1|Page
COMPREHENSIVE ATI MEDICAL-SURGICAL
PROCTORED EXAM STUDY GUIDE 2026-2027
Edition | Complete Practice Examination 100%
Verified Answers with Detailed Rationales | High-
Yield Content
TABLE OF CONTENTS
Section Title Questions
I Cardiovascular System Disorders 35
II Respiratory System Disorders 30
III Gastrointestinal System Disorders 30
IV Neurological System Disorders 25
V Endocrine System Disorders 25
VI Renal & Urinary System Disorders 20
VII Musculoskeletal System Disorders 20
VIII Hematologic & Immune System Disorders 20
IX Integumentary System Disorders 15
X Perioperative & Critical Care 20
,2|Page
Section Title Questions
XI Fluid, Electrolyte & Acid-Base Balance 20
XII Pharmacology & Medication Management 25
XIII Clinical Case Vignettes 25
TOTAL 310 Questions
SECTION I: CARDIOVASCULAR SYSTEM DISORDERS
1. A nurse is assessing a client with heart failure. Which finding is
the earliest sign of left-sided heart failure?
A) Peripheral edema
B) Jugular venous distention
C) Dyspnea on exertion
D) Hepatomegaly
Answer: C) Dyspnea on exertion
Rationale: Dyspnea on exertion is the earliest sign of left-sided heart
failure due to pulmonary congestion from the left ventricle's inability to
pump blood forward. As left ventricular function declines, blood backs
up into the pulmonary circulation, causing dyspnea. Peripheral edema,
JVD, and hepatomegaly are signs of right-sided heart failure .
,3|Page
2. A client with angina pectoris is prescribed nitroglycerin
sublingual. Which instruction should the nurse include?
A) "Take one tablet every 5 minutes until pain subsides, up to three
doses"
B) "Swallow the tablet with a full glass of water"
C) "Store the tablets in a warm, moist environment"
D) "Take the medication only when pain is severe"
Answer: A) "Take one tablet every 5 minutes until pain subsides, up
to three doses"
Rationale: Nitroglycerin sublingual should be taken at the onset of chest
pain. If pain is not relieved after one tablet, the client should call 911
and take a second tablet. A third tablet may be taken after 5 minutes if
pain persists. The medication should be stored in a cool, dark place in
the original container and replaced every 6 months .
3. A nurse is caring for a client following a myocardial infarction.
Which laboratory value is most indicative of cardiac muscle
damage?
A) Creatine kinase-MB (CK-MB)
B) Troponin I
C) Myoglobin
D) C-reactive protein (CRP)
Answer: B) Troponin I
Rationale: Troponin I and troponin T are the most specific and sensitive
markers of cardiac muscle damage. Troponin levels begin to rise within
3-4 hours of myocardial injury, peak at 12-24 hours, and remain elevated
for up to 14 days. CK-MB rises within 3-6 hours and returns to normal
within 72 hours. Myoglobin is early but non-specific .
, 4|Page
4. A client with hypertension is prescribed a thiazide diuretic.
Which adverse effect should the nurse monitor?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypercalcemia
Answer: B) Hypokalemia
Rationale: Thiazide diuretics cause potassium wasting, leading to
hypokalemia. The nurse should monitor serum potassium levels and
assess for signs of hypokalemia (muscle weakness, fatigue, cardiac
dysrhythmias). Potassium supplements or potassium-sparing diuretics
may be prescribed. Thiazides can also cause hyponatremia,
hypercalcemia, and hyperglycemia .
5. A nurse is assessing a client with peripheral arterial disease
(PAD). Which finding is characteristic of PAD?
A) Bilateral lower extremity edema
B) Intermittent claudication
C) Brownish discoloration of the lower legs
D) Thickened, leathery skin
Answer: B) Intermittent claudication
Rationale: Intermittent claudication (muscle pain with exercise relieved
by rest) is a classic symptom of peripheral arterial disease caused by
atherosclerosis. PAD causes decreased blood flow to the extremities,
leading to pain with activity. Edema, brownish discoloration, and
leathery skin are characteristic of chronic venous insufficiency .
