1
ATI RN FUNDAMENTALS PROCTORED EXAM 2023
ACTUAL 70 QUESTIONS WITH DETAILED VERIFIED
ANSWERS
Format: Next Generation NCLEX (NGN) – Case Studies, Bow-tie, Multiple-Select, & Traditional Multiple
Choice
Source: Aggregated from Verified Student Reports & Retake Guides
Section 1: Next Generation (NGN) Case Studies & Clinical Judgment
1. NGN Case Study: COPD Exacerbation
A 68-year-old male client with a history of COPD is admitted with worsening shortness of breath and a
productive cough. He is on 2L/min oxygen via nasal cannula. Assessment reveals decreased breath
sounds in the lower lobes, respiratory rate of 28/min, and use of accessory muscles.
Arterial Blood Gas (ABG) Results:
• pH: 7.30
• PaCO₂: 60 mmHg
• HCO₃⁻: 27 mEq/L
• PaO₂: 58 mmHg
Question: Which nursing intervention is most appropriate at this time?
A) Increase the oxygen flow rate to 6 L/min
B) Administer PRN morphine sulfate for respiratory distress
C) Notify the healthcare provider and prepare for possible non-invasive ventilation (BiPAP)
D) Encourage the client to rest and continue current treatment
✔✔ Answer ✔✔ C
Rationale: The ABG results show respiratory acidosis (low pH, high PaCO₂) with hypoxemia, indicating
acute respiratory failure . Clients with COPD retain CO₂, and increasing oxygen beyond prescribed levels
may suppress their hypoxic drive. Morphine can further depress respiration. The priority is to notify the
provider for possible BiPAP initiation to avoid intubation.
,2
2. NGN Case Study: Pulmonary Embolism (PE)
A 29-year-old female postoperative client (open cholecystectomy 8 hours ago) suddenly reports chest
pain and shortness of breath. Vital signs: BP 102/68, HR 118, RR 32, SpO₂ 89% on room air. The nurse
notes unilateral swelling in the left leg.
Question: What should the nurse do first?
A) Obtain a 12-lead ECG
B) Apply oxygen via non-rebreather mask and notify the provider immediately
C) Administer prescribed pain medication
D) Request a Doppler ultrasound of the lower extremities
✔✔ Answer ✔✔ B
Rationale: The client displays classic signs of pulmonary embolism (PE): sudden dyspnea, chest pain,
hypoxia, tachypnea, and unilateral leg swelling (DVT origin) . The first priority is to ensure oxygenation
by applying high-flow oxygen, followed by urgent provider notification. A Doppler ultrasound and ECG
may be ordered but are not first-line during an acute decompensation.
3. NGN Case Study: Wound Infection & Culture
A 45-year-old client with type 2 diabetes is admitted for a non-healing foot ulcer. The nurse notes
purulent drainage, surrounding erythema, and foul odor. Vital signs: T 100.9°F, HR 106 bpm. WBC count
is 14,500/mm³.
Question: The provider prescribes IV antibiotics and a wound culture. What action should the nurse
take first?
A) Administer the IV antibiotic as ordered
B) Apply a sterile dressing to the wound
C) Obtain the wound culture before starting antibiotics
D) Assess the client’s blood glucose level
✔✔ Answer ✔✔ C
Rationale: Before administering antibiotics, a wound culture must be collected to avoid contamination
and ensure accurate identification of the pathogen . Administering antibiotics first may result in false-
negative culture results, hindering targeted therapy.
4. NGN Case Study: Dementia & Agitation
An elderly client with dementia becomes increasingly agitated during morning care. He attempts to get
out of bed unassisted and strikes out at staff.
Question: Which is the most appropriate nursing intervention?
A) Request a prescription for a PRN antipsychotic
,3
B) Apply wrist restraints per facility policy
C) Attempt redirection using calm communication and validate his feelings
D) Leave the client alone for 15 minutes to cool off
✔✔ Answer ✔✔ C
Rationale: Agitation in dementia is often worsened by overstimulation or unmet needs . The best non-
pharmacological intervention is redirection with calm, validating communication. PRN antipsychotics
and restraints are last resorts; leaving the client alone could compromise safety.
5. NGN Case Study: Lithium Therapy & Toxicity
A client admitted with bipolar disorder is receiving lithium therapy. Admission weight: 165 lbs. Current
weight: 164 lbs.
Question: The client is most likely developing and should be monitored for which of the following?
A) Lithium toxicity
B) Urinary tract infection
C) Metabolic syndrome
D) Neuroleptic malignant syndrome
✔✔ Answer ✔✔ A
Rationale: A minor reduction in body weight, especially in the setting of lithium therapy, can
concentrate serum lithium levels, increasing the risk of toxicity . Lithium has a narrow therapeutic index,
and even modest dehydration or fluid loss can precipitate toxicity.
