**The Synapse Igniter: NCLEX-RN, HESI
Exit & ATI Comprehensive Final Review
2025/2026**
Question 1
A nurse is assessing a client who is 12 hours post-appendectomy. The client reports sudden sharp
abdominal pain and the nurse notes abdominal rigidity. What is the priority action?
A. Administer IV morphine
B. Apply a heating pad to the abdomen
C. Notify the provider immediately
D. Position the client in high Fowler’s
---
💫RATIONALE✔️✔️: Sudden sharp pain with rigidity suggests peritonitis or perforation, a surgical
emergency requiring immediate provider notification.
💫ANSWER✔️✔️: C. Notify the provider immediately
---
Question 2
A client with a history of heart failure is prescribed carvedilol. The client’s heart rate is 54 bpm. Which
action should the nurse take first?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Check the client’s blood pressure
D. Give atropine per protocol
---
💫RATIONALE✔️✔️: Beta-blockers are held for HR <60; first check BP to confirm hemodynamic status
before notifying the provider.
💫ANSWER✔️✔️: C. Check the client’s blood pressure
---
,Question 3
A client with a new ileostomy reports output of 1,200 mL in 12 hours. Which finding should the nurse
assess first?
A. Skin integrity around the stoma
B. Blood pressure and heart rate
C. Stoma color and moisture
D. Serum potassium level
---
💫RATIONALE✔️✔️: High ileostomy output (>1,000 mL/12h) risks dehydration and hypovolemia; assess
vital signs for hypotension and tachycardia first.
💫ANSWER✔️✔️: B. Blood pressure and heart rate
---
Question 4
A nurse is teaching a client with a new prescription for nitroglycerin transdermal patch. Which
instruction is correct?
A. “Apply the patch to the same site every day to ensure absorption.”
B. “Remove the patch for 10–12 hours each day to prevent tolerance.”
C. “Shave the application site to improve patch adhesion.”
D. “Cover the patch with plastic wrap to keep it dry during showers.”
---
💫RATIONALE✔️✔️: A nitrate-free interval of 10–12 hours (usually overnight) prevents tolerance; rotate
sites and do not shave (use clippers).
💫ANSWER✔️✔️: B. “Remove the patch for 10–12 hours each day to prevent tolerance.”
---
Question 5
A client with a history of alcohol use disorder is admitted with jaundice and ascites. Which laboratory
finding is most consistent with alcoholic liver disease?
A. AST:ALT ratio of 2.5:1
B. Albumin 5.0 g/dL
C. INR 1.0
, D. Platelet count 400,000/mm³
---
💫RATIONALE✔️✔️: In alcoholic liver disease, AST is typically > ALT, often with ratio >2; other labs show
low albumin, high INR, low platelets.
💫ANSWER✔️✔️: A. AST:ALT ratio of 2.5:1
---
Question 6
A nurse is caring for a client with a chest tube. The nurse notes continuous bubbling in the water seal
chamber. What is the priority action?
A. Increase the suction pressure
B. Clamp the tube near the insertion site
C. Assess the system for an air leak
D. Document the finding as normal
---
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak; assess the
system from the client to the drainage unit to locate it.
💫ANSWER✔️✔️: C. Assess the system for an air leak
---
Question 7
A client with a new diagnosis of type 1 diabetes has a blood glucose of 450 mg/dL and serum potassium
of 3.2 mEq/L. The nurse is preparing to start an insulin drip. Which action should the nurse take first?
A. Begin insulin drip at 0.1 units/kg/hour
B. Administer IV potassium chloride
C. Give 50% dextrose IV push
D. Start IV fluid with 0.9% normal saline
---
💫RATIONALE✔️✔️: Hypokalemia must be corrected before starting insulin to prevent cardiac
arrhythmias; insulin drives potassium into cells, worsening hypokalemia.
💫ANSWER✔️✔️: B. Administer IV potassium chloride
---
Exit & ATI Comprehensive Final Review
2025/2026**
Question 1
A nurse is assessing a client who is 12 hours post-appendectomy. The client reports sudden sharp
abdominal pain and the nurse notes abdominal rigidity. What is the priority action?
A. Administer IV morphine
B. Apply a heating pad to the abdomen
C. Notify the provider immediately
D. Position the client in high Fowler’s
---
💫RATIONALE✔️✔️: Sudden sharp pain with rigidity suggests peritonitis or perforation, a surgical
emergency requiring immediate provider notification.
💫ANSWER✔️✔️: C. Notify the provider immediately
---
Question 2
A client with a history of heart failure is prescribed carvedilol. The client’s heart rate is 54 bpm. Which
action should the nurse take first?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Check the client’s blood pressure
D. Give atropine per protocol
---
💫RATIONALE✔️✔️: Beta-blockers are held for HR <60; first check BP to confirm hemodynamic status
before notifying the provider.
💫ANSWER✔️✔️: C. Check the client’s blood pressure
---
,Question 3
A client with a new ileostomy reports output of 1,200 mL in 12 hours. Which finding should the nurse
assess first?
A. Skin integrity around the stoma
B. Blood pressure and heart rate
C. Stoma color and moisture
D. Serum potassium level
---
💫RATIONALE✔️✔️: High ileostomy output (>1,000 mL/12h) risks dehydration and hypovolemia; assess
vital signs for hypotension and tachycardia first.
💫ANSWER✔️✔️: B. Blood pressure and heart rate
---
Question 4
A nurse is teaching a client with a new prescription for nitroglycerin transdermal patch. Which
instruction is correct?
A. “Apply the patch to the same site every day to ensure absorption.”
B. “Remove the patch for 10–12 hours each day to prevent tolerance.”
C. “Shave the application site to improve patch adhesion.”
D. “Cover the patch with plastic wrap to keep it dry during showers.”
---
💫RATIONALE✔️✔️: A nitrate-free interval of 10–12 hours (usually overnight) prevents tolerance; rotate
sites and do not shave (use clippers).
💫ANSWER✔️✔️: B. “Remove the patch for 10–12 hours each day to prevent tolerance.”
---
Question 5
A client with a history of alcohol use disorder is admitted with jaundice and ascites. Which laboratory
finding is most consistent with alcoholic liver disease?
A. AST:ALT ratio of 2.5:1
B. Albumin 5.0 g/dL
C. INR 1.0
, D. Platelet count 400,000/mm³
---
💫RATIONALE✔️✔️: In alcoholic liver disease, AST is typically > ALT, often with ratio >2; other labs show
low albumin, high INR, low platelets.
💫ANSWER✔️✔️: A. AST:ALT ratio of 2.5:1
---
Question 6
A nurse is caring for a client with a chest tube. The nurse notes continuous bubbling in the water seal
chamber. What is the priority action?
A. Increase the suction pressure
B. Clamp the tube near the insertion site
C. Assess the system for an air leak
D. Document the finding as normal
---
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak; assess the
system from the client to the drainage unit to locate it.
💫ANSWER✔️✔️: C. Assess the system for an air leak
---
Question 7
A client with a new diagnosis of type 1 diabetes has a blood glucose of 450 mg/dL and serum potassium
of 3.2 mEq/L. The nurse is preparing to start an insulin drip. Which action should the nurse take first?
A. Begin insulin drip at 0.1 units/kg/hour
B. Administer IV potassium chloride
C. Give 50% dextrose IV push
D. Start IV fluid with 0.9% normal saline
---
💫RATIONALE✔️✔️: Hypokalemia must be corrected before starting insulin to prevent cardiac
arrhythmias; insulin drives potassium into cells, worsening hypokalemia.
💫ANSWER✔️✔️: B. Administer IV potassium chloride
---
