles only
Correct Answer: C
Rationale: Right HF backs up to body: peripheral edema, JVD, ascites, hepatomegaly, weight gain, nocturia.
3. MI - First action for crushing chest pain radiating to arm? (2026/2027 Variant 3)
A. Obtain 12-lead ECG within 10 min, give O2 if SpO2 <94%, aspirin, nitro, morphine per protocol
B. Give food
C. Encourage ambulation
D. Discharge
Correct Answer: A
Rationale: Chest pain protocol: ECG within 10 min, O2 if hypoxic, aspirin chewed if prescribed, nitro if BP OK, morphine.
4. Heparin infusion therapeutic aPTT? (2026/2027 Variant 4)
A. 100-150
B. 60-80 seconds (1.5-2x control)
C. 10-20 sec
D. 0-10
Correct Answer: B
Rationale: Heparin therapeutic aPTT 60-80 sec. Monitor platelets for HIT. Protamine antidote.
5. Warfarin INR therapeutic for AFib? (2026/2027 Variant 5)
A. 0.5-1
B. 5-6
C. 10
D. 2-3 for AFib/DVT/PE
Correct Answer: D
Rationale: Warfarin therapeutic INR 2-3 for AFib, DVT/PE. 2.5-3.5 for mechanical valve. Vitamin K antidote.
6. Digoxin toxicity signs? (2026/2027 Variant 6)
A. Weight gain
B. Nausea, vomiting, anorexia, yellow-green halos, bradycardia, confusion
C. Diarrhea only
, D. Tachycardia, hypertension
Correct Answer: B
Rationale: Digoxin toxicity: GI upset, anorexia, visual halos, bradycardia, confusion. Check K+, Mg2+, dig level.
7. COPD O2 target? (2026/2027 Variant 7)
A. 15L
B. 100% non-rebreather
C. 88-92% with 1-2L nasal cannula
D. No O2
Correct Answer: C
Rationale: COPD chronic CO2 retainer: low-flow O2 1-2L, target 88-92% to avoid suppressing hypoxic drive.
8. Asthma status asthmaticus treatment? (2026/2027 Variant 8)
A. Exercise
B. Stop all meds
C. Continuous albuterol, ipratropium, systemic steroids, magnesium, O2, prepare intubation
D. Sedatives
Correct Answer: C
Rationale: Status asthmaticus: continuous nebs, steroids, magnesium, O2, monitor ABGs.
9. Pneumonia pleuritic pain reason? (2026/2027 Variant 9)
A. Cardiac ischemia
B. Anxiety
C. GERD
D. Inflamed pleura rubbing during breathing
Correct Answer: D
Rationale: Pneumonia inflames pleura -> pleuritic pain with breathing/coughing.
10. Chest tube dislodged - first? (2026/2027 Variant 10)
A. Give water
B. Cover insertion site with occlusive dressing taped on 3 sides, call provider
C. Reinsert immediately
D. Leave open
Correct Answer: B
Rationale: Dislodged chest tube: occlusive dressing 3 sides to prevent tension pneumothorax.
11. Chest tube tidaling absent means? (2026/2027 Variant 11)
A. Infection
B. Always normal
C. Tube obstructed/clotted or lung fully re-expanded - assess
D. Pneumothorax
Correct Answer: C
Rationale: Absent tidaling may mean obstruction/kink or lung re-expanded. Assess breath sounds, drainage.
12. ABG pH 7.30 PaCO2 50 HCO3 24 indicates? (2026/2027 Variant 12)
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis - hypoventilation retaining CO2
D. Metabolic alkalosis
Correct Answer: C
Rationale: Low pH with high CO2 = respiratory acidosis.
13. DKA signs? (2026/2027 Variant 13)
A. Kussmaul deep rapid, fruity acetone breath, hyperglycemia >250, ketones positive
B. Bradypnea
C. Hypoglycemia
D. Weight gain, no thirst
,Correct Answer: A
Rationale: DKA: hyperglycemia >250, ketosis, metabolic acidosis, Kussmaul, fruity breath, dehydration.
14. DKA first fluid? (2026/2027 Variant 14)
A. D5W
B. LR
C. 0.9% Normal Saline to restore volume
D. 0.45% NS first
Correct Answer: C
Rationale: DKA: NS first to restore volume, then 0.45% NS, add dextrose when <250.
15. Hypoglycemia 55 mg/dL treatment conscious? (2026/2027 Variant 15)
A. Nothing
B. Water
C. 15g fast carbs: 4 oz juice, 3 glucose tabs, recheck 15 min
D. Give insulin
Correct Answer: C
Rationale: Rule of 15: 15g fast carb, recheck 15 min, repeat if <70, then snack.
