ATI RN Adult Medical Surgical | ATI Adult Medical-
Surgical Nursing Study Guide & Exam Prep
2026/2027 | ATI RN Med-Surg Review, Adult Health
Nursing, Cardiovascular, Respiratory, Neurological,
Renal & Urinary, Endocrine, Gastrointestinal,
Hematologic, Immune & Infectious Disorders, Fluid &
Electrolyte Balance, Pharmacology, Critical Care,
Clinical Judgment, Prioritization, Practice Questions,
Answers & Detailed Rationales
Question 1: A patient with chronic kidney disease is scheduled for an
arteriovenous (AV) fistula creation in the left arm. Which preoperative nursing
action is most appropriate?
A. Instruct the patient to avoid heavy lifting with the left arm post-operatively.
B. Assist the patient in performing range-of-motion exercises on the left arm.
C. Apply a cold compress to the left arm to reduce swelling.
D. Obtain a baseline blood pressure reading from the left arm.
CORRECT ANSWER: A. Instruct the patient to avoid heavy lifting with the left
arm post-operatively.
Rationale: The patient should be instructed to avoid heavy lifting or constrictive clothing
on the extremity where the AV fistula will be placed to protect the vessel. Blood pressure
measurements, venipunctures, and tight jewelry should be avoided on that arm post-
operatively, not pre-operatively. Range-of-motion exercises and cold compresses are not
standard pre-operative interventions for this procedure.
Question 2: A patient is admitted with acute pancreatitis. Which laboratory
value is most specific for diagnosing this condition?
A. Elevated serum lipase
B. Elevated serum amylase
C. Elevated serum glucose
D. Decreased serum calcium
CORRECT ANSWER: A. Elevated serum lipase
Rationale: Serum lipase is more specific and sensitive for acute pancreatitis than serum
amylase. It remains elevated longer and is not affected by other conditions like salivary
gland disorders. Elevated serum glucose and decreased serum calcium can occur
secondary to pancreatitis but are not diagnostic.
Question 3: A patient with heart failure is prescribed furosemide. Which
assessment finding indicates the medication is having the desired therapeutic
effect?
A. Decreased peripheral edema
B. Increased blood pressure
,C. Increased heart rate
D. Decreased urine output
CORRECT ANSWER: A. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired therapeutic effect is a reduction in signs of fluid overload, such as
peripheral edema, pulmonary congestion, and dyspnea. Blood pressure should decrease,
urine output should increase, and heart rate should normalize.
Question 4: A patient who had a total hip arthroplasty is one day post-
operative. Which nursing action is most important to prevent dislocation of
the new joint?
A. Maintain the hip in adduction
B. Keep the hips in a neutral position with an abduction pillow
C. Allow the patient to cross their legs at the ankles only
D. Encourage the patient to sit in low chairs
CORRECT ANSWER: B. Keep the hips in a neutral position with an abduction
pillow
Rationale: Following a total hip arthroplasty, the hip must be maintained in a neutral
position, and an abduction pillow is used to prevent adduction and internal rotation,
which can cause dislocation. The patient should avoid crossing legs, sitting in low chairs,
and adducting the hip.
Question 5: A patient with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing pH 7.30, PaCO2 55 mmHg, and
HCO3 30 mEq/L. How does the nurse interpret these findings?
A. Uncompensated respiratory acidosis
B. Fully compensated respiratory acidosis
C. Partially compensated respiratory acidosis
D. Partially compensated metabolic acidosis
CORRECT ANSWER: C. Partially compensated respiratory acidosis
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and HCO3 is
elevated (metabolic compensation). Because the pH is not yet within normal range, the
compensation is partial. Fully compensated would have a normal pH.
Question 6: A patient is receiving a continuous heparin infusion for a deep
vein thrombosis. Which laboratory value is the priority to monitor?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count
CORRECT ANSWER: B. Activated partial thromboplastin time (aPTT)
,Rationale: Heparin therapy is monitored by the aPTT, which should be 1.5 to 2.5 times
the normal control value. PT and INR are used to monitor warfarin therapy. Platelet
count should be monitored but is not the primary value for dose adjustment.
