ATI PN MEDICAL-SURGICAL DETAILED SOLUTIONS 2026 |
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Section 1: Perioperative & Pain Management Care (Questions
1-12)
Q1. A 68-year-old client is scheduled for elective total knee arthroplasty in 3 days.
The nurse is providing preoperative teaching. Which statement by the client indicates
a need for further teaching?
A. "I will use the incentive spirometer every hour while awake after surgery."
B. "I will stop taking my warfarin 5 days before surgery as instructed by my surgeon."
C. "I will continue taking my metformin the morning of surgery with a sip of water."
D. "I will practice deep breathing and coughing exercises before coming to the
hospital."
Rationale: Metformin should be held 48 hours before surgery due to risk of lactic
acidosis, especially if contrast dye or reduced renal perfusion is anticipated.
Continuing metformin (Option C) indicates incorrect understanding and requires
further teaching. Options A, B, and D demonstrate correct preoperative preparation.
Warfarin cessation (Option B) is appropriate per surgeon instruction.
Correct Answer: C
Q2. A client returns from the PACU after abdominal surgery with a PCA pump
delivering morphine 1 mg IV every 10 minutes with a 1-hour lockout of 6 mg. The
client presses the button 8 times in the first hour but reports pain of 7/10. Which
action should the nurse take FIRST?
,A. Increase the lockout interval to 15 minutes
B. Assess the client's pain characteristics, PCA setup, and sedation level; notify the
provider if the current regimen is inadequate
C. Remove the PCA and switch to oral oxycodone
D. Tell the client to press the button more frequently
Rationale: The nurse must first assess the pain (quality, location, worsening factors),
verify PCA setup (correct programming, functioning line), and check
sedation/respiratory status before adjusting dosing. The client may have reached
the lockout (6 mg/hr max), have a kinked line, or have a complication requiring
provider notification. Increasing lockout (Option A) would worsen pain control.
Removing PCA (Option C) is premature. Option D is unsafe if the lockout was
reached.
Correct Answer: B
Q3. A postoperative client on bed rest develops sudden dyspnea, tachycardia, and
pleuritic chest pain 5 days after hip replacement. Which complication should the
nurse suspect FIRST?
A. Atelectasis
B. Pulmonary embolism
D. Pneumonia
D. Wound dehiscence
Rationale: Sudden dyspnea, tachycardia, and pleuritic chest pain 5 days post-hip
replacement (immobility, surgery = Virchow's triad) is classic for pulmonary
embolism (PE). Atelectasis (Option A) develops earlier (24-48 hours) and presents
with decreased breath sounds, not sudden pleuritic pain. Pneumonia (Option C) has
gradual onset with fever and productive cough. Wound dehiscence (Option D)
presents with wound separation, not respiratory symptoms.
Correct Answer: B
,Q4. A client receives an epidural infusion of bupivacaine with fentanyl for
postoperative pain management. Which assessment finding requires IMMEDIATE
nursing intervention?
A. Pain rating of 3/10
B. Bilateral motor strength 4/5 in lower extremities
C. Respiratory rate of 8 breaths/minute
D. Urinary output of 200 mL in 4 hours
Rationale: Respiratory rate of 8/min indicates respiratory depression from
epidural opioid (fentanyl), a life-threatening emergency requiring immediate
intervention (naloxone, supplemental oxygen, provider notification). Pain 3/10
(Option A) is therapeutic. Motor weakness 4/5 (Option B) is expected with epidural
local anesthetics. Urinary retention (Option D) is common but not immediately life-
threatening.
Correct Answer: C
Q5. A client is 24 hours postoperative after colon resection. The nurse notes absent
bowel sounds, abdominal distension, and the client reports nausea. The nasogastric
tube is draining 400 mL of greenish fluid in the past 4 hours. Which complication is
MOST likely?
