ATI Comprehensive Exit Exam 2026/2027 Actual Exam with
Detailed Rationales | Complete Exam-Style Questions | 100%
Verified Pass Guaranteed – A+ Graded
Total Questions: 180 | Time: 240 min | Pass: Level 2 Proficiency
TABLE OF CONTENTS
Section 1 | Medical-Surgical Nursing | Q1 – Q45
Section 2 | Maternal-Newborn & Pediatric Nursing | Q46 – Q90
Section 3 | Psychiatric-Mental Health & Pharmacology | Q91 – Q135
Section 4 | Leadership, Management & Community Health | Q136 – Q180
Instructions: Choose the single best answer. Pass: Level 2 proficiency in 240 minutes.
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SECTION 1: MEDICAL-SURGICAL NURSING Q1 – Q45
══════════════════════════════════════
Question 1 of 180
A 68-year-old client with a history of chronic heart failure is admitted with worsening
dyspnea and 2+ pitting edema in both lower extremities. The provider orders
furosemide 40 mg IV push. Which assessment finding indicates the medication is
producing the desired effect?
A. Decreased serum potassium level from 4.2 to 3.8 mEq/L
B. Urine output of 150 mL over the past 2 hours
C. Weight decrease of 1.2 kg from admission ✓ CORRECT
D. Heart rate increase from 88 to 96 beats per minute
Correct Answer: C
Rationale: A measurable weight decrease reflects fluid loss, which is the primary
therapeutic goal of furosemide in acute decompensated heart failure. While increased
urine output is expected, a specific volume over 2 hours is less reliable than a weight
trend for gauging overall fluid status. Monitoring daily weights at the same time each
,day remains the most accurate bedside method for tracking fluid balance in heart
failure clients.
Question 2 of 180
A 54-year-old client is 2 hours post-op following a total thyroidectomy. The nurse
observes mild swelling around the incision and notes the client is reporting a tingling
sensation in the fingertips. Which action should the nurse take first?
A. Place a tracheostomy set at the bedside
B. Administer the prescribed calcium gluconate ✓ CORRECT
C. Call the provider to request a STAT chest X-ray
D. Increase the humidified oxygen flow rate to 6 L
Correct Answer: B
Rationale: Tingling in the fingertips after thyroidectomy strongly suggests hypocalcemia
from accidental parathyroid removal or trauma, requiring prompt calcium replacement.
Although airway compromise from hemorrhage is a serious post-thyroidectomy risk, the
absence of respiratory distress or severe neck swelling makes hypocalcemia the more
immediate concern. Early calcium administration can prevent progression to tetany or
laryngospasm.
Question 3 of 180
A 72-year-old client with emphysema is receiving oxygen at 2 L/min via nasal cannula.
The nurse notices the client has become increasingly somnolent, and the pulse
oximeter reads 94%. Which adjustment should the nurse make?
A. Increase the oxygen flow to 4 L/min to improve saturation
B. Encourage the client to use pursed-lip breathing techniques
C. Maintain the current oxygen flow and notify the provider ✓ CORRECT
D. Switch the delivery device to a simple face mask at 35%
Correct Answer: C
,Rationale: In clients with COPD who retain carbon dioxide, excessive oxygen can
suppress the hypoxic respiratory drive and worsen hypercapnia, causing somnolence;
maintaining the current flow prevents further CO2 narcosis. Increasing the oxygen flow
would likely exacerbate the client's decreasing level of consciousness rather than
improve it. The provider needs to evaluate for possible noninvasive positive pressure
ventilation or arterial blood gas analysis.
Question 4 of 180
A 45-year-old client with cirrhosis presents with asterixis, confusion, and a flapping
hand tremor. The provider suspects hepatic encephalopathy. Which dietary modification
should the nurse anticipate?
