ATI Medical-Surgical Perioperative
Nursing Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
SECTION 1: PREOPERATIVE NURSING CARE (Questions 1–18)
Q1: A nurse is assessing a 68-year-old client scheduled for elective total knee arthroplasty. The
client has a history of loud snoring, daytime fatigue, observed apneas by the spouse, and a BMI of
38 kg/m². Using the STOP-BANG questionnaire, which score indicates this client is at high risk for
obstructive sleep apnea?
A. 2
B. 3
C. 5
D. 7
Correct Answer: C
,Rationale: The correct action is to identify a STOP-BANG score of 5 as high risk for
moderate-to-severe OSA because the client meets five criteria: Snoring, Tired, Observed apnea,
BMI >35, and Age >50. According to ATI Medical-Surgical Nursing (Edition 12), a score ≥5 indicates
high risk for moderate-to-severe OSA and warrants perioperative risk stratification and possible
referral for sleep study prior to surgery.
Q2: A nurse is completing the preoperative airway assessment for a client undergoing general
anesthesia. The client can visualize the uvula, soft palate, and fauces when the mouth is opened
and tongue extended. Which Mallampati classification should the nurse document?
A. Class I
B. Class II
C. Class III
D. Class IV
Correct Answer: B
Rationale: The correct action is to document Mallampati Class II because visualization of the uvula,
soft palate, and fauces without visualization of the pillars defines Class II. According to ATI
Medical-Surgical Nursing (Edition 12), Mallampati Class II predicts possible difficult intubation and
should prompt the nurse to ensure difficult airway equipment is available and to communicate
findings to the anesthesia provider.
,Q3: A nurse is reviewing the ASA physical status classification for a client with controlled
hypertension and no functional limitations who is scheduled for laparoscopic cholecystectomy.
Which ASA classification is appropriate?
A. ASA I
B. ASA II
C. ASA III
D. ASA IV
Correct Answer: B
Rationale: The correct action is to classify this client as ASA II because the client has mild systemic
disease (controlled hypertension) without functional limitation. According to ATI Medical-Surgical
Nursing (Edition 12), ASA II indicates a patient with mild systemic disease that does not limit activity,
distinguishing it from ASA I (healthy) and ASA III (severe systemic disease with functional limitation).
Q4: A nurse is providing preoperative teaching to a client scheduled for abdominal surgery. The
client asks when they should stop eating solid foods before surgery. Which response by the nurse
is correct?
A. "You may eat a light meal up to 2 hours before surgery."
B. "Stop eating solid foods at least 6 hours before surgery."
C. "You may have clear liquids up to 4 hours before surgery."
, D. "Stop all oral intake 8 hours before surgery."
Correct Answer: B
Rationale: The correct action is to instruct the client to stop eating solid foods at least 6 hours
before surgery according to the 2-4-6-8 NPO rule. According to ATI Medical-Surgical Nursing
(Edition 12), the 2-4-6-8 rule states: clear liquids 2 hours, breast milk 4 hours, infant formula/light
meal 6 hours, and fatty meal 8 hours prior to anesthesia. Solid foods require a minimum 6-hour fast
to reduce aspiration risk.
Q5: A nurse is reviewing medications with a client in the preoperative holding area. The client
reports taking warfarin 5 mg daily for atrial fibrillation, ginkgo biloba for memory, and prednisone 10
mg daily for rheumatoid arthritis. Which medication requires the most urgent communication with
the surgeon prior to surgery?
A. Ginkgo biloba
B. Prednisone
C. Warfarin
D. All require equal communication
Correct Answer: C
Rationale: The correct action is to prioritize communication about warfarin because anticoagulants
significantly increase bleeding risk during surgery and typically require bridging therapy or
discontinuation based on thromboembolic risk stratification. According to ATI Medical-Surgical
Nursing (Edition 12) and current AORN guidelines, while herbal supplements like ginkgo and
Nursing Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
SECTION 1: PREOPERATIVE NURSING CARE (Questions 1–18)
Q1: A nurse is assessing a 68-year-old client scheduled for elective total knee arthroplasty. The
client has a history of loud snoring, daytime fatigue, observed apneas by the spouse, and a BMI of
38 kg/m². Using the STOP-BANG questionnaire, which score indicates this client is at high risk for
obstructive sleep apnea?
A. 2
B. 3
C. 5
D. 7
Correct Answer: C
,Rationale: The correct action is to identify a STOP-BANG score of 5 as high risk for
moderate-to-severe OSA because the client meets five criteria: Snoring, Tired, Observed apnea,
BMI >35, and Age >50. According to ATI Medical-Surgical Nursing (Edition 12), a score ≥5 indicates
high risk for moderate-to-severe OSA and warrants perioperative risk stratification and possible
referral for sleep study prior to surgery.
Q2: A nurse is completing the preoperative airway assessment for a client undergoing general
anesthesia. The client can visualize the uvula, soft palate, and fauces when the mouth is opened
and tongue extended. Which Mallampati classification should the nurse document?
A. Class I
B. Class II
C. Class III
D. Class IV
Correct Answer: B
Rationale: The correct action is to document Mallampati Class II because visualization of the uvula,
soft palate, and fauces without visualization of the pillars defines Class II. According to ATI
Medical-Surgical Nursing (Edition 12), Mallampati Class II predicts possible difficult intubation and
should prompt the nurse to ensure difficult airway equipment is available and to communicate
findings to the anesthesia provider.
,Q3: A nurse is reviewing the ASA physical status classification for a client with controlled
hypertension and no functional limitations who is scheduled for laparoscopic cholecystectomy.
Which ASA classification is appropriate?
A. ASA I
B. ASA II
C. ASA III
D. ASA IV
Correct Answer: B
Rationale: The correct action is to classify this client as ASA II because the client has mild systemic
disease (controlled hypertension) without functional limitation. According to ATI Medical-Surgical
Nursing (Edition 12), ASA II indicates a patient with mild systemic disease that does not limit activity,
distinguishing it from ASA I (healthy) and ASA III (severe systemic disease with functional limitation).
Q4: A nurse is providing preoperative teaching to a client scheduled for abdominal surgery. The
client asks when they should stop eating solid foods before surgery. Which response by the nurse
is correct?
A. "You may eat a light meal up to 2 hours before surgery."
B. "Stop eating solid foods at least 6 hours before surgery."
C. "You may have clear liquids up to 4 hours before surgery."
, D. "Stop all oral intake 8 hours before surgery."
Correct Answer: B
Rationale: The correct action is to instruct the client to stop eating solid foods at least 6 hours
before surgery according to the 2-4-6-8 NPO rule. According to ATI Medical-Surgical Nursing
(Edition 12), the 2-4-6-8 rule states: clear liquids 2 hours, breast milk 4 hours, infant formula/light
meal 6 hours, and fatty meal 8 hours prior to anesthesia. Solid foods require a minimum 6-hour fast
to reduce aspiration risk.
Q5: A nurse is reviewing medications with a client in the preoperative holding area. The client
reports taking warfarin 5 mg daily for atrial fibrillation, ginkgo biloba for memory, and prednisone 10
mg daily for rheumatoid arthritis. Which medication requires the most urgent communication with
the surgeon prior to surgery?
A. Ginkgo biloba
B. Prednisone
C. Warfarin
D. All require equal communication
Correct Answer: C
Rationale: The correct action is to prioritize communication about warfarin because anticoagulants
significantly increase bleeding risk during surgery and typically require bridging therapy or
discontinuation based on thromboembolic risk stratification. According to ATI Medical-Surgical
Nursing (Edition 12) and current AORN guidelines, while herbal supplements like ginkgo and
