ATI Fundamentals Proctored Exam 2025 –
Updated Multiple-Choice Practice Questions with
Correct Answers and Detailed Rationales for
Guaranteed Nursing Exam Success
Question 1
A nurse is caring for an 82-year-old client in the ER who has an oral body temp of 38.3°C
(101°F), a pulse rate of 114/min, and a RR of 22/min. He is restless and his skin is warm.
Which of the following are appropriate nursing interventions for this client? Select all
that apply.
A. Obtain culture specimens before initiating antimicrobials
B. Restrict the client's oral fluid intake
C. Encourage the client to limit activity and rest
D. Allow the client to shiver to dispel excess heat
E. Assist the client with oral hygiene frequently
Correct answers: A, C, E
Rationale: Cultures should be obtained before starting antibiotics to ensure accurate
results. Rest conserves energy and helps reduce metabolic demands. Oral hygiene
helps prevent drying and cracking of the mucous membranes.
Question 2
A nurse is instructing an AP in caring for a client who has a low platelet count due to
chemotherapy. What is the nurse's priority instruction for measuring vital signs?
A. "Don't measure the client's temp rectally."
B. "Count the client's radial pulse for 30 sec and multiply by 2."
C. "Don't let the client know you are counting her respirations."
D. "Let the client rest for 5 minutes before you measure her BP."
Correct answer: A
Rationale: Rectal temperature measurement could lead to mucosal injury and
bleeding, which is a high risk in thrombocytopenic patients.
Question 3
A nurse is instructing nursing students in measuring a client's respiratory rate. Which
guidelines should the nurse include? Select all that apply.
A. Place the client in semi-Fowler's position
B. Have the client rest an arm across the abdomen
,C. Observe one full respiratory cycle before counting the rate
D. Count the rate for 1 min if it is regular
E. Count and report any sighs the client demonstrates
Correct answers: A, B, C
Rationale: These practices improve accuracy. Sighs are normal and don’t need to be
reported. A full 1-minute count is necessary only if the rate is irregular.
Question 4
A nurse is admitting a client who has a fractured femur and obtains a BP reading of
140/94 mmHg. The client denies any history of hypertension. What should the nurse do
next?
A. Request a prescription for antihypertensive medication
B. Ask the client if she is experiencing pain
C. Request a prescription for anti-anxiety medication
D. Return in 30 minutes to recheck the client's BP
Correct answer: B
Rationale: Pain can elevate BP; assessing pain is the priority.
Question 5
A nurse finds that a client's radial pulse is 68/min and apical pulse is 84/min. What is
the pulse deficit?
A. 12/min
B. 14/min
C. 16/min
D. 18/min
Correct answer: C (16/min)
Rationale: Subtract the radial pulse from the apical pulse: 84 - 68 = 16/min.
Question 6
A nurse is educating a client on fecal occult blood testing at home. Which information
should be included?
A. Eating more protein is optimal prior to testing
B. One stool specimen is sufficient for testing
C. A red color change indicates a positive test
D. The specimen cannot be contaminated
Correct answer: D
Rationale: Water or urine contamination can alter the test results.
,Question 7
Which foods should a nurse recommend to a client with constipation?
A. Macaroni and cheese
B. Fresh fruit and whole wheat toast
C. Rice pudding and ripe bananas
D. Roast chicken and white rice
Correct answer: B
Rationale: High-fiber foods promote bowel movement.
Question 8
A nurse is assessing a client who has had diarrhea for the past four days. Which findings
should be expected? Select all that apply.
A. Bradycardia
B. Hypotension
C. Fever
D. Poor skin turgor
E. Peripheral edema
Correct answers: B, C, D
Rationale: Dehydration from diarrhea leads to hypotension, fever, and poor turgor.
Peripheral edema is linked to fluid overload.
Question 9
A nurse is preparing to administer a cleansing enema. Which steps are appropriate?
Select all that apply.
A. Warm the enema prior to instillation
B. Position the client on the left side with right leg flexed
C. Lubricate the rectal tube
D. Insert the tube 2 inches
E. Hang enema 24 inches above the anus
Correct answers: A, B, C
Rationale: 3-4 inches is correct for adults; 24 inches is too high (18 inches
recommended).
Question 10
While administering an enema, the client reports cramping. What should the nurse do?
A. Have the client hold their breath
, B. Discontinue the instillation
C. Remind the client it's common
D. Lower the enema container
Correct answer: D
Rationale: Slowing the flow can relieve discomfort.
Question 11
A client has been sitting for 3 hours. What risk is associated with this?
A. Stasis of secretions
B. Muscle atrophy
C. Pressure ulcer
D. Fecal impaction
Correct answer: C
Rationale: Sitting increases pressure over bony areas, leading to ulcers.
Question 12
A nurse is caring for a client on bed rest. How can the nurse maintain airway patency?
A. Encourage isometric exercises
B. Suction every 8 hours
C. Administer low-dose heparin
D. Promote incentive spirometry use
Correct answer: D
Rationale: Incentive spirometers help prevent atelectasis.
Question 13
Which nursing interventions help prevent thrombus formation postoperatively? Select
all that apply.
A. Instruct the client not to use the Valsalva maneuver
B. Apply elastic stockings
C. Review total protein levels
D. Place pillows under knees
E. Help the client change position frequently
Correct answers: B, E
Rationale: Elastic stockings and movement promote circulation.
Question 14
Which client statement indicates understanding of sequential compression device use?
