ATI RN Adult Medical Surgical Exam 2026
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Free ATI RN Adult Medical Surgical Exam 2026 Questions
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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 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?
- Glycosylated hemoglobin level
- Oral glucose tolerance test results
- Fasting blood glucose level
- 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 admitting a client who reports tightness in their chest that radiates to left arm.
Exhibit 1
Nurses' Notes
1000:
Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, "I had scrambled eggs and bacon like I do every morning." Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds are present in all 4 quadrants. +1 pedal pulses. Skin is cool to touch. Capillary refill less than 2 seconds.
Exhibit 2
Vital Signs
1000:
Temperature 37.1° C (98.8° F)
Heart rate 110/min and irregular
Respiratory rate 24/min
Blood pressure 164/80 mm Hg
Oxygen saturation 93% on room air
Exhibit 3
Diagnostic Results
1000:
Myoglobin 100 mcg/L (less than 90 mcg/L)
Creatine kinase 180 units/L (55 to 170 units/L)
Troponin T 0.40 ng/mL (less than 0.1 ng/mL)
Troponin I 0.35 ng/mL (less than 0.03 ng/mL)
Cholesterol 244 mg/dL (less than 200 mg/dL)
Triglycerides 180 mg/dL (40 to 160 mg/dL)
LDL cholesterol 148 mg/dL (less than 130 mg/dL)
HDL cholesterol 42 mg/dL (greater than 45 mg/dL)
C-reactive protein 2 mg/mL (less than 1.0 mg/mL)
Blood glucose 103 mg/dL (74 to 106 mg/dL)
12-lead electrocardiogram: tachycardia with ST segment elevation and T wave changes. Chest x-ray: lungs are clear in all lobes
Exhibit 4
History and Physical
1000:
Client reports after eating breakfast this morning at 0630 that they began feeling tightness in chest that radiates fo left arm.
History:
Hyperlipidemia, hypertension, type 2 diabetes mellitus.
Non-smoker. Denies use of alcohol or recreational drug use. The nurse is reviewing the client's medical record. Select the four findings that require immediate follow-up.
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Blood glucose level
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Bowel sounds
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Blood pressure
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Pain level
- Electrocardiogram findings
- Lung sounds
- Troponin T level
Explanation
Correct Answer:
Blood pressure
Pain level
Electrocardiogram findings
Troponin T level
Explanation:
These four findings all indicate active or worsening myocardial injury and require urgent intervention to prevent further cardiac damage or death.
Elevated blood pressure (164/80 mmHg) increases the workload on the heart, which can exacerbate ischemia during an acute coronary event. Prompt control of blood pressure is essential to reduce myocardial oxygen demand and limit infarct size.
A pain level of seven out of ten, especially with radiating chest discomfort, suggests ongoing cardiac ischemia. This symptom reflects inadequate oxygen delivery to the heart muscle and must be addressed immediately with analgesics and anti-ischemic therapy.
Electrocardiogram findings of tachycardia with ST segment elevation and T wave changes are classic signs of an ST-elevation myocardial infarction (STEMI). This is a cardiac emergency that requires immediate pharmacologic and/or interventional treatment to restore coronary perfusion.
A troponin T level of 0.40 ng/mL is significantly elevated above the normal range (<0.1 ng/mL), confirming myocardial cell death. This lab result is diagnostic for myocardial infarction and necessitates urgent management to limit further cardiac injury and monitor for complications.
Why Other Options Are Wrong:
Blood glucose level (103 mg/dL)
This is a normal value and does not require urgent follow-up. Although the client has type 2 diabetes, the glucose level is within the target range for hospitalized patients. There is no immediate threat related to this value in the context of an acute myocardial infarction.
Bowel sounds (present in all four quadrants)
This is a normal assessment finding and does not suggest any acute abdominal or systemic issue. The presence of bowel sounds indicates normal gastrointestinal activity, which is not relevant to the emergent cardiac condition.
Lung sounds (clear in all lobes)
Clear lung sounds are a reassuring finding, suggesting there is no pulmonary edema or respiratory distress. In the context of a cardiac event, this means the lungs are not currently affected, and no immediate intervention is required for this aspect of the assessment.
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Contact precautions
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Airborne precautions
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Protective environment
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Droplet precautions
Explanation
Correct Answer: B) Airborne precautions
Tuberculosis is transmitted through airborne particles that remain suspended in the air for extended periods. Airborne precautions require placement in a negative-pressure room and use of an N95 respirator to prevent inhalation of infectious droplets.
Contact precautions are for direct contact infections, droplet precautions are for larger respiratory droplets, and protective environments are for immunocompromised clients.
A nurse is creating a plan of care for a client who has a newly implanted transcutaneous pacemaker. Which of the following interventions should the nurse include in the plan?
- Place a pressure dressing over the incision site
- Administer an analgesic to the client
- Instruct the client to restrict arm movement for 1 week
- Apply antibiotic ointment to the skin around the site
Explanation
Explanation
Correct Answer: B) Administer an analgesic to the client
A transcutaneous pacemaker delivers electrical impulses through the chest wall, which can be uncomfortable or painful for the client. Administering analgesics is essential to promote comfort and ensure the client can tolerate the therapy.
