ATI PN ADULT MEDICAL SURGICAL (MED-SURG)
2026/2027 Proctored Exam with NGN Actual Exam
100% Verified Questions Detailed Rationales Pass
Guaranteed - A+ Graded
Total Questions: 100 | Time: 120 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Perioperative & Intraoperative Care | Q1 – Q17
Section 2 | Respiratory Disorders | Q18 – Q33
Section 3 | Cardiovascular Disorders | Q34 – Q49
Section 4 | Gastrointestinal & Nutritional Disorders | Q50 – Q65
Section 5 | Renal, Genitourinary & Endocrine Disorders | Q66 – Q81
Section 6 | Neurologic, Musculoskeletal & Integumentary Disorders | Q82 – Q100
Instructions: Choose the single best answer. Pass: 80% in 120 minutes.
══════════════════════════════════════
SECTION 1: PERIOPERATIVE & INTRAOPERATIVE CARE Q1 – Q17
══════════════════════════════════════
Question 1 of 100
A 68-year-old client is scheduled for an elective total knee replacement in the morning.
During the preoperative assessment, the nurse notes the client takes warfarin 5 mg
daily for atrial fibrillation. The surgeon's orders state to hold the warfarin 5 days prior to
surgery. The client asks the nurse why this medication must be stopped so far in
advance.
A. "Warfarin increases your risk of blood clots during surgery, so we need to clear it from
your system."
B. "Your liver needs time to regenerate clotting factors that warfarin suppresses." ✓
CORRECT
C. "We stop it early so we can switch you to a safer blood thinner before surgery."
,D. "The anesthesia team requires all anticoagulants to be held for a full week."
Correct Answer: B
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X), and these
factors require approximately 5 days to regenerate to therapeutic levels once the drug is
discontinued. Option A is incorrect because warfarin actually increases bleeding risk,
not clot risk, during surgery. Most surgical teams coordinate with the provider to bridge
with low molecular weight heparin if the thromboembolic risk is high.
Question 2 of 100
A 54-year-old client is in the PACU following an open cholecystectomy. The nurse
observes the client is restless, has shallow respirations at 24 breaths per minute, and an
oxygen saturation of 88% on 2 L nasal cannula. The client's breath sounds are
diminished bilaterally at the bases.
A. Encourage the client to take deep breaths and cough every hour while awake
B. Increase the oxygen to 4 L and reassess in 15 minutes
C. Position the client in high-Fowler's and apply a non-rebreather mask ✓ CORRECT
D. Administer the prescribed PRN morphine sulfate 2 mg IV for restlessness
Correct Answer: C
Rationale: This client is exhibiting signs of significant hypoventilation and hypoxemia
following general anesthesia, which requires immediate high-flow oxygen and optimal
positioning to maximize lung expansion. Option A is tempting but insufficient for a
saturation of 88%; deep breathing exercises are preventive, not rescue interventions.
Restlessness in the postoperative period is often an early sign of hypoxia rather than
pain, so giving morphine could worsen respiratory depression.
Question 3 of 100
,A 45-year-old client is receiving preoperative teaching for a scheduled laparoscopic
appendectomy. The client states, "I had a bad reaction to anesthesia when I was a kid,
but I don't remember what it was called." Which action by the nurse is most appropriate?
A. Document the statement and notify the anesthesia provider prior to surgery ✓
CORRECT
B. Reassure the client that modern anesthesia is much safer than in the past
C. Ask the client to contact their parents to obtain the specific medication name
D. Place an allergy band on the client's wrist for "unknown anesthesia reaction"
Correct Answer: A
Rationale: A reported adverse reaction to anesthesia warrants immediate
communication with the anesthesia team so they can review options and potentially
obtain old records before the procedure. Option C delays necessary communication and
places responsibility on the client during a stressful time. While documentation is
essential, the critical step is alerting the provider who can make informed decisions
about anesthetic agents.
Question 4 of 100
A 72-year-old client returns to the surgical unit following a transurethral resection of the
prostate (TURP). The nurse notes continuous bladder irrigation is infusing and the
drainage bag contains bright red urine with several small clots. The client reports mild
lower abdominal discomfort.
