ATI RN Adult Medical-Surgical Nursing
2026/2027 Study Guide | ATI Medical-
Surgical Content Mastery Series (CMS) Exam
Prep | Adult Med-Surg Practice Questions &
Answers, NGN Clinical Judgment, Detailed
Rationales, Cardiovascular, Respiratory,
Renal, Endocrine, Neurological &
Comprehensive NCLEX-RN Review
Question 1: A client with chronic kidney disease is prescribed calcium acetate.
Which of the following laboratory values would indicate that the medication is
having the desired therapeutic effect?
A. Increased serum calcium
B. Decreased serum phosphorus
C. Decreased serum potassium
D. Increased serum albumin
CORRECT ANSWER: B. Decreased serum phosphorus
Rationale: Calcium acetate is a phosphate binder. It works by binding to dietary
phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is
then excreted in the feces. This prevents the absorption of phosphorus, leading to a
decrease in serum phosphorus levels, which is the desired effect in clients with chronic
kidney disease to prevent renal osteodystrophy.
Question 2: A nurse is caring for a client in the immediate postoperative period
following a thyroidectomy. Which of the following findings should be reported
to the healthcare provider immediately?
A. Pain in the incision site rated 4 on a 0-10 scale
B. Serosanguineous drainage on the dressing
C. Client reports a tingling sensation around the mouth
D. Client is drowsy from anesthetic agents
CORRECT ANSWER: C. Client reports a tingling sensation around the mouth
Rationale: Tingling around the mouth (paresthesia) is an early sign of hypocalcemia,
which can occur if the parathyroid glands are inadvertently damaged or removed during
a thyroidectomy. Hypocalcemia can lead to life-threatening laryngospasm and seizures,
so this finding requires immediate reporting and intervention.
Question 3: A client with heart failure is prescribed furosemide. Which of the
following adverse effects is most important for the nurse to monitor?
,A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to increased excretion of potassium as well.
Hypokalemia is a significant adverse effect that can predispose the client to cardiac
dysrhythmias, especially if the client is also taking digoxin.
Question 4: A client with type 1 diabetes mellitus is experiencing nausea and
vomiting and is unable to eat. Which of the following instructions should the
nurse provide regarding insulin administration?
A. "Take your usual dose of insulin, as your body still needs it."
B. "Hold your insulin until you can eat something."
C. "Decrease your insulin dose by half until you feel better."
D. "Take your insulin only if your blood glucose is above 300 mg/dL."
CORRECT ANSWER: A. "Take your usual dose of insulin, as your body still
needs it."
Rationale: Clients with type 1 diabetes should never omit insulin, even when ill and not
eating. The body continues to produce counterregulatory hormones (glucagon,
epinephrine) during illness, which can lead to hyperglycemia and diabetic ketoacidosis
(DKA). The client should continue to take insulin and monitor blood glucose and ketone
levels frequently.
Question 5: A nurse is preparing to administer a blood transfusion to a client.
Which of the following intravenous solutions should be used to prime the
blood administration tubing?
A. 0.9% sodium chloride
B. 0.45% sodium chloride
C. 5% dextrose in water
D. Lactated Ringer's solution
CORRECT ANSWER: A. 0.9% sodium chloride
Rationale: 0.9% sodium chloride (normal saline) is the only solution that should be used
to prime blood tubing and to infuse with blood products. Dextrose solutions can cause
red blood cell lysis and agglutination, and lactated Ringer's contains calcium, which can
cause clotting in the tubing.
,Question 6: The nurse is assessing a client with a chest tube to a water-seal
drainage system. Which of the following findings indicates a malfunction in the
system?
A. Gentle bubbling in the water-seal chamber
B. Continuous vigorous bubbling in the water-seal chamber
C. Fluctuation (tidaling) of the fluid level in the water-seal chamber
D. Drainage in the collection chamber
CORRECT ANSWER: B. Continuous vigorous bubbling in the water-seal
chamber
Rationale: Continuous vigorous bubbling in the water-seal chamber indicates an air leak,
which is a malfunction. Gentle bubbling is normal initially as air is being evacuated, and
tidaling (fluctuation) is a normal finding indicating that the chest tube is patent. Drainage
in the collection chamber is expected.
Question 7: A client with cirrhosis has ascites. Which of the following nursing
interventions is a priority to monitor?
A. Daily weight and abdominal girth measurements
B. Intake and output every 4 hours
C. Nutritional intake of protein
D. Level of consciousness
CORRECT ANSWER: D. Level of consciousness
Rationale: While all options are important, monitoring level of consciousness is the
priority. Clients with cirrhosis and ascites are at risk for hepatic encephalopathy due to
the liver's inability to metabolize ammonia. A change in level of consciousness,
confusion, or asterixis indicates a worsening condition that requires immediate
intervention.
Question 8: A client is being discharged with a new prescription for warfarin.
