ATI/NCLEX Comprehensive Exit Practice Exam
Questions And Answers with Rationales-
2026
Question 1 – Adult Medical-Surgical Nursing
A nurse is caring for a client admitted with acute heart failure. Which assessment finding requires
immediate intervention?
A. Bilateral ankle edema
B. Blood pressure 150/88 mm Hg
C. Crackles throughout both lung fields with oxygen saturation of 86%
D. Weight gain of 1 kg (2.2 lb) over 24 hours
Answer: C
Rationale: Crackles with an SpO₂ of 86% indicate impaired oxygenation from pulmonary edema.
Maintaining airway and breathing is the priority.
Question 2 – Pharmacology
A nurse prepares to administer digoxin. Which finding requires withholding the medication?
A. Apical pulse 54/min
B. Potassium 4.2 mEq/L
C. Blood pressure 128/76 mm Hg
D. Respiratory rate 18/min
Answer: A
Rationale: Digoxin can further slow the heart rate. An apical pulse below 60/min should be reported
before administration.
Question 3 – Fundamentals
Which client should the nurse assess first?
A. Client with postoperative pain rated 8/10
B. Client with asthma who has diminished breath sounds and increasing anxiety
C. Client requesting assistance to the bathroom
D. Client with diabetes awaiting breakfast
Answer: B
Rationale: Diminished breath sounds and anxiety suggest worsening airway obstruction. Airway
takes priority.
,Question 4 – Infection Control
Which disease requires airborne precautions?
A. Influenza
B. Clostridioides difficile
C. Tuberculosis
D. MRSA wound infection
Answer: C
Rationale:
Airborne: Tuberculosis, measles, varicella.
Droplet: Influenza.
Contact: C. difficile and MRSA.
Question 5 – Electrolytes
A client has a serum potassium level of 2.9 mEq/L. Which assessment finding is expected?
A. Peaked T waves
B. Muscle weakness
C. Hyperactive bowel sounds
D. Bradycardia with hypertension
Answer: B
Rationale: Hypokalemia commonly causes muscle weakness, fatigue, constipation, and cardiac
dysrhythmias.
Question 6 – Diabetes
A conscious client has a blood glucose level of 52 mg/dL. What should the nurse do first?
A. Administer glucagon IM.
B. Give 15 g of fast-acting carbohydrates.
C. Start an IV infusion of dextrose.
D. Notify the provider.
Answer: B
Rationale: A conscious client who can swallow should receive 15 g of fast-acting carbohydrates, with
glucose rechecked after 15 minutes.
Question 7 – Pharmacology
A client receiving IV heparin develops bleeding gums. Which medication is the antidote?
,A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Acetylcysteine
Answer: B
Rationale:
Heparin → Protamine sulfate
Warfarin → Vitamin K
Opioids → Naloxone
Acetaminophen → Acetylcysteine
Question 8 – Cardiovascular
Which finding indicates effective treatment for a client receiving furosemide for heart failure?
A. Increased jugular vein distention
B. Decreased crackles on lung auscultation
C. Increased peripheral edema
D. Weight gain of 2 kg
Answer: B
Rationale: Improvement in lung sounds indicates reduced pulmonary fluid overload.
Question 9 – Prioritization
The nurse receives report on four clients. Which client should be assessed first?
A. Client with COPD whose oxygen saturation is 88% on prescribed oxygen
B. Client with chest pain rated 9/10 and diaphoresis
C. Client with chronic kidney disease awaiting dialysis
D. Client requesting pain medication after surgery
Answer: B
Rationale: Chest pain with diaphoresis may indicate an acute myocardial infarction and requires
immediate assessment.
Question 10 – NGN Case Study
A client admitted with pneumonia has:
Temperature: 39.1°C (102.4°F)
Respiratory rate: 32/min
, Heart rate: 118/min
Blood pressure: 88/54 mm Hg
SpO₂: 89% on room air
Which provider prescription should the nurse implement first?
A. Obtain blood cultures.
B. Administer IV broad-spectrum antibiotics.
C. Begin oxygen therapy.
D. Administer acetaminophen.
Answer: C
Rationale: Although cultures and antibiotics are important, the client is hypoxemic. Following the
ABCs, oxygenation is the priority intervention.
Question 11 – SATA: Heart Failure
A nurse is caring for a client with worsening heart failure. Which findings are consistent with fluid
volume overload? (Select all that apply.)
A. Jugular vein distention
B. Bilateral crackles in the lungs
C. Dry mucous membranes
D. Pitting edema of the lower extremities
E. Sudden weight gain of 2 kg (4.4 lb) in 2 days
F. Hypotension from dehydration
Answer: A, B, D, E
Rationale:
A: Increased venous pressure causes jugular vein distention.
B: Fluid backs up into the lungs, producing crackles.
D: Peripheral edema is common.
E: Rapid weight gain reflects fluid retention.
C and F suggest dehydration rather than fluid overload.
Question 12 – Pharmacology
A client taking furosemide reports muscle cramps and weakness. Which laboratory result should the
nurse expect?
