ATI RN Adult Medical Surgical Exam 2026
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Free ATI RN Adult Medical Surgical Exam 2026 Questions
A nurse is teaching a group of young adult clients about risk factors for hearing loss. Which of the following factors should the nurse include in the teaching
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Born with a high birth weight
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Frequent exposure to low-volume noise
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Use of a loop diuretic
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Chronic infections of the middle ear
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Perforation of the eardrum
Explanation
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.
A nurse is evaluating a postoperative client for progression of shock. Which of the following findings indicate the client is entering the progressive stage of shock? (Select all that apply)
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Decreased urine output
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Decreased oxygen saturation
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Altered mental status
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Increased hemoglobin level
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Stable blood pressure
Explanation
Correct Answer: A) Decreased urine output, B) Decreased oxygen saturation, C) Altered mental status
In the progressive stage of shock, tissue perfusion worsens, leading to organ dysfunction. Decreased urine output reflects reduced kidney perfusion. Lower oxygen saturation indicates impaired gas exchange and worsening hypoxia. Altered mental status occurs due to decreased cerebral perfusion and oxygen delivery to the brain.
Hemoglobin does not increase in this stage; it may decrease due to dilution or bleeding. Blood pressure is typically unstable or decreasing, not stable, as shock progresses.
A nurse is caring for a client who is receiving potassium chloride 40 mEq IV every 4 hr. Which of the following findings indicate the client is becoming hyperkalemic
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Hypoactive bowel sounds
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Shallow respirations
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Irritability and anxiety
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Sinus rhythm with peaked T waves
Explanation
Correct Answer:
Sinus rhythm with peaked T waves
Explanation:
This is correct. Peaked T waves are a classic and early sign of hyperkalemia, particularly when potassium levels rise in the blood. As potassium increases, it affects the electrical activity of the heart, resulting in tall, narrow, and sharply pointed T waves on an electrocardiogram (ECG). If left untreated, hyperkalemia can lead to more severe arrhythmias, so recognizing these ECG changes early is essential to prevent life-threatening consequences.
Why Other Options Are Wrong:
"Hypoactive bowel sounds"
This is incorrect because hyperkalemia typically causes hyperactive bowel sounds and diarrhea due to the increased smooth muscle activity in the gastrointestinal tract. Hypoactive bowel sounds are more commonly associated with hypokalemia or other conditions that slow down gastrointestinal motility.
"Shallow respirations"
This is incorrect because shallow respirations are more commonly seen with hypokalemia, where the deficiency in potassium can lead to muscle weakness, including the respiratory muscles. In hyperkalemia, shallow respirations are not a primary symptom; however, severe cases may lead to respiratory distress due to muscle weakness.
"Irritability and anxiety"
This is incorrect because while irritability and anxiety can occur with various electrolyte imbalances, they are nonspecific and not strong indicators of hyperkalemia. The more definitive signs of hyperkalemia are related to the cardiac system (such as the ECG changes mentioned) and muscle function (e.g., weakness, paresthesias). Irritability and anxiety are not hallmark symptoms for hyperkalemia.
A nurse is caring for a client diagnosed with diabetic ketoacidosis (DKA). Which of the following represents the correct order of initial treatment priority?
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Administer IV insulin, then replace potassium
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Administer IV fluids, then start IV insulin infusion once potassium is confirmed above 3.3 mEq/L
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Replace potassium, then administer subcutaneous insulin
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Start IV insulin infusion, then initiate IV fluid resuscitation
Explanation
Correct Answer: B) Administer IV fluids, then start IV insulin infusion once potassium is confirmed above 3.3 mEq/L
The correct sequence of DKA management follows a strict, evidence-based order. IV fluid resuscitation with 0.9% sodium chloride must always be initiated first to correct the severe dehydration caused by osmotic diuresis, restore intravascular volume, and improve renal perfusion. Only after fluid resuscitation is underway and potassium levels are confirmed to be at least 3.3 mEq/L should continuous IV insulin infusion be started via a DKA protocol.
