2026 ATI RN Fundamentals Practice Exam
Questions with Answers and Detailed
Rationales
1. A nurse is caring for a client who is 4 hr postoperative
following abdominal surgery. The client reports increasing
abdominal pain despite receiving prescribed opioid
analgesia. Which finding requires the nurse to take
immediate action?
A. Pain rating of 7/10
B. Heart rate of 104/min
C. Absent bowel sounds
D. Rigid, board-like abdomen
Rationale: A rigid, board-like abdomen can indicate peritonitis
or an acute intra-abdominal complication such as perforation
or hemorrhage. This finding requires immediate assessment
and provider notification. Pain and mild tachycardia may
occur postoperatively, while decreased bowel sounds are
common after abdominal surgery.
2. A nurse is assessing a client who is receiving continuous
enteral tube feeding. Which finding is most concerning?
A. Gastric residual volume of 80 mL
B. Loose stool twice during the shift
,C. New onset of coughing and oxygen saturation of 88%
D. Bowel sounds present in all four quadrants
Rationale: New coughing accompanied by hypoxemia during
enteral feeding suggests aspiration and requires immediate
intervention. The nurse should stop the feeding, assess
respiratory status, position the client appropriately, and
follow institutional protocols. Mild diarrhoea and a modest
residual volume are less immediately concerning.
3. A nurse is preparing to administer an intravenous
medication. The medication label is difficult to read because
part of the print is smudged. Which action should the nurse
take?
A. Ask another nurse to identify the medication
B. Compare the medication with the electronic medication
record
C. Contact the pharmacy after administering the medication
D. Discard the medication and obtain a clearly labelled
replacement
Rationale: A medication with an illegible label should never
be administered. The nurse must be able to verify the
medication, concentration, expiration date, and other
required information before administration. Asking another
nurse to identify an unclear medication does not replace
proper verification.
,4. A client with dysphagia following a cerebrovascular
accident is prescribed oral medications. Which intervention
should the nurse implement first?
A. Administer medications with a large glass of water
B. Crush all medications and mix them with applesauce
C. Place the client in a supine position
D. Verify the client's swallowing ability and prescribed diet
consistency
Rationale: Dysphagia significantly increases aspiration risk.
The nurse should first determine the client's swallowing status
and follow recommendations from speech-language
pathology or the prescribed diet. Not all medications can be
crushed, and thin liquids can increase aspiration risk in some
clients.
5. A nurse is caring for a client with a central venous
catheter. Which finding requires immediate intervention?
A. Transparent dressing changed 48 hr ago
B. Catheter flushed with prescribed solution
C. Mild tenderness at the insertion site immediately after
placement
D. Sudden dyspnoea and chest pain during catheter
manipulation
Rationale: Sudden dyspnoea and chest pain during central
line manipulation can indicate an air embolism or catheter-
related complication. The nurse should stop the procedure,
provide appropriate positioning and oxygen as indicated, and
, notify the provider immediately.
6. A nurse is caring for a client who has a prescription for
oxygen at 2 L/min via nasal cannula. The client's oxygen
saturation is 89%, and the client is increasingly restless.
Which action should the nurse take first?
A. Increase oxygen to 6 L/min
B. Notify the provider
C. Assess airway and breathing and verify oxygen delivery
equipment
D. Administer an opioid analgesic
Rationale: The nurse should first assess the client's airway
and breathing and ensure the oxygen equipment is
functioning correctly. Increasing oxygen without assessment
may be inappropriate, particularly for clients with chronic
respiratory disease. Immediate assessment establishes the
cause of hypoxaemia and guides further intervention.
Difficulty: Hard
7. A nurse is teaching a client how to use an incentive
spirometer after surgery. Which statement indicates correct
understanding?
A. "I will use it once each morning."
B. "I will breathe out forcefully into the device."
C. "I will use it only when I feel short of breath."
D. "I will inhale slowly and deeply through the mouthpiece
and hold my breath briefly."
