RN Adult Medical Surgical 2026
Proctored Exam Bundle- All
Passing Versions
SECTION I — PERIOPERATIVE NURSING
1. A client is scheduled for surgery in 2 hours and reports eating a full breakfast. Which action
should the nurse take first?
A. Document the finding and proceed with prep
B. Notify the surgeon and anesthesia provider immediately
C. Administer preoperative antibiotics as ordered
D. Reassure the client that breakfast is acceptable
Correct: B
Rationale: NPO status is critical for preventing aspiration during anesthesia. Any breach
must be reported immediately so the case can be delayed or cancelled. Documentation alone
(A) delays safety. Antibiotics (C) don't address aspiration risk. Reassurance (D) is false.
2. Which findings indicate the client is ready for discharge from the PACU? SATA
A. Aldrete score of 9
B. Oxygen saturation 88% on room air
C. Awake and oriented
D. Systolic BP within 20% of baseline
E. Urine output 10 mL/hr
F. No active bleeding
Correct: A, C, D, F
Rationale: Discharge criteria include adequate oxygenation, orientation, stable vital signs,
and hemostasis. SpO₂ 88% (B) and urine output 10 mL/hr (E) are below acceptable thresholds.
,3. A postoperative client has a body temperature of 102.4°F (39.1°C) on POD 2 with tachycardia
and hypotension. Which complication should the nurse suspect?
A. Malignant hyperthermia
B. Atelectasis
C. Sepsis
D. Pulmonary embolism
Correct: C
Rationale: Fever with tachycardia and hypotension on POD 2 suggests sepsis. Malignant
hyperthermia (A) occurs intraoperatively with rigidity and hypercarbia. Atelectasis (B) causes
low-grade fever. PE (D) presents with dyspnea, pleuritic pain, and tachycardia without high
fever.
4. A client is 6 hours postoperative from an open cholecystectomy. Which assessment finding
requires immediate intervention?
A. Serosanguineous drainage on the dressing
B. Blood pressure 88/52 with heart rate 122
C. Pain rated 6/10 at the incision
D. Temperature 99.8°F (37.7°C)
Correct: B
Rationale: Hypotension with tachycardia suggests hypovolemic shock from hemorrhage. The
other findings are expected postoperatively.
5. The nurse is teaching a client about preventing DVT after total hip arthroplasty. Which
statements indicate understanding? SATA
A. "I will cross my legs when sitting."
B. "I will use the incentive spirometer every hour."
C. "I will take my enoxaparin as prescribed."
D. "I will perform ankle pumps frequently."
E. "I will massage my calves daily."
F. "I will drink plenty of fluids."
, Correct: B, C, D, F
Rationale: Leg crossing (A) impedes venous return. Calf massage (E) can dislodge a
thrombus.
6. Which client is at highest risk for malignant hyperthermia during surgery?
A. Client with a history of asthma
B. Client with a family history of malignant hyperthermia
C. Client taking beta-blockers
D. Client with diabetes mellitus
Correct: B
Rationale: Malignant hyperthermia is an autosomal dominant genetic disorder triggered by
volatile anesthetics and succinylcholine. Family history is the strongest risk factor.
7. A client is being prepared for surgery and asks why he must stop taking warfarin. What is the
best response?
A. "It can cause high blood pressure during surgery."
B. "It increases your risk of bleeding during and after surgery."
C. "It interferes with anesthesia."
D. "It can cause an allergic reaction."
Correct: B
Rationale: Anticoagulants increase intraoperative and postoperative bleeding risk. Warfarin
is typically held 5 days preoperatively.
8. The nurse receives a client from surgery with a Jackson-Pratt drain. Which action is correct?
A. Empty and recompress the drain every shift
B. Irrigate the drain with normal saline
C. Clamp the drain between shifts
D. Keep the drain below the insertion site without compression
Correct: A
Rationale: JP drains must be emptied and recompressed to maintain suction. Irrigation (B)
and clamping (C) are incorrect. Compression is required (D).
, 9. A client reports nausea and vomiting 4 hours after surgery. Which action should the nurse
take first?
A. Administer an antiemetic as ordered
B. Position the client on the side
C. Assess the client's airway and vital signs
D. Notify the surgeon
Correct: C
Rationale: Airway is always the priority. Assessment precedes intervention. Turning the
client to the side (B) is part of airway management but assessment comes first.
10. A postoperative client has not voided 8 hours after surgery. Which action should the nurse
take first?
A. Insert an indwelling catheter
B. Palpate the bladder and assist to the bathroom
C. Administer a diuretic
D. Encourage oral fluids only
Correct: B
Rationale: The least invasive intervention first — assess for bladder distention and attempt
natural voiding. Catheterization (A) is reserved for retention.
11. Which preoperative teaching is most important for a client undergoing abdominal surgery?
A. "You will be on bed rest for 3 days."
B. "Splint your incision with a pillow when coughing."
C. "Avoid all movement for 24 hours."
D. "You may eat immediately after surgery."
Correct: B
Rationale: Splinting reduces incisional pain and dehiscence risk during coughing and deep
breathing.
