ATI RN Adult Medical Surgical 2026
Proctored Exam: The Ultimate -
Question Practice Test Bank with
Detailed Rationales
Q1: A 68-year-old patient scheduled for elective total knee
replacement takes warfarin 5 mg daily for atrial fibrillation. Which
action by the nurse is most appropriate?
A. Hold warfarin on the morning of surgery and administer vitamin K as
ordered
B. Continue warfarin through the morning of surgery to prevent stroke
C. Hold warfarin 5 days prior to surgery per the surgeon's protocol and
document the last dose taken
D. Switch the patient to aspirin 81 mg daily until the day of surgery
Answer: C
Rationale: Warfarin has a long half-life and requires approximately 5 days
to clear from the system. Holding it before surgery reduces bleeding risk
during the procedure. The nurse should 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 use of incentive spirometry every hour
B. Administer the prescribed PRN opioid analgesic and reassess in 30
minutes
C. Apply a warm compress to the incision site
D. Reposition the patient to a side-lying position
Answer: B
Rationale: Uncontrolled postoperative pain leads to shallow breathing,
increasing the risk of atelectasis and pneumonia. Pain management is the
priority so the patient can then participate effectively in deep breathing,
coughing, and mobilization.
Q3: A postoperative patient on day 2 after laparoscopic
cholecystectomy has not had a bowel movement and reports mild
abdominal bloating. Vital signs are stable, and bowel sounds are
present. What is the nurse's best initial action?
A. Administer a Fleet enema
B. Encourage ambulation and increase oral fluid intake
C. Contact the provider for an abdominal X-ray
D. Place the patient on NPO status
Answer: B
Rationale: Postoperative ileus is common after abdominal surgery and
typically resolves with conservative measures like early ambulation and
adequate hydration. This addresses the underlying cause—decreased
,peristalsis from anesthesia and immobility—without unnecessary
interventions.
Q4: A patient recovering from spinal surgery on strict bed rest has a
reddened area on the 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
Answer: D
Rationale: Blanchable erythema means the skin is intact and blood flow
returns when pressure is released—this is a warning sign, not an actual
pressure injury. Stage 1 requires non-blanchable erythema. The nurse
should document accurately and implement preventive measures
immediately.
Q5: In what order should the nurse open a sterile package?
A. Closest flap, side flaps, farthest flap
B. Side flaps, closest flap, farthest flap
C. Farthest flap, side flaps, then closest flap
D. Right side, left side, closest flap
Answer: C
Rationale: The sterile package should be opened by unfolding the flap
, farthest from the body first, followed by the side flaps, and finally the flap
closest to the body. This technique prevents the nurse's arms and body
from reaching over the sterile field, reducing contamination risk.
Q6: A nurse is wearing sterile gloves for a sterile procedure. Which
objects can the nurse touch without breaking sterile technique? (Select
all that apply)
A. Bottle containing sterile solution
B. Edge of sterile drape at the base of the field
C. Inner wrapping of an item on the sterile field
D. Irrigation syringe on the sterile field
E. One gloved hand with the other gloved hand
Answer: C, D, E
Rationale: The nurse can touch the inner wrapping of a sterile item (1 inch
border is considered sterile), sterile instruments on the field, and one sterile
gloved hand with the other sterile gloved hand. The bottle is not sterile,
and the outer 1-inch border of the sterile drape is considered
contaminated.
Q7: A nurse has prepared a sterile field for a chest tube insertion.
Which events should the nurse recognize as contaminating the field?
(Select all that apply)
A. Provider drops a sterile instrument onto the near side of the sterile field
B. Nurse moistens a cotton ball with sterile normal saline and places it on
Proctored Exam: The Ultimate -
Question Practice Test Bank with
Detailed Rationales
Q1: A 68-year-old patient scheduled for elective total knee
replacement takes warfarin 5 mg daily for atrial fibrillation. Which
action by the nurse is most appropriate?
A. Hold warfarin on the morning of surgery and administer vitamin K as
ordered
B. Continue warfarin through the morning of surgery to prevent stroke
C. Hold warfarin 5 days prior to surgery per the surgeon's protocol and
document the last dose taken
D. Switch the patient to aspirin 81 mg daily until the day of surgery
Answer: C
Rationale: Warfarin has a long half-life and requires approximately 5 days
to clear from the system. Holding it before surgery reduces bleeding risk
during the procedure. The nurse should 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 use of incentive spirometry every hour
B. Administer the prescribed PRN opioid analgesic and reassess in 30
minutes
C. Apply a warm compress to the incision site
D. Reposition the patient to a side-lying position
Answer: B
Rationale: Uncontrolled postoperative pain leads to shallow breathing,
increasing the risk of atelectasis and pneumonia. Pain management is the
priority so the patient can then participate effectively in deep breathing,
coughing, and mobilization.
Q3: A postoperative patient on day 2 after laparoscopic
cholecystectomy has not had a bowel movement and reports mild
abdominal bloating. Vital signs are stable, and bowel sounds are
present. What is the nurse's best initial action?
A. Administer a Fleet enema
B. Encourage ambulation and increase oral fluid intake
C. Contact the provider for an abdominal X-ray
D. Place the patient on NPO status
Answer: B
Rationale: Postoperative ileus is common after abdominal surgery and
typically resolves with conservative measures like early ambulation and
adequate hydration. This addresses the underlying cause—decreased
,peristalsis from anesthesia and immobility—without unnecessary
interventions.
Q4: A patient recovering from spinal surgery on strict bed rest has a
reddened area on the 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
Answer: D
Rationale: Blanchable erythema means the skin is intact and blood flow
returns when pressure is released—this is a warning sign, not an actual
pressure injury. Stage 1 requires non-blanchable erythema. The nurse
should document accurately and implement preventive measures
immediately.
Q5: In what order should the nurse open a sterile package?
A. Closest flap, side flaps, farthest flap
B. Side flaps, closest flap, farthest flap
C. Farthest flap, side flaps, then closest flap
D. Right side, left side, closest flap
Answer: C
Rationale: The sterile package should be opened by unfolding the flap
, farthest from the body first, followed by the side flaps, and finally the flap
closest to the body. This technique prevents the nurse's arms and body
from reaching over the sterile field, reducing contamination risk.
Q6: A nurse is wearing sterile gloves for a sterile procedure. Which
objects can the nurse touch without breaking sterile technique? (Select
all that apply)
A. Bottle containing sterile solution
B. Edge of sterile drape at the base of the field
C. Inner wrapping of an item on the sterile field
D. Irrigation syringe on the sterile field
E. One gloved hand with the other gloved hand
Answer: C, D, E
Rationale: The nurse can touch the inner wrapping of a sterile item (1 inch
border is considered sterile), sterile instruments on the field, and one sterile
gloved hand with the other sterile gloved hand. The bottle is not sterile,
and the outer 1-inch border of the sterile drape is considered
contaminated.
Q7: A nurse has prepared a sterile field for a chest tube insertion.
Which events should the nurse recognize as contaminating the field?
(Select all that apply)
A. Provider drops a sterile instrument onto the near side of the sterile field
B. Nurse moistens a cotton ball with sterile normal saline and places it on
