RN Adult Medical-Surgical Nursing Content Mastery Series
Ed 12.0 (ATI CMS) 2026/2027 | Medical-Surgical Nursing,
NGN Clinical Judgment & ATI Exam Prep | 100 Verified
Questions with Detailed Rationales
Foundations of Adult Medical-Surgical Nursing
Q1: A nurse is reviewing the preoperative assessment for a 68-year-old patient scheduled for an elective
total knee replacement. The patient has a history of type 2 diabetes mellitus, hypertension, and takes
warfarin daily. Which preoperative intervention should the nurse prioritize?
A. Ensuring the patient has been NPO for at least 4 hours before surgery
B. Verifying the patient's INR is within therapeutic range and coordinating with the surgeon about
warfarin management [CORRECT]
C. Scheduling the patient for a preoperative EKG only if they report chest pain
D. Instructing the patient to continue taking the warfarin up until the morning of surgery
Correct Answer: B
Rationale: The best answer is B. This choice is correct because warfarin significantly increases bleeding
risk during surgery, and the ATI CMS guidelines emphasize that anticoagulant management must be
coordinated preoperatively. The nurse needs to verify the INR and ensure the surgeon has a clear plan
for holding or bridging the anticoagulant. In clinical practice, we prioritize bleeding risk assessment and
multidisciplinary communication before any elective procedure involving patients on warfarin. The other
options either underestimate the bleeding risk or provide incomplete guidance.
Q2: During the intraoperative phase, the circulating nurse notices that the patient's body temperature
has dropped to 35.8°C (96.4°F). Which action should the nurse take first?
A. Document the finding and continue monitoring every 15 minutes
B. Apply a forced-air warming blanket and notify the anesthesia provider [CORRECT]
C. Increase the room temperature to 75°F and recheck in 30 minutes
D. Administer a warmed IV fluid bolus without consulting the anesthesia team
Correct Answer: B
,Rationale: The best answer is B. This choice is correct because unintended perioperative hypothermia
below 36°C increases the risk of surgical site infection, coagulopathy, and cardiac events. The ATI CMS
guidelines direct us to implement active warming measures immediately and communicate with the
anesthesia provider, who manages the patient's thermoregulation during surgery. In clinical practice, we
don't wait—active rewarming and interdisciplinary communication are the standard of care.
Q3: A postoperative patient on the medical-surgical unit develops tachycardia, hypotension, and
restlessness 6 hours after abdominal surgery. The patient's dressing is saturated with bright red blood.
Which assessment finding would the nurse expect to see next if this patient is experiencing hemorrhagic
shock?
A. Bradycardia and bounding peripheral pulses
B. Warm, flushed skin and increased urine output
C. Cool, clammy skin and decreased urine output [CORRECT]
D. Hypertension and widened pulse pressure
Correct Answer: C
Rationale: The best answer is C. This choice is correct because hemorrhagic shock triggers compensatory
vasoconstriction, which shunts blood to vital organs and produces cool, clammy skin along with
decreased renal perfusion and reduced urine output. The ATI CMS content on shock emphasizes that
these are classic signs of progressive hypovolemic shock. In clinical practice, when we see tachycardia,
hypotension, and active bleeding, we anticipate the body's compensatory response and monitor for
these perfusion changes.
Q4: Which statement by a patient during preoperative teaching indicates an understanding of deep
breathing and coughing exercises?
A. "I should hold my breath for 10 seconds after each deep breath"
B. "I'll splint my incision with a pillow when I cough to reduce pain and protect the surgical site"
[CORRECT]
C. "I only need to do these exercises once a day after surgery"
D. "Coughing is not necessary if I use the incentive spirometer regularly"
Correct Answer: B
Rationale: The best answer is B. This choice is correct because splinting the incision with a pillow or
folded blanket reduces pain, minimizes incisional stress, and encourages more effective coughing. The
ATI CMS guidelines on perioperative nursing teach that splinting is a key technique for promoting lung
expansion and preventing atelectasis. In clinical practice, we teach patients that effective coughing with
proper splinting is more important than frequency alone.
