ATI Adult Medical Surgical Nursing (CMS) Exam Prep
Document | 2026/2027 Edition | 250 Verified Questions
ATI Adult Medical Surgical Nursing (CMS) Exam 2026-2027 QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document contains 250 verified questions and expert explanations for
the ATI Adult Medical Surgical Nursing (CMS) Exam, updated for the 2026/2027 academic year. Each
question is aligned with the latest NCLEX and ATI test plans, covering key content areas such as
perioperative care, cardiovascular disorders, respiratory conditions, and more. The document is
designed to help nursing students achieve a top score by providing detailed rationales for correct and
incorrect answers, along with test-taking strategies. Ideal for self-study or group review, this guide
ensures mastery of adult medical-surgical nursing concepts.
Key Features:
Perioperative Nursing Care
Cardiovascular Disorders
Respiratory Disorders
Gastrointestinal Disorders
Endocrine Disorders
Renal and Urinary Disorders
Updates for 2026:
- Incorporated 2026/2027 ATI test plan changes
- Added new questions on COVID-19 management and long-term effects
- Revised rationales to reflect current evidence-based practice guidelines
- Updated pharmacology content with new drug classifications and interactions
- Enhanced distractors to mirror recent exam trends
Abstract:
This document provides a rigorous preparation tool for the ATI Adult Medical Surgical Nursing (CMS) Exam,
featuring 250 carefully selected questions that reflect the breadth and depth of the actual exam. Each question is
accompanied by a detailed expert explanation that clarifies the correct answer and analyzes common
misconceptions. The content is organized by body system and nursing process, allowing for targeted study.
Updated for the 2026/2027 academic year, this guide incorporates the latest clinical guidelines and test plan
modifications. The rationales emphasize critical thinking and clinical judgment, preparing students for both the
exam and real-world practice. By mastering these questions, learners will build confidence and competence in
adult medical-surgical nursing. This resource is essential for nursing students seeking a comprehensive review and
a guaranteed A+ grade.
Keywords:
ATI Adult Medical Surgical Nursing, CMS Exam, 250 questions, 2026/2027 update, NCLEX preparation,
evidence-based practice, clinical judgment, nursing test bank
Answer Format:
Each question includes a correct answer with a detailed rationale explaining why it is correct, as well as
explanations for each incorrect option (distractors). Rationales are written in a clear, concise manner and reference
current nursing standards and guidelines. This format helps students understand the underlying concepts and avoid
common mistakes.
Compliance Checklist:
Page 1
, Aligned with 2026/2027 ATI CMS test plan
Questions reviewed by subject matter experts
Rationales cite current evidence-based practice
Includes pharmacology updates per latest FDA approvals
Covers all major content areas with appropriate weighting
Designed to simulate actual exam difficulty and format
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing Care 1-40 Preoperative assessment, intraoperative care, 16%
postoperative complications, pain
management
Cardiovascular Disorders 41-85 Heart failure, myocardial infarction, 18%
hypertension, arrhythmias, cardiac surgery
Respiratory Disorders 86-125 COPD, pneumonia, asthma, pulmonary 16%
embolism, chest tube management
Gastrointestinal Disorders 126-165 Bowel obstruction, pancreatitis, liver 16%
disease, ostomy care, nutrition
Endocrine Disorders 166-200 Diabetes mellitus, thyroid disorders, adrenal 14%
insufficiency, insulin therapy
Renal and Urinary Disorders 201-250 Acute kidney injury, chronic kidney disease, 20%
dialysis, urinary tract infections, fluid and
electrolyte balance
Page 2
,Q1. A patient with a history of chronic heart failure (HFrEF) on sacubitril/valsartan presents with
orthostatic hypotension, dry cough, and serum potassium of 5.6 mEq/L. Which of the following is the most
appropriate nursing action?
A. Hold the next dose of sacubitril/valsartan and notify the provider.
B. Administer the medication with a full glass of water and monitor blood pressure.
C. Increase fluid intake to 3 L per day to manage hypotension.
D. Switch to an ACE inhibitor to resolve the cough and hyperkalemia.
Correct Answer: A. Hold the next dose of sacubitril/valsartan and notify the provider.
