ATI PN Comprehensive Exit Exam 2024/2025 - NGN
Format | 180 Authentic Questions with 100% Verified
Answers & Detailed Rationales | A+ Graded
1. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic obstructive
pulmonary disease (COPD). The results are: pH 7.30, PaCO2 58 mm Hg, HCO3- 30 mEq/L.
Which compensatory mechanism is the client's body primarily using?
A. Respiratory alkalosis compensation via renal excretion of bicarbonate
B. Metabolic alkalosis compensation via hypoventilation
C. Metabolic compensation for respiratory acidosis via renal retention of bicarbonate
D. Respiratory compensation for metabolic alkalosis via hyperventilation
Answer: C
Rationale: The ABG shows respiratory acidosis (low pH, high PaCO2) with an elevated HCO3-,
indicating metabolic compensation. The kidneys retain bicarbonate to buffer the acidosis. Option C
correctly identifies this. Options A and D describe opposite conditions; B misidentifies the primary
disorder.
2. A nurse is caring for a client receiving a continuous intravenous infusion of heparin. The client's
activated partial thromboplastin time (aPTT) is 120 seconds (therapeutic range 60-80 seconds).
Which action should the nurse take first?
A. Decrease the heparin infusion rate by 50%
B. Stop the heparin infusion immediately
C. Administer protamine sulfate as ordered
D. Notify the healthcare provider of the aPTT result
Answer: B
Rationale: An aPTT of 120 seconds indicates supratherapeutic anticoagulation and high bleeding risk.
The priority is to stop the infusion to prevent hemorrhage. Decreasing the rate (A) may not be sufficient;
protamine (C) is an antidote but requires a provider order and is not the first action; notifying (D) is
important but secondary to stopping the infusion.
3. A nurse is assessing a client who has just returned from a cardiac catheterization via the right
femoral artery. Which finding requires immediate intervention?
A. Blood pressure 110/70 mm Hg, heart rate 88/min
B. Right pedal pulse 1+ and capillary refill 3 seconds
C. Small amount of serosanguinous drainage on the groin dressing
D. Client reports feeling warm and flushed
Answer: B
Rationale: A diminished pedal pulse (1+) and prolonged capillary refill (3 seconds) on the affected
extremity suggest arterial compromise, possibly due to a hematoma or thrombus. This requires
Page 1
,immediate intervention to prevent limb ischemia. Option A is within normal limits; C is expected; D is a
common reaction to contrast dye.
4. A nurse is providing discharge teaching to a client prescribed warfarin. Which statement by the
client indicates an understanding of dietary precautions?
A. I will increase my intake of green leafy vegetables to prevent anemia.
B. I should avoid foods high in vitamin K, such as broccoli and spinach.
C. I can take ibuprofen if I have mild pain.
D. I will use a soft toothbrush and electric razor.
Answer: B
Rationale: Warfarin is a vitamin K antagonist; consistent intake of vitamin K-rich foods can alter INR.
Clients should maintain a consistent intake, but avoiding high vitamin K foods is often advised to
prevent fluctuations. Option A would increase vitamin K; C increases bleeding risk; D is about safety
but not dietary.
5. A nurse is evaluating a client's understanding of insulin administration. The client uses a
mixture of NPH and regular insulin. Which action by the client indicates correct technique?
A. Draws up the regular insulin first, then the NPH insulin into the same syringe
B. Draws up the NPH insulin first, then the regular insulin into the same syringe
C. Shakes the NPH insulin vigorously before drawing it up
D. Administers the mixture subcutaneously into the deltoid muscle
Answer: A
Rationale: When mixing insulins, regular (clear) should be drawn first to avoid contaminating the vial
with NPH (cloudy). Option A is correct. Option B reverses the order, which can lead to inaccurate
dosing. Shaking (C) can froth the insulin, altering absorption; deltoid (D) is not a preferred site for
insulin.
