ATI Medical-Surgical Proctored Exam Prep
Document 2026/2027 | Adult Health Nursing, Clinical
Judgment & NGN Medical-Surgical Review | 100
Verified Questions with Detailed Rationales
Foundations of Medical-Surgical Nursing
Q1: A 68-year-old patient is scheduled for an elective total knee replacement. During the preoperative
assessment, the nurse notes the patient takes warfarin 5 mg daily for atrial fibrillation. Which action by
the nurse is most appropriate?
A. Hold the warfarin on the morning of surgery and administer vitamin K as ordered
B. Continue the warfarin through the morning of surgery to prevent stroke
C. Hold the warfarin 5 days prior to surgery per the surgeon's protocol and document the last dose
taken [CORRECT]
D. Switch the patient to aspirin 81 mg daily until the day of surgery
Correct Answer: C
Rationale: The best answer is C. Warfarin has a long half-life and requires approximately 5 days to clear
from the system, so holding it before surgery reduces bleeding risk during the procedure. This aligns
with the standard of care which states that anticoagulants must be managed preoperatively to balance
thromboembolic risk against surgical bleeding risk. The nurse's role is to verify the last dose, document
it, and communicate with the surgical team about bridging therapy if needed.
Q2: During the immediate postoperative period, a patient who had abdominal surgery reports severe
pain at the incision site rated 9/10. The nurse notes the patient is guarding the abdomen and has
shallow respirations. Which nursing intervention takes priority?
A. Encourage the patient to use the incentive spirometer every hour
B. Administer the prescribed PRN opioid analgesic and reassess in 30 minutes [CORRECT]
C. Apply a warm compress to the incision site to promote comfort
D. Reposition the patient to a side-lying position to reduce tension on the incision
Correct Answer: B
Rationale: The best answer is B. Uncontrolled postoperative pain leads to shallow breathing, which
increases the risk of atelectasis and pneumonia—this is why pain management is a priority in the
,immediate post-op period. In clinical practice, we prioritize treating severe pain first so the patient can
then participate effectively in deep breathing, coughing, and mobilization. Once pain is controlled, the
other interventions become much more feasible.
Q3: A nurse is caring for a postoperative patient on the second day after a laparoscopic
cholecystectomy. The patient has not had a bowel movement since before surgery and reports mild
abdominal bloating. The patient's vital signs are stable, and bowel sounds are present in all four
quadrants. What is the nurse's best initial action?
A. Administer a Fleet enema to stimulate peristalsis
B. Encourage ambulation and increase oral fluid intake [CORRECT]
C. Contact the provider to request an abdominal X-ray
D. Place the patient on NPO status until bowel function returns
Correct Answer: B
Rationale: The best answer is B. Postoperative ileus is common after abdominal surgery and typically
resolves with conservative measures like early ambulation and adequate hydration. This choice is
correct because it addresses the underlying cause—decreased peristalsis from anesthesia and
immobility—without introducing unnecessary interventions. In clinical practice, we always start with the
least invasive approach when the patient is otherwise stable.
Q4: A patient is recovering from spinal surgery and is on strict bed rest with a flat bed position as
ordered. The nurse is performing a skin assessment and notes a reddened area on the patient's sacrum
that blanches with fingertip pressure. How should the nurse document this finding?
A. Stage 2 pressure injury with partial-thickness skin loss
B. Stage 1 pressure injury with non-blanchable erythema
C. Non-blanchable erythema indicating deep tissue pressure injury
D. Blanchable erythema at risk for pressure injury development [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Blanchable erythema means the skin is still intact and blood flow
returns when pressure is released—this is a warning sign, not an actual pressure injury. This aligns with
the standard of care which states that Stage 1 requires non-blanchable erythema. The nurse should
document the finding accurately and implement preventive measures immediately.
Q5: Which assessment finding in a postoperative patient who had general anesthesia 4 hours ago would
require the most immediate nursing intervention?
