ATI Med-Surg Proctored Exam (NGN) (10 New
Versions, 2023/2024) and Correct Q and A
SECTION I: PERIOPERATIVE CARE & SURGICAL NURSING
1. A nurse is caring for a client immediately following a laparoscopic
cholecystectomy. Which assessment finding requires immediate intervention?
A. Scant serosanguineous drainage on the dressing
B. Report of right shoulder pain
C. Respiratory rate of 28/min with shallow breathing
D. Abdominal distention with absent bowel sounds
Correct Answer: C
Rationale: A respiratory rate of 28/min with shallow breathing indicates
possible respiratory depression or splinting, which can lead to atelectasis and
hypoxia—this is the priority. Shoulder pain (B) is expected from CO₂ insufflation.
Scant drainage (A) is normal. Absent bowel sounds (D) are expected immediately
post-op.
2. A client is scheduled for surgery in 2 hours. The nurse notices the consent
form is signed but the client states, "I don't really understand what they're
doing." What is the nurse's priority action?
A. Have the client sign a new consent form
B. Notify the surgeon to explain the procedure
C. Witness the consent and proceed with surgery
D. Document the client's statement and continue preparation
Correct Answer: B
Rationale: Informed consent requires the client to understand the procedure.
The nurse's role is to witness the signature, not to explain the surgery. The
,surgeon must provide education. Proceeding without understanding is a legal
violation.
3. A nurse is teaching a client about preventing postoperative complications.
Which instructions should the nurse include? (SATA)
A. "Splint your incision when coughing."
B. "Use an incentive spirometer every 1–2 hours while awake."
C. "Remain on bed rest for the first 48 hours."
D. "Perform leg exercises every hour while awake."
E. "Drink at least 2–3 liters of fluid daily unless contraindicated."
Correct Answers: A, B, D, E
Rationale: Splinting reduces pain and prevents dehiscence. Incentive
spirometry prevents atelectasis. Leg exercises prevent DVT. Adequate hydration
prevents constipation and supports healing. Bed rest (C) is incorrect—early
ambulation is encouraged.
4. A client who had major abdominal surgery 12 hours ago has a blood pressure
of 88/56 mm Hg, heart rate 122/min, and urine output of 15 mL/hr. Which
complication should the nurse suspect?
A. Infection
B. Hemorrhage
C. Atelectasis
D. Paralytic ileus
Correct Answer: B
Rationale: Hypotension, tachycardia, and oliguria indicate hypovolemic shock,
likely from postoperative hemorrhage. Infection (A) would present with fever.
Atelectasis (C) causes respiratory symptoms. Ileus (D) causes abdominal distention
and nausea.
,5. A nurse is preparing a client for emergency surgery. Which finding places the
client at highest risk for surgical complications?
A. BMI of 32
B. History of smoking
C. International Normalized Ratio (INR) of 2.8
D. Age 72
Correct Answer: C
Rationale: An INR of 2.8 indicates increased bleeding risk, which is critical for
emergency surgery. Obesity (A), smoking (B), and age (D) increase risk but are not
immediately life-threatening.
6. A postoperative client reports a "popping" sensation in the incision and the
nurse observes wound edges separating with bowel visible. What is the priority
action?
A. Apply a sterile dressing soaked in sterile saline
B. Push the bowel back into place
C. Notify the surgeon and cover the wound with a sterile dressing
D. Place the client in high-Fowler's position
Correct Answer: C
Rationale: This is wound evisceration. The nurse should cover the wound with
a sterile saline-soaked dressing and notify the surgeon immediately. Never push
organs back (B). Position in low-Fowler's with knees bent to reduce tension (D is
wrong).
7. A nurse is assessing a client in the PACU. Which finding indicates the client is
ready for discharge from Phase I PACU?
, A. Aldrete score of 7
B. Aldrete score of 9
C. Aldrete score of 5
D. Aldrete score of 3
Correct Answer: B
Rationale: An Aldrete score of 9–10 indicates readiness for Phase II discharge.
Scores below 8 require continued Phase I monitoring.
8. A client is 24 hours post-op from a total hip replacement. Which action should
the nurse include in the plan of care?
A. Place a pillow between the legs when turning
B. Keep the affected hip flexed at 90 degrees
C. Avoid using an abduction pillow
D. Encourage crossing the legs for comfort
Correct Answer: A
Rationale: An abduction pillow or regular pillow between the legs prevents
hip dislocation. Hip flexion beyond 90 degrees (B), crossing legs (D), and not using
an abduction device (C) increase dislocation risk.
9. A nurse is monitoring a client receiving moderate sedation for a colonoscopy.
Which finding requires immediate intervention?
