ATI Med-Surg Proctored Exam (NGN) (10
New Versions, 2023/2024) and Correct
Q and A
Section 1: Perioperative Care (Q1–12)
Q1. A nurse is preparing a client for surgery. Which of the following actions should the nurse
take first?
A. Verify the informed consent is signed
B. Administer preoperative antibiotics
C. Confirm the client's NPO status
D. Remove the client's jewelry
Correct Answer: A. Verify the informed consent is signed
Rationale: Verifying informed consent is the priority before any surgical preparation.
Consent must be obtained before sedation and before other preparations. NPO status,
antibiotics, and jewelry removal follow. The nurse's role is to witness the signature, not to
explain the procedure (that is the provider's responsibility).
Q2. A nurse is caring for a client 24 hours post-op. Which finding requires immediate
intervention?
A. Serosanguineous drainage on the dressing
B. Temperature of 37.8°C (100.0°F)
C. Sudden shortness of breath with tachycardia
D. Pain rated 5/10 at the incision site
Correct Answer: C. Sudden shortness of breath with tachycardia
Rationale: Sudden dyspnea with tachycardia post-op suggests pulmonary embolism,
atelectasis, or pneumothorax — a life-threatening emergency. Serosanguineous drainage is
expected. Low-grade fever is common post-op. Moderate pain is expected.
Q3. A nurse is teaching a client about postoperative incentive spirometry. Which statement
indicates understanding?
,A. "I will use it once every 8 hours."
B. "I will inhale slowly and deeply, holding my breath for 3 seconds."
C. "I will exhale forcefully into the device."
D. "I will use it only when I feel short of breath."
Correct Answer: B. "I will inhale slowly and deeply, holding my breath for 3 seconds."
Rationale: Incentive spirometry promotes deep lung expansion. The client should inhale
slowly and deeply, hold for 3 seconds, then exhale. It should be used 10 times per hour while
awake, not PRN.
Q4. SATA — A nurse is assessing a client for malignant hyperthermia during surgery. Which
findings should the nurse expect? (Select all that apply.)
A. Muscle rigidity
B. Hypercarbia
C. Tachycardia
D. Hypothermia
E. Elevated creatine kinase
Correct Answers: A, B, C, E
Rationale: Malignant hyperthermia is a life-threatening reaction to inhaled
anesthetics/succinylcholine. Findings include muscle rigidity, hypercarbia (earliest sign),
tachycardia, hyperthermia (not hypothermia), and elevated CK. Treatment is dantrolene.
Q5. A nurse is caring for a client who had a colon resection 2 days ago. The client reports
abdominal pain and the nurse notes absent bowel sounds. Which action should the nurse take
first?
A. Administer a prescribed opioid
B. Insert a nasogastric tube
C. Assess for abdominal distention and notify the provider
D. Encourage ambulation
Correct Answer: C. Assess for abdominal distention and notify the provider
Rationale: Absent bowel sounds with pain suggest paralytic ileus. The nurse should assess
further (distention, nausea, vomiting) and notify the provider. Opioids can worsen ileus. NG
tube may be ordered but requires assessment first. Ambulation helps prevent but does not treat
acute ileus.
,Q6. A nurse is reviewing discharge instructions with a client after cataract surgery. Which
instruction is priority?
A. "Avoid bending at the waist."
B. "Sleep on the operative side."
C. "Use tap water to irrigate the eye."
D. "Return to driving immediately."
Correct Answer: A. "Avoid bending at the waist."
Rationale: Bending increases intraocular pressure and risks dislocation of the implant. Sleep
on the non-operative side. Do not irrigate the eye. Driving is restricted until cleared.
Q7. A nurse is preparing a client for a lumbar puncture. Which action is essential?
A. Ensure the client empties their bladder
B. Position the client in high Fowler's
C. Administer a sedative
D. Restrict fluids
Correct Answer: A. Ensure the client empties their bladder
Rationale: An empty bladder prevents discomfort and injury during positioning. The client is
positioned lateral recumbent or sitting, not high Fowler's. Sedation is not routine. Fluids are
encouraged post-procedure to prevent headache.
