ATI Fundamentals Proctored Exam 2026 | Complete
Study Guide & Answers
1. A nurse is preparing to administer a medication via nasogastric tube. Which action best
ensures accurate dosing and prevents tube occlusion?
A. Crush a sustained-release tablet and mix with 30 mL sterile water.
B. Administer each medication separately and flush with 15 mL water between each.
C. Mix all crushed medications together in 60 mL of warm water.
D. Use the plunger of the syringe to push medication through the tube rapidly.
Answer: B
Rationale: Administering each medication separately with a water flush prevents drug-drug
interactions and tube clogging. Sustained-release tablets should never be crushed (A). Mixing
multiple drugs increases risk of incompatibility (C). Rapid pushing can cause tube rupture or
aspiration (D).
2. A nurse is assessing a patient with chest tubes connected to a dry suction water seal
system. Which finding requires immediate intervention?
A. Intermittent bubbling in the water seal chamber during exhalation.
B. Continuous bubbling in the suction control chamber at -20 cm H2O.
C. Tidaling in the water seal chamber with respirations.
D. No fluctuation in the water seal chamber for 4 hours post-insertion.
Answer: D
Rationale: Absence of fluctuation (tidaling) for 4 hours may indicate a blocked or kinked tube, or
lung re-expansion; but if it persists suddenly, it suggests occlusion or disconnection. Intermittent
bubbling on exhalation (A) is normal air leak. Continuous bubbling in suction chamber (B)
indicates proper suction. Tidaling (C) is expected.
3. A nurse is caring for a patient with a pressure injury on the sacrum. The wound bed is
covered with yellow slough and has moderate serosanguinous drainage. Which dressing
should the nurse select?
A. Hydrocolloid dressing.
B. Alginate dressing.
C. Transparent film dressing.
D. Hydrogel dressing.
Answer: B
Rationale: Alginate dressings are highly absorbent and appropriate for wounds with moderate to
heavy exudate and slough. Hydrocolloid (A) is for light exudate. Transparent film (C) is for dry
wounds or protection. Hydrogel (D) is for dry wounds with slough but not for moderate
Page 1
,drainage.
4. A nurse is teaching a patient with a new colostomy about dietary management. Which
statement by the patient indicates understanding?
A. I will avoid foods like yogurt and buttermilk to prevent odor.
B. I should eat more high-fiber foods like nuts and seeds to thicken stool.
C. I need to chew food thoroughly and eat at regular intervals.
D. I can use a stool softener daily to prevent constipation.
Answer: C
Rationale: Chewing food thoroughly and eating at regular intervals reduces gas and blockage
risk. Yogurt and buttermilk actually help reduce odor (A). High-fiber foods like nuts can cause
blockage (B). Stool softeners are not routinely recommended (D).
5. A nurse is preparing to administer a blood transfusion. The patient's vital signs are: BP
98/60, HR 110, RR 22, temp 37.1°C. Which action should the nurse take first?
A. Start the transfusion slowly at 2 mL/min.
B. Notify the provider of the low blood pressure.
C. Obtain a baseline set of vital signs.
D. Administer 0.9% sodium chloride with the blood.
Answer: C
Rationale: Obtaining baseline vital signs is essential before any transfusion to compare during
and after. Starting the transfusion (A) without baseline is unsafe. The BP is within acceptable
range for transfusion (B is not needed). Saline is used but not the first action (D).
6. A nurse is assessing a patient receiving a continuous IV infusion of heparin. The aPTT is
90 seconds. The infusion rate is 14 units/kg/hr. The patient weighs 70 kg. The available
concentration is 25,000 units in 500 mL D5W. What action should the nurse take?
A. Increase the infusion rate to 18 units/kg/hr.
B. Decrease the infusion rate to 12 units/kg/hr.
C. Continue the current infusion rate.
D. Stop the infusion and notify the provider.
Answer: C
Rationale: The therapeutic aPTT range for heparin is typically 60-100 seconds. An aPTT of 90
seconds is within range, so no rate change is needed. The current rate delivers 14 units/kg/hr,
which is appropriate. Options A, B, and D would cause over- or under-anticoagulation.
7. A nurse is caring for a patient who has a nasogastric tube set to low intermittent suction.
The patient reports nausea and abdominal distention. Which action should the nurse take
first?
A. Irrigate the NG tube with 30 mL of normal saline.
Page 2
,B. Reposition the patient onto their left side.