16. Diabetic foot teaching? (2026/2027 Variant 16)
A. Inspect feet daily, moisturize not between toes, closed shoes, never barefoot
B. Soak in hot water
C. Cut corns
D. Open sandals
Correct Answer: A
Rationale: Diabetic foot: inspect daily, moisturize feet not between toes, closed shoes, never barefoot.
17. Thyroidectomy tingling around mouth (2026/2027 Variant 17)
A. Hyperkalemia
B. Hypercalcemia
C. Hyponatremia
D. Hypocalcemia from parathyroid injury - Chvostek/Trousseau
Correct Answer: D
Rationale: Parathyroid damage -> low Ca2+ -> tingling, muscle cramps, Chvostek/Trousseau. Calcium gluconate.
18. Addison's disease (2026/2027 Variant 18)
A. Hyperglycemia
B. Bronze hyperpigmentation, hypotension, hyponatremia, hyperkalemia
C. Weight gain
D. Moon face, buffalo hump
Correct Answer: B
Rationale: Addison's adrenal insufficiency: hypotension, hyponatremia, hyperkalemia, hyperpigmentation.
19. AKI oliguric phase (2026/2027 Variant 19)
A. 2000 mL
B. Normal
C. <400 mL/day - monitor hyperkalemia, fluid overload
D. 1000 mL/day
Correct Answer: C
Rationale: Oliguric AKI <400 mL/day. Risk hyperkalemia, fluid overload, acidosis.
20. Hyperkalemia peaked T waves first (2026/2027 Variant 20)
A. Furosemide only
B. Insulin only
C. Sodium bicarbonate only
D. Calcium gluconate to stabilize myocardium first, then insulin+glucose, then removal
Correct Answer: D
, Rationale: Hyperkalemia: Calcium gluconate stabilizes heart first, then shift K+ in with insulin+glucose, then remove.
21. Hyponatremia symptoms (2026/2027 Variant 21)
A. Headache, confusion, nausea, cramps, seizures if <120
B. Flushed dry skin
C. Polyuria
D. Thirst
Correct Answer: A
Rationale: Hyponatremia: neuro symptoms cerebral edema - headache, confusion, nausea, seizures.
22. GCS <8 indicates (2026/2027 Variant 22)
A. Coma, unable to protect airway, needs intubation
B. Normal
C. Mild confusion
D. Alert
Correct Answer: A
Rationale: GCS <8 coma, inability to protect airway, intubate.
23. Stroke tPA contraindication (2026/2027 Variant 23)
A. BP 130/80
B. Age 60
C. Onset 1 hour
D. Recent surgery within 14 days, active bleeding, hemorrhagic stroke, HTN >185/110
Correct Answer: D
Rationale: tPA contraindicated: recent surgery, bleeding, hemorrhagic stroke, severe HTN, low platelets, high INR.
24. Seizure precautions (2026/2027 Variant 24)
A. Padded rails, O2 and suction at bedside, turn side-lying, no objects in mouth
B. Tongue blade
C. Water during seizure
D. Restrain
Correct Answer: A
Rationale: Seizure: protect, side-lying, suction, O2, padded rails, do NOT restrain or put objects in mouth.
25. Fat embolism early sign (2026/2027 Variant 25)
A. Weight gain
B. Restlessness, tachycardia, tachypnea, petechiae on chest/axilla 24-48h post fracture
C. Hypertension
D. Bradycardia
Correct Answer: B
Rationale: Fat embolism: restlessness, tachypnea, tachycardia, dyspnea, petechiae 24-48h post long bone fracture.
26. NG tube placement check (2026/2027 Variant 26)
A. Air auscultation only
B. pH 1-4 and X-ray gold standard
C. Give water
D. Look at tube
Correct Answer: B
Rationale: NG: X-ray gold standard. pH 1-4 gastric. Never air auscultation alone.
27. Post-op hemorrhage first sign (2026/2027 Variant 27)
A. Bradycardia
B. Hypertension
C. Tachycardia, tachypnea, restlessness, pale cool skin, hypotension late
D. Warm skin
Correct Answer: C
Rationale: Hemorrhage early: tachycardia, tachypnea, restlessness, cool pale skin. Late hypotension.
FORMAT - 400 VERIFIED QUESTIONS WITH ANSWERS A, B, C, D MIXED &
DETAILED RATIONALES | A+ GRADED | LEVEL 3
Course: ATI Adult Medical Surgical CMS Proctored 2026/2027 | 400 Questions | NGN | Answers Mixed
A/B/C/D (Not All A) | 2026/2027 Edition
Coverage: Cardiovascular, Respiratory, GI, Endocrine, Renal, Fluids/Electrolytes, Neuro, Musculoskeletal, Oncology, Perioperative,
Hematology, Immunology - All NGN Clinical Judgment Model with Bow-tie, Matrix, Case Studies
Original 2026/2027 content based on ATI Med-Surg standards, Lewis Medical-Surgical Nursing, Saunders NCLEX, NCSBN CJMM. Author-created, mixed answer
keys for exam realism. Not copied from official ATI.
