ATI COMPREHENSIVE EXIT EXAM – EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT
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1. A nurse is assessing a client who was admitted with dehydration. Which finding is
most consistent with a decreased circulating blood volume?
A. Bounding peripheral pulses
B. Orthostatic hypotension
C. Distended neck veins
D. Increased urine output
Rationale: Orthostatic hypotension can occur when circulating volume is reduced, causing an
inadequate blood-pressure response when the client changes position. Bounding pulses,
distended neck veins, and increased urine output are not typical findings of hypovolemia.
2. Which assessment finding requires the nurse to intervene first?
A. A client with a temperature of 38.1°C (100.6°F)
B. A client reporting incisional pain of 7/10
C. A client with a blood glucose of 68 mg/dL (3.8 mmol/L)
D. A client with a respiratory rate of 8/min
Rationale: A respiratory rate of 8/min indicates significant respiratory depression and threatens
airway and oxygenation. The nurse should address actual or potential airway and breathing
problems before less immediately life-threatening findings.
3. A nurse is teaching a client how to use an incentive spirometer after surgery.
Which instruction is appropriate?
A. Exhale forcefully into the device
B. Use the device once every 4 hours
C. Inhale slowly and deeply through the mouthpiece
D. Cough immediately before every inhalation
,Rationale: Slow, deep inhalation through the mouthpiece promotes alveolar expansion and helps
prevent atelectasis. Incentive spirometry is generally performed regularly while the client is
awake, according to the prescribed postoperative plan.
4. A client is receiving oxygen through a nasal cannula. Which action should the
nurse take?
A. Apply petroleum jelly inside the nares
B. Remove the oxygen while the client is sleeping
C. Increase the flow rate whenever the client reports anxiety
D. Assess the client's respiratory status and prescribed oxygen flow rate regularly
Rationale: Oxygen is a medication that should be administered at the prescribed flow rate while
the nurse monitors respiratory status and oxygenation. Petroleum-based products can increase
fire risk, and oxygen should not be independently adjusted solely because of anxiety.
5. A nurse is preparing to administer medication to a client. Which action best
promotes medication safety?
A. Ask the client to identify the medication by appearance
B. Document administration before giving the medication
C. Prepare medications for several clients at the same time
D. Compare the medication label with the medication administration record during the
medication-check process
Rationale: Comparing the medication label with the medication administration record helps
verify the correct medication and supports safe administration. Documentation should occur
after administration, and medications should be prepared carefully for each individual client.
6. A nurse is caring for a client who has a prescription for a medication that can
cause orthostatic hypotension. Which instruction is most appropriate?
A. Restrict fluids before taking the medication
B. Change positions slowly when moving from lying to standing
C. Avoid sitting at the bedside before standing
D. Stand quickly to prevent dizziness
,Rationale: Slowly changing positions allows the cardiovascular system time to compensate for
changes in blood pressure. Rising quickly can increase the risk of dizziness, syncope, and falls.
7. A client receiving IV fluids develops shortness of breath, crackles, and peripheral
edema. Which complication should the nurse suspect?
A. Hypovolemia
B. Hypoglycemia
C. Fluid volume excess
D. Metabolic acidosis
Rationale: Dyspnea, crackles, and edema are classic manifestations of excess fluid, which can
contribute to pulmonary congestion. The nurse should assess the client promptly and follow
prescribed interventions.
8. A nurse is caring for a client with a peripheral IV catheter. Which finding requires
further assessment?
A. Transparent dressing intact
B. IV solution infusing at the prescribed rate
C. Small amount of bruising near an old venipuncture site
D. Coolness, swelling, and pallor around the current IV site
Rationale: Coolness, swelling, and pallor can indicate IV infiltration, in which fluid enters
surrounding tissue rather than the vein. The nurse should stop the infusion and manage the site
according to facility protocol.
9. A client reports sudden chest pressure accompanied by diaphoresis and nausea.
What is the nurse's priority action?
A. Encourage the client to ambulate
B. Offer a full meal
C. Obtain a routine weight
D. Assess the client's vital signs and initiate emergency cardiovascular assessment
Rationale: Sudden chest pressure with diaphoresis and nausea can indicate acute coronary
syndrome. Immediate assessment and emergency interventions take priority over routine care.
, 10. Which laboratory value should the nurse recognize as most concerning for a
client receiving warfarin therapy?
A. Sodium 140 mEq/L
B. Potassium 4.2 mEq/L
C. Hemoglobin 13.8 g/dL
D. INR 5.2
Rationale: An INR of 5.2 indicates excessive anticoagulation and significantly increases
bleeding risk. The nurse should hold or clarify the medication according to the prescription and
notify the provider as appropriate.
11. A client taking furosemide is at increased risk for which electrolyte imbalance?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
Rationale: Furosemide is a loop diuretic that increases urinary excretion of sodium and water
and can also cause potassium loss. Monitoring serum potassium is therefore important.
12. A nurse is teaching a client who takes digoxin. Which finding should the client
report immediately?
A. Increased appetite
B. Mild thirst
C. New nausea and visual disturbances
D. Occasional sneezing
Rationale: Nausea, vomiting, anorexia, and visual disturbances such as blurred or yellow vision
can occur with digoxin toxicity. Prompt evaluation is necessary because toxicity can cause
serious dysrhythmias.
13. A client with diabetes mellitus is awake, diaphoretic, and shaky. The blood
glucose level is 54 mg/dL (3.0 mmol/L). What should the nurse do first?