C. Check the suction canister for proper connection.
D. Advance the NG tube 5 cm and re-secure it.
Answer: C
Rationale: First, verify that suction is functioning properly; a disconnected or malfunctioning
suction can cause distention and nausea. Irrigation (A) may be done after ensuring suction
works. Repositioning (B) may help but is not the first step. Advancing the tube (D) is not
indicated without verification.
8. A nurse is evaluating a patient's ability to use a cane. Which observation indicates
correct technique?
A. The patient holds the cane in the hand opposite the weak leg.
B. The patient advances the cane at the same time as the weak leg.
C. The patient holds the cane in the hand on the same side as the weak leg.
D. The patient uses the cane to bear full weight on the weak leg.
Answer: A
Rationale: The cane should be held in the hand opposite the weak leg to provide a wide base of
support and reduce stress on the weak side. Advancing cane with weak leg (B) is incorrect; the
cane and weak leg move together. Same-side hold (C) reduces stability. Full weight bearing on
cane (D) is unsafe.
9. A nurse is assessing a patient who has a new diagnosis of diabetes mellitus. The patient's
lab results show: HbA1c 9.2%, fasting glucose 180 mg/dL, and urine ketones positive.
Which nursing intervention is most important?
A. Teach the patient to administer insulin based on sliding scale.
B. Instruct the patient to monitor blood glucose at least four times daily.
C. Administer intravenous fluids as prescribed.
D. Refer the patient to a dietitian for medical nutrition therapy.
Answer: C
Rationale: Positive urine ketones and elevated glucose indicate possible diabetic ketoacidosis
(DKA). Immediate priority is to correct dehydration and acidosis with IV fluids. Insulin sliding
scale (A) and glucose monitoring (B) are important but not the first priority. Dietitian referral
(D) is long-term.
10. A nurse is providing discharge teaching to a patient who has a new prescription for
warfarin. Which statement by the patient indicates a need for further teaching?
A. I will use an electric razor for shaving.
B. I should avoid eating large amounts of green leafy vegetables.
C. I will take aspirin if I get a headache.
D. I need to have my blood checked regularly as scheduled.
Page 3
, Answer: C
Rationale: Aspirin increases bleeding risk and should be avoided while on warfarin. Electric
razor (A) reduces bleeding risk. Consistent vitamin K intake (B) is important but not avoidance.
Regular INR monitoring (D) is correct. Taking aspirin without consulting provider is dangerous.
11. A patient with a history of chronic kidney disease (stage 4) is admitted for pneumonia.
The provider orders IV fluids at 125 mL/hr and a single dose of gentamicin. Which finding
requires immediate nursing action?
A. Serum creatinine 2.8 mg/dL
B. Urine output 30 mL/hr
C. Blood urea nitrogen 45 mg/dL
D. Serum potassium 5.1 mEq/L
Answer: A
Rationale: Gentamicin is nephrotoxic and renally excreted. In stage 4 CKD (creatinine >2.0), a
single dose can accumulate, worsening renal function. A creatinine of 2.8 is elevated but stable;
however, the combination with gentamicin demands monitoring. Urine output 30 mL/hr is low
but not critical. BUN 45 and K+ 5.1 are expected in CKD. The key is the drug-disease
interaction; the nurse should question the order and monitor creatinine closely.
12. During a blood transfusion, a patient develops chills, headache, and lower back pain.
Vital signs: BP 90/50, HR 110, temp 38.9°C. After stopping the transfusion, what is the
priority action?
A. Administer antipyretics as ordered
B. Obtain a urine specimen for hemoglobin
C. Start IV normal saline at a keep-vein-open rate
D. Notify the provider and prepare for emergency medications
Answer: B
Rationale: The symptoms (chills, back pain, hypotension, fever) suggest an acute hemolytic
reaction. After stopping the transfusion, the priority is to obtain a urine specimen to check for
hemoglobinuria, which confirms hemolysis. Antipyretics may be given later. IV fluids should be
increased, not KVO. Notifying the provider is important but not the first action; collecting
evidence of hemolysis is critical for diagnosis and management.
13. A nurse is preparing to administer a heparin infusion. The prescription reads:
"Administer heparin 25,000 units in 500 mL D5W at 1000 units/hr." What rate in mL/hr
should the infusion pump be set to?
