NUR 283 ATI Comprehensive Mock Exam A |
Questions and Answers with Rationales |
2026/2027 Updated | 100% Correct - Galen.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
146 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
ATI Comprehensive Mock Exam A assesses entry-level nursing competence across the NCLEX-RN test plan:
safe and effective care environment, health promotion, psychosocial integrity, and physiological integrity.
Items require clinical judgment, prioritization, and application of current evidence-based guidelines.
STUDY GUIDE
Recommended duration: 2 hours. Passing target: 70% (35/50 correct).
HIGHP - Page 1 of 47
,1. A nurse is reviewing a client's arterial blood gas results: pH 7.28, PaCO2 32 mm Hg,
HCO3 18 mEq/L. Which acid-base imbalance should the nurse document?
[ ] A. Respiratory alkalosis
[ ] B. Metabolic acidosis
[ ] C. Metabolic alkalosis
[ ] D. Respiratory acidosis
CORRECT: B. Metabolic acidosis
Low pH indicates acidosis; low HCO3 indicates the metabolic (renal) system is the primary cause, and the
low PaCO2 reflects compensatory hyperventilation. Respiratory alkalosis would have an elevated pH, and
respiratory acidosis would have an elevated PaCO2. Metabolic alkalosis would present with an elevated pH
and elevated HCO3.
2. A client prescribed warfarin has an INR of 6.2 with no active bleeding. Which action
should the nurse anticipate implementing first?
[ ] A. Administer vitamin K (phytonadione) subcutaneously or intravenously
[ ] B. Transfuse fresh frozen plasma immediately
[ ] C. Hold the next warfarin dose and monitor closely
[ ] D. Administer protamine sulfate intravenously
CORRECT: A. Administer vitamin K (phytonadione) subcutaneously or intravenously
An INR of 6.2 without bleeding requires reversal with vitamin K to prevent hemorrhage; the nurse should also
hold warfarin. FFP is reserved for active serious bleeding, protamine reverses heparin (not warfarin), and
simply holding the dose is insufficient at this supratherapeutic level. This reflects current anticoagulation
reversal guidelines.
3. A client receiving lithium carbonate reports coarse hand tremors, vomiting, and
unsteady gait. Which finding is most consistent with lithium toxicity?
[ ] A. Serum lithium level of 0.6 mEq/L
[ ] B. Serum lithium level of 1.0 mEq/L
[ ] C. Serum lithium level of 1.8 mEq/L
[ ] D. Serum lithium level of 0.4 mEq/L
CORRECT: C. Serum lithium level of 1.8 mEq/L
The therapeutic lithium range is 0.6-1.2 mEq/L; levels above 1.5 mEq/L produce toxicity with GI, neurological,
and cardiac symptoms. Values of 0.4 and 0.6 mEq/L are subtherapeutic or low therapeutic, and 1.0 mEq/L is
within the therapeutic range. Coarse tremors, vomiting, and ataxia are classic signs of moderate toxicity.
HIGHP - Page 2 of 47
,4. A nurse is caring for a client with a new colostomy. Which stoma assessment finding
requires immediate follow-up?
[ ] A. Beefy red, moist stoma
[ ] B. Dusky blue-black stoma with absent bleeding when touched
[ ] C. Slight edema at the stoma base
[ ] D. Small amount of serosanguineous drainage
CORRECT: B. Dusky blue-black stoma with absent bleeding when touched
A healthy stoma is beefy red and moist; a dusky blue-black stoma that does not bleed indicates
ischemia/necrosis and requires immediate provider notification. Slight edema and small serosanguineous
drainage are expected postoperative findings. The color change is the priority concern.
5. A client in the second stage of labor has a fetal heart rate tracing showing recurrent late
decelerations. Which nursing action is the priority?
[ ] A. Increase the oxytocin infusion rate
[ ] B. Reposition the client to a side-lying position and administer oxygen
[ ] C. Document the finding and continue monitoring
[ ] D. Perform a sterile vaginal exam to assess dilation
CORRECT: B. Reposition the client to a side-lying position and administer oxygen
Late decelerations indicate uteroplacental insufficiency; intrauterine resuscitation includes maternal
repositioning (left lateral), oxygen, IV fluids, and stopping oxytocin. Increasing oxytocin worsens the insult,
and documentation alone is insufficient. Vaginal exam does not address fetal oxygenation and is not the
priority intervention.
6. A nurse is preparing to administer digoxin to a client. Which assessment finding should
prompt the nurse to withhold the dose?
[ ] A. Apical heart rate of 58 beats/min
[ ] B. Serum potassium of 4.2 mEq/L
[ ] C. Blood pressure of 118/76 mm Hg
[ ] D. Serum digoxin level of 1.0 ng/mL
CORRECT: A. Apical heart rate of 58 beats/min
Digoxin should be withheld for an adult apical pulse below 60 beats/min because of its negative chronotropic
effect. A potassium of 4.2 mEq/L and digoxin level of 1.0 ng/mL are therapeutic, and the blood pressure is
normal. Administering digoxin with bradycardia increases risk of toxicity and dysrhythmias.
