1
ATI RN Medical-Surgical Proctored Exam Actual
Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
[Perioperative & Postoperative Care]
Q1: The nurse is preparing a patient for abdominal surgery scheduled for tomorrow morning.
Which statement by the patient indicates a need for further teaching regarding preoperative
instructions?
A. "I will not eat or drink anything after midnight tonight."
B. "I should take my usual blood pressure medication with a sip of water early in the morning."
C. "I need to remove my nail polish and makeup before surgery."
D. "I will bring my hearing aids with me to the operating room."
Correct Answer: A
Rationale: While NPO status is standard, specific fasting times depend on the facility's protocol
and the type of anesthesia; clear liquids are often permitted up to 2 hours before surgery for
healthy patients, so a blanket "nothing after midnight" may be outdated or incorrect. The other
options are correct instructions: taking certain cardiac meds with a sip of water is common,
removing nail polish allows for pulse oximetry monitoring, and bringing hearing aids aids
communication during the immediate postoperative period.
Q2: During the intraoperative phase, the nurse notices the patient’s temperature has risen to 39°C
(102.2°F), muscle rigidity is present, and end-tidal carbon dioxide is increasing. The nurse
immediately recognizes these signs as indicative of:
A. Malignant hyperthermia
B. Anaphylactic reaction
C. Septic shock
D. Hypothermic shivering
Correct Answer: A
,2
Rationale: The classic triad of malignant hyperthermia includes a rapid rise in temperature,
muscle rigidity, and hypercarbia (increased end-tidal CO2). This is a life-threatening emergency
caused by certain anesthetic agents, requiring immediate treatment with dantrolene and
discontinuation of triggering agents.
Q3: A patient arrives in the Post-Anesthesia Care Unit (PACU) following a laparoscopic
cholecystectomy. The nurse prioritizes which assessment first?
A. Surgical incision site
B. Level of consciousness
C. Airway patency and respiratory status
D. Pain level
Correct Answer: C
Rationale: The primary priority in the PACU is always ABC (Airway, Breathing, Circulation).
Anesthesia can depress airway reflexes and respiratory drive, so assessing the airway and
breathing is the nurse's first action to ensure oxygenation and ventilation.
Q4: The nurse is caring for a postoperative patient who has a patient-controlled analgesia (PCA)
pump. The family member asks the nurse to push the button for the patient because they look
uncomfortable. What is the best response by the nurse?
A. "I will go ahead and push it for them since they are sleeping."
B. "Only the patient should push the button, even if they are sleeping, to prevent overdose."
C. "For safety, the patient must be awake enough to push the button themselves."
D. "I can administer a dose through the pump manually if they are in pain."
Correct Answer: C
Rationale: PCA pumps are designed for the patient to self-administer pain medication. Family
members or staff should not push the button for the patient because the patient's sedation level is
a safeguard against overdose; if they are too drowsy to push it, they should not receive another
dose.
,3
Q5: A nurse is assessing a patient 24 hours after a total knee replacement. The nurse notes the
calf is swollen, warm, red, and painful upon palpation. Which sign should the nurse check for to
further confirm a deep vein thrombosis (DVT)?
A. Positive Homans' sign
B. Negative Homans' sign
C. Absent pedal pulses
D. Bounding distal pulses
Correct Answer: A
Rationale: While not diagnostic alone, a positive Homans' sign (pain in the calf upon
dorsiflexion of the foot) has historically been associated with DVT. Although current evidence
suggests it has low sensitivity and specificity, in the context of a swollen, warm, and painful calf,
it is a relevant assessment finding to check. Pedal pulses are typically normal in DVT unless
arterial compromise is also present.
Q6: The nurse is teaching a patient how to use an incentive spirometer preoperatively. Which
instruction indicates the patient understands the proper technique?
A. "I should inhale quickly and shallowly to raise the piston."
B. "I will seal my lips tightly around the mouthpiece and breathe in slowly to keep the disk
elevated."
C. "I need to blow into the mouthpiece as hard as I can to move the marker."
D. "I will use the device three times a day, regardless of how I feel."
Correct Answer: B
Rationale: The correct technique for an incentive spirometer involves placing the mouthpiece in
the mouth, sealing the lips tightly, and inhaling slowly and deeply to sustain the elevation of the
piston or disk, which promotes lung expansion and prevents atelectasis.