,A. Pain rated 6/10 at the surgical incision site
B. Oxygen saturation of 89% on room air with shallow respirations [CORRECT]
C. Urine output of 60 mL in the past 2 hours
D. Nausea with one episode of vomiting
Correct Answer: B
Rationale: The best answer is B. A SpO2 of 89% indicates significant hypoxemia, and shallow respirations
suggest the patient is not ventilating adequately—this is a life-threatening situation that demands
immediate action. In clinical practice, we prioritize airway and breathing over all other concerns because
hypoxia can rapidly lead to cardiac arrest or permanent organ damage. The nurse should apply
supplemental oxygen, stimulate deep breathing, and notify the provider.
Q6: A nurse is reviewing discharge instructions with a patient who had a total hip arthroplasty. Which
statement by the patient indicates a need for further teaching?
A. "I will use a raised toilet seat for the first 6 weeks after surgery."
B. "I can cross my legs at the knee when sitting in a chair." [CORRECT]
C. "I will avoid bending forward more than 90 degrees at the hip."
D. "I will sleep with a pillow between my legs to keep my hips aligned."
Correct Answer: B
Rationale: The best answer is B. Crossing the legs at the knee after total hip arthroplasty places the hip
in adduction and internal rotation, which risks hip dislocation—this is a critical hip precaution violation.
This choice is correct because it represents a dangerous misunderstanding of postoperative restrictions.
The nurse needs to re-educate the patient on all hip precautions before discharge.
Q7: A patient is receiving morphine via patient-controlled analgesia (PCA) pump after major abdominal
surgery. The nurse notes the patient has pressed the button 8 times in the past hour but reports pain
still at 7/10. Respiratory rate is 14, SpO2 is 92% on 2L nasal cannula. What is the nurse's best next
action?
A. Increase the basal rate on the PCA pump by 50%
B. Assess the patient's pain more thoroughly and notify the provider [CORRECT]
C. Discontinue the PCA and switch to oral oxycodone
D. Administer a PRN dose of naloxone as a precaution
Correct Answer: B
Rationale: The best answer is B. Frequent PCA dosing with inadequate pain relief suggests either
insufficient dosing, tolerance, or a complication like compartment syndrome or internal bleeding. This
aligns with the standard of care which states that uncontrolled pain despite appropriate dosing requires
reassessment and provider notification. The nurse should do a thorough pain assessment, check the
, surgical site, and communicate findings to the provider for possible dose adjustment or alternative
analgesia.
Q8: During a preoperative assessment, a patient states they have sleep apnea and use a CPAP machine
at home. The patient is scheduled for surgery under general anesthesia. Which nursing action is most
important?
A. Document the sleep apnea and plan to use the CPAP in the post-anesthesia care unit [CORRECT]
B. Advise the patient to skip CPAP use the night before surgery to avoid airway complications
C. Request that the anesthesiologist avoid intubation to preserve the patient's airway
D. Place the patient in a supine position for surgery to maintain airway patency
Correct Answer: A
Rationale: The best answer is A. Patients with obstructive sleep apnea have increased risk of airway
obstruction and respiratory depression postoperatively, especially after general anesthesia. In clinical
practice, we prioritize ensuring CPAP availability and use in the PACU and throughout the hospital stay
to maintain airway patency. The anesthesiologist also needs this information to plan safe airway
management.
Q9: A nurse is caring for a patient on the first postoperative day after a total abdominal hysterectomy.
The patient has a Jackson-Pratt drain in place with 45 mL of serosanguineous output in the past 8 hours.
The patient's abdomen is soft and non-distended. Which nursing action is appropriate?
A. Irrigate the drain with sterile normal saline to maintain patency
B. Document the output and continue routine monitoring [CORRECT]
C. Notify the surgeon immediately because the output is excessive
D. Remove the drain since the output has decreased significantly
Correct Answer: B
Rationale: The best answer is B. Serosanguineous drainage of 45 mL in 8 hours is within normal limits for
a postoperative JP drain, and a soft, non-distended abdomen indicates no internal bleeding or fluid
accumulation. This choice is correct because it reflects appropriate assessment without unnecessary
intervention. The nurse should continue to monitor output characteristics, amount, and trends.
Q10: A patient is being prepared for discharge after an appendectomy performed 24 hours ago via
laparoscopic approach. The patient asks when they can return to work as a construction laborer. What is
the nurse's best response?
