ATI MEDICAL-SURGICAL PROCTORED EXAM
2026/2027 Edition | 100 Verified Questions
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ATI Nursing Education Medical-Surgical Assessment
Comprehensive Adult Medical-Surgical Questions & Verified Answers with Rationales
Updated Per Latest NGN & ATI Guidelines | Graded A+
Key Features
✓ Comprehensive adult medical-surgical nursing across all major body systems
✓ Next Generation NCLEX (NGN) clinical judgment measurement model application
✓ Advanced pharmacological interventions and safe medication administration
✓ Complex patient care management and clinical prioritization
✓ Evidence-based patient education and discharge planning
Updates for 2026
• Full integration of the NCSBN Clinical Judgment Measurement Model (CJMM) in all ATI
case studies: The 2026 ATI curriculum fully embeds the CJMM framework requiring candidates to
recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate
outcomes across all medical-surgical case studies.
• Updated 2026 National Patient Safety Goals (NPSGs) for high-alert medications and fall
prevention: The Joint Commission has revised NPSGs to include enhanced protocols for
anticoagulant safety, insulin administration verification, and fall risk assessment tools specifically
adapted for medical-surgical units.
• Revised clinical reasoning frameworks for managing complex, multi-system adult patient
scenarios: ATI has updated its clinical reasoning case studies to reflect current evidence-based
standards for sepsis management, stroke protocols, and multi-organ dysfunction prioritization
using the latest Surviving Sepsis Campaign guidelines.
Abstract
This actual exam document provides a rigorous, evidence-based assessment of comprehensive
medical-surgical nursing knowledge aligned with the 2026/2027 ATI Nursing Education curriculum
and Next Generation NCLEX (NGN) standards. The 100 questions span five critical content
domains: cardiovascular and respiratory disorders, neurological and musculoskeletal conditions,
gastrointestinal and renal or urinary disorders, endocrine and hematology disorders, and integrated
clinical concepts with NGN case studies. Each question reinforces clinical judgment competencies
,including the ability to recognize and analyze clinical cues, prioritize patient needs, generate
evidence-based solutions, and evaluate outcomes. The format mirrors NGN-style clinical judgment
scenarios and ATI proctored examination questions, promoting critical thinking, safe patient-
centered care, and NCLEX readiness.
Keywords
ATI Medical-Surgical, Proctored Exam, NGN, Clinical Judgment, Med-Surg, Pharmacology, Patient
Safety, Acute Care, NCLEX Readiness, Evidence-Based Standards
Answer Format
Each question presents four answer options (A through D). The correct answer is displayed in bold
with a [Correct] marker. Following the options, a detailed Rationale explains the clinical
reasoning. A Why Wrong section provides distractor explanations. A Reference cites the relevant
ATI textbook chapter, NGN case study, or clinical guideline.
Content Area Overview
Content Area Questions Key Topics Weight
Cardiovascular & Respiratory 20 Heart failure, MI, dysrhythmias, 20%
Disorders COPD, pneumonia, asthma, HTN,
atherosclerosis, thrombophlebitis
Neurological & Musculoskeletal 20 Stroke, seizures, TBI, spinal cord 20%
Conditions injury, MS, Parkinson, fractures,
osteoporosis, joint replacement
Gastrointestinal & Renal/Urinary 20 GI bleeding, bowel obstruction, 20%
Disorders cirrhosis, pancreatitis, AKI, CKD, UTI,
nephrolithiasis, dialysis
Endocrine & Hematology 20 DM, DKA, thyroid disorders, adrenal 20%
Disorders crisis, anemia, leukemia, coagulation
disorders, blood transfusion
Integrated Clinical Concepts & 20 Sepsis, shock, perioperative care, 20%
NGN Cases fluid/electrolyte imbalances, trauma,
prioritization, delegation
,Examination Questions
Domain 1: Cardiovascular & Respiratory Disorders (Q1–Q20)
Q1. A nurse is reviewing the medical record of a client admitted with left-sided heart
failure. Which of the following findings should the nurse identify as an expected
manifestation?
A) Crackles in the lung fields [Correct]
B) Dependent peripheral edema
C) Jugular venous distention
D) Hepatomegaly
Correct Answer: A
Rationale: Left-sided heart failure impairs the left ventricle's ability to pump blood forward, causing
blood to back up into the pulmonary circulation. This pulmonary congestion leads to crackles
auscultated in the lung fields, dyspnea, orthopnea, and a productive cough with frothy sputum. These
respiratory manifestations are the hallmark of left-sided heart failure and should be identified early to
guide evidence-based standards of care. The nurse should monitor lung sounds frequently and elevate
the head of the bed to promote oxygenation.
