ATI RN ADULT MED-SURG PRACTICE
EXAM - 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 MED-SURG PRACTICE EXAM - 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 Med-surg NGN & WITH Rationales 2026/2027 Adult
Medical-surgical Nursing NEXT Generation Nclex Style Undergraduate YEAR 3 / Graduate
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-22 Acute, Appropriate, Develops, Kidney, Intervention
Safety AND Infection Control 23-44 Finding, Acute, Shock, Receiving, Intervention
Health Promotion AND 45-66 Finding, Indicates, Intervention, Acute, Receiving
Maintenance
Psychosocial Integrity 67-88 Acute, Kidney, Finding, Injury, Pressure
Basic CARE AND Comfort 89-110 Acute, Intervention, Finding, Appropriate, Chronic
Pharmacological Therapies 111-130 Acute, Develops, Kidney, Intervention, Appropriate
TOTAL 130 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
A patient with acute decompensated heart failure and severe pulmonary edema is
receiving positive inotropic therapy. Which hemodynamic parameter best indicates that
the therapy is achieving its intended effect?
A. Decreased pulmonary capillary wedge B. Increased systemic vascular resistance
pressure (PCWP) (SVR)
C. Decreased heart rate D. Increased central venous pressure (CVP)
Correct: A - Decreased pulmonary capillary wedge pressure (PCWP)
Rationale:Positive inotropes (e.g., dobutamine) increase cardiac contractility and output,
which reduces left ventricular filling pressures, thereby decreasing PCWP. Reduced PCWP
indicates improvement in pulmonary congestion. Increased SVR would worsen afterload, and
decreased heart rate is not a primary effect of inotropes; CVP would decrease, not increase,
with improved cardiac function.
Why the other answers are wrong:
B. Increased SVR would increase afterload and worsen heart failure, not be a therapeutic goal.
C. Positive inotropes often increase heart rate or have minimal effect; bradycardia is not the
intended effect.
D. Improved cardiac output would decrease CVP, not increase it.
Reference: Ignatavicius, D. & Workman, M.L. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 35.
Q2.
A patient with acute pancreatitis develops sudden onset of ecchymosis around the
umbilicus and flank. Which pathophysiological process is most directly responsible for
these findings?
A. Retroperitoneal hemorrhage from eroded B. Intra-abdominal fat necrosis and
vessels saponification
C. Disseminated intravascular coagulation D. Portal hypertension and variceal bleeding
Correct: A - Retroperitoneal hemorrhage from eroded vessels
Rationale:Cullen's sign and Grey Turner's sign indicate retroperitoneal hemorrhage, which
can occur in severe acute pancreatitis due to erosion of retroperitoneal vessels by activated
pancreatic enzymes. These signs are associated with high mortality. Fat necrosis (B) causes
hypocalcemia, DIC (C) is a coagulopathy, and portal hypertension (D) is a chronic
complication.
Why the other answers are wrong:
Page 3
, Section A - Management OF CARE
B. Fat necrosis leads to hypocalcemia, not ecchymosis.
C. DIC causes petechiae and bleeding, but not specifically periumbilical/flank ecchymosis.
D. Portal hypertension is a chronic complication, not acute hemorrhage in pancreatitis.
Reference: Lewis, S.L. et al. (2026). Medical-Surgical Nursing, 11th Ed., Ch. 46.
Q3.
A patient with chronic kidney disease (CKD) stage 5 is about to start hemodialysis. Which
laboratory value requires the most immediate intervention before initiating dialysis?
A. Serum potassium 6.2 mEq/L B. Serum creatinine 8.5 mg/dL
C. Hemoglobin 8.0 g/dL D. Serum phosphate 6.0 mg/dL
Correct: A - Serum potassium 6.2 mEq/L
Rationale:Hyperkalemia (K+ >6.0) is a life-threatening electrolyte imbalance that can cause
cardiac arrhythmias; emergency treatment (calcium gluconate, insulin/glucose, or kayexalate)
is needed before dialysis. Elevated creatinine (B) is expected in CKD but not an acute threat.
Anemia (C) is chronic and managed with erythropoietin. Hyperphosphatemia (D) is important
but not immediately life-threatening.
Why the other answers are wrong:
B. Elevated creatinine is a marker of renal failure but does not require immediate intervention.
C. Anemia in CKD is chronic and treated with ESA, not an emergency.
D. Hyperphosphatemia is managed with phosphate binders, but is not immediately
life-threatening.
Reference: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Ed., Ch. 62.
Q4.
A postoperative patient develops sudden onset of pleuritic chest pain, dyspnea, and
tachycardia. An ECG shows sinus tachycardia, and ABG reveals respiratory alkalosis.
Which diagnostic test is most appropriate to confirm the suspected diagnosis?
A. Ventilation-perfusion (V/Q) scan B. Chest x-ray
C. D-dimer assay D. Pulmonary angiography
Correct: A - Ventilation-perfusion (V/Q) scan
Rationale:The clinical picture suggests pulmonary embolism (PE). V/Q scan is a noninvasive
diagnostic test that can confirm PE by showing ventilation-perfusion mismatch. While CT
pulmonary angiography is the gold standard, V/Q scan is often used when CT is
contraindicated. D-dimer is a screening test, chest x-ray is nonspecific, and pulmonary
angiography is invasive.