Questions with Answers and Detailed
Rationales
1. A nurse is caring for a client who is 4 hr postoperative
following abdominal surgery. The client reports increasing
abdominal pain despite receiving prescribed opioid
analgesia. Which finding requires the nurse to take
immediate action?
A. Pain rating of 7/10
B. Heart rate of 104/min
C. Absent bowel sounds
D. Rigid, board-like abdomen
Rationale: A rigid, board-like abdomen can indicate peritonitis
or an acute intra-abdominal complication such as perforation
or hemorrhage. This finding requires immediate assessment
and provider notification. Pain and mild tachycardia may
occur postoperatively, while decreased bowel sounds are
common after abdominal surgery.
2. A nurse is assessing a client who is receiving continuous
enteral tube feeding. Which finding is most concerning?
A. Gastric residual volume of 80 mL
B. Loose stool twice during the shift
,C. New onset of coughing and oxygen saturation of 88%
D. Bowel sounds present in all four quadrants
Rationale: New coughing accompanied by hypoxemia during
enteral feeding suggests aspiration and requires immediate
intervention. The nurse should stop the feeding, assess
respiratory status, position the client appropriately, and
follow institutional protocols. Mild diarrhoea and a modest
residual volume are less immediately concerning.
3. A nurse is preparing to administer an intravenous
medication. The medication label is difficult to read because
part of the print is smudged. Which action should the nurse
take?
A. Ask another nurse to identify the medication
B. Compare the medication with the electronic medication
record
C. Contact the pharmacy after administering the medication
D. Discard the medication and obtain a clearly labelled
replacement
Rationale: A medication with an illegible label should never
be administered. The nurse must be able to verify the
medication, concentration, expiration date, and other
required information before administration. Asking another
nurse to identify an unclear medication does not replace
proper verification.
,4. A client with dysphagia following a cerebrovascular
accident is prescribed oral medications. Which intervention
should the nurse implement first?
A. Administer medications with a large glass of water
B. Crush all medications and mix them with applesauce
C. Place the client in a supine position
D. Verify the client's swallowing ability and prescribed diet
consistency
Rationale: Dysphagia significantly increases aspiration risk.
The nurse should first determine the client's swallowing status
and follow recommendations from speech-language
pathology or the prescribed diet. Not all medications can be
crushed, and thin liquids can increase aspiration risk in some
clients.
5. A nurse is caring for a client with a central venous
catheter. Which finding requires immediate intervention?
A. Transparent dressing changed 48 hr ago
B. Catheter flushed with prescribed solution
C. Mild tenderness at the insertion site immediately after
placement
D. Sudden dyspnoea and chest pain during catheter
manipulation
Rationale: Sudden dyspnoea and chest pain during central
line manipulation can indicate an air embolism or catheter-
related complication. The nurse should stop the procedure,
provide appropriate positioning and oxygen as indicated, and
, notify the provider immediately.
6. A nurse is caring for a client who has a prescription for
oxygen at 2 L/min via nasal cannula. The client's oxygen
saturation is 89%, and the client is increasingly restless.
Which action should the nurse take first?
A. Increase oxygen to 6 L/min
B. Notify the provider
C. Assess airway and breathing and verify oxygen delivery
equipment
D. Administer an opioid analgesic
Rationale: The nurse should first assess the client's airway
and breathing and ensure the oxygen equipment is
functioning correctly. Increasing oxygen without assessment
may be inappropriate, particularly for clients with chronic
respiratory disease. Immediate assessment establishes the
cause of hypoxaemia and guides further intervention.
Difficulty: Hard
7. A nurse is teaching a client how to use an incentive
spirometer after surgery. Which statement indicates correct
understanding?
A. "I will use it once each morning."
B. "I will breathe out forcefully into the device."
C. "I will use it only when I feel short of breath."
D. "I will inhale slowly and deeply through the mouthpiece
and hold my breath briefly."