A. Increase the irrigation flow rate to flush the clots through the catheter
B. Manually irrigate the catheter with 30 mL sterile saline using a piston syringe
C. Notify the surgeon immediately and prepare for return to the OR
D. Ensure the drainage tubing is free of kinks and assess the irrigation system ✓
CORRECT
Correct Answer: D
, Rationale: The first step with any drainage issue is to check for mechanical problems
such as kinked tubing or dependent loops before assuming the client is actively
bleeding. Option A could increase bladder distension if outflow is obstructed. Small
clots and bright red urine are expected in the immediate post-TURP period; manual
irrigation is reserved for suspected obstruction.
Question 5 of 100
A 38-year-old client is scheduled for a same-day arthroscopic knee surgery. During the
preoperative assessment, the client admits to drinking 3 to 4 beers every night after
work. The surgery is scheduled for 0800. What is the priority nursing intervention?
A. Instruct the client to have their last beer no later than midnight before surgery
B. Notify the surgeon and anesthesia provider about the alcohol use ✓ CORRECT
C. Explain that alcohol withdrawal is unlikely after knee surgery
D. Assess the client's liver enzymes before proceeding with anesthesia
Correct Answer: B
Rationale: Daily alcohol consumption increases the risk of withdrawal, cross-tolerance
with anesthetic agents, and postoperative complications, making provider notification
essential for planning. Option A is unsafe advice that could lead to aspiration risk and
does not address the underlying concern. The anesthesia team needs this information
to adjust medications and monitor for withdrawal.
Question 6 of 100
A 61-year-old client underwent an abdominal hysterectomy 8 hours ago. The nurse is
assessing the surgical incision and notes the Jackson-Pratt drain has drained 150 mL
of serosanguineous fluid in the past 4 hours. The client's vital signs are stable.
A. Compress the drain bulb and reestablish suction to increase drainage
B. Document the findings and continue routine monitoring ✓ CORRECT
C. Notify the surgeon of excessive drainage from the surgical site
2026/2027 Proctored Exam with NGN Actual Exam
100% Verified Questions Detailed Rationales Pass
Guaranteed - A+ Graded
Total Questions: 100 | Time: 120 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Perioperative & Intraoperative Care | Q1 – Q17
Section 2 | Respiratory Disorders | Q18 – Q33
Section 3 | Cardiovascular Disorders | Q34 – Q49
Section 4 | Gastrointestinal & Nutritional Disorders | Q50 – Q65
Section 5 | Renal, Genitourinary & Endocrine Disorders | Q66 – Q81
Section 6 | Neurologic, Musculoskeletal & Integumentary Disorders | Q82 – Q100
Instructions: Choose the single best answer. Pass: 80% in 120 minutes.
══════════════════════════════════════
SECTION 1: PERIOPERATIVE & INTRAOPERATIVE CARE Q1 – Q17
══════════════════════════════════════
Question 1 of 100
A 68-year-old client is scheduled for an elective total knee replacement in the morning.
During the preoperative assessment, the nurse notes the client takes warfarin 5 mg
daily for atrial fibrillation. The surgeon's orders state to hold the warfarin 5 days prior to
surgery. The client asks the nurse why this medication must be stopped so far in
advance.
A. "Warfarin increases your risk of blood clots during surgery, so we need to clear it from
your system."
B. "Your liver needs time to regenerate clotting factors that warfarin suppresses." ✓
CORRECT
C. "We stop it early so we can switch you to a safer blood thinner before surgery."
,D. "The anesthesia team requires all anticoagulants to be held for a full week."
Correct Answer: B
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X), and these
factors require approximately 5 days to regenerate to therapeutic levels once the drug is
discontinued. Option A is incorrect because warfarin actually increases bleeding risk,
not clot risk, during surgery. Most surgical teams coordinate with the provider to bridge
with low molecular weight heparin if the thromboembolic risk is high.