6. A nurse is caring for a client with heart failure who is receiving furosemide 40 mg IV push.
Which laboratory value requires immediate notification of the healthcare provider?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 138 mEq/L
C. Serum creatinine 0.9 mg/dL
D. Serum magnesium 2.0 mg/dL
Answer: A
Rationale: Furosemide is a loop diuretic that can cause hypokalemia. A potassium of 3.2 mEq/L is below
normal (3.5-5.0) and increases the risk of cardiac dysrhythmias, especially in heart failure. The nurse
should report this immediately. Options B, C, and D are within normal limits.
7. A nurse is assessing a client who has a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse take?
A. Clamp the chest tube near the insertion site
B. Increase the suction pressure
Page 2
,C. Check the drainage system for an air leak
D. Milk the tubing to dislodge any clots
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak, either from the system
or from the patient. The nurse should first check for a leak in the system (e.g., loose connections).
Clamping (A) is dangerous; increasing suction (B) may worsen a leak; milking (D) is not indicated.
8. A nurse is preparing to administer a blood transfusion to a client. Which action is most
important to prevent a transfusion reaction?
A. Verify the client's identity using two identifiers
B. Check the blood product against the client's medical record
C. Start the transfusion slowly at 2 mL/min for the first 15 minutes
D. Obtain baseline vital signs before starting the transfusion
Answer: A
Rationale: The most critical step to prevent a transfusion reaction is verifying the correct patient and
blood product using two identifiers (e.g., name and date of birth) to avoid ABO incompatibility. While
all options are important, patient identification is the primary safeguard. Option C is a safety measure
but not the most important.
9. A nurse is caring for a client who is 2 hours post-operative following a transurethral resection of
the prostate (TURP). The client has a three-way indwelling urinary catheter with continuous
bladder irrigation. Which finding requires immediate action?
A. Urine output 800 mL in 2 hours
B. Bright red urine with multiple clots
C. Catheter traction applied to the thigh
D. Client reports mild suprapubic discomfort
Answer: B
Rationale: Bright red urine with multiple clots indicates active bleeding, which can obstruct the catheter
and lead to clot retention. This requires immediate intervention such as increasing irrigation rate or
notifying the surgeon. Option A is expected with irrigation; C is a standard post-TURP intervention; D
is common but not emergent.
10. A nurse is assessing a client who has been on long-term corticosteroid therapy. Which finding is
most indicative of Cushing's syndrome?
A. Hyperpigmentation of the skin
B. Weight loss and muscle wasting
C. Moon face and buffalo hump
D. Hypotension and bradycardia
Answer: C
Rationale: Long-term corticosteroid use can cause iatrogenic Cushing's syndrome, characterized by
moon face, buffalo hump, central obesity, and striae. Option C is classic. Hyperpigmentation (A) is seen
in Addison's disease; weight loss (B) is not typical; hypotension (D) is not a feature of Cushing's.
Page 3
, 11. A patient with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia (K+ 6.2
mEq/L) and metabolic acidosis (pH 7.28, HCO3- 16 mEq/L). The provider orders intravenous
sodium bicarbonate. Which of the following additional findings would most strongly
contraindicate the administration of sodium bicarbonate in this patient?
A. Serum calcium level of 8.0 mg/dL (ionized calcium 1.0 mmol/L)
B. Serum phosphorus level of 6.5 mg/dL
C. Serum albumin level of 2.8 g/dL
D. Serum magnesium level of 2.5 mg/dL
Answer: A
Rationale: Sodium bicarbonate administration can precipitate hypocalcemic tetany by increasing calcium
binding to albumin and reducing ionized calcium. In CKD, hypocalcemia is common due to phosphate
retention and vitamin D deficiency. The low ionized calcium (1.0 mmol/L) indicates significant
hypocalcemia, making bicarbonate risky. Hyperphosphatemia (B) is common but not a direct
contraindication. Hypoalbuminemia (C) affects total calcium but not ionized calcium directly.
Hypermagnesemia (D) is not acutely worsened by bicarbonate.