Section 2: Pharmacology & Medication Administration
6. Case Study: Heparin Infusion
A client with deep vein thrombosis is receiving heparin via continuous IV infusion. Lab results reveal:
• aPTT: 95 seconds (Reference range: 30–40 seconds)
• Platelets: 150,000/mm³
• No signs of bleeding noted
Question: Which action should the nurse take first?
A) Increase the infusion rate
B) Stop the infusion immediately
C) Notify the provider and prepare to adjust the dose
D) Continue the current infusion rate
✔✔ Answer ✔✔ C
, 4
Rationale: An aPTT >70 seconds indicates a high risk of bleeding . The provider should be notified to
adjust the dose; stopping the infusion is not needed unless bleeding is present.
7. Case Study: Warfarin Over-anticoagulation
A 72-year-old client with atrial fibrillation is started on warfarin. The INR value is 4.2.
Question: What is the priority nursing action?
A) Administer protamine sulfate
B) Administer phytonadione (Vitamin K)
C) Hold the next dose and notify the provider
D) Continue therapy and recheck INR in 3 days
✔✔ Answer ✔✔ B
Rationale: An INR > 4 places the client at high risk for bleeding . Vitamin K (phytonadione) is the
antidote to reverse warfarin effects.
8. Multiple-Select: Isoniazid (INH) Teaching
Question: A nurse is teaching a client prescribed isoniazid for tuberculosis. Which of the following
should be included? (Select all that apply)
A) “Avoid alcohol while on this medication.”
B) “Report any tingling or numbness in your hands or feet.”
C) “You may notice orange-colored urine.”
D) “Take vitamin B6 supplements to reduce side effects.”
E) “You need to take this medication with antacids.”
✔✔ Answer ✔✔ A, B, D
Rationale: Isoniazid can cause hepatotoxicity (worsened by alcohol) and peripheral neuropathy
(prevented by vitamin B6) . Orange urine is a side effect of rifampin, not isoniazid. Antacids interfere
with absorption.
9. Case Study: Clozapine (Clozaril)
A client prescribed clozapine reports fatigue and a sore throat.
Question: Which lab value is most important to review?
A) Hemoglobin
B) WBC count
C) Platelet count
D) Blood glucose
✔✔ Answer ✔✔ B
ATI RN FUNDAMENTALS PROCTORED EXAM 2023
ACTUAL 70 QUESTIONS WITH DETAILED VERIFIED
ANSWERS
Format: Next Generation NCLEX (NGN) – Case Studies, Bow-tie, Multiple-Select, & Traditional Multiple
Choice
Source: Aggregated from Verified Student Reports & Retake Guides
Section 1: Next Generation (NGN) Case Studies & Clinical Judgment
1. NGN Case Study: COPD Exacerbation
A 68-year-old male client with a history of COPD is admitted with worsening shortness of breath and a
productive cough. He is on 2L/min oxygen via nasal cannula. Assessment reveals decreased breath
sounds in the lower lobes, respiratory rate of 28/min, and use of accessory muscles.
Arterial Blood Gas (ABG) Results:
• pH: 7.30
• PaCO₂: 60 mmHg
• HCO₃⁻: 27 mEq/L
• PaO₂: 58 mmHg
Question: Which nursing intervention is most appropriate at this time?
A) Increase the oxygen flow rate to 6 L/min
B) Administer PRN morphine sulfate for respiratory distress
C) Notify the healthcare provider and prepare for possible non-invasive ventilation (BiPAP)
D) Encourage the client to rest and continue current treatment
✔✔ Answer ✔✔ C
Rationale: The ABG results show respiratory acidosis (low pH, high PaCO₂) with hypoxemia, indicating
acute respiratory failure . Clients with COPD retain CO₂, and increasing oxygen beyond prescribed levels
may suppress their hypoxic drive. Morphine can further depress respiration. The priority is to notify the
provider for possible BiPAP initiation to avoid intubation.
,2
2. NGN Case Study: Pulmonary Embolism (PE)
A 29-year-old female postoperative client (open cholecystectomy 8 hours ago) suddenly reports chest
pain and shortness of breath. Vital signs: BP 102/68, HR 118, RR 32, SpO₂ 89% on room air. The nurse
notes unilateral swelling in the left leg.
Question: What should the nurse do first?
A) Obtain a 12-lead ECG
B) Apply oxygen via non-rebreather mask and notify the provider immediately
C) Administer prescribed pain medication
D) Request a Doppler ultrasound of the lower extremities
✔✔ Answer ✔✔ B
Rationale: The client displays classic signs of pulmonary embolism (PE): sudden dyspnea, chest pain,
hypoxia, tachypnea, and unilateral leg swelling (DVT origin) . The first priority is to ensure oxygenation
by applying high-flow oxygen, followed by urgent provider notification. A Doppler ultrasound and ECG
may be ordered but are not first-line during an acute decompensation.