7. A client with major depressive disorder is started on sertraline. Which statement by the
client indicates a need for further teaching?
[ ] A. "I should take this medication in the morning with food."
HIGHP - Page 3 of 47
, [ ] B. "I may feel better within 1 to 2 weeks, but full effects take 4 to 6 weeks."
[ ] C. "I can stop the medication abruptly once I feel better."
[ ] D. "I should report any worsening thoughts of self-harm immediately."
CORRECT: C. "I can stop the medication abruptly once I feel better."
SSRIs must be tapered, not stopped abruptly, to avoid discontinuation syndrome; abrupt cessation is unsafe.
Taking sertraline in the morning with food, expecting gradual onset over 4-6 weeks, and reporting worsening
suicidal ideation are all correct. This reflects current antidepressant safety teaching.
8. A community health nurse is planning interventions to reduce the spread of
multidrug-resistant organisms. Which strategy is most effective at the population level?
[ ] A. Prescribing broad-spectrum antibiotics for all respiratory infections
[ ] B. Implementing antimicrobial stewardship programs and hand hygiene campaigns
[ ] C. Isolating all clients with any bacterial infection
[ ] D. Restricting vaccination to high-risk groups only
CORRECT: B. Implementing antimicrobial stewardship programs and hand hygiene campaigns
Antimicrobial stewardship and consistent hand hygiene are evidence-based population strategies to curb
multidrug-resistant organisms. Broad-spectrum prescribing promotes resistance, universal isolation is
impractical and not indicated, and limiting vaccination increases susceptibility. These align with CDC and
WHO guidance.
9. A nurse manager is reviewing staffing for the upcoming shift. Which client should the
nurse assign to the most experienced RN?
[ ] A. A client awaiting discharge after an uncomplicated appendectomy
[ ] B. A client with a new tracheostomy requiring frequent suctioning and ventilator management
[ ] C. A client receiving oral antibiotics for cellulitis
[ ] D. A client requesting education on a low-sodium diet
CORRECT: B. A client with a new tracheostomy requiring frequent suctioning and ventilator
management
A new tracheostomy with ventilator management requires complex, high-acuity nursing skills and should be
assigned to the most experienced RN. The other clients have stable, lower-acuity needs appropriate for less
experienced staff. This reflects principles of delegation and patient acuity assignment.
10. A nurse is reviewing a prescription for a client with heart failure: 'Furosemide 40 mg IV
push now.' Which laboratory value should the nurse check before administration?
[ ] A. Serum potassium
[ ] B. Serum calcium
[ ] C. Serum magnesium
HIGHP - Page 4 of 47
Questions and Answers with Rationales |
2026/2027 Updated | 100% Correct - Galen.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
146 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
ATI Comprehensive Mock Exam A assesses entry-level nursing competence across the NCLEX-RN test plan:
safe and effective care environment, health promotion, psychosocial integrity, and physiological integrity.
Items require clinical judgment, prioritization, and application of current evidence-based guidelines.
STUDY GUIDE
Recommended duration: 2 hours. Passing target: 70% (35/50 correct).
HIGHP - Page 1 of 47
,1. A nurse is reviewing a client's arterial blood gas results: pH 7.28, PaCO2 32 mm Hg,
HCO3 18 mEq/L. Which acid-base imbalance should the nurse document?
[ ] A. Respiratory alkalosis
[ ] B. Metabolic acidosis
[ ] C. Metabolic alkalosis
[ ] D. Respiratory acidosis
CORRECT: B. Metabolic acidosis
Low pH indicates acidosis; low HCO3 indicates the metabolic (renal) system is the primary cause, and the
low PaCO2 reflects compensatory hyperventilation. Respiratory alkalosis would have an elevated pH, and
respiratory acidosis would have an elevated PaCO2. Metabolic alkalosis would present with an elevated pH
and elevated HCO3.
2. A client prescribed warfarin has an INR of 6.2 with no active bleeding. Which action
should the nurse anticipate implementing first?
[ ] A. Administer vitamin K (phytonadione) subcutaneously or intravenously
[ ] B. Transfuse fresh frozen plasma immediately
[ ] C. Hold the next warfarin dose and monitor closely
[ ] D. Administer protamine sulfate intravenously
CORRECT: A. Administer vitamin K (phytonadione) subcutaneously or intravenously
An INR of 6.2 without bleeding requires reversal with vitamin K to prevent hemorrhage; the nurse should also
hold warfarin. FFP is reserved for active serious bleeding, protamine reverses heparin (not warfarin), and
simply holding the dose is insufficient at this supratherapeutic level. This reflects current anticoagulation
reversal guidelines.
3. A client receiving lithium carbonate reports coarse hand tremors, vomiting, and
unsteady gait. Which finding is most consistent with lithium toxicity?