12. A nurse is reviewing the medication administration record of a patient receiving warfarin for
atrial fibrillation. The patient's INR is 3.8. Which of the following findings would most likely
require immediate discontinuation of warfarin and administration of phytonadione?
A. Presence of microscopic hematuria on urinalysis
B. Development of a large, painful hematoma on the thigh after minor trauma
C. Platelet count of 150,000/mm³
D. Activated partial thromboplastin time (aPTT) of 45 seconds
Answer: B
Rationale: A large, painful hematoma suggests significant bleeding into muscle tissue, which is a serious
adverse effect of warfarin over-anticoagulation (INR 3.8 is above therapeutic range of 2-3). This
requires immediate reversal with phytonadione (vitamin K). Microscopic hematuria (A) is common and
may not require reversal if transient. Platelet count of 150,000 (C) is normal. aPTT of 45 seconds (D) is
slightly prolonged but not directly relevant to warfarin effect (warfarin primarily affects PT/INR).
13. A patient with type 2 diabetes mellitus is admitted with hyperglycemic hyperosmolar state
(HHS). Serum glucose is 680 mg/dL, serum osmolality 340 mOsm/kg, and serum sodium 148
mEq/L. The nurse initiates intravenous fluids. Which of the following fluid choices is most
appropriate initially?
A. 0.9% sodium chloride at 250 mL/hr
B. 0.45% sodium chloride at 500 mL/hr
C. Lactated Ringer's solution at 200 mL/hr
D. D5W at 150 mL/hr
Answer: B
Rationale: In HHS, patients have severe hyperosmolality and hypernatremia due to profound
dehydration. Initial fluid resuscitation with 0.45% sodium chloride (half-normal saline) is recommended
to correct hypernatremia and free water deficit. 0.9% saline (A) may exacerbate hypernatremia.
Lactated Ringer's (C) is isotonic and contains lactate, which can be converted to glucose. D5W (D)
provides dextrose, which would worsen hyperglycemia.
Page 4
Format | 180 Authentic Questions with 100% Verified
Answers & Detailed Rationales | A+ Graded
1. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic obstructive
pulmonary disease (COPD). The results are: pH 7.30, PaCO2 58 mm Hg, HCO3- 30 mEq/L.
Which compensatory mechanism is the client's body primarily using?
A. Respiratory alkalosis compensation via renal excretion of bicarbonate
B. Metabolic alkalosis compensation via hypoventilation
C. Metabolic compensation for respiratory acidosis via renal retention of bicarbonate
D. Respiratory compensation for metabolic alkalosis via hyperventilation
Answer: C
Rationale: The ABG shows respiratory acidosis (low pH, high PaCO2) with an elevated HCO3-,
indicating metabolic compensation. The kidneys retain bicarbonate to buffer the acidosis. Option C
correctly identifies this. Options A and D describe opposite conditions; B misidentifies the primary
disorder.
2. A nurse is caring for a client receiving a continuous intravenous infusion of heparin. The client's
activated partial thromboplastin time (aPTT) is 120 seconds (therapeutic range 60-80 seconds).
Which action should the nurse take first?
A. Decrease the heparin infusion rate by 50%
B. Stop the heparin infusion immediately
C. Administer protamine sulfate as ordered
D. Notify the healthcare provider of the aPTT result
Answer: B
Rationale: An aPTT of 120 seconds indicates supratherapeutic anticoagulation and high bleeding risk.
The priority is to stop the infusion to prevent hemorrhage. Decreasing the rate (A) may not be sufficient;
protamine (C) is an antidote but requires a provider order and is not the first action; notifying (D) is
important but secondary to stopping the infusion.
3. A nurse is assessing a client who has just returned from a cardiac catheterization via the right
femoral artery. Which finding requires immediate intervention?
