ATI Exit Actual Exam 2026/2027 |
Verified Questions
Assessment Technologies Institute (ATI) | Verified Q&A |
Professional Nursing Students and Candidates
Comprehensive 180-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 180-question actual exam set provides original Professional nursing questions
covering Medical-Surgical Nursing, Maternal-Newborn Nursing, Pediatric Nursing, Mental Health Nursing, and
Leadership, Management, and Professional Nursing Concepts with Next Generation NCLEX clinical judgment
scenarios. The content is designed to reinforce official ATI Exit assessment objectives for actual exam readiness
and clinical proficiency by strengthening prioritization, safety, delegation, care coordination, pathophysiology,
medication awareness, health promotion, and evidence-based nursing decisions across the registered nursing
curriculum. Each item includes Verified Questions with concise rationales grounded in ATI Exit assessment
materials, evidence-based clinical guidelines, and current nursing standards of care.
Domain: Medical-Surgical Nursing
1. A client with chest pain has diaphoresis and recent ST elevation on the monitor. Which nursing
action has the highest priority?
A. Delay action until the next routine round.
B. Activate emergency cardiac response and obtain ordered rapid interventions.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: ST elevation with ischemic symptoms suggests acute coronary occlusion, requiring rapid
reperfusion-focused care.
2. Which finding requires immediate action for a client receiving IV heparin?
A. recent severe headache with unilateral weakness.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Heparin increases bleeding risk, and acute neurologic change can indicate intracranial
hemorrhage.
3. A client with heart failure has sudden pink frothy sputum and severe dyspnea. What should the
nurse do first?
A. Delay action until the next routine round.
B. Place the client upright and call for rapid assistance.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Pulmonary edema impairs gas exchange; upright positioning and urgent team support are
priorities.
4. Which laboratory value is most important to monitor before administering digoxin?
ATI Exit Actual Exam 2026/2027 | Verified Questions
, A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Potassium level.
Correct Answer: D
Rationale: Hypokalemia increases sensitivity to digoxin and raises toxicity risk.
5. A client with atrial fibrillation reports palpitations and has a rapid irregular pulse. Which
complication is most important to prevent?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Embolic stroke.
Correct Answer: D
Rationale: Atrial fibrillation can promote atrial clot formation that may embolize to the brain.
6. Which assessment finding suggests left-sided heart failure?
A. Crackles in the lungs with exertional dyspnea.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Left-sided failure causes pulmonary congestion and impaired oxygen exchange.
7. A client taking furosemide reports muscle weakness. Which electrolyte imbalance is most
likely?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Hypokalemia.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Loop diuretics increase potassium loss and can cause weakness and dysrhythmias.
8. Which teaching is appropriate for a client with hypertension starting lifestyle changes?
A. Delay action until the next routine round.
B. Reduce sodium intake, increase activity as tolerated, and take medications consistently.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Blood pressure control combines lifestyle measures with adherence to prescribed therapy.
9. Which symptom is most concerning for a client after cardiac catheterization through the
femoral artery?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Cool pale leg with diminished pedal pulse.
Correct Answer: D
Rationale: Reduced distal perfusion can indicate arterial obstruction or vascular complication.
10. Which finding suggests hypovolemic shock after trauma?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Rapid weak pulse with cool clammy skin.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Volume loss causes compensatory tachycardia and peripheral vasoconstriction.
ATI Exit Actual Exam 2026/2027 | Verified Questions
,11. A client with COPD becomes drowsy after high-flow oxygen. What should the nurse assess
first?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Respiratory rate and carbon dioxide retention indicators.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Some clients with COPD are vulnerable to hypercapnia, and decreased alertness can signal
ventilatory failure.
12. Which instruction is best for a client using a metered-dose inhaler with a spacer?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Inhale slowly and deeply after actuation, then hold the breath briefly.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Slow inhalation with a spacer improves medication delivery to lower airways.
13. Which finding indicates worsening asthma?
A. Delay action until the next routine round.
B. Silent chest with increasing respiratory effort.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Diminished airflow despite effort is an ominous sign of severe obstruction.
14. A client with pneumonia has confusion, hypotension, and tachypnea. What complication is the
nurse concerned about?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Sepsis.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Infection with organ dysfunction signs such as hypotension and altered mentation suggests
sepsis.