Rationale: Sacubitril/valsartan can cause hypotension, cough (less common than ACE inhibitors), and
hyperkalemia. With K+ >5.5 mEq/L, the drug should be held and the provider notified. Administering (B) ignores
hyperkalemia; increasing fluids (C) could worsen heart failure; switching to an ACE inhibitor (D) is not
recommended due to angioedema risk and would not address hyperkalemia.
Why Wrong:
B - Administering the medication without addressing hyperkalemia and hypotension could precipitate
arrhythmias and worsening renal function.
C - Increasing fluid intake to 3 L per day may exacerbate fluid overload in heart failure, leading to pulmonary
edema.
D - Switching to an ACE inhibitor is contraindicated within 36 hours of sacubitril/valsartan due to risk of
angioedema, and hyperkalemia would persist.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 44
Q2. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled mechanical
ventilation with FiO2 0.8, PEEP 15 cm H2O, and plateau pressure 32 cm H2O. Arterial blood gas shows pH
7.25, PaCO2 55 mm Hg, PaO2 60 mm Hg. Which intervention should the nurse anticipate?
A. Increase PEEP to 20 cm H2O and prone positioning.
B. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate.
C. Administer sodium bicarbonate infusion to correct acidosis.
D. Switch to pressure-controlled ventilation with inverse ratio.
Correct Answer: B. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate.
Rationale: The plateau pressure >30 cm H2O indicates risk of ventilator-induced lung injury. With ARDS,
lung-protective ventilation using low tidal volumes (4-6 mL/kg IBW) is standard. Permissive hypercapnia is
acceptable; acidosis can be managed by increasing respiratory rate (if not causing air trapping). Increasing PEEP
(A) may further elevate plateau pressure; sodium bicarbonate (C) is not recommended in ARDS; inverse ratio
ventilation (D) is not first-line.
Why Wrong:
A - Increasing PEEP to 20 cm H2O may further raise plateau pressure and worsen lung injury without proven
benefit.
C - Sodium bicarbonate is not recommended for respiratory acidosis in ARDS as it can cause paradoxical
intracellular acidosis and worsen oxygenation.
D - Switching to pressure-controlled ventilation with inverse ratio is not standard initial therapy and may
increase air trapping.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing, 9th Ed., Ch. 16
Q3. A patient with a history of type 2 diabetes mellitus and chronic kidney disease (stage 3) is admitted with
hyperglycemia (blood glucose 450 mg/dL) and metabolic acidosis (pH 7.28, bicarbonate 16 mEq/L, anion gap
18). Urine ketones are moderate. Which of the following is the most appropriate initial fluid resuscitation?
A. 0.9% sodium chloride at 500 mL/hour for 2 hours.
B. 0.45% sodium chloride at 250 mL/hour.
C. Lactated Ringer's solution at 500 mL/hour.
Page 3
, D. D5 0.45% sodium chloride at 200 mL/hour.
Correct Answer: A. 0.9% sodium chloride at 500 mL/hour for 2 hours.
Rationale: This patient likely has diabetic ketoacidosis (DKA) with hyperglycemia and metabolic acidosis. Initial fluid
resuscitation with 0.9% sodium chloride at 15-20 mL/kg/hour (approx. 1 L in first hour) is recommended to restore
intravascular volume. Hypotonic fluids (B, D) are not first-line because they can cause rapid osmotic shifts; lactated Ringer's
(C) contains lactate which may exacerbate acidosis in some settings.
Why Wrong:
B - 0.45% sodium chloride is hypotonic and not recommended for initial volume expansion in DKA due to risk of
cerebral edema.
C - Lactated Ringer's contains lactate, which may worsen acidosis in DKA and is not preferred for initial resuscitation.
D - D5 0.45% sodium chloride contains dextrose, which is not indicated until blood glucose falls below 250 mg/dL, and
is hypotonic.
Reference: American Diabetes Association. (2026). Standards of Medical Care in Diabetes, Diabetes Care, 49(Suppl 1),
S16-S22.
Q4. A patient with cirrhosis and ascites develops acute variceal hemorrhage. After initial resuscitation, which
of the following pharmacologic interventions should the nurse anticipate to reduce portal pressure and
control bleeding?
A. Octreotide continuous infusion.
B. Propranolol orally twice daily.
C. Lactulose 30 mL every 6 hours.
D. Spironolactone 100 mg daily.
Correct Answer: A. Octreotide continuous infusion.
