ATI RN Adult Medical Surgical Exam 2026
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Free ATI RN Adult Medical Surgical Exam 2026 Questions
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Elevated blood pressure
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Pitting edema
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Dyspnea
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Skin tenting
Explanation
Correct Answer: D) Skin tenting
Skin tenting (poor skin turgor) is a classic sign of fluid volume deficit (dehydration). When the skin is pinched, it fails to return to its normal position quickly, indicating decreased interstitial fluid and loss of tissue elasticity due to dehydration.
Elevated blood pressure is associated with fluid volume excess, not deficit. Pitting edema indicates fluid volume excess, as excess fluid accumulates in the interstitial spaces. Dyspnea is associated with fluid overload causing pulmonary congestion, not fluid deficit.
A nurse is assessing a client who has a long leg cast. Which of the following assessments is the nurse's priority A nurse is assessing a client who has a long leg cast. Which of the following assessments is the nurse's priority
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Pain level
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Wound drainage
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Swelling
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Peripheral pulses
Explanation
Correct Answer D: Peripheral pulses
Explanation of the Correct Answer:
Peripheral pulses are the priority because they help the nurse assess for adequate circulation distal to the cast. A compromised pulse can indicate impaired perfusion or compartment syndrome, which is a medical emergency. Prompt recognition can prevent permanent tissue damage or limb loss.
Why the Other Options Are Incorrect:
A) Pain level:
While important, pain is a subjective indicator and may not directly confirm circulation impairment. It can support findings but is not the priority over assessing perfusion.
B) Wound drainage:
Drainage can indicate infection, but in the context of cast care, it is not as immediately life- or limb-threatening as compromised circulation.
C) Swelling:
Swelling can be a symptom of complications like compartment syndrome, but the assessment of pulses gives more critical information about perfusion status.
A nurse is teaching a client about using a metered-dose rescue inhaler. Which of the following statements should the nurse include in the teaching?
- "Use peroxide to clean the mouthpiece of your inhaler."
- "Exhale fully before bringing the inhaler to your lips."
- "Do not shake your inhaler before use."
- "Depress the canister after you inhale."
Explanation
Explanation
Correct Answer: B
Exhaling fully before bringing the inhaler to the lips empties the lungs, allowing the client to take a slow, deep inhalation after actuating the device. This technique ensures that medication reaches the lower airways rather than depositing in the mouth or throat. Proper exhalation prior to inhalation maximizes bronchodilation and therapeutic effect.
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? (Select all that apply.)
- Born with a high birth weight
- Frequent exposure to low-volume noise
- Use of a loop diuretic
- Chronic infections of the middle ear
- Perforation of the eardrum
Explanation
Explanation:
Correct Answers: (C) Use of a loop diuretic, (D) Chronic infections of the middle ear, (E) Perforation of the eardrum
Use of a loop diuretic — Loop diuretics such as furosemide are ototoxic medications that can damage the hair cells of the cochlea, leading to sensorineural hearing loss. This is a well-established and significant risk factor.
Chronic infections of the middle ear — Repeated middle ear infections (chronic otitis media) can cause structural damage to the ossicles and tympanic membrane, resulting in conductive hearing loss over time.
Perforation of the eardrum — A perforated tympanic membrane disrupts the normal transmission of sound waves through the middle ear, leading to conductive hearing loss. Repeated or large perforations can cause significant permanent hearing impairment.
Why Other Options are Incorrect:
- A. Being born with a high birth weight is not a risk factor for hearing loss. Conversely, low birth weight is associated with increased risk due to potential complications such as hypoxia, hyperbilirubinemia, and NICU interventions including ototoxic medications.
- B. Frequent exposure to low-volume noise does not cause hearing loss. It is high-intensity noise (above 85 decibels) with prolonged or repeated exposure that damages the hair cells of the cochlea and leads to noise-induced hearing loss.
- "I can resume regular activities, such as heavy lifting, immediately."
- "I should take a warm bath to ease discomfort at the incision site."
- "I need to keep my incision clean and dry and watch for signs of infection."
- "I can eat any foods I want as soon as I feel hungry."
Explanation
The correct answer is C) "I need to keep my incision clean and dry and watch for signs of infection."
Proper care of the incision site is crucial to prevent infection and ensure proper healing after surgery.
A nurse is caring for a client who is experiencing an increase in intracranial pressure (ICP). The nurse should expect which of the following as an early manifestation of increased ICP
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Projectile vomiting
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Restlessness
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Papilledema
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Decorticate posturing
Explanation
Correct Answer:
Restlessness
Explanation:
Restlessness is one of the earliest signs of increased intracranial pressure (ICP). As ICP begins to rise, cerebral perfusion is compromised, leading to subtle but critical changes in neurological function. Early signs include altered mental status, confusion, irritability, and restlessness due to reduced oxygen delivery to brain tissue. These behavioral changes often precede more overt or alarming neurological symptoms. Recognizing restlessness as a potential indicator of rising ICP allows for timely interventions such as repositioning, medication administration, or further neurological assessment to prevent further decompensation.
