NSG 4800 ATI EXIT EXAM
Comprehensive Practice Exam 2026
Questions with ANSWERs and Rationales !!!
Question 1
A nurse is caring for a client who has bipolar disorder and is taking lithium. The client reports blurred
vision and an increase in urine output. The nurse notes the client is having clonic jerking of upper
extremities. Which of the following conditions should the nurse suspect?
A. Lithium toxicity
B. Urinary tract infection
C. Metabolic syndrome
D. Neuroleptic malignant syndrome
ANSWER: A
Rationale:
A. Lithium toxicity - CORRECT. Blurred vision, increased urine output (polyuria), and clonic jerking are
classic signs of lithium toxicity. Therapeutic lithium levels are 0.6-1.2 mEq/L, and toxicity occurs above
1.5 mEq/L.
B. Urinary tract infection - Incorrect. While increased urination can occur with UTI, the combination of
visual disturbances and neuromuscular symptoms (clonic jerking) is not characteristic of UTI.
C. Metabolic syndrome - Incorrect. Metabolic syndrome involves hypertension, hyperglycemia, excess
body fat, and abnormal cholesterol levels, not the acute neurological symptoms presented.
D. Neuroleptic malignant syndrome - Incorrect. NMS is associated with antipsychotic medications and
presents with fever, muscle rigidity, altered mental status, and autonomic instability, not the specific
symptoms described.
Question 2
A nurse is preparing to initiate intravenous fluids via infusion pump for a client. Which of the following
actions should the nurse take first?
A. Obtain a surge protector that can accommodate the pump and several other appliances
,B. Verify that the extension cord for the pump is ungrounded
C. Report the pump has a frayed cord and proceed with the infusion
D. Check the expiration date on the safety inspection sticker of the pump
ANSWER: D
Rationale:
A. Obtain a surge protector - Incorrect. While electrical safety is important, this is not the priority action
before using an infusion pump.
B. Verify that the extension cord is ungrounded - Incorrect. Extension cords should be grounded for
safety. Using ungrounded cords is unsafe practice.
C. Report the pump has a frayed cord and proceed - Incorrect. A pump with a frayed cord should NOT be
used under any circumstances due to electrical hazard risks.
D. Check the expiration date on the safety inspection sticker - CORRECT. The nurse must verify the pump
has current safety inspection to ensure it is functioning properly and safely before use.
Question 3
A nurse is caring for a client who has an implanted venous access port. Which of the following should
the nurse use to access the port?
A. A noncoring needle
B. An angiocatheter
C. A butterfly needle
D. A 25-gauge needle
ANSWER: A
Rationale:
A. A noncoring needle - CORRECT. Implanted ports require a noncoring (Huber) needle to prevent
damage to the port septum. Coring needles can cut pieces of the silicone septum.
B. An angiocatheter - Incorrect. Angiocatheters are used for peripheral IV access, not for accessing
implanted ports.
C. A butterfly needle - Incorrect. Butterfly needles are used for peripheral venipuncture or blood draws,
not for port access.
D. A 25-gauge needle - Incorrect. While gauge size is important, the critical factor is using a noncoring
needle specifically designed for port access.
Question 4
,A nurse is conducting an initial assessment of a client and notices a discrepancy between the client's
current IV infusion and the information received during the shift report. Which of the following actions
should the nurse take first?
A. Contact the charge nurse to see if the prescription was changed
B. Complete an incident report and place it in the client's medical record
C. Submit a written warning for the nurse involved in the incident
D. Compare the current infusion with the prescription in the client's medication record
ANSWER: D
Rationale:
A. Contact the charge nurse - Incorrect. This may be necessary later, but the nurse should first verify the
discrepancy independently.
B. Complete an incident report - Incorrect. An incident report may be needed, but only after confirming
there is an actual error. Incident reports are not placed in the client's medical record.
C. Submit a written warning - Incorrect. This is a management function and not within the nurse's scope.
Also, this is premature before investigation.
D. Compare the current infusion with the prescription - CORRECT. The nurse should first verify the
discrepancy by checking the current infusion against the provider's prescription in the medical record
before taking further action.
Question 5
A nurse is assessing a client who is 2 hours postoperative following a total hip arthroplasty. Which of the
following findings should the nurse report to the provider immediately?
