ATI Medical-Surgical Nursing Part A ATI Testing Academic
Year 2026/2027 Comprehensive Examination Preparation 100
Original Questions
About This Exam Bank
This comprehensive 148-question exam bank is designed to prepare candidates for ATI Medical-Surgical Nursing
Part A ATI Testing Academic Year 2026/2027 Comprehensive Examination Preparation 100 Original Questions.
Every question is aligned with the latest official content outline and includes a detailed, evidence-based rationale, an
explanation of why each remaining option is incorrect, and a supporting reference.
Keywords
ATI Medical-Surgical Nursing Part A ATI Testing Academic Year 2026/2027 Comprehensive Examination
Preparation 100 Original Questions, exam bank, practice questions, verified answers, detailed rationales, test prep,
study guide, review questions, certification exam, latest update, ATI Medical-Surgical Nursing Part A ATI Testing
Academic Year 2026/2027 Comprehensive Examination Preparation 100 Original Questions, exam bank, practice
questions, verified answers, detailed rationales
PART 1: APPLY CLINICAL JUDGMENT TO PRIORITIZE ASSESSMENT AND
INTERVENTION FOR ADULTS WITH ACUTE AND CHRONIC MEDICAL-SURGICAL
ALTERATIONS
1. A client receiving continuous heparin infusion has an aPTT of 96 seconds (control 30 seconds) and new
hematuria. Which action should the nurse anticipate implementing first?
A) Administer vitamin K 10 mg IV push
B) Stop the heparin infusion and prepare to administer protamine sulfate
C) Hold the next dose and continue the infusion at the current rate
D) Transfuse fresh frozen plasma and continue heparin
' Correct Answer: B
Rationale: An aPTT >2.5 times control with bleeding indicates heparin toxicity; the infusion is stopped and
protamine sulfate is the antidote. Vitamin K reverses warfarin, not heparin; continuing the infusion worsens
bleeding; FFP is not first-line for heparin reversal.
2. Following a thyroidectomy, a client develops stridor, neck swelling, and a rapidly expanding hematoma. Which
complication should the nurse identify as the immediate priority?
A) Hypocalcemia from parathyroid injury
B) Thyroid storm from surgical manipulation
C) Airway obstruction from postoperative hemorrhage
D) Recurrent laryngeal nerve injury
' Correct Answer: C
Rationale: Stridor with expanding neck hematoma after thyroidectomy signals airway compromise from
hemorrhage, requiring immediate intervention. Hypocalcemia causes tingling/spasms, thyroid storm causes
hypermetabolic symptoms, and nerve injury causes hoarseness-none produce acute airway obstruction with
hematoma.
3. For each potential provider prescription, indicate whether it is anticipated, nonessential, or contraindicated.
Page 1
, A) All prescriptions anticipated
B) Mixed anticipated, nonessential, and contraindicated
C) All prescriptions contraindicated
D) All prescriptions nonessential
' Correct Answer: B
Rationale: Diuresis, oxygenation, and positioning are anticipated; fluid bolus and IV beta-blockade are
contraindicated in decompensated HF with hypotension and pulmonary edema; daily weights are important but not
immediately essential. This reflects safe prioritization in acute HF management.
4. A client with chronic kidney disease (stage 4) has the following labs: K+ 6.2 mEq/L, BUN 68 mg/dL, creatinine
4.9 mg/dL, and peaked T waves on ECG. Which intervention should the nurse implement first?
A) Administer sodium polystyrene sulfonate orally
B) Administer IV calcium gluconate
C) Administer regular insulin with dextrose IV
D) Prepare for emergent hemodialysis
' Correct Answer: B
Rationale: IV calcium gluconate is given first to stabilize cardiac membranes and prevent lethal arrhythmias from
hyperkalemia. Insulin/dextrose and polystyrene shift or eliminate potassium but do not immediately protect the
myocardium; dialysis is definitive but not the first immediate action.
5. A client with a new colostomy has a stoma that is dark purple, edematous, and without output 12 hours
postoperatively. Which action should the nurse take?
A) Apply a warm compress and reassess in 4 hours
B) Notify the surgeon immediately
C) Document as a normal finding and continue monitoring
D) Irrigate the stoma with sterile saline
' Correct Answer: B
Rationale: A dark purple, edematous stoma with absent output suggests ischemia/necrosis and requires immediate
surgical notification. Warm compresses, documentation as normal, and irrigation delay necessary intervention and
may worsen tissue damage.