[ ] A. Serum lithium level of 0.6 mEq/L
[ ] B. Serum lithium level of 1.0 mEq/L
[ ] C. Serum lithium level of 1.8 mEq/L
[ ] D. Serum lithium level of 0.4 mEq/L
CORRECT: C. Serum lithium level of 1.8 mEq/L
The therapeutic lithium range is 0.6-1.2 mEq/L; levels above 1.5 mEq/L produce toxicity with GI, neurological,
and cardiac symptoms. Values of 0.4 and 0.6 mEq/L are subtherapeutic or low therapeutic, and 1.0 mEq/L is
within the therapeutic range. Coarse tremors, vomiting, and ataxia are classic signs of moderate toxicity.
HIGHP - Page 2 of 47
,4. A nurse is caring for a client with a new colostomy. Which stoma assessment finding
requires immediate follow-up?
[ ] A. Beefy red, moist stoma
[ ] B. Dusky blue-black stoma with absent bleeding when touched
[ ] C. Slight edema at the stoma base
[ ] D. Small amount of serosanguineous drainage
CORRECT: B. Dusky blue-black stoma with absent bleeding when touched
A healthy stoma is beefy red and moist; a dusky blue-black stoma that does not bleed indicates
ischemia/necrosis and requires immediate provider notification. Slight edema and small serosanguineous
drainage are expected postoperative findings. The color change is the priority concern.
5. A client in the second stage of labor has a fetal heart rate tracing showing recurrent late
decelerations. Which nursing action is the priority?
[ ] A. Increase the oxytocin infusion rate
[ ] B. Reposition the client to a side-lying position and administer oxygen
[ ] C. Document the finding and continue monitoring
[ ] D. Perform a sterile vaginal exam to assess dilation
CORRECT: B. Reposition the client to a side-lying position and administer oxygen
Late decelerations indicate uteroplacental insufficiency; intrauterine resuscitation includes maternal
repositioning (left lateral), oxygen, IV fluids, and stopping oxytocin. Increasing oxytocin worsens the insult,
and documentation alone is insufficient. Vaginal exam does not address fetal oxygenation and is not the
priority intervention.
6. A nurse is preparing to administer digoxin to a client. Which assessment finding should
prompt the nurse to withhold the dose?
[ ] A. Apical heart rate of 58 beats/min
[ ] B. Serum potassium of 4.2 mEq/L
[ ] C. Blood pressure of 118/76 mm Hg
[ ] D. Serum digoxin level of 1.0 ng/mL
CORRECT: A. Apical heart rate of 58 beats/min
Digoxin should be withheld for an adult apical pulse below 60 beats/min because of its negative chronotropic
effect. A potassium of 4.2 mEq/L and digoxin level of 1.0 ng/mL are therapeutic, and the blood pressure is
normal. Administering digoxin with bradycardia increases risk of toxicity and dysrhythmias.
7. A client with major depressive disorder is started on sertraline. Which statement by the
client indicates a need for further teaching?
[ ] A. "I should take this medication in the morning with food."
HIGHP - Page 3 of 47
, [ ] B. "I may feel better within 1 to 2 weeks, but full effects take 4 to 6 weeks."
[ ] C. "I can stop the medication abruptly once I feel better."
[ ] D. "I should report any worsening thoughts of self-harm immediately."
CORRECT: C. "I can stop the medication abruptly once I feel better."
SSRIs must be tapered, not stopped abruptly, to avoid discontinuation syndrome; abrupt cessation is unsafe.
Taking sertraline in the morning with food, expecting gradual onset over 4-6 weeks, and reporting worsening
suicidal ideation are all correct. This reflects current antidepressant safety teaching.
8. A community health nurse is planning interventions to reduce the spread of
multidrug-resistant organisms. Which strategy is most effective at the population level?
[ ] A. Prescribing broad-spectrum antibiotics for all respiratory infections
[ ] B. Implementing antimicrobial stewardship programs and hand hygiene campaigns
[ ] C. Isolating all clients with any bacterial infection
[ ] D. Restricting vaccination to high-risk groups only
CORRECT: B. Implementing antimicrobial stewardship programs and hand hygiene campaigns
Antimicrobial stewardship and consistent hand hygiene are evidence-based population strategies to curb
multidrug-resistant organisms. Broad-spectrum prescribing promotes resistance, universal isolation is
impractical and not indicated, and limiting vaccination increases susceptibility. These align with CDC and
WHO guidance.
9. A nurse manager is reviewing staffing for the upcoming shift. Which client should the
nurse assign to the most experienced RN?
[ ] A. A client awaiting discharge after an uncomplicated appendectomy
[ ] B. A client with a new tracheostomy requiring frequent suctioning and ventilator management
[ ] C. A client receiving oral antibiotics for cellulitis
[ ] D. A client requesting education on a low-sodium diet
CORRECT: B. A client with a new tracheostomy requiring frequent suctioning and ventilator
management
A new tracheostomy with ventilator management requires complex, high-acuity nursing skills and should be
assigned to the most experienced RN. The other clients have stable, lower-acuity needs appropriate for less
experienced staff. This reflects principles of delegation and patient acuity assignment.
10. A nurse is reviewing a prescription for a client with heart failure: 'Furosemide 40 mg IV
push now.' Which laboratory value should the nurse check before administration?
[ ] A. Serum potassium
[ ] B. Serum calcium
[ ] C. Serum magnesium
HIGHP - Page 4 of 47