A. Potassium 2.8 mEq/L
B. Sodium 150 mEq/L
C. Calcium 11.2 mg/dL
D. Magnesium 3.0 mg/dL
Answer: A
Questions And Answers with Rationales-
2026
Question 1 – Adult Medical-Surgical Nursing
A nurse is caring for a client admitted with acute heart failure. Which assessment finding requires
immediate intervention?
A. Bilateral ankle edema
B. Blood pressure 150/88 mm Hg
C. Crackles throughout both lung fields with oxygen saturation of 86%
D. Weight gain of 1 kg (2.2 lb) over 24 hours
Answer: C
Rationale: Crackles with an SpO₂ of 86% indicate impaired oxygenation from pulmonary edema.
Maintaining airway and breathing is the priority.
Question 2 – Pharmacology
A nurse prepares to administer digoxin. Which finding requires withholding the medication?
A. Apical pulse 54/min
B. Potassium 4.2 mEq/L
C. Blood pressure 128/76 mm Hg
D. Respiratory rate 18/min
Answer: A
Rationale: Digoxin can further slow the heart rate. An apical pulse below 60/min should be reported
before administration.
Question 3 – Fundamentals
Which client should the nurse assess first?
A. Client with postoperative pain rated 8/10
B. Client with asthma who has diminished breath sounds and increasing anxiety
C. Client requesting assistance to the bathroom
D. Client with diabetes awaiting breakfast
Answer: B
Rationale: Diminished breath sounds and anxiety suggest worsening airway obstruction. Airway
takes priority.
,Question 4 – Infection Control
Which disease requires airborne precautions?
A. Influenza
B. Clostridioides difficile
C. Tuberculosis
D. MRSA wound infection
Answer: C
Rationale:
Airborne: Tuberculosis, measles, varicella.
Droplet: Influenza.
Contact: C. difficile and MRSA.
Question 5 – Electrolytes
A client has a serum potassium level of 2.9 mEq/L. Which assessment finding is expected?
A. Peaked T waves
B. Muscle weakness
C. Hyperactive bowel sounds
D. Bradycardia with hypertension
Answer: B
Rationale: Hypokalemia commonly causes muscle weakness, fatigue, constipation, and cardiac
dysrhythmias.
Question 6 – Diabetes
A conscious client has a blood glucose level of 52 mg/dL. What should the nurse do first?
A. Administer glucagon IM.
B. Give 15 g of fast-acting carbohydrates.
C. Start an IV infusion of dextrose.
D. Notify the provider.
Answer: B
Rationale: A conscious client who can swallow should receive 15 g of fast-acting carbohydrates, with
glucose rechecked after 15 minutes.
Question 7 – Pharmacology
A client receiving IV heparin develops bleeding gums. Which medication is the antidote?
,A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Acetylcysteine
Answer: B
Rationale:
Heparin → Protamine sulfate
Warfarin → Vitamin K
Opioids → Naloxone
Acetaminophen → Acetylcysteine
Question 8 – Cardiovascular
Which finding indicates effective treatment for a client receiving furosemide for heart failure?
A. Increased jugular vein distention
B. Decreased crackles on lung auscultation
C. Increased peripheral edema
D. Weight gain of 2 kg
Answer: B
Rationale: Improvement in lung sounds indicates reduced pulmonary fluid overload.
Question 9 – Prioritization
The nurse receives report on four clients. Which client should be assessed first?
A. Client with COPD whose oxygen saturation is 88% on prescribed oxygen
B. Client with chest pain rated 9/10 and diaphoresis
C. Client with chronic kidney disease awaiting dialysis
D. Client requesting pain medication after surgery
Answer: B
Rationale: Chest pain with diaphoresis may indicate an acute myocardial infarction and requires
immediate assessment.
Question 10 – NGN Case Study
A client admitted with pneumonia has:
Temperature: 39.1°C (102.4°F)
Respiratory rate: 32/min
, Heart rate: 118/min
Blood pressure: 88/54 mm Hg
SpO₂: 89% on room air
Which provider prescription should the nurse implement first?
A. Obtain blood cultures.
B. Administer IV broad-spectrum antibiotics.
C. Begin oxygen therapy.
D. Administer acetaminophen.
Answer: C
Rationale: Although cultures and antibiotics are important, the client is hypoxemic. Following the
ABCs, oxygenation is the priority intervention.
Question 11 – SATA: Heart Failure
A nurse is caring for a client with worsening heart failure. Which findings are consistent with fluid
volume overload? (Select all that apply.)
A. Jugular vein distention
B. Bilateral crackles in the lungs
C. Dry mucous membranes
D. Pitting edema of the lower extremities
E. Sudden weight gain of 2 kg (4.4 lb) in 2 days
F. Hypotension from dehydration
Answer: A, B, D, E
Rationale:
A: Increased venous pressure causes jugular vein distention.
B: Fluid backs up into the lungs, producing crackles.
D: Peripheral edema is common.
E: Rapid weight gain reflects fluid retention.
C and F suggest dehydration rather than fluid overload.
Question 12 – Pharmacology
A client taking furosemide reports muscle cramps and weakness. Which laboratory result should the
nurse expect?
A. Potassium 2.8 mEq/L
B. Sodium 150 mEq/L
C. Calcium 11.2 mg/dL
D. Magnesium 3.0 mg/dL
Answer: A