6. A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with PEEP 12 cm H2O.
Which assessment finding indicates a priority complication of this therapy?
A) BP 84/50 mm Hg and HR 122/min
B) SpO2 92% and RR 24/min
C) Urine output 40 mL/hr
D) Temperature 37.8°C (100.0°F)
' Correct Answer: A
Rationale: High PEEP increases intrathoracic pressure, reducing venous return and causing
hypotension/tachycardia. The other findings are not directly indicative of PEEP-related hemodynamic compromise
and are within acceptable ranges for this client.
7. A client with type 1 diabetes has a blood glucose of 42 mg/dL and is unresponsive. Which action should the nurse
take first?
A) Administer 15 g oral glucose gel
B) Administer glucagon 1 mg IM
C) Start an IV and administer 50% dextrose
D) Recheck glucose in 15 minutes
Page 2
,' Correct Answer: B
Rationale: For an unresponsive client with hypoglycemia, glucagon IM is the immediate intervention when IV
access is unavailable. Oral glucose is unsafe due to aspiration risk; IV dextrose requires established access;
rechecking delays treatment of a life-threatening glucose level.
8. A client with increased intracranial pressure (ICP) from a traumatic brain injury has ICP 22 mm Hg and MAP 70
mm Hg. Which intervention should the nurse anticipate as the priority?
A) Administer mannitol 0.5 g/kg IV
B) Hyperventilate to a PaCO2 of 25 mm Hg
C) Position the client in Trendelenburg
D) Administer 0.9% sodium chloride 1 L bolus
' Correct Answer: A
Rationale: Mannitol is the osmotic diuretic of choice to reduce cerebral edema and lower ICP when CPP is
compromised. Hyperventilation is avoided except as a temporary rescue; Trendelenburg increases ICP; rapid
isotonic bolus may worsen cerebral edema.
9. A client with a new below-the-knee amputation reports a sudden 'tearing' sensation at the surgical site with bright
red bleeding. Which action should the nurse take first?
A) Elevate the limb above the heart
B) Apply direct pressure to the bleeding site
C) Notify the surgeon and prepare for reoperation
D) Reinforce the dressing and monitor
' Correct Answer: B
Rationale: Sudden bright red bleeding with a tearing sensation suggests suture line disruption; immediate direct
pressure controls hemorrhage. Elevation, notification, and dressing reinforcement do not address active arterial
bleeding first.
10. A client receiving chemotherapy has an absolute neutrophil count (ANC) of 450/mm³ and a temperature of
38.3°C (101.0°F). Which action should the nurse implement first?
A) Administer acetaminophen and reassess in 4 hours
B) Obtain blood cultures and administer broad-spectrum antibiotics
C) Place the client in a negative-pressure room
D) Administer colony-stimulating factor (G-CSF)
' Correct Answer: B
Rationale: Febrile neutropenia is an oncologic emergency requiring immediate cultures and empiric
broad-spectrum antibiotics. Antipyretics mask fever, negative-pressure isolation is for airborne precautions not
neutropenia, and G-CSF is supportive but not the first emergency action.
11. A patient receiving continuous enteral tube feedings via a small-bore nasogastric tube develops sudden
respiratory distress, and the nurse suspects pulmonary aspiration. Which action should the nurse take first?
A) Instill 30 mL of air into the tube and auscultate the epigastric area
B) Stop the feeding and place the patient in high-Fowler's position
C) Obtain a stat chest radiograph to confirm tube placement
D) Flush the tube with 30 mL of sterile water to clear the lumen
' Correct Answer: B
Rationale: Stopping the feeding and repositioning upright minimizes further aspiration and is the priority
immediate intervention. Auscultating air instillation is unreliable for verifying placement, radiograph confirmation is
diagnostic but not the first action, and flushing the tube would push more formula into the airway.
Page 3
, 12. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.8 mEq/L and a heart rate of 52
beats/min with peaked T waves. Which prescription should the nurse question?