Which of the following client statements indicates a need for further teaching?
A. "I will use an electric razor to shave."
B. "I will eat the same amount of green leafy vegetables each week."
C. "I will take an antacid if I get heartburn."
D. "I will report any bruising or bleeding to my healthcare provider."
CORRECT ANSWER: C. "I will take an antacid if I get heartburn."
Rationale: Clients on warfarin should avoid over-the-counter medications like antacids,
as they can affect the absorption and metabolism of warfarin. If heartburn occurs, the
client should consult their healthcare provider for a safe alternative. Consistent intake of
, vitamin K (found in green leafy vegetables) is important, and using an electric razor and
reporting bleeding are appropriate.
Question 9: A client presents to the emergency department with acute chest
pain. The electrocardiogram (ECG) shows ST-segment elevation in leads V1-
V4. The nurse should suspect which of the following?
A. Inferior wall myocardial infarction
B. Lateral wall myocardial infarction
C. Anterior wall myocardial infarction
D. Posterior wall myocardial infarction
CORRECT ANSWER: C. Anterior wall myocardial infarction
Rationale: Leads V1-V4 represent the anterior wall of the left ventricle. ST-segment
elevation in these leads indicates an anterior wall MI. This type of MI is often caused by
occlusion of the left anterior descending (LAD) artery.
Question 10: A nurse is caring for a client with a new colostomy. Which of the
following findings would indicate a complication?
A. A stoma that is pink and moist
B. The stoma is slightly edematous
C. The stoma is dark red to purple in color
D. A small amount of bleeding from the stoma
CORRECT ANSWER: C. The stoma is dark red to purple in color
Rationale: A healthy stoma should be pink and moist, and may be slightly edematous for
2-3 weeks postoperatively. A dark red to purple or black color indicates ischemia or
necrosis of the stoma tissue, which is a serious complication requiring immediate
surgical intervention.
Question 11: The nurse is administering an intravenous dose of potassium
chloride. Which of the following actions is most appropriate?
A. Administer the medication via IV push over 2 minutes
B. Administer the medication via IV infusion at a rate of 20 mEq/hour
C. Administer the medication by IM injection in the ventrogluteal site
D. Administer the medication via subcutaneous injection
CORRECT ANSWER: B. Administer the medication via IV infusion at a rate of
20 mEq/hour
Rationale: Potassium chloride must be diluted and administered via IV infusion, never as
an IV push or bolus, as this can cause fatal cardiac dysrhythmias. The maximum
2026/2027 Study Guide | ATI Medical-
Surgical Content Mastery Series (CMS) Exam
Prep | Adult Med-Surg Practice Questions &
Answers, NGN Clinical Judgment, Detailed
Rationales, Cardiovascular, Respiratory,
Renal, Endocrine, Neurological &
Comprehensive NCLEX-RN Review
Question 1: A client with chronic kidney disease is prescribed calcium acetate.
Which of the following laboratory values would indicate that the medication is
having the desired therapeutic effect?
A. Increased serum calcium
B. Decreased serum phosphorus
C. Decreased serum potassium
D. Increased serum albumin
CORRECT ANSWER: B. Decreased serum phosphorus
Rationale: Calcium acetate is a phosphate binder. It works by binding to dietary
phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is
then excreted in the feces. This prevents the absorption of phosphorus, leading to a
decrease in serum phosphorus levels, which is the desired effect in clients with chronic
kidney disease to prevent renal osteodystrophy.
Question 2: A nurse is caring for a client in the immediate postoperative period
following a thyroidectomy. Which of the following findings should be reported
to the healthcare provider immediately?
A. Pain in the incision site rated 4 on a 0-10 scale
B. Serosanguineous drainage on the dressing
C. Client reports a tingling sensation around the mouth
D. Client is drowsy from anesthetic agents
CORRECT ANSWER: C. Client reports a tingling sensation around the mouth
Rationale: Tingling around the mouth (paresthesia) is an early sign of hypocalcemia,
which can occur if the parathyroid glands are inadvertently damaged or removed during
a thyroidectomy. Hypocalcemia can lead to life-threatening laryngospasm and seizures,
so this finding requires immediate reporting and intervention.
Question 3: A client with heart failure is prescribed furosemide. Which of the
following adverse effects is most important for the nurse to monitor?
,A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to increased excretion of potassium as well.
Hypokalemia is a significant adverse effect that can predispose the client to cardiac
dysrhythmias, especially if the client is also taking digoxin.
Question 4: A client with type 1 diabetes mellitus is experiencing nausea and
vomiting and is unable to eat. Which of the following instructions should the
nurse provide regarding insulin administration?
A. "Take your usual dose of insulin, as your body still needs it."
B. "Hold your insulin until you can eat something."
C. "Decrease your insulin dose by half until you feel better."
D. "Take your insulin only if your blood glucose is above 300 mg/dL."
CORRECT ANSWER: A. "Take your usual dose of insulin, as your body still
needs it."
Rationale: Clients with type 1 diabetes should never omit insulin, even when ill and not
eating. The body continues to produce counterregulatory hormones (glucagon,
epinephrine) during illness, which can lead to hyperglycemia and diabetic ketoacidosis
(DKA). The client should continue to take insulin and monitor blood glucose and ketone
levels frequently.
Question 5: A nurse is preparing to administer a blood transfusion to a client.
Which of the following intravenous solutions should be used to prime the
blood administration tubing?
A. 0.9% sodium chloride
B. 0.45% sodium chloride
C. 5% dextrose in water
D. Lactated Ringer's solution
CORRECT ANSWER: A. 0.9% sodium chloride
Rationale: 0.9% sodium chloride (normal saline) is the only solution that should be used
to prime blood tubing and to infuse with blood products. Dextrose solutions can cause
red blood cell lysis and agglutination, and lactated Ringer's contains calcium, which can
cause clotting in the tubing.
,Question 6: The nurse is assessing a client with a chest tube to a water-seal
drainage system. Which of the following findings indicates a malfunction in the
system?
A. Gentle bubbling in the water-seal chamber
B. Continuous vigorous bubbling in the water-seal chamber
C. Fluctuation (tidaling) of the fluid level in the water-seal chamber
D. Drainage in the collection chamber
CORRECT ANSWER: B. Continuous vigorous bubbling in the water-seal
chamber
Rationale: Continuous vigorous bubbling in the water-seal chamber indicates an air leak,
which is a malfunction. Gentle bubbling is normal initially as air is being evacuated, and
tidaling (fluctuation) is a normal finding indicating that the chest tube is patent. Drainage
in the collection chamber is expected.
Question 7: A client with cirrhosis has ascites. Which of the following nursing
interventions is a priority to monitor?
A. Daily weight and abdominal girth measurements
B. Intake and output every 4 hours
C. Nutritional intake of protein
D. Level of consciousness
CORRECT ANSWER: D. Level of consciousness
Rationale: While all options are important, monitoring level of consciousness is the
priority. Clients with cirrhosis and ascites are at risk for hepatic encephalopathy due to
the liver's inability to metabolize ammonia. A change in level of consciousness,
confusion, or asterixis indicates a worsening condition that requires immediate
intervention.
Question 8: A client is being discharged with a new prescription for warfarin.
Which of the following client statements indicates a need for further teaching?
A. "I will use an electric razor to shave."
B. "I will eat the same amount of green leafy vegetables each week."
C. "I will take an antacid if I get heartburn."
D. "I will report any bruising or bleeding to my healthcare provider."
CORRECT ANSWER: C. "I will take an antacid if I get heartburn."
Rationale: Clients on warfarin should avoid over-the-counter medications like antacids,
as they can affect the absorption and metabolism of warfarin. If heartburn occurs, the
client should consult their healthcare provider for a safe alternative. Consistent intake of
, vitamin K (found in green leafy vegetables) is important, and using an electric razor and
reporting bleeding are appropriate.
Question 9: A client presents to the emergency department with acute chest
pain. The electrocardiogram (ECG) shows ST-segment elevation in leads V1-
V4. The nurse should suspect which of the following?
A. Inferior wall myocardial infarction
B. Lateral wall myocardial infarction
C. Anterior wall myocardial infarction
D. Posterior wall myocardial infarction
CORRECT ANSWER: C. Anterior wall myocardial infarction
Rationale: Leads V1-V4 represent the anterior wall of the left ventricle. ST-segment
elevation in these leads indicates an anterior wall MI. This type of MI is often caused by
occlusion of the left anterior descending (LAD) artery.
Question 10: A nurse is caring for a client with a new colostomy. Which of the
following findings would indicate a complication?
A. A stoma that is pink and moist
B. The stoma is slightly edematous
C. The stoma is dark red to purple in color
D. A small amount of bleeding from the stoma
CORRECT ANSWER: C. The stoma is dark red to purple in color
Rationale: A healthy stoma should be pink and moist, and may be slightly edematous for
2-3 weeks postoperatively. A dark red to purple or black color indicates ischemia or
necrosis of the stoma tissue, which is a serious complication requiring immediate
surgical intervention.
Question 11: The nurse is administering an intravenous dose of potassium
chloride. Which of the following actions is most appropriate?
A. Administer the medication via IV push over 2 minutes
B. Administer the medication via IV infusion at a rate of 20 mEq/hour
C. Administer the medication by IM injection in the ventrogluteal site
D. Administer the medication via subcutaneous injection
CORRECT ANSWER: B. Administer the medication via IV infusion at a rate of
20 mEq/hour
Rationale: Potassium chloride must be diluted and administered via IV infusion, never as
an IV push or bolus, as this can cause fatal cardiac dysrhythmias. The maximum