Q8. SATA — A nurse is providing preoperative teaching. Which statements indicate the client
understands? (Select all that apply.)
A. "I should stop smoking at least 24 hours before surgery."
B. "I will practice coughing and deep breathing."
C. "I should not eat or drink after midnight."
D. "I will need to sign a consent form."
E. "I can wear my wedding ring into surgery."
Correct Answers: A, B, C, D
Rationale: Smoking cessation reduces pulmonary complications. Coughing/deep breathing
prevents atelectasis. NPO status prevents aspiration. Consent is required. Jewelry must be
removed to prevent burns (electrocautery) and loss.
, Q9. A nurse is assessing a client's surgical incision and notes dehiscence. Which action should
the nurse take first?
A. Reapproximate the wound edges
B. Cover the wound with a sterile saline dressing
C. Notify the surgeon immediately
D. Apply an abdominal binder
Correct Answer: B. Cover the wound with a sterile saline dressing
Rationale: For dehiscence, the priority is to cover the wound with sterile saline-soaked
gauze to prevent evisceration and infection, position the client low Fowler's with knees bent,
then notify the surgeon. Do not reapproximate.
Q10. A nurse is caring for a client who is 6 hours post-op from a thyroidectomy. The client
reports tingling around the mouth. Which action should the nurse take?
A. Administer calcium gluconate as prescribed
B. Encourage the client to drink milk
C. Assess for Chvostek's sign
D. Both A and C
Correct Answer: D. Both A and C
Rationale: Tingling around the mouth suggests hypocalcemia from parathyroid injury. The
nurse should assess for Chvostek's and Trousseau's signs and prepare to administer calcium
gluconate. Oral calcium is not the priority for acute symptoms.
Q11. A nurse is teaching a client about preventing DVT postoperatively. Which instruction is
most important?
A. "Cross your legs when sitting."
B. "Perform ankle pumps every hour."
C. "Massage your calves daily."
D. "Stay in bed to rest."
Correct Answer: B. "Perform ankle pumps every hour."
Rationale: Ankle pumps promote venous return. Crossing legs, massaging calves (risk of
dislodging clot), and immobility increase DVT risk.
New Versions, 2023/2024) and Correct
Q and A
Section 1: Perioperative Care (Q1–12)
Q1. A nurse is preparing a client for surgery. Which of the following actions should the nurse
take first?
A. Verify the informed consent is signed
B. Administer preoperative antibiotics
C. Confirm the client's NPO status
D. Remove the client's jewelry
Correct Answer: A. Verify the informed consent is signed
Rationale: Verifying informed consent is the priority before any surgical preparation.
Consent must be obtained before sedation and before other preparations. NPO status,
antibiotics, and jewelry removal follow. The nurse's role is to witness the signature, not to
explain the procedure (that is the provider's responsibility).
Q2. A nurse is caring for a client 24 hours post-op. Which finding requires immediate
intervention?
A. Serosanguineous drainage on the dressing
B. Temperature of 37.8°C (100.0°F)
C. Sudden shortness of breath with tachycardia
D. Pain rated 5/10 at the incision site
Correct Answer: C. Sudden shortness of breath with tachycardia
Rationale: Sudden dyspnea with tachycardia post-op suggests pulmonary embolism,
atelectasis, or pneumothorax — a life-threatening emergency. Serosanguineous drainage is
expected. Low-grade fever is common post-op. Moderate pain is expected.
Q3. A nurse is teaching a client about postoperative incentive spirometry. Which statement
indicates understanding?
,A. "I will use it once every 8 hours."
B. "I will inhale slowly and deeply, holding my breath for 3 seconds."
C. "I will exhale forcefully into the device."
D. "I will use it only when I feel short of breath."
Correct Answer: B. "I will inhale slowly and deeply, holding my breath for 3 seconds."
Rationale: Incentive spirometry promotes deep lung expansion. The client should inhale
slowly and deeply, hold for 3 seconds, then exhale. It should be used 10 times per hour while
awake, not PRN.
Q4. SATA — A nurse is assessing a client for malignant hyperthermia during surgery. Which
findings should the nurse expect? (Select all that apply.)