A) Administer sodium polystyrene sulfonate orally
B) Administer regular insulin IV with dextrose 50%
C) Administer calcium gluconate IV
D) Administer spironolactone orally
' Correct Answer: D
Rationale: Spironolactone is a potassium-sparing diuretic and would worsen hyperkalemia in CKD; it should be
questioned. Insulin with dextrose, calcium gluconate, and sodium polystyrene sulfonate are all appropriate
treatments for hyperkalemia.
13. A patient with acute decompensated heart failure is receiving IV furosemide. Which assessment finding best
indicates a therapeutic response?
A) Serum potassium of 3.2 mEq/L
B) Urine output of 50 mL/hr with decreased dyspnea
C) Weight loss of 0.5 kg in 24 hours
D) Blood pressure of 90/60 mm Hg
' Correct Answer: B
Rationale: Increased urine output with reduced dyspnea reflects effective diuresis and fluid mobilization.
Hypokalemia, minimal weight loss, and hypotension are adverse effects or inadequate responses, not therapeutic
indicators.
14. A patient is prescribed enoxaparin subcutaneously for venous thromboembolism prophylaxis. Which laboratory
value should the nurse monitor to evaluate the therapeutic effect?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
C) Anti-factor Xa activity
D) Bleeding time
' Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin, and anti-factor Xa levels are used to monitor its
anticoagulant effect, especially in renal impairment or obesity. aPTT and INR are not reliable for LMWH
monitoring, and bleeding time is nonspecific.
15. A patient with type 1 diabetes mellitus has a blood glucose of 42 mg/dL and is conscious but diaphoretic and
confused. Which action should the nurse implement first?
A) Administer 1 mg glucagon intramuscularly
B) Give 15 g of a fast-acting carbohydrate orally
C) Start an IV infusion of dextrose 10% in water
D) Recheck the blood glucose in 15 minutes
' Correct Answer: B
Rationale: For a conscious patient with hypoglycemia, the first intervention is to provide 15 g of fast-acting oral
carbohydrate, followed by rechecking glucose in 15 minutes. Glucagon and IV dextrose are for unconscious patients
or those unable to swallow.
16. A patient with a new ileostomy has a high-output stoma (greater than 1,500 mL/day). Which complication
should the nurse anticipate?
A) Hyperkalemia
B) Metabolic alkalosis
Page 4
Year 2026/2027 Comprehensive Examination Preparation 100
Original Questions
About This Exam Bank
This comprehensive 148-question exam bank is designed to prepare candidates for ATI Medical-Surgical Nursing
Part A ATI Testing Academic Year 2026/2027 Comprehensive Examination Preparation 100 Original Questions.
Every question is aligned with the latest official content outline and includes a detailed, evidence-based rationale, an
explanation of why each remaining option is incorrect, and a supporting reference.
Keywords
ATI Medical-Surgical Nursing Part A ATI Testing Academic Year 2026/2027 Comprehensive Examination
Preparation 100 Original Questions, exam bank, practice questions, verified answers, detailed rationales, test prep,
study guide, review questions, certification exam, latest update, ATI Medical-Surgical Nursing Part A ATI Testing
Academic Year 2026/2027 Comprehensive Examination Preparation 100 Original Questions, exam bank, practice
questions, verified answers, detailed rationales
PART 1: APPLY CLINICAL JUDGMENT TO PRIORITIZE ASSESSMENT AND
INTERVENTION FOR ADULTS WITH ACUTE AND CHRONIC MEDICAL-SURGICAL
ALTERATIONS
1. A client receiving continuous heparin infusion has an aPTT of 96 seconds (control 30 seconds) and new
hematuria. Which action should the nurse anticipate implementing first?
A) Administer vitamin K 10 mg IV push
B) Stop the heparin infusion and prepare to administer protamine sulfate
C) Hold the next dose and continue the infusion at the current rate
D) Transfuse fresh frozen plasma and continue heparin
' Correct Answer: B
Rationale: An aPTT >2.5 times control with bleeding indicates heparin toxicity; the infusion is stopped and
protamine sulfate is the antidote. Vitamin K reverses warfarin, not heparin; continuing the infusion worsens
bleeding; FFP is not first-line for heparin reversal.
2. Following a thyroidectomy, a client develops stridor, neck swelling, and a rapidly expanding hematoma. Which
complication should the nurse identify as the immediate priority?