,Q5: A nurse is caring for a postoperative patient who received general anesthesia. The patient is drowsy
but responds to verbal stimuli. Which assessment is the nurse's highest priority at this time?
A. Checking the surgical dressing for drainage
B. Assessing the patient's airway, breathing, and circulation [CORRECT]
C. Evaluating the patient's pain level using a 0-10 scale
D. Documenting the time the patient returned to the unit
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the immediate postoperative period
carries the highest risk for airway obstruction, hypoventilation, and hemodynamic instability due to
residual anesthesia effects. The ATI CMS guidelines and standard nursing practice direct us to prioritize
the ABCs—airway, breathing, and circulation—before any other assessment. In clinical practice, we
always secure the airway first; everything else can wait until breathing and perfusion are stable.
Q6: A patient is receiving patient-controlled analgesia (PCA) with morphine following open
cholecystectomy. Which action by the nurse is most appropriate to ensure safe administration?
A. Allowing the patient's family member to press the PCA button when the patient is sleeping
B. Monitoring the patient's respiratory rate and sedation level every 2 hours and after each dose
adjustment [CORRECT]
C. Teaching the patient to wait until pain is severe before pressing the button
D. Discontinuing the PCA if the patient reports a pain level of 3 out of 10
Correct Answer: B
Rationale: The best answer is B. This choice is correct because opioid-induced respiratory depression is
the most serious risk with PCA therapy, and frequent monitoring of respiratory rate and sedation level is
the standard safety protocol. The ATI CMS content on postoperative pain management emphasizes that
sedation level often precedes respiratory depression as an early warning sign. In clinical practice, we
monitor closely, especially after dose changes, because catching respiratory compromise early can
prevent a code situation.
Q7: Which nursing intervention is most effective in preventing postoperative atelectasis in a patient who
had abdominal surgery?
A. Encouraging the patient to remain on bed rest for the first 48 hours
B. Administering prophylactic antibiotics within 1 hour of incision
C. Assisting the patient to turn, cough, and deep breathe every 2 hours while awake [CORRECT]
, D. Applying supplemental oxygen at 4 L/min via nasal cannula continuously
Correct Answer: C
Rationale: The best answer is C. This choice is correct because turning, coughing, and deep breathing
mobilizes secretions, promotes alveolar expansion, and prevents the collapse of lung segments that
occurs with shallow breathing and immobility after surgery. The ATI CMS guidelines identify this as a
fundamental postoperative nursing intervention. In clinical practice, we know that oxygen alone doesn't
prevent atelectasis—lung expansion and secretion clearance are what matter most.
Q8: A nurse is preparing a patient for discharge after laparoscopic appendectomy. Which statement by
the patient requires immediate follow-up by the nurse?
A. "I will keep my incision clean and dry for the first 48 hours"
B. "I can return to my desk job in about one week"
C. "I will call my doctor if I develop a fever or notice redness around my incision" [CORRECT]
D. "I plan to take my prescribed pain medication only when the pain is unbearable"
Correct Answer: C
Rationale: The best answer is C. This choice is correct because recognizing signs of infection—fever,
erythema, warmth, or purulent drainage—is a critical self-monitoring skill for postoperative patients.
While the other statements show some understanding, the ATI CMS discharge teaching content
emphasizes that patients must know when to seek help. In clinical practice, we reinforce that early
recognition of infection prevents complications like abscess formation or sepsis, and this statement
demonstrates the patient grasps a key safety concept.
Q9: A patient in the post-anesthesia care unit (PACU) has an oral airway in place and is making gurgling
sounds. The patient's oxygen saturation is 88% on 2 L/min nasal cannula. What is the nurse's first
action?