15. Which action helps prevent aspiration in a client with dysphagia?
A. Keep the client upright during meals and use prescribed swallowing strategies.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Upright positioning and swallowing techniques reduce aspiration risk.
16. A client with a chest tube has continuous bubbling in the water-seal chamber. What should the
nurse suspect?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Air leak in the system or from the client.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Continuous water-seal bubbling indicates air is entering the system and requires assessment.
17. Which sign indicates tension pneumothorax?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
ATI Exit Actual Exam 2026/2027 | Verified Questions
, D. Tracheal deviation with severe respiratory distress.
Correct Answer: D
Rationale: Air under pressure shifts mediastinal structures and rapidly compromises breathing and
circulation.
18. A client after thyroidectomy reports tingling around the mouth. Which action is priority?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Assess calcium level and notify the provider.
Correct Answer: D
Rationale: Perioral tingling can indicate hypocalcemia from parathyroid injury after thyroid surgery.
19. Which finding is consistent with hyperthyroidism?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Heat intolerance, weight loss, and tachycardia.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Excess thyroid hormone increases metabolic rate and sympathetic manifestations.
20. Which teaching is important for a client taking levothyroxine?
A. Take it in the morning on an empty stomach at the same time each day.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Consistent timing and empty stomach dosing improve absorption and stable thyroid
replacement.
21. A client with diabetes has tremors, diaphoresis, and confusion. What is the priority if the
client can swallow?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Give fast-acting carbohydrate.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Symptoms suggest hypoglycemia, and oral glucose is appropriate when the client can swallow
safely.
22. Which finding indicates diabetic ketoacidosis?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Kussmaul respirations and fruity breath.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Metabolic acidosis from ketone accumulation causes deep respirations and fruity breath.
23. Which instruction is appropriate for sick-day diabetes management?
A. Continue glucose monitoring and follow the prescribed plan for fluids and medication.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Illness can increase glucose variability, so monitoring and the sick-day plan are central.
24. A client taking prednisone long term should be taught to report which symptom?
A. Delay action until the next routine round.
ATI Exit Actual Exam 2026/2027 | Verified Questions
Verified Questions
Assessment Technologies Institute (ATI) | Verified Q&A |
Professional Nursing Students and Candidates
Comprehensive 180-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 180-question actual exam set provides original Professional nursing questions
covering Medical-Surgical Nursing, Maternal-Newborn Nursing, Pediatric Nursing, Mental Health Nursing, and
Leadership, Management, and Professional Nursing Concepts with Next Generation NCLEX clinical judgment
scenarios. The content is designed to reinforce official ATI Exit assessment objectives for actual exam readiness
and clinical proficiency by strengthening prioritization, safety, delegation, care coordination, pathophysiology,
medication awareness, health promotion, and evidence-based nursing decisions across the registered nursing
curriculum. Each item includes Verified Questions with concise rationales grounded in ATI Exit assessment
materials, evidence-based clinical guidelines, and current nursing standards of care.
Domain: Medical-Surgical Nursing
1. A client with chest pain has diaphoresis and recent ST elevation on the monitor. Which nursing
action has the highest priority?
A. Delay action until the next routine round.
B. Activate emergency cardiac response and obtain ordered rapid interventions.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: ST elevation with ischemic symptoms suggests acute coronary occlusion, requiring rapid
reperfusion-focused care.
2. Which finding requires immediate action for a client receiving IV heparin?
A. recent severe headache with unilateral weakness.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Heparin increases bleeding risk, and acute neurologic change can indicate intracranial
hemorrhage.
3. A client with heart failure has sudden pink frothy sputum and severe dyspnea. What should the
nurse do first?
A. Delay action until the next routine round.
B. Place the client upright and call for rapid assistance.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Pulmonary edema impairs gas exchange; upright positioning and urgent team support are
priorities.
4. Which laboratory value is most important to monitor before administering digoxin?
ATI Exit Actual Exam 2026/2027 | Verified Questions
, A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Potassium level.
Correct Answer: D
Rationale: Hypokalemia increases sensitivity to digoxin and raises toxicity risk.
5. A client with atrial fibrillation reports palpitations and has a rapid irregular pulse. Which
complication is most important to prevent?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Embolic stroke.
