ATI Fundamentals Practice
Assessment B: Comprehensive
150-Question Exam Bank -
Version 2.0 well written one
year 2025 /2026 updated
graded A+
Instructions
This examination consists of 150 multiple-choice questions designed to assess advanced-level
nursing fundamentals knowledge consistent with ATI Fundamentals Practice Assessment B standards.
Each question contains one correct answer and includes a detailed rationale explaining the clinical
reasoning behind the correct response. Questions encompass conceptual understanding, clinical
application, and complex scenario-based reasoning across the full spectrum of foundational
nursing practice.
Target Audience: Nursing students preparing for ATI proctored assessments and NCLEX-RN
examination
Difficulty Level: Advanced/Hard – requires synthesis of multiple concepts and prioritization skills
,Questions 1-50: Clinical Judgment, Safety, and Infection Control
Question 1
A nurse is caring for a client who has a central venous catheter and develops chills, fever, and
hypotension. Which of the following actions should the nurse take first?
A) Administer antipyretics
B) Obtain blood cultures
C) Notify the provider
D) Discontinue the catheter
- detailed answer 100 % correct :-D) Discontinue the catheter
Rationale: Signs of catheter-related bloodstream infection (CRBSI) require immediate removal of the
suspected central line to prevent further contamination and septic shock. Blood cultures should be
obtained from the catheter and a peripheral site before initiating antibiotics, but removing the
catheter is the priority to eliminate the source of infection.
Question 2
A nurse is providing discharge teaching to a client who has a new prescription for enoxaparin. Which
of the following statements by the client indicates understanding?
A) "I will massage the injection site after administration."
B) "I will inject the medication into the subcutaneous tissue of my abdomen."
C) "I will expel the air bubble from the syringe before injection."
D) "I will use a 3-inch needle for the injection."
- detailed answer 100 % correct :-B) "I will inject the medication into the subcutaneous tissue of
my abdomen."
Rationale: Enoxaparin is administered subcutaneously in the abdomen, rotating sites. The air bubble
should not be expelled as it ensures full medication delivery. Massaging the site can cause bruising. A
short (⅝-inch) needle is used for subcutaneous injections.
Question 3
A nurse is assessing a client who has a fecal impaction. Which of the following findings should the
nurse expect?
,A) Frequent liquid stools
B) Absent bowel sounds
C) Abdominal distention with hyperactive bowel sounds
D) Hard, dry stool with no stool passage for several days
- detailed answer 100 % correct :-A) Frequent liquid stools
Rationale: Paradoxical diarrhea (frequent liquid stools) is a classic sign of fecal impaction as liquid
stool leaks around the impacted mass. Bowel sounds may be decreased, not absent. The client may
also experience abdominal cramping and rectal pain.
Question 4
A nurse is preparing to administer a blood transfusion to a client. Which of the following actions
should the nurse take to prevent a transfusion reaction?
A) Verify the client's blood type with a second nurse
B) Start the transfusion at 150 mL/hr
C) Use a 20-gauge IV catheter for the transfusion
D) Administer the transfusion within 1 hour of removing from refrigeration
- detailed answer 100 % correct :-A) Verify the client's blood type with a second nurse
Rationale: Verification of blood type and crossmatch with another licensed nurse is a critical safety
step to prevent ABO incompatibility reactions. Transfusions should be started slowly (first 15 minutes
at 50 mL/hr). A 22-gauge or larger catheter is acceptable. Blood should be administered within 4 hours
of removal from refrigeration.
Question 5
A nurse is caring for a client who has a pressure injury that is full-thickness with visible bone and
tendon. Which stage of pressure injury is this?
A) Stage 2
B) Stage 3
C) Stage 4
D) Unstageable
- detailed answer 100 % correct :-C) Stage 4
, Rationale: Stage 4 pressure injuries involve full-thickness tissue loss with exposed bone, tendon, or
muscle. Stage 2 is partial-thickness, Stage 3 involves subcutaneous tissue but not bone, and
unstageable has eschar or slough covering the wound base.
Question 6
A nurse is providing teaching to a client about the use of a patient-controlled analgesia (PCA) pump.
Which of the following statements by the client indicates a need for further teaching?
A) "I will press the button when my pain is at a 3 on a 0-10 scale."
B) "I can have my family press the button if I am sleeping."
C) "The pump has a lockout interval to prevent overdosing."
D) "I will report if I feel nauseated or drowsy."
- detailed answer 100 % correct :-B) "I can have my family press the button if I am sleeping."
Rationale: Only the client should press the PCA button to prevent accidental overdose. Family
members should not press the button. The other statements demonstrate correct understanding of
PCA therapy.
Question 7
A nurse is assessing a client who has a chest tube connected to a closed drainage system. Which of the
following findings should the nurse report to the provider?
A) Tidaling in the water seal chamber with inspiration
B) Constant bubbling in the water seal chamber
C) Intermittent bubbling in the suction control chamber
D) Serosanguineous drainage in the collection chamber
- detailed answer 100 % correct :-B) Constant bubbling in the water seal chamber
Rationale: Constant bubbling in the water seal chamber indicates an air leak that requires immediate
reporting. Tidaling (fluctuation) is a normal finding. Intermittent bubbling in the suction control
chamber is expected. Serosanguineous drainage is normal.
Question 8
A nurse is preparing to administer a medication to a client who has dysphagia. Which of the following
actions should the nurse take?
