The ATI 2023 NGN Exit Exam
Mastery Guide: 300 Questions,
Answers, and Rationales [100%
Correct]
1–10: Fundamentals & Safety
1. A client is on fall precautions. Which action is most
important?
Answer: Keep the bed in the lowest position with brakes locked.
Rationale: Low bed position minimizes injury risk if the client rolls
out; locked brakes prevent bed movement.
2. A client with a nasogastric (NG) tube to suction has absent
bowel sounds and abdominal distention. What is the priority?
Answer: Discontinue the suction and notify the provider.
Rationale: This suggests possible bowel obstruction or
perforation; continued suction can worsen the condition.
3. Which client is at highest risk for a pressure injury?
Answer: An 80-year-old with incontinence and limited mobility.
, Rationale: Moisture (incontinence) + immobility + advanced age
are major risk factors.
4. A nurse is applying restraints. How often must the client be
assessed?
Answer: Every 2 hours (or per facility policy, but at least every 2
hours for circulation, nutrition, hydration, and toileting).
Rationale: Restraints require frequent monitoring to prevent
complications and ensure safety.
5. A client on contact precautions for C. diff. Which hand
hygiene method is correct?
Answer: Wash hands with soap and water (not alcohol-based
sanitizer).
Rationale: Alcohol does not kill C. diff spores; mechanical friction
with soap and water is required.
6. A client refuses a medication. What should the nurse do?
Answer: Withhold the medication, document the refusal, and
notify the provider.
Rationale: The client has the right to refuse; the nurse must
respect autonomy and document objectively.
7. A client is post-op and reports pain 8/10. Which action
first?
Answer: Assess the characteristics of the pain (location, quality,
radiation).
Rationale: Always assess first before administering analgesics to
rule out complications.
, 8. A nurse witnesses a consent form signed. What does this
confirm?
Answer: The signature is authentic, and the client appears
competent to consent.
Rationale: The nurse does not explain the procedure—that is the
provider's responsibility.
9. A client has a living will. What is the nurse's responsibility?
Answer: Ensure the advance directive is in the medical record and
follow the client's wishes.
Rationale: Advance directives must be honored and readily
accessible.
10. A client is receiving a blood transfusion. 15 minutes in,
they report chills and low back pain. What is the priority?
Answer: Stop the transfusion immediately.
Rationale: This is a sign of an acute hemolytic transfusion
reaction; stopping the infusion is the first step.
11–20: Pharmacology
11. A client is prescribed digoxin. Which finding indicates
toxicity?
Answer: Visual disturbances (yellow/green halos) and nausea.
Rationale: Digoxin toxicity also presents with bradycardia and
confusion.
, 12. A client on warfarin has an INR of 4.5. What is the
priority?
Answer: Hold the next dose and notify the provider.
Rationale: Therapeutic INR for most indications is 2–3; 4.5
indicates increased bleeding risk.
13. A client is started on lithium. What teaching is essential?
Answer: Maintain adequate sodium and fluid intake; avoid
dehydration.
Rationale: Low sodium or dehydration increases lithium levels,
leading to toxicity.
14. A client with asthma is prescribed albuterol. What is the
expected effect?
Answer: Bronchodilation (relief of wheezing and shortness of
breath).
Rationale: Albuterol is a beta-2 agonist that relaxes airway
smooth muscle.
15. A client is taking furosemide. Which lab value requires
monitoring?
Answer: Potassium (hypokalemia is a common side effect).
Rationale: Loop diuretics deplete potassium, which can cause
cardiac arrhythmias.
16. A client is prescribed metformin. What is a serious adverse
effect?
Mastery Guide: 300 Questions,
Answers, and Rationales [100%
Correct]
1–10: Fundamentals & Safety
1. A client is on fall precautions. Which action is most
important?
Answer: Keep the bed in the lowest position with brakes locked.
Rationale: Low bed position minimizes injury risk if the client rolls
out; locked brakes prevent bed movement.
2. A client with a nasogastric (NG) tube to suction has absent
bowel sounds and abdominal distention. What is the priority?
Answer: Discontinue the suction and notify the provider.
Rationale: This suggests possible bowel obstruction or
perforation; continued suction can worsen the condition.
3. Which client is at highest risk for a pressure injury?
Answer: An 80-year-old with incontinence and limited mobility.
, Rationale: Moisture (incontinence) + immobility + advanced age
are major risk factors.
4. A nurse is applying restraints. How often must the client be
assessed?
Answer: Every 2 hours (or per facility policy, but at least every 2
hours for circulation, nutrition, hydration, and toileting).
Rationale: Restraints require frequent monitoring to prevent
complications and ensure safety.
5. A client on contact precautions for C. diff. Which hand
hygiene method is correct?
Answer: Wash hands with soap and water (not alcohol-based
sanitizer).
Rationale: Alcohol does not kill C. diff spores; mechanical friction
with soap and water is required.
6. A client refuses a medication. What should the nurse do?
Answer: Withhold the medication, document the refusal, and
notify the provider.
Rationale: The client has the right to refuse; the nurse must
respect autonomy and document objectively.
7. A client is post-op and reports pain 8/10. Which action
first?
Answer: Assess the characteristics of the pain (location, quality,
radiation).
Rationale: Always assess first before administering analgesics to
rule out complications.
, 8. A nurse witnesses a consent form signed. What does this
confirm?
Answer: The signature is authentic, and the client appears
competent to consent.
Rationale: The nurse does not explain the procedure—that is the
provider's responsibility.
9. A client has a living will. What is the nurse's responsibility?
Answer: Ensure the advance directive is in the medical record and
follow the client's wishes.
Rationale: Advance directives must be honored and readily
accessible.
10. A client is receiving a blood transfusion. 15 minutes in,
they report chills and low back pain. What is the priority?
Answer: Stop the transfusion immediately.
Rationale: This is a sign of an acute hemolytic transfusion
reaction; stopping the infusion is the first step.
11–20: Pharmacology
11. A client is prescribed digoxin. Which finding indicates
toxicity?
Answer: Visual disturbances (yellow/green halos) and nausea.
Rationale: Digoxin toxicity also presents with bradycardia and
confusion.
, 12. A client on warfarin has an INR of 4.5. What is the
priority?
Answer: Hold the next dose and notify the provider.
Rationale: Therapeutic INR for most indications is 2–3; 4.5
indicates increased bleeding risk.
13. A client is started on lithium. What teaching is essential?
Answer: Maintain adequate sodium and fluid intake; avoid
dehydration.
Rationale: Low sodium or dehydration increases lithium levels,
leading to toxicity.
14. A client with asthma is prescribed albuterol. What is the
expected effect?
Answer: Bronchodilation (relief of wheezing and shortness of
breath).
Rationale: Albuterol is a beta-2 agonist that relaxes airway
smooth muscle.
15. A client is taking furosemide. Which lab value requires
monitoring?
Answer: Potassium (hypokalemia is a common side effect).
Rationale: Loop diuretics deplete potassium, which can cause
cardiac arrhythmias.
16. A client is prescribed metformin. What is a serious adverse
effect?