Question 7: A patient with diabetes mellitus type 1 is exhibiting signs of
hypoglycemia. Which action should the nurse take first?
A. Administer 50% dextrose IV push
B. Give the patient a glass of orange juice
C. Check the patient's blood glucose level
D. Administer glucagon subcutaneously
CORRECT ANSWER: C. Check the patient's blood glucose level
Rationale: The first action is to verify the blood glucose level to confirm hypoglycemia
before treatment. If the patient is conscious and able to swallow, oral glucose (orange
juice) is the next step. If the patient is unconscious, IV dextrose or glucagon would be
used.
Question 8: A patient is post-operative following a right-sided
pneumonectomy. Which position is most appropriate for the nurse to place the
patient in?
A. Right side-lying position
B. Left side-lying position
C. Supine position
D. High Fowler's position
CORRECT ANSWER: A. Right side-lying position
Rationale: After a pneumonectomy, the patient should be positioned on the operative
side (right side-lying) to allow the remaining lung to expand and to prevent mediastinal
shift. This position promotes ventilation and perfusion of the healthy lung.
Question 9: The nurse is caring for a patient with an intracranial pressure
(ICP) monitor. Which finding requires immediate intervention?
A. ICP 15 mmHg
B. PaCO2 30 mmHg
C. ICP 22 mmHg
D. Mean arterial pressure (MAP) 85 mmHg
CORRECT ANSWER: C. ICP 22 mmHg
Rationale: Normal ICP is 5-15 mmHg. An ICP of 22 mmHg is elevated and requires
immediate intervention to prevent herniation. PaCO2 of 30 mmHg is slightly low but not
a critical finding. MAP 85 mmHg is acceptable for maintaining cerebral perfusion
pressure.
Question 10: A patient is diagnosed with acute exacerbation of ulcerative
colitis. Which nursing intervention is a priority?
, A. Administer a high-fiber diet
B. Encourage oral fluid intake to maintain hydration
C. Administer antidiarrheal medications as prescribed
D. Monitor intake and output and serum electrolytes
CORRECT ANSWER: D. Monitor intake and output and serum electrolytes
Rationale: The priority in ulcerative colitis is to monitor for fluid and electrolyte
imbalances due to severe diarrhea. Antidiarrheals are often contraindicated during acute
exacerbations. A low-fiber diet is preferred, and oral fluids may be limited if the patient
is NPO for rest.
Question 11: A patient with a history of heart failure is admitted with
shortness of breath and crackles in the lungs. Which medication is most likely
to be prescribed to reduce preload?
A. Dobutamine
B. Furosemide
C. Digoxin
D. Amlodipine
CORRECT ANSWER: B. Furosemide
Rationale: Furosemide is a diuretic that reduces preload by decreasing fluid volume.
Dobutamine is a positive inotrope; Digoxin increases contractility; Amlodipine is a
vasodilator that reduces afterload.
Question 12: A patient is receiving total parenteral nutrition (TPN). Which
assessment finding is most indicative of a complication related to the TPN?
A. Blood glucose level of 110 mg/dL
B. Daily weight increase of 2 kg in 24 hours
C. Serum potassium of 4.0 mEq/L
D. Urine output of 30 mL/hour
CORRECT ANSWER: B. Daily weight increase of 2 kg in 24 hours
Rationale: A rapid weight gain of 2 kg in 24 hours indicates fluid overload, a potential
complication of TPN due to fluid and sodium content. Hyperglycemia, electrolyte
imbalances, and dehydration are also complications.
Question 13: A patient presents with acute respiratory distress syndrome
(ARDS). Which arterial blood gas finding is characteristic in the early stages?
