NGN ATI Comprehensive Exit Retake Exam Test Bank:
The Complete 4-Volume NCLEX-RN Mastery Collection
Featuring , NGN-Style Questions with Expert-Verified
Answers, In-Depth Clinical Judgment Rationales, High-
Yield Content Review, and Strategic Test-Taking
Frameworks to Guarantee First-Attempt Success on
Your Proctored Retake Assessment
1. A nurse is caring for a client who is at 33 weeks of gestation following an
amniocentesis. The nurse should monitor the client for which of the following
complications?
• A) Infection
• B) Preterm labor
• C) Hemorrhage
• D) Rh sensitization
Answer: B) Preterm labor
Rationale: Amniocentesis carries a risk of inducing preterm labor or contractions. The
nurse should closely monitor the client for uterine contractions, vaginal bleeding, or
leakage of fluid. While infection and hemorrhage are risks, preterm labor is the most direct
and common complication to monitor for in this scenario.
2. A nurse is providing teaching to an older adult client about methods to promote
nighttime sleep. Which of the following instructions should the nurse include?
, • A) "Avoid eating anything for 2 hours before going to bed."
• B) "Take a long nap during the day to make up for lost sleep at night."
• C) "Eat a light snack before bedtime."
• D) "Drink a glass of warm milk with honey right before sleep."
Answer: C) Eat a light snack before bedtime.
Rationale: For older adults, a light snack before bed can help prevent hunger from
disrupting sleep. However, heavy meals should be avoided. It is also generally
recommended to limit daytime naps to 20-30 minutes to avoid disrupting the nighttime
sleep cycle. Options A and D provide more specific advice that may not be universally
applicable or evidence-based for promoting sleep in older adults.
3. A nurse is caring for a client who is receiving intermittent enteral tube feedings.
Which of the following factors places the client at the greatest risk for aspiration?
• A) A history of gastroesophageal reflux disease (GERD)
• B) Receiving feedings via a nasogastric tube
• C) Being in a supine position during the feeding
• D) Having a decreased level of consciousness
Answer: A) A history of gastroesophageal reflux disease (GERD)
Rationale: GERD is a significant risk factor for aspiration as it increases the likelihood of
stomach contents refluxing into the esophagus and pharynx, which can then be aspirated .
While other options are risk factors for aspiration, a history of GERD is a direct and high-
risk factor.
4. A nurse is reviewing assessment data from several clients. For which of the
following clients should the nurse recommend a referral to a dietitian?
• A) A client who has a body mass index (BMI) of 28
• B) A client who has a non-healing leg ulcer
• C) A client who reports a recent 5-pound weight loss
• D) A client who has a new diagnosis of hypertension
,Answer: B) A client who has a non-healing leg ulcer
Rationale: A non-healing wound is a strong indicator of a nutritional deficit, particularly
protein and vitamin C, which are crucial for wound healing. A dietitian can perform a
comprehensive nutritional assessment and recommend dietary changes or supplements
to support wound healing.
5. A nurse is providing discharge teaching to a client who has chronic kidney
disease and is receiving hemodialysis. Which of the following instructions should
the nurse include?
• A) "Eat 1 g/kg of protein per day."
• B) "Limit your daily fluid intake to 1,000 mL."
• C) "Increase your intake of potassium-rich foods."
• D) "Avoid foods high in phosphorus."
Answer: A) Eat 1 g/kg of protein per day.
Rationale: Clients on hemodialysis need a higher protein intake (often 1.0-1.2 g/kg of ideal
body weight) to compensate for protein loss during dialysis and to maintain muscle mass,
while also managing phosphorus and potassium restrictions. The other options represent
typical dietary restrictions but do not address the core nutritional need of a high-protein
diet.
6. A nurse is assessing a client who has a new diagnosis of deep vein thrombosis
(DVT) in the left calf. Which of the following findings should the nurse expect?
• A) Bilateral pedal edema
• B) Left calf circumference 2 cm larger than the right
• C) Pallor of the left foot with capillary refill > 5 seconds
• D) Sharp, stabbing chest pain
Answer: B) Left calf circumference 2 cm larger than the right
Rationale: Unilateral swelling and increased circumference are hallmark signs of DVT.
Pallor and delayed cap refill suggest arterial insufficiency. Chest pain suggests a
pulmonary embolism, a complication of DVT.
, 7. A nurse is preparing to administer digoxin to a client who has heart failure.
Which of the following findings should indicate to the nurse to withhold the
medication and notify the provider?
• A) Apical pulse of 68/min
• B) Serum potassium of 3.0 mEq/L
• C) Serum digoxin level of 1.2 ng/mL
• D) Blood pressure of 110/70 mmHg
Answer: B) Serum potassium of 3.0 mEq/L
Rationale: Hypokalemia (normal 3.5–5.0) increases the risk of digoxin toxicity. The nurse
should hold the dose and notify the provider. A pulse < 60 is also a reason to hold, but 68
is safe.
8. A nurse is caring for a client who is postoperative following a total hip
arthroplasty. Which of the following actions should the nurse take to prevent
dislocation?
• A) Keep the client’s hips in an adducted position
• B) Place a pillow between the client’s legs when turning
• C) Encourage the client to cross legs while sitting
• D) Flex the client’s hip beyond 90 degrees when sitting up
Answer: B) Place a pillow between the client’s legs when turning
Rationale: An abduction pillow prevents adduction and internal rotation, which are the
main positions that cause hip dislocation post-arthroplasty.