A) Hypocalcemia from parathyroid injury
B) Thyroid storm from surgical manipulation
C) Airway obstruction from postoperative hemorrhage
D) Recurrent laryngeal nerve injury
' Correct Answer: C
Rationale: Stridor with expanding neck hematoma after thyroidectomy signals airway compromise from
hemorrhage, requiring immediate intervention. Hypocalcemia causes tingling/spasms, thyroid storm causes
hypermetabolic symptoms, and nerve injury causes hoarseness-none produce acute airway obstruction with
hematoma.
3. For each potential provider prescription, indicate whether it is anticipated, nonessential, or contraindicated.
Page 1
, A) All prescriptions anticipated
B) Mixed anticipated, nonessential, and contraindicated
C) All prescriptions contraindicated
D) All prescriptions nonessential
' Correct Answer: B
Rationale: Diuresis, oxygenation, and positioning are anticipated; fluid bolus and IV beta-blockade are
contraindicated in decompensated HF with hypotension and pulmonary edema; daily weights are important but not
immediately essential. This reflects safe prioritization in acute HF management.
4. A client with chronic kidney disease (stage 4) has the following labs: K+ 6.2 mEq/L, BUN 68 mg/dL, creatinine
4.9 mg/dL, and peaked T waves on ECG. Which intervention should the nurse implement first?
A) Administer sodium polystyrene sulfonate orally
B) Administer IV calcium gluconate
C) Administer regular insulin with dextrose IV
D) Prepare for emergent hemodialysis
' Correct Answer: B
Rationale: IV calcium gluconate is given first to stabilize cardiac membranes and prevent lethal arrhythmias from
hyperkalemia. Insulin/dextrose and polystyrene shift or eliminate potassium but do not immediately protect the
myocardium; dialysis is definitive but not the first immediate action.
5. A client with a new colostomy has a stoma that is dark purple, edematous, and without output 12 hours
postoperatively. Which action should the nurse take?
A) Apply a warm compress and reassess in 4 hours
B) Notify the surgeon immediately
C) Document as a normal finding and continue monitoring
D) Irrigate the stoma with sterile saline
' Correct Answer: B
Rationale: A dark purple, edematous stoma with absent output suggests ischemia/necrosis and requires immediate
surgical notification. Warm compresses, documentation as normal, and irrigation delay necessary intervention and
may worsen tissue damage.
6. A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with PEEP 12 cm H2O.
Which assessment finding indicates a priority complication of this therapy?
A) BP 84/50 mm Hg and HR 122/min
B) SpO2 92% and RR 24/min
C) Urine output 40 mL/hr
D) Temperature 37.8°C (100.0°F)
' Correct Answer: A
Rationale: High PEEP increases intrathoracic pressure, reducing venous return and causing
hypotension/tachycardia. The other findings are not directly indicative of PEEP-related hemodynamic compromise
and are within acceptable ranges for this client.
7. A client with type 1 diabetes has a blood glucose of 42 mg/dL and is unresponsive. Which action should the nurse
take first?
A) Administer 15 g oral glucose gel
B) Administer glucagon 1 mg IM
C) Start an IV and administer 50% dextrose
D) Recheck glucose in 15 minutes
Page 2
,' Correct Answer: B
Rationale: For an unresponsive client with hypoglycemia, glucagon IM is the immediate intervention when IV
access is unavailable. Oral glucose is unsafe due to aspiration risk; IV dextrose requires established access;
rechecking delays treatment of a life-threatening glucose level.
8. A client with increased intracranial pressure (ICP) from a traumatic brain injury has ICP 22 mm Hg and MAP 70
mm Hg. Which intervention should the nurse anticipate as the priority?
A) Administer mannitol 0.5 g/kg IV
B) Hyperventilate to a PaCO2 of 25 mm Hg
C) Position the client in Trendelenburg
D) Administer 0.9% sodium chloride 1 L bolus
' Correct Answer: A
Rationale: Mannitol is the osmotic diuretic of choice to reduce cerebral edema and lower ICP when CPP is
compromised. Hyperventilation is avoided except as a temporary rescue; Trendelenburg increases ICP; rapid
isotonic bolus may worsen cerebral edema.
9. A client with a new below-the-knee amputation reports a sudden 'tearing' sensation at the surgical site with bright
red bleeding. Which action should the nurse take first?
