ATI COMPREHENSIVE PRACTICE EXAM 2026/2027| Questions
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
1. A 68-year-old client with COPD is receiving oxygen at 4 L/min via nasal cannula.
The client becomes increasingly somnolent and his ABG reveals pH 7.28, PaCO₂
68 mm Hg, PaO₂ 58 mm Hg. Which action should the nurse take first?
A. Increase oxygen to 6 L/min
B. Obtain a stat chest x-ray
C. Decrease oxygen to 1–2 L/min and notify provider
D. Administer oral mucomyst
Correct Answer: C
Rationale: High-flow O₂ in chronic CO₂ retainers can blunt hypoxic drive →
hypercarbia & acidosis. Lowering FiO₂ is priority to re-establish respiratory drive.
Teaching Point: Always titrate oxygen to target SpO₂ 88–92% in COPD clients.
2. A postpartum client has a fourth-degree laceration. The nurse observes a large
amount of lochia rubra on the perineal pad 2 hours after delivery. Which finding
should the reported immediately?
A. Fundus firm at umbilicus
B. BP 90/50 mm Hg
C. Pulse 88 bpm
D. Client states “I’m so thirsty”
Correct Answer: B
Rationale: Hypotension + heavy lochia suggests hemorrhagic shock; requires
immediate intervention.
Teaching Point: Postpartum hemorrhage = EBL >500 mL vaginal or >1000 mL
cesarean; shock can occur quickly.
3. A client is admitted with DKA. The provider orders an insulin gtt at 0.1
units/kg/hr. Client weight = 70 kg. The pharmacy supplies a solution of 100 units
regular insulin in 100 mL NS. Calculate the infusion rate in mL/hr.
, Correct Answer: 7 mL/hr
Rationale: 0.1 units/kg/hr × 70 kg = 7 units/hr; concentration = 1 unit/mL → 7
mL/hr.
4. A school-age child with sickle-cell disease is in vaso-occlusive crisis. Which
nursing intervention is most effective to promote comfort?
A. Apply cold packs to painful joints
B. Limit PO fluids to 1 L/day
C. Administer morphine 0.05 mg/kg IV q4h PRN
D. Encourage diversional activities only
Correct Answer: C
Rationale: Opioids are first-line for severe pain; cold increases sickling.
Teaching Point: Hydration, warmth, and adequate analgesia are crisis pillars.
5. A client with major depressive disorder is started on phenelzine 15 mg bid. Which
food choice indicates the need for further teaching?
A. Fresh blueberries
B. Aged cheddar cheese
C. Whole-wheat toast
D. Apple juice
Correct Answer: B
Rationale: Aged cheese is high in tyramine → hypertensive crisis with MAOIs.
Teaching Point: Provide MAOI diet list: avoid aged, fermented, smoked foods.
6. A 2-day-old newborn is jittery, HR 180 bpm, and has a high-pitched cry. Mother
has type 1 DM. Which is the priority nursing action?
A. Obtain blood glucose
B. Administer oxygen
C. Start IV fluids
D. Check temperature
Correct Answer: A
Rationale: Infant of diabetic mother at risk for hypoglycemia; s/s mimic CNS
irritability.
Teaching Point: Glucose <40 mg/dL in newborn requires immediate feeding or IV
dextrose.
,7. A nurse is delegating tasks on a medical floor. Which task can be assigned to
assistive personnel (AP)?
A. Check NG tube placement
B. Accu-check blood glucose
C. Insert a urinary catheter
D. Perform sterile wound packing
Correct Answer: B
Rationale: Glucometer use is non-invasive and within AP scope.
Teaching Point: AP may perform stable, non-invasive tasks; nurse retains
assessment & sterile duties.
8. The nurse is assessing a client 6 hours after a thyroidectomy. The client reports
tingling around the mouth and fingertips. Which electrolyte imbalance is
suspected?
A. Hypokalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
Correct Answer: B
Rationale: Tingling, Trousseau/Chvostek signs = hypocalcemia from accidental
parathyroid removal.
Teaching Point: Keep calcium gluconate at bedside post-thyroidectomy.