Why the other answers are wrong:
B. Chest x-ray is not diagnostic for PE; it may be normal or show atelectasis.
Page 4
EXAM - 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 MED-SURG PRACTICE EXAM - 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 Med-surg NGN & WITH Rationales 2026/2027 Adult
Medical-surgical Nursing NEXT Generation Nclex Style Undergraduate YEAR 3 / Graduate
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-22 Acute, Appropriate, Develops, Kidney, Intervention
Safety AND Infection Control 23-44 Finding, Acute, Shock, Receiving, Intervention
Health Promotion AND 45-66 Finding, Indicates, Intervention, Acute, Receiving
Maintenance
Psychosocial Integrity 67-88 Acute, Kidney, Finding, Injury, Pressure
Basic CARE AND Comfort 89-110 Acute, Intervention, Finding, Appropriate, Chronic
Pharmacological Therapies 111-130 Acute, Develops, Kidney, Intervention, Appropriate
TOTAL 130 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
A patient with acute decompensated heart failure and severe pulmonary edema is
receiving positive inotropic therapy. Which hemodynamic parameter best indicates that
the therapy is achieving its intended effect?
A. Decreased pulmonary capillary wedge B. Increased systemic vascular resistance
pressure (PCWP) (SVR)
C. Decreased heart rate D. Increased central venous pressure (CVP)
Correct: A - Decreased pulmonary capillary wedge pressure (PCWP)
Rationale:Positive inotropes (e.g., dobutamine) increase cardiac contractility and output,
which reduces left ventricular filling pressures, thereby decreasing PCWP. Reduced PCWP
indicates improvement in pulmonary congestion. Increased SVR would worsen afterload, and
decreased heart rate is not a primary effect of inotropes; CVP would decrease, not increase,
with improved cardiac function.
Why the other answers are wrong:
B. Increased SVR would increase afterload and worsen heart failure, not be a therapeutic goal.
C. Positive inotropes often increase heart rate or have minimal effect; bradycardia is not the
intended effect.
D. Improved cardiac output would decrease CVP, not increase it.
Reference: Ignatavicius, D. & Workman, M.L. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 35.
Q2.
A patient with acute pancreatitis develops sudden onset of ecchymosis around the
umbilicus and flank. Which pathophysiological process is most directly responsible for
these findings?
A. Retroperitoneal hemorrhage from eroded B. Intra-abdominal fat necrosis and
vessels saponification
C. Disseminated intravascular coagulation D. Portal hypertension and variceal bleeding
Correct: A - Retroperitoneal hemorrhage from eroded vessels
Rationale:Cullen's sign and Grey Turner's sign indicate retroperitoneal hemorrhage, which
can occur in severe acute pancreatitis due to erosion of retroperitoneal vessels by activated
pancreatic enzymes. These signs are associated with high mortality. Fat necrosis (B) causes
hypocalcemia, DIC (C) is a coagulopathy, and portal hypertension (D) is a chronic
complication.
Why the other answers are wrong:
Page 3
, Section A - Management OF CARE
B. Fat necrosis leads to hypocalcemia, not ecchymosis.
C. DIC causes petechiae and bleeding, but not specifically periumbilical/flank ecchymosis.
D. Portal hypertension is a chronic complication, not acute hemorrhage in pancreatitis.
Reference: Lewis, S.L. et al. (2026). Medical-Surgical Nursing, 11th Ed., Ch. 46.
Q3.
A patient with chronic kidney disease (CKD) stage 5 is about to start hemodialysis. Which
laboratory value requires the most immediate intervention before initiating dialysis?
A. Serum potassium 6.2 mEq/L B. Serum creatinine 8.5 mg/dL
C. Hemoglobin 8.0 g/dL D. Serum phosphate 6.0 mg/dL
Correct: A - Serum potassium 6.2 mEq/L
Rationale:Hyperkalemia (K+ >6.0) is a life-threatening electrolyte imbalance that can cause
cardiac arrhythmias; emergency treatment (calcium gluconate, insulin/glucose, or kayexalate)
is needed before dialysis. Elevated creatinine (B) is expected in CKD but not an acute threat.
Anemia (C) is chronic and managed with erythropoietin. Hyperphosphatemia (D) is important
but not immediately life-threatening.
Why the other answers are wrong:
B. Elevated creatinine is a marker of renal failure but does not require immediate intervention.
C. Anemia in CKD is chronic and treated with ESA, not an emergency.
D. Hyperphosphatemia is managed with phosphate binders, but is not immediately
life-threatening.
Reference: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Ed., Ch. 62.
Q4.
A postoperative patient develops sudden onset of pleuritic chest pain, dyspnea, and
tachycardia. An ECG shows sinus tachycardia, and ABG reveals respiratory alkalosis.
Which diagnostic test is most appropriate to confirm the suspected diagnosis?
A. Ventilation-perfusion (V/Q) scan B. Chest x-ray
C. D-dimer assay D. Pulmonary angiography
Correct: A - Ventilation-perfusion (V/Q) scan
Rationale:The clinical picture suggests pulmonary embolism (PE). V/Q scan is a noninvasive
diagnostic test that can confirm PE by showing ventilation-perfusion mismatch. While CT
pulmonary angiography is the gold standard, V/Q scan is often used when CT is
contraindicated. D-dimer is a screening test, chest x-ray is nonspecific, and pulmonary
angiography is invasive.
Why the other answers are wrong:
B. Chest x-ray is not diagnostic for PE; it may be normal or show atelectasis.
Page 4