Document 2026/2027 | Adult Health Nursing, Clinical
Judgment & NGN Medical-Surgical Review | 100
Verified Questions with Detailed Rationales
Foundations of Medical-Surgical Nursing
Q1: A 68-year-old patient is scheduled for an elective total knee replacement. During the preoperative
assessment, the nurse notes the patient takes warfarin 5 mg daily for atrial fibrillation. Which action by
the nurse is most appropriate?
A. Hold the warfarin on the morning of surgery and administer vitamin K as ordered
B. Continue the warfarin through the morning of surgery to prevent stroke
C. Hold the warfarin 5 days prior to surgery per the surgeon's protocol and document the last dose
taken [CORRECT]
D. Switch the patient to aspirin 81 mg daily until the day of surgery
Correct Answer: C
Rationale: The best answer is C. Warfarin has a long half-life and requires approximately 5 days to clear
from the system, so holding it before surgery reduces bleeding risk during the procedure. This aligns
with the standard of care which states that anticoagulants must be managed preoperatively to balance
thromboembolic risk against surgical bleeding risk. The nurse's role is to verify the last dose, document
it, and communicate with the surgical team about bridging therapy if needed.
Q2: During the immediate postoperative period, a patient who had abdominal surgery reports severe
pain at the incision site rated 9/10. The nurse notes the patient is guarding the abdomen and has
shallow respirations. Which nursing intervention takes priority?
A. Encourage the patient to use the incentive spirometer every hour
B. Administer the prescribed PRN opioid analgesic and reassess in 30 minutes [CORRECT]
C. Apply a warm compress to the incision site to promote comfort
D. Reposition the patient to a side-lying position to reduce tension on the incision
Correct Answer: B
Rationale: The best answer is B. Uncontrolled postoperative pain leads to shallow breathing, which
increases the risk of atelectasis and pneumonia—this is why pain management is a priority in the
,immediate post-op period. In clinical practice, we prioritize treating severe pain first so the patient can
then participate effectively in deep breathing, coughing, and mobilization. Once pain is controlled, the
other interventions become much more feasible.
Q3: A nurse is caring for a postoperative patient on the second day after a laparoscopic
cholecystectomy. The patient has not had a bowel movement since before surgery and reports mild
abdominal bloating. The patient's vital signs are stable, and bowel sounds are present in all four
quadrants. What is the nurse's best initial action?
A. Administer a Fleet enema to stimulate peristalsis
B. Encourage ambulation and increase oral fluid intake [CORRECT]
C. Contact the provider to request an abdominal X-ray
D. Place the patient on NPO status until bowel function returns
Correct Answer: B
Rationale: The best answer is B. Postoperative ileus is common after abdominal surgery and typically
resolves with conservative measures like early ambulation and adequate hydration. This choice is
correct because it addresses the underlying cause—decreased peristalsis from anesthesia and
immobility—without introducing unnecessary interventions. In clinical practice, we always start with the
least invasive approach when the patient is otherwise stable.
Q4: A patient is recovering from spinal surgery and is on strict bed rest with a flat bed position as
ordered. The nurse is performing a skin assessment and notes a reddened area on the patient's sacrum
that blanches with fingertip pressure. How should the nurse document this finding?
A. Stage 2 pressure injury with partial-thickness skin loss
B. Stage 1 pressure injury with non-blanchable erythema
C. Non-blanchable erythema indicating deep tissue pressure injury
D. Blanchable erythema at risk for pressure injury development [CORRECT]
Correct Answer: D
Rationale: The best answer is D. Blanchable erythema means the skin is still intact and blood flow
returns when pressure is released—this is a warning sign, not an actual pressure injury. This aligns with
the standard of care which states that Stage 1 requires non-blanchable erythema. The nurse should
document the finding accurately and implement preventive measures immediately.
Q5: Which assessment finding in a postoperative patient who had general anesthesia 4 hours ago would
require the most immediate nursing intervention?