Why Wrong: B is incorrect because Dependent peripheral edema is a manifestation of right-sided
heart failure due to systemic venous congestion, not left-sided failure. | C is incorrect because Jugular
venous distention results from increased right atrial pressure associated with right-sided heart failure,
not left-sided failure. | D is incorrect because Hepatomegaly is caused by congestion in the hepatic
veins secondary to right-sided heart failure and is not an expected finding in left-sided heart failure.
Reference: ATI Medical-Surgical Nursing Review Module (2026 Ed.), Ch. 12
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Q2. A nurse is caring for a client who has right-sided heart failure. Which of the following
findings should the nurse expect?
A) Pulmonary crackles
B) Weight loss
C) Increased urinary output
D) Distended neck veins [Correct]
Correct Answer: D
Rationale: Right-sided heart failure causes blood to back up from the right ventricle into the
systemic venous circulation, leading to jugular venous distention, dependent peripheral edema, and
hepatosplenomegaly. Distended neck veins are a classic sign of systemic venous congestion and
should be assessed with the client seated at a 30- to 45-degree angle. Monitoring these findings aligns
with clinical standards for heart failure management. The nurse should also assess for ascites and
anorexia as part of a comprehensive evaluation.
Why Wrong: A is incorrect because Pulmonary crackles are associated with left-sided heart failure
from pulmonary congestion and are not an expected finding in right-sided heart failure. | B is
incorrect because Weight gain, not weight loss, is expected due to fluid retention and sodium
reabsorption in right-sided heart failure. | C is incorrect because Decreased, not increased, urinary
output occurs because reduced cardiac output impairs renal perfusion and triggers fluid retention.
Reference: Lewis Medical-Surgical Nursing 11th Ed., Ch. 30
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Q3. A nurse in an emergency department is caring for a client who has acute
decompensated heart failure (ADHF) with severe dyspnea. Which of the following
interventions should the nurse implement first?
A) Administer IV furosemide as prescribed
, B) Obtain a 12-lead electrocardiogram
C) Place the client in high-Fowler's position [Correct]
D) Prepare the client for intubation
Correct Answer: C
Rationale: The priority intervention for a client in ADHF is to improve oxygenation and reduce
respiratory distress. Placing the client in high-Fowler's position decreases venous return, reduces
preload, and facilitates diaphragmatic movement, which immediately relieves dyspnea. This
intervention follows evidence-based standards for the initial management of ADHF and addresses the
most life-threatening concern first. Following positioning, the nurse should then proceed with
medication administration and further diagnostics.
Why Wrong: A is incorrect because Although IV furosemide is a critical pharmacologic intervention,
positioning should precede medication administration to rapidly improve respiratory status. | B is
incorrect because A 12-lead ECG is important for diagnosis but does not take priority over immediate
oxygenation in a client with severe dyspnea. | D is incorrect because Intubation may be necessary if
the client does not respond to initial interventions but is not the first action; less invasive measures
are attempted first.
Reference: AHA Guidelines for the Management of Heart Failure, 2024 Update
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Q4. A nurse is evaluating a client who is receiving digoxin for heart failure. Which of the
following findings should the nurse identify as an indication of digoxin toxicity?
A) Heart rate of 62 bpm
B) Blurred vision and yellow-tinged vision [Correct]
C) Blood pressure of 118/76 mm Hg
D) Increased urine output
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index, and toxicity can manifest with visual
disturbances such as blurred vision, yellow-tinged vision (xanthopsia), and photophobia.
Gastrointestinal symptoms including nausea, vomiting, and anorexia are also early indicators of
toxicity. The nurse should monitor serum digoxin levels and hold the medication if toxicity is
suspected, consistent with proven methodologies in pharmacological management. Cardiac
manifestations include dysrhythmias such as premature ventricular contractions and heart block.
Why Wrong: A is incorrect because A heart rate of 62 bpm is within normal range and does not
indicate toxicity; bradycardia below 60 bpm or new-onset dysrhythmias would be more concerning. |
B is incorrect because | C is incorrect because A blood pressure of 118/76 mm Hg is a normal finding
and is not related to digoxin toxicity. | D is incorrect because Increased urine output is an expected
therapeutic effect of digoxin due to improved cardiac output, not a sign of toxicity.
Reference: ATI Medical-Surgical Nursing Review Module (2026 Ed.), Ch. 12
────────────────────────────────────────────────────────────
Q5. A nurse is reviewing laboratory results for a client who is being evaluated for a
myocardial infarction. The nurse should understand that which of the following cardiac
biomarkers is most specific to myocardial injury?
