ATI RN MEDICAL-SURGICAL
PRACTICE QUESTIONS
& 100% CORRECT ANSWERS
Aligned with the 2026-2027 ATI Medical-Surgical Blueprint
and NGN Clinical Judgment Competency Framework
Total Questions 100
Cognitive Distribution 30% Recall / 50% Application / 20% Analysis
Question Style 75% Scenario-based / 15% Direct Recall / 10% Clinical Analysis
Passing Score 70%
Sections 10 (Cardiovascular through NGN Case Scenarios)
Clinical Judgment Model NCSBN Six-Step (Recognize Cues through Evaluate Outcomes)
This comprehensive examination integrates Next-Generation NCLEX (NGN) clinical judgment scenarios
across ten content domains. Each item includes a detailed rationale linking pathophysiology,
evidence-based practice, safety principles, and ATI-specific references to support mastery learning.
ATI RN Medical-Surgical Practice Exam | Page 1
, EXAMINATION OVERVIEW
Section
Cardiovascular and Peripheral Vascular Disorders Q1 - Q20
1
Section
Respiratory Disorders Q21 - Q30
2
Section
Gastrointestinal and Hepatobiliary Disorders Q31 - Q40
3
Section
Renal and Genitourinary Disorders Q41 - Q48
4
Section
Endocrine and Metabolic Disorders Q49 - Q58
5
Section
Neurological and Sensory Disorders Q59 - Q68
6
Section
Musculoskeletal and Integumentary Disorders Q69 - Q76
7
Section
Immunological, Hematological, and Oncology Disorders Q77 - Q85
8
Section
Perioperative and Emergency Nursing Care Q86 - Q93
9
Section
NGN-Style Integrated Clinical Case Scenarios Q94 - Q100
10
ATI RN Medical-Surgical Practice Exam | Page 2
,Section 1: Cardiovascular and Peripheral Vascular Disorders
(Q1–Q20)
Q1: A 68-year-old female is admitted with acute decompensated heart failure. Which assessment finding
is the most reliable indicator that her condition is worsening?
A. Bilateral 2+ pitting edema of the lower extremities
B. Weight gain of 1.5 kg (3.3 lb) over the past 24 hours [CORRECT]
C. Blood pressure of 148/88 mmHg
D. Heart rate of 92 beats/minute and irregular
Correct Answer: B
Rationale: Daily weight is the single most sensitive, objective indicator of fluid status change in heart failure. A gain
of 1 kg corresponds to roughly 1 L of retained fluid, and a 1.5 kg gain in 24 hours signals significant volume overload
preceding visible edema or dyspnea. Edema (A) is a later sign, blood pressure (C) fluctuates with medications, and
heart rate (D) is influenced by beta-blockers and atrial fibrillation, none of which are as reliable for trending fluid
retention.
Q2: The nurse is teaching a patient with left-sided heart failure about symptom recognition. Which
statement by the patient indicates correct understanding of left-sided heart failure manifestations?
A. I will probably notice swelling in my ankles and feet at the end of the day.
B. I should watch for shortness of breath, especially when lying flat at night. [CORRECT]
C. I will gain weight from fluid collecting in my abdomen.
D. I should expect my neck veins to stick out more than usual.
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary congestion because the left ventricle cannot effectively pump
blood forward, leading to fluid backing up into the pulmonary vasculature. Classic manifestations include dyspnea,
orthopnea, paroxysmal nocturnal dyspnea, crackles, and frothy sputum. The other options describe right-sided heart
failure, which produces systemic congestion: peripheral edema (A), ascites and weight gain (C), and jugular venous
distention (D) from backward flow into the venous system.
Q3: A patient with heart failure is prescribed furosemide 40 mg IV push and an ACE inhibitor. Which
laboratory value must the nurse monitor most closely after initiating this regimen?
A. Sodium
B. Potassium [CORRECT]
C. Calcium
D. Magnesium
Correct Answer: B
Rationale: Both furosemide (a loop diuretic) and ACE inhibitors independently alter potassium. Furosemide causes
renal loss of potassium, producing hypokalemia, while ACE inhibitors reduce aldosterone secretion and can cause
potassium retention and hyperkalemia. Used together, the effects are unpredictable and potentially dangerous because
hypokalemia increases the risk of digoxin toxicity and arrhythmias, while hyperkalemia can precipitate cardiac arrest.
Sodium (A), calcium (C), and magnesium (D) are also monitored, but potassium is the highest priority given the
immediate cardiac risk.
ATI RN Medical-Surgical Practice Exam | Page 3
, Q4: A patient receiving digoxin 0.25 mg daily for heart failure has a digoxin level of 2.8 ng/mL
(therapeutic 0.5–2.0 ng/mL) and reports seeing yellow halos around lights. Which action should the nurse
take first?