Updated Multiple-Choice Practice Questions with
Correct Answers and Detailed Rationales for
Guaranteed Nursing Exam Success
Question 1
A nurse is caring for an 82-year-old client in the ER who has an oral body temp of 38.3°C
(101°F), a pulse rate of 114/min, and a RR of 22/min. He is restless and his skin is warm.
Which of the following are appropriate nursing interventions for this client? Select all
that apply.
A. Obtain culture specimens before initiating antimicrobials
B. Restrict the client's oral fluid intake
C. Encourage the client to limit activity and rest
D. Allow the client to shiver to dispel excess heat
E. Assist the client with oral hygiene frequently
Correct answers: A, C, E
Rationale: Cultures should be obtained before starting antibiotics to ensure accurate
results. Rest conserves energy and helps reduce metabolic demands. Oral hygiene
helps prevent drying and cracking of the mucous membranes.
Question 2
A nurse is instructing an AP in caring for a client who has a low platelet count due to
chemotherapy. What is the nurse's priority instruction for measuring vital signs?
A. "Don't measure the client's temp rectally."
B. "Count the client's radial pulse for 30 sec and multiply by 2."
C. "Don't let the client know you are counting her respirations."
D. "Let the client rest for 5 minutes before you measure her BP."
Correct answer: A
Rationale: Rectal temperature measurement could lead to mucosal injury and
bleeding, which is a high risk in thrombocytopenic patients.
Question 3
A nurse is instructing nursing students in measuring a client's respiratory rate. Which
guidelines should the nurse include? Select all that apply.
A. Place the client in semi-Fowler's position
B. Have the client rest an arm across the abdomen
,C. Observe one full respiratory cycle before counting the rate
D. Count the rate for 1 min if it is regular
E. Count and report any sighs the client demonstrates
Correct answers: A, B, C
Rationale: These practices improve accuracy. Sighs are normal and don’t need to be
reported. A full 1-minute count is necessary only if the rate is irregular.
Question 4
A nurse is admitting a client who has a fractured femur and obtains a BP reading of
140/94 mmHg. The client denies any history of hypertension. What should the nurse do
next?
A. Request a prescription for antihypertensive medication
B. Ask the client if she is experiencing pain
C. Request a prescription for anti-anxiety medication
D. Return in 30 minutes to recheck the client's BP
Correct answer: B
Rationale: Pain can elevate BP; assessing pain is the priority.
Question 5
A nurse finds that a client's radial pulse is 68/min and apical pulse is 84/min. What is
the pulse deficit?
A. 12/min
B. 14/min
C. 16/min
D. 18/min
Correct answer: C (16/min)
Rationale: Subtract the radial pulse from the apical pulse: 84 - 68 = 16/min.
Question 6
A nurse is educating a client on fecal occult blood testing at home. Which information
should be included?
A. Eating more protein is optimal prior to testing
B. One stool specimen is sufficient for testing
C. A red color change indicates a positive test
D. The specimen cannot be contaminated
Correct answer: D
Rationale: Water or urine contamination can alter the test results.
,Question 7
Which foods should a nurse recommend to a client with constipation?
A. Macaroni and cheese
B. Fresh fruit and whole wheat toast
C. Rice pudding and ripe bananas
D. Roast chicken and white rice
Correct answer: B
Rationale: High-fiber foods promote bowel movement.
Question 8
A nurse is assessing a client who has had diarrhea for the past four days. Which findings
should be expected? Select all that apply.
A. Bradycardia
B. Hypotension
C. Fever
D. Poor skin turgor
E. Peripheral edema
Correct answers: B, C, D
Rationale: Dehydration from diarrhea leads to hypotension, fever, and poor turgor.
Peripheral edema is linked to fluid overload.
Question 9
A nurse is preparing to administer a cleansing enema. Which steps are appropriate?
Select all that apply.
A. Warm the enema prior to instillation
B. Position the client on the left side with right leg flexed
C. Lubricate the rectal tube
D. Insert the tube 2 inches
E. Hang enema 24 inches above the anus
Correct answers: A, B, C
Rationale: 3-4 inches is correct for adults; 24 inches is too high (18 inches
recommended).
Question 10
While administering an enema, the client reports cramping. What should the nurse do?
A. Have the client hold their breath
, B. Discontinue the instillation
C. Remind the client it's common
D. Lower the enema container
Correct answer: D
Rationale: Slowing the flow can relieve discomfort.
Question 11
A client has been sitting for 3 hours. What risk is associated with this?
A. Stasis of secretions
B. Muscle atrophy
C. Pressure ulcer
D. Fecal impaction
Correct answer: C
Rationale: Sitting increases pressure over bony areas, leading to ulcers.
Question 12
A nurse is caring for a client on bed rest. How can the nurse maintain airway patency?
A. Encourage isometric exercises
B. Suction every 8 hours
C. Administer low-dose heparin
D. Promote incentive spirometry use
Correct answer: D
Rationale: Incentive spirometers help prevent atelectasis.
Question 13
Which nursing interventions help prevent thrombus formation postoperatively? Select
all that apply.
A. Instruct the client not to use the Valsalva maneuver
B. Apply elastic stockings
C. Review total protein levels
D. Place pillows under knees
E. Help the client change position frequently
Correct answers: B, E
Rationale: Elastic stockings and movement promote circulation.
Question 14
Which client statement indicates understanding of sequential compression device use?
