NGN ATI Comprehensive Exit Retake Exam Test Bank
Versions 1–4 | NCLEX Prep Guide (2026/2027)
Section 1: Pharmacology & Medication Administration
Q1: A nurse is caring for a client receiving IV furosemide for heart
failure. Which of the following findings indicates the client is
experiencing an adverse effect of this medication? Select all that apply.
A) Serum potassium 3.1 mEq/L
B) Bilateral crackles in the lung bases
C) Presence of a S3 heart sound
D) Muscle weakness and cramping
E) Serum potassium 5.4 mEq/L
CORRECT ANSWER>: A, D.
Rationale: Furosemide is a loop diuretic that wastes potassium. A serum
potassium of 3.1 mEq/L (normal 3.5-5.0) and muscle
weakness/cramping are classic signs of hypokalemia. Bilateral crackles
and an S3 heart sound indicate worsening heart failure (therapeutic
failure), not an adverse effect of the drug.
Q2: A client is prescribed enoxaparin following a total knee arthroplasty.
The nurse understands that the antidote for this medication is which of
the following?
A) Vitamin K
,B) Protamine sulfate
C) Acetylcysteine
D) Flumazenil
CORRECT ANSWER>: B) Protamine sulfate.
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH). The
specific antidote for heparin and LMWH is protamine sulfate. Vitamin K
reverses warfarin; acetylcysteine reverses acetaminophen; flumazenil
reverses benzodiazepines.
Q3: A nurse is preparing to administer digoxin to a client with atrial
fibrillation. The client's apical heart rate is 52/min. Which of the
following actions should the nurse take first?
A) Administer the medication and reassess the heart rate in 30 minutes.
B) Withhold the medication and notify the provider.
C) Administer a 500 mL IV fluid bolus.
D) Document the finding and continue with the routine medication
pass.
CORRECT ANSWER>: B) Withhold the medication and notify the
provider.
Rationale: Digoxin causes a decrease in heart rate. If the apical pulse is
less than 60 bpm, the nurse must withhold the medication and notify
the provider to prevent digoxin toxicity and severe bradycardia.
,Q4: A client taking lisinopril for hypertension develops a persistent dry
cough. The nurse should identify that this finding is caused by which of
the following mechanisms?
A) Histamine release in the bronchi
B) Increased bradykinin levels
C) Bronchospasm due to beta-2 blockade
D) Fluid overload in the pulmonary vasculature
CORRECT ANSWER>: B) Increased bradykinin levels.
Rationale: ACE inhibitors like lisinopril block the breakdown of
bradykinin. The accumulation of bradykinin in the lungs causes a
persistent, non-productive dry cough. The provider should be notified
to switch the client to an ARB, which does not cause bradykinin
accumulation.
Q5: Which of the following clients should the nurse assess first after
receiving morning shift report?
A) A client receiving gentamicin with a BUN of 24 mg/dL.
B) A client receiving lithium with a lithium level of 1.2 mEq/L.
C) A client receiving amphotericin B with a potassium of 3.0 mEq/L.
D) A client receiving warfarin with an INR of 2.5.
CORRECT ANSWER>: C) A client receiving amphotericin B with a
potassium of 3.0 mEq/L.
, Rationale: Using the ABC and acute vs. chronic framework, a potassium
of 3.0 mEq/L (severe hypokalemia) places the client at high risk for life-
threatening cardiac dysrhythmias. Amphotericin B is highly nephrotoxic
and causes severe electrolyte wasting. This client requires immediate
assessment and intervention. (Lithium 1.2 is therapeutic; INR 2.5 is
therapeutic; BUN 24 is slightly elevated but requires monitoring, not
immediate intervention).
Section 2: Medical-Surgical & Adult Health
Q6: A nurse is caring for a client with a chest tube connected to a water-
seal drainage system. The nurse notes constant bubbling in the water-
seal chamber. Which of the following is the correct nursing action?
A) Clamp the chest tube immediately.
B) Check the system for an air leak.
C) Document the finding as expected.
D) Add more water to the suction control chamber.
CORRECT ANSWER>: B) Check the system for an air leak.
Rationale: Intermittent bubbling in the water-seal chamber is expected
as air is evacuated from the pleural space. However, continuous
bubbling indicates an air leak in the system (e.g., a loose connection or
a crack in the tubing). The nurse must assess and tighten connections.