9. A client with schizophrenia is prescribed haloperidol 5 mg PO bid. Two weeks
later the client demonstrates severe muscle rigidity and fever 39.4 °C. The nurse
suspects:
A. Tardive dyskinesia
B. Akathisia
C. Neuroleptic malignant syndrome
D. Dystonia
Correct Answer: C
Rationale: High fever + rigidity + autonomic instability = NMS medical emergency.
Teaching Point: Discontinue antipsychotic, cool client, provide ICU support &
dantrolene/bromocriptine.
10. A client is receiving TPN through a central line. The nurse notes the infusion has
stopped for 2 hours. The most immediate concern is:
, A. Hyperglycemia
B. Infection
C. Hypoglycemia
D. Fluid overload
Correct Answer: C
Rationale: Abrupt cessation of high-glucose TPN can cause rebound
hypoglycemia.
Teaching Point: Wean TPN gradually or switch to 10% dextrose if infusion must
be interrupted.
11. A client 8 hours post-MI is prescribed metoprolol 25 mg PO. HR is 54 bpm, BP
98/60 mm Hg. The nurse should:
A. Give the medication as scheduled
B. Hold dose and reassess in 1 hour
C. Split tablet and give half dose
D. Contact provider for dosage change
Correct Answer: B
Rationale: Beta-blockers are held for HR <60 or SBP <100 to avoid cardiogenic
shock.
Teaching Point: Always check apical pulse ≥60 & SBP ≥90 before beta-blocker.
12. A client with asthma uses fluticasone/salmeterol daily. Which finding indicates
good technique?
A. Rinses mouth after inhaler
B. Exhales into device before actuation
C. Uses inhaler 3 times daily PRN
D. Stores inhaler in bathroom cabinet
Correct Answer: A
Rationale: Mouth rinsing prevents oral candidiasis from inhaled corticosteroid.
Teaching Point: Teach slow deep inhalation & rinse mouth to reduce local side
effects.
13. A client is admitted with acute pancreatitis. Which lab value is the most reliable
indicator of severity?
A. Serum amylase 1200 U/L
B. Lipase 1800 U/L
C. CRP 18 mg/dL
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
1. A 68-year-old client with COPD is receiving oxygen at 4 L/min via nasal cannula.
The client becomes increasingly somnolent and his ABG reveals pH 7.28, PaCO₂
68 mm Hg, PaO₂ 58 mm Hg. Which action should the nurse take first?
A. Increase oxygen to 6 L/min
B. Obtain a stat chest x-ray
C. Decrease oxygen to 1–2 L/min and notify provider
D. Administer oral mucomyst
Correct Answer: C
Rationale: High-flow O₂ in chronic CO₂ retainers can blunt hypoxic drive →
hypercarbia & acidosis. Lowering FiO₂ is priority to re-establish respiratory drive.
Teaching Point: Always titrate oxygen to target SpO₂ 88–92% in COPD clients.
2. A postpartum client has a fourth-degree laceration. The nurse observes a large
amount of lochia rubra on the perineal pad 2 hours after delivery. Which finding
should the reported immediately?
A. Fundus firm at umbilicus
B. BP 90/50 mm Hg
C. Pulse 88 bpm
D. Client states “I’m so thirsty”
Correct Answer: B
Rationale: Hypotension + heavy lochia suggests hemorrhagic shock; requires
immediate intervention.
Teaching Point: Postpartum hemorrhage = EBL >500 mL vaginal or >1000 mL
cesarean; shock can occur quickly.
3. A client is admitted with DKA. The provider orders an insulin gtt at 0.1
units/kg/hr. Client weight = 70 kg. The pharmacy supplies a solution of 100 units
regular insulin in 100 mL NS. Calculate the infusion rate in mL/hr.
, Correct Answer: 7 mL/hr
Rationale: 0.1 units/kg/hr × 70 kg = 7 units/hr; concentration = 1 unit/mL → 7
mL/hr.
4. A school-age child with sickle-cell disease is in vaso-occlusive crisis. Which
nursing intervention is most effective to promote comfort?
A. Apply cold packs to painful joints
B. Limit PO fluids to 1 L/day
C. Administer morphine 0.05 mg/kg IV q4h PRN
D. Encourage diversional activities only
Correct Answer: C
Rationale: Opioids are first-line for severe pain; cold increases sickling.
Teaching Point: Hydration, warmth, and adequate analgesia are crisis pillars.
5. A client with major depressive disorder is started on phenelzine 15 mg bid. Which
food choice indicates the need for further teaching?
A. Fresh blueberries
B. Aged cheddar cheese
C. Whole-wheat toast
D. Apple juice
Correct Answer: B
Rationale: Aged cheese is high in tyramine → hypertensive crisis with MAOIs.
Teaching Point: Provide MAOI diet list: avoid aged, fermented, smoked foods.
6. A 2-day-old newborn is jittery, HR 180 bpm, and has a high-pitched cry. Mother
has type 1 DM. Which is the priority nursing action?
A. Obtain blood glucose
B. Administer oxygen
C. Start IV fluids
D. Check temperature
Correct Answer: A
Rationale: Infant of diabetic mother at risk for hypoglycemia; s/s mimic CNS
irritability.
Teaching Point: Glucose <40 mg/dL in newborn requires immediate feeding or IV
dextrose.
,7. A nurse is delegating tasks on a medical floor. Which task can be assigned to
assistive personnel (AP)?
A. Check NG tube placement
B. Accu-check blood glucose
C. Insert a urinary catheter
D. Perform sterile wound packing
Correct Answer: B
Rationale: Glucometer use is non-invasive and within AP scope.
Teaching Point: AP may perform stable, non-invasive tasks; nurse retains
assessment & sterile duties.
8. The nurse is assessing a client 6 hours after a thyroidectomy. The client reports
tingling around the mouth and fingertips. Which electrolyte imbalance is
suspected?
A. Hypokalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
Correct Answer: B
Rationale: Tingling, Trousseau/Chvostek signs = hypocalcemia from accidental
parathyroid removal.
Teaching Point: Keep calcium gluconate at bedside post-thyroidectomy.
9. A client with schizophrenia is prescribed haloperidol 5 mg PO bid. Two weeks
later the client demonstrates severe muscle rigidity and fever 39.4 °C. The nurse
suspects:
A. Tardive dyskinesia
B. Akathisia
C. Neuroleptic malignant syndrome
D. Dystonia
Correct Answer: C
Rationale: High fever + rigidity + autonomic instability = NMS medical emergency.
Teaching Point: Discontinue antipsychotic, cool client, provide ICU support &
dantrolene/bromocriptine.
10. A client is receiving TPN through a central line. The nurse notes the infusion has
stopped for 2 hours. The most immediate concern is:
, A. Hyperglycemia
B. Infection
C. Hypoglycemia
D. Fluid overload
Correct Answer: C
Rationale: Abrupt cessation of high-glucose TPN can cause rebound
hypoglycemia.
Teaching Point: Wean TPN gradually or switch to 10% dextrose if infusion must
be interrupted.
11. A client 8 hours post-MI is prescribed metoprolol 25 mg PO. HR is 54 bpm, BP
98/60 mm Hg. The nurse should:
A. Give the medication as scheduled
B. Hold dose and reassess in 1 hour
C. Split tablet and give half dose
D. Contact provider for dosage change
Correct Answer: B
Rationale: Beta-blockers are held for HR <60 or SBP <100 to avoid cardiogenic
shock.
Teaching Point: Always check apical pulse ≥60 & SBP ≥90 before beta-blocker.
12. A client with asthma uses fluticasone/salmeterol daily. Which finding indicates
good technique?
A. Rinses mouth after inhaler
B. Exhales into device before actuation
C. Uses inhaler 3 times daily PRN
D. Stores inhaler in bathroom cabinet
Correct Answer: A
Rationale: Mouth rinsing prevents oral candidiasis from inhaled corticosteroid.
Teaching Point: Teach slow deep inhalation & rinse mouth to reduce local side
effects.
13. A client is admitted with acute pancreatitis. Which lab value is the most reliable
indicator of severity?
A. Serum amylase 1200 U/L
B. Lipase 1800 U/L
C. CRP 18 mg/dL
