ATI RN Adult Medical Surgical Exam 2026

Explanation

Correct Answer: B) Acute myocardial infarction

The combination of chest tightness radiating to the left arm, diaphoresis, shortness of breath, irregular tachycardic heart rate, and cool skin are all classic hallmark signs of acute myocardial infarction (MI). These findings collectively indicate that the myocardium is not receiving adequate oxygen, triggering sympathetic nervous system activation and reduced cardiac output. The nurse must act immediately by obtaining a 12-lead ECG within 10 minutes, establishing IV access, administering oxygen, and notifying the provider — following the standard MONA protocol (Morphine, Oxygen, Nitroglycerin, Aspirin) as prescribed.

Correct Answer D: Pedal pulses +1

Explanation of the Correct Answer:

A +1 pedal pulse is weak and may indicate compromised circulation, especially concerning in a client with bilateral leg casts. This requires prompt neurovascular assessment and possible intervention to prevent complications like compartment syndrome or ischemia.

Why the Other Options Are Incorrect:

A. Feet warm to the touch

This is a normal finding indicating adequate perfusion and is reassuring.

B. Oral temperature 37.8° C (100° F)

This is a low-grade temperature, which can be expected with limited mobility. It does not necessarily indicate infection or need for immediate intervention.

C. Client can wiggle their toes

This indicates preserved motor function, which is a positive finding and does not require intervention.

Correct Answer C: Calcium 9.6 mg/dL (9 to 10.5 mg/dL)

Explanation of the Correct Answer:

Hypoparathyroidism results in low levels of parathyroid hormone (PTH), which causes hypocalcemia. The goal of treatment is to normalize serum calcium levels, typically through calcium and vitamin D supplementation. A calcium level of 9.6 mg/dL is within the normal range, indicating that the treatment is effective.

Why the Other Options Are Incorrect:

A. Potassium 4.3 mEq/L

This is a normal potassium level, but potassium is not directly affected by hypoparathyroidism, so it does not indicate treatment effectiveness.

B. Sodium 142 mEq/L

Sodium levels are unrelated to the primary concern in hypoparathyroidism and do not reflect treatment response.

D. Glucose 96 mg/dL

This is a normal glucose level but is not relevant to evaluating treatment for hypoparathyroidism.

Explanation:

Correct Answer: (D) Vanilla pudding Trigeminal neuralgia causes severe facial pain triggered by stimuli such as temperature extremes, chewing, or facial movement. Vanilla pudding is soft, requires minimal chewing, and is served at room temperature, making it the least likely to trigger pain episodes.

Why Other Options are Incorrect:

• A. Ice cream is extremely cold, and temperature extremes are a well-known trigger for trigeminal neuralgia pain. Cold foods should be avoided.
• B. Vegetable soup is typically served hot, and heat can also trigger trigeminal neuralgia episodes. Temperature extremes in either direction should be avoided.
• C. Graham crackers are hard and crunchy, requiring significant chewing and jaw movement, which are common triggers for trigeminal neuralgia pain.

Correct Answers:

Use of a loop diuretic, Chronic infections of the middle ear, Perforation of the eardrum

Explanation:

Use of a loop diuretic is a valid risk factor for hearing loss. Medications like furosemide can cause ototoxicity by disrupting the fluid and electrolyte balance in the inner ear, especially when given in high doses or intravenously at a fast rate. This can result in temporary or permanent sensorineural hearing loss.

Chronic infections of the middle ear (chronic otitis media) contribute to hearing loss by damaging the tympanic membrane or ossicles. Persistent inflammation can interfere with the transmission of sound and result in long-term conductive hearing impairment.

Perforation of the eardrum interrupts the normal pathway of sound waves, reducing hearing ability. A perforated tympanic membrane may also lead to recurrent infections, further compounding the risk of permanent hearing loss.

Why Other Options Are Wrong:

Born with a high birth weight is not associated with hearing loss. In fact, low birth weight and prematurity are the actual neonatal risk factors because of increased susceptibility to hypoxia, infection, or exposure to ototoxic medications in neonatal care. High birth weight does not adversely affect auditory development.

Frequent exposure to low-volume noise is not harmful to hearing. Damage to the auditory system occurs with prolonged or repeated exposure to high-decibel sounds (e.g., loud music, industrial machinery, gunfire). Low-volume noise does not cause trauma to the hair cells of the cochlea or impair hearing.

Correct Answer:

Urinary output of 250 mL over past 12 hr

Explanation:

Urine output is a critical indicator of kidney perfusion and fluid balance. A postoperative client should have a urine output of at least 30 mL/hr, totaling a minimum of 360 mL over 12 hours. A urine output of only 250 mL in that time frame suggests inadequate kidney perfusion, possibly due to hypovolemia, acute kidney injury, or circulatory compromise. This is a priority concern that should be reported to the healthcare provider promptly for assessment and intervention.

Why the Other Options Are Incorrect:

150 mL of greenish yellow NG drainage

This is an expected finding after abdominal surgery. The NG tube typically drains gastric and bile secretions that may appear greenish-yellow. Unless the volume is excessive or accompanied by signs of infection or obstruction, this does not require immediate provider notification.