Q7: A patient is recovering from surgery and suddenly reports a "popping" sensation in their
incision. Upon assessment, the nurse observes a loop of bowel protruding through the wound.
What is the immediate nursing action?
A. Apply a sterile gauze dressing moistened with saline.
B. Push the bowel back into the abdomen gently.
, 4
C. Place the patient in high Fowler's position.
D. Administer an oral dose of pain medication.
Correct Answer: A
Rationale: The patient is experiencing evisceration. The nurse should cover the protruding organs
with a sterile, saline-moistened dressing to prevent drying and infection and immediately notify
the surgeon. The nurse should never attempt to reinsert the organs, as this can cause severe injury
or infection.
Q8: The nurse is administering 0.9% Normal Saline IV at a rate of 150 mL/hr to a postoperative
patient who has had nothing by mouth (NPO) for 24 hours. Which finding would indicate the
patient is responding favorably to fluid resuscitation?
A. Urine output of 15 mL/hr
B. Heart rate increasing from 80 to 110 bpm
C. Blood pressure of 90/50 mmHg
D. Urine output of 45 mL/hr
Correct Answer: D
Rationale: A urine output of at least 30 mL/hr (or 0.5 mL/kg/hr) is the primary indicator of
adequate organ perfusion and fluid volume status. An output of 45 mL/hr suggests the kidneys
are being perfused effectively. The other findings (oliguria, tachycardia, hypotension) indicate
hypovolemia.
Q9: A patient with a history of obstructive sleep apnea (OSA) is recovering from general
anesthesia. The nurse places the patient in which position to best maintain a patent airway?
A. Prone position
B. Trendelenburg position
C. Side-lying position or lateral recumbent
D. High Fowler's position with neck flexed
Correct Answer: C
Rationale: The lateral or side-lying position helps prevent the tongue from falling back and
obstructing the airway and reduces the risk of aspiration. It is particularly important for patients
with sleep apnea who are at higher risk for airway obstruction post-surgery.
ATI RN Medical-Surgical Proctored Exam Actual
Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
[Perioperative & Postoperative Care]
Q1: The nurse is preparing a patient for abdominal surgery scheduled for tomorrow morning.
Which statement by the patient indicates a need for further teaching regarding preoperative
instructions?
A. "I will not eat or drink anything after midnight tonight."
B. "I should take my usual blood pressure medication with a sip of water early in the morning."
C. "I need to remove my nail polish and makeup before surgery."
D. "I will bring my hearing aids with me to the operating room."
Correct Answer: A
Rationale: While NPO status is standard, specific fasting times depend on the facility's protocol
and the type of anesthesia; clear liquids are often permitted up to 2 hours before surgery for
healthy patients, so a blanket "nothing after midnight" may be outdated or incorrect. The other
options are correct instructions: taking certain cardiac meds with a sip of water is common,
removing nail polish allows for pulse oximetry monitoring, and bringing hearing aids aids
communication during the immediate postoperative period.
Q2: During the intraoperative phase, the nurse notices the patient’s temperature has risen to 39°C
(102.2°F), muscle rigidity is present, and end-tidal carbon dioxide is increasing. The nurse
immediately recognizes these signs as indicative of:
A. Malignant hyperthermia
B. Anaphylactic reaction
C. Septic shock
D. Hypothermic shivering
Correct Answer: A
,2
Rationale: The classic triad of malignant hyperthermia includes a rapid rise in temperature,
muscle rigidity, and hypercarbia (increased end-tidal CO2). This is a life-threatening emergency
caused by certain anesthetic agents, requiring immediate treatment with dantrolene and
discontinuation of triggering agents.
Q3: A patient arrives in the Post-Anesthesia Care Unit (PACU) following a laparoscopic
cholecystectomy. The nurse prioritizes which assessment first?
A. Surgical incision site
B. Level of consciousness
C. Airway patency and respiratory status
D. Pain level
Correct Answer: C
Rationale: The primary priority in the PACU is always ABC (Airway, Breathing, Circulation).