A. Administer the next dose as scheduled and recheck the level tomorrow.
B. Withhold the digoxin dose and notify the provider immediately. [CORRECT]
C. Administer activated charcoal to bind the medication.
D. Give potassium chloride to stabilize myocardial cells.
Correct Answer: B
Rationale: Yellow-green halos and visual disturbances are classic signs of digoxin toxicity, and the serum level of 2.8
ng/mL is above the therapeutic range. The priority action is to withhold the next dose and notify the provider, who may
order digoxin Fab antibody fragments (Digibind). Continuing the dose (A) would worsen toxicity. Activated charcoal
(C) is useful only within the first hour of oral ingestion and is not appropriate for chronic toxicity. Potassium (D)
should be given only if the patient is hypokalemic, because hyperkalemia is also a feature of digoxin toxicity.
Q5: A 58-year-old male presents to the emergency department with crushing substernal chest pain
radiating to the left jaw, diaphoresis, and nausea. The ECG shows ST-segment elevation in leads II, III,
and aVF. Which interpretation is correct?
A. Anterior wall myocardial infarction
B. Inferior wall myocardial infarction [CORRECT]
C. Lateral wall myocardial infarction
D. Subendocardial (non-ST-elevation) myocardial infarction
Correct Answer: B
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, supplied by
the right coronary artery. Anterior MI (A) is reflected in V1–V4 and is supplied by the left anterior descending artery.
Lateral MI (C) shows changes in I, aVL, and V5–V6. The presence of ST elevation distinguishes this from a
non-ST-elevation MI (D), which would show ST depression or T-wave inversion without elevation. Recognizing the
location guides treatment and predicts complications such as right ventricular involvement in inferior MI.
Q6: A patient is brought to the ED with suspected acute myocardial infarction. The provider orders the
MONA protocol. Which medication should the nurse administer first?
A. Morphine 4 mg IV
B. Oxygen 2 L/min via nasal cannula
C. Nitroglycerin 0.4 mg sublingual
D. Aspirin 325 mg chewable [CORRECT]
Correct Answer: D
Rationale: Aspirin 325 mg chewable is given first because it produces rapid antiplatelet effect by inhibiting
thromboxane A2, limiting further clot propagation in the occluded coronary artery and reducing mortality. Oxygen (B)
is now given only if SpO2 is below 90% because routine high-flow oxygen can worsen outcomes in normoxic patients.
Nitroglycerin (C) is contraindicated with hypotension, right ventricular infarction, or recent phosphodiesterase
inhibitor use. Morphine (A) is reserved for pain unrelieved by nitroglycerin, as recent data suggest it may delay
antiplatelet absorption.
ATI RN Medical-Surgical Practice Exam | Page 4
PRACTICE QUESTIONS
& 100% CORRECT ANSWERS
Aligned with the 2026-2027 ATI Medical-Surgical Blueprint
and NGN Clinical Judgment Competency Framework
Total Questions 100
Cognitive Distribution 30% Recall / 50% Application / 20% Analysis
Question Style 75% Scenario-based / 15% Direct Recall / 10% Clinical Analysis
Passing Score 70%
Sections 10 (Cardiovascular through NGN Case Scenarios)
Clinical Judgment Model NCSBN Six-Step (Recognize Cues through Evaluate Outcomes)
This comprehensive examination integrates Next-Generation NCLEX (NGN) clinical judgment scenarios
across ten content domains. Each item includes a detailed rationale linking pathophysiology,
evidence-based practice, safety principles, and ATI-specific references to support mastery learning.
ATI RN Medical-Surgical Practice Exam | Page 1
, EXAMINATION OVERVIEW
Section
Cardiovascular and Peripheral Vascular Disorders Q1 - Q20
1
Section
Respiratory Disorders Q21 - Q30
2
Section
Gastrointestinal and Hepatobiliary Disorders Q31 - Q40
3
Section
Renal and Genitourinary Disorders Q41 - Q48
4
Section
Endocrine and Metabolic Disorders Q49 - Q58
5
Section
Neurological and Sensory Disorders Q59 - Q68
6
Section
Musculoskeletal and Integumentary Disorders Q69 - Q76
7
Section
Immunological, Hematological, and Oncology Disorders Q77 - Q85
8
Section
Perioperative and Emergency Nursing Care Q86 - Q93
9
Section
NGN-Style Integrated Clinical Case Scenarios Q94 - Q100
10
ATI RN Medical-Surgical Practice Exam | Page 2
,Section 1: Cardiovascular and Peripheral Vascular Disorders
(Q1–Q20)
Q1: A 68-year-old female is admitted with acute decompensated heart failure. Which assessment finding
is the most reliable indicator that her condition is worsening?
A. Bilateral 2+ pitting edema of the lower extremities
B. Weight gain of 1.5 kg (3.3 lb) over the past 24 hours [CORRECT]
C. Blood pressure of 148/88 mmHg
D. Heart rate of 92 beats/minute and irregular
Correct Answer: B
Rationale: Daily weight is the single most sensitive, objective indicator of fluid status change in heart failure. A gain
of 1 kg corresponds to roughly 1 L of retained fluid, and a 1.5 kg gain in 24 hours signals significant volume overload
preceding visible edema or dyspnea. Edema (A) is a later sign, blood pressure (C) fluctuates with medications, and
heart rate (D) is influenced by beta-blockers and atrial fibrillation, none of which are as reliable for trending fluid
retention.