A. Respiratory acidosis with high PaCO2
B. Metabolic acidosis with low HCO3
C. Respiratory alkalosis with low PaCO2
D. Metabolic alkalosis with high HCO3
CORRECT ANSWER: C. Respiratory alkalosis with low PaCO2
Surgical Nursing Study Guide & Exam Prep
2026/2027 | ATI RN Med-Surg Review, Adult Health
Nursing, Cardiovascular, Respiratory, Neurological,
Renal & Urinary, Endocrine, Gastrointestinal,
Hematologic, Immune & Infectious Disorders, Fluid &
Electrolyte Balance, Pharmacology, Critical Care,
Clinical Judgment, Prioritization, Practice Questions,
Answers & Detailed Rationales
Question 1: A patient with chronic kidney disease is scheduled for an
arteriovenous (AV) fistula creation in the left arm. Which preoperative nursing
action is most appropriate?
A. Instruct the patient to avoid heavy lifting with the left arm post-operatively.
B. Assist the patient in performing range-of-motion exercises on the left arm.
C. Apply a cold compress to the left arm to reduce swelling.
D. Obtain a baseline blood pressure reading from the left arm.
CORRECT ANSWER: A. Instruct the patient to avoid heavy lifting with the left
arm post-operatively.
Rationale: The patient should be instructed to avoid heavy lifting or constrictive clothing
on the extremity where the AV fistula will be placed to protect the vessel. Blood pressure
measurements, venipunctures, and tight jewelry should be avoided on that arm post-
operatively, not pre-operatively. Range-of-motion exercises and cold compresses are not
standard pre-operative interventions for this procedure.
Question 2: A patient is admitted with acute pancreatitis. Which laboratory
value is most specific for diagnosing this condition?
A. Elevated serum lipase
B. Elevated serum amylase
C. Elevated serum glucose
D. Decreased serum calcium
CORRECT ANSWER: A. Elevated serum lipase
Rationale: Serum lipase is more specific and sensitive for acute pancreatitis than serum
amylase. It remains elevated longer and is not affected by other conditions like salivary
gland disorders. Elevated serum glucose and decreased serum calcium can occur
secondary to pancreatitis but are not diagnostic.
Question 3: A patient with heart failure is prescribed furosemide. Which
assessment finding indicates the medication is having the desired therapeutic
effect?
A. Decreased peripheral edema
B. Increased blood pressure
,C. Increased heart rate
D. Decreased urine output
CORRECT ANSWER: A. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired therapeutic effect is a reduction in signs of fluid overload, such as
peripheral edema, pulmonary congestion, and dyspnea. Blood pressure should decrease,
urine output should increase, and heart rate should normalize.
Question 4: A patient who had a total hip arthroplasty is one day post-
operative. Which nursing action is most important to prevent dislocation of
the new joint?
A. Maintain the hip in adduction
B. Keep the hips in a neutral position with an abduction pillow
C. Allow the patient to cross their legs at the ankles only
D. Encourage the patient to sit in low chairs
CORRECT ANSWER: B. Keep the hips in a neutral position with an abduction
pillow
Rationale: Following a total hip arthroplasty, the hip must be maintained in a neutral
position, and an abduction pillow is used to prevent adduction and internal rotation,
which can cause dislocation. The patient should avoid crossing legs, sitting in low chairs,
and adducting the hip.
Question 5: A patient with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing pH 7.30, PaCO2 55 mmHg, and
HCO3 30 mEq/L. How does the nurse interpret these findings?
A. Uncompensated respiratory acidosis
B. Fully compensated respiratory acidosis
C. Partially compensated respiratory acidosis
D. Partially compensated metabolic acidosis
CORRECT ANSWER: C. Partially compensated respiratory acidosis
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and HCO3 is
elevated (metabolic compensation). Because the pH is not yet within normal range, the
compensation is partial. Fully compensated would have a normal pH.
Question 6: A patient is receiving a continuous heparin infusion for a deep
vein thrombosis. Which laboratory value is the priority to monitor?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count
CORRECT ANSWER: B. Activated partial thromboplastin time (aPTT)
,Rationale: Heparin therapy is monitored by the aPTT, which should be 1.5 to 2.5 times
the normal control value. PT and INR are used to monitor warfarin therapy. Platelet
count should be monitored but is not the primary value for dose adjustment.