Versions 1–4 | NCLEX Prep Guide (2026/2027)
Section 1: Pharmacology & Medication Administration
Q1: A nurse is caring for a client receiving IV furosemide for heart
failure. Which of the following findings indicates the client is
experiencing an adverse effect of this medication? Select all that apply.
A) Serum potassium 3.1 mEq/L
B) Bilateral crackles in the lung bases
C) Presence of a S3 heart sound
D) Muscle weakness and cramping
E) Serum potassium 5.4 mEq/L
CORRECT ANSWER>: A, D.
Rationale: Furosemide is a loop diuretic that wastes potassium. A serum
potassium of 3.1 mEq/L (normal 3.5-5.0) and muscle
weakness/cramping are classic signs of hypokalemia. Bilateral crackles
and an S3 heart sound indicate worsening heart failure (therapeutic
failure), not an adverse effect of the drug.
Q2: A client is prescribed enoxaparin following a total knee arthroplasty.
The nurse understands that the antidote for this medication is which of
the following?
A) Vitamin K
,B) Protamine sulfate
C) Acetylcysteine
D) Flumazenil
CORRECT ANSWER>: B) Protamine sulfate.
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH). The
specific antidote for heparin and LMWH is protamine sulfate. Vitamin K
reverses warfarin; acetylcysteine reverses acetaminophen; flumazenil
reverses benzodiazepines.
Q3: A nurse is preparing to administer digoxin to a client with atrial
fibrillation. The client's apical heart rate is 52/min. Which of the
following actions should the nurse take first?
A) Administer the medication and reassess the heart rate in 30 minutes.
B) Withhold the medication and notify the provider.
C) Administer a 500 mL IV fluid bolus.
D) Document the finding and continue with the routine medication
pass.
CORRECT ANSWER>: B) Withhold the medication and notify the
provider.
Rationale: Digoxin causes a decrease in heart rate. If the apical pulse is
less than 60 bpm, the nurse must withhold the medication and notify
the provider to prevent digoxin toxicity and severe bradycardia.
,Q4: A client taking lisinopril for hypertension develops a persistent dry
cough. The nurse should identify that this finding is caused by which of
the following mechanisms?
A) Histamine release in the bronchi
B) Increased bradykinin levels
C) Bronchospasm due to beta-2 blockade
D) Fluid overload in the pulmonary vasculature
CORRECT ANSWER>: B) Increased bradykinin levels.
Rationale: ACE inhibitors like lisinopril block the breakdown of
bradykinin. The accumulation of bradykinin in the lungs causes a
persistent, non-productive dry cough. The provider should be notified
to switch the client to an ARB, which does not cause bradykinin
accumulation.
Q5: Which of the following clients should the nurse assess first after
receiving morning shift report?
A) A client receiving gentamicin with a BUN of 24 mg/dL.
B) A client receiving lithium with a lithium level of 1.2 mEq/L.
C) A client receiving amphotericin B with a potassium of 3.0 mEq/L.
D) A client receiving warfarin with an INR of 2.5.
CORRECT ANSWER>: C) A client receiving amphotericin B with a
potassium of 3.0 mEq/L.
, Rationale: Using the ABC and acute vs. chronic framework, a potassium
of 3.0 mEq/L (severe hypokalemia) places the client at high risk for life-
threatening cardiac dysrhythmias. Amphotericin B is highly nephrotoxic
and causes severe electrolyte wasting. This client requires immediate
assessment and intervention. (Lithium 1.2 is therapeutic; INR 2.5 is
therapeutic; BUN 24 is slightly elevated but requires monitoring, not
immediate intervention).
Section 2: Medical-Surgical & Adult Health
Q6: A nurse is caring for a client with a chest tube connected to a water-
seal drainage system. The nurse notes constant bubbling in the water-
seal chamber. Which of the following is the correct nursing action?
A) Clamp the chest tube immediately.
B) Check the system for an air leak.
C) Document the finding as expected.
D) Add more water to the suction control chamber.
CORRECT ANSWER>: B) Check the system for an air leak.
Rationale: Intermittent bubbling in the water-seal chamber is expected
as air is evacuated from the pleural space. However, continuous
bubbling indicates an air leak in the system (e.g., a loose connection or
a crack in the tubing). The nurse must assess and tighten connections.
