ATI COMPREHENSIVE EXIT FINAL EXAM REVIEW
2026/2027 | Actual Questions and Correct
Verified Answers Study Guide
Section 1: Questions 1–50
1. A nurse is caring for a client who is post-operative day 2 following an open reduction
internal fixation of the right femur. The client has a history of heart failure with
preserved ejection fraction, CKD stage 3b, and type 2 diabetes. Morning labs show
potassium 5.8 mEq/L. Which action should the nurse take first?
A. Administer 10 units regular insulin IV push.
B. Hold empagliflozin and metformin.
C. Administer 1 g calcium gluconate IV.
D. Obtain blood cultures.
Rationale: A potassium level of 5.8 mEq/L in a client with CKD is a medical emergency
due to the risk of life-threatening cardiac dysrhythmias. Calcium gluconate is
administered first to stabilize the cardiac cell membrane, providing protection while
other measures (insulin/dextrose, potassium removal) are implemented. Holding
medications is appropriate but is not the most urgent action .
2. A nurse is caring for a client who has a new prescription for enoxaparin. Which action
should the nurse take?
A. Administer the medication via the IM route.
B. Expel the air bubble from the prefilled syringe.
C. Inject the medication into the abdomen.
D. Aspirate for blood return before injection.
Rationale: Enoxaparin is a low-molecular-weight heparin administered subcutaneously
into the abdomen to ensure proper absorption and reduce hematoma risk. The IM
route is contraindicated. The air bubble should not be expelled as it prevents
medication loss. Aspiration is unnecessary and can cause tissue damage .
3. A charge nurse is teaching a newly licensed nurse about clients designating a health
care proxy. Which information should the charge nurse include?
A. "The proxy should make health care decisions for the client regardless of the
client's ability to do so."
B. "The proxy can make financial decisions if the need arises."
C. "The proxy can make treatment decisions if the client is unable to do so."
D. "The proxy should manage legal issues for the client."
Rationale: A health care proxy is designated to make health care decisions on the
client's behalf only when the client is unable to make those decisions. The proxy does
, not manage financial or legal issues, and does not override the client's ability to make
decisions .
4. A nurse is receiving change-of-shift report on four clients. Which client should the
nurse assess first?
A. A client with a dressing that needs reinforcement.
B. A client reporting pain rated 6/10.
C. A client whose urinary output was 100 mL in 12 hours.
D. A client scheduled for discharge.
Rationale: A urinary output of 100 mL in 12 hours is critically low (normal is at least 30
mL/hr) and indicates possible renal failure or hypovolemia, requiring immediate
assessment. The other findings are important but not immediately life-threatening .
5. A nurse is preparing to delegate tasks to unlicensed assistive personnel (UAP). Which
task is appropriate to delegate?
A. Assessing a client's pain level.
B. Measuring vital signs on a stable client.
C. Teaching a client about medication side effects.
D. Evaluating the client's response to treatment.
Rationale: UAPs can perform routine, standardized tasks such as measuring vital signs
on stable clients. Assessment, teaching, and evaluation are nursing responsibilities that
require clinical judgment and cannot be delegated .
6. A charge nurse is assigning rooms for four clients. Which client should be placed in a
private room?
A. A client with pneumonia.
B. A client with Clostridioides difficile.
C. A client with cellulitis.
D. A client with a urinary tract infection.
Rationale: C. difficile requires contact precautions and a private room to prevent spore
transmission. Pneumonia may require droplet precautions but not necessarily a private
room. Cellulitis and UTI require standard precautions only .
7. A client is on airborne precautions. Which personal protective equipment is essential
when entering the room?
A. Surgical mask.
B. N95 respirator.
C. Gown and gloves only.
D. Face shield.
Rationale: Airborne precautions require a fit-tested N95 respirator or higher-level
respirator for entry into the room. A surgical mask is insufficient for airborne
transmission .
8. A nurse is caring for a client who has a chest tube to water seal drainage. The nurse
notes continuous bubbling in the water seal chamber. What is the priority nursing
action?
A. Clamp the chest tube immediately.
B. Notify the healthcare provider.
, C. Locate the source of the air leak.
