ATI COMPREHENSIVE EXIT EXAM 2023
WITH NGN (Answer Key at the End)
1. A competent adult client refuses a blood transfusion for religious reasons. Which action
should the nurse take?
A. Administer the transfusion if the Hgb is critically low.
B. Ask the family to override the client's decision.
C. Verify the client understands the risks and document the refusal.
D. Call a social worker to declare the client incompetent.
Answer: C
Rationale: Competent adults have the right to autonomy and can refuse treatment. The nurse
must ensure the client understands the risks of refusal, then document the refusal and notify
the provider .
2. Which client should the nurse assess first?
A. A post-op client with a pain level of 6/10.
B. A COPD client with an O₂ sat of 88% on room air.
C. A client waiting for discharge teaching.
D. A stable diabetic requesting a snack.
Answer: B
Rationale: Airway and oxygenation are the top priorities. An O₂ sat of 88% indicates a significant
oxygenation issue and requires immediate assessment and intervention .
3. A nurse is caring for a client receiving a blood transfusion who develops urticaria and
wheezing. Which type of transfusion reaction should the nurse suspect?
A. Acute hemolytic
B. Febrile
C. Anaphylactic
D. Circulatory overload
Answer: C
Rationale: Urticaria (hives) and wheezing are hallmark signs of an anaphylactic transfusion
reaction, a severe allergic response to plasma proteins in the donated blood .
4. A nurse is planning to obtain a 12-lead ECG for a client with a history of cardiac
dysrhythmias. Which action should the nurse plan to take?
A. Instruct the client to remain as still as possible during the recording.
B. Place the client in a supine position with the head of bed elevated 90 degrees.
C. Apply the electrodes to the client's bony prominences.
,D. Instruct the client to hold their breath during the recording.
Answer: A
Rationale: Movement can cause artifact on the ECG tracing. The client should remain as still as
possible to ensure an accurate recording .
5. A nurse is admitting a client with a new diagnosis of a terminal illness. The client's family is
arguing about whether to initiate tube feedings. This situation best describes:
A. A breach of confidentiality.
B. An ethical dilemma.
C. A failure of the chain of command.
D. A violation of client rights.
Answer: B
Rationale: An ethical dilemma occurs when there is a conflict between two or more ethical
principles (e.g., beneficence vs. autonomy) and no clear right course of action exists .
6. A nurse is caring for a client who is postoperative following abdominal surgery and has a
wound evisceration. Which action should the nurse take?
A. Hold gentle, direct pressure on the protruding organ.
B. Place the client's knees in an extended position.
C. Raise the head of the bed to a 45° angle.
D. Cover the protruding organs with sterile saline-moistened gauze.
Answer: D
Rationale: The nurse should cover the protruding organs with sterile saline-moistened gauze,
keep the client supine with knees bent, and never apply direct pressure to the organs .
7. A nurse is reinforcing teaching about advance directives with a client who has end-stage
heart failure. Which statement indicates an understanding of the teaching?
A. "I should discuss this document with my family after I sign it."
B. "Advance directives include a living will."
C. "An advance directive will ensure I receive all possible treatments."
D. "My family can change my advance directives at any time."
Answer: B
Rationale: Advance directives, such as a living will and durable power of attorney for healthcare,
allow a client to document their end-of-life treatment preferences. A living will is a key
component .
8. A nurse is caring for a client who has a prescription for NPH insulin 10 units and regular
insulin 15 units subcutaneously. Which action should the nurse take?
A. Withdraw 15 units of regular insulin first.
B. Withdraw 10 units of NPH insulin first.
, C. Verify the dosage with another nurse before drawing up the insulin.
D. Mix the two insulins in the same syringe by drawing up the NPH insulin first.
Answer: A
Rationale: To prevent contamination of the regular insulin vial with NPH insulin, the nurse
should draw up the clear regular insulin first, then the cloudy NPH insulin .
9. A charge nurse is supervising a newly licensed nurse on a mental health unit. For which
action should the charge nurse intervene?
A. Telling a client he will lose his phone privileges if he does not take his medication.
B. Setting limits on a client's manipulative behavior.
C. Using therapeutic communication to de-escalate an agitated client.
D. Administering PRN medication to a client experiencing anxiety.
Answer: A
Rationale: Threatening a client with punishment, especially for not taking medication, is
coercive, unethical, and can damage the therapeutic relationship. This action warrants
intervention .
10. A nurse is caring for a client who has an indwelling urinary catheter. Which of the
following is a correct action?
A. Hang the drainage bag on the side rail of the bed.
B. Empty the collection bag when it is three-quarters full.
C. Secure the catheter tubing to the client's thigh.
D. Irrigate the catheter with normal saline every 8 hours.
Answer: C
Rationale: Securing the catheter tubing to the client's thigh prevents tension and accidental
dislodgement. The bag should hang below the level of the bladder, and routine irrigation is not
standard .
11. A nurse is caring for a client who has diabetes mellitus and reports feeling shaky and
sweaty. The client's blood glucose is 55 mg/dL. Which action should the nurse take first?
A. Administer 50% dextrose IV push.
B. Give 15 g of fast-acting carbohydrates.
C. Recheck blood glucose in 30 minutes.
D. Administer glucagon 1 mg IM.
Answer: B
Rationale: For a conscious client with hypoglycemia, the first action is to give 15g of fast-acting
carbohydrates (e.g., glucose tablets, fruit juice) .
12. An assistive personnel (AP) tells the charge nurse her assignment is too demanding and
angrily asks to have a task reassigned. Which action should the charge nurse take to resolve
WITH NGN (Answer Key at the End)
1. A competent adult client refuses a blood transfusion for religious reasons. Which action
should the nurse take?
A. Administer the transfusion if the Hgb is critically low.
B. Ask the family to override the client's decision.
C. Verify the client understands the risks and document the refusal.
D. Call a social worker to declare the client incompetent.
Answer: C
Rationale: Competent adults have the right to autonomy and can refuse treatment. The nurse
must ensure the client understands the risks of refusal, then document the refusal and notify
the provider .
2. Which client should the nurse assess first?
A. A post-op client with a pain level of 6/10.
B. A COPD client with an O₂ sat of 88% on room air.
C. A client waiting for discharge teaching.
D. A stable diabetic requesting a snack.
Answer: B
Rationale: Airway and oxygenation are the top priorities. An O₂ sat of 88% indicates a significant
oxygenation issue and requires immediate assessment and intervention .
3. A nurse is caring for a client receiving a blood transfusion who develops urticaria and
wheezing. Which type of transfusion reaction should the nurse suspect?
A. Acute hemolytic
B. Febrile
C. Anaphylactic
D. Circulatory overload
Answer: C
Rationale: Urticaria (hives) and wheezing are hallmark signs of an anaphylactic transfusion
reaction, a severe allergic response to plasma proteins in the donated blood .
4. A nurse is planning to obtain a 12-lead ECG for a client with a history of cardiac
dysrhythmias. Which action should the nurse plan to take?
A. Instruct the client to remain as still as possible during the recording.
B. Place the client in a supine position with the head of bed elevated 90 degrees.
C. Apply the electrodes to the client's bony prominences.
,D. Instruct the client to hold their breath during the recording.
Answer: A
Rationale: Movement can cause artifact on the ECG tracing. The client should remain as still as
possible to ensure an accurate recording .
5. A nurse is admitting a client with a new diagnosis of a terminal illness. The client's family is
arguing about whether to initiate tube feedings. This situation best describes:
A. A breach of confidentiality.
B. An ethical dilemma.
C. A failure of the chain of command.
D. A violation of client rights.
Answer: B
Rationale: An ethical dilemma occurs when there is a conflict between two or more ethical
principles (e.g., beneficence vs. autonomy) and no clear right course of action exists .
6. A nurse is caring for a client who is postoperative following abdominal surgery and has a
wound evisceration. Which action should the nurse take?
A. Hold gentle, direct pressure on the protruding organ.
B. Place the client's knees in an extended position.
C. Raise the head of the bed to a 45° angle.
D. Cover the protruding organs with sterile saline-moistened gauze.
Answer: D
Rationale: The nurse should cover the protruding organs with sterile saline-moistened gauze,
keep the client supine with knees bent, and never apply direct pressure to the organs .
7. A nurse is reinforcing teaching about advance directives with a client who has end-stage
heart failure. Which statement indicates an understanding of the teaching?
A. "I should discuss this document with my family after I sign it."
B. "Advance directives include a living will."
C. "An advance directive will ensure I receive all possible treatments."
D. "My family can change my advance directives at any time."
Answer: B
Rationale: Advance directives, such as a living will and durable power of attorney for healthcare,
allow a client to document their end-of-life treatment preferences. A living will is a key
component .
8. A nurse is caring for a client who has a prescription for NPH insulin 10 units and regular
insulin 15 units subcutaneously. Which action should the nurse take?
A. Withdraw 15 units of regular insulin first.
B. Withdraw 10 units of NPH insulin first.
, C. Verify the dosage with another nurse before drawing up the insulin.
D. Mix the two insulins in the same syringe by drawing up the NPH insulin first.
Answer: A
Rationale: To prevent contamination of the regular insulin vial with NPH insulin, the nurse
should draw up the clear regular insulin first, then the cloudy NPH insulin .
9. A charge nurse is supervising a newly licensed nurse on a mental health unit. For which
action should the charge nurse intervene?
A. Telling a client he will lose his phone privileges if he does not take his medication.
B. Setting limits on a client's manipulative behavior.
C. Using therapeutic communication to de-escalate an agitated client.
D. Administering PRN medication to a client experiencing anxiety.
Answer: A
Rationale: Threatening a client with punishment, especially for not taking medication, is
coercive, unethical, and can damage the therapeutic relationship. This action warrants
intervention .
10. A nurse is caring for a client who has an indwelling urinary catheter. Which of the
following is a correct action?
A. Hang the drainage bag on the side rail of the bed.
B. Empty the collection bag when it is three-quarters full.
C. Secure the catheter tubing to the client's thigh.
D. Irrigate the catheter with normal saline every 8 hours.
Answer: C
Rationale: Securing the catheter tubing to the client's thigh prevents tension and accidental
dislodgement. The bag should hang below the level of the bladder, and routine irrigation is not
standard .
11. A nurse is caring for a client who has diabetes mellitus and reports feeling shaky and
sweaty. The client's blood glucose is 55 mg/dL. Which action should the nurse take first?
A. Administer 50% dextrose IV push.
B. Give 15 g of fast-acting carbohydrates.
C. Recheck blood glucose in 30 minutes.
D. Administer glucagon 1 mg IM.
Answer: B
Rationale: For a conscious client with hypoglycemia, the first action is to give 15g of fast-acting
carbohydrates (e.g., glucose tablets, fruit juice) .
12. An assistive personnel (AP) tells the charge nurse her assignment is too demanding and
angrily asks to have a task reassigned. Which action should the charge nurse take to resolve