A. Pain level of 6 on a scale of 0 to 10
B. Serous drainage on the dressing
C. Shortness of breath and chest pain
D. Temperature of 37.8°C (100°F)
ANSWER: C
Rationale:
A. Pain level of 6 - Incorrect. Moderate pain is expected postoperatively and should be managed with
analgesics but is not an emergency.
B. Serous drainage - Incorrect. Small amounts of serous drainage are expected in the immediate
postoperative period.
, C. Shortness of breath and chest pain - CORRECT. These are signs of pulmonary embolism, a life-
threatening complication that requires immediate intervention, especially in orthopedic surgery
patients.
D. Temperature of 37.8°C - Incorrect. Low-grade fever is common in the first 24-48 hours
postoperatively due to the inflammatory response.
Question 6
A nurse is teaching a client who has a new prescription for warfarin. Which of the following statements
by the client indicates an understanding of the teaching?
A. "I will take ibuprofen for headaches while on this medication."
B. "I will increase my intake of leafy green vegetables."
C. "I will use a soft-bristled toothbrush."
D. "I will stop taking this medication if I notice bruising."
ANSWER: C
Rationale:
A. "I will take ibuprofen" - Incorrect. NSAIDs like ibuprofen increase bleeding risk when taken with
warfarin and should be avoided.
B. "I will increase my intake of leafy green vegetables" - Incorrect. Leafy greens are high in vitamin K,
which antagonizes warfarin. Intake should be consistent, not increased.
C. "I will use a soft-bristled toothbrush" - CORRECT. This helps prevent bleeding gums, an important
safety measure for clients on anticoagulants.
D. "I will stop taking this medication if I notice bruising" - Incorrect. Bruising is expected with warfarin.
The medication should not be stopped without provider notification.
Question 7
A nurse is caring for a client who has diabetes mellitus and is experiencing hypoglycemia. Which of the
following actions should the nurse take first?
A. Administer 15 grams of simple carbohydrates
B. Check the client's blood glucose level
C. Notify the provider
D. Recheck blood glucose in 15 minutes
ANSWER: B
Rationale:
Comprehensive Practice Exam 2026
Questions with ANSWERs and Rationales !!!
Question 1
A nurse is caring for a client who has bipolar disorder and is taking lithium. The client reports blurred
vision and an increase in urine output. The nurse notes the client is having clonic jerking of upper
extremities. Which of the following conditions should the nurse suspect?
A. Lithium toxicity
B. Urinary tract infection
C. Metabolic syndrome
D. Neuroleptic malignant syndrome
ANSWER: A
Rationale:
A. Lithium toxicity - CORRECT. Blurred vision, increased urine output (polyuria), and clonic jerking are
classic signs of lithium toxicity. Therapeutic lithium levels are 0.6-1.2 mEq/L, and toxicity occurs above
1.5 mEq/L.
B. Urinary tract infection - Incorrect. While increased urination can occur with UTI, the combination of
visual disturbances and neuromuscular symptoms (clonic jerking) is not characteristic of UTI.
C. Metabolic syndrome - Incorrect. Metabolic syndrome involves hypertension, hyperglycemia, excess
body fat, and abnormal cholesterol levels, not the acute neurological symptoms presented.
D. Neuroleptic malignant syndrome - Incorrect. NMS is associated with antipsychotic medications and
presents with fever, muscle rigidity, altered mental status, and autonomic instability, not the specific
symptoms described.
Question 2
A nurse is preparing to initiate intravenous fluids via infusion pump for a client. Which of the following
actions should the nurse take first?
A. Obtain a surge protector that can accommodate the pump and several other appliances
,B. Verify that the extension cord for the pump is ungrounded
C. Report the pump has a frayed cord and proceed with the infusion
D. Check the expiration date on the safety inspection sticker of the pump
ANSWER: D
Rationale:
A. Obtain a surge protector - Incorrect. While electrical safety is important, this is not the priority action
before using an infusion pump.
B. Verify that the extension cord is ungrounded - Incorrect. Extension cords should be grounded for
safety. Using ungrounded cords is unsafe practice.
C. Report the pump has a frayed cord and proceed - Incorrect. A pump with a frayed cord should NOT be
used under any circumstances due to electrical hazard risks.