Proctored Exam Bundle- All
Passing Versions
SECTION I — PERIOPERATIVE NURSING
1. A client is scheduled for surgery in 2 hours and reports eating a full breakfast. Which action
should the nurse take first?
A. Document the finding and proceed with prep
B. Notify the surgeon and anesthesia provider immediately
C. Administer preoperative antibiotics as ordered
D. Reassure the client that breakfast is acceptable
Correct: B
Rationale: NPO status is critical for preventing aspiration during anesthesia. Any breach
must be reported immediately so the case can be delayed or cancelled. Documentation alone
(A) delays safety. Antibiotics (C) don't address aspiration risk. Reassurance (D) is false.
2. Which findings indicate the client is ready for discharge from the PACU? SATA
A. Aldrete score of 9
B. Oxygen saturation 88% on room air
C. Awake and oriented
D. Systolic BP within 20% of baseline
E. Urine output 10 mL/hr
F. No active bleeding
Correct: A, C, D, F
Rationale: Discharge criteria include adequate oxygenation, orientation, stable vital signs,
and hemostasis. SpO₂ 88% (B) and urine output 10 mL/hr (E) are below acceptable thresholds.
,3. A postoperative client has a body temperature of 102.4°F (39.1°C) on POD 2 with tachycardia
and hypotension. Which complication should the nurse suspect?
A. Malignant hyperthermia
B. Atelectasis
C. Sepsis
D. Pulmonary embolism
Correct: C
Rationale: Fever with tachycardia and hypotension on POD 2 suggests sepsis. Malignant
hyperthermia (A) occurs intraoperatively with rigidity and hypercarbia. Atelectasis (B) causes
low-grade fever. PE (D) presents with dyspnea, pleuritic pain, and tachycardia without high
fever.
4. A client is 6 hours postoperative from an open cholecystectomy. Which assessment finding
requires immediate intervention?
A. Serosanguineous drainage on the dressing
B. Blood pressure 88/52 with heart rate 122
C. Pain rated 6/10 at the incision
D. Temperature 99.8°F (37.7°C)
Correct: B
Rationale: Hypotension with tachycardia suggests hypovolemic shock from hemorrhage. The
other findings are expected postoperatively.
5. The nurse is teaching a client about preventing DVT after total hip arthroplasty. Which
statements indicate understanding? SATA
A. "I will cross my legs when sitting."
B. "I will use the incentive spirometer every hour."
C. "I will take my enoxaparin as prescribed."
D. "I will perform ankle pumps frequently."
E. "I will massage my calves daily."
F. "I will drink plenty of fluids."
, Correct: B, C, D, F
Rationale: Leg crossing (A) impedes venous return. Calf massage (E) can dislodge a
thrombus.
6. Which client is at highest risk for malignant hyperthermia during surgery?
A. Client with a history of asthma
B. Client with a family history of malignant hyperthermia
C. Client taking beta-blockers
D. Client with diabetes mellitus
Correct: B
Rationale: Malignant hyperthermia is an autosomal dominant genetic disorder triggered by
volatile anesthetics and succinylcholine. Family history is the strongest risk factor.
7. A client is being prepared for surgery and asks why he must stop taking warfarin. What is the
best response?
A. "It can cause high blood pressure during surgery."
B. "It increases your risk of bleeding during and after surgery."
C. "It interferes with anesthesia."
D. "It can cause an allergic reaction."
Correct: B
Rationale: Anticoagulants increase intraoperative and postoperative bleeding risk. Warfarin
is typically held 5 days preoperatively.
8. The nurse receives a client from surgery with a Jackson-Pratt drain. Which action is correct?
A. Empty and recompress the drain every shift
B. Irrigate the drain with normal saline
C. Clamp the drain between shifts
D. Keep the drain below the insertion site without compression
Correct: A
Rationale: JP drains must be emptied and recompressed to maintain suction. Irrigation (B)
and clamping (C) are incorrect. Compression is required (D).
, 9. A client reports nausea and vomiting 4 hours after surgery. Which action should the nurse
take first?
A. Administer an antiemetic as ordered
B. Position the client on the side
C. Assess the client's airway and vital signs
D. Notify the surgeon
Correct: C
Rationale: Airway is always the priority. Assessment precedes intervention. Turning the
client to the side (B) is part of airway management but assessment comes first.
10. A postoperative client has not voided 8 hours after surgery. Which action should the nurse
take first?
A. Insert an indwelling catheter
B. Palpate the bladder and assist to the bathroom
C. Administer a diuretic
D. Encourage oral fluids only
Correct: B
Rationale: The least invasive intervention first — assess for bladder distention and attempt
natural voiding. Catheterization (A) is reserved for retention.
11. Which preoperative teaching is most important for a client undergoing abdominal surgery?
A. "You will be on bed rest for 3 days."
B. "Splint your incision with a pillow when coughing."
C. "Avoid all movement for 24 hours."
D. "You may eat immediately after surgery."
Correct: B
Rationale: Splinting reduces incisional pain and dehiscence risk during coughing and deep
breathing.