A. Blood pressure 110/70 mm Hg, heart rate 88/min
B. Right pedal pulse 1+ and capillary refill 3 seconds
C. Small amount of serosanguinous drainage on the groin dressing
D. Client reports feeling warm and flushed
Answer: B
Rationale: A diminished pedal pulse (1+) and prolonged capillary refill (3 seconds) on the affected
extremity suggest arterial compromise, possibly due to a hematoma or thrombus. This requires
Page 1
,immediate intervention to prevent limb ischemia. Option A is within normal limits; C is expected; D is a
common reaction to contrast dye.
4. A nurse is providing discharge teaching to a client prescribed warfarin. Which statement by the
client indicates an understanding of dietary precautions?
A. I will increase my intake of green leafy vegetables to prevent anemia.
B. I should avoid foods high in vitamin K, such as broccoli and spinach.
C. I can take ibuprofen if I have mild pain.
D. I will use a soft toothbrush and electric razor.
Answer: B
Rationale: Warfarin is a vitamin K antagonist; consistent intake of vitamin K-rich foods can alter INR.
Clients should maintain a consistent intake, but avoiding high vitamin K foods is often advised to
prevent fluctuations. Option A would increase vitamin K; C increases bleeding risk; D is about safety
but not dietary.
5. A nurse is evaluating a client's understanding of insulin administration. The client uses a
mixture of NPH and regular insulin. Which action by the client indicates correct technique?
A. Draws up the regular insulin first, then the NPH insulin into the same syringe
B. Draws up the NPH insulin first, then the regular insulin into the same syringe
C. Shakes the NPH insulin vigorously before drawing it up
D. Administers the mixture subcutaneously into the deltoid muscle
Answer: A
Rationale: When mixing insulins, regular (clear) should be drawn first to avoid contaminating the vial
with NPH (cloudy). Option A is correct. Option B reverses the order, which can lead to inaccurate
dosing. Shaking (C) can froth the insulin, altering absorption; deltoid (D) is not a preferred site for
insulin.
6. A nurse is caring for a client with heart failure who is receiving furosemide 40 mg IV push.
Which laboratory value requires immediate notification of the healthcare provider?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 138 mEq/L
C. Serum creatinine 0.9 mg/dL
D. Serum magnesium 2.0 mg/dL
Answer: A
Rationale: Furosemide is a loop diuretic that can cause hypokalemia. A potassium of 3.2 mEq/L is below
normal (3.5-5.0) and increases the risk of cardiac dysrhythmias, especially in heart failure. The nurse
should report this immediately. Options B, C, and D are within normal limits.
7. A nurse is assessing a client who has a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse take?
A. Clamp the chest tube near the insertion site
B. Increase the suction pressure
Page 2
,C. Check the drainage system for an air leak
D. Milk the tubing to dislodge any clots
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak, either from the system
or from the patient. The nurse should first check for a leak in the system (e.g., loose connections).
Clamping (A) is dangerous; increasing suction (B) may worsen a leak; milking (D) is not indicated.
8. A nurse is preparing to administer a blood transfusion to a client. Which action is most
important to prevent a transfusion reaction?
A. Verify the client's identity using two identifiers
B. Check the blood product against the client's medical record
C. Start the transfusion slowly at 2 mL/min for the first 15 minutes
D. Obtain baseline vital signs before starting the transfusion
Answer: A
Rationale: The most critical step to prevent a transfusion reaction is verifying the correct patient and
blood product using two identifiers (e.g., name and date of birth) to avoid ABO incompatibility. While
all options are important, patient identification is the primary safeguard. Option C is a safety measure
but not the most important.
9. A nurse is caring for a client who is 2 hours post-operative following a transurethral resection of
the prostate (TURP). The client has a three-way indwelling urinary catheter with continuous
bladder irrigation. Which finding requires immediate action?
A. Urine output 800 mL in 2 hours
B. Bright red urine with multiple clots
C. Catheter traction applied to the thigh
D. Client reports mild suprapubic discomfort
Answer: B
Rationale: Bright red urine with multiple clots indicates active bleeding, which can obstruct the catheter
and lead to clot retention. This requires immediate intervention such as increasing irrigation rate or
notifying the surgeon. Option A is expected with irrigation; C is a standard post-TURP intervention; D
is common but not emergent.