Rationale: Octreotide, a somatostatin analog, reduces splanchnic blood flow and portal pressure, and is first-line
pharmacologic therapy for acute variceal hemorrhage. Propranolol (B) is used for primary prophylaxis but not
acute bleeding. Lactulose (C) treats hepatic encephalopathy, not hemorrhage. Spironolactone (D) is for ascites
management but not acute bleeding.
Why Wrong:
B - Propranolol is a nonselective beta-blocker used for primary prophylaxis of variceal bleeding, not for acute
hemorrhage.
C - Lactulose is indicated for hepatic encephalopathy, not for control of variceal bleeding.
D - Spironolactone is a diuretic for ascites management and does not reduce portal pressure acutely.
Reference: Garcia-Tsao, G., & Bosch, J. (2026). Portal Hypertension and Variceal Bleeding. In Sleisenger and
Fordtran's Gastrointestinal and Liver Disease, 11th Ed., Ch. 89.
Q5. A patient with acute kidney injury (AKI) due to contrast-induced nephropathy has urine output of 200
mL over 24 hours, serum creatinine 3.8 mg/dL, BUN 80 mg/dL, and potassium 5.9 mEq/L. Which of the
following interventions should the nurse question?
A. Administration of sodium polystyrene sulfonate (SPS) 15 g orally.
B. Insertion of a temporary hemodialysis catheter.
C. Infusion of 0.9% sodium chloride at 150 mL/hour.
D. Administering calcium gluconate IV for ECG changes.
Correct Answer: C. Infusion of 0.9% sodium chloride at 150 mL/hour.
Rationale: The patient is oliguric with hyperkalemia and elevated creatinine, indicating severe AKI. Continuing
aggressive IV fluids (C) may cause volume overload and pulmonary edema without improving renal function. SPS
(A) can lower potassium; hemodialysis (B) is indicated for severe AKI with hyperkalemia; calcium gluconate (D) is
appropriate for cardiac membrane stabilization if ECG changes are present.
Why Wrong:
A - Sodium polystyrene sulfonate is used to treat hyperkalemia, which is appropriate here.
Page 4
Document | 2026/2027 Edition | 250 Verified Questions
ATI Adult Medical Surgical Nursing (CMS) Exam 2026-2027 QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document contains 250 verified questions and expert explanations for
the ATI Adult Medical Surgical Nursing (CMS) Exam, updated for the 2026/2027 academic year. Each
question is aligned with the latest NCLEX and ATI test plans, covering key content areas such as
perioperative care, cardiovascular disorders, respiratory conditions, and more. The document is
designed to help nursing students achieve a top score by providing detailed rationales for correct and
incorrect answers, along with test-taking strategies. Ideal for self-study or group review, this guide
ensures mastery of adult medical-surgical nursing concepts.
Key Features:
Perioperative Nursing Care
Cardiovascular Disorders
Respiratory Disorders
Gastrointestinal Disorders
Endocrine Disorders
Renal and Urinary Disorders
Updates for 2026:
- Incorporated 2026/2027 ATI test plan changes
- Added new questions on COVID-19 management and long-term effects
- Revised rationales to reflect current evidence-based practice guidelines
- Updated pharmacology content with new drug classifications and interactions
- Enhanced distractors to mirror recent exam trends
Abstract:
This document provides a rigorous preparation tool for the ATI Adult Medical Surgical Nursing (CMS) Exam,
featuring 250 carefully selected questions that reflect the breadth and depth of the actual exam. Each question is
accompanied by a detailed expert explanation that clarifies the correct answer and analyzes common
misconceptions. The content is organized by body system and nursing process, allowing for targeted study.
Updated for the 2026/2027 academic year, this guide incorporates the latest clinical guidelines and test plan
modifications. The rationales emphasize critical thinking and clinical judgment, preparing students for both the
exam and real-world practice. By mastering these questions, learners will build confidence and competence in
adult medical-surgical nursing. This resource is essential for nursing students seeking a comprehensive review and
a guaranteed A+ grade.
