ATI RN COMPREHENSIVE EXIT EXAM -
ADVANCED NURSING CONCEPTS
1. A nurse is caring for a client who has developed cardiac tamponade. Which of the following
findings should the nurse expect?
A. Widening pulse pressure
B. Pulsus paradoxus
C. Bradycardia
D. Flattened neck veins
Answer: B
Conceptual Explanation: Pulsus paradoxus (a drop in systolic blood pressure > 10 mmHg
during inspiration) is a hallmark sign of cardiac tamponade, along with Beck’s Triad:
hypotension, jugular venous distention, and muffled heart sounds.
2. A nurse is managing a client with a chest tube. The nurse notes continuous bubbling in the
water seal chamber. Which action should the nurse take first?
A. Increase the suction pressure
B. Notify the provider immediately
C. Check the system for an air leak
,D. Document the finding as normal
Answer: C
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak. The nurse should first assess the system and the client to locate the source before
notifying the provider.
3. A client is receiving magnesium sulfate for preeclampsia. Which of the following findings is
the priority to report to the provider?
A. Serum magnesium level of 6 mEq/L
B. Urinary output of 40 mL/hr
C. Absent patellar reflexes
D. Respiratory rate of 10/min
Answer: D
Conceptual Explanation: While absent reflexes are a sign of toxicity, a respiratory rate of
10/min indicates severe respiratory depression, which is life-threatening and the highest
priority (ABC assessment).
4. A nurse is teaching a client with new-onset Type 1 Diabetes Mellitus about the Somogyi
effect. Which of the following information should the nurse include?
A. It is a swing to high blood glucose in the morning after a hypoglycemic episode at night.
B. It is a result of excessive carbohydrate intake before bedtime.
, C. It is characterized by hyperglycemia in the morning caused by a rise in growth hormone.
D. It requires an increase in the evening NPH insulin dose.
Answer: A
Conceptual Explanation: The Somogyi effect is rebound hyperglycemia following an
untreated episode of hypoglycemia during sleep. Management usually involves decreasing
the evening insulin dose or having a bedtime snack.
5. A nurse is assessing a client with Cushing’s Syndrome. Which of the following laboratory
findings is expected?
A. Hypernatremia
B. Hyperkalemia
C. Hypoglycemia
D. Hypotension
Answer: A
Conceptual Explanation: Cushing’s syndrome involves excessive cortisol, leading to
hypernatremia, hypokalemia, and hyperglycemia due to mineralocorticoid and
glucocorticoid effects.
6. Which of the following interventions is most appropriate for a client in the manic phase of
Bipolar Disorder?
A. Encourage participation in a group volleyball game
ADVANCED NURSING CONCEPTS
1. A nurse is caring for a client who has developed cardiac tamponade. Which of the following
findings should the nurse expect?
A. Widening pulse pressure
B. Pulsus paradoxus
C. Bradycardia
D. Flattened neck veins
Answer: B
Conceptual Explanation: Pulsus paradoxus (a drop in systolic blood pressure > 10 mmHg
during inspiration) is a hallmark sign of cardiac tamponade, along with Beck’s Triad:
hypotension, jugular venous distention, and muffled heart sounds.
2. A nurse is managing a client with a chest tube. The nurse notes continuous bubbling in the
water seal chamber. Which action should the nurse take first?
A. Increase the suction pressure
B. Notify the provider immediately
C. Check the system for an air leak
,D. Document the finding as normal
Answer: C
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak. The nurse should first assess the system and the client to locate the source before
notifying the provider.
3. A client is receiving magnesium sulfate for preeclampsia. Which of the following findings is
the priority to report to the provider?
A. Serum magnesium level of 6 mEq/L
B. Urinary output of 40 mL/hr
C. Absent patellar reflexes
D. Respiratory rate of 10/min
Answer: D
Conceptual Explanation: While absent reflexes are a sign of toxicity, a respiratory rate of
10/min indicates severe respiratory depression, which is life-threatening and the highest
priority (ABC assessment).
4. A nurse is teaching a client with new-onset Type 1 Diabetes Mellitus about the Somogyi
effect. Which of the following information should the nurse include?
A. It is a swing to high blood glucose in the morning after a hypoglycemic episode at night.
B. It is a result of excessive carbohydrate intake before bedtime.
, C. It is characterized by hyperglycemia in the morning caused by a rise in growth hormone.
D. It requires an increase in the evening NPH insulin dose.
Answer: A
Conceptual Explanation: The Somogyi effect is rebound hyperglycemia following an
untreated episode of hypoglycemia during sleep. Management usually involves decreasing
the evening insulin dose or having a bedtime snack.
5. A nurse is assessing a client with Cushing’s Syndrome. Which of the following laboratory
findings is expected?
A. Hypernatremia
B. Hyperkalemia
C. Hypoglycemia
D. Hypotension
Answer: A
Conceptual Explanation: Cushing’s syndrome involves excessive cortisol, leading to
hypernatremia, hypokalemia, and hyperglycemia due to mineralocorticoid and
glucocorticoid effects.
6. Which of the following interventions is most appropriate for a client in the manic phase of
Bipolar Disorder?
A. Encourage participation in a group volleyball game