This sequencing is critical because starting insulin before correcting potassium levels is dangerous — insulin drives potassium into cells, which can rapidly precipitate life-threatening hypokalemia and fatal cardiac arrhythmias. Therefore, potassium must always be checked and corrected before insulin is initiated.
Administering insulin before fluids is incorrect and dangerous, as it worsens hypokalemia and can cause cardiovascular collapse. Subcutaneous insulin is never appropriate for active DKA — only continuous IV infusion allows for the precise titration needed to safely manage the condition. Starting insulin before confirming adequate potassium levels places the client at immediate risk for cardiac arrest.
A home health nurse is planning to use nonpharmacological pain relief measures for a client who has severe chronic back pain. Which of the following pain management guidelines should the nurse use
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Use imagery with clients who have difficulty with focus and concentration.
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Discontinue opioids before trying nonpharmacological methods of pain relief.
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Distraction changes the client's perception of pain, but it does not affect the cause.
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Pain relief from the use of heat and cold continues for several hours after removal of the stimulus.
Explanation
Correct Answer:
Distraction changes the client's perception of pain, but it does not affect the cause.
Explanation:
Distraction is a nonpharmacological pain management strategy that works by diverting the client's attention from the pain. It alters the way the brain processes pain signals, effectively reducing the perception of pain and providing emotional relief. However, distraction does not address the underlying physical cause of the pain. This makes it particularly useful for managing chronic or acute pain where full pain elimination might not be possible, but improving comfort and coping is a key goal.
Why Other Options Are Incorrect:
Use imagery with clients who have difficulty with focus and concentration is incorrect because imagery requires focus and concentration. For clients who struggle with focus, techniques that do not demand mental concentration (like simpler distraction methods) might be more effective.
Discontinue opioids before trying nonpharmacological methods of pain relief is incorrect. Opioids and nonpharmacological methods can be used together to enhance pain control. Stopping opioids before trying nonpharmacological techniques is unnecessary and may compromise pain management. The goal is often to reduce reliance on opioids, not eliminate them abruptly.
Pain relief from the use of heat and cold continues for several hours after removal of the stimulus is incorrect because the pain-relieving effects of heat and cold therapy are usually temporary. Once the stimulus is removed, the pain relief typically lasts only for a short time (from minutes to an hour), as the body returns to its normal state.
Summary:
The correct answer is distraction, which modifies the client's perception of pain but does not impact its cause. The other options either misunderstand how certain techniques work, recommend inappropriate actions, or inaccurately describe the duration of therapeutic effects.
A nurse is caring for a client who has diabetes mellitus and has been following a treatment plan for 3 months. Which of the following laboratory results should the nurse monitor to determine long-term glycemic control?
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Glycosylated hemoglobin level
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Oral glucose tolerance test results
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Fasting blood glucose level
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Postprandial blood glucose level
Explanation
Explanation:
Correct Answer: (A) Glycosylated hemoglobin level The glycosylated hemoglobin (HbA1c) reflects the average blood glucose level over the preceding 2 to 3 months by measuring the percentage of hemoglobin with attached glucose molecules. It is the gold standard laboratory test for evaluating long-term glycemic control in clients with diabetes mellitus. A target HbA1c of less than 7% is generally recommended for most diabetic clients.
Why Other Options are Incorrect:
- B. The oral glucose tolerance test is used primarily to diagnose diabetes mellitus or gestational diabetes. It is not used to monitor ongoing long-term glycemic control.
- C. Fasting blood glucose reflects glucose levels at a single point in time after an overnight fast. It does not provide information about long-term glucose trends or overall glycemic management.
- D. Postprandial blood glucose measures glucose levels after a meal at a single point in time. While useful for adjusting meal-time insulin, it does not reflect long-term glycemic control over months.
A nurse is preparing to administer medications to a client who has hyperthyroidism. Which of the following prescriptions should the nurse verify with the provider
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A prescription for propylthiouracil
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A prescription for propranolol
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A prescription for levothyroxine
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A prescription for methimazole
Explanation
Correct Answer C: A prescription for levothyroxine
Explanation of the Correct Answer:
Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism, not hyperthyroidism. Administering this medication to a client with hyperthyroidism would worsen the condition by increasing thyroid hormone levels. Therefore, the nurse should verify this prescription with the provider.
Why the Other Options Are Incorrect:
A. A prescription for propylthiouracil
Propylthiouracil is an antithyroid medication used to reduce the production of thyroid hormones in clients with hyperthyroidism. It is appropriate for this condition.
B. A prescription for propranolol
Propranolol is a beta-blocker that helps manage symptoms of hyperthyroidism such as tachycardia, anxiety, and tremors. It does not affect thyroid hormone levels but provides symptomatic relief and is appropriate.
D. A prescription for methimazole
Methimazole is another antithyroid medication used to treat hyperthyroidism by inhibiting thyroid hormone synthesis. It is also an appropriate prescription for this condition.
A nurse is preparing to administer 30 units of NPH and 10 units of regular insulin to a client. Which of the following actions should the nurse take
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Aspirate NPH insulin first.
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Roll the cloudy insulin between the hands several times.
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Keep insulins stored in the refrigerator.
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Inject air into the regular insulin first.
Explanation
Correct Answer B: Roll the cloudy insulin between the hands several times.
Explanation of the Correct Answer:
NPH insulin is cloudy and should be gently rolled between the hands to mix it thoroughly without creating bubbles. This ensures even distribution of insulin particles and accurate dosing. Shaking can cause frothing and inaccuracy.
Why the Other Options Are Incorrect:
A. Aspirate NPH insulin first.
When mixing insulins, air is injected into the NPH vial first, but aspiration (drawing up) occurs from the regular (clear) insulin first to avoid contaminating it with the cloudy NPH.
C. Keep insulins stored in the refrigerator.
While unopened insulin vials should be refrigerated, once opened, insulin can be kept at room temperature for up to 28 days. Cold insulin can be uncomfortable to inject and may affect absorption.
D. Inject air into the regular insulin first.
The correct procedure is to inject air into the NPH insulin first, then into the regular insulin vial, and draw up the regular insulin before the NPH. This prevents contamination of the clear insulin with the cloudy one.
A nurse in a provider’s office is caring for a client who reports generalized weakness and increased fatigue over the past few months. The client states they become short of breath after climbing a flight of stairs and have difficulty keeping up with their grandchildren. The client has a history of rheumatoid arthritis and reports taking naproxen 500 mg BID. Which of the following actions should the nurse take first?
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Begin a complete blood count (CBC)
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Assess for orthostatic hypotension
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Check the client’s oxygen saturation
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Review the client’s medication history
Explanation
Explanation:
Correct Answer: (A) Begin a complete blood count (CBC)
A CBC will help the nurse determine if anemia is present, which could explain the client’s fatigue, weakness, and shortness of breath. Given the client’s history of fatigue and difficulty with exertion, iron deficiency anemia or another type of anemia is a likely cause.
Why Other Options are Incorrect:
B. Assess for orthostatic hypotension
While orthostatic hypotension may cause dizziness and fatigue, the primary concern here is possible anemia. The first action should focus on identifying potential blood loss or insufficiency rather than assessing for orthostatic hypotension initially.
C. Check the client’s oxygen saturation
Checking oxygen saturation is important, but it would not be the first step in this scenario. It’s crucial to first rule out anemia, which may be contributing to the client’s symptoms.
D. Review the client’s medication history
The medication history is important but secondary in this situation. The priority is to assess the client’s current symptoms and determine whether anemia or another condition is the cause of their fatigue.
A nurse is assessing a client. Which of the following findings should the nurse identify as an indication of respiratory failure?
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Agitation
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Friction rub
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Xerostomia
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Decreased end-tidal CO₂
Explanation
Correct Answer: A) Agitation
Agitation is a key early sign of respiratory failure. When the brain is deprived of adequate oxygen (hypoxia), it manifests as restlessness, confusion, and agitation — a critical warning sign requiring immediate assessment and intervention.
A friction rub is a pleural sound associated with pleuritis, not respiratory failure. Xerostomia (dry mouth) is unrelated to respiratory failure. Respiratory failure typically causes CO₂ retention (increased end-tidal CO₂) due to inadequate ventilation, not a decrease.
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