ATI NCLEX-RN 2026/2027 | ATI Comprehensive NCLEX-RN
Review & Exam Prep Study Guide | NCLEX-RN Practice
Questions, Answers & Detailed Rationales | ATI RN
Comprehensive Predictor, Virtual-ATI, Clinical Judgment,
NGN-Style Questions, Pharmacology, Fundamentals, Adult
Medical-Surgical, Maternal-Newborn, Pediatrics, Mental
Health, Community Health, Leadership & Management
Question 1: A nurse is assessing a client who has been taking lithium
carbonate for bipolar disorder. Which of the following findings should the
nurse identify as an early indication of lithium toxicity?
A. Blood pressure 148/92 mm Hg
B. Serum lithium level 0.8 mEq/L
C. Fine hand tremor
D. Constipation
CORRECT ANSWER: C. Fine hand tremor
Rationale: A fine hand tremor is an early sign of lithium toxicity, often occurring when
serum levels begin to rise above the therapeutic range. Blood pressure elevation is not a
classic early sign, a level of 0.8 mEq/L is within the therapeutic range (0.6–1.2 mEq/L),
and constipation is not typically an early indicator of toxicity.
Question 2: A nurse is caring for a client who is receiving heparin via
continuous IV infusion. Which of the following laboratory values should the
nurse monitor to evaluate the effectiveness of the therapy?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Bleeding time
CORRECT ANSWER: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using the aPTT, which measures the intrinsic
coagulation pathway. PT and INR are used to monitor warfarin therapy, and bleeding
time is not the standard test for evaluating heparin effectiveness.
Question 3: A nurse is teaching a client who has a new prescription for
levothyroxine. Which of the following instructions should the nurse include?
A. Take the medication at bedtime.
B. Take the medication with a meal.
C. Take the medication on an empty stomach.
D. Take the medication with an antacid.
CORRECT ANSWER: C. Take the medication on an empty stomach.
Rationale: Levothyroxine should be taken on an empty stomach, typically 30 to 60
minutes before breakfast, to enhance absorption. Taking it with food, antacids, or at
bedtime can reduce its effectiveness.
,Question 4: A nurse is assessing a client who has a new onset of atrial
fibrillation. Which of the following findings is the priority for the nurse to
report?
A. Heart rate of 110/min
B. Blood pressure of 88/54 mm Hg
C. Client report of palpitations
D. Irregular radial pulse
CORRECT ANSWER: B. Blood pressure of 88/54 mm Hg
Rationale: A blood pressure of 88/54 mm Hg indicates hemodynamic instability, which
is the priority finding in a client with atrial fibrillation. Palpitations and an irregular pulse
are expected with atrial fibrillation, and a heart rate of 110/min is concerning but less
urgent than hypotension.
Question 5: A nurse is preparing to administer digoxin to a client who has
heart failure. Which of the following findings should the nurse identify as a
contraindication to administering the medication?
A. Heart rate of 58/min
B. Serum potassium level of 4.0 mEq/L
C. Serum digoxin level of 0.5 ng/mL
D. Blood pressure of 110/70 mm Hg
CORRECT ANSWER: A. Heart rate of 58/min
Rationale: Digoxin should be withheld if the apical pulse is below 60/min in adults, as
bradycardia is a sign of digoxin toxicity. A potassium level of 4.0 mEq/L is normal, a
digoxin level of 0.5 ng/mL is subtherapeutic but not a contraindication, and a blood
pressure of 110/70 mm Hg is acceptable.
Question 6: A nurse is caring for a client who is postoperative following a
thyroidectomy. Which of the following findings should the nurse report
immediately?
A. Hoarse voice
B. Serum calcium level of 8.0 mg/dL
C. Tingling in the fingertips
D. Blood pressure of 130/80 mm Hg
CORRECT ANSWER: C. Tingling in the fingertips
Rationale: Tingling in the fingertips indicates hypocalcemia, which can occur following
thyroidectomy due to accidental removal or damage to the parathyroid glands. This can
progress to tetany and laryngospasm, making it an emergency. Hoarseness may be
expected from surgical trauma, calcium of 8.0 mg/dL is slightly low but not critical, and
the blood pressure is within normal limits.
