ATI RN ADULT MEDICAL SURGICAL
PROCTORED EXAM 2026 WITH NGN QUESTIONS
AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF.
Core Domains
,1. Cardiovascular and Hematologic Disorders
2. Respiratory and Acid-Base Disorders
3. Renal and Genitourinary Disorders
4. Endocrine and Metabolic Disorders
5. Gastrointestinal and Hepatic Disorders
6. Neurological and Musculoskeletal Disorders
7. Oncologic and Immunologic Disorders
8. Perioperative Care and Emergency Management
9. Infection Control and Pharmacology
10. Clinical Judgment and NGN Decision-Making
Introduction
This comprehensive assessment evaluates the clinical judgment and nursing
knowledge required for safe, effective adult medical-surgical practice. It covers
cardiovascular, respiratory, renal, endocrine, gastrointestinal, neurological,
musculoskeletal, oncologic, and perioperative care. Questions are structured
as multiple-choice and Next Generation NCLEX (NGN) scenario-based items
that require analysis, prioritization, and evidence-based decision-making. The
examination emphasizes real-world application, patient safety, and the ability
to recognize subtle clinical changes, interpret laboratory data, and implement
appropriate nursing interventions. Candidates must demonstrate readiness to
manage complex, multisystem patient conditions in acute care settings.
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client who has heart failure and is receiving
furosemide. Which of the following findings indicates a therapeutic
response to the medication?
A. Weight loss of 2 kg in 24 hours
B. Heart rate of 110/min
C. Bibasilar crackles
D. Jugular venous distention
, A. Weight loss of 2 kg in 24 hours
RATIONALE: Furosemide is a loop diuretic that reduces fluid volume. A
weight loss of 2 kg in 24 hours indicates effective diuresis and fluid removal.
Tachycardia, crackles, and JVD indicate worsening fluid overload.
2. A client with COPD is receiving oxygen at 4 L/min via nasal cannula.
The client becomes drowsy and confused. Which action should the
nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Decrease the oxygen flow rate to 1-2 L/min
C. Administer a bronchodilator
D. Place the client in a supine position
B. Decrease the oxygen flow rate to 1-2 L/min
RATIONALE: Clients with COPD may have hypoxic drive, and high
oxygen levels can suppress respiration, leading to CO2 retention and
drowsiness. The nurse should decrease oxygen to 1-2 L/min and monitor.
3. A nurse is assessing a client who has acute kidney injury. Which of
the following findings indicates the client is in the oliguric phase?
A. Urine output of 50 mL/hr
B. Urine output of 200 mL/24 hours
C. Serum potassium of 3.5 mEq/L
D. Serum creatinine of 0.8 mg/dL
B. Urine output of 200 mL/24 hours
RATIONALE: The oliguric phase of AKI is characterized by urine output
less than 400 mL/24 hours. A output of 200 mL/24 hours is consistent with
oliguria. Hyperkalemia and elevated creatinine are also expected.
, 4. A client with type 1 diabetes mellitus has a blood glucose of 450
mg/dL, pH 7.25, and positive urine ketones. Which of the following is
the priority nursing action?
A. Administer regular insulin IV
B. Administer sodium bicarbonate
C. Provide a high-carbohydrate snack
D. Encourage oral fluids
A. Administer regular insulin IV
RATIONALE: The client is in diabetic ketoacidosis (DKA). The priority is
to administer regular insulin IV to lower blood glucose and stop ketone
production. Bicarbonate is used only for severe acidosis, and fluids are given
IV.
5. A nurse is caring for a client who has cirrhosis and ascites. Which of
the following dietary instructions should the nurse provide?
A. Increase protein intake to 2 g/kg/day
B. Restrict sodium to 2 g/day
C. Increase fluid intake to 3 L/day
D. Restrict potassium intake
B. Restrict sodium to 2 g/day
RATIONALE: Clients with cirrhosis and ascites require sodium restriction
to reduce fluid retention. Protein may be restricted if hepatic encephalopathy
is present. Fluids may be restricted, and potassium is often not restricted.
6. A client is admitted with a suspected stroke. Which of the following
findings is a contraindication to administering tissue plasminogen
activator (tPA)?