A) Creatine kinase-MB (CK-MB)
B) Myoglobin
C) Troponin I [Correct]
D) C-reactive protein (CRP)
Correct Answer: C
Rationale: Troponin I is the most specific and sensitive cardiac biomarker for detecting myocardial
injury and is the gold standard for diagnosing both STEMI and NSTEMI according to current clinical
2026/2027 Edition | 100 Verified Questions
────────────────────────────────────────
ATI Nursing Education Medical-Surgical Assessment
Comprehensive Adult Medical-Surgical Questions & Verified Answers with Rationales
Updated Per Latest NGN & ATI Guidelines | Graded A+
Key Features
✓ Comprehensive adult medical-surgical nursing across all major body systems
✓ Next Generation NCLEX (NGN) clinical judgment measurement model application
✓ Advanced pharmacological interventions and safe medication administration
✓ Complex patient care management and clinical prioritization
✓ Evidence-based patient education and discharge planning
Updates for 2026
• Full integration of the NCSBN Clinical Judgment Measurement Model (CJMM) in all ATI
case studies: The 2026 ATI curriculum fully embeds the CJMM framework requiring candidates to
recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate
outcomes across all medical-surgical case studies.
• Updated 2026 National Patient Safety Goals (NPSGs) for high-alert medications and fall
prevention: The Joint Commission has revised NPSGs to include enhanced protocols for
anticoagulant safety, insulin administration verification, and fall risk assessment tools specifically
adapted for medical-surgical units.
• Revised clinical reasoning frameworks for managing complex, multi-system adult patient
scenarios: ATI has updated its clinical reasoning case studies to reflect current evidence-based
standards for sepsis management, stroke protocols, and multi-organ dysfunction prioritization
using the latest Surviving Sepsis Campaign guidelines.
Abstract
This actual exam document provides a rigorous, evidence-based assessment of comprehensive
medical-surgical nursing knowledge aligned with the 2026/2027 ATI Nursing Education curriculum
and Next Generation NCLEX (NGN) standards. The 100 questions span five critical content
domains: cardiovascular and respiratory disorders, neurological and musculoskeletal conditions,
gastrointestinal and renal or urinary disorders, endocrine and hematology disorders, and integrated
clinical concepts with NGN case studies. Each question reinforces clinical judgment competencies
,including the ability to recognize and analyze clinical cues, prioritize patient needs, generate
evidence-based solutions, and evaluate outcomes. The format mirrors NGN-style clinical judgment
scenarios and ATI proctored examination questions, promoting critical thinking, safe patient-
centered care, and NCLEX readiness.
Keywords
ATI Medical-Surgical, Proctored Exam, NGN, Clinical Judgment, Med-Surg, Pharmacology, Patient
Safety, Acute Care, NCLEX Readiness, Evidence-Based Standards
Answer Format
Each question presents four answer options (A through D). The correct answer is displayed in bold
with a [Correct] marker. Following the options, a detailed Rationale explains the clinical
reasoning. A Why Wrong section provides distractor explanations. A Reference cites the relevant
ATI textbook chapter, NGN case study, or clinical guideline.
Content Area Overview
Content Area Questions Key Topics Weight
Cardiovascular & Respiratory 20 Heart failure, MI, dysrhythmias, 20%
Disorders COPD, pneumonia, asthma, HTN,
atherosclerosis, thrombophlebitis
Neurological & Musculoskeletal 20 Stroke, seizures, TBI, spinal cord 20%
Conditions injury, MS, Parkinson, fractures,
osteoporosis, joint replacement
Gastrointestinal & Renal/Urinary 20 GI bleeding, bowel obstruction, 20%
Disorders cirrhosis, pancreatitis, AKI, CKD, UTI,
nephrolithiasis, dialysis
Endocrine & Hematology 20 DM, DKA, thyroid disorders, adrenal 20%
Disorders crisis, anemia, leukemia, coagulation
disorders, blood transfusion
Integrated Clinical Concepts & 20 Sepsis, shock, perioperative care, 20%
NGN Cases fluid/electrolyte imbalances, trauma,
prioritization, delegation
,Examination Questions
Domain 1: Cardiovascular & Respiratory Disorders (Q1–Q20)
Q1. A nurse is reviewing the medical record of a client admitted with left-sided heart
failure. Which of the following findings should the nurse identify as an expected
manifestation?
A) Crackles in the lung fields [Correct]
B) Dependent peripheral edema
C) Jugular venous distention
D) Hepatomegaly
Correct Answer: A
Rationale: Left-sided heart failure impairs the left ventricle's ability to pump blood forward, causing
blood to back up into the pulmonary circulation. This pulmonary congestion leads to crackles
auscultated in the lung fields, dyspnea, orthopnea, and a productive cough with frothy sputum. These
respiratory manifestations are the hallmark of left-sided heart failure and should be identified early to
guide evidence-based standards of care. The nurse should monitor lung sounds frequently and elevate
the head of the bed to promote oxygenation.
Why Wrong: B is incorrect because Dependent peripheral edema is a manifestation of right-sided
heart failure due to systemic venous congestion, not left-sided failure. | C is incorrect because Jugular
venous distention results from increased right atrial pressure associated with right-sided heart failure,
not left-sided failure. | D is incorrect because Hepatomegaly is caused by congestion in the hepatic
veins secondary to right-sided heart failure and is not an expected finding in left-sided heart failure.