1. Left-sided heart failure pulmonary edema signs? (2026/2027 Variant 1)
A. Nocturia only
B. Weight loss
C. Dyspnea, crackles, frothy sputum, tachypnea, orthopnea
D. Peripheral edema only
Correct Answer: C
Rationale: Left HF backs up to lungs -> pulmonary congestion: dyspnea, crackles, cough frothy sputum, tachypnea, orthopnea, PND.
2. Right-sided heart failure signs? (2026/2027 Variant 2)
A. Dry cough
B. Frothy sputum
C. Peripheral edema, JVD, ascites, weight gain, hepatomegaly
D. Lung crackles only
Correct Answer: C
Rationale: Right HF backs up to body: peripheral edema, JVD, ascites, hepatomegaly, weight gain, nocturia.
3. MI - First action for crushing chest pain radiating to arm? (2026/2027 Variant 3)
A. Obtain 12-lead ECG within 10 min, give O2 if SpO2 <94%, aspirin, nitro, morphine per protocol
B. Give food
C. Encourage ambulation
D. Discharge
Correct Answer: A
Rationale: Chest pain protocol: ECG within 10 min, O2 if hypoxic, aspirin chewed if prescribed, nitro if BP OK, morphine.
4. Heparin infusion therapeutic aPTT? (2026/2027 Variant 4)
A. 100-150
B. 60-80 seconds (1.5-2x control)
C. 10-20 sec
D. 0-10
Correct Answer: B
Rationale: Heparin therapeutic aPTT 60-80 sec. Monitor platelets for HIT. Protamine antidote.
5. Warfarin INR therapeutic for AFib? (2026/2027 Variant 5)
A. 0.5-1
B. 5-6
C. 10
D. 2-3 for AFib/DVT/PE
Correct Answer: D
Rationale: Warfarin therapeutic INR 2-3 for AFib, DVT/PE. 2.5-3.5 for mechanical valve. Vitamin K antidote.
6. Digoxin toxicity signs? (2026/2027 Variant 6)
A. Weight gain
B. Nausea, vomiting, anorexia, yellow-green halos, bradycardia, confusion
C. Diarrhea only
, D. Tachycardia, hypertension
Correct Answer: B
Rationale: Digoxin toxicity: GI upset, anorexia, visual halos, bradycardia, confusion. Check K+, Mg2+, dig level.
7. COPD O2 target? (2026/2027 Variant 7)
A. 15L
B. 100% non-rebreather
C. 88-92% with 1-2L nasal cannula
D. No O2
Correct Answer: C
Rationale: COPD chronic CO2 retainer: low-flow O2 1-2L, target 88-92% to avoid suppressing hypoxic drive.
8. Asthma status asthmaticus treatment? (2026/2027 Variant 8)
A. Exercise
B. Stop all meds
C. Continuous albuterol, ipratropium, systemic steroids, magnesium, O2, prepare intubation
D. Sedatives
Correct Answer: C
Rationale: Status asthmaticus: continuous nebs, steroids, magnesium, O2, monitor ABGs.
9. Pneumonia pleuritic pain reason? (2026/2027 Variant 9)
A. Cardiac ischemia
B. Anxiety
C. GERD
D. Inflamed pleura rubbing during breathing
Correct Answer: D
Rationale: Pneumonia inflames pleura -> pleuritic pain with breathing/coughing.
10. Chest tube dislodged - first? (2026/2027 Variant 10)
A. Give water
B. Cover insertion site with occlusive dressing taped on 3 sides, call provider
C. Reinsert immediately
D. Leave open
Correct Answer: B
Rationale: Dislodged chest tube: occlusive dressing 3 sides to prevent tension pneumothorax.
11. Chest tube tidaling absent means? (2026/2027 Variant 11)
A. Infection
B. Always normal
C. Tube obstructed/clotted or lung fully re-expanded - assess
D. Pneumothorax
Correct Answer: C
Rationale: Absent tidaling may mean obstruction/kink or lung re-expanded. Assess breath sounds, drainage.
12. ABG pH 7.30 PaCO2 50 HCO3 24 indicates? (2026/2027 Variant 12)
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis - hypoventilation retaining CO2
D. Metabolic alkalosis
Correct Answer: C
Rationale: Low pH with high CO2 = respiratory acidosis.
13. DKA signs? (2026/2027 Variant 13)
A. Kussmaul deep rapid, fruity acetone breath, hyperglycemia >250, ketones positive
B. Bradypnea
C. Hypoglycemia
D. Weight gain, no thirst
,Correct Answer: A
Rationale: DKA: hyperglycemia >250, ketosis, metabolic acidosis, Kussmaul, fruity breath, dehydration.