Keywords:
ATI Adult Medical Surgical Nursing, CMS Exam, 250 questions, 2026/2027 update, NCLEX preparation,
evidence-based practice, clinical judgment, nursing test bank
Answer Format:
Each question includes a correct answer with a detailed rationale explaining why it is correct, as well as
explanations for each incorrect option (distractors). Rationales are written in a clear, concise manner and reference
current nursing standards and guidelines. This format helps students understand the underlying concepts and avoid
common mistakes.
Compliance Checklist:
Page 1
, Aligned with 2026/2027 ATI CMS test plan
Questions reviewed by subject matter experts
Rationales cite current evidence-based practice
Includes pharmacology updates per latest FDA approvals
Covers all major content areas with appropriate weighting
Designed to simulate actual exam difficulty and format
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing Care 1-40 Preoperative assessment, intraoperative care, 16%
postoperative complications, pain
management
Cardiovascular Disorders 41-85 Heart failure, myocardial infarction, 18%
hypertension, arrhythmias, cardiac surgery
Respiratory Disorders 86-125 COPD, pneumonia, asthma, pulmonary 16%
embolism, chest tube management
Gastrointestinal Disorders 126-165 Bowel obstruction, pancreatitis, liver 16%
disease, ostomy care, nutrition
Endocrine Disorders 166-200 Diabetes mellitus, thyroid disorders, adrenal 14%
insufficiency, insulin therapy
Renal and Urinary Disorders 201-250 Acute kidney injury, chronic kidney disease, 20%
dialysis, urinary tract infections, fluid and
electrolyte balance
Page 2
,Q1. A patient with a history of chronic heart failure (HFrEF) on sacubitril/valsartan presents with
orthostatic hypotension, dry cough, and serum potassium of 5.6 mEq/L. Which of the following is the most
appropriate nursing action?
A. Hold the next dose of sacubitril/valsartan and notify the provider.
B. Administer the medication with a full glass of water and monitor blood pressure.
C. Increase fluid intake to 3 L per day to manage hypotension.
D. Switch to an ACE inhibitor to resolve the cough and hyperkalemia.
Correct Answer: A. Hold the next dose of sacubitril/valsartan and notify the provider.
Rationale: Sacubitril/valsartan can cause hypotension, cough (less common than ACE inhibitors), and
hyperkalemia. With K+ >5.5 mEq/L, the drug should be held and the provider notified. Administering (B) ignores
hyperkalemia; increasing fluids (C) could worsen heart failure; switching to an ACE inhibitor (D) is not
recommended due to angioedema risk and would not address hyperkalemia.
Why Wrong:
B - Administering the medication without addressing hyperkalemia and hypotension could precipitate
arrhythmias and worsening renal function.
C - Increasing fluid intake to 3 L per day may exacerbate fluid overload in heart failure, leading to pulmonary
edema.
D - Switching to an ACE inhibitor is contraindicated within 36 hours of sacubitril/valsartan due to risk of
angioedema, and hyperkalemia would persist.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 44
Q2. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled mechanical
ventilation with FiO2 0.8, PEEP 15 cm H2O, and plateau pressure 32 cm H2O. Arterial blood gas shows pH
7.25, PaCO2 55 mm Hg, PaO2 60 mm Hg. Which intervention should the nurse anticipate?
A. Increase PEEP to 20 cm H2O and prone positioning.
B. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate.
C. Administer sodium bicarbonate infusion to correct acidosis.
D. Switch to pressure-controlled ventilation with inverse ratio.
Correct Answer: B. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate.
Rationale: The plateau pressure >30 cm H2O indicates risk of ventilator-induced lung injury. With ARDS,
lung-protective ventilation using low tidal volumes (4-6 mL/kg IBW) is standard. Permissive hypercapnia is
acceptable; acidosis can be managed by increasing respiratory rate (if not causing air trapping). Increasing PEEP
(A) may further elevate plateau pressure; sodium bicarbonate (C) is not recommended in ARDS; inverse ratio
ventilation (D) is not first-line.
Why Wrong:
A - Increasing PEEP to 20 cm H2O may further raise plateau pressure and worsen lung injury without proven
benefit.
C - Sodium bicarbonate is not recommended for respiratory acidosis in ARDS as it can cause paradoxical
intracellular acidosis and worsen oxygenation.
