ATI PN FUNDAMENTALS PROCTORED EXAM 2023
ASSESSMENT
Comprehensive Practice Exam with Detailed Rationales | 180 Questions and Answers
40
Section 1: Safe, Effective Care Environment
Q1: A practical nurse (PN) is caring for a group of clients on a medical-surgical unit. Which of the following tasks
should the PN delegate to an unlicensed assistive personnel (UAP)?
A. Obtain a blood pressure reading on a client who is 2 hours post-procedure
B. Perform an initial admission assessment on a newly assigned client
C. Administer an oral analgesic to a client reporting pain at a level of 6/10 [CORRECT]
D. Evaluate the effectiveness of a new medication regimen for a client with hypertension
Correct Answer: C
Rationale: The PN may delegate vital sign measurement to a UAP, as obtaining blood pressure is within the UAP scope of practice and does
not require clinical judgment. Performing an initial admission assessment and evaluating medication effectiveness are RN responsibilities that
require clinical expertise. Administering oral medications is within the PN scope, not a delegatable UAP task.
Q2: A client who is scheduled for a colonoscopy has signed an informed consent form. The client tells the PN, 'I do
not really understand what this procedure involves.' What is the most appropriate action by the PN?
A. Explain the procedure in detail to the client using simple terms
B. Notify the provider who will perform the procedure immediately [CORRECT]
C. Tell the client that the provider has already explained the procedure adequately
D. Have the client sign a new consent form after providing additional information
Correct Answer: B
Rationale: The provider is responsible for obtaining informed consent and ensuring the client understands the procedure, risks, benefits, and
alternatives. The PN's role is to witness the signature and verify the client's understanding. When a client indicates a lack of understanding,
the PN must notify the provider so the provider can re-educate the client. The PN should not independently explain the procedure in detail, as
this exceeds the PN scope for informed consent.
Q3: A PN is reviewing the medical record of a client who has an advance directive. Which of the following
statements by the client indicates a need for further clarification regarding the advance directive?
A. 'This document tells my family what my wishes are if I cannot speak for myself.'
B. 'My healthcare proxy can make decisions for me even when I am able to communicate.' [CORRECT]
C. 'I can change this document at any time as long as I am competent to do so.'
D. 'This document goes into effect only if I am unable to make my own decisions.'
Correct Answer: B
Rationale: A healthcare proxy or durable power of attorney for healthcare only makes decisions when the client is no longer able to
communicate or make decisions for themselves. If the client is competent and able to communicate, the client retains the right to make their
own healthcare decisions. The other statements accurately reflect the purpose and characteristics of an advance directive, including the ability
to modify it and its activation only upon loss of decision-making capacity.
Q4: A PN is caring for a client who has a prescription for wrist restraints. Which of the following actions should
the PN take?
Page 1
, A. Apply the restraints tightly to prevent the client from removing an IV line
B. Secure the restraints to the side rails of the bed for easy access
C. Remove the restraints every 2 hours to assess skin integrity and circulation [CORRECT]
D. Tie the restraint knots where the client cannot reach them but keep them visible
Correct Answer: C
Rationale: Restraints must be removed at least every 2 hours to assess the client's skin integrity, circulation, range of motion, and need for
continued restraint use. Restraints should never be applied tightly, as this can compromise circulation and cause injury. They should be
secured to the bed frame (not side rails, which could cause entrapment if rails are lowered), and knots should be quick-release type for
safety. The client's condition must be continually reassessed, and restraints discontinued as soon as the client is safe.
Q5: A PN is preparing to administer medications to a client. Which of the following actions implements the 'Three
Checks' of medication administration?
A. Verifying the medication against the medication administration record (MAR) at the bedside, during preparation,
and after administration
B. Comparing the medication label to the MAR when removing it from storage, when preparing it, and when
returning it to storage
C. Checking the medication with the MAR when retrieving it from the dispensing system, when preparing the dose,
and at the bedside prior to administering [CORRECT]
D. Confirming the medication with the pharmacy, the charge nurse, and the client prior to administration
Correct Answer: C
Rationale: The Three Checks system requires the nurse to verify the medication against the MAR at three critical points: when removing the
medication from the dispensing system, when preparing the dose, and again at the bedside immediately before administering it to the client.