A. High-protein diet to promote albumin synthesis
B. Restricted protein intake with vegetable sources preferred ✓ CORRECT
C. Sodium restriction to 4 g per day
D. Full liquid diet with glucose supplementation
Correct Answer: B
Rationale: Protein restriction reduces ammonia production in the gut, which is central to
managing hepatic encephalopathy, with vegetable proteins being better tolerated than
animal proteins. A high-protein diet would increase ammonia levels and worsen the
client's neurologic status. Sodium restriction is important for ascites management but
does not directly address the encephalopathy.
Question 5 of 180
A 38-year-old client sustained a spinal cord injury at the T6 level 48 hours ago. During
the assessment, the nurse notes a severe throbbing headache, bradycardia at 52
beats/minute, and profuse sweating above the level of injury. Which condition is the
nurse recognizing?
, A. Neurogenic shock
B. Autonomic dysreflexia ✓ CORRECT
C. Spinal cord compression syndrome
D. Malignant hyperthermia
Correct Answer: B
Rationale: Autonomic dysreflexia is a life-threatening emergency in clients with T6 or
higher injuries, characterized by hypertension, bradycardia, pounding headache, and
flushing or sweating above the lesion level. Neurogenic shock typically presents with
hypotension and warm, dry skin rather than hypertension and sweating. The nurse must
immediately identify and remove the noxious stimulus, most commonly a distended
bladder or bowel impaction.
Question 6 of 180
A 61-year-old client is receiving warfarin for atrial fibrillation. The nurse reviews the INR
result and notes it is 4.8. Which client teaching point is most appropriate?
A. Increase the warfarin dose to maintain therapeutic anticoagulation
B. Avoid green leafy vegetables until the INR normalizes
C. Use a soft toothbrush and an electric razor ✓ CORRECT
D. Take aspirin daily to enhance the anticoagulant effect
Correct Answer: C
Rationale: An INR of 4.8 indicates supratherapeutic anticoagulation, significantly
increasing bleeding risk, so the nurse should reinforce bleeding precautions such as
using soft toothbrushes and electric razors. Increasing the warfarin dose would further
elevate the INR and dangerously increase hemorrhage risk. The provider will likely hold
or reduce the next dose rather than adjust the client's diet as the primary intervention.
Question 7 of 180
Detailed Rationales | Complete Exam-Style Questions | 100%
Verified Pass Guaranteed – A+ Graded
Total Questions: 180 | Time: 240 min | Pass: Level 2 Proficiency
TABLE OF CONTENTS
Section 1 | Medical-Surgical Nursing | Q1 – Q45
Section 2 | Maternal-Newborn & Pediatric Nursing | Q46 – Q90
Section 3 | Psychiatric-Mental Health & Pharmacology | Q91 – Q135
Section 4 | Leadership, Management & Community Health | Q136 – Q180
Instructions: Choose the single best answer. Pass: Level 2 proficiency in 240 minutes.
══════════════════════════════════════
SECTION 1: MEDICAL-SURGICAL NURSING Q1 – Q45
══════════════════════════════════════
Question 1 of 180
A 68-year-old client with a history of chronic heart failure is admitted with worsening
dyspnea and 2+ pitting edema in both lower extremities. The provider orders
furosemide 40 mg IV push. Which assessment finding indicates the medication is
producing the desired effect?
A. Decreased serum potassium level from 4.2 to 3.8 mEq/L
B. Urine output of 150 mL over the past 2 hours
C. Weight decrease of 1.2 kg from admission ✓ CORRECT
D. Heart rate increase from 88 to 96 beats per minute
Correct Answer: C
Rationale: A measurable weight decrease reflects fluid loss, which is the primary
therapeutic goal of furosemide in acute decompensated heart failure. While increased
urine output is expected, a specific volume over 2 hours is less reliable than a weight
trend for gauging overall fluid status. Monitoring daily weights at the same time each
,day remains the most accurate bedside method for tracking fluid balance in heart
failure clients.
Question 2 of 180
A 54-year-old client is 2 hours post-op following a total thyroidectomy. The nurse
observes mild swelling around the incision and notes the client is reporting a tingling
sensation in the fingertips. Which action should the nurse take first?
