ATI RN ADULT MEDICAL SURGICAL
(NGN) QUESTIONS & ANSWERS
WITH RATIONALES 2026/2027
130 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
ATI RN ADULT MEDICAL SURGICAL (NGN) QUESTIONS & ANSWERS WITH RATIONALES 2026/2027. It
contains 130 carefully selected questions that reflect the most current exam content and testing strategies. Each
question is accompanied by a correct answer and a detailed rationale that explains the underlying
pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 130 Questions
Foundations - Application - ATI RN Adult Medical Surgical NGN & WITH Rationales 2026/2027 Adult
Medical-surgical Nursing NGN Undergraduate YEAR 3 / Graduate
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-22 Intervention, Finding, Norepinephrine, Laboratory, Septic Shock
Safety AND Infection Control 23-44 Prescribed, Acute, Finding, Injury, Intervention
Health Promotion AND 45-66 Finding, Develops, Intervention, Indicates, Acute
Maintenance
Psychosocial Integrity 67-88 Finding, Indicates, Pressure, Intervention, Pulmonary
Basic CARE AND Comfort 89-110 Finding, Indicates, Intervention, Severe, Immediate
Pharmacological Therapies 111-130 Finding, Acute, Consistent, Develops, Immediate
TOTAL 130 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
In the management of a patient with septic shock, which hemodynamic parameter is most
indicative of adequate tissue perfusion when titrating norepinephrine?
A. Mean arterial pressure (MAP) 65 mm Hg B. Central venous pressure (CVP) 8-12 mm
Hg
C. Serum lactate normalization D. Mixed venous oxygen saturation (SvO2)
> 70%
Correct: C - Serum lactate normalization
Rationale:While MAP is a target, lactate normalization reflects improved tissue perfusion and
is the most direct indicator of adequate oxygen delivery. CVP and SvO2 are indirect and can
be influenced by other factors. Therefore, serum lactate normalization is the best indicator of
tissue perfusion.
Why the other answers are wrong:
A. MAP is a pressure target, not a direct measure of tissue perfusion, and can be normal
despite ongoing hypoperfusion.
B. CVP is a static measure of preload and does not reliably reflect tissue perfusion.
D. SvO2 is a surrogate for cardiac output and oxygen extraction, but can be falsely elevated in
sepsis due to shunting.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 18; Rivers, E. (2001).
NEJM.
Q2.
A patient with a new tracheostomy has copious, thick secretions. Which intervention is
most effective in facilitating airway clearance?
A. Instill 5 mL of normal saline into the B. Hyperoxygenate with 100% FiO2 for 30
tracheostomy before suctioning. seconds before suctioning.
C. Use a closed suction system to minimize D. Perform chest physiotherapy with
oxygen desaturation. percussion and postural drainage.
Correct: D - Perform chest physiotherapy with percussion and postural drainage.
Rationale:Chest physiotherapy helps mobilize thick secretions from the lower airways, which
is more effective than saline instillation (which is not recommended) or simply
hyperoxygenating. Closed suction is for infection control and oxygenation, not secretion
mobilization. Thus, chest PT is the most effective intervention.
Why the other answers are wrong:
Page 3
, Section A - Management OF CARE
A. Normal saline instillation is no longer recommended as it can cause bronchospasm and
does not thin secretions effectively.
B. Hyperoxygenation is important before suctioning but does not facilitate clearance of secretions.
C. Closed suction reduces oxygen loss but does not actively mobilize secretions.
Reference: Urden, L.D. (2026). Critical Care Nursing, 9th Ed., Ch. 18.
Q3.
In a patient with hyperkalemia and ECG changes, which medication should be
administered first to stabilize the cardiac membrane?
A. Calcium gluconate 10% B. Sodium bicarbonate
C. Regular insulin with dextrose D. Sodium polystyrene sulfonate
(Kayexalate)
Correct: A - Calcium gluconate 10%
Rationale:Calcium gluconate antagonizes the effects of hyperkalemia on the cardiac
membrane, rapidly stabilizing the myocardium to prevent arrhythmias. It does not lower
serum potassium but provides immediate cardioprotection. Other agents lower potassium but
take longer to act.
Why the other answers are wrong:
B. Sodium bicarbonate shifts potassium into cells but is not the first line for ECG changes; it
has delayed onset.
C. Insulin with dextrose shifts potassium into cells but takes 15-30 minutes to work.
D. Kayexalate removes potassium from the body but has a slow onset of action.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 56.
Q4.
A patient with cirrhosis presents with ascites and a serum sodium of 128 mEq/L. Which
intervention is most appropriate?
A. Administer 3% hypertonic saline IV B. Restrict fluid to 1500 mL/day
C. Administer oral salt tablets D. Encourage intake of sports drinks
Correct: B - Restrict fluid to 1500 mL/day
Rationale:In cirrhosis, hyponatremia is typically dilutional due to fluid retention. Fluid
restriction is the mainstay of treatment, not hypertonic saline, which is reserved for severe
symptomatic hyponatremia. Salt tablets and sports drinks would worsen the imbalance.
Why the other answers are wrong:
A. Hypertonic saline is only for severe hyponatremia with neurological symptoms; it can cause
fluid overload.