A) Elevate the limb above the heart
B) Apply direct pressure to the bleeding site
C) Notify the surgeon and prepare for reoperation
D) Reinforce the dressing and monitor
' Correct Answer: B
Rationale: Sudden bright red bleeding with a tearing sensation suggests suture line disruption; immediate direct
pressure controls hemorrhage. Elevation, notification, and dressing reinforcement do not address active arterial
bleeding first.
10. A client receiving chemotherapy has an absolute neutrophil count (ANC) of 450/mm³ and a temperature of
38.3°C (101.0°F). Which action should the nurse implement first?
A) Administer acetaminophen and reassess in 4 hours
B) Obtain blood cultures and administer broad-spectrum antibiotics
C) Place the client in a negative-pressure room
D) Administer colony-stimulating factor (G-CSF)
' Correct Answer: B
Rationale: Febrile neutropenia is an oncologic emergency requiring immediate cultures and empiric
broad-spectrum antibiotics. Antipyretics mask fever, negative-pressure isolation is for airborne precautions not
neutropenia, and G-CSF is supportive but not the first emergency action.
11. A patient receiving continuous enteral tube feedings via a small-bore nasogastric tube develops sudden
respiratory distress, and the nurse suspects pulmonary aspiration. Which action should the nurse take first?
A) Instill 30 mL of air into the tube and auscultate the epigastric area
B) Stop the feeding and place the patient in high-Fowler's position
C) Obtain a stat chest radiograph to confirm tube placement
D) Flush the tube with 30 mL of sterile water to clear the lumen
' Correct Answer: B
Rationale: Stopping the feeding and repositioning upright minimizes further aspiration and is the priority
immediate intervention. Auscultating air instillation is unreliable for verifying placement, radiograph confirmation is
diagnostic but not the first action, and flushing the tube would push more formula into the airway.
Page 3
, 12. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.8 mEq/L and a heart rate of 52
beats/min with peaked T waves. Which prescription should the nurse question?
A) Administer sodium polystyrene sulfonate orally
B) Administer regular insulin IV with dextrose 50%
C) Administer calcium gluconate IV
D) Administer spironolactone orally
' Correct Answer: D
Rationale: Spironolactone is a potassium-sparing diuretic and would worsen hyperkalemia in CKD; it should be
questioned. Insulin with dextrose, calcium gluconate, and sodium polystyrene sulfonate are all appropriate
treatments for hyperkalemia.
13. A patient with acute decompensated heart failure is receiving IV furosemide. Which assessment finding best
indicates a therapeutic response?
A) Serum potassium of 3.2 mEq/L
B) Urine output of 50 mL/hr with decreased dyspnea
C) Weight loss of 0.5 kg in 24 hours
D) Blood pressure of 90/60 mm Hg
' Correct Answer: B
Rationale: Increased urine output with reduced dyspnea reflects effective diuresis and fluid mobilization.
Hypokalemia, minimal weight loss, and hypotension are adverse effects or inadequate responses, not therapeutic
indicators.
14. A patient is prescribed enoxaparin subcutaneously for venous thromboembolism prophylaxis. Which laboratory
value should the nurse monitor to evaluate the therapeutic effect?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
C) Anti-factor Xa activity
D) Bleeding time
' Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin, and anti-factor Xa levels are used to monitor its
anticoagulant effect, especially in renal impairment or obesity. aPTT and INR are not reliable for LMWH
monitoring, and bleeding time is nonspecific.
15. A patient with type 1 diabetes mellitus has a blood glucose of 42 mg/dL and is conscious but diaphoretic and
confused. Which action should the nurse implement first?
A) Administer 1 mg glucagon intramuscularly
B) Give 15 g of a fast-acting carbohydrate orally
C) Start an IV infusion of dextrose 10% in water
D) Recheck the blood glucose in 15 minutes
' Correct Answer: B
Rationale: For a conscious patient with hypoglycemia, the first intervention is to provide 15 g of fast-acting oral
carbohydrate, followed by rechecking glucose in 15 minutes. Glucagon and IV dextrose are for unconscious patients
or those unable to swallow.
16. A patient with a new ileostomy has a high-output stoma (greater than 1,500 mL/day). Which complication
should the nurse anticipate?
A) Hyperkalemia
B) Metabolic alkalosis
Page 4