A. 10 mL/hr
B. 20 mL/hr
C. 25 mL/hr
D. 50 mL/hr
Page 4
Study Guide & Answers
1. A nurse is preparing to administer a medication via nasogastric tube. Which action best
ensures accurate dosing and prevents tube occlusion?
A. Crush a sustained-release tablet and mix with 30 mL sterile water.
B. Administer each medication separately and flush with 15 mL water between each.
C. Mix all crushed medications together in 60 mL of warm water.
D. Use the plunger of the syringe to push medication through the tube rapidly.
Answer: B
Rationale: Administering each medication separately with a water flush prevents drug-drug
interactions and tube clogging. Sustained-release tablets should never be crushed (A). Mixing
multiple drugs increases risk of incompatibility (C). Rapid pushing can cause tube rupture or
aspiration (D).
2. A nurse is assessing a patient with chest tubes connected to a dry suction water seal
system. Which finding requires immediate intervention?
A. Intermittent bubbling in the water seal chamber during exhalation.
B. Continuous bubbling in the suction control chamber at -20 cm H2O.
C. Tidaling in the water seal chamber with respirations.
D. No fluctuation in the water seal chamber for 4 hours post-insertion.
Answer: D
Rationale: Absence of fluctuation (tidaling) for 4 hours may indicate a blocked or kinked tube, or
lung re-expansion; but if it persists suddenly, it suggests occlusion or disconnection. Intermittent
bubbling on exhalation (A) is normal air leak. Continuous bubbling in suction chamber (B)
indicates proper suction. Tidaling (C) is expected.
3. A nurse is caring for a patient with a pressure injury on the sacrum. The wound bed is
covered with yellow slough and has moderate serosanguinous drainage. Which dressing
should the nurse select?
A. Hydrocolloid dressing.
B. Alginate dressing.
C. Transparent film dressing.
D. Hydrogel dressing.
Answer: B
Rationale: Alginate dressings are highly absorbent and appropriate for wounds with moderate to
heavy exudate and slough. Hydrocolloid (A) is for light exudate. Transparent film (C) is for dry
wounds or protection. Hydrogel (D) is for dry wounds with slough but not for moderate
Page 1
,drainage.
4. A nurse is teaching a patient with a new colostomy about dietary management. Which
statement by the patient indicates understanding?
A. I will avoid foods like yogurt and buttermilk to prevent odor.
B. I should eat more high-fiber foods like nuts and seeds to thicken stool.
C. I need to chew food thoroughly and eat at regular intervals.
D. I can use a stool softener daily to prevent constipation.
Answer: C
Rationale: Chewing food thoroughly and eating at regular intervals reduces gas and blockage
risk. Yogurt and buttermilk actually help reduce odor (A). High-fiber foods like nuts can cause
blockage (B). Stool softeners are not routinely recommended (D).
5. A nurse is preparing to administer a blood transfusion. The patient's vital signs are: BP
98/60, HR 110, RR 22, temp 37.1°C. Which action should the nurse take first?
A. Start the transfusion slowly at 2 mL/min.
B. Notify the provider of the low blood pressure.
C. Obtain a baseline set of vital signs.
D. Administer 0.9% sodium chloride with the blood.
Answer: C
Rationale: Obtaining baseline vital signs is essential before any transfusion to compare during
and after. Starting the transfusion (A) without baseline is unsafe. The BP is within acceptable
range for transfusion (B is not needed). Saline is used but not the first action (D).
6. A nurse is assessing a patient receiving a continuous IV infusion of heparin. The aPTT is
90 seconds. The infusion rate is 14 units/kg/hr. The patient weighs 70 kg. The available
concentration is 25,000 units in 500 mL D5W. What action should the nurse take?
A. Increase the infusion rate to 18 units/kg/hr.
B. Decrease the infusion rate to 12 units/kg/hr.
C. Continue the current infusion rate.
D. Stop the infusion and notify the provider.
Answer: C
Rationale: The therapeutic aPTT range for heparin is typically 60-100 seconds. An aPTT of 90
seconds is within range, so no rate change is needed. The current rate delivers 14 units/kg/hr,
which is appropriate. Options A, B, and D would cause over- or under-anticoagulation.
7. A nurse is caring for a patient who has a nasogastric tube set to low intermittent suction.
The patient reports nausea and abdominal distention. Which action should the nurse take
first?
A. Irrigate the NG tube with 30 mL of normal saline.
Page 2
,B. Reposition the patient onto their left side.