C. Salt tablets increase sodium but also exacerbate fluid retention and ascites.
Page 4
(NGN) QUESTIONS & ANSWERS
WITH RATIONALES 2026/2027
130 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
ATI RN ADULT MEDICAL SURGICAL (NGN) QUESTIONS & ANSWERS WITH RATIONALES 2026/2027. It
contains 130 carefully selected questions that reflect the most current exam content and testing strategies. Each
question is accompanied by a correct answer and a detailed rationale that explains the underlying
pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 130 Questions
Foundations - Application - ATI RN Adult Medical Surgical NGN & WITH Rationales 2026/2027 Adult
Medical-surgical Nursing NGN Undergraduate YEAR 3 / Graduate
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-22 Intervention, Finding, Norepinephrine, Laboratory, Septic Shock
Safety AND Infection Control 23-44 Prescribed, Acute, Finding, Injury, Intervention
Health Promotion AND 45-66 Finding, Develops, Intervention, Indicates, Acute
Maintenance
Psychosocial Integrity 67-88 Finding, Indicates, Pressure, Intervention, Pulmonary
Basic CARE AND Comfort 89-110 Finding, Indicates, Intervention, Severe, Immediate
Pharmacological Therapies 111-130 Finding, Acute, Consistent, Develops, Immediate
TOTAL 130 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
In the management of a patient with septic shock, which hemodynamic parameter is most
indicative of adequate tissue perfusion when titrating norepinephrine?
A. Mean arterial pressure (MAP) 65 mm Hg B. Central venous pressure (CVP) 8-12 mm
Hg
C. Serum lactate normalization D. Mixed venous oxygen saturation (SvO2)
> 70%
Correct: C - Serum lactate normalization
Rationale:While MAP is a target, lactate normalization reflects improved tissue perfusion and
is the most direct indicator of adequate oxygen delivery. CVP and SvO2 are indirect and can
be influenced by other factors. Therefore, serum lactate normalization is the best indicator of
tissue perfusion.
Why the other answers are wrong:
A. MAP is a pressure target, not a direct measure of tissue perfusion, and can be normal
despite ongoing hypoperfusion.
B. CVP is a static measure of preload and does not reliably reflect tissue perfusion.
D. SvO2 is a surrogate for cardiac output and oxygen extraction, but can be falsely elevated in
sepsis due to shunting.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 18; Rivers, E. (2001).
NEJM.
Q2.
A patient with a new tracheostomy has copious, thick secretions. Which intervention is
most effective in facilitating airway clearance?
A. Instill 5 mL of normal saline into the B. Hyperoxygenate with 100% FiO2 for 30
tracheostomy before suctioning. seconds before suctioning.
C. Use a closed suction system to minimize D. Perform chest physiotherapy with
oxygen desaturation. percussion and postural drainage.
Correct: D - Perform chest physiotherapy with percussion and postural drainage.
Rationale:Chest physiotherapy helps mobilize thick secretions from the lower airways, which
is more effective than saline instillation (which is not recommended) or simply
hyperoxygenating. Closed suction is for infection control and oxygenation, not secretion
mobilization. Thus, chest PT is the most effective intervention.
Why the other answers are wrong:
Page 3
, Section A - Management OF CARE
A. Normal saline instillation is no longer recommended as it can cause bronchospasm and
does not thin secretions effectively.
B. Hyperoxygenation is important before suctioning but does not facilitate clearance of secretions.
C. Closed suction reduces oxygen loss but does not actively mobilize secretions.
Reference: Urden, L.D. (2026). Critical Care Nursing, 9th Ed., Ch. 18.
Q3.
In a patient with hyperkalemia and ECG changes, which medication should be
administered first to stabilize the cardiac membrane?
A. Calcium gluconate 10% B. Sodium bicarbonate
C. Regular insulin with dextrose D. Sodium polystyrene sulfonate
(Kayexalate)
Correct: A - Calcium gluconate 10%
Rationale:Calcium gluconate antagonizes the effects of hyperkalemia on the cardiac
membrane, rapidly stabilizing the myocardium to prevent arrhythmias. It does not lower
serum potassium but provides immediate cardioprotection. Other agents lower potassium but
take longer to act.
Why the other answers are wrong:
B. Sodium bicarbonate shifts potassium into cells but is not the first line for ECG changes; it
has delayed onset.
C. Insulin with dextrose shifts potassium into cells but takes 15-30 minutes to work.
D. Kayexalate removes potassium from the body but has a slow onset of action.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 56.
Q4.
A patient with cirrhosis presents with ascites and a serum sodium of 128 mEq/L. Which
intervention is most appropriate?
A. Administer 3% hypertonic saline IV B. Restrict fluid to 1500 mL/day
C. Administer oral salt tablets D. Encourage intake of sports drinks
Correct: B - Restrict fluid to 1500 mL/day
Rationale:In cirrhosis, hyponatremia is typically dilutional due to fluid retention. Fluid
restriction is the mainstay of treatment, not hypertonic saline, which is reserved for severe
symptomatic hyponatremia. Salt tablets and sports drinks would worsen the imbalance.
Why the other answers are wrong:
A. Hypertonic saline is only for severe hyponatremia with neurological symptoms; it can cause
fluid overload.
C. Salt tablets increase sodium but also exacerbate fluid retention and ascites.
Page 4