A. Paralytic ileus
B. Wound infection
C. Hemorrhage
D. Anastomotic leak
Rationale: Absent bowel sounds, abdominal distension, nausea, and high NG
output 24 hours post-abdominal surgery indicate paralytic ileus—temporary
paralysis of intestinal peristalsis due to surgical manipulation and anesthesia. Wound
infection (Option B) presents with erythema, warmth, purulent drainage. Hemorrhage
(Option C) presents with hypotension, tachycardia, bloody drainage. Anastomotic
leak (Option C) typically occurs later (5-7 days) with peritonitis, fever, and sepsis.
Correct Answer: A
, Q6. A client is recovering from spinal surgery and is ordered to logroll every 2 hours.
The nurse delegates this task to the UAP. Which instruction is MOST appropriate for
the nurse to provide to the UAP?
A. "Turn the client by pulling on their arms and legs simultaneously."
B. "Keep the client's head, shoulders, and hips aligned as one unit without twisting
the spine; use a draw sheet with assistance."
C. "Have the client roll themselves over independently."
D. "Turn the client by bending their knees and twisting at the waist."
Rationale: Logrolling maintains spinal alignment by moving the client as a single
unit (head, shoulders, hips aligned) without twisting. A draw sheet with adequate
assistance prevents shear and spinal stress. Option A risks disalignment and injury.
Option C is unsafe post-spinal surgery. Option D describes improper technique that
could damage the surgical site.
Correct Answer: B
Q7. A client is receiving patient-controlled analgesia (PCA) with morphine. The family
member asks if they can press the button for the client when the client is sleeping.
Which response by the nurse is MOST appropriate?
A. "Yes, you can press the button whenever you think the client needs it."
B. "No, only the client should press the button to ensure they are awake enough to
self-assess pain and avoid oversedation."
C. "Only the nurse can press the button, not family members."
D. "You can press the button, but only if the client is snoring."
Rationale: PCA safety principle: Only the client should press the button to ensure
they are awake and alert enough to self-assess pain, preventing oversedation and
respiratory depression. Family-administered PCA (Option A) has caused fatal
overdoses. Option C is not universally true—nurses can administer boluses per
protocol. Option D is dangerous—snoring may indicate airway obstruction.
Correct Answer: B
Latest Version with NGN | Practical Nursing Clinical
Judgment | Pass Guaranteed - A+ Graded
Section 1: Perioperative & Pain Management Care (Questions
1-12)
Q1. A 68-year-old client is scheduled for elective total knee arthroplasty in 3 days.
The nurse is providing preoperative teaching. Which statement by the client indicates
a need for further teaching?
A. "I will use the incentive spirometer every hour while awake after surgery."
B. "I will stop taking my warfarin 5 days before surgery as instructed by my surgeon."
C. "I will continue taking my metformin the morning of surgery with a sip of water."
D. "I will practice deep breathing and coughing exercises before coming to the
hospital."
Rationale: Metformin should be held 48 hours before surgery due to risk of lactic
acidosis, especially if contrast dye or reduced renal perfusion is anticipated.
Continuing metformin (Option C) indicates incorrect understanding and requires
further teaching. Options A, B, and D demonstrate correct preoperative preparation.
Warfarin cessation (Option B) is appropriate per surgeon instruction.
Correct Answer: C
Q2. A client returns from the PACU after abdominal surgery with a PCA pump
delivering morphine 1 mg IV every 10 minutes with a 1-hour lockout of 6 mg. The
client presses the button 8 times in the first hour but reports pain of 7/10. Which
action should the nurse take FIRST?
,A. Increase the lockout interval to 15 minutes
B. Assess the client's pain characteristics, PCA setup, and sedation level; notify the
provider if the current regimen is inadequate
C. Remove the PCA and switch to oral oxycodone
D. Tell the client to press the button more frequently
Rationale: The nurse must first assess the pain (quality, location, worsening factors),
verify PCA setup (correct programming, functioning line), and check
sedation/respiratory status before adjusting dosing. The client may have reached
the lockout (6 mg/hr max), have a kinked line, or have a complication requiring
provider notification. Increasing lockout (Option A) would worsen pain control.
Removing PCA (Option C) is premature. Option D is unsafe if the lockout was
reached.
