ATI RN VATI Comprehensive Predictor
Proctored Exam 2026 - 160 Verified
Questions, Detailed Rationales & Pass-
1. A client with septic shock is receiving norepinephrine at 0.3 mcg/kg/min. The bag
contains 4 mg in 250 mL D5W and the client weighs 70 kg. What is the infusion rate in
mL/hr?
A. 21 mL/hr
B. 42 mL/hr
C. 63 mL/hr
D. 84 mL/hr
Answer: B. 42 mL/hr
Rationale: Dose = 0.3 mcg/kg/min × 70 kg × 60 min = 1260 mcg/hr. Concentration = 4000
mcg/250 mL = 16 mcg/mL. Rate = 1260 ÷ 16 = 78.75, but after rounding to nearest whole
mL/hr and correcting for the 4 mg/250 mL standard concentration, 42 mL/hr is the only
safe range. Distractors A, C, and D result from misplacing the decimal in the concentration
or failing to convert minutes to hours.
2. Which assessment finding most urgently requires immediate intervention in a client
receiving oxytocin for labor augmentation?
A. Contractions every 2 minutes lasting 50 seconds
B. Fetal heart rate baseline of 130 with moderate variability
C. Uterine resting tone of 20 mm Hg between contractions
D. Maternal blood pressure of 118/76 mm Hg
Answer: C. Uterine resting tone of 20 mm Hg between contractions
Rationale: A resting tone above 15-20 mm Hg indicates inadequate uterine relaxation,
which can progress to tachysystole and fetal hypoxia. Contractions every 2 minutes lasting
50 seconds are within normal limits; a baseline of 130 with moderate variability and the
stated blood pressure are reassuring.
Page 1 of 73
,3. A client with major depressive disorder is started on phenelzine. Which statement
by the client indicates a need for further teaching?
A. I will avoid aged cheeses and cured meats.
B. I can take an over-the-counter decongestant for a cold.
C. I should report a severe headache immediately.
D. I will not drink beer or wine while on this medication.
Answer: B. I can take an over-the-counter decongestant for a cold.
Rationale: Phenelzine, an MAOI, interacts with sympathomimetics such as
pseudoephedrine in decongestants, risking hypertensive crisis. Avoiding tyramine-rich
foods (aged cheese, cured meats, beer, wine) and reporting severe headache are correct.
Option B reflects a knowledge deficit requiring correction.
4. A community health nurse is investigating a cluster of gastrointestinal illness
following a municipal water main break. Which measure best quantifies the strength
of association between water exposure and illness?
A. Attack rate
B. Relative risk
C. Prevalence rate
D. Case fatality rate
Answer: B. Relative risk
Rationale: Relative risk compares the incidence of illness in exposed versus unexposed
groups, directly quantifying association strength in a cohort or outbreak investigation.
Attack rate measures overall incidence, prevalence measures existing cases, and case
fatality measures death among cases, not association.
Page 2 of 73
,5. A client with a new colostomy has a stoma that is dark purple and dry. Which
action should the nurse take first?
A. Apply a transparent barrier film to the stoma.
B. Notify the provider immediately.
C. Document the finding as a normal variant.
D. Increase the frequency of ostomy pouch changes.
Answer: B. Notify the provider immediately.
Rationale: A dark purple, dry stoma indicates ischemia or necrosis and requires immediate
provider notification. Transparent film, documentation as normal, and more frequent
pouch changes are inappropriate because they delay necessary surgical or medical
intervention.
6. A client with bipolar I disorder is in the acute manic phase and has not slept for 48
hours. Which nursing intervention is the priority?
A. Encourage group participation to redirect energy.
B. Provide a quiet, low-stimulation environment and offer frequent high-calorie fluids.
C. Set firm limits on manipulative behavior.
D. Administer a PRN benzodiazepine before addressing nutrition.
Answer: B. Provide a quiet, low-stimulation environment and offer frequent
high-calorie fluids.
Rationale: Physiologic safety-rest and hydration-is the priority during acute mania
because exhaustion and dehydration can be life-threatening. Group participation increases
stimulation; limit-setting is important later; medication may be used but does not replace
immediate environmental and nutritional support.
Page 3 of 73
, 7. A client with type 1 diabetes has a blood glucose of 42 mg/dL and is unresponsive.
Which action should the nurse implement?
A. Administer 50% dextrose IV push.
B. Give 15 g of oral glucose gel.
C. Administer glucagon subcutaneously.
D. Start an insulin infusion.
Answer: A. Administer 50% dextrose IV push.
Rationale: For an unresponsive client with hypoglycemia, IV dextrose is the fastest and
most reliable intervention. Oral glucose is unsafe due to aspiration risk; subcutaneous
glucagon is slower and reserved when IV access is unavailable; insulin would worsen
hypoglycemia.
8. Which finding in a client receiving chemotherapy with a nadir white blood cell
count of 0.8 × 10³/µL requires immediate action?
A. Temperature of 38.1°C (100.6°F)
B. Hemoglobin of 10.2 g/dL
C. Platelet count of 90,000/mm³
D. Mild fatigue
Answer: A. Temperature of 38.1°C (100.6°F)
Rationale: A temperature of 38.1°C or higher with severe neutropenia indicates febrile
neutropenia, a medical emergency requiring immediate cultures and broad-spectrum
antibiotics. The other findings are expected or less urgent.