Reference: ATI Medical-Surgical Nursing Review Module (2026 Ed.), Ch. 12
────────────────────────────────────────────────────────────
Q2. A nurse is caring for a client who has right-sided heart failure. Which of the following
findings should the nurse expect?
A) Pulmonary crackles
B) Weight loss
C) Increased urinary output
D) Distended neck veins [Correct]
Correct Answer: D
Rationale: Right-sided heart failure causes blood to back up from the right ventricle into the
systemic venous circulation, leading to jugular venous distention, dependent peripheral edema, and
hepatosplenomegaly. Distended neck veins are a classic sign of systemic venous congestion and
should be assessed with the client seated at a 30- to 45-degree angle. Monitoring these findings aligns
with clinical standards for heart failure management. The nurse should also assess for ascites and
anorexia as part of a comprehensive evaluation.
Why Wrong: A is incorrect because Pulmonary crackles are associated with left-sided heart failure
from pulmonary congestion and are not an expected finding in right-sided heart failure. | B is
incorrect because Weight gain, not weight loss, is expected due to fluid retention and sodium
reabsorption in right-sided heart failure. | C is incorrect because Decreased, not increased, urinary
output occurs because reduced cardiac output impairs renal perfusion and triggers fluid retention.
Reference: Lewis Medical-Surgical Nursing 11th Ed., Ch. 30
────────────────────────────────────────────────────────────
Q3. A nurse in an emergency department is caring for a client who has acute
decompensated heart failure (ADHF) with severe dyspnea. Which of the following
interventions should the nurse implement first?
A) Administer IV furosemide as prescribed
, B) Obtain a 12-lead electrocardiogram
C) Place the client in high-Fowler's position [Correct]
D) Prepare the client for intubation
Correct Answer: C
Rationale: The priority intervention for a client in ADHF is to improve oxygenation and reduce
respiratory distress. Placing the client in high-Fowler's position decreases venous return, reduces
preload, and facilitates diaphragmatic movement, which immediately relieves dyspnea. This
intervention follows evidence-based standards for the initial management of ADHF and addresses the
most life-threatening concern first. Following positioning, the nurse should then proceed with
medication administration and further diagnostics.
Why Wrong: A is incorrect because Although IV furosemide is a critical pharmacologic intervention,
positioning should precede medication administration to rapidly improve respiratory status. | B is
incorrect because A 12-lead ECG is important for diagnosis but does not take priority over immediate
oxygenation in a client with severe dyspnea. | D is incorrect because Intubation may be necessary if
the client does not respond to initial interventions but is not the first action; less invasive measures
are attempted first.
Reference: AHA Guidelines for the Management of Heart Failure, 2024 Update
────────────────────────────────────────────────────────────
Q4. A nurse is evaluating a client who is receiving digoxin for heart failure. Which of the
following findings should the nurse identify as an indication of digoxin toxicity?
A) Heart rate of 62 bpm
B) Blurred vision and yellow-tinged vision [Correct]
C) Blood pressure of 118/76 mm Hg
D) Increased urine output
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index, and toxicity can manifest with visual
disturbances such as blurred vision, yellow-tinged vision (xanthopsia), and photophobia.
Gastrointestinal symptoms including nausea, vomiting, and anorexia are also early indicators of
toxicity. The nurse should monitor serum digoxin levels and hold the medication if toxicity is
suspected, consistent with proven methodologies in pharmacological management. Cardiac
manifestations include dysrhythmias such as premature ventricular contractions and heart block.
Why Wrong: A is incorrect because A heart rate of 62 bpm is within normal range and does not
indicate toxicity; bradycardia below 60 bpm or new-onset dysrhythmias would be more concerning. |
B is incorrect because | C is incorrect because A blood pressure of 118/76 mm Hg is a normal finding
and is not related to digoxin toxicity. | D is incorrect because Increased urine output is an expected
therapeutic effect of digoxin due to improved cardiac output, not a sign of toxicity.
Reference: ATI Medical-Surgical Nursing Review Module (2026 Ed.), Ch. 12
────────────────────────────────────────────────────────────
Q5. A nurse is reviewing laboratory results for a client who is being evaluated for a
myocardial infarction. The nurse should understand that which of the following cardiac
biomarkers is most specific to myocardial injury?
A) Creatine kinase-MB (CK-MB)
B) Myoglobin
C) Troponin I [Correct]
D) C-reactive protein (CRP)
Correct Answer: C
Rationale: Troponin I is the most specific and sensitive cardiac biomarker for detecting myocardial
injury and is the gold standard for diagnosing both STEMI and NSTEMI according to current clinical