A. Heart rate of 88/min
B. Oxygen saturation of 84%
C. Blood pressure of 110/70 mm Hg
D. Respiratory rate of 14/min
Correct Answer: B
Rationale: SpO₂ of 84% indicates hypoxemia and requires immediate
Versions, 2023/2024) and Correct Q and A
SECTION I: PERIOPERATIVE CARE & SURGICAL NURSING
1. A nurse is caring for a client immediately following a laparoscopic
cholecystectomy. Which assessment finding requires immediate intervention?
A. Scant serosanguineous drainage on the dressing
B. Report of right shoulder pain
C. Respiratory rate of 28/min with shallow breathing
D. Abdominal distention with absent bowel sounds
Correct Answer: C
Rationale: A respiratory rate of 28/min with shallow breathing indicates
possible respiratory depression or splinting, which can lead to atelectasis and
hypoxia—this is the priority. Shoulder pain (B) is expected from CO₂ insufflation.
Scant drainage (A) is normal. Absent bowel sounds (D) are expected immediately
post-op.
2. A client is scheduled for surgery in 2 hours. The nurse notices the consent
form is signed but the client states, "I don't really understand what they're
doing." What is the nurse's priority action?
A. Have the client sign a new consent form
B. Notify the surgeon to explain the procedure
C. Witness the consent and proceed with surgery
D. Document the client's statement and continue preparation
Correct Answer: B
Rationale: Informed consent requires the client to understand the procedure.
The nurse's role is to witness the signature, not to explain the surgery. The
,surgeon must provide education. Proceeding without understanding is a legal
violation.
3. A nurse is teaching a client about preventing postoperative complications.
Which instructions should the nurse include? (SATA)
A. "Splint your incision when coughing."
B. "Use an incentive spirometer every 1–2 hours while awake."
C. "Remain on bed rest for the first 48 hours."
D. "Perform leg exercises every hour while awake."
E. "Drink at least 2–3 liters of fluid daily unless contraindicated."
Correct Answers: A, B, D, E
Rationale: Splinting reduces pain and prevents dehiscence. Incentive
spirometry prevents atelectasis. Leg exercises prevent DVT. Adequate hydration
prevents constipation and supports healing. Bed rest (C) is incorrect—early
ambulation is encouraged.
4. A client who had major abdominal surgery 12 hours ago has a blood pressure
of 88/56 mm Hg, heart rate 122/min, and urine output of 15 mL/hr. Which
complication should the nurse suspect?
A. Infection
B. Hemorrhage
C. Atelectasis
D. Paralytic ileus
Correct Answer: B
Rationale: Hypotension, tachycardia, and oliguria indicate hypovolemic shock,
likely from postoperative hemorrhage. Infection (A) would present with fever.
Atelectasis (C) causes respiratory symptoms. Ileus (D) causes abdominal distention
and nausea.
,5. A nurse is preparing a client for emergency surgery. Which finding places the
client at highest risk for surgical complications?
A. BMI of 32
B. History of smoking
C. International Normalized Ratio (INR) of 2.8
D. Age 72
Correct Answer: C
Rationale: An INR of 2.8 indicates increased bleeding risk, which is critical for
emergency surgery. Obesity (A), smoking (B), and age (D) increase risk but are not
immediately life-threatening.
6. A postoperative client reports a "popping" sensation in the incision and the
nurse observes wound edges separating with bowel visible. What is the priority
action?
A. Apply a sterile dressing soaked in sterile saline
B. Push the bowel back into place
C. Notify the surgeon and cover the wound with a sterile dressing
D. Place the client in high-Fowler's position
Correct Answer: C
Rationale: This is wound evisceration. The nurse should cover the wound with
a sterile saline-soaked dressing and notify the surgeon immediately. Never push
organs back (B). Position in low-Fowler's with knees bent to reduce tension (D is
wrong).
7. A nurse is assessing a client in the PACU. Which finding indicates the client is
ready for discharge from Phase I PACU?
, A. Aldrete score of 7
B. Aldrete score of 9
C. Aldrete score of 5
D. Aldrete score of 3
Correct Answer: B
Rationale: An Aldrete score of 9–10 indicates readiness for Phase II discharge.
Scores below 8 require continued Phase I monitoring.
8. A client is 24 hours post-op from a total hip replacement. Which action should
the nurse include in the plan of care?
A. Place a pillow between the legs when turning
B. Keep the affected hip flexed at 90 degrees
C. Avoid using an abduction pillow
D. Encourage crossing the legs for comfort
Correct Answer: A
Rationale: An abduction pillow or regular pillow between the legs prevents
hip dislocation. Hip flexion beyond 90 degrees (B), crossing legs (D), and not using
an abduction device (C) increase dislocation risk.
9. A nurse is monitoring a client receiving moderate sedation for a colonoscopy.
Which finding requires immediate intervention?
A. Heart rate of 88/min
B. Oxygen saturation of 84%
C. Blood pressure of 110/70 mm Hg
D. Respiratory rate of 14/min
Correct Answer: B
Rationale: SpO₂ of 84% indicates hypoxemia and requires immediate