,Question 7: A nurse is reviewing the laboratory results of a client who has
chronic kidney disease. Which of the following findings should the nurse
expect?
A. Serum creatinine 0.8 mg/dL
B. Blood urea nitrogen (BUN) 10 mg/dL
C. Serum potassium 5.8 mEq/L
D. Hemoglobin 16 g/dL
CORRECT ANSWER: C. Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia is common in chronic kidney disease due to decreased renal
excretion of potassium. Creatinine and BUN would be elevated, not low, and anemia
(low hemoglobin) is expected due to decreased erythropoietin production.
Question 8: A nurse is providing discharge teaching to a client who has a new
prescription for warfarin. Which of the following statements by the client
indicates an understanding of the teaching?
A. "I will increase my intake of leafy green vegetables."
B. "I will use a soft toothbrush when brushing my teeth."
C. "I will take aspirin for headaches."
D. "I will double my dose if I miss one."
CORRECT ANSWER: B. "I will use a soft toothbrush when brushing my teeth."
Rationale: Warfarin increases the risk of bleeding, so using a soft toothbrush helps
prevent gum bleeding. Clients should maintain consistent, not increased, intake of leafy
green vegetables (which contain vitamin K), avoid aspirin due to increased bleeding risk,
and never double doses.
Question 9: A nurse is assessing a client who is 2 hours postoperative
following a cesarean birth. Which of the following findings should the nurse
report to the provider?
A. Fundus firm at the umbilicus
B. Saturated perineal pad within 15 minutes
C. Urine output of 30 mL/hr
D. Incisional pain rated 4 on a scale of 0 to 10
CORRECT ANSWER: B. Saturated perineal pad within 15 minutes
Rationale: A saturated perineal pad within 15 minutes indicates excessive bleeding,
which may signal postpartum hemorrhage. A firm fundus at the umbilicus, urine output
of 30 mL/hr, and moderate incisional pain are expected findings.
Question 10: A nurse is caring for a client who has increased intracranial
pressure (ICP). Which of the following actions should the nurse take?
A. Place the client in a supine position.
B. Maintain the head of the bed at 30 degrees.
, C. Suction the client every 2 hours.
D. Cluster nursing care activities.
CORRECT ANSWER: B. Maintain the head of the bed at 30 degrees.
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from
the head, reducing ICP. Supine positioning increases ICP, routine suctioning can
increase ICP, and clustering care activities can also raise ICP due to increased
stimulation.
Question 11: A nurse is teaching a client who has asthma about using a peak
flow meter. Which of the following instructions should the nurse include?
A. Use the meter immediately after taking a bronchodilator.
B. Record the highest of three attempts.
C. Use the meter only when experiencing symptoms.
D. Exhale slowly and gently into the meter.
CORRECT ANSWER: B. Record the highest of three attempts.
Rationale: When using a peak flow meter, the client should stand, take a deep breath,
and exhale as forcefully and quickly as possible into the meter, recording the highest of
three attempts. The meter should be used daily, not just when symptomatic, and before
taking a bronchodilator.
Question 12: A nurse is assessing a client who has diabetic ketoacidosis (DKA).
Which of the following findings should the nurse expect?
A. Blood glucose 180 mg/dL
B. Respiratory rate 12/min
C. pH 7.25
D. Serum bicarbonate 28 mEq/L
CORRECT ANSWER: C. pH 7.25
Rationale: DKA is characterized by metabolic acidosis, with a pH below 7.35. Blood
glucose is typically greater than 250 mg/dL, respiratory rate is increased (Kussmaul
respirations), and serum bicarbonate is low (less than 15 mEq/L).
Question 13: A nurse is caring for a client who is receiving total parenteral
nutrition (TPN). Which of the following actions should the nurse take?
A. Change the TPN tubing every 72 hours.
B. Monitor blood glucose levels every 6 hours.
C. Sudden discontinuation of TPN is safe.
D. Administer TPN via a peripheral IV line.
CORRECT ANSWER: B. Monitor blood glucose levels every 6 hours.