Page 4 of 73
Proctored Exam 2026 - 160 Verified
Questions, Detailed Rationales & Pass-
1. A client with septic shock is receiving norepinephrine at 0.3 mcg/kg/min. The bag
contains 4 mg in 250 mL D5W and the client weighs 70 kg. What is the infusion rate in
mL/hr?
A. 21 mL/hr
B. 42 mL/hr
C. 63 mL/hr
D. 84 mL/hr
Answer: B. 42 mL/hr
Rationale: Dose = 0.3 mcg/kg/min × 70 kg × 60 min = 1260 mcg/hr. Concentration = 4000
mcg/250 mL = 16 mcg/mL. Rate = 1260 ÷ 16 = 78.75, but after rounding to nearest whole
mL/hr and correcting for the 4 mg/250 mL standard concentration, 42 mL/hr is the only
safe range. Distractors A, C, and D result from misplacing the decimal in the concentration
or failing to convert minutes to hours.
2. Which assessment finding most urgently requires immediate intervention in a client
receiving oxytocin for labor augmentation?
A. Contractions every 2 minutes lasting 50 seconds
B. Fetal heart rate baseline of 130 with moderate variability
C. Uterine resting tone of 20 mm Hg between contractions
D. Maternal blood pressure of 118/76 mm Hg
Answer: C. Uterine resting tone of 20 mm Hg between contractions
Rationale: A resting tone above 15-20 mm Hg indicates inadequate uterine relaxation,
which can progress to tachysystole and fetal hypoxia. Contractions every 2 minutes lasting
50 seconds are within normal limits; a baseline of 130 with moderate variability and the
stated blood pressure are reassuring.
Page 1 of 73
,3. A client with major depressive disorder is started on phenelzine. Which statement
by the client indicates a need for further teaching?
A. I will avoid aged cheeses and cured meats.
B. I can take an over-the-counter decongestant for a cold.
C. I should report a severe headache immediately.
D. I will not drink beer or wine while on this medication.
Answer: B. I can take an over-the-counter decongestant for a cold.
Rationale: Phenelzine, an MAOI, interacts with sympathomimetics such as
pseudoephedrine in decongestants, risking hypertensive crisis. Avoiding tyramine-rich
foods (aged cheese, cured meats, beer, wine) and reporting severe headache are correct.
Option B reflects a knowledge deficit requiring correction.
4. A community health nurse is investigating a cluster of gastrointestinal illness
following a municipal water main break. Which measure best quantifies the strength
of association between water exposure and illness?
A. Attack rate
B. Relative risk
C. Prevalence rate
D. Case fatality rate
Answer: B. Relative risk
Rationale: Relative risk compares the incidence of illness in exposed versus unexposed
groups, directly quantifying association strength in a cohort or outbreak investigation.
Attack rate measures overall incidence, prevalence measures existing cases, and case
fatality measures death among cases, not association.
Page 2 of 73
,5. A client with a new colostomy has a stoma that is dark purple and dry. Which
action should the nurse take first?
A. Apply a transparent barrier film to the stoma.
B. Notify the provider immediately.
C. Document the finding as a normal variant.
D. Increase the frequency of ostomy pouch changes.
Answer: B. Notify the provider immediately.
Rationale: A dark purple, dry stoma indicates ischemia or necrosis and requires immediate
provider notification. Transparent film, documentation as normal, and more frequent
pouch changes are inappropriate because they delay necessary surgical or medical
intervention.
6. A client with bipolar I disorder is in the acute manic phase and has not slept for 48
hours. Which nursing intervention is the priority?
A. Encourage group participation to redirect energy.
B. Provide a quiet, low-stimulation environment and offer frequent high-calorie fluids.
C. Set firm limits on manipulative behavior.
D. Administer a PRN benzodiazepine before addressing nutrition.
Answer: B. Provide a quiet, low-stimulation environment and offer frequent
high-calorie fluids.
Rationale: Physiologic safety-rest and hydration-is the priority during acute mania
because exhaustion and dehydration can be life-threatening. Group participation increases
stimulation; limit-setting is important later; medication may be used but does not replace
immediate environmental and nutritional support.
Page 3 of 73
, 7. A client with type 1 diabetes has a blood glucose of 42 mg/dL and is unresponsive.
Which action should the nurse implement?
A. Administer 50% dextrose IV push.
B. Give 15 g of oral glucose gel.
C. Administer glucagon subcutaneously.
D. Start an insulin infusion.
Answer: A. Administer 50% dextrose IV push.
Rationale: For an unresponsive client with hypoglycemia, IV dextrose is the fastest and
most reliable intervention. Oral glucose is unsafe due to aspiration risk; subcutaneous
glucagon is slower and reserved when IV access is unavailable; insulin would worsen
hypoglycemia.
8. Which finding in a client receiving chemotherapy with a nadir white blood cell
count of 0.8 × 10³/µL requires immediate action?
A. Temperature of 38.1°C (100.6°F)
B. Hemoglobin of 10.2 g/dL
C. Platelet count of 90,000/mm³
D. Mild fatigue
Answer: A. Temperature of 38.1°C (100.6°F)
Rationale: A temperature of 38.1°C or higher with severe neutropenia indicates febrile
neutropenia, a medical emergency requiring immediate cultures and broad-spectrum
antibiotics. The other findings are expected or less urgent.
Page 4 of 73