Pressure dressings and antibiotic ointment are not routine for this device, and arm restriction is more appropriate for implanted pacemakers rather than transcutaneous pacing.
A nurse is teaching a client who has type 1 diabetes mellitus about treating a hypoglycemic episode. Which of the following statements should the nurse include in the teaching
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Drink 4 to 6 ounces of juice.
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Eat two crackers with peanut butter.
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Consume 1 teaspoon of corn syrup-based glucose gel.
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Consume two glucose tablets and check your blood glucose 1 hour later.
Explanation
Correct Answer A: Drink 4 to 6 ounces of juice.
Explanation of the Correct Answer
For a mild to moderate hypoglycemic episode, the nurse should instruct the client to consume 15 grams of fast-acting carbohydrates, such as 4 to 6 ounces of fruit juice. This quickly raises blood glucose levels. After 15 minutes, the client should recheck their blood glucose and repeat the treatment if levels are still low.
Why the Other Options Are Incorrect:
B. Eat two crackers with peanut butter.
While peanut butter and crackers provide sustained energy, they contain fat, which slows carbohydrate absorption and delays glucose correction. This is more suitable for preventing a drop in blood glucose, not for treating acute hypoglycemia.
C. Consume 1 teaspoon of corn syrup-based glucose gel.
One teaspoon of glucose gel typically provides only about 5 grams of carbohydrates, which is less than the recommended 15 grams needed to treat hypoglycemia effectively.
D. Consume two glucose tablets and check your blood glucose 1 hour later.
Most glucose tablets contain about 4 grams of carbohydrate each, so two would only provide 8 grams—insufficient to treat hypoglycemia. Also, the client should recheck their blood glucose after 15 minutes, not 1 hour.
A nurse is preparing to perform an ocular irrigation for a client who received a chemical splash in the eye. Which of the following actions should the nurse plan to take?
- Direct the flow of the solution from the outer corner to the nasal corner of the eye
- Place the client in a lateral position
- Continue irrigation until the tonometry reading is greater than 21 mm Hg
- Use 0.9% sodium chloride solution to wash out the irritant
Explanation
Explanation
Correct Answer: D) Use 0.9% sodium chloride solution to wash out the irritant
Immediate and copious irrigation is the priority after a chemical eye injury to dilute and remove the irritant. Normal saline (0.9% sodium chloride) is appropriate because it is isotonic and safe for ocular tissues. Irrigation should continue until the pH of the eye returns to normal, not based on intraocular pressure.
The solution should flow from the inner (nasal) to the outer (lateral) canthus to prevent contamination of the unaffected eye. Positioning should support drainage, but lateral positioning is not the primary intervention.
A nurse is caring for a client who is experiencing diabetic ketoacidosis (DKA). Which of the following is the priority intervention by the nurse?
- Initiate a continuous IV insulin infusion.
- Begin bicarbonate continuous IV infusion.
- Administer 0.9% sodium chloride.
- Check potassium levels.
Explanation
Explanation:
Correct Answer: (C) Administer 0.9% sodium chloride. The priority intervention in DKA is fluid replacement with 0.9% sodium chloride (normal saline). DKA causes severe dehydration due to osmotic diuresis from hyperglycemia. Restoring circulating volume is the first step because it improves perfusion, begins to lower blood glucose through dilution, and stabilizes the client before insulin therapy is initiated.
Why Other Options are Incorrect:
- A. IV insulin infusion is essential in DKA but is initiated after fluid resuscitation has begun. Giving insulin before correcting dehydration can cause dangerous cardiovascular collapse.
- B. Bicarbonate infusion is not routinely recommended in DKA unless the pH is severely low (below 6.9). It is not a priority intervention.
- D. Checking potassium levels is important before starting insulin (as insulin drives potassium into cells and can cause life-threatening hypokalemia), but fluid resuscitation remains the first priority action.
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Photosensitivity
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Hypoglycemia
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Diarrhea
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Blurred vision
Explanation
Correct Answer: C) Diarrhea
Cefaclor is a second-generation cephalosporin antibiotic. Diarrhea is one of the most common adverse effects of cephalosporins due to disruption of normal gut flora. In severe cases, this can progress to Clostridioides difficile-associated diarrhea (CDAD), which requires immediate medical attention. Nurses must monitor bowel patterns and educate clients to report persistent or bloody diarrhea.
Photosensitivity is more commonly associated with fluoroquinolones and tetracyclines, not cephalosporins. Hypoglycemia is not a recognized adverse effect of cefaclor. Blurred vision is not an expected adverse effect of this medication class.
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Ice cream
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Graham crackers
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Vegetable soup
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Vanilla pudding
Explanation
Correct Answer: D) Vanilla pudding
Trigeminal neuralgia causes severe facial pain that can be triggered by chewing, temperature extremes, or coarse textures. Soft, smooth, and non-irritating foods like pudding reduce stimulation of the trigeminal nerve and minimize pain.
Ice cream may trigger pain due to cold sensitivity, graham crackers are coarse and require chewing, and soup may be too hot and irritating.
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