D. Document the finding as normal.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
drainage system. The nurse should systematically check connections from the patient
to the drainage unit to locate and correct the leak. Clamping is contraindicated due to
risk of tension pneumothorax. Intermittent bubbling (tidaling) is normal .
9. A client is receiving a unit of packed red blood cells. Thirty minutes into the infusion,
the client reports chills and back pain. What is the nurse's priority action?
A. Slow the infusion rate.
B. Administer prescribed acetaminophen.
C. Stop the transfusion immediately.
D. Notify the blood bank.
Rationale: Chills and back pain are classic signs of an acute hemolytic transfusion
reaction, which is life-threatening. The priority is to stop the transfusion immediately to
prevent further infusion of incompatible blood, then maintain IV access with normal
saline and notify the provider .
10. A client with cirrhosis is experiencing confusion and asterixis. The nurse should
anticipate which medication order?
A. Lactulose PO or via NG tube.
B. Neomycin IV.
C. Furosemide IV.
D. Vitamin K IM.
Rationale: The client is demonstrating signs of hepatic encephalopathy, caused by
accumulation of ammonia. Lactulose acidifies the colon, converting ammonia to
ammonium, which is trapped and excreted in stool. It is the first-line treatment .
11. A nurse is evaluating a dark-skinned client for cyanosis. Which location is best to
assess?
A. Sacral area.
B. Palms of the hands.
C. Shoulders.
D. A bruised area.
Rationale: Cyanosis may be easier to see in areas with thinner skin and less
pigmentation, such as the palms, soles, or oral mucosa. The sacrum and shoulders are
less reliable due to skin thickness and pigmentation .
12. A charge nurse is reviewing factors that place a client at increased risk for becoming
violent. Which factor is the best predictor?
A. A history of imprisonment.
B. Male gender.
C. Delusions.
D. Previous violent behavior.
Rationale: An established history of violence is the strongest predictor of future violent
behavior, more than diagnosis or demographic factors alone .
, 13. A nurse is assessing a client in active labor. Which finding should be reported to the
provider immediately?
A. Temperature of 37.4°C (99.3°F).
B. Early fetal heart rate decelerations.
C. Baseline fetal heart rate of 170/min.
D. Contractions lasting 80 seconds.
Rationale: A normal fetal heart rate baseline ranges from 110 to 160/min. An FHR of
170/min indicates fetal tachycardia and warrants further evaluation. Early
decelerations are benign, and contractions lasting 80 seconds are within normal limits .
14. A quality-control nurse is reviewing multiple medication prescriptions. Which
prescription is complete and acceptable?
A. Tetracycline 200 mg PO.
B. Epoetin alfa 150 units/kg three times weekly.
C. Digoxin 0.25 mg PO daily.
D. Cimetidine PO twice daily.
Rationale: A complete prescription includes the drug name, dose, route, and frequency.
Only "Digoxin 0.25 mg PO daily" meets all requirements .
15. A nurse is teaching a client who has a new diagnosis of genital herpes. Which
statement indicates the client understands the teaching?
A. "I can stop taking my antiviral medication once the sores heal."
B. "I should avoid sexual contact during outbreaks."
C. "I am no longer contagious once the sores are gone."
D. "This infection will go away on its own without treatment."
Rationale: The client should avoid sexual contact during outbreaks to prevent
transmission. Antiviral medication may be used for suppression therapy even between
outbreaks. The virus remains in the body and can be shed even without visible sores.
16. A nurse is caring for a client who has been diagnosed with active tuberculosis. Which
type of isolation precautions should the nurse implement?
A. Contact precautions.
B. Droplet precautions.
C. Airborne precautions.
D. Standard precautions only.
Rationale: Tuberculosis is transmitted via airborne particles (droplet nuclei) that can
remain suspended in the air for long periods. Airborne precautions, including a
negative pressure room and N95 respirator, are required.
17. A client with chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which
medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate.