Assessment B: Comprehensive
150-Question Exam Bank -
Version 2.0 well written one
year 2025 /2026 updated
graded A+
Instructions
This examination consists of 150 multiple-choice questions designed to assess advanced-level
nursing fundamentals knowledge consistent with ATI Fundamentals Practice Assessment B standards.
Each question contains one correct answer and includes a detailed rationale explaining the clinical
reasoning behind the correct response. Questions encompass conceptual understanding, clinical
application, and complex scenario-based reasoning across the full spectrum of foundational
nursing practice.
Target Audience: Nursing students preparing for ATI proctored assessments and NCLEX-RN
examination
Difficulty Level: Advanced/Hard – requires synthesis of multiple concepts and prioritization skills
,Questions 1-50: Clinical Judgment, Safety, and Infection Control
Question 1
A nurse is caring for a client who has a central venous catheter and develops chills, fever, and
hypotension. Which of the following actions should the nurse take first?
A) Administer antipyretics
B) Obtain blood cultures
C) Notify the provider
D) Discontinue the catheter
- detailed answer 100 % correct :-D) Discontinue the catheter
Rationale: Signs of catheter-related bloodstream infection (CRBSI) require immediate removal of the
suspected central line to prevent further contamination and septic shock. Blood cultures should be
obtained from the catheter and a peripheral site before initiating antibiotics, but removing the
catheter is the priority to eliminate the source of infection.
Question 2
A nurse is providing discharge teaching to a client who has a new prescription for enoxaparin. Which
of the following statements by the client indicates understanding?
A) "I will massage the injection site after administration."
B) "I will inject the medication into the subcutaneous tissue of my abdomen."
C) "I will expel the air bubble from the syringe before injection."
D) "I will use a 3-inch needle for the injection."
- detailed answer 100 % correct :-B) "I will inject the medication into the subcutaneous tissue of
my abdomen."
Rationale: Enoxaparin is administered subcutaneously in the abdomen, rotating sites. The air bubble
should not be expelled as it ensures full medication delivery. Massaging the site can cause bruising. A
short (⅝-inch) needle is used for subcutaneous injections.
Question 3
A nurse is assessing a client who has a fecal impaction. Which of the following findings should the
nurse expect?
,A) Frequent liquid stools
B) Absent bowel sounds
C) Abdominal distention with hyperactive bowel sounds
D) Hard, dry stool with no stool passage for several days
- detailed answer 100 % correct :-A) Frequent liquid stools
Rationale: Paradoxical diarrhea (frequent liquid stools) is a classic sign of fecal impaction as liquid
stool leaks around the impacted mass. Bowel sounds may be decreased, not absent. The client may
also experience abdominal cramping and rectal pain.
Question 4
A nurse is preparing to administer a blood transfusion to a client. Which of the following actions
should the nurse take to prevent a transfusion reaction?
A) Verify the client's blood type with a second nurse
B) Start the transfusion at 150 mL/hr
C) Use a 20-gauge IV catheter for the transfusion
D) Administer the transfusion within 1 hour of removing from refrigeration
- detailed answer 100 % correct :-A) Verify the client's blood type with a second nurse
Rationale: Verification of blood type and crossmatch with another licensed nurse is a critical safety
step to prevent ABO incompatibility reactions. Transfusions should be started slowly (first 15 minutes
at 50 mL/hr). A 22-gauge or larger catheter is acceptable. Blood should be administered within 4 hours
of removal from refrigeration.
Question 5
A nurse is caring for a client who has a pressure injury that is full-thickness with visible bone and
tendon. Which stage of pressure injury is this?
A) Stage 2
B) Stage 3
C) Stage 4
D) Unstageable
- detailed answer 100 % correct :-C) Stage 4
, Rationale: Stage 4 pressure injuries involve full-thickness tissue loss with exposed bone, tendon, or
muscle. Stage 2 is partial-thickness, Stage 3 involves subcutaneous tissue but not bone, and
unstageable has eschar or slough covering the wound base.
Question 6
A nurse is providing teaching to a client about the use of a patient-controlled analgesia (PCA) pump.
Which of the following statements by the client indicates a need for further teaching?
A) "I will press the button when my pain is at a 3 on a 0-10 scale."
B) "I can have my family press the button if I am sleeping."
C) "The pump has a lockout interval to prevent overdosing."
D) "I will report if I feel nauseated or drowsy."
- detailed answer 100 % correct :-B) "I can have my family press the button if I am sleeping."
Rationale: Only the client should press the PCA button to prevent accidental overdose. Family
members should not press the button. The other statements demonstrate correct understanding of
PCA therapy.
Question 7
A nurse is assessing a client who has a chest tube connected to a closed drainage system. Which of the
following findings should the nurse report to the provider?
A) Tidaling in the water seal chamber with inspiration
B) Constant bubbling in the water seal chamber
C) Intermittent bubbling in the suction control chamber
D) Serosanguineous drainage in the collection chamber
- detailed answer 100 % correct :-B) Constant bubbling in the water seal chamber
Rationale: Constant bubbling in the water seal chamber indicates an air leak that requires immediate
reporting. Tidaling (fluctuation) is a normal finding. Intermittent bubbling in the suction control
chamber is expected. Serosanguineous drainage is normal.
Question 8
A nurse is preparing to administer a medication to a client who has dysphagia. Which of the following
actions should the nurse take?