Correct Answer: D
Rationale: Atrial fibrillation can promote atrial clot formation that may embolize to the brain.
6. Which assessment finding suggests left-sided heart failure?
A. Crackles in the lungs with exertional dyspnea.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Left-sided failure causes pulmonary congestion and impaired oxygen exchange.
7. A client taking furosemide reports muscle weakness. Which electrolyte imbalance is most
likely?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Hypokalemia.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Loop diuretics increase potassium loss and can cause weakness and dysrhythmias.
8. Which teaching is appropriate for a client with hypertension starting lifestyle changes?
A. Delay action until the next routine round.
B. Reduce sodium intake, increase activity as tolerated, and take medications consistently.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Blood pressure control combines lifestyle measures with adherence to prescribed therapy.
9. Which symptom is most concerning for a client after cardiac catheterization through the
femoral artery?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Cool pale leg with diminished pedal pulse.
Correct Answer: D
Rationale: Reduced distal perfusion can indicate arterial obstruction or vascular complication.
10. Which finding suggests hypovolemic shock after trauma?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Rapid weak pulse with cool clammy skin.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Volume loss causes compensatory tachycardia and peripheral vasoconstriction.
ATI Exit Actual Exam 2026/2027 | Verified Questions
,11. A client with COPD becomes drowsy after high-flow oxygen. What should the nurse assess
first?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Respiratory rate and carbon dioxide retention indicators.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Some clients with COPD are vulnerable to hypercapnia, and decreased alertness can signal
ventilatory failure.
12. Which instruction is best for a client using a metered-dose inhaler with a spacer?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Inhale slowly and deeply after actuation, then hold the breath briefly.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Slow inhalation with a spacer improves medication delivery to lower airways.
13. Which finding indicates worsening asthma?
A. Delay action until the next routine round.
B. Silent chest with increasing respiratory effort.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Diminished airflow despite effort is an ominous sign of severe obstruction.
14. A client with pneumonia has confusion, hypotension, and tachypnea. What complication is the
nurse concerned about?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Sepsis.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Infection with organ dysfunction signs such as hypotension and altered mentation suggests
sepsis.
15. Which action helps prevent aspiration in a client with dysphagia?
A. Keep the client upright during meals and use prescribed swallowing strategies.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Upright positioning and swallowing techniques reduce aspiration risk.
16. A client with a chest tube has continuous bubbling in the water-seal chamber. What should the
nurse suspect?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Air leak in the system or from the client.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Continuous water-seal bubbling indicates air is entering the system and requires assessment.
17. Which sign indicates tension pneumothorax?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
ATI Exit Actual Exam 2026/2027 | Verified Questions
, D. Tracheal deviation with severe respiratory distress.
Correct Answer: D
Rationale: Air under pressure shifts mediastinal structures and rapidly compromises breathing and
circulation.
18. A client after thyroidectomy reports tingling around the mouth. Which action is priority?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Assess calcium level and notify the provider.
Correct Answer: D
Rationale: Perioral tingling can indicate hypocalcemia from parathyroid injury after thyroid surgery.
19. Which finding is consistent with hyperthyroidism?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Heat intolerance, weight loss, and tachycardia.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Excess thyroid hormone increases metabolic rate and sympathetic manifestations.
20. Which teaching is important for a client taking levothyroxine?
A. Take it in the morning on an empty stomach at the same time each day.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Consistent timing and empty stomach dosing improve absorption and stable thyroid
replacement.
21. A client with diabetes has tremors, diaphoresis, and confusion. What is the priority if the
client can swallow?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Give fast-acting carbohydrate.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Symptoms suggest hypoglycemia, and oral glucose is appropriate when the client can swallow
safely.
22. Which finding indicates diabetic ketoacidosis?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Kussmaul respirations and fruity breath.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Metabolic acidosis from ketone accumulation causes deep respirations and fruity breath.
23. Which instruction is appropriate for sick-day diabetes management?
A. Continue glucose monitoring and follow the prescribed plan for fluids and medication.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Illness can increase glucose variability, so monitoring and the sick-day plan are central.
24. A client taking prednisone long term should be taught to report which symptom?
A. Delay action until the next routine round.
ATI Exit Actual Exam 2026/2027 | Verified Questions