B. IV regular insulin and IV dextrose.
C. Calcium gluconate IV.
D. Furosemide.
Rationale: A potassium level of 6.8 mEq/L is severely elevated and places the client at
high risk for life-threatening cardiac dysrhythmias. IV calcium gluconate is given first
2026/2027 | Actual Questions and Correct
Verified Answers Study Guide
Section 1: Questions 1–50
1. A nurse is caring for a client who is post-operative day 2 following an open reduction
internal fixation of the right femur. The client has a history of heart failure with
preserved ejection fraction, CKD stage 3b, and type 2 diabetes. Morning labs show
potassium 5.8 mEq/L. Which action should the nurse take first?
A. Administer 10 units regular insulin IV push.
B. Hold empagliflozin and metformin.
C. Administer 1 g calcium gluconate IV.
D. Obtain blood cultures.
Rationale: A potassium level of 5.8 mEq/L in a client with CKD is a medical emergency
due to the risk of life-threatening cardiac dysrhythmias. Calcium gluconate is
administered first to stabilize the cardiac cell membrane, providing protection while
other measures (insulin/dextrose, potassium removal) are implemented. Holding
medications is appropriate but is not the most urgent action .
2. A nurse is caring for a client who has a new prescription for enoxaparin. Which action
should the nurse take?
A. Administer the medication via the IM route.
B. Expel the air bubble from the prefilled syringe.
C. Inject the medication into the abdomen.
D. Aspirate for blood return before injection.
Rationale: Enoxaparin is a low-molecular-weight heparin administered subcutaneously
into the abdomen to ensure proper absorption and reduce hematoma risk. The IM
route is contraindicated. The air bubble should not be expelled as it prevents
medication loss. Aspiration is unnecessary and can cause tissue damage .
3. A charge nurse is teaching a newly licensed nurse about clients designating a health
care proxy. Which information should the charge nurse include?
A. "The proxy should make health care decisions for the client regardless of the
client's ability to do so."
B. "The proxy can make financial decisions if the need arises."
C. "The proxy can make treatment decisions if the client is unable to do so."
D. "The proxy should manage legal issues for the client."
Rationale: A health care proxy is designated to make health care decisions on the
client's behalf only when the client is unable to make those decisions. The proxy does
, not manage financial or legal issues, and does not override the client's ability to make
decisions .
4. A nurse is receiving change-of-shift report on four clients. Which client should the
nurse assess first?
A. A client with a dressing that needs reinforcement.
B. A client reporting pain rated 6/10.
C. A client whose urinary output was 100 mL in 12 hours.
D. A client scheduled for discharge.
Rationale: A urinary output of 100 mL in 12 hours is critically low (normal is at least 30
mL/hr) and indicates possible renal failure or hypovolemia, requiring immediate
assessment. The other findings are important but not immediately life-threatening .
5. A nurse is preparing to delegate tasks to unlicensed assistive personnel (UAP). Which
task is appropriate to delegate?
A. Assessing a client's pain level.
B. Measuring vital signs on a stable client.
C. Teaching a client about medication side effects.
D. Evaluating the client's response to treatment.
Rationale: UAPs can perform routine, standardized tasks such as measuring vital signs
on stable clients. Assessment, teaching, and evaluation are nursing responsibilities that
require clinical judgment and cannot be delegated .
6. A charge nurse is assigning rooms for four clients. Which client should be placed in a
private room?
A. A client with pneumonia.
B. A client with Clostridioides difficile.
C. A client with cellulitis.
D. A client with a urinary tract infection.
Rationale: C. difficile requires contact precautions and a private room to prevent spore
transmission. Pneumonia may require droplet precautions but not necessarily a private
room. Cellulitis and UTI require standard precautions only .
7. A client is on airborne precautions. Which personal protective equipment is essential
when entering the room?
A. Surgical mask.
B. N95 respirator.
C. Gown and gloves only.
D. Face shield.
Rationale: Airborne precautions require a fit-tested N95 respirator or higher-level
respirator for entry into the room. A surgical mask is insufficient for airborne
transmission .
8. A nurse is caring for a client who has a chest tube to water seal drainage. The nurse
notes continuous bubbling in the water seal chamber. What is the priority nursing
action?
A. Clamp the chest tube immediately.
B. Notify the healthcare provider.
, C. Locate the source of the air leak.