Question 2 of 100
A 54-year-old client is in the PACU following an open cholecystectomy. The nurse
observes the client is restless, has shallow respirations at 24 breaths per minute, and an
oxygen saturation of 88% on 2 L nasal cannula. The client's breath sounds are
diminished bilaterally at the bases.
A. Encourage the client to take deep breaths and cough every hour while awake
B. Increase the oxygen to 4 L and reassess in 15 minutes
C. Position the client in high-Fowler's and apply a non-rebreather mask ✓ CORRECT
D. Administer the prescribed PRN morphine sulfate 2 mg IV for restlessness
Correct Answer: C
Rationale: This client is exhibiting signs of significant hypoventilation and hypoxemia
following general anesthesia, which requires immediate high-flow oxygen and optimal
positioning to maximize lung expansion. Option A is tempting but insufficient for a
saturation of 88%; deep breathing exercises are preventive, not rescue interventions.
Restlessness in the postoperative period is often an early sign of hypoxia rather than
pain, so giving morphine could worsen respiratory depression.
Question 3 of 100
,A 45-year-old client is receiving preoperative teaching for a scheduled laparoscopic
appendectomy. The client states, "I had a bad reaction to anesthesia when I was a kid,
but I don't remember what it was called." Which action by the nurse is most appropriate?
A. Document the statement and notify the anesthesia provider prior to surgery ✓
CORRECT
B. Reassure the client that modern anesthesia is much safer than in the past
C. Ask the client to contact their parents to obtain the specific medication name
D. Place an allergy band on the client's wrist for "unknown anesthesia reaction"
Correct Answer: A
Rationale: A reported adverse reaction to anesthesia warrants immediate
communication with the anesthesia team so they can review options and potentially
obtain old records before the procedure. Option C delays necessary communication and
places responsibility on the client during a stressful time. While documentation is
essential, the critical step is alerting the provider who can make informed decisions
about anesthetic agents.
Question 4 of 100
A 72-year-old client returns to the surgical unit following a transurethral resection of the
prostate (TURP). The nurse notes continuous bladder irrigation is infusing and the
drainage bag contains bright red urine with several small clots. The client reports mild
lower abdominal discomfort.
A. Increase the irrigation flow rate to flush the clots through the catheter
B. Manually irrigate the catheter with 30 mL sterile saline using a piston syringe
C. Notify the surgeon immediately and prepare for return to the OR
D. Ensure the drainage tubing is free of kinks and assess the irrigation system ✓
CORRECT
Correct Answer: D
, Rationale: The first step with any drainage issue is to check for mechanical problems
such as kinked tubing or dependent loops before assuming the client is actively
bleeding. Option A could increase bladder distension if outflow is obstructed. Small
clots and bright red urine are expected in the immediate post-TURP period; manual
irrigation is reserved for suspected obstruction.
Question 5 of 100
A 38-year-old client is scheduled for a same-day arthroscopic knee surgery. During the
preoperative assessment, the client admits to drinking 3 to 4 beers every night after
work. The surgery is scheduled for 0800. What is the priority nursing intervention?
A. Instruct the client to have their last beer no later than midnight before surgery
B. Notify the surgeon and anesthesia provider about the alcohol use ✓ CORRECT
C. Explain that alcohol withdrawal is unlikely after knee surgery
D. Assess the client's liver enzymes before proceeding with anesthesia
Correct Answer: B
Rationale: Daily alcohol consumption increases the risk of withdrawal, cross-tolerance
with anesthetic agents, and postoperative complications, making provider notification
essential for planning. Option A is unsafe advice that could lead to aspiration risk and
does not address the underlying concern. The anesthesia team needs this information
to adjust medications and monitor for withdrawal.
Question 6 of 100
A 61-year-old client underwent an abdominal hysterectomy 8 hours ago. The nurse is
assessing the surgical incision and notes the Jackson-Pratt drain has drained 150 mL
of serosanguineous fluid in the past 4 hours. The client's vital signs are stable.
A. Compress the drain bulb and reestablish suction to increase drainage
B. Document the findings and continue routine monitoring ✓ CORRECT
C. Notify the surgeon of excessive drainage from the surgical site