Rationale: TPN contains high concentrations of glucose, so blood glucose should be
monitored regularly (every 4 to 6 hours). TPN tubing should be changed every 24 hours,
Review & Exam Prep Study Guide | NCLEX-RN Practice
Questions, Answers & Detailed Rationales | ATI RN
Comprehensive Predictor, Virtual-ATI, Clinical Judgment,
NGN-Style Questions, Pharmacology, Fundamentals, Adult
Medical-Surgical, Maternal-Newborn, Pediatrics, Mental
Health, Community Health, Leadership & Management
Question 1: A nurse is assessing a client who has been taking lithium
carbonate for bipolar disorder. Which of the following findings should the
nurse identify as an early indication of lithium toxicity?
A. Blood pressure 148/92 mm Hg
B. Serum lithium level 0.8 mEq/L
C. Fine hand tremor
D. Constipation
CORRECT ANSWER: C. Fine hand tremor
Rationale: A fine hand tremor is an early sign of lithium toxicity, often occurring when
serum levels begin to rise above the therapeutic range. Blood pressure elevation is not a
classic early sign, a level of 0.8 mEq/L is within the therapeutic range (0.6–1.2 mEq/L),
and constipation is not typically an early indicator of toxicity.
Question 2: A nurse is caring for a client who is receiving heparin via
continuous IV infusion. Which of the following laboratory values should the
nurse monitor to evaluate the effectiveness of the therapy?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Bleeding time
CORRECT ANSWER: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using the aPTT, which measures the intrinsic
coagulation pathway. PT and INR are used to monitor warfarin therapy, and bleeding
time is not the standard test for evaluating heparin effectiveness.
Question 3: A nurse is teaching a client who has a new prescription for
levothyroxine. Which of the following instructions should the nurse include?
A. Take the medication at bedtime.
B. Take the medication with a meal.
C. Take the medication on an empty stomach.
D. Take the medication with an antacid.
CORRECT ANSWER: C. Take the medication on an empty stomach.
Rationale: Levothyroxine should be taken on an empty stomach, typically 30 to 60
minutes before breakfast, to enhance absorption. Taking it with food, antacids, or at
bedtime can reduce its effectiveness.
,Question 4: A nurse is assessing a client who has a new onset of atrial
fibrillation. Which of the following findings is the priority for the nurse to
report?
A. Heart rate of 110/min
B. Blood pressure of 88/54 mm Hg
C. Client report of palpitations
D. Irregular radial pulse
CORRECT ANSWER: B. Blood pressure of 88/54 mm Hg
Rationale: A blood pressure of 88/54 mm Hg indicates hemodynamic instability, which
is the priority finding in a client with atrial fibrillation. Palpitations and an irregular pulse
are expected with atrial fibrillation, and a heart rate of 110/min is concerning but less
urgent than hypotension.
Question 5: A nurse is preparing to administer digoxin to a client who has
heart failure. Which of the following findings should the nurse identify as a
contraindication to administering the medication?
A. Heart rate of 58/min
B. Serum potassium level of 4.0 mEq/L
C. Serum digoxin level of 0.5 ng/mL
D. Blood pressure of 110/70 mm Hg
CORRECT ANSWER: A. Heart rate of 58/min
Rationale: Digoxin should be withheld if the apical pulse is below 60/min in adults, as
bradycardia is a sign of digoxin toxicity. A potassium level of 4.0 mEq/L is normal, a
digoxin level of 0.5 ng/mL is subtherapeutic but not a contraindication, and a blood
pressure of 110/70 mm Hg is acceptable.
Question 6: A nurse is caring for a client who is postoperative following a
thyroidectomy. Which of the following findings should the nurse report
immediately?
A. Hoarse voice
B. Serum calcium level of 8.0 mg/dL
C. Tingling in the fingertips
D. Blood pressure of 130/80 mm Hg
CORRECT ANSWER: C. Tingling in the fingertips
Rationale: Tingling in the fingertips indicates hypocalcemia, which can occur following
thyroidectomy due to accidental removal or damage to the parathyroid glands. This can
progress to tetany and laryngospasm, making it an emergency. Hoarseness may be
expected from surgical trauma, calcium of 8.0 mg/dL is slightly low but not critical, and
the blood pressure is within normal limits.