Question 7: A patient with diabetes mellitus type 1 is exhibiting signs of
hypoglycemia. Which action should the nurse take first?
A. Administer 50% dextrose IV push
B. Give the patient a glass of orange juice
C. Check the patient's blood glucose level
D. Administer glucagon subcutaneously
CORRECT ANSWER: C. Check the patient's blood glucose level
Rationale: The first action is to verify the blood glucose level to confirm hypoglycemia
before treatment. If the patient is conscious and able to swallow, oral glucose (orange
juice) is the next step. If the patient is unconscious, IV dextrose or glucagon would be
used.
Question 8: A patient is post-operative following a right-sided
pneumonectomy. Which position is most appropriate for the nurse to place the
patient in?
A. Right side-lying position
B. Left side-lying position
C. Supine position
D. High Fowler's position
CORRECT ANSWER: A. Right side-lying position
Rationale: After a pneumonectomy, the patient should be positioned on the operative
side (right side-lying) to allow the remaining lung to expand and to prevent mediastinal
shift. This position promotes ventilation and perfusion of the healthy lung.
Question 9: The nurse is caring for a patient with an intracranial pressure
(ICP) monitor. Which finding requires immediate intervention?
A. ICP 15 mmHg
B. PaCO2 30 mmHg
C. ICP 22 mmHg
D. Mean arterial pressure (MAP) 85 mmHg
CORRECT ANSWER: C. ICP 22 mmHg
Rationale: Normal ICP is 5-15 mmHg. An ICP of 22 mmHg is elevated and requires
immediate intervention to prevent herniation. PaCO2 of 30 mmHg is slightly low but not
a critical finding. MAP 85 mmHg is acceptable for maintaining cerebral perfusion
pressure.
Question 10: A patient is diagnosed with acute exacerbation of ulcerative
colitis. Which nursing intervention is a priority?
, A. Administer a high-fiber diet
B. Encourage oral fluid intake to maintain hydration
C. Administer antidiarrheal medications as prescribed
D. Monitor intake and output and serum electrolytes
CORRECT ANSWER: D. Monitor intake and output and serum electrolytes
Rationale: The priority in ulcerative colitis is to monitor for fluid and electrolyte
imbalances due to severe diarrhea. Antidiarrheals are often contraindicated during acute
exacerbations. A low-fiber diet is preferred, and oral fluids may be limited if the patient
is NPO for rest.
Question 11: A patient with a history of heart failure is admitted with
shortness of breath and crackles in the lungs. Which medication is most likely
to be prescribed to reduce preload?
A. Dobutamine
B. Furosemide
C. Digoxin
D. Amlodipine
CORRECT ANSWER: B. Furosemide
Rationale: Furosemide is a diuretic that reduces preload by decreasing fluid volume.
Dobutamine is a positive inotrope; Digoxin increases contractility; Amlodipine is a
vasodilator that reduces afterload.
Question 12: A patient is receiving total parenteral nutrition (TPN). Which
assessment finding is most indicative of a complication related to the TPN?
A. Blood glucose level of 110 mg/dL
B. Daily weight increase of 2 kg in 24 hours
C. Serum potassium of 4.0 mEq/L
D. Urine output of 30 mL/hour
CORRECT ANSWER: B. Daily weight increase of 2 kg in 24 hours
Rationale: A rapid weight gain of 2 kg in 24 hours indicates fluid overload, a potential
complication of TPN due to fluid and sodium content. Hyperglycemia, electrolyte
imbalances, and dehydration are also complications.
Question 13: A patient presents with acute respiratory distress syndrome
(ARDS). Which arterial blood gas finding is characteristic in the early stages?
A. Respiratory acidosis with high PaCO2
B. Metabolic acidosis with low HCO3
C. Respiratory alkalosis with low PaCO2
D. Metabolic alkalosis with high HCO3
CORRECT ANSWER: C. Respiratory alkalosis with low PaCO2