14. DKA first fluid? (2026/2027 Variant 14)
A. D5W
B. LR
C. 0.9% Normal Saline to restore volume
D. 0.45% NS first
Correct Answer: C
Rationale: DKA: NS first to restore volume, then 0.45% NS, add dextrose when <250.
15. Hypoglycemia 55 mg/dL treatment conscious? (2026/2027 Variant 15)
A. Nothing
B. Water
C. 15g fast carbs: 4 oz juice, 3 glucose tabs, recheck 15 min
D. Give insulin
Correct Answer: C
Rationale: Rule of 15: 15g fast carb, recheck 15 min, repeat if <70, then snack.
16. Diabetic foot teaching? (2026/2027 Variant 16)
A. Inspect feet daily, moisturize not between toes, closed shoes, never barefoot
B. Soak in hot water
C. Cut corns
D. Open sandals
Correct Answer: A
Rationale: Diabetic foot: inspect daily, moisturize feet not between toes, closed shoes, never barefoot.
17. Thyroidectomy tingling around mouth (2026/2027 Variant 17)
A. Hyperkalemia
B. Hypercalcemia
C. Hyponatremia
D. Hypocalcemia from parathyroid injury - Chvostek/Trousseau
Correct Answer: D
Rationale: Parathyroid damage -> low Ca2+ -> tingling, muscle cramps, Chvostek/Trousseau. Calcium gluconate.
18. Addison's disease (2026/2027 Variant 18)
A. Hyperglycemia
B. Bronze hyperpigmentation, hypotension, hyponatremia, hyperkalemia
C. Weight gain
D. Moon face, buffalo hump
Correct Answer: B
Rationale: Addison's adrenal insufficiency: hypotension, hyponatremia, hyperkalemia, hyperpigmentation.
19. AKI oliguric phase (2026/2027 Variant 19)
A. 2000 mL
B. Normal
C. <400 mL/day - monitor hyperkalemia, fluid overload
D. 1000 mL/day
Correct Answer: C
Rationale: Oliguric AKI <400 mL/day. Risk hyperkalemia, fluid overload, acidosis.
20. Hyperkalemia peaked T waves first (2026/2027 Variant 20)
A. Furosemide only
B. Insulin only
C. Sodium bicarbonate only
D. Calcium gluconate to stabilize myocardium first, then insulin+glucose, then removal
Correct Answer: D
, Rationale: Hyperkalemia: Calcium gluconate stabilizes heart first, then shift K+ in with insulin+glucose, then remove.
21. Hyponatremia symptoms (2026/2027 Variant 21)
A. Headache, confusion, nausea, cramps, seizures if <120
B. Flushed dry skin
C. Polyuria
D. Thirst
Correct Answer: A
Rationale: Hyponatremia: neuro symptoms cerebral edema - headache, confusion, nausea, seizures.
22. GCS <8 indicates (2026/2027 Variant 22)
A. Coma, unable to protect airway, needs intubation
B. Normal
C. Mild confusion
D. Alert
Correct Answer: A
Rationale: GCS <8 coma, inability to protect airway, intubate.
23. Stroke tPA contraindication (2026/2027 Variant 23)
A. BP 130/80
B. Age 60
C. Onset 1 hour
D. Recent surgery within 14 days, active bleeding, hemorrhagic stroke, HTN >185/110
Correct Answer: D
Rationale: tPA contraindicated: recent surgery, bleeding, hemorrhagic stroke, severe HTN, low platelets, high INR.
24. Seizure precautions (2026/2027 Variant 24)
A. Padded rails, O2 and suction at bedside, turn side-lying, no objects in mouth
B. Tongue blade
C. Water during seizure
D. Restrain
Correct Answer: A
Rationale: Seizure: protect, side-lying, suction, O2, padded rails, do NOT restrain or put objects in mouth.
25. Fat embolism early sign (2026/2027 Variant 25)
A. Weight gain
B. Restlessness, tachycardia, tachypnea, petechiae on chest/axilla 24-48h post fracture
C. Hypertension
D. Bradycardia
Correct Answer: B
Rationale: Fat embolism: restlessness, tachypnea, tachycardia, dyspnea, petechiae 24-48h post long bone fracture.
26. NG tube placement check (2026/2027 Variant 26)
A. Air auscultation only
B. pH 1-4 and X-ray gold standard
C. Give water
D. Look at tube
Correct Answer: B
Rationale: NG: X-ray gold standard. pH 1-4 gastric. Never air auscultation alone.
27. Post-op hemorrhage first sign (2026/2027 Variant 27)
A. Bradycardia
B. Hypertension
C. Tachycardia, tachypnea, restlessness, pale cool skin, hypotension late
D. Warm skin
Correct Answer: C
Rationale: Hemorrhage early: tachycardia, tachypnea, restlessness, cool pale skin. Late hypotension.
