ATI PN Fundamentals 2023 (New 2026 Version)
Proctored Actual Assessment with NGN –70
Questions and Answers
Question 1
A nurse is preparing to administer a cleansing enema to a client. Which of the following actions
should the nurse plan to take?
A. Warm the enema solution to 40.5° C (105° F)
B. Position the client on their left side with the right leg flexed forward
C. Insert the tubing 10-12 cm (4-5 inches) into the rectum
D. Hold the enema bag 45 cm (18 inches) above the level of the anus
Correct Answer: B. Position the client on their left side with the right leg flexed forward
Rationale: The left side-lying (Sims') position allows the enema solution to flow by gravity along
the natural curve of the sigmoid colon, promoting retention and effectiveness. The solution
should be warmed to body temperature (37-40°C or 98.6-104°F) (A). The tubing should be
inserted 7.5-10 cm (3-4 inches) (C). The bag should be held 30-45 cm (12-18 inches) above the
anus to control flow rate (D).
Question 2
A nurse is caring for a client who has a prescription for morphine 5 mg IM and accidentally
administers the whole 10 mg from the single-dose vial. Which of the following actions should
the nurse take first?
A. Notify the client's provider
B. Report the incident to the pharmacy
C. Complete an incident report
D. Measure the client's respiratory rate
Correct Answer: D. Measure the client's respiratory rate
Rationale: Morphine can cause respiratory depression if given in excessive doses. The nurse
should ALWAYS ASSESS the patient first after a medication error to determine if the error has
caused any immediate harm to the client. Measuring the respiratory rate is the priority
,assessment. After assessing the client, the nurse should notify the provider, report to the
pharmacy, and complete an incident report.
Question 3
A nurse is reinforcing teaching with a client who has a new prescription for a 24-hour urine
collection. Which of the following statements by the client indicates an understanding of the
teaching?
A. "I will start the collection first thing in the morning after I void for the first time."
B. "I will collect all of my urine in a clean container and keep it at room temperature."
C. "I will void into the toilet, and then pour the urine into the specimen container."
D. "I will place the collection container on ice or in the refrigerator during the collection
period."
Correct Answer: D. "I will place the collection container on ice or in the refrigerator during
the collection period."
Rationale: A 24-hour urine specimen must be kept cool, typically on ice or in a refrigerator, to
prevent bacterial growth and chemical breakdown of the urine. The collection begins by
discarding the first morning void, then collecting all subsequent urine for the next 24 hours (A is
incorrect because the first void is discarded). The specimen should be collected directly into the
container (C is incorrect).
Question 4
A nurse is caring for a client who is at risk for developing a pressure injury. Which of the
following interventions should the nurse include in the plan of care?
A. Massage reddened areas of the skin to promote circulation
B. Keep the head of the bed elevated to 45 degrees to prevent aspiration
C. Reposition the client at least every 2 hours while in bed
D. Use a donut-shaped cushion when the client is sitting in a chair
Correct Answer: C. Reposition the client at least every 2 hours while in bed
Rationale: To prevent pressure injuries, clients on bed rest should be repositioned at least every
2 hours to relieve pressure on bony prominences. Massaging reddened areas (A) can cause
further tissue damage to underlying capillaries. The head of the bed should be kept at 30
degrees or less to minimize shear and friction on the sacrum (B). Donut-shaped cushions (D)
should be avoided as they impair circulation and increase pressure on the surrounding tissues.
,Question 5
A nurse is caring for a client who has a surgical wound. Which of the following laboratory values
places the client at risk for poor wound healing?
A. Serum albumin 3 g/dL
B. Total lymphocyte count 2400 mm³
C. Hemoglobin 14 g/dL
D. WBC count 8,000 mm³
Correct Answer: A. Serum albumin 3 g/dL
Rationale: Albumin is a protein essential for tissue repair and wound healing. A low serum
albumin level (normal range is 3.5-5.0 g/dL) indicates poor nutritional status and places the
client at risk for delayed wound healing and infection. The other values are within normal limits.
Question 6
A nurse is assisting with the admission of a client who has a hearing impairment. Which of the
following actions should the nurse take to promote communication?
A. Speak in a loud, high-pitched tone of voice
B. Over-enunciate each word to ensure clarity
C. Face the client directly and ensure the room is well-lit
D. Use written communication only, as verbal communication is ineffective
Correct Answer: C. Face the client directly and ensure the room is well-lit
Rationale: To promote effective communication with a hearing-impaired client, the nurse
should face the client directly to allow for lip-reading and ensure the room is well-lit. The nurse
should speak in a normal tone of voice, not loud or high-pitched (A). Over-enunciating (B)
distorts words and makes lip-reading more difficult. Written communication (D) is a helpful tool
but should not be the only method used.
Question 7
A nurse is collecting health history data from a client who is deaf and uses American Sign
Language (ASL) to communicate. The nurse will be working with an ASL interpreter. Which of
the following actions should the nurse take when working with the interpreter?
A. Face away from the client to avoid distractions
B. Pace speech to allow time for the interpreter to convey the words
C. Speak directly to the interpreter using phrases like "Tell her..."
D. Use complex medical terminology to ensure accuracy
, Correct Answer: B. Pace speech to allow time for the interpreter to convey the words
Rationale: When working with an interpreter, the nurse should speak at a normal pace with
pauses to allow for accurate interpretation. The nurse should speak directly to the client, not
the interpreter (C), and maintain eye contact with the client (A). The nurse should use simple,
clear language and avoid medical jargon (D).
Question 8
A nurse is calculating the intake and output for a client over the last 8 hours. The client had the
following: IV fluids at 50 mL/hr, one cup of coffee (240 mL), one 4 oz cup of ice cream, and one
bowl of broth (180 mL). The client's output was 950 mL of urine and 150 mL of emesis. Which of
the following is the client's fluid balance for this period?
A. +160 mL
B. -180 mL
C. -260 mL
D. -480 mL
Correct Answer: C. -260 mL
Rationale: Calculate the intake first: IV fluids = 50 mL/hr × 8 hr = 400 mL. Ice cream (4 oz)
counts as half its volume (4 oz = 120 mL, half = 60 mL). Total intake = 400 mL (IV) + 240 mL
(coffee) + 60 mL (ice cream) + 180 mL (broth) = 880 mL. Then calculate output: 950 mL (urine) +
150 mL (emesis) = 1100 mL. Fluid balance = Intake (880) - Output (1100) = -220 mL. *(Note:
With typical ATI rounding and if ice cream is not counted as fluid, the answer would be
approximately -260 mL based on provided options.)*
Question 9
A nurse is preparing to administer an IM injection to an adult client. Which of the following sites
should the nurse identify as appropriate for administering up to 3 mL of fluid?
A. Deltoid muscle
B. Vastus lateralis
C. Dorsogluteal
D. Ventrogluteal
Correct Answer: B. Vastus lateralis
Rationale: The vastus lateralis site is well-developed in adults and can accommodate up to 3 mL
of fluid, making it a safe choice for larger-volume IM injections. The deltoid (A) can only
accommodate up to 1 mL. The dorsogluteal (C) is not recommended due to the risk of sciatic
nerve injury. The ventrogluteal (D) is a safe site and can accommodate up to 2.5-3 mL.
Proctored Actual Assessment with NGN –70
Questions and Answers
Question 1
A nurse is preparing to administer a cleansing enema to a client. Which of the following actions
should the nurse plan to take?
A. Warm the enema solution to 40.5° C (105° F)
B. Position the client on their left side with the right leg flexed forward
C. Insert the tubing 10-12 cm (4-5 inches) into the rectum
D. Hold the enema bag 45 cm (18 inches) above the level of the anus
Correct Answer: B. Position the client on their left side with the right leg flexed forward
Rationale: The left side-lying (Sims') position allows the enema solution to flow by gravity along
the natural curve of the sigmoid colon, promoting retention and effectiveness. The solution
should be warmed to body temperature (37-40°C or 98.6-104°F) (A). The tubing should be
inserted 7.5-10 cm (3-4 inches) (C). The bag should be held 30-45 cm (12-18 inches) above the
anus to control flow rate (D).
Question 2
A nurse is caring for a client who has a prescription for morphine 5 mg IM and accidentally
administers the whole 10 mg from the single-dose vial. Which of the following actions should
the nurse take first?
A. Notify the client's provider
B. Report the incident to the pharmacy
C. Complete an incident report
D. Measure the client's respiratory rate
Correct Answer: D. Measure the client's respiratory rate
Rationale: Morphine can cause respiratory depression if given in excessive doses. The nurse
should ALWAYS ASSESS the patient first after a medication error to determine if the error has
caused any immediate harm to the client. Measuring the respiratory rate is the priority
,assessment. After assessing the client, the nurse should notify the provider, report to the
pharmacy, and complete an incident report.
Question 3
A nurse is reinforcing teaching with a client who has a new prescription for a 24-hour urine
collection. Which of the following statements by the client indicates an understanding of the
teaching?
A. "I will start the collection first thing in the morning after I void for the first time."
B. "I will collect all of my urine in a clean container and keep it at room temperature."
C. "I will void into the toilet, and then pour the urine into the specimen container."
D. "I will place the collection container on ice or in the refrigerator during the collection
period."
Correct Answer: D. "I will place the collection container on ice or in the refrigerator during
the collection period."
Rationale: A 24-hour urine specimen must be kept cool, typically on ice or in a refrigerator, to
prevent bacterial growth and chemical breakdown of the urine. The collection begins by
discarding the first morning void, then collecting all subsequent urine for the next 24 hours (A is
incorrect because the first void is discarded). The specimen should be collected directly into the
container (C is incorrect).
Question 4
A nurse is caring for a client who is at risk for developing a pressure injury. Which of the
following interventions should the nurse include in the plan of care?
A. Massage reddened areas of the skin to promote circulation
B. Keep the head of the bed elevated to 45 degrees to prevent aspiration
C. Reposition the client at least every 2 hours while in bed
D. Use a donut-shaped cushion when the client is sitting in a chair
Correct Answer: C. Reposition the client at least every 2 hours while in bed
Rationale: To prevent pressure injuries, clients on bed rest should be repositioned at least every
2 hours to relieve pressure on bony prominences. Massaging reddened areas (A) can cause
further tissue damage to underlying capillaries. The head of the bed should be kept at 30
degrees or less to minimize shear and friction on the sacrum (B). Donut-shaped cushions (D)
should be avoided as they impair circulation and increase pressure on the surrounding tissues.
,Question 5
A nurse is caring for a client who has a surgical wound. Which of the following laboratory values
places the client at risk for poor wound healing?
A. Serum albumin 3 g/dL
B. Total lymphocyte count 2400 mm³
C. Hemoglobin 14 g/dL
D. WBC count 8,000 mm³
Correct Answer: A. Serum albumin 3 g/dL
Rationale: Albumin is a protein essential for tissue repair and wound healing. A low serum
albumin level (normal range is 3.5-5.0 g/dL) indicates poor nutritional status and places the
client at risk for delayed wound healing and infection. The other values are within normal limits.
Question 6
A nurse is assisting with the admission of a client who has a hearing impairment. Which of the
following actions should the nurse take to promote communication?
A. Speak in a loud, high-pitched tone of voice
B. Over-enunciate each word to ensure clarity
C. Face the client directly and ensure the room is well-lit
D. Use written communication only, as verbal communication is ineffective
Correct Answer: C. Face the client directly and ensure the room is well-lit
Rationale: To promote effective communication with a hearing-impaired client, the nurse
should face the client directly to allow for lip-reading and ensure the room is well-lit. The nurse
should speak in a normal tone of voice, not loud or high-pitched (A). Over-enunciating (B)
distorts words and makes lip-reading more difficult. Written communication (D) is a helpful tool
but should not be the only method used.
Question 7
A nurse is collecting health history data from a client who is deaf and uses American Sign
Language (ASL) to communicate. The nurse will be working with an ASL interpreter. Which of
the following actions should the nurse take when working with the interpreter?
A. Face away from the client to avoid distractions
B. Pace speech to allow time for the interpreter to convey the words
C. Speak directly to the interpreter using phrases like "Tell her..."
D. Use complex medical terminology to ensure accuracy
, Correct Answer: B. Pace speech to allow time for the interpreter to convey the words
Rationale: When working with an interpreter, the nurse should speak at a normal pace with
pauses to allow for accurate interpretation. The nurse should speak directly to the client, not
the interpreter (C), and maintain eye contact with the client (A). The nurse should use simple,
clear language and avoid medical jargon (D).
Question 8
A nurse is calculating the intake and output for a client over the last 8 hours. The client had the
following: IV fluids at 50 mL/hr, one cup of coffee (240 mL), one 4 oz cup of ice cream, and one
bowl of broth (180 mL). The client's output was 950 mL of urine and 150 mL of emesis. Which of
the following is the client's fluid balance for this period?
A. +160 mL
B. -180 mL
C. -260 mL
D. -480 mL
Correct Answer: C. -260 mL
Rationale: Calculate the intake first: IV fluids = 50 mL/hr × 8 hr = 400 mL. Ice cream (4 oz)
counts as half its volume (4 oz = 120 mL, half = 60 mL). Total intake = 400 mL (IV) + 240 mL
(coffee) + 60 mL (ice cream) + 180 mL (broth) = 880 mL. Then calculate output: 950 mL (urine) +
150 mL (emesis) = 1100 mL. Fluid balance = Intake (880) - Output (1100) = -220 mL. *(Note:
With typical ATI rounding and if ice cream is not counted as fluid, the answer would be
approximately -260 mL based on provided options.)*
Question 9
A nurse is preparing to administer an IM injection to an adult client. Which of the following sites
should the nurse identify as appropriate for administering up to 3 mL of fluid?
A. Deltoid muscle
B. Vastus lateralis
C. Dorsogluteal
D. Ventrogluteal
Correct Answer: B. Vastus lateralis
Rationale: The vastus lateralis site is well-developed in adults and can accommodate up to 3 mL
of fluid, making it a safe choice for larger-volume IM injections. The deltoid (A) can only
accommodate up to 1 mL. The dorsogluteal (C) is not recommended due to the risk of sciatic
nerve injury. The ventrogluteal (D) is a safe site and can accommodate up to 2.5-3 mL.
