2026-2027 EDITION
ATI RN Adult
Med-Surg Proctored Exam
Updated 100% Verified Answers
Comprehensive exam aligned with the 2026-2027 ATI Medical-Surgical
Blueprint and the Next-Generation NCLEX (NGN) Clinical Judgment
Framework. Includes A+ graded rationales with evidence-based
medical-surgical reasoning.
110 10 17 70%
QUESTIONS SECTIONS NGN CASES PASS SCORE
C O N T E N T B LU E P R I N T C OV E RAG E
Cardiovascular Respiratory GI / Hepatobiliary Renal / GU Endocrine
Neurological Musculoskeletal Immuno / Heme / Onc Perioperative
NGN Clinical Judgment
NCSBN CLINICAL JUDGMENT MODEL Recognize Cues · Analyze · Prioritize · Act · Evaluate
,ATI RN Adult Med-Surg Proctored Exam Updated 100% Verified Answers - 2026-2027 Edition
ATI RN Adult Med-Surg Proctored Exam
Updated 100% Verified Answers | 2026-2027 Edition
This comprehensive examination is designed to assess the clinical knowledge and judgment required of registered
nurses in adult medical-surgical practice. Aligned with the 2026-2027 ATI Medical-Surgical Blueprint and the
Next-Generation NCLEX (NGN) Clinical Judgment Framework, this exam integrates the NCSBN Clinical Judgment
Model (Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes)
throughout scenario-based questions. Each question includes a detailed rationale with evidence-based
medical-surgical reasoning to support learning and exam preparation.
110 10 70% 17
Total Content Passing NGN
Questions Sections Score Cases
Cognitive Level Distribution
Recall 30% - Foundational knowledge and concept recognition
Application 50% - Clinical scenario application and prioritization
Analysis 20% - Complex clinical judgment and synthesis
Question Design
Question styles are distributed as follows: 70% scenario-based questions that present realistic clinical situations
requiring application of nursing knowledge; 15% NGN-style questions that integrate the NCSBN Clinical Judgment
Model with extended case scenarios; 10% direct recall questions testing foundational medical-surgical knowledge;
and 5% clinical analysis questions requiring synthesis of multiple data points. Each multiple-choice question has four
options (A-D) with one correct answer, marked with [CORRECT]. Distractors represent common ATI Med-Surg
errors and misconceptions. Comprehensive rationales (2-3 sentences) explain why the correct answer is right and why
the distractors are wrong, including pathophysiology, evidence-based practice, safety principles, and ATI-specific
references.
Content Sections
Section 1: Cardiovascular Disorders Q1 - Q18
Section 2: Respiratory Disorders Q19 - Q28
Section 3: Gastrointestinal and Hepatobiliary Disorders Q29 - Q38
Section 4: Renal and Genitourinary Disorders Q39 - Q46
Section 5: Endocrine and Metabolic Disorders Q47 - Q56
Section 6: Neurological and Sensory Disorders Q57 - Q66
Section 7: Musculoskeletal and Integumentary Disorders Q67 - Q74
Section 8: Immunological, Hematological, and Oncology Disorders Q75 - Q83
Section 9: Perioperative, Emergency, and Critical Care Nursing Q84 - Q93
Section 10: NGN-Style Integrated Clinical Case Scenarios Q94 - Q110
110 Questions | 10 Sections | Passing Score 70% NCSBN Clinical Judgment Model Page 1
,ATI RN Adult Med-Surg Proctored Exam Updated 100% Verified Answers - 2026-2027 Edition
Section 1: Cardiovascular Disorders Q1 - Q18
Heart Failure (Left/Right), Myocardial Infarction, Hypertension, Peripheral Vascular Disease, Abdominal Aortic
Aneurysm, CABG Postoperative Care.
Q1. A 68-year-old female with a history of hypertension and CAD is admitted with worsening dyspnea,
orthopnea, and waking up gasping for air at night. On assessment, the nurse notes bilateral basilar crackles, an
S3 heart sound, and a productive cough with pink frothy sputum. Which finding is most characteristic of
LEFT-sided heart failure?
A. Jugular venous distension (JVD)
B. Sacral edema
C. Pink frothy sputum and bilateral basilar crackles [CORRECT]
D. Hepatomegaly and ascites
Correct Answer: C
Rationale: Left-sided heart failure causes backward congestion into the pulmonary circulation, producing
pulmonary manifestations including dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), bilateral basilar
crackles, S3 gallop, and pink frothy sputum (classic for pulmonary edema). JVD, sacral edema, hepatomegaly,
and ascites are systemic manifestations of RIGHT-sided heart failure caused by backward congestion into the
venous system. Recognizing this left/right distinction is critical for ATI exam success.