Q2: The nurse is teaching a patient with left-sided heart failure about symptom recognition. Which
statement by the patient indicates correct understanding of left-sided heart failure manifestations?
A. I will probably notice swelling in my ankles and feet at the end of the day.
B. I should watch for shortness of breath, especially when lying flat at night. [CORRECT]
C. I will gain weight from fluid collecting in my abdomen.
D. I should expect my neck veins to stick out more than usual.
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary congestion because the left ventricle cannot effectively pump
blood forward, leading to fluid backing up into the pulmonary vasculature. Classic manifestations include dyspnea,
orthopnea, paroxysmal nocturnal dyspnea, crackles, and frothy sputum. The other options describe right-sided heart
failure, which produces systemic congestion: peripheral edema (A), ascites and weight gain (C), and jugular venous
distention (D) from backward flow into the venous system.
Q3: A patient with heart failure is prescribed furosemide 40 mg IV push and an ACE inhibitor. Which
laboratory value must the nurse monitor most closely after initiating this regimen?
A. Sodium
B. Potassium [CORRECT]
C. Calcium
D. Magnesium
Correct Answer: B
Rationale: Both furosemide (a loop diuretic) and ACE inhibitors independently alter potassium. Furosemide causes
renal loss of potassium, producing hypokalemia, while ACE inhibitors reduce aldosterone secretion and can cause
potassium retention and hyperkalemia. Used together, the effects are unpredictable and potentially dangerous because
hypokalemia increases the risk of digoxin toxicity and arrhythmias, while hyperkalemia can precipitate cardiac arrest.
Sodium (A), calcium (C), and magnesium (D) are also monitored, but potassium is the highest priority given the
immediate cardiac risk.
ATI RN Medical-Surgical Practice Exam | Page 3
, Q4: A patient receiving digoxin 0.25 mg daily for heart failure has a digoxin level of 2.8 ng/mL
(therapeutic 0.5–2.0 ng/mL) and reports seeing yellow halos around lights. Which action should the nurse
take first?
A. Administer the next dose as scheduled and recheck the level tomorrow.
B. Withhold the digoxin dose and notify the provider immediately. [CORRECT]
C. Administer activated charcoal to bind the medication.
D. Give potassium chloride to stabilize myocardial cells.
Correct Answer: B
Rationale: Yellow-green halos and visual disturbances are classic signs of digoxin toxicity, and the serum level of 2.8
ng/mL is above the therapeutic range. The priority action is to withhold the next dose and notify the provider, who may
order digoxin Fab antibody fragments (Digibind). Continuing the dose (A) would worsen toxicity. Activated charcoal
(C) is useful only within the first hour of oral ingestion and is not appropriate for chronic toxicity. Potassium (D)
should be given only if the patient is hypokalemic, because hyperkalemia is also a feature of digoxin toxicity.
Q5: A 58-year-old male presents to the emergency department with crushing substernal chest pain
radiating to the left jaw, diaphoresis, and nausea. The ECG shows ST-segment elevation in leads II, III,
and aVF. Which interpretation is correct?
A. Anterior wall myocardial infarction
B. Inferior wall myocardial infarction [CORRECT]
C. Lateral wall myocardial infarction
D. Subendocardial (non-ST-elevation) myocardial infarction
Correct Answer: B
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, supplied by
the right coronary artery. Anterior MI (A) is reflected in V1–V4 and is supplied by the left anterior descending artery.
Lateral MI (C) shows changes in I, aVL, and V5–V6. The presence of ST elevation distinguishes this from a
non-ST-elevation MI (D), which would show ST depression or T-wave inversion without elevation. Recognizing the
location guides treatment and predicts complications such as right ventricular involvement in inferior MI.
Q6: A patient is brought to the ED with suspected acute myocardial infarction. The provider orders the
MONA protocol. Which medication should the nurse administer first?
A. Morphine 4 mg IV
B. Oxygen 2 L/min via nasal cannula
C. Nitroglycerin 0.4 mg sublingual
D. Aspirin 325 mg chewable [CORRECT]
Correct Answer: D
Rationale: Aspirin 325 mg chewable is given first because it produces rapid antiplatelet effect by inhibiting
thromboxane A2, limiting further clot propagation in the occluded coronary artery and reducing mortality. Oxygen (B)
is now given only if SpO2 is below 90% because routine high-flow oxygen can worsen outcomes in normoxic patients.
Nitroglycerin (C) is contraindicated with hypotension, right ventricular infarction, or recent phosphodiesterase
inhibitor use. Morphine (A) is reserved for pain unrelieved by nitroglycerin, as recent data suggest it may delay
antiplatelet absorption.
ATI RN Medical-Surgical Practice Exam | Page 4