COMPREHENSIVE ATI MEDICAL-SURGICAL
PROCTORED EXAM STUDY GUIDE 2026-2027
Edition | Complete Practice Examination 100%
Verified Answers with Detailed Rationales | High-
Yield Content
TABLE OF CONTENTS
Section Title Questions
I Cardiovascular System Disorders 35
II Respiratory System Disorders 30
III Gastrointestinal System Disorders 30
IV Neurological System Disorders 25
V Endocrine System Disorders 25
VI Renal & Urinary System Disorders 20
VII Musculoskeletal System Disorders 20
VIII Hematologic & Immune System Disorders 20
IX Integumentary System Disorders 15
X Perioperative & Critical Care 20
,2|Page
Section Title Questions
XI Fluid, Electrolyte & Acid-Base Balance 20
XII Pharmacology & Medication Management 25
XIII Clinical Case Vignettes 25
TOTAL 310 Questions
SECTION I: CARDIOVASCULAR SYSTEM DISORDERS
1. A nurse is assessing a client with heart failure. Which finding is
the earliest sign of left-sided heart failure?
A) Peripheral edema
B) Jugular venous distention
C) Dyspnea on exertion
D) Hepatomegaly
Answer: C) Dyspnea on exertion
Rationale: Dyspnea on exertion is the earliest sign of left-sided heart
failure due to pulmonary congestion from the left ventricle's inability to
pump blood forward. As left ventricular function declines, blood backs
up into the pulmonary circulation, causing dyspnea. Peripheral edema,
JVD, and hepatomegaly are signs of right-sided heart failure .
,3|Page
2. A client with angina pectoris is prescribed nitroglycerin
sublingual. Which instruction should the nurse include?
A) "Take one tablet every 5 minutes until pain subsides, up to three
doses"
B) "Swallow the tablet with a full glass of water"
C) "Store the tablets in a warm, moist environment"
D) "Take the medication only when pain is severe"
Answer: A) "Take one tablet every 5 minutes until pain subsides, up
to three doses"
Rationale: Nitroglycerin sublingual should be taken at the onset of chest
pain. If pain is not relieved after one tablet, the client should call 911
and take a second tablet. A third tablet may be taken after 5 minutes if
pain persists. The medication should be stored in a cool, dark place in
the original container and replaced every 6 months .
3. A nurse is caring for a client following a myocardial infarction.
Which laboratory value is most indicative of cardiac muscle
damage?
A) Creatine kinase-MB (CK-MB)
B) Troponin I
C) Myoglobin
D) C-reactive protein (CRP)
Answer: B) Troponin I
Rationale: Troponin I and troponin T are the most specific and sensitive
markers of cardiac muscle damage. Troponin levels begin to rise within
3-4 hours of myocardial injury, peak at 12-24 hours, and remain elevated
for up to 14 days. CK-MB rises within 3-6 hours and returns to normal
within 72 hours. Myoglobin is early but non-specific .
, 4|Page
4. A client with hypertension is prescribed a thiazide diuretic.
Which adverse effect should the nurse monitor?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypercalcemia
Answer: B) Hypokalemia
Rationale: Thiazide diuretics cause potassium wasting, leading to
hypokalemia. The nurse should monitor serum potassium levels and
assess for signs of hypokalemia (muscle weakness, fatigue, cardiac
dysrhythmias). Potassium supplements or potassium-sparing diuretics
may be prescribed. Thiazides can also cause hyponatremia,
hypercalcemia, and hyperglycemia .
5. A nurse is assessing a client with peripheral arterial disease
(PAD). Which finding is characteristic of PAD?
A) Bilateral lower extremity edema
B) Intermittent claudication
C) Brownish discoloration of the lower legs
D) Thickened, leathery skin
Answer: B) Intermittent claudication
Rationale: Intermittent claudication (muscle pain with exercise relieved
by rest) is a classic symptom of peripheral arterial disease caused by
atherosclerosis. PAD causes decreased blood flow to the extremities,
leading to pain with activity. Edema, brownish discoloration, and
leathery skin are characteristic of chronic venous insufficiency .