A. Increase the oxygen flow rate to 6 L/min
B. Suction the oropharynx and reposition the patient's head [CORRECT]
C. Remove the oral airway and insert a nasopharyngeal airway
D. Prepare for emergency intubation
Correct Answer: B
Rationale: The best answer is B. This choice is correct because gurgling sounds indicate secretions in the
upper airway, and the first step is to clear the airway through suctioning and repositioning to promote
drainage. The ATI CMS PACU content teaches that airway patency is the foundation of postoperative
Ed 12.0 (ATI CMS) 2026/2027 | Medical-Surgical Nursing,
NGN Clinical Judgment & ATI Exam Prep | 100 Verified
Questions with Detailed Rationales
Foundations of Adult Medical-Surgical Nursing
Q1: A nurse is reviewing the preoperative assessment for a 68-year-old patient scheduled for an elective
total knee replacement. The patient has a history of type 2 diabetes mellitus, hypertension, and takes
warfarin daily. Which preoperative intervention should the nurse prioritize?
A. Ensuring the patient has been NPO for at least 4 hours before surgery
B. Verifying the patient's INR is within therapeutic range and coordinating with the surgeon about
warfarin management [CORRECT]
C. Scheduling the patient for a preoperative EKG only if they report chest pain
D. Instructing the patient to continue taking the warfarin up until the morning of surgery
Correct Answer: B
Rationale: The best answer is B. This choice is correct because warfarin significantly increases bleeding
risk during surgery, and the ATI CMS guidelines emphasize that anticoagulant management must be
coordinated preoperatively. The nurse needs to verify the INR and ensure the surgeon has a clear plan
for holding or bridging the anticoagulant. In clinical practice, we prioritize bleeding risk assessment and
multidisciplinary communication before any elective procedure involving patients on warfarin. The other
options either underestimate the bleeding risk or provide incomplete guidance.
Q2: During the intraoperative phase, the circulating nurse notices that the patient's body temperature
has dropped to 35.8°C (96.4°F). Which action should the nurse take first?
A. Document the finding and continue monitoring every 15 minutes
B. Apply a forced-air warming blanket and notify the anesthesia provider [CORRECT]
C. Increase the room temperature to 75°F and recheck in 30 minutes
D. Administer a warmed IV fluid bolus without consulting the anesthesia team
Correct Answer: B
,Rationale: The best answer is B. This choice is correct because unintended perioperative hypothermia
below 36°C increases the risk of surgical site infection, coagulopathy, and cardiac events. The ATI CMS
guidelines direct us to implement active warming measures immediately and communicate with the
anesthesia provider, who manages the patient's thermoregulation during surgery. In clinical practice, we
don't wait—active rewarming and interdisciplinary communication are the standard of care.
Q3: A postoperative patient on the medical-surgical unit develops tachycardia, hypotension, and
restlessness 6 hours after abdominal surgery. The patient's dressing is saturated with bright red blood.
Which assessment finding would the nurse expect to see next if this patient is experiencing hemorrhagic
shock?
A. Bradycardia and bounding peripheral pulses
B. Warm, flushed skin and increased urine output
C. Cool, clammy skin and decreased urine output [CORRECT]
D. Hypertension and widened pulse pressure
Correct Answer: C
Rationale: The best answer is C. This choice is correct because hemorrhagic shock triggers compensatory
vasoconstriction, which shunts blood to vital organs and produces cool, clammy skin along with
decreased renal perfusion and reduced urine output. The ATI CMS content on shock emphasizes that
these are classic signs of progressive hypovolemic shock. In clinical practice, when we see tachycardia,
hypotension, and active bleeding, we anticipate the body's compensatory response and monitor for
these perfusion changes.
Q4: Which statement by a patient during preoperative teaching indicates an understanding of deep
breathing and coughing exercises?
A. "I should hold my breath for 10 seconds after each deep breath"
B. "I'll splint my incision with a pillow when I cough to reduce pain and protect the surgical site"
[CORRECT]
C. "I only need to do these exercises once a day after surgery"
D. "Coughing is not necessary if I use the incentive spirometer regularly"
Correct Answer: B
Rationale: The best answer is B. This choice is correct because splinting the incision with a pillow or
folded blanket reduces pain, minimizes incisional stress, and encourages more effective coughing. The
ATI CMS guidelines on perioperative nursing teach that splinting is a key technique for promoting lung
expansion and preventing atelectasis. In clinical practice, we teach patients that effective coughing with
proper splinting is more important than frequency alone.