C. Check the suction canister for proper connection.
D. Advance the NG tube 5 cm and re-secure it.
Answer: C
Rationale: First, verify that suction is functioning properly; a disconnected or malfunctioning
suction can cause distention and nausea. Irrigation (A) may be done after ensuring suction
works. Repositioning (B) may help but is not the first step. Advancing the tube (D) is not
indicated without verification.
8. A nurse is evaluating a patient's ability to use a cane. Which observation indicates
correct technique?
A. The patient holds the cane in the hand opposite the weak leg.
B. The patient advances the cane at the same time as the weak leg.
C. The patient holds the cane in the hand on the same side as the weak leg.
D. The patient uses the cane to bear full weight on the weak leg.
Answer: A
Rationale: The cane should be held in the hand opposite the weak leg to provide a wide base of
support and reduce stress on the weak side. Advancing cane with weak leg (B) is incorrect; the
cane and weak leg move together. Same-side hold (C) reduces stability. Full weight bearing on
cane (D) is unsafe.
9. A nurse is assessing a patient who has a new diagnosis of diabetes mellitus. The patient's
lab results show: HbA1c 9.2%, fasting glucose 180 mg/dL, and urine ketones positive.
Which nursing intervention is most important?
A. Teach the patient to administer insulin based on sliding scale.
B. Instruct the patient to monitor blood glucose at least four times daily.
C. Administer intravenous fluids as prescribed.
D. Refer the patient to a dietitian for medical nutrition therapy.
Answer: C
Rationale: Positive urine ketones and elevated glucose indicate possible diabetic ketoacidosis
(DKA). Immediate priority is to correct dehydration and acidosis with IV fluids. Insulin sliding
scale (A) and glucose monitoring (B) are important but not the first priority. Dietitian referral
(D) is long-term.
10. A nurse is providing discharge teaching to a patient who has a new prescription for
warfarin. Which statement by the patient indicates a need for further teaching?
A. I will use an electric razor for shaving.
B. I should avoid eating large amounts of green leafy vegetables.
C. I will take aspirin if I get a headache.
D. I need to have my blood checked regularly as scheduled.
Page 3
, Answer: C
Rationale: Aspirin increases bleeding risk and should be avoided while on warfarin. Electric
razor (A) reduces bleeding risk. Consistent vitamin K intake (B) is important but not avoidance.
Regular INR monitoring (D) is correct. Taking aspirin without consulting provider is dangerous.
11. A patient with a history of chronic kidney disease (stage 4) is admitted for pneumonia.
The provider orders IV fluids at 125 mL/hr and a single dose of gentamicin. Which finding
requires immediate nursing action?
A. Serum creatinine 2.8 mg/dL
B. Urine output 30 mL/hr
C. Blood urea nitrogen 45 mg/dL
D. Serum potassium 5.1 mEq/L
Answer: A
Rationale: Gentamicin is nephrotoxic and renally excreted. In stage 4 CKD (creatinine >2.0), a
single dose can accumulate, worsening renal function. A creatinine of 2.8 is elevated but stable;
however, the combination with gentamicin demands monitoring. Urine output 30 mL/hr is low
but not critical. BUN 45 and K+ 5.1 are expected in CKD. The key is the drug-disease
interaction; the nurse should question the order and monitor creatinine closely.
12. During a blood transfusion, a patient develops chills, headache, and lower back pain.
Vital signs: BP 90/50, HR 110, temp 38.9°C. After stopping the transfusion, what is the
priority action?
A. Administer antipyretics as ordered
B. Obtain a urine specimen for hemoglobin
C. Start IV normal saline at a keep-vein-open rate
D. Notify the provider and prepare for emergency medications
Answer: B
Rationale: The symptoms (chills, back pain, hypotension, fever) suggest an acute hemolytic
reaction. After stopping the transfusion, the priority is to obtain a urine specimen to check for
hemoglobinuria, which confirms hemolysis. Antipyretics may be given later. IV fluids should be
increased, not KVO. Notifying the provider is important but not the first action; collecting
evidence of hemolysis is critical for diagnosis and management.
13. A nurse is preparing to administer a heparin infusion. The prescription reads:
"Administer heparin 25,000 units in 500 mL D5W at 1000 units/hr." What rate in mL/hr
should the infusion pump be set to?
A. 10 mL/hr
B. 20 mL/hr
C. 25 mL/hr
D. 50 mL/hr
Page 4