The Complete 4-Volume NCLEX-RN Mastery Collection
Featuring , NGN-Style Questions with Expert-Verified
Answers, In-Depth Clinical Judgment Rationales, High-
Yield Content Review, and Strategic Test-Taking
Frameworks to Guarantee First-Attempt Success on
Your Proctored Retake Assessment
1. A nurse is caring for a client who is at 33 weeks of gestation following an
amniocentesis. The nurse should monitor the client for which of the following
complications?
• A) Infection
• B) Preterm labor
• C) Hemorrhage
• D) Rh sensitization
Answer: B) Preterm labor
Rationale: Amniocentesis carries a risk of inducing preterm labor or contractions. The
nurse should closely monitor the client for uterine contractions, vaginal bleeding, or
leakage of fluid. While infection and hemorrhage are risks, preterm labor is the most direct
and common complication to monitor for in this scenario.
2. A nurse is providing teaching to an older adult client about methods to promote
nighttime sleep. Which of the following instructions should the nurse include?
, • A) "Avoid eating anything for 2 hours before going to bed."
• B) "Take a long nap during the day to make up for lost sleep at night."
• C) "Eat a light snack before bedtime."
• D) "Drink a glass of warm milk with honey right before sleep."
Answer: C) Eat a light snack before bedtime.
Rationale: For older adults, a light snack before bed can help prevent hunger from
disrupting sleep. However, heavy meals should be avoided. It is also generally
recommended to limit daytime naps to 20-30 minutes to avoid disrupting the nighttime
sleep cycle. Options A and D provide more specific advice that may not be universally
applicable or evidence-based for promoting sleep in older adults.
3. A nurse is caring for a client who is receiving intermittent enteral tube feedings.
Which of the following factors places the client at the greatest risk for aspiration?
• A) A history of gastroesophageal reflux disease (GERD)
• B) Receiving feedings via a nasogastric tube
• C) Being in a supine position during the feeding
• D) Having a decreased level of consciousness
Answer: A) A history of gastroesophageal reflux disease (GERD)
Rationale: GERD is a significant risk factor for aspiration as it increases the likelihood of
stomach contents refluxing into the esophagus and pharynx, which can then be aspirated .
While other options are risk factors for aspiration, a history of GERD is a direct and high-
risk factor.
4. A nurse is reviewing assessment data from several clients. For which of the
following clients should the nurse recommend a referral to a dietitian?
• A) A client who has a body mass index (BMI) of 28
• B) A client who has a non-healing leg ulcer
• C) A client who reports a recent 5-pound weight loss
• D) A client who has a new diagnosis of hypertension
,Answer: B) A client who has a non-healing leg ulcer
Rationale: A non-healing wound is a strong indicator of a nutritional deficit, particularly
protein and vitamin C, which are crucial for wound healing. A dietitian can perform a
comprehensive nutritional assessment and recommend dietary changes or supplements
to support wound healing.
5. A nurse is providing discharge teaching to a client who has chronic kidney
disease and is receiving hemodialysis. Which of the following instructions should
the nurse include?
• A) "Eat 1 g/kg of protein per day."
• B) "Limit your daily fluid intake to 1,000 mL."
• C) "Increase your intake of potassium-rich foods."
• D) "Avoid foods high in phosphorus."
Answer: A) Eat 1 g/kg of protein per day.
Rationale: Clients on hemodialysis need a higher protein intake (often 1.0-1.2 g/kg of ideal
body weight) to compensate for protein loss during dialysis and to maintain muscle mass,
while also managing phosphorus and potassium restrictions. The other options represent
typical dietary restrictions but do not address the core nutritional need of a high-protein
diet.
6. A nurse is assessing a client who has a new diagnosis of deep vein thrombosis
(DVT) in the left calf. Which of the following findings should the nurse expect?
• A) Bilateral pedal edema
• B) Left calf circumference 2 cm larger than the right
• C) Pallor of the left foot with capillary refill > 5 seconds
• D) Sharp, stabbing chest pain
Answer: B) Left calf circumference 2 cm larger than the right
Rationale: Unilateral swelling and increased circumference are hallmark signs of DVT.
Pallor and delayed cap refill suggest arterial insufficiency. Chest pain suggests a
pulmonary embolism, a complication of DVT.
, 7. A nurse is preparing to administer digoxin to a client who has heart failure.
Which of the following findings should indicate to the nurse to withhold the
medication and notify the provider?
• A) Apical pulse of 68/min
• B) Serum potassium of 3.0 mEq/L
• C) Serum digoxin level of 1.2 ng/mL
• D) Blood pressure of 110/70 mmHg
Answer: B) Serum potassium of 3.0 mEq/L
Rationale: Hypokalemia (normal 3.5–5.0) increases the risk of digoxin toxicity. The nurse
should hold the dose and notify the provider. A pulse < 60 is also a reason to hold, but 68
is safe.
8. A nurse is caring for a client who is postoperative following a total hip
arthroplasty. Which of the following actions should the nurse take to prevent
dislocation?
• A) Keep the client’s hips in an adducted position
• B) Place a pillow between the client’s legs when turning
• C) Encourage the client to cross legs while sitting
• D) Flex the client’s hip beyond 90 degrees when sitting up
Answer: B) Place a pillow between the client’s legs when turning
Rationale: An abduction pillow prevents adduction and internal rotation, which are the
main positions that cause hip dislocation post-arthroplasty.