,A. Pain rated 6/10 at the surgical incision site
B. Oxygen saturation of 89% on room air with shallow respirations [CORRECT]
C. Urine output of 60 mL in the past 2 hours
D. Nausea with one episode of vomiting
Correct Answer: B
Rationale: The best answer is B. A SpO2 of 89% indicates significant hypoxemia, and shallow respirations
suggest the patient is not ventilating adequately—this is a life-threatening situation that demands
immediate action. In clinical practice, we prioritize airway and breathing over all other concerns because
hypoxia can rapidly lead to cardiac arrest or permanent organ damage. The nurse should apply
supplemental oxygen, stimulate deep breathing, and notify the provider.
Q6: A nurse is reviewing discharge instructions with a patient who had a total hip arthroplasty. Which
statement by the patient indicates a need for further teaching?
A. "I will use a raised toilet seat for the first 6 weeks after surgery."
B. "I can cross my legs at the knee when sitting in a chair." [CORRECT]
C. "I will avoid bending forward more than 90 degrees at the hip."
D. "I will sleep with a pillow between my legs to keep my hips aligned."
Correct Answer: B
Rationale: The best answer is B. Crossing the legs at the knee after total hip arthroplasty places the hip
in adduction and internal rotation, which risks hip dislocation—this is a critical hip precaution violation.
This choice is correct because it represents a dangerous misunderstanding of postoperative restrictions.
The nurse needs to re-educate the patient on all hip precautions before discharge.
Q7: A patient is receiving morphine via patient-controlled analgesia (PCA) pump after major abdominal
surgery. The nurse notes the patient has pressed the button 8 times in the past hour but reports pain
still at 7/10. Respiratory rate is 14, SpO2 is 92% on 2L nasal cannula. What is the nurse's best next
action?
A. Increase the basal rate on the PCA pump by 50%
B. Assess the patient's pain more thoroughly and notify the provider [CORRECT]
C. Discontinue the PCA and switch to oral oxycodone
D. Administer a PRN dose of naloxone as a precaution
Correct Answer: B
Rationale: The best answer is B. Frequent PCA dosing with inadequate pain relief suggests either
insufficient dosing, tolerance, or a complication like compartment syndrome or internal bleeding. This
aligns with the standard of care which states that uncontrolled pain despite appropriate dosing requires
reassessment and provider notification. The nurse should do a thorough pain assessment, check the
, surgical site, and communicate findings to the provider for possible dose adjustment or alternative
analgesia.
Q8: During a preoperative assessment, a patient states they have sleep apnea and use a CPAP machine
at home. The patient is scheduled for surgery under general anesthesia. Which nursing action is most
important?
A. Document the sleep apnea and plan to use the CPAP in the post-anesthesia care unit [CORRECT]
B. Advise the patient to skip CPAP use the night before surgery to avoid airway complications
C. Request that the anesthesiologist avoid intubation to preserve the patient's airway
D. Place the patient in a supine position for surgery to maintain airway patency
Correct Answer: A
Rationale: The best answer is A. Patients with obstructive sleep apnea have increased risk of airway
obstruction and respiratory depression postoperatively, especially after general anesthesia. In clinical
practice, we prioritize ensuring CPAP availability and use in the PACU and throughout the hospital stay
to maintain airway patency. The anesthesiologist also needs this information to plan safe airway
management.
Q9: A nurse is caring for a patient on the first postoperative day after a total abdominal hysterectomy.
The patient has a Jackson-Pratt drain in place with 45 mL of serosanguineous output in the past 8 hours.
The patient's abdomen is soft and non-distended. Which nursing action is appropriate?
A. Irrigate the drain with sterile normal saline to maintain patency
B. Document the output and continue routine monitoring [CORRECT]
C. Notify the surgeon immediately because the output is excessive
D. Remove the drain since the output has decreased significantly
Correct Answer: B
Rationale: The best answer is B. Serosanguineous drainage of 45 mL in 8 hours is within normal limits for
a postoperative JP drain, and a soft, non-distended abdomen indicates no internal bleeding or fluid
accumulation. This choice is correct because it reflects appropriate assessment without unnecessary
intervention. The nurse should continue to monitor output characteristics, amount, and trends.
Q10: A patient is being prepared for discharge after an appendectomy performed 24 hours ago via
laparoscopic approach. The patient asks when they can return to work as a construction laborer. What is
the nurse's best response?