10. A nurse is assessing a client who has been on long-term corticosteroid therapy. Which finding is
most indicative of Cushing's syndrome?
A. Hyperpigmentation of the skin
B. Weight loss and muscle wasting
C. Moon face and buffalo hump
D. Hypotension and bradycardia
Answer: C
Rationale: Long-term corticosteroid use can cause iatrogenic Cushing's syndrome, characterized by
moon face, buffalo hump, central obesity, and striae. Option C is classic. Hyperpigmentation (A) is seen
in Addison's disease; weight loss (B) is not typical; hypotension (D) is not a feature of Cushing's.
Page 3
, 11. A patient with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia (K+ 6.2
mEq/L) and metabolic acidosis (pH 7.28, HCO3- 16 mEq/L). The provider orders intravenous
sodium bicarbonate. Which of the following additional findings would most strongly
contraindicate the administration of sodium bicarbonate in this patient?
A. Serum calcium level of 8.0 mg/dL (ionized calcium 1.0 mmol/L)
B. Serum phosphorus level of 6.5 mg/dL
C. Serum albumin level of 2.8 g/dL
D. Serum magnesium level of 2.5 mg/dL
Answer: A
Rationale: Sodium bicarbonate administration can precipitate hypocalcemic tetany by increasing calcium
binding to albumin and reducing ionized calcium. In CKD, hypocalcemia is common due to phosphate
retention and vitamin D deficiency. The low ionized calcium (1.0 mmol/L) indicates significant
hypocalcemia, making bicarbonate risky. Hyperphosphatemia (B) is common but not a direct
contraindication. Hypoalbuminemia (C) affects total calcium but not ionized calcium directly.
Hypermagnesemia (D) is not acutely worsened by bicarbonate.
12. A nurse is reviewing the medication administration record of a patient receiving warfarin for
atrial fibrillation. The patient's INR is 3.8. Which of the following findings would most likely
require immediate discontinuation of warfarin and administration of phytonadione?
A. Presence of microscopic hematuria on urinalysis
B. Development of a large, painful hematoma on the thigh after minor trauma
C. Platelet count of 150,000/mm³
D. Activated partial thromboplastin time (aPTT) of 45 seconds
Answer: B
Rationale: A large, painful hematoma suggests significant bleeding into muscle tissue, which is a serious
adverse effect of warfarin over-anticoagulation (INR 3.8 is above therapeutic range of 2-3). This
requires immediate reversal with phytonadione (vitamin K). Microscopic hematuria (A) is common and
may not require reversal if transient. Platelet count of 150,000 (C) is normal. aPTT of 45 seconds (D) is
slightly prolonged but not directly relevant to warfarin effect (warfarin primarily affects PT/INR).
13. A patient with type 2 diabetes mellitus is admitted with hyperglycemic hyperosmolar state
(HHS). Serum glucose is 680 mg/dL, serum osmolality 340 mOsm/kg, and serum sodium 148
mEq/L. The nurse initiates intravenous fluids. Which of the following fluid choices is most
appropriate initially?
A. 0.9% sodium chloride at 250 mL/hr
B. 0.45% sodium chloride at 500 mL/hr
C. Lactated Ringer's solution at 200 mL/hr
D. D5W at 150 mL/hr
Answer: B
Rationale: In HHS, patients have severe hyperosmolality and hypernatremia due to profound
dehydration. Initial fluid resuscitation with 0.45% sodium chloride (half-normal saline) is recommended
to correct hypernatremia and free water deficit. 0.9% saline (A) may exacerbate hypernatremia.
Lactated Ringer's (C) is isotonic and contains lactate, which can be converted to glucose. D5W (D)
provides dextrose, which would worsen hyperglycemia.
Page 4