PROCTORED EXAM 2026 WITH NGN QUESTIONS
AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF.
Core Domains
,1. Cardiovascular and Hematologic Disorders
2. Respiratory and Acid-Base Disorders
3. Renal and Genitourinary Disorders
4. Endocrine and Metabolic Disorders
5. Gastrointestinal and Hepatic Disorders
6. Neurological and Musculoskeletal Disorders
7. Oncologic and Immunologic Disorders
8. Perioperative Care and Emergency Management
9. Infection Control and Pharmacology
10. Clinical Judgment and NGN Decision-Making
Introduction
This comprehensive assessment evaluates the clinical judgment and nursing
knowledge required for safe, effective adult medical-surgical practice. It covers
cardiovascular, respiratory, renal, endocrine, gastrointestinal, neurological,
musculoskeletal, oncologic, and perioperative care. Questions are structured
as multiple-choice and Next Generation NCLEX (NGN) scenario-based items
that require analysis, prioritization, and evidence-based decision-making. The
examination emphasizes real-world application, patient safety, and the ability
to recognize subtle clinical changes, interpret laboratory data, and implement
appropriate nursing interventions. Candidates must demonstrate readiness to
manage complex, multisystem patient conditions in acute care settings.
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client who has heart failure and is receiving
furosemide. Which of the following findings indicates a therapeutic
response to the medication?
A. Weight loss of 2 kg in 24 hours
B. Heart rate of 110/min
C. Bibasilar crackles
D. Jugular venous distention
, A. Weight loss of 2 kg in 24 hours
RATIONALE: Furosemide is a loop diuretic that reduces fluid volume. A
weight loss of 2 kg in 24 hours indicates effective diuresis and fluid removal.
Tachycardia, crackles, and JVD indicate worsening fluid overload.
2. A client with COPD is receiving oxygen at 4 L/min via nasal cannula.
The client becomes drowsy and confused. Which action should the
nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Decrease the oxygen flow rate to 1-2 L/min
C. Administer a bronchodilator
D. Place the client in a supine position
B. Decrease the oxygen flow rate to 1-2 L/min
RATIONALE: Clients with COPD may have hypoxic drive, and high
oxygen levels can suppress respiration, leading to CO2 retention and
drowsiness. The nurse should decrease oxygen to 1-2 L/min and monitor.
3. A nurse is assessing a client who has acute kidney injury. Which of
the following findings indicates the client is in the oliguric phase?
A. Urine output of 50 mL/hr
B. Urine output of 200 mL/24 hours
C. Serum potassium of 3.5 mEq/L
D. Serum creatinine of 0.8 mg/dL
B. Urine output of 200 mL/24 hours
RATIONALE: The oliguric phase of AKI is characterized by urine output
less than 400 mL/24 hours. A output of 200 mL/24 hours is consistent with
oliguria. Hyperkalemia and elevated creatinine are also expected.
, 4. A client with type 1 diabetes mellitus has a blood glucose of 450
mg/dL, pH 7.25, and positive urine ketones. Which of the following is
the priority nursing action?
A. Administer regular insulin IV
B. Administer sodium bicarbonate
C. Provide a high-carbohydrate snack
D. Encourage oral fluids
A. Administer regular insulin IV
RATIONALE: The client is in diabetic ketoacidosis (DKA). The priority is
to administer regular insulin IV to lower blood glucose and stop ketone
production. Bicarbonate is used only for severe acidosis, and fluids are given
IV.
5. A nurse is caring for a client who has cirrhosis and ascites. Which of
the following dietary instructions should the nurse provide?
A. Increase protein intake to 2 g/kg/day
B. Restrict sodium to 2 g/day
C. Increase fluid intake to 3 L/day
D. Restrict potassium intake
B. Restrict sodium to 2 g/day
RATIONALE: Clients with cirrhosis and ascites require sodium restriction
to reduce fluid retention. Protein may be restricted if hepatic encephalopathy
is present. Fluids may be restricted, and potassium is often not restricted.
6. A client is admitted with a suspected stroke. Which of the following
findings is a contraindication to administering tissue plasminogen
activator (tPA)?
