2026/2027
ATI Capstone Adult Medical
Surgical Assessment 2 Exam
Comprehensive 2026/2027 Study
Guide Featuring Assessment Review,
Practice Tests, and Critical Care
Concepts
Question 1
A nurse is teaching a client about proper use of a metered-dose inhaler with a spacer.
Which instruction is most appropriate?
A. Wait 5 minutes between inhalations from the same inhaler
B. Breathe in rapidly during medication inhalation
C. Clean the inhaler mouthpiece weekly using cold water
D. Shake the inhaler vigorously before each use
Correct Answer: D. Shake the inhaler vigorously before each use
Rationale: Metered-dose inhalers contain suspended medication that separates when
left standing, so shaking ensures even drug distribution for accurate dosing. Option B
is incorrect because inhalation should be slow and deep, not rapid, to allow
medication deposition in the lungs. Option A is incorrect because spacing between
puffs is usually 30–60 seconds, not 5 minutes. Option C is incorrect because cleaning
is typically recommended weekly but involves warm water and air-drying, not
specifically cold water as stated.
Question 2
A nurse is caring for a client receiving mechanical ventilation. Which intervention is
most important?
A. Provide a means of communication
B. Keep the head of bed flat
C. Suction every 4 hours routinely
D. Perform oral care every 8 hours
Correct Answer: A. Provide a means of communication
,2026/2027
Rationale: Clients on mechanical ventilation are often unable to speak, so
communication tools such as boards or electronic devices are essential to reduce
anxiety and promote safety. Option B is incorrect because the head of bed should be
elevated to reduce aspiration risk. Option C is incorrect because suctioning is done as
needed, not routinely. Option D is incorrect because oral care should be performed
more frequently (at least every 2–4 hours) to prevent ventilator-associated pneumonia.
Question 3
A nurse evaluates IV fluid therapy in a dehydrated client. Which finding indicates
improvement?
A. Sodium 165 mEq/L
B. Potassium 5.2 mEq/L
C. Urine specific gravity 1.020
D. Hematocrit 62%
Correct Answer: C. Urine specific gravity 1.020
Rationale: Normal urine specific gravity ranges from 1.005–1.030, and a value within
this range indicates improved hydration status. Option A and D indicate severe
dehydration due to elevated concentration of blood components. Option B suggests
possible electrolyte imbalance but does not directly reflect hydration status.
Question 4
A postoperative client has lab results. Which indicates bleeding risk?
A. PT 11.5 seconds
B. aPTT 35 seconds
C. Platelets 80,000/mm³
D. RBC 4.0 million/mm³
Correct Answer: C. Platelets 80,000/mm³
Rationale: Normal platelet count is 150,000–400,000/mm³. A low platelet count
significantly increases bleeding risk. PT and aPTT in options A and B are within
normal ranges. RBC levels reflect oxygen-carrying capacity but not bleeding risk.
Question 5
Priority care for a client with cervical spinal cord injury includes:
A. Turn every 2 hours
B. Pad cervical collar edges
,2026/2027
C. Assess bladder distention
D. Assist with quad coughing
Correct Answer: D. Assist with quad coughing
Rationale: Cervical spinal injuries compromise respiratory muscles, making airway
clearance the priority. Quad coughing helps expel secretions using abdominal
pressure. Other interventions are important but secondary to airway maintenance.
Question 6
Which finding suggests transfusion-associated circulatory overload (TACO)?
A. Nausea
B. Hypothermia
C. Dyspnea
D. Bradycardia
Correct Answer: C. Dyspnea
Rationale: TACO causes fluid overload leading to pulmonary congestion and
respiratory distress. Dyspnea is an early and key sign. Other symptoms may occur but
are not specific indicators.
Question 7
A client receiving chest radiation reports which adverse effect?
A. Hair loss
B. Sweating at site
C. Altered taste
D. Cold intolerance
Correct Answer: C. Altered taste
Rationale: Radiation damages rapidly dividing cells, affecting taste buds and causing
dysgeusia. Hair loss depends on radiation field, sweating is not typical, and cold
intolerance is unrelated.
Question 8
Which actions are appropriate before PRBC transfusion? (Select all that apply)
A. Obtain baseline temperature
B. Use lactated Ringer’s for priming
, 2026/2027
C. Verify blood with second nurse
D. Use 20-gauge IV catheter
E. Assign AP to monitor transfusion
Correct Answers: A, C, D
Rationale: Baseline vitals establish transfusion reaction comparison. Blood must be
verified by two licensed nurses. A large-bore IV (18–20G) is required. Lactated
Ringer’s is incompatible with blood products. Assistive personnel cannot monitor
transfusions due to safety risks.
Question 9
Which BUN level suggests dehydration?
A. 3.6 mg/dL
B. 8 mg/dL
C. 18.7 mg/dL
D. 26 mg/dL
Correct Answer: D. 26 mg/dL
Rationale: Elevated BUN indicates dehydration due to decreased renal perfusion and
increased reabsorption of urea. Normal range is 10–20 mg/dL.
Question 10
Which ECG finding indicates atrial fibrillation?
A. Irregular baseline with no distinct P waves
B. HR 140–180 regular rhythm
C. No P waves with wide QRS tachycardia
D. Normal sinus rhythm 60–100 bpm
Correct Answer: A. Irregular baseline with no distinct P waves
Rationale: Atrial fibrillation is characterized by chaotic atrial activity and irregular
ventricular response. Other options represent sinus tachycardia or ventricular rhythms.