,Question 7: A nurse is reviewing the laboratory results of a client who has
chronic kidney disease. Which of the following findings should the nurse
expect?
A. Serum creatinine 0.8 mg/dL
B. Blood urea nitrogen (BUN) 10 mg/dL
C. Serum potassium 5.8 mEq/L
D. Hemoglobin 16 g/dL
CORRECT ANSWER: C. Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia is common in chronic kidney disease due to decreased renal
excretion of potassium. Creatinine and BUN would be elevated, not low, and anemia
(low hemoglobin) is expected due to decreased erythropoietin production.
Question 8: A nurse is providing discharge teaching to a client who has a new
prescription for warfarin. Which of the following statements by the client
indicates an understanding of the teaching?
A. "I will increase my intake of leafy green vegetables."
B. "I will use a soft toothbrush when brushing my teeth."
C. "I will take aspirin for headaches."
D. "I will double my dose if I miss one."
CORRECT ANSWER: B. "I will use a soft toothbrush when brushing my teeth."
Rationale: Warfarin increases the risk of bleeding, so using a soft toothbrush helps
prevent gum bleeding. Clients should maintain consistent, not increased, intake of leafy
green vegetables (which contain vitamin K), avoid aspirin due to increased bleeding risk,
and never double doses.
Question 9: A nurse is assessing a client who is 2 hours postoperative
following a cesarean birth. Which of the following findings should the nurse
report to the provider?
A. Fundus firm at the umbilicus
B. Saturated perineal pad within 15 minutes
C. Urine output of 30 mL/hr
D. Incisional pain rated 4 on a scale of 0 to 10
CORRECT ANSWER: B. Saturated perineal pad within 15 minutes
Rationale: A saturated perineal pad within 15 minutes indicates excessive bleeding,
which may signal postpartum hemorrhage. A firm fundus at the umbilicus, urine output
of 30 mL/hr, and moderate incisional pain are expected findings.
Question 10: A nurse is caring for a client who has increased intracranial
pressure (ICP). Which of the following actions should the nurse take?
A. Place the client in a supine position.
B. Maintain the head of the bed at 30 degrees.
, C. Suction the client every 2 hours.
D. Cluster nursing care activities.
CORRECT ANSWER: B. Maintain the head of the bed at 30 degrees.
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from
the head, reducing ICP. Supine positioning increases ICP, routine suctioning can
increase ICP, and clustering care activities can also raise ICP due to increased
stimulation.
Question 11: A nurse is teaching a client who has asthma about using a peak
flow meter. Which of the following instructions should the nurse include?
A. Use the meter immediately after taking a bronchodilator.
B. Record the highest of three attempts.
C. Use the meter only when experiencing symptoms.
D. Exhale slowly and gently into the meter.
CORRECT ANSWER: B. Record the highest of three attempts.
Rationale: When using a peak flow meter, the client should stand, take a deep breath,
and exhale as forcefully and quickly as possible into the meter, recording the highest of
three attempts. The meter should be used daily, not just when symptomatic, and before
taking a bronchodilator.
Question 12: A nurse is assessing a client who has diabetic ketoacidosis (DKA).
Which of the following findings should the nurse expect?
A. Blood glucose 180 mg/dL
B. Respiratory rate 12/min
C. pH 7.25
D. Serum bicarbonate 28 mEq/L
CORRECT ANSWER: C. pH 7.25
Rationale: DKA is characterized by metabolic acidosis, with a pH below 7.35. Blood
glucose is typically greater than 250 mg/dL, respiratory rate is increased (Kussmaul
respirations), and serum bicarbonate is low (less than 15 mEq/L).
Question 13: A nurse is caring for a client who is receiving total parenteral
nutrition (TPN). Which of the following actions should the nurse take?
A. Change the TPN tubing every 72 hours.
B. Monitor blood glucose levels every 6 hours.
C. Sudden discontinuation of TPN is safe.
D. Administer TPN via a peripheral IV line.
CORRECT ANSWER: B. Monitor blood glucose levels every 6 hours.
Rationale: TPN contains high concentrations of glucose, so blood glucose should be
monitored regularly (every 4 to 6 hours). TPN tubing should be changed every 24 hours,