D - Switching to pressure-controlled ventilation with inverse ratio is not standard initial therapy and may
increase air trapping.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing, 9th Ed., Ch. 16
Q3. A patient with a history of type 2 diabetes mellitus and chronic kidney disease (stage 3) is admitted with
hyperglycemia (blood glucose 450 mg/dL) and metabolic acidosis (pH 7.28, bicarbonate 16 mEq/L, anion gap
18). Urine ketones are moderate. Which of the following is the most appropriate initial fluid resuscitation?
A. 0.9% sodium chloride at 500 mL/hour for 2 hours.
B. 0.45% sodium chloride at 250 mL/hour.
C. Lactated Ringer's solution at 500 mL/hour.
Page 3
, D. D5 0.45% sodium chloride at 200 mL/hour.
Correct Answer: A. 0.9% sodium chloride at 500 mL/hour for 2 hours.
Rationale: This patient likely has diabetic ketoacidosis (DKA) with hyperglycemia and metabolic acidosis. Initial fluid
resuscitation with 0.9% sodium chloride at 15-20 mL/kg/hour (approx. 1 L in first hour) is recommended to restore
intravascular volume. Hypotonic fluids (B, D) are not first-line because they can cause rapid osmotic shifts; lactated Ringer's
(C) contains lactate which may exacerbate acidosis in some settings.
Why Wrong:
B - 0.45% sodium chloride is hypotonic and not recommended for initial volume expansion in DKA due to risk of
cerebral edema.
C - Lactated Ringer's contains lactate, which may worsen acidosis in DKA and is not preferred for initial resuscitation.
D - D5 0.45% sodium chloride contains dextrose, which is not indicated until blood glucose falls below 250 mg/dL, and
is hypotonic.
Reference: American Diabetes Association. (2026). Standards of Medical Care in Diabetes, Diabetes Care, 49(Suppl 1),
S16-S22.
Q4. A patient with cirrhosis and ascites develops acute variceal hemorrhage. After initial resuscitation, which
of the following pharmacologic interventions should the nurse anticipate to reduce portal pressure and
control bleeding?
A. Octreotide continuous infusion.
B. Propranolol orally twice daily.
C. Lactulose 30 mL every 6 hours.
D. Spironolactone 100 mg daily.
Correct Answer: A. Octreotide continuous infusion.
Rationale: Octreotide, a somatostatin analog, reduces splanchnic blood flow and portal pressure, and is first-line
pharmacologic therapy for acute variceal hemorrhage. Propranolol (B) is used for primary prophylaxis but not
acute bleeding. Lactulose (C) treats hepatic encephalopathy, not hemorrhage. Spironolactone (D) is for ascites
management but not acute bleeding.
Why Wrong:
B - Propranolol is a nonselective beta-blocker used for primary prophylaxis of variceal bleeding, not for acute
hemorrhage.
C - Lactulose is indicated for hepatic encephalopathy, not for control of variceal bleeding.
D - Spironolactone is a diuretic for ascites management and does not reduce portal pressure acutely.
Reference: Garcia-Tsao, G., & Bosch, J. (2026). Portal Hypertension and Variceal Bleeding. In Sleisenger and
Fordtran's Gastrointestinal and Liver Disease, 11th Ed., Ch. 89.
Q5. A patient with acute kidney injury (AKI) due to contrast-induced nephropathy has urine output of 200
mL over 24 hours, serum creatinine 3.8 mg/dL, BUN 80 mg/dL, and potassium 5.9 mEq/L. Which of the
following interventions should the nurse question?
A. Administration of sodium polystyrene sulfonate (SPS) 15 g orally.
B. Insertion of a temporary hemodialysis catheter.
C. Infusion of 0.9% sodium chloride at 150 mL/hour.
D. Administering calcium gluconate IV for ECG changes.
Correct Answer: C. Infusion of 0.9% sodium chloride at 150 mL/hour.
Rationale: The patient is oliguric with hyperkalemia and elevated creatinine, indicating severe AKI. Continuing
aggressive IV fluids (C) may cause volume overload and pulmonary edema without improving renal function. SPS
(A) can lower potassium; hemodialysis (B) is indicated for severe AKI with hyperkalemia; calcium gluconate (D) is
appropriate for cardiac membrane stabilization if ECG changes are present.
Why Wrong:
A - Sodium polystyrene sulfonate is used to treat hyperkalemia, which is appropriate here.
Page 4