Anesthesia can depress airway reflexes and respiratory drive, so assessing the airway and
breathing is the nurse's first action to ensure oxygenation and ventilation.
Q4: The nurse is caring for a postoperative patient who has a patient-controlled analgesia (PCA)
pump. The family member asks the nurse to push the button for the patient because they look
uncomfortable. What is the best response by the nurse?
A. "I will go ahead and push it for them since they are sleeping."
B. "Only the patient should push the button, even if they are sleeping, to prevent overdose."
C. "For safety, the patient must be awake enough to push the button themselves."
D. "I can administer a dose through the pump manually if they are in pain."
Correct Answer: C
Rationale: PCA pumps are designed for the patient to self-administer pain medication. Family
members or staff should not push the button for the patient because the patient's sedation level is
a safeguard against overdose; if they are too drowsy to push it, they should not receive another
dose.
,3
Q5: A nurse is assessing a patient 24 hours after a total knee replacement. The nurse notes the
calf is swollen, warm, red, and painful upon palpation. Which sign should the nurse check for to
further confirm a deep vein thrombosis (DVT)?
A. Positive Homans' sign
B. Negative Homans' sign
C. Absent pedal pulses
D. Bounding distal pulses
Correct Answer: A
Rationale: While not diagnostic alone, a positive Homans' sign (pain in the calf upon
dorsiflexion of the foot) has historically been associated with DVT. Although current evidence
suggests it has low sensitivity and specificity, in the context of a swollen, warm, and painful calf,
it is a relevant assessment finding to check. Pedal pulses are typically normal in DVT unless
arterial compromise is also present.
Q6: The nurse is teaching a patient how to use an incentive spirometer preoperatively. Which
instruction indicates the patient understands the proper technique?
A. "I should inhale quickly and shallowly to raise the piston."
B. "I will seal my lips tightly around the mouthpiece and breathe in slowly to keep the disk
elevated."
C. "I need to blow into the mouthpiece as hard as I can to move the marker."
D. "I will use the device three times a day, regardless of how I feel."
Correct Answer: B
Rationale: The correct technique for an incentive spirometer involves placing the mouthpiece in
the mouth, sealing the lips tightly, and inhaling slowly and deeply to sustain the elevation of the
piston or disk, which promotes lung expansion and prevents atelectasis.
Q7: A patient is recovering from surgery and suddenly reports a "popping" sensation in their
incision. Upon assessment, the nurse observes a loop of bowel protruding through the wound.
What is the immediate nursing action?
A. Apply a sterile gauze dressing moistened with saline.
B. Push the bowel back into the abdomen gently.
, 4
C. Place the patient in high Fowler's position.
D. Administer an oral dose of pain medication.
Correct Answer: A
Rationale: The patient is experiencing evisceration. The nurse should cover the protruding organs
with a sterile, saline-moistened dressing to prevent drying and infection and immediately notify
the surgeon. The nurse should never attempt to reinsert the organs, as this can cause severe injury
or infection.
Q8: The nurse is administering 0.9% Normal Saline IV at a rate of 150 mL/hr to a postoperative
patient who has had nothing by mouth (NPO) for 24 hours. Which finding would indicate the
patient is responding favorably to fluid resuscitation?
A. Urine output of 15 mL/hr
B. Heart rate increasing from 80 to 110 bpm
C. Blood pressure of 90/50 mmHg
D. Urine output of 45 mL/hr
Correct Answer: D
Rationale: A urine output of at least 30 mL/hr (or 0.5 mL/kg/hr) is the primary indicator of
adequate organ perfusion and fluid volume status. An output of 45 mL/hr suggests the kidneys
are being perfused effectively. The other findings (oliguria, tachycardia, hypotension) indicate
hypovolemia.
Q9: A patient with a history of obstructive sleep apnea (OSA) is recovering from general
anesthesia. The nurse places the patient in which position to best maintain a patent airway?
A. Prone position
B. Trendelenburg position
C. Side-lying position or lateral recumbent
D. High Fowler's position with neck flexed
Correct Answer: C
Rationale: The lateral or side-lying position helps prevent the tongue from falling back and
obstructing the airway and reduces the risk of aspiration. It is particularly important for patients
with sleep apnea who are at higher risk for airway obstruction post-surgery.