D. Document the finding as normal.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
drainage system. The nurse should systematically check connections from the patient
to the drainage unit to locate and correct the leak. Clamping is contraindicated due to
risk of tension pneumothorax. Intermittent bubbling (tidaling) is normal .
9. A client is receiving a unit of packed red blood cells. Thirty minutes into the infusion,
the client reports chills and back pain. What is the nurse's priority action?
A. Slow the infusion rate.
B. Administer prescribed acetaminophen.
C. Stop the transfusion immediately.
D. Notify the blood bank.
Rationale: Chills and back pain are classic signs of an acute hemolytic transfusion
reaction, which is life-threatening. The priority is to stop the transfusion immediately to
prevent further infusion of incompatible blood, then maintain IV access with normal
saline and notify the provider .
10. A client with cirrhosis is experiencing confusion and asterixis. The nurse should
anticipate which medication order?
A. Lactulose PO or via NG tube.
B. Neomycin IV.
C. Furosemide IV.
D. Vitamin K IM.
Rationale: The client is demonstrating signs of hepatic encephalopathy, caused by
accumulation of ammonia. Lactulose acidifies the colon, converting ammonia to
ammonium, which is trapped and excreted in stool. It is the first-line treatment .
11. A nurse is evaluating a dark-skinned client for cyanosis. Which location is best to
assess?
A. Sacral area.
B. Palms of the hands.
C. Shoulders.
D. A bruised area.
Rationale: Cyanosis may be easier to see in areas with thinner skin and less
pigmentation, such as the palms, soles, or oral mucosa. The sacrum and shoulders are
less reliable due to skin thickness and pigmentation .
12. A charge nurse is reviewing factors that place a client at increased risk for becoming
violent. Which factor is the best predictor?
A. A history of imprisonment.
B. Male gender.
C. Delusions.
D. Previous violent behavior.
Rationale: An established history of violence is the strongest predictor of future violent
behavior, more than diagnosis or demographic factors alone .
, 13. A nurse is assessing a client in active labor. Which finding should be reported to the
provider immediately?
A. Temperature of 37.4°C (99.3°F).
B. Early fetal heart rate decelerations.
C. Baseline fetal heart rate of 170/min.
D. Contractions lasting 80 seconds.
Rationale: A normal fetal heart rate baseline ranges from 110 to 160/min. An FHR of
170/min indicates fetal tachycardia and warrants further evaluation. Early
decelerations are benign, and contractions lasting 80 seconds are within normal limits .
14. A quality-control nurse is reviewing multiple medication prescriptions. Which
prescription is complete and acceptable?
A. Tetracycline 200 mg PO.
B. Epoetin alfa 150 units/kg three times weekly.
C. Digoxin 0.25 mg PO daily.
D. Cimetidine PO twice daily.
Rationale: A complete prescription includes the drug name, dose, route, and frequency.
Only "Digoxin 0.25 mg PO daily" meets all requirements .
15. A nurse is teaching a client who has a new diagnosis of genital herpes. Which
statement indicates the client understands the teaching?
A. "I can stop taking my antiviral medication once the sores heal."
B. "I should avoid sexual contact during outbreaks."
C. "I am no longer contagious once the sores are gone."
D. "This infection will go away on its own without treatment."
Rationale: The client should avoid sexual contact during outbreaks to prevent
transmission. Antiviral medication may be used for suppression therapy even between
outbreaks. The virus remains in the body and can be shed even without visible sores.
16. A nurse is caring for a client who has been diagnosed with active tuberculosis. Which
type of isolation precautions should the nurse implement?
A. Contact precautions.
B. Droplet precautions.
C. Airborne precautions.
D. Standard precautions only.
Rationale: Tuberculosis is transmitted via airborne particles (droplet nuclei) that can
remain suspended in the air for long periods. Airborne precautions, including a
negative pressure room and N95 respirator, are required.
17. A client with chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which
medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate.
B. IV regular insulin and IV dextrose.
C. Calcium gluconate IV.
D. Furosemide.
Rationale: A potassium level of 6.8 mEq/L is severely elevated and places the client at
high risk for life-threatening cardiac dysrhythmias. IV calcium gluconate is given first