,Q5: A nurse is caring for a postoperative patient who received general anesthesia. The patient is drowsy
but responds to verbal stimuli. Which assessment is the nurse's highest priority at this time?
A. Checking the surgical dressing for drainage
B. Assessing the patient's airway, breathing, and circulation [CORRECT]
C. Evaluating the patient's pain level using a 0-10 scale
D. Documenting the time the patient returned to the unit
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the immediate postoperative period
carries the highest risk for airway obstruction, hypoventilation, and hemodynamic instability due to
residual anesthesia effects. The ATI CMS guidelines and standard nursing practice direct us to prioritize
the ABCs—airway, breathing, and circulation—before any other assessment. In clinical practice, we
always secure the airway first; everything else can wait until breathing and perfusion are stable.
Q6: A patient is receiving patient-controlled analgesia (PCA) with morphine following open
cholecystectomy. Which action by the nurse is most appropriate to ensure safe administration?
A. Allowing the patient's family member to press the PCA button when the patient is sleeping
B. Monitoring the patient's respiratory rate and sedation level every 2 hours and after each dose
adjustment [CORRECT]
C. Teaching the patient to wait until pain is severe before pressing the button
D. Discontinuing the PCA if the patient reports a pain level of 3 out of 10
Correct Answer: B
Rationale: The best answer is B. This choice is correct because opioid-induced respiratory depression is
the most serious risk with PCA therapy, and frequent monitoring of respiratory rate and sedation level is
the standard safety protocol. The ATI CMS content on postoperative pain management emphasizes that
sedation level often precedes respiratory depression as an early warning sign. In clinical practice, we
monitor closely, especially after dose changes, because catching respiratory compromise early can
prevent a code situation.
Q7: Which nursing intervention is most effective in preventing postoperative atelectasis in a patient who
had abdominal surgery?
A. Encouraging the patient to remain on bed rest for the first 48 hours
B. Administering prophylactic antibiotics within 1 hour of incision
C. Assisting the patient to turn, cough, and deep breathe every 2 hours while awake [CORRECT]
, D. Applying supplemental oxygen at 4 L/min via nasal cannula continuously
Correct Answer: C
Rationale: The best answer is C. This choice is correct because turning, coughing, and deep breathing
mobilizes secretions, promotes alveolar expansion, and prevents the collapse of lung segments that
occurs with shallow breathing and immobility after surgery. The ATI CMS guidelines identify this as a
fundamental postoperative nursing intervention. In clinical practice, we know that oxygen alone doesn't
prevent atelectasis—lung expansion and secretion clearance are what matter most.
Q8: A nurse is preparing a patient for discharge after laparoscopic appendectomy. Which statement by
the patient requires immediate follow-up by the nurse?
A. "I will keep my incision clean and dry for the first 48 hours"
B. "I can return to my desk job in about one week"
C. "I will call my doctor if I develop a fever or notice redness around my incision" [CORRECT]
D. "I plan to take my prescribed pain medication only when the pain is unbearable"
Correct Answer: C
Rationale: The best answer is C. This choice is correct because recognizing signs of infection—fever,
erythema, warmth, or purulent drainage—is a critical self-monitoring skill for postoperative patients.
While the other statements show some understanding, the ATI CMS discharge teaching content
emphasizes that patients must know when to seek help. In clinical practice, we reinforce that early
recognition of infection prevents complications like abscess formation or sepsis, and this statement
demonstrates the patient grasps a key safety concept.
Q9: A patient in the post-anesthesia care unit (PACU) has an oral airway in place and is making gurgling
sounds. The patient's oxygen saturation is 88% on 2 L/min nasal cannula. What is the nurse's first
action?
A. Increase the oxygen flow rate to 6 L/min
B. Suction the oropharynx and reposition the patient's head [CORRECT]
C. Remove the oral airway and insert a nasopharyngeal airway
D. Prepare for emergency intubation
Correct Answer: B
Rationale: The best answer is B. This choice is correct because gurgling sounds indicate secretions in the
upper airway, and the first step is to clear the airway through suctioning and repositioning to promote
drainage. The ATI CMS PACU content teaches that airway patency is the foundation of postoperative