Q2. A nurse is caring for a client with heart failure who is receiving furosemide 40 mg IV twice daily. The
client's potassium is 3.1 mEq/L, and they report muscle cramps and weakness. Which action should the nurse
take FIRST?
A. Administer the scheduled furosemide dose
B. Assess for cardiac dysrhythmias and notify the provider [CORRECT]
C. Encourage intake of potassium-rich foods like bananas
D. Document the finding and reassess in 4 hours
Correct Answer: B
Rationale: A potassium of 3.1 mEq/L is severe hypokalemia and places the client at high risk for life-threatening
cardiac dysrhythmias, especially in a heart failure client already prone to arrhythmias. The nurse must assess
cardiac status (ECG monitoring for U waves, ST depression, T wave inversion) and notify the provider
immediately for IV potassium replacement. Administering furosemide would worsen hypokalemia. Dietary
potassium alone is insufficient for a level this low. Documenting and reassessing delays critical intervention.
Q3. A client with heart failure is being discharged with a new prescription for lisinopril 10 mg daily. Which
instruction should the nurse include in discharge teaching?
A. Take the medication at bedtime to prevent dizziness
B. Report a persistent dry cough to the provider [CORRECT]
C. Increase sodium intake to maintain blood pressure
D. Stop taking the medication if blood pressure is normal
110 Questions | 10 Sections | Passing Score 70% NCSBN Clinical Judgment Model Page 2
, ATI RN Adult Med-Surg Proctored Exam Updated 100% Verified Answers - 2026-2027 Edition
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor that can cause a persistent dry cough due to bradykinin accumulation in
the lungs; this occurs in up to 20% of patients and should be reported to the provider, who may switch the client
to an ARB. ACE inhibitors should be taken in the morning (not bedtime) due to first-dose hypotension risk,
sodium should be restricted (not increased) in heart failure, and the medication should never be stopped abruptly
as this can cause rebound hypertension and worsen heart failure.
Q4. A nurse is teaching a client with heart failure about daily weight monitoring. Which statement by the client
indicates that teaching has been effective?
A. I will weigh myself once a week before breakfast
B. I will weigh myself at bedtime after drinking fluids
C. I will weigh myself every morning after urinating, before eating [CORRECT]
D. I will weigh myself whenever I feel short of breath
Correct Answer: C
Rationale: Daily weights are the most reliable indicator of fluid status in heart failure. The client should weigh
themselves every morning at the same time, after urinating, before eating or drinking, wearing similar clothing,
and using the same scale. A weight gain of 2-3 lb in 24 hours or 5 lb in a week indicates fluid retention and should
be reported to the provider immediately. Weekly weighing is too infrequent, postprandial weights are inaccurate,
and symptom-based weighing is inconsistent.
Q5. A 55-year-old male presents to the ED with crushing substernal chest pain radiating to the left arm and
jaw, diaphoresis, nausea, and a sense of impending doom. The 12-lead ECG shows ST elevation in leads II, III,
and aVF. Which intervention should the nurse anticipate FIRST?
A. Administer sublingual nitroglycerin every 5 minutes
B. Initiate cardiac cath lab activation for primary PCI [CORRECT]
C. Administer morphine 4 mg IV push for pain
D. Apply oxygen via nasal cannula at 6 L/min
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall STEMI. The definitive treatment for
STEMI is primary percutaneous coronary intervention (PCI), which should be performed within 90 minutes of
first medical contact (door-to-balloon time). While MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) was
historically the initial approach, current guidelines prioritize immediate PCI activation. Aspirin 162-325 mg
chewed should be administered, and oxygen is only given if SpO2 <90%. Nitroglycerin is contraindicated in
inferior MI due to risk of right ventricular involvement and profound hypotension.
Q6. A client is admitted with a suspected acute myocardial infarction. Which cardiac biomarker is MOST
specific for myocardial injury and is used to confirm the diagnosis?