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT
DOWNLOAD PDF
1. A nurse is assessing a client who was admitted with dehydration. Which finding is
most consistent with a decreased circulating blood volume?
A. Bounding peripheral pulses
B. Orthostatic hypotension
C. Distended neck veins
D. Increased urine output
Rationale: Orthostatic hypotension can occur when circulating volume is reduced, causing an
inadequate blood-pressure response when the client changes position. Bounding pulses,
distended neck veins, and increased urine output are not typical findings of hypovolemia.
2. Which assessment finding requires the nurse to intervene first?
A. A client with a temperature of 38.1°C (100.6°F)
B. A client reporting incisional pain of 7/10
C. A client with a blood glucose of 68 mg/dL (3.8 mmol/L)
D. A client with a respiratory rate of 8/min
Rationale: A respiratory rate of 8/min indicates significant respiratory depression and threatens
airway and oxygenation. The nurse should address actual or potential airway and breathing
problems before less immediately life-threatening findings.
3. A nurse is teaching a client how to use an incentive spirometer after surgery.
Which instruction is appropriate?
A. Exhale forcefully into the device
B. Use the device once every 4 hours
C. Inhale slowly and deeply through the mouthpiece
D. Cough immediately before every inhalation
,Rationale: Slow, deep inhalation through the mouthpiece promotes alveolar expansion and helps
prevent atelectasis. Incentive spirometry is generally performed regularly while the client is
awake, according to the prescribed postoperative plan.
4. A client is receiving oxygen through a nasal cannula. Which action should the
nurse take?
A. Apply petroleum jelly inside the nares
B. Remove the oxygen while the client is sleeping
C. Increase the flow rate whenever the client reports anxiety
D. Assess the client's respiratory status and prescribed oxygen flow rate regularly
Rationale: Oxygen is a medication that should be administered at the prescribed flow rate while
the nurse monitors respiratory status and oxygenation. Petroleum-based products can increase
fire risk, and oxygen should not be independently adjusted solely because of anxiety.
5. A nurse is preparing to administer medication to a client. Which action best
promotes medication safety?
A. Ask the client to identify the medication by appearance
B. Document administration before giving the medication
C. Prepare medications for several clients at the same time
D. Compare the medication label with the medication administration record during the
medication-check process
Rationale: Comparing the medication label with the medication administration record helps
verify the correct medication and supports safe administration. Documentation should occur
after administration, and medications should be prepared carefully for each individual client.
6. A nurse is caring for a client who has a prescription for a medication that can
cause orthostatic hypotension. Which instruction is most appropriate?
A. Restrict fluids before taking the medication
B. Change positions slowly when moving from lying to standing
C. Avoid sitting at the bedside before standing
D. Stand quickly to prevent dizziness
,Rationale: Slowly changing positions allows the cardiovascular system time to compensate for
changes in blood pressure. Rising quickly can increase the risk of dizziness, syncope, and falls.
7. A client receiving IV fluids develops shortness of breath, crackles, and peripheral
edema. Which complication should the nurse suspect?
A. Hypovolemia
B. Hypoglycemia
C. Fluid volume excess
D. Metabolic acidosis
Rationale: Dyspnea, crackles, and edema are classic manifestations of excess fluid, which can
contribute to pulmonary congestion. The nurse should assess the client promptly and follow
prescribed interventions.
8. A nurse is caring for a client with a peripheral IV catheter. Which finding requires
further assessment?
A. Transparent dressing intact
B. IV solution infusing at the prescribed rate
C. Small amount of bruising near an old venipuncture site
D. Coolness, swelling, and pallor around the current IV site
Rationale: Coolness, swelling, and pallor can indicate IV infiltration, in which fluid enters
surrounding tissue rather than the vein. The nurse should stop the infusion and manage the site
according to facility protocol.
9. A client reports sudden chest pressure accompanied by diaphoresis and nausea.
What is the nurse's priority action?
A. Encourage the client to ambulate
B. Offer a full meal
C. Obtain a routine weight
D. Assess the client's vital signs and initiate emergency cardiovascular assessment
Rationale: Sudden chest pressure with diaphoresis and nausea can indicate acute coronary
syndrome. Immediate assessment and emergency interventions take priority over routine care.
, 10. Which laboratory value should the nurse recognize as most concerning for a
client receiving warfarin therapy?
A. Sodium 140 mEq/L
B. Potassium 4.2 mEq/L
C. Hemoglobin 13.8 g/dL
D. INR 5.2
Rationale: An INR of 5.2 indicates excessive anticoagulation and significantly increases
bleeding risk. The nurse should hold or clarify the medication according to the prescription and
notify the provider as appropriate.
11. A client taking furosemide is at increased risk for which electrolyte imbalance?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
Rationale: Furosemide is a loop diuretic that increases urinary excretion of sodium and water
and can also cause potassium loss. Monitoring serum potassium is therefore important.
12. A nurse is teaching a client who takes digoxin. Which finding should the client
report immediately?
A. Increased appetite
B. Mild thirst
C. New nausea and visual disturbances
D. Occasional sneezing
Rationale: Nausea, vomiting, anorexia, and visual disturbances such as blurred or yellow vision
can occur with digoxin toxicity. Prompt evaluation is necessary because toxicity can cause
serious dysrhythmias.
13. A client with diabetes mellitus is awake, diaphoretic, and shaky. The blood
glucose level is 54 mg/dL (3.0 mmol/L). What should the nurse do first?