This three-point verification system reduces the risk of medication errors by catching discrepancies at multiple stages of the administration
process. Checking after administration or with the charge nurse and pharmacy does not constitute the standard Three Checks protocol.
Q6: A PN receives a telephone order from a provider for a new medication. Which of the following actions should
the PN take first?
A. Administer the medication immediately to avoid a delay in treatment
B. Read back the order to the provider for verification and document as a telephone order [CORRECT]
C. Ask the charge nurse to cosign the order before administering the medication
D. Wait for the provider to come to the unit to write the order in person
Correct Answer: B
Rationale: When receiving a telephone order, the PN must first read back the complete order to the provider for verification to ensure
accuracy. The order should then be documented as a telephone order with the provider's name, date, time, and the notation that it was
verified. Many facilities require a second nurse to listen and cosign. The PN should not administer the medication until the order has been
properly verified and documented. Waiting for the provider to arrive would delay necessary treatment.
Q7: A PN is assigned to care for four clients. Which of the following clients should the PN assess first?
A. A client who is 1 day post-appendectomy with a temperature of 37.2 degrees C (99.0 degrees F)
B. A client with heart failure who reports shortness of breath after ambulating 10 feet [CORRECT]
C. A client with diabetes mellitus who has a blood glucose level of 180 mg/dL
D. A client who is scheduled for a chest x-ray in 2 hours and needs to be prepared
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the client with heart failure reporting shortness of breath
should be assessed first because breathing difficulties indicate a potential respiratory compromise that requires immediate intervention. The
client's shortness of breath on minimal exertion may signal worsening heart failure or pulmonary edema. The post-appendectomy client's
temperature is within normal limits. A blood glucose of 180 mg/dL, while elevated, does not require immediate intervention. The chest x-ray
preparation is a routine task that can wait.
Page 2
,Q8: A client tells a PN, 'I do not want to take my medication anymore.' Which of the following responses by the PN
demonstrates therapeutic communication?
A. 'You need to take your medication so you can get better and go home.'
B. 'Why do you not want to take your medication? That is very important for your recovery.'
C. 'Can you tell me more about what is making you not want to take your medication?' [CORRECT]
D. 'Your doctor prescribed this medication for a reason, so you really should take it.'
Correct Answer: C
Rationale: Using a broad opening and inviting the client to elaborate is a therapeutic communication technique that encourages the client to
express their concerns without feeling judged. Asking 'why' questions (option B) can make the client feel defensive and is considered
non-therapeutic. Giving advice (options A and D) and using 'should' statements are also non-therapeutic because they impose the nurse's
perspective rather than exploring the client's feelings and concerns.
Q9: A PN is reviewing the laboratory results of a client who is receiving heparin therapy. The client's activated
partial thromboplastin time (aPTT) is 85 seconds. Which of the following actions should the PN take?
A. Administer the next dose of heparin as scheduled
B. Hold the heparin infusion and notify the provider [CORRECT]
C. Increase the heparin infusion rate as prescribed
D. Document the finding and continue monitoring every 4 hours
Correct Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5 times the control value, or approximately 46 to 70
seconds for most facilities. An aPTT of 85 seconds is above the therapeutic range, indicating that the client is at increased risk for bleeding.
The PN should hold the heparin infusion and notify the provider immediately. The provider may order a bolus of protamine sulfate, the
antidote for heparin, depending on the clinical situation. Continuing or increasing the heparin would be unsafe.
Q10: A PN is caring for a client who has a do-not-resuscitate (DNR) order. The client's family member requests
that 'everything possible' be done when the client's heart stops. What is the most appropriate response by the PN?