A. Creatine kinase (CK)
B. CK-MB
C. Troponin I [CORRECT]
D. Myoglobin
110 Questions | 10 Sections | Passing Score 70% NCSBN Clinical Judgment Model Page 3
ATI RN Adult
Med-Surg Proctored Exam
Updated 100% Verified Answers
Comprehensive exam aligned with the 2026-2027 ATI Medical-Surgical
Blueprint and the Next-Generation NCLEX (NGN) Clinical Judgment
Framework. Includes A+ graded rationales with evidence-based
medical-surgical reasoning.
110 10 17 70%
QUESTIONS SECTIONS NGN CASES PASS SCORE
C O N T E N T B LU E P R I N T C OV E RAG E
Cardiovascular Respiratory GI / Hepatobiliary Renal / GU Endocrine
Neurological Musculoskeletal Immuno / Heme / Onc Perioperative
NGN Clinical Judgment
NCSBN CLINICAL JUDGMENT MODEL Recognize Cues · Analyze · Prioritize · Act · Evaluate
,ATI RN Adult Med-Surg Proctored Exam Updated 100% Verified Answers - 2026-2027 Edition
ATI RN Adult Med-Surg Proctored Exam
Updated 100% Verified Answers | 2026-2027 Edition
This comprehensive examination is designed to assess the clinical knowledge and judgment required of registered
nurses in adult medical-surgical practice. Aligned with the 2026-2027 ATI Medical-Surgical Blueprint and the
Next-Generation NCLEX (NGN) Clinical Judgment Framework, this exam integrates the NCSBN Clinical Judgment
Model (Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes)
throughout scenario-based questions. Each question includes a detailed rationale with evidence-based
medical-surgical reasoning to support learning and exam preparation.
110 10 70% 17
Total Content Passing NGN
Questions Sections Score Cases
Cognitive Level Distribution
Recall 30% - Foundational knowledge and concept recognition
Application 50% - Clinical scenario application and prioritization
Analysis 20% - Complex clinical judgment and synthesis
Question Design
Question styles are distributed as follows: 70% scenario-based questions that present realistic clinical situations
requiring application of nursing knowledge; 15% NGN-style questions that integrate the NCSBN Clinical Judgment
Model with extended case scenarios; 10% direct recall questions testing foundational medical-surgical knowledge;
and 5% clinical analysis questions requiring synthesis of multiple data points. Each multiple-choice question has four
options (A-D) with one correct answer, marked with [CORRECT]. Distractors represent common ATI Med-Surg
errors and misconceptions. Comprehensive rationales (2-3 sentences) explain why the correct answer is right and why
the distractors are wrong, including pathophysiology, evidence-based practice, safety principles, and ATI-specific
references.
Content Sections
Section 1: Cardiovascular Disorders Q1 - Q18
Section 2: Respiratory Disorders Q19 - Q28
Section 3: Gastrointestinal and Hepatobiliary Disorders Q29 - Q38
Section 4: Renal and Genitourinary Disorders Q39 - Q46
Section 5: Endocrine and Metabolic Disorders Q47 - Q56
Section 6: Neurological and Sensory Disorders Q57 - Q66
Section 7: Musculoskeletal and Integumentary Disorders Q67 - Q74
Section 8: Immunological, Hematological, and Oncology Disorders Q75 - Q83
Section 9: Perioperative, Emergency, and Critical Care Nursing Q84 - Q93
Section 10: NGN-Style Integrated Clinical Case Scenarios Q94 - Q110
110 Questions | 10 Sections | Passing Score 70% NCSBN Clinical Judgment Model Page 1
,ATI RN Adult Med-Surg Proctored Exam Updated 100% Verified Answers - 2026-2027 Edition
Section 1: Cardiovascular Disorders Q1 - Q18
Heart Failure (Left/Right), Myocardial Infarction, Hypertension, Peripheral Vascular Disease, Abdominal Aortic
Aneurysm, CABG Postoperative Care.
Q1. A 68-year-old female with a history of hypertension and CAD is admitted with worsening dyspnea,
orthopnea, and waking up gasping for air at night. On assessment, the nurse notes bilateral basilar crackles, an
S3 heart sound, and a productive cough with pink frothy sputum. Which finding is most characteristic of
LEFT-sided heart failure?
A. Jugular venous distension (JVD)
B. Sacral edema
C. Pink frothy sputum and bilateral basilar crackles [CORRECT]
D. Hepatomegaly and ascites
Correct Answer: C
Rationale: Left-sided heart failure causes backward congestion into the pulmonary circulation, producing
pulmonary manifestations including dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), bilateral basilar
crackles, S3 gallop, and pink frothy sputum (classic for pulmonary edema). JVD, sacral edema, hepatomegaly,
and ascites are systemic manifestations of RIGHT-sided heart failure caused by backward congestion into the
venous system. Recognizing this left/right distinction is critical for ATI exam success.
Q2. A nurse is caring for a client with heart failure who is receiving furosemide 40 mg IV twice daily. The
client's potassium is 3.1 mEq/L, and they report muscle cramps and weakness. Which action should the nurse
take FIRST?
A. Administer the scheduled furosemide dose
B. Assess for cardiac dysrhythmias and notify the provider [CORRECT]
C. Encourage intake of potassium-rich foods like bananas
D. Document the finding and reassess in 4 hours
Correct Answer: B
Rationale: A potassium of 3.1 mEq/L is severe hypokalemia and places the client at high risk for life-threatening
cardiac dysrhythmias, especially in a heart failure client already prone to arrhythmias. The nurse must assess
cardiac status (ECG monitoring for U waves, ST depression, T wave inversion) and notify the provider
immediately for IV potassium replacement. Administering furosemide would worsen hypokalemia. Dietary
potassium alone is insufficient for a level this low. Documenting and reassessing delays critical intervention.
Q3. A client with heart failure is being discharged with a new prescription for lisinopril 10 mg daily. Which
instruction should the nurse include in discharge teaching?
A. Take the medication at bedtime to prevent dizziness
B. Report a persistent dry cough to the provider [CORRECT]
C. Increase sodium intake to maintain blood pressure
D. Stop taking the medication if blood pressure is normal
110 Questions | 10 Sections | Passing Score 70% NCSBN Clinical Judgment Model Page 2
, ATI RN Adult Med-Surg Proctored Exam Updated 100% Verified Answers - 2026-2027 Edition
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor that can cause a persistent dry cough due to bradykinin accumulation in
the lungs; this occurs in up to 20% of patients and should be reported to the provider, who may switch the client
to an ARB. ACE inhibitors should be taken in the morning (not bedtime) due to first-dose hypotension risk,
sodium should be restricted (not increased) in heart failure, and the medication should never be stopped abruptly
as this can cause rebound hypertension and worsen heart failure.
Q4. A nurse is teaching a client with heart failure about daily weight monitoring. Which statement by the client
indicates that teaching has been effective?
A. I will weigh myself once a week before breakfast
B. I will weigh myself at bedtime after drinking fluids
C. I will weigh myself every morning after urinating, before eating [CORRECT]
D. I will weigh myself whenever I feel short of breath
Correct Answer: C
Rationale: Daily weights are the most reliable indicator of fluid status in heart failure. The client should weigh
themselves every morning at the same time, after urinating, before eating or drinking, wearing similar clothing,
and using the same scale. A weight gain of 2-3 lb in 24 hours or 5 lb in a week indicates fluid retention and should
be reported to the provider immediately. Weekly weighing is too infrequent, postprandial weights are inaccurate,
and symptom-based weighing is inconsistent.
Q5. A 55-year-old male presents to the ED with crushing substernal chest pain radiating to the left arm and
jaw, diaphoresis, nausea, and a sense of impending doom. The 12-lead ECG shows ST elevation in leads II, III,
and aVF. Which intervention should the nurse anticipate FIRST?
A. Administer sublingual nitroglycerin every 5 minutes
B. Initiate cardiac cath lab activation for primary PCI [CORRECT]
C. Administer morphine 4 mg IV push for pain
D. Apply oxygen via nasal cannula at 6 L/min
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall STEMI. The definitive treatment for
STEMI is primary percutaneous coronary intervention (PCI), which should be performed within 90 minutes of
first medical contact (door-to-balloon time). While MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) was
historically the initial approach, current guidelines prioritize immediate PCI activation. Aspirin 162-325 mg
chewed should be administered, and oxygen is only given if SpO2 <90%. Nitroglycerin is contraindicated in
inferior MI due to risk of right ventricular involvement and profound hypotension.
Q6. A client is admitted with a suspected acute myocardial infarction. Which cardiac biomarker is MOST
specific for myocardial injury and is used to confirm the diagnosis?
A. Creatine kinase (CK)
B. CK-MB
C. Troponin I [CORRECT]
D. Myoglobin
110 Questions | 10 Sections | Passing Score 70% NCSBN Clinical Judgment Model Page 3
