ATI Comprehensive Exit Exam (NGN) – ATI RN
Comprehensive Predictor Study Guide, Original NGN-Style
Practice Questions & Answers, Comprehensive Nursing
Exit Exam Preparation, Next Generation NCLEX Clinical
Judgment, Fundamentals, Medical-Surgical Nursing,
Pharmacology, Maternal-Newborn, Pediatrics, Mental
Health, Leadership, Prioritization, Delegation, Patient
Safety & NCLEX Readiness Review
Question 1: A nurse is caring for a client with heart failure who has been
prescribed furosemide. Which of the following findings indicates that the
medication is having the desired therapeutic effect?
A. Increase in blood pressure from 100/60 to 140/90 mmHg
B. Decrease in peripheral edema and weight loss of 1.5 kg in 24 hours
C. Heart rate increase from 80 to 110 beats per minute
D. Urine output of 20 mL/hr over the last two hours
CORRECT ANSWER: B. Decrease in peripheral edema and weight loss of 1.5 kg
in 24 hours
Rationale: Furosemide is a loop diuretic prescribed to reduce fluid volume overload in
heart failure. The desired therapeutic effect is a reduction in extracellular fluid,
evidenced by decreased peripheral edema, weight loss, and improved dyspnea. A
weight loss of 1-2 kg in 24 hours indicates effective diuresis. An increase in blood
pressure or heart rate and oliguria (less than 30 mL/hr) are signs of worsening condition
or adverse effects.
Question 2: A nurse is preparing to administer an enteral feeding through a
nasogastric tube. Which of the following actions should the nurse take to
verify correct tube placement prior to the feeding?
A. Aspirate gastric contents and check the pH.
B. Auscultate for air bubbles over the epigastric area.
C. Place the end of the tube in water to check for bubbling.
D. Assess the client's ability to swallow.
CORRECT ANSWER: A. Aspirate gastric contents and check the pH.
Rationale: The most reliable method to verify NG tube placement before administration
of enteral feeding is to measure the pH of aspirated gastric contents. A pH of 5 or less
indicates gastric placement. Auscultation (the "whoosh" test) is no longer considered a
reliable method by itself. Placing the tube in water to check for bubbling is a method to
check for an air leak and is not a standard placement verification. The client's
swallowing ability is unrelated to verifying tube placement.
Question 3: A nurse is performing a focused assessment on a client 4 hours
after a total hip arthroplasty. Which of the following findings should the nurse
report to the provider immediately?
,A. Pain rating of 4 on a scale of 0-10 at the surgical site
B. Slight serosanguineous drainage on the dressing
C. Client's inability to dorsiflex the foot on the affected side
D. Heart rate of 88 beats per minute and blood pressure of 118/76 mmHg
CORRECT ANSWER: C. Client's inability to dorsiflex the foot on the affected
side
Rationale: Inability to dorsiflex the foot suggests possible injury to the sciatic or
peroneal nerve, which can occur during hip surgery or be a sign of compartment
syndrome. This is a significant neurological finding that requires immediate reporting to
the provider to prevent permanent nerve damage. Mild to moderate pain, slight
drainage, and stable vital signs are expected findings post-operatively.
Question 4: A nurse is providing discharge teaching to 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 my headaches instead of acetaminophen."
B. "I can continue to eat my usual daily salad for lunch."
C. "I should watch for bleeding gums when I brush my teeth."
D. "I will monitor my blood glucose levels more frequently."
CORRECT ANSWER: C. "I should watch for bleeding gums when I brush my
teeth."
Rationale: Warfarin is an anticoagulant that increases the risk of bleeding. Clients should
be taught to monitor for signs of bleeding, such as bleeding gums, easy bruising,
petechiae, and dark stools. Ibuprofen (an NSAID) increases bleeding risk and should be
avoided. Clients should maintain a consistent intake of Vitamin K-rich foods (like leafy
green salads) to keep INR stable, not change their diet drastically. Warfarin does not
affect blood glucose levels.
Question 5: A nurse in a provider's office is assessing a client who has a
diagnosis of Parkinson's disease. Which of the following findings is most
characteristic of this condition?
A. Intention tremor
B. Pigeon-toed gait
C. Cogwheel rigidity
D. Choreiform movements
CORRECT ANSWER: C. Cogwheel rigidity
Rationale: Cogwheel rigidity is a classic motor sign of Parkinson's disease, characterized
by a ratchet-like resistance to passive movement of a joint. Intention tremors are more
characteristic of cerebellar disorders. A shuffling, festinating gait is common, not pigeon-
toed. Choreiform (jerky) movements are associated with Huntington's disease.
,Question 6: A nurse is caring for a client 2 days post-operative following a
bowel resection. The client's abdominal wound has started to separate and the
nurse notes loops of bowel protruding through the incision. Which of the
following actions should the nurse take first?
A. Place the client in a supine position.
B. Cover the wound with a sterile saline-moistened dressing.
C. Re-approximate the wound edges with sterile tape.
D. Irrigate the wound with normal saline.
CORRECT ANSWER: B. Cover the wound with a sterile saline-moistened
dressing.
Rationale: The client is experiencing wound dehiscence with evisceration. The first
action is to cover the exposed bowel and wound with a sterile dressing moistened with
normal saline to keep the tissue moist and prevent infection. The nurse should then
place the client in a low Fowler's position with knees bent to reduce abdominal tension.
The nurse should not attempt to re-approximate the wound or irrigate it.
Question 7: A charge nurse is making client assignments on a medical-surgical
unit. Which of the following clients should be assigned to the most
experienced RN?
A. A client with an ileostomy who requires stoma care teaching
B. A client with a new diagnosis of diabetes mellitus requiring initial insulin teaching
C. A client with COPD who is stable and ready for discharge
D. A client with a chest tube who is experiencing bubbling in the water seal chamber
CORRECT ANSWER: D. A client with a chest tube who is experiencing bubbling
in the water seal chamber
Rationale: A client with a chest tube who has continuous bubbling in the water seal
chamber indicates an air leak and requires immediate assessment and intervention by
an experienced nurse to prevent complications such as tension pneumothorax. A stable
client ready for discharge can be assigned to a less experienced nurse. Complex
teaching, like discharge teaching for a new ileostomy or insulin administration, while
important, can be delegated to a competent nurse, but the unstable respiratory issue is
the priority for the experienced RN.
Question 8: A nurse is reviewing the laboratory results of a client who has
preeclampsia. Which of the following findings should indicate to the nurse that
the client is developing HELLP syndrome?
A. Decreased liver enzymes
B. Elevated platelet count
C. Elevated aspartate aminotransferase (AST)
D. Decreased blood urea nitrogen (BUN)
CORRECT ANSWER: C. Elevated aspartate aminotransferase (AST)
, Rationale: HELLP syndrome is a life-threatening complication of preeclampsia
characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets. An elevated
AST indicates liver involvement and is a key diagnostic criterion. HELLP syndrome
would present with low platelets, not elevated, and elevated liver enzymes, not
decreased.
Question 9: A nurse is performing a cardiac assessment on a client. Which of
the following sounds should the nurse expect to hear when auscultating over
the mitral valve area?
A. S1 louder than S2
B. S2 louder than S1
C. A pericardial friction rub
D. An S3 gallop
CORRECT ANSWER: A. S1 louder than S2
Rationale: The mitral valve is best auscultated at the 5th intercostal space, midclavicular
line (the apex). The S1 heart sound, which is louder at the apex, is caused by the closure
of the mitral and tricuspid valves. S2 is heard best at the base of the heart. A pericardial
friction rub suggests pericarditis, and an S3 gallop is an extra heart sound.
Question 10: A nurse is caring for a client who is receiving a continuous
heparin infusion for a deep vein thrombosis. The client's aPTT is 120 seconds,
and the baseline was 30 seconds. Which of the following actions should the
nurse take?
A. Continue the infusion at the current rate.
B. Decrease the infusion rate.
C. Increase the infusion rate.
D. Stop the infusion.
CORRECT ANSWER: D. Stop the infusion.
Rationale: The target therapeutic range for aPTT on heparin is typically 1.5 to 2.5 times
the baseline. With a baseline of 30 seconds, the target would be 45-75 seconds. An
aPTT of 120 seconds is dangerously high (more than 4 times the baseline), placing the
client at significant risk for hemorrhage. The nurse should stop the infusion and notify
the provider immediately.
Question 11: A nurse is preparing to administer a blood transfusion of packed
red blood cells to a client. Which of the following actions is most important for
the nurse to take to ensure client safety?
A. Verify the client's identity with a second licensed nurse using two identifiers.
B. Initiate the transfusion with a 24-gauge IV catheter.
C. Infuse the blood over 4 hours to prevent fluid overload.
D. Check the client's temperature 30 minutes after the transfusion starts.
Comprehensive Predictor Study Guide, Original NGN-Style
Practice Questions & Answers, Comprehensive Nursing
Exit Exam Preparation, Next Generation NCLEX Clinical
Judgment, Fundamentals, Medical-Surgical Nursing,
Pharmacology, Maternal-Newborn, Pediatrics, Mental
Health, Leadership, Prioritization, Delegation, Patient
Safety & NCLEX Readiness Review
Question 1: A nurse is caring for a client with heart failure who has been
prescribed furosemide. Which of the following findings indicates that the
medication is having the desired therapeutic effect?
A. Increase in blood pressure from 100/60 to 140/90 mmHg
B. Decrease in peripheral edema and weight loss of 1.5 kg in 24 hours
C. Heart rate increase from 80 to 110 beats per minute
D. Urine output of 20 mL/hr over the last two hours
CORRECT ANSWER: B. Decrease in peripheral edema and weight loss of 1.5 kg
in 24 hours
Rationale: Furosemide is a loop diuretic prescribed to reduce fluid volume overload in
heart failure. The desired therapeutic effect is a reduction in extracellular fluid,
evidenced by decreased peripheral edema, weight loss, and improved dyspnea. A
weight loss of 1-2 kg in 24 hours indicates effective diuresis. An increase in blood
pressure or heart rate and oliguria (less than 30 mL/hr) are signs of worsening condition
or adverse effects.
Question 2: A nurse is preparing to administer an enteral feeding through a
nasogastric tube. Which of the following actions should the nurse take to
verify correct tube placement prior to the feeding?
A. Aspirate gastric contents and check the pH.
B. Auscultate for air bubbles over the epigastric area.
C. Place the end of the tube in water to check for bubbling.
D. Assess the client's ability to swallow.
CORRECT ANSWER: A. Aspirate gastric contents and check the pH.
Rationale: The most reliable method to verify NG tube placement before administration
of enteral feeding is to measure the pH of aspirated gastric contents. A pH of 5 or less
indicates gastric placement. Auscultation (the "whoosh" test) is no longer considered a
reliable method by itself. Placing the tube in water to check for bubbling is a method to
check for an air leak and is not a standard placement verification. The client's
swallowing ability is unrelated to verifying tube placement.
Question 3: A nurse is performing a focused assessment on a client 4 hours
after a total hip arthroplasty. Which of the following findings should the nurse
report to the provider immediately?
,A. Pain rating of 4 on a scale of 0-10 at the surgical site
B. Slight serosanguineous drainage on the dressing
C. Client's inability to dorsiflex the foot on the affected side
D. Heart rate of 88 beats per minute and blood pressure of 118/76 mmHg
CORRECT ANSWER: C. Client's inability to dorsiflex the foot on the affected
side
Rationale: Inability to dorsiflex the foot suggests possible injury to the sciatic or
peroneal nerve, which can occur during hip surgery or be a sign of compartment
syndrome. This is a significant neurological finding that requires immediate reporting to
the provider to prevent permanent nerve damage. Mild to moderate pain, slight
drainage, and stable vital signs are expected findings post-operatively.
Question 4: A nurse is providing discharge teaching to 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 my headaches instead of acetaminophen."
B. "I can continue to eat my usual daily salad for lunch."
C. "I should watch for bleeding gums when I brush my teeth."
D. "I will monitor my blood glucose levels more frequently."
CORRECT ANSWER: C. "I should watch for bleeding gums when I brush my
teeth."
Rationale: Warfarin is an anticoagulant that increases the risk of bleeding. Clients should
be taught to monitor for signs of bleeding, such as bleeding gums, easy bruising,
petechiae, and dark stools. Ibuprofen (an NSAID) increases bleeding risk and should be
avoided. Clients should maintain a consistent intake of Vitamin K-rich foods (like leafy
green salads) to keep INR stable, not change their diet drastically. Warfarin does not
affect blood glucose levels.
Question 5: A nurse in a provider's office is assessing a client who has a
diagnosis of Parkinson's disease. Which of the following findings is most
characteristic of this condition?
A. Intention tremor
B. Pigeon-toed gait
C. Cogwheel rigidity
D. Choreiform movements
CORRECT ANSWER: C. Cogwheel rigidity
Rationale: Cogwheel rigidity is a classic motor sign of Parkinson's disease, characterized
by a ratchet-like resistance to passive movement of a joint. Intention tremors are more
characteristic of cerebellar disorders. A shuffling, festinating gait is common, not pigeon-
toed. Choreiform (jerky) movements are associated with Huntington's disease.
,Question 6: A nurse is caring for a client 2 days post-operative following a
bowel resection. The client's abdominal wound has started to separate and the
nurse notes loops of bowel protruding through the incision. Which of the
following actions should the nurse take first?
A. Place the client in a supine position.
B. Cover the wound with a sterile saline-moistened dressing.
C. Re-approximate the wound edges with sterile tape.
D. Irrigate the wound with normal saline.
CORRECT ANSWER: B. Cover the wound with a sterile saline-moistened
dressing.
Rationale: The client is experiencing wound dehiscence with evisceration. The first
action is to cover the exposed bowel and wound with a sterile dressing moistened with
normal saline to keep the tissue moist and prevent infection. The nurse should then
place the client in a low Fowler's position with knees bent to reduce abdominal tension.
The nurse should not attempt to re-approximate the wound or irrigate it.
Question 7: A charge nurse is making client assignments on a medical-surgical
unit. Which of the following clients should be assigned to the most
experienced RN?
A. A client with an ileostomy who requires stoma care teaching
B. A client with a new diagnosis of diabetes mellitus requiring initial insulin teaching
C. A client with COPD who is stable and ready for discharge
D. A client with a chest tube who is experiencing bubbling in the water seal chamber
CORRECT ANSWER: D. A client with a chest tube who is experiencing bubbling
in the water seal chamber
Rationale: A client with a chest tube who has continuous bubbling in the water seal
chamber indicates an air leak and requires immediate assessment and intervention by
an experienced nurse to prevent complications such as tension pneumothorax. A stable
client ready for discharge can be assigned to a less experienced nurse. Complex
teaching, like discharge teaching for a new ileostomy or insulin administration, while
important, can be delegated to a competent nurse, but the unstable respiratory issue is
the priority for the experienced RN.
Question 8: A nurse is reviewing the laboratory results of a client who has
preeclampsia. Which of the following findings should indicate to the nurse that
the client is developing HELLP syndrome?
A. Decreased liver enzymes
B. Elevated platelet count
C. Elevated aspartate aminotransferase (AST)
D. Decreased blood urea nitrogen (BUN)
CORRECT ANSWER: C. Elevated aspartate aminotransferase (AST)
, Rationale: HELLP syndrome is a life-threatening complication of preeclampsia
characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets. An elevated
AST indicates liver involvement and is a key diagnostic criterion. HELLP syndrome
would present with low platelets, not elevated, and elevated liver enzymes, not
decreased.
Question 9: A nurse is performing a cardiac assessment on a client. Which of
the following sounds should the nurse expect to hear when auscultating over
the mitral valve area?
A. S1 louder than S2
B. S2 louder than S1
C. A pericardial friction rub
D. An S3 gallop
CORRECT ANSWER: A. S1 louder than S2
Rationale: The mitral valve is best auscultated at the 5th intercostal space, midclavicular
line (the apex). The S1 heart sound, which is louder at the apex, is caused by the closure
of the mitral and tricuspid valves. S2 is heard best at the base of the heart. A pericardial
friction rub suggests pericarditis, and an S3 gallop is an extra heart sound.
Question 10: A nurse is caring for a client who is receiving a continuous
heparin infusion for a deep vein thrombosis. The client's aPTT is 120 seconds,
and the baseline was 30 seconds. Which of the following actions should the
nurse take?
A. Continue the infusion at the current rate.
B. Decrease the infusion rate.
C. Increase the infusion rate.
D. Stop the infusion.
CORRECT ANSWER: D. Stop the infusion.
Rationale: The target therapeutic range for aPTT on heparin is typically 1.5 to 2.5 times
the baseline. With a baseline of 30 seconds, the target would be 45-75 seconds. An
aPTT of 120 seconds is dangerously high (more than 4 times the baseline), placing the
client at significant risk for hemorrhage. The nurse should stop the infusion and notify
the provider immediately.
Question 11: A nurse is preparing to administer a blood transfusion of packed
red blood cells to a client. Which of the following actions is most important for
the nurse to take to ensure client safety?
A. Verify the client's identity with a second licensed nurse using two identifiers.
B. Initiate the transfusion with a 24-gauge IV catheter.
C. Infuse the blood over 4 hours to prevent fluid overload.
D. Check the client's temperature 30 minutes after the transfusion starts.