A. Explain to the family that the DNR order must be followed regardless of their wishes
B. Inform the family that the DNR can be revoked at any time by the client if they are competent
C. Contact the charge nurse and provider to facilitate a discussion with the family about the DNR order [CORRECT]
D. Tell the family that their wishes cannot be honored because the legal document is already in place
Correct Answer: C
Rationale: The PN should involve the charge nurse and provider to facilitate a discussion with the family about the DNR order. This complex
ethical situation requires collaboration with the healthcare team to address the family's concerns while respecting the client's documented
wishes. The PN should not independently counsel the family about legal aspects of the DNR. A DNR order can be revoked by a competent
client at any time, but the PN should not assume the client wants to revoke it based solely on the family's request. The provider should lead
any discussions about modifying the DNR status.
Q11: A PN is documenting client care in the medical record. Which of the following entries demonstrates objective
documentation?
A. The client appears to be in a great deal of pain
B. The client seems anxious about the upcoming procedure
C. The client's surgical incision is 5 cm in length with no drainage or erythema [CORRECT]
D. The client states they feel much better than yesterday
Correct Answer: C
Rationale: Objective documentation includes measurable, observable, and factual data that any healthcare provider would assess the same
way. A surgical incision described with specific measurements (5 cm) and observable findings (no drainage or erythema) is objective. Stating
the client 'appears' to be in pain or 'seems' anxious represents subjective interpretation. While a client's direct quote about feeling better is
factual, it is a subjective statement from the client rather than an objective clinical observation.
Page 3
, Q12: A PN is preparing to transfer a client from the bed to a wheelchair using a mechanical lift. Which of the
following actions should the PN take?
A. Place the sling under the client while the client is sitting on the edge of the bed
B. Ensure the client's arms are positioned inside the sling straps during transfer
C. Roll the client to one side to position the sling beneath them before lifting [CORRECT]
D. Leave the side rails down during the transfer to allow easier access
Correct Answer: C
Rationale: When using a mechanical lift, the client should be rolled to one side so the sling can be positioned beneath them before the lift is
applied. This ensures proper sling placement and client safety. The client's arms should be positioned outside the sling straps (not inside) to
prevent injury during the lift. Side rails should be raised when the client is in bed and not being actively transferred. The sling cannot be
properly placed while the client is sitting on the edge of the bed.
Q13: A PN is caring for a client who is receiving continuous enteral feedings via a nasogastric tube. The PN should
monitor for which of the following potential complications?
A. Hypertension and bradycardia
B. Aspiration pneumonia and diarrhea [CORRECT]
C. Hyperglycemia and polyuria
D. Joint pain and muscle weakness
Correct Answer: B
Rationale: Continuous enteral feedings via nasogastric tube carry a risk of aspiration, particularly if the tube becomes displaced or if the
client has impaired gag reflexes. Aspiration of gastric contents can lead to aspiration pneumonia, a serious and potentially life-threatening
complication. Diarrhea is another common complication of enteral feedings, often related to formula osmolarity, rate of administration, or
bacterial contamination. Hypertension, bradycardia, hyperglycemia, and joint pain are not typical complications associated with enteral
feedings.
Q14: A PN is reviewing the assignment sheet for the shift. Which of the following clients is most appropriate to
assign to a new graduate PN?
A. A client who is 6 hours postoperative following a thoracotomy with a chest tube
B. A client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula
[CORRECT]
C. A client who was just admitted with acute chest pain and has an ST-elevation on ECG
D. A client with a new tracheostomy who requires frequent suctioning and tracheostomy care
Correct Answer: B
Rationale: A client with stable COPD receiving low-flow oxygen is the most appropriate assignment for a new graduate PN. This client is
stable, the oxygen therapy is routine, and the PN scope includes managing stable clients with predictable outcomes. A client 6 hours
post-thoracotomy with a chest tube, a client with acute STEMI, and a client with a new tracheostomy requiring frequent suctioning all
represent higher-acuity situations that require more experienced nursing assessment and intervention, and would be more appropriate for an
experienced PN or RN assignment.
Q15: A PN is caring for a client who reports pain at a level of 4 on a 0-10 scale. Which of the following
non-pharmacological interventions should the PN implement first?
A. Apply a heating pad to the affected area
B. Administer the prescribed PRN acetaminophen
C. Reposition the client and provide a back massage [CORRECT]
D. Offer the client a diversional activity such as watching television