Why Other Options Are Wrong:
Projectile vomiting
Projectile vomiting occurs due to direct stimulation of the vomiting center in the medulla by increased pressure, but it typically presents later in the progression of increased ICP. It is often sudden, forceful, and not preceded by nausea, but it signifies that the intracranial pressure has already become significantly elevated. By the time vomiting appears, the opportunity for early intervention may have passed, which is why it is not considered an early sign.
Papilledema
Papilledema is the swelling of the optic disc due to increased ICP transmitted along the optic nerve sheath. However, it is a delayed finding that can take hours to days to develop and typically requires an ophthalmoscopic exam to detect. It is not a symptom that is immediately apparent or useful for early detection in an acute setting. Therefore, it cannot be relied upon for early identification of increased ICP.
Decorticate posturing
Decorticate posturing is an abnormal motor response indicating severe damage to the corticospinal tract, often due to advanced or prolonged increased ICP. It represents a late-stage neurologic deterioration and is associated with a poor prognosis if not addressed immediately. By the time posturing is observed, intracranial pressure has likely reached critical levels, and brain herniation may be imminent or already occurring.
A nurse is caring for a client following a bronchoscopy. Which of the following actions should the nurse take first
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Inform the client they might experience a low-grade fever.
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Provide the client with sips of water.
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Instruct the client to report bleeding.
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Check the client's gag reflex.
Explanation
Correct Answer:
Check the client's gag reflex.
Explanation:
Following a bronchoscopy, the client's airway is temporarily anesthetized to suppress the gag reflex and reduce discomfort during the procedure. This suppression puts the client at high risk for aspiration if they consume fluids or food too soon. Therefore, the immediate nursing priority is to verify that the gag reflex has returned before allowing any oral intake or initiating further education. This assessment ensures the client can safely protect their airway, which is fundamental in preventing serious complications such as aspiration pneumonia. Restoring airway protection is a critical first step in post-procedure care.
Why Other Options Are Wrong:
"Inform the client they might experience a low-grade fever."
This is incorrect because although a low-grade fever can occur after bronchoscopy due to minor airway irritation, it is not the first concern immediately following the procedure. Patient safety takes priority, specifically airway protection. Teaching about possible post-procedure symptoms can wait until after the client’s immediate risk of aspiration has been ruled out.
"Provide the client with sips of water."
This is incorrect because giving the client anything by mouth before confirming the return of the gag reflex can lead to choking or aspiration. The throat may still be numb from local anesthesia used during the bronchoscopy. Administering fluids prematurely disregards the fundamental principle of maintaining airway safety.
"Instruct the client to report bleeding."
This is incorrect because although bleeding is a potential complication of bronchoscopy and should be monitored for, it is not the first priority action. The client’s ability to swallow and protect their airway must be confirmed before providing any further instructions. Once the gag reflex is assessed and confirmed, the nurse can then proceed with teaching about symptoms to watch for, including bleeding.
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?
- Begin a complete blood count (CBC)
- Assess for orthostatic hypotension
- Check the client’s oxygen saturation
- 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 providing discharge teaching for a client who had a partial colectomy 2 days ago. Which of the following information should the nurse include in the teaching?
- "Notify your provider if your stoma becomes dark red."
- "Place an aspirin in your ostomy pouch to control odor."
- "Empty your ostomy pouch when it becomes a third to halfway full."
- "Your ostomy should start functioning in five days."
Explanation
Explanation:
Correct Answer: (A) "Notify your provider if your stoma becomes dark red." A healthy stoma should appear beefy red and moist. A dark red, purple, or black stoma indicates compromised blood supply and ischemia, which is a serious complication requiring immediate provider notification to prevent stoma necrosis.
Why Other Options are Incorrect:
- B. Aspirin should never be placed in an ostomy pouch. It can cause mucosal irritation and damage to the stoma. Deodorizing drops or tablets specifically designed for ostomy pouches should be used instead.
- C. The ostomy pouch should be emptied when it is one-third to one-half full, not a third to halfway — this is essentially correct, however the standard teaching is to empty at one-third full to prevent the pouch from becoming too heavy and breaking the seal.
- D. A new ostomy typically begins functioning within 24–72 hours postoperatively, not five days. Absence of function beyond this timeframe warrants provider notification.
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"Wear loose-fitting slippers around the house."
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"Use a heating pad to keep your feet warm at night."
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"Wear cotton rather than nylon socks."
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"Wash your feet twice per day with antibacterial soap and hot water."
Explanation
Correct Answer: C) "Wear cotton rather than nylon socks."
Cotton socks are recommended for diabetic patients because they are breathable, absorb moisture, and reduce friction, which helps prevent skin breakdown, blisters, and ulcers. Nylon socks trap moisture and increase friction, raising the risk of skin injury in patients who already have compromised sensation and circulation.
Loose-fitting slippers do not provide adequate foot protection — properly fitted, closed-toe shoes are recommended. Heating pads are contraindicated in diabetic patients due to peripheral neuropathy, which impairs the ability to sense heat and greatly increases the risk of burns. Feet should be washed with lukewarm (not hot) water, as hot water can cause burns in patients with reduced sensation.
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