Correct Answer: B
Q3. A postoperative client on bed rest develops sudden dyspnea, tachycardia, and
pleuritic chest pain 5 days after hip replacement. Which complication should the
nurse suspect FIRST?
A. Atelectasis
B. Pulmonary embolism
D. Pneumonia
D. Wound dehiscence
Rationale: Sudden dyspnea, tachycardia, and pleuritic chest pain 5 days post-hip
replacement (immobility, surgery = Virchow's triad) is classic for pulmonary
embolism (PE). Atelectasis (Option A) develops earlier (24-48 hours) and presents
with decreased breath sounds, not sudden pleuritic pain. Pneumonia (Option C) has
gradual onset with fever and productive cough. Wound dehiscence (Option D)
presents with wound separation, not respiratory symptoms.
Correct Answer: B
,Q4. A client receives an epidural infusion of bupivacaine with fentanyl for
postoperative pain management. Which assessment finding requires IMMEDIATE
nursing intervention?
A. Pain rating of 3/10
B. Bilateral motor strength 4/5 in lower extremities
C. Respiratory rate of 8 breaths/minute
D. Urinary output of 200 mL in 4 hours
Rationale: Respiratory rate of 8/min indicates respiratory depression from
epidural opioid (fentanyl), a life-threatening emergency requiring immediate
intervention (naloxone, supplemental oxygen, provider notification). Pain 3/10
(Option A) is therapeutic. Motor weakness 4/5 (Option B) is expected with epidural
local anesthetics. Urinary retention (Option D) is common but not immediately life-
threatening.
Correct Answer: C
Q5. A client is 24 hours postoperative after colon resection. The nurse notes absent
bowel sounds, abdominal distension, and the client reports nausea. The nasogastric
tube is draining 400 mL of greenish fluid in the past 4 hours. Which complication is
MOST likely?
A. Paralytic ileus
B. Wound infection
C. Hemorrhage
D. Anastomotic leak
Rationale: Absent bowel sounds, abdominal distension, nausea, and high NG
output 24 hours post-abdominal surgery indicate paralytic ileus—temporary
paralysis of intestinal peristalsis due to surgical manipulation and anesthesia. Wound
infection (Option B) presents with erythema, warmth, purulent drainage. Hemorrhage
(Option C) presents with hypotension, tachycardia, bloody drainage. Anastomotic
leak (Option C) typically occurs later (5-7 days) with peritonitis, fever, and sepsis.
Correct Answer: A
, Q6. A client is recovering from spinal surgery and is ordered to logroll every 2 hours.
The nurse delegates this task to the UAP. Which instruction is MOST appropriate for
the nurse to provide to the UAP?
A. "Turn the client by pulling on their arms and legs simultaneously."
B. "Keep the client's head, shoulders, and hips aligned as one unit without twisting
the spine; use a draw sheet with assistance."
C. "Have the client roll themselves over independently."
D. "Turn the client by bending their knees and twisting at the waist."
Rationale: Logrolling maintains spinal alignment by moving the client as a single
unit (head, shoulders, hips aligned) without twisting. A draw sheet with adequate
assistance prevents shear and spinal stress. Option A risks disalignment and injury.
Option C is unsafe post-spinal surgery. Option D describes improper technique that
could damage the surgical site.
Correct Answer: B
Q7. A client is receiving patient-controlled analgesia (PCA) with morphine. The family
member asks if they can press the button for the client when the client is sleeping.
Which response by the nurse is MOST appropriate?
A. "Yes, you can press the button whenever you think the client needs it."
B. "No, only the client should press the button to ensure they are awake enough to
self-assess pain and avoid oversedation."
C. "Only the nurse can press the button, not family members."
D. "You can press the button, but only if the client is snoring."
Rationale: PCA safety principle: Only the client should press the button to ensure
they are awake and alert enough to self-assess pain, preventing oversedation and
respiratory depression. Family-administered PCA (Option A) has caused fatal
overdoses. Option C is not universally true—nurses can administer boluses per
protocol. Option D is dangerous—snoring may indicate airway obstruction.
Correct Answer: B