A. Muscle rigidity
B. Hypercarbia
C. Tachycardia
D. Hypothermia
E. Elevated creatine kinase
Correct Answers: A, B, C, E
Rationale: Malignant hyperthermia is a life-threatening reaction to inhaled
anesthetics/succinylcholine. Findings include muscle rigidity, hypercarbia (earliest sign),
tachycardia, hyperthermia (not hypothermia), and elevated CK. Treatment is dantrolene.
Q5. A nurse is caring for a client who had a colon resection 2 days ago. The client reports
abdominal pain and the nurse notes absent bowel sounds. Which action should the nurse take
first?
A. Administer a prescribed opioid
B. Insert a nasogastric tube
C. Assess for abdominal distention and notify the provider
D. Encourage ambulation
Correct Answer: C. Assess for abdominal distention and notify the provider
Rationale: Absent bowel sounds with pain suggest paralytic ileus. The nurse should assess
further (distention, nausea, vomiting) and notify the provider. Opioids can worsen ileus. NG
tube may be ordered but requires assessment first. Ambulation helps prevent but does not treat
acute ileus.
,Q6. A nurse is reviewing discharge instructions with a client after cataract surgery. Which
instruction is priority?
A. "Avoid bending at the waist."
B. "Sleep on the operative side."
C. "Use tap water to irrigate the eye."
D. "Return to driving immediately."
Correct Answer: A. "Avoid bending at the waist."
Rationale: Bending increases intraocular pressure and risks dislocation of the implant. Sleep
on the non-operative side. Do not irrigate the eye. Driving is restricted until cleared.
Q7. A nurse is preparing a client for a lumbar puncture. Which action is essential?
A. Ensure the client empties their bladder
B. Position the client in high Fowler's
C. Administer a sedative
D. Restrict fluids
Correct Answer: A. Ensure the client empties their bladder
Rationale: An empty bladder prevents discomfort and injury during positioning. The client is
positioned lateral recumbent or sitting, not high Fowler's. Sedation is not routine. Fluids are
encouraged post-procedure to prevent headache.
Q8. SATA — A nurse is providing preoperative teaching. Which statements indicate the client
understands? (Select all that apply.)
A. "I should stop smoking at least 24 hours before surgery."
B. "I will practice coughing and deep breathing."
C. "I should not eat or drink after midnight."
D. "I will need to sign a consent form."
E. "I can wear my wedding ring into surgery."
Correct Answers: A, B, C, D
Rationale: Smoking cessation reduces pulmonary complications. Coughing/deep breathing
prevents atelectasis. NPO status prevents aspiration. Consent is required. Jewelry must be
removed to prevent burns (electrocautery) and loss.
, Q9. A nurse is assessing a client's surgical incision and notes dehiscence. Which action should
the nurse take first?
A. Reapproximate the wound edges
B. Cover the wound with a sterile saline dressing
C. Notify the surgeon immediately
D. Apply an abdominal binder
Correct Answer: B. Cover the wound with a sterile saline dressing
Rationale: For dehiscence, the priority is to cover the wound with sterile saline-soaked
gauze to prevent evisceration and infection, position the client low Fowler's with knees bent,
then notify the surgeon. Do not reapproximate.
Q10. A nurse is caring for a client who is 6 hours post-op from a thyroidectomy. The client
reports tingling around the mouth. Which action should the nurse take?
A. Administer calcium gluconate as prescribed
B. Encourage the client to drink milk
C. Assess for Chvostek's sign
D. Both A and C
Correct Answer: D. Both A and C
Rationale: Tingling around the mouth suggests hypocalcemia from parathyroid injury. The
nurse should assess for Chvostek's and Trousseau's signs and prepare to administer calcium
gluconate. Oral calcium is not the priority for acute symptoms.
Q11. A nurse is teaching a client about preventing DVT postoperatively. Which instruction is
most important?
A. "Cross your legs when sitting."
B. "Perform ankle pumps every hour."
C. "Massage your calves daily."
D. "Stay in bed to rest."
Correct Answer: B. "Perform ankle pumps every hour."
Rationale: Ankle pumps promote venous return. Crossing legs, massaging calves (risk of
dislodging clot), and immobility increase DVT risk.