Client requests medication for nausea

Nausea is a common postoperative symptom due to anesthesia, opioid use, or slowed GI motility. While it should be addressed with antiemetics for comfort and to prevent vomiting, it is not a priority safety concern requiring urgent provider contact.

Hypoactive bowel sounds

This is a normal finding in the early postoperative period, especially after abdominal surgery. Anesthesia and surgical manipulation often lead to temporary reduced bowel motility. Continued monitoring is appropriate unless signs of ileus or bowel obstruction develop.

Conclusion:

Low urine output is the most urgent and clinically significant finding and must be reported to prevent further complications.

Explanation:

Correct Answer: B) Infection The client's WBC count is below the normal range of 5,000 to 10,000/mm³ at both time points and continues to decline. In a client with HIV-1, a falling WBC count reflects progressive destruction of CD4+ T lymphocytes and worsening immunosuppression. This places the client at increasing risk for opportunistic infections — the leading cause of morbidity and mortality in clients with HIV. Infection is therefore the priority risk supported by both the medical history and the trending laboratory data.

Why Other Options are Incorrect:

• A) The client's platelet count shows only a minimal decline from 164,000 to 162,000/mm³ and remains within the normal range of 150,000 to 400,000/mm³ at both time points. There is no current laboratory evidence to support bleeding as the priority risk.
• C) The client's BUN remains within the normal range of 10 to 20 mg/dL at both visits — 16 mg/dL at diagnosis and 18 mg/dL at 3 months. There is no indication of declining renal function in the available data, making renal failure a low-priority concern at this time.
• D) The client's sodium and potassium levels remain within or at the lower limit of normal at both time points. While potassium has decreased to 3.5 mEq/L — the minimum of the normal range — this value alone does not indicate an immediate risk for dysrhythmias and is not the priority concern compared to the consistently abnormal and declining WBC count.

A nurse is planning care for a client who is experiencing seizures secondary to meningitis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

A) Place a tongue blade at the bedside.

B) Dim the overhead lights.

C) Assist the client to ambulate every 4 hr.

D) Apply a warming blanket.

E) Have suction equipment at the bedside.

Explanation:

Correct Answers: B) Dim the overhead lights, E) Have suction equipment at the bedside. Dimming overhead lights reduces environmental stimulation, which is essential for clients with meningitis as photophobia (sensitivity to light) is a hallmark symptom. Reducing light stimulation also minimizes the risk of triggering seizures. Suction equipment must be kept at the bedside at all times for clients experiencing seizures to maintain airway patency and prevent aspiration of secretions during or after a seizure episode.

Why Other Options are Incorrect:

• A) Placing a tongue blade at the bedside is an outdated and dangerous practice. Inserting any object into the mouth during a seizure can cause oral trauma, broken teeth, and airway obstruction. Current seizure safety guidelines strictly prohibit placing anything in the mouth of a seizing client.
• C) Ambulating the client every 4 hours is contraindicated for a client actively experiencing seizures. Ambulation poses a serious fall and injury risk. The client must remain in bed with padded side rails up during the acute seizure phase.
• D) Applying a warming blanket is not indicated for seizures secondary to meningitis. Meningitis is commonly associated with fever, and applying a warming blanket would increase body temperature, potentially worsening the condition and increasing seizure risk.

Correct Answer:

"I will take my iron supplement 1 hour before a meal."

"I should increase green leafy vegetables in my diet."

"The iron supplement might cause my stools to be black."

Explanation:

Taking the iron supplement on an empty stomach (about 1 hour before a meal) is the best way to maximize absorption. Food can interfere with iron absorption, so taking the supplement away from meals ensures more effective results. However, if stomach upset occurs, the supplement can be taken with food, but ideally, it should be taken on an empty stomach.

Increasing green leafy vegetables in the diet is also an excellent strategy to improve iron intake. These vegetables are rich in non-heme iron, which is important for individuals who may not consume animal products that provide heme iron. Iron-rich foods such as spinach, kale, and broccoli are good dietary additions.

The statement about black stools is correct as well. Iron supplements commonly cause dark, greenish-black stools due to unabsorbed iron. This is a harmless side effect, but it is important for clients to be aware of it to prevent confusion with gastrointestinal bleeding.

Why Other Options Are Wrong:

"I should expect to have swelling in my feet."

This is incorrect because swelling in the feet is not a common side effect of iron supplementation. Swelling (peripheral edema) could indicate other conditions, such as heart failure or fluid overload, and should not be attributed to iron therapy. If swelling occurs, the client should report it to the healthcare provider for further evaluation.

"The iron supplement might cause ringing in my ears."

This is incorrect because ringing in the ears (tinnitus) is not a typical side effect of iron supplementation. Tinnitus may be caused by other factors, such as certain medications or ear issues, but it is not associated with iron therapy. If a client experiences tinnitus, it should be reported, as it is unrelated to iron supplementation.