Question 11
Priority item for a new tracheostomy client:
A. Obturator
B. Hydrogen peroxide
ATI Capstone Adult Medical
Surgical Assessment 2 Exam
Comprehensive 2026/2027 Study
Guide Featuring Assessment Review,
Practice Tests, and Critical Care
Concepts
Question 1
A nurse is teaching a client about proper use of a metered-dose inhaler with a spacer.
Which instruction is most appropriate?
A. Wait 5 minutes between inhalations from the same inhaler
B. Breathe in rapidly during medication inhalation
C. Clean the inhaler mouthpiece weekly using cold water
D. Shake the inhaler vigorously before each use
Correct Answer: D. Shake the inhaler vigorously before each use
Rationale: Metered-dose inhalers contain suspended medication that separates when
left standing, so shaking ensures even drug distribution for accurate dosing. Option B
is incorrect because inhalation should be slow and deep, not rapid, to allow
medication deposition in the lungs. Option A is incorrect because spacing between
puffs is usually 30–60 seconds, not 5 minutes. Option C is incorrect because cleaning
is typically recommended weekly but involves warm water and air-drying, not
specifically cold water as stated.
Question 2
A nurse is caring for a client receiving mechanical ventilation. Which intervention is
most important?
A. Provide a means of communication
B. Keep the head of bed flat
C. Suction every 4 hours routinely
D. Perform oral care every 8 hours
Correct Answer: A. Provide a means of communication
,2026/2027
Rationale: Clients on mechanical ventilation are often unable to speak, so
communication tools such as boards or electronic devices are essential to reduce
anxiety and promote safety. Option B is incorrect because the head of bed should be
elevated to reduce aspiration risk. Option C is incorrect because suctioning is done as
needed, not routinely. Option D is incorrect because oral care should be performed
more frequently (at least every 2–4 hours) to prevent ventilator-associated pneumonia.
Question 3
A nurse evaluates IV fluid therapy in a dehydrated client. Which finding indicates
improvement?
A. Sodium 165 mEq/L
B. Potassium 5.2 mEq/L
C. Urine specific gravity 1.020
D. Hematocrit 62%
Correct Answer: C. Urine specific gravity 1.020
Rationale: Normal urine specific gravity ranges from 1.005–1.030, and a value within
this range indicates improved hydration status. Option A and D indicate severe
dehydration due to elevated concentration of blood components. Option B suggests
possible electrolyte imbalance but does not directly reflect hydration status.
Question 4
A postoperative client has lab results. Which indicates bleeding risk?
A. PT 11.5 seconds
B. aPTT 35 seconds
C. Platelets 80,000/mm³
D. RBC 4.0 million/mm³
Correct Answer: C. Platelets 80,000/mm³
Rationale: Normal platelet count is 150,000–400,000/mm³. A low platelet count
significantly increases bleeding risk. PT and aPTT in options A and B are within
normal ranges. RBC levels reflect oxygen-carrying capacity but not bleeding risk.
Question 5
Priority care for a client with cervical spinal cord injury includes:
A. Turn every 2 hours
B. Pad cervical collar edges
,2026/2027
C. Assess bladder distention
D. Assist with quad coughing
Correct Answer: D. Assist with quad coughing
Rationale: Cervical spinal injuries compromise respiratory muscles, making airway
clearance the priority. Quad coughing helps expel secretions using abdominal
pressure. Other interventions are important but secondary to airway maintenance.
Question 6
Which finding suggests transfusion-associated circulatory overload (TACO)?
A. Nausea
B. Hypothermia
C. Dyspnea
D. Bradycardia
Correct Answer: C. Dyspnea
Rationale: TACO causes fluid overload leading to pulmonary congestion and
respiratory distress. Dyspnea is an early and key sign. Other symptoms may occur but
are not specific indicators.
Question 7
A client receiving chest radiation reports which adverse effect?
A. Hair loss
B. Sweating at site
C. Altered taste
D. Cold intolerance
Correct Answer: C. Altered taste
Rationale: Radiation damages rapidly dividing cells, affecting taste buds and causing
dysgeusia. Hair loss depends on radiation field, sweating is not typical, and cold
intolerance is unrelated.
Question 8
Which actions are appropriate before PRBC transfusion? (Select all that apply)
A. Obtain baseline temperature
B. Use lactated Ringer’s for priming
, 2026/2027
C. Verify blood with second nurse
D. Use 20-gauge IV catheter
E. Assign AP to monitor transfusion
Correct Answers: A, C, D
Rationale: Baseline vitals establish transfusion reaction comparison. Blood must be
verified by two licensed nurses. A large-bore IV (18–20G) is required. Lactated
Ringer’s is incompatible with blood products. Assistive personnel cannot monitor
transfusions due to safety risks.
Question 9
Which BUN level suggests dehydration?
A. 3.6 mg/dL
B. 8 mg/dL
C. 18.7 mg/dL
D. 26 mg/dL
Correct Answer: D. 26 mg/dL
Rationale: Elevated BUN indicates dehydration due to decreased renal perfusion and
increased reabsorption of urea. Normal range is 10–20 mg/dL.
Question 10
Which ECG finding indicates atrial fibrillation?
A. Irregular baseline with no distinct P waves
B. HR 140–180 regular rhythm
C. No P waves with wide QRS tachycardia
D. Normal sinus rhythm 60–100 bpm
Correct Answer: A. Irregular baseline with no distinct P waves
Rationale: Atrial fibrillation is characterized by chaotic atrial activity and irregular
ventricular response. Other options represent sinus tachycardia or ventricular rhythms.
Question 11
Priority item for a new tracheostomy client:
A. Obturator
B. Hydrogen peroxide