A. Place a tracheostomy set at the bedside
B. Administer the prescribed calcium gluconate ✓ CORRECT
C. Call the provider to request a STAT chest X-ray
D. Increase the humidified oxygen flow rate to 6 L
Correct Answer: B
Rationale: Tingling in the fingertips after thyroidectomy strongly suggests hypocalcemia
from accidental parathyroid removal or trauma, requiring prompt calcium replacement.
Although airway compromise from hemorrhage is a serious post-thyroidectomy risk, the
absence of respiratory distress or severe neck swelling makes hypocalcemia the more
immediate concern. Early calcium administration can prevent progression to tetany or
laryngospasm.
Question 3 of 180
A 72-year-old client with emphysema is receiving oxygen at 2 L/min via nasal cannula.
The nurse notices the client has become increasingly somnolent, and the pulse
oximeter reads 94%. Which adjustment should the nurse make?
A. Increase the oxygen flow to 4 L/min to improve saturation
B. Encourage the client to use pursed-lip breathing techniques
C. Maintain the current oxygen flow and notify the provider ✓ CORRECT
D. Switch the delivery device to a simple face mask at 35%
Correct Answer: C
,Rationale: In clients with COPD who retain carbon dioxide, excessive oxygen can
suppress the hypoxic respiratory drive and worsen hypercapnia, causing somnolence;
maintaining the current flow prevents further CO2 narcosis. Increasing the oxygen flow
would likely exacerbate the client's decreasing level of consciousness rather than
improve it. The provider needs to evaluate for possible noninvasive positive pressure
ventilation or arterial blood gas analysis.
Question 4 of 180
A 45-year-old client with cirrhosis presents with asterixis, confusion, and a flapping
hand tremor. The provider suspects hepatic encephalopathy. Which dietary modification
should the nurse anticipate?
A. High-protein diet to promote albumin synthesis
B. Restricted protein intake with vegetable sources preferred ✓ CORRECT
C. Sodium restriction to 4 g per day
D. Full liquid diet with glucose supplementation
Correct Answer: B
Rationale: Protein restriction reduces ammonia production in the gut, which is central to
managing hepatic encephalopathy, with vegetable proteins being better tolerated than
animal proteins. A high-protein diet would increase ammonia levels and worsen the
client's neurologic status. Sodium restriction is important for ascites management but
does not directly address the encephalopathy.
Question 5 of 180
A 38-year-old client sustained a spinal cord injury at the T6 level 48 hours ago. During
the assessment, the nurse notes a severe throbbing headache, bradycardia at 52
beats/minute, and profuse sweating above the level of injury. Which condition is the
nurse recognizing?
, A. Neurogenic shock
B. Autonomic dysreflexia ✓ CORRECT
C. Spinal cord compression syndrome
D. Malignant hyperthermia
Correct Answer: B
Rationale: Autonomic dysreflexia is a life-threatening emergency in clients with T6 or
higher injuries, characterized by hypertension, bradycardia, pounding headache, and
flushing or sweating above the lesion level. Neurogenic shock typically presents with
hypotension and warm, dry skin rather than hypertension and sweating. The nurse must
immediately identify and remove the noxious stimulus, most commonly a distended
bladder or bowel impaction.
Question 6 of 180
A 61-year-old client is receiving warfarin for atrial fibrillation. The nurse reviews the INR
result and notes it is 4.8. Which client teaching point is most appropriate?
A. Increase the warfarin dose to maintain therapeutic anticoagulation
B. Avoid green leafy vegetables until the INR normalizes
C. Use a soft toothbrush and an electric razor ✓ CORRECT
D. Take aspirin daily to enhance the anticoagulant effect
Correct Answer: C
Rationale: An INR of 4.8 indicates supratherapeutic anticoagulation, significantly
increasing bleeding risk, so the nurse should reinforce bleeding precautions such as
using soft toothbrushes and electric razors. Increasing the warfarin dose would further
elevate the INR and dangerously increase hemorrhage risk. The provider will likely hold
or reduce the next dose rather than adjust the client's diet as the primary intervention.
Question 7 of 180