3. NGN Case Study: Wound Infection & Culture
A 45-year-old client with type 2 diabetes is admitted for a non-healing foot ulcer. The nurse notes
purulent drainage, surrounding erythema, and foul odor. Vital signs: T 100.9°F, HR 106 bpm. WBC count
is 14,500/mm³.
Question: The provider prescribes IV antibiotics and a wound culture. What action should the nurse
take first?
A) Administer the IV antibiotic as ordered
B) Apply a sterile dressing to the wound
C) Obtain the wound culture before starting antibiotics
D) Assess the client’s blood glucose level
✔✔ Answer ✔✔ C
Rationale: Before administering antibiotics, a wound culture must be collected to avoid contamination
and ensure accurate identification of the pathogen . Administering antibiotics first may result in false-
negative culture results, hindering targeted therapy.
4. NGN Case Study: Dementia & Agitation
An elderly client with dementia becomes increasingly agitated during morning care. He attempts to get
out of bed unassisted and strikes out at staff.
Question: Which is the most appropriate nursing intervention?
A) Request a prescription for a PRN antipsychotic
,3
B) Apply wrist restraints per facility policy
C) Attempt redirection using calm communication and validate his feelings
D) Leave the client alone for 15 minutes to cool off
✔✔ Answer ✔✔ C
Rationale: Agitation in dementia is often worsened by overstimulation or unmet needs . The best non-
pharmacological intervention is redirection with calm, validating communication. PRN antipsychotics
and restraints are last resorts; leaving the client alone could compromise safety.
5. NGN Case Study: Lithium Therapy & Toxicity
A client admitted with bipolar disorder is receiving lithium therapy. Admission weight: 165 lbs. Current
weight: 164 lbs.
Question: The client is most likely developing and should be monitored for which of the following?
A) Lithium toxicity
B) Urinary tract infection
C) Metabolic syndrome
D) Neuroleptic malignant syndrome
✔✔ Answer ✔✔ A
Rationale: A minor reduction in body weight, especially in the setting of lithium therapy, can
concentrate serum lithium levels, increasing the risk of toxicity . Lithium has a narrow therapeutic index,
and even modest dehydration or fluid loss can precipitate toxicity.
Section 2: Pharmacology & Medication Administration
6. Case Study: Heparin Infusion
A client with deep vein thrombosis is receiving heparin via continuous IV infusion. Lab results reveal:
• aPTT: 95 seconds (Reference range: 30–40 seconds)
• Platelets: 150,000/mm³
• No signs of bleeding noted
Question: Which action should the nurse take first?
A) Increase the infusion rate
B) Stop the infusion immediately
C) Notify the provider and prepare to adjust the dose
D) Continue the current infusion rate
✔✔ Answer ✔✔ C
, 4
Rationale: An aPTT >70 seconds indicates a high risk of bleeding . The provider should be notified to
adjust the dose; stopping the infusion is not needed unless bleeding is present.
7. Case Study: Warfarin Over-anticoagulation
A 72-year-old client with atrial fibrillation is started on warfarin. The INR value is 4.2.
Question: What is the priority nursing action?
A) Administer protamine sulfate
B) Administer phytonadione (Vitamin K)
C) Hold the next dose and notify the provider
D) Continue therapy and recheck INR in 3 days
✔✔ Answer ✔✔ B
Rationale: An INR > 4 places the client at high risk for bleeding . Vitamin K (phytonadione) is the
antidote to reverse warfarin effects.
8. Multiple-Select: Isoniazid (INH) Teaching
Question: A nurse is teaching a client prescribed isoniazid for tuberculosis. Which of the following
should be included? (Select all that apply)
A) “Avoid alcohol while on this medication.”
B) “Report any tingling or numbness in your hands or feet.”
C) “You may notice orange-colored urine.”
D) “Take vitamin B6 supplements to reduce side effects.”
E) “You need to take this medication with antacids.”
✔✔ Answer ✔✔ A, B, D
Rationale: Isoniazid can cause hepatotoxicity (worsened by alcohol) and peripheral neuropathy
(prevented by vitamin B6) . Orange urine is a side effect of rifampin, not isoniazid. Antacids interfere
with absorption.
9. Case Study: Clozapine (Clozaril)
A client prescribed clozapine reports fatigue and a sore throat.
Question: Which lab value is most important to review?
A) Hemoglobin
B) WBC count
C) Platelet count
D) Blood glucose
✔✔ Answer ✔✔ B