D. Check the expiration date on the safety inspection sticker - CORRECT. The nurse must verify the pump
has current safety inspection to ensure it is functioning properly and safely before use.
Question 3
A nurse is caring for a client who has an implanted venous access port. Which of the following should
the nurse use to access the port?
A. A noncoring needle
B. An angiocatheter
C. A butterfly needle
D. A 25-gauge needle
ANSWER: A
Rationale:
A. A noncoring needle - CORRECT. Implanted ports require a noncoring (Huber) needle to prevent
damage to the port septum. Coring needles can cut pieces of the silicone septum.
B. An angiocatheter - Incorrect. Angiocatheters are used for peripheral IV access, not for accessing
implanted ports.
C. A butterfly needle - Incorrect. Butterfly needles are used for peripheral venipuncture or blood draws,
not for port access.
D. A 25-gauge needle - Incorrect. While gauge size is important, the critical factor is using a noncoring
needle specifically designed for port access.
Question 4
,A nurse is conducting an initial assessment of a client and notices a discrepancy between the client's
current IV infusion and the information received during the shift report. Which of the following actions
should the nurse take first?
A. Contact the charge nurse to see if the prescription was changed
B. Complete an incident report and place it in the client's medical record
C. Submit a written warning for the nurse involved in the incident
D. Compare the current infusion with the prescription in the client's medication record
ANSWER: D
Rationale:
A. Contact the charge nurse - Incorrect. This may be necessary later, but the nurse should first verify the
discrepancy independently.
B. Complete an incident report - Incorrect. An incident report may be needed, but only after confirming
there is an actual error. Incident reports are not placed in the client's medical record.
C. Submit a written warning - Incorrect. This is a management function and not within the nurse's scope.
Also, this is premature before investigation.
D. Compare the current infusion with the prescription - CORRECT. The nurse should first verify the
discrepancy by checking the current infusion against the provider's prescription in the medical record
before taking further action.
Question 5
A nurse is assessing a client who is 2 hours postoperative following a total hip arthroplasty. Which of the
following findings should the nurse report to the provider immediately?
A. Pain level of 6 on a scale of 0 to 10
B. Serous drainage on the dressing
C. Shortness of breath and chest pain
D. Temperature of 37.8°C (100°F)
ANSWER: C
Rationale:
A. Pain level of 6 - Incorrect. Moderate pain is expected postoperatively and should be managed with
analgesics but is not an emergency.
B. Serous drainage - Incorrect. Small amounts of serous drainage are expected in the immediate
postoperative period.
, C. Shortness of breath and chest pain - CORRECT. These are signs of pulmonary embolism, a life-
threatening complication that requires immediate intervention, especially in orthopedic surgery
patients.
D. Temperature of 37.8°C - Incorrect. Low-grade fever is common in the first 24-48 hours
postoperatively due to the inflammatory response.
Question 6
A nurse is teaching a client who has a new prescription for warfarin. Which of the following statements
by the client indicates an understanding of the teaching?
A. "I will take ibuprofen for headaches while on this medication."
B. "I will increase my intake of leafy green vegetables."
C. "I will use a soft-bristled toothbrush."
D. "I will stop taking this medication if I notice bruising."
ANSWER: C
Rationale:
A. "I will take ibuprofen" - Incorrect. NSAIDs like ibuprofen increase bleeding risk when taken with
warfarin and should be avoided.
B. "I will increase my intake of leafy green vegetables" - Incorrect. Leafy greens are high in vitamin K,
which antagonizes warfarin. Intake should be consistent, not increased.
C. "I will use a soft-bristled toothbrush" - CORRECT. This helps prevent bleeding gums, an important
safety measure for clients on anticoagulants.
D. "I will stop taking this medication if I notice bruising" - Incorrect. Bruising is expected with warfarin.
The medication should not be stopped without provider notification.
Question 7
A nurse is caring for a client who has diabetes mellitus and is experiencing hypoglycemia. Which of the
following actions should the nurse take first?
A. Administer 15 grams of simple carbohydrates
B. Check the client's blood glucose level
C. Notify the provider
D. Recheck blood glucose in 15 minutes
ANSWER: B
Rationale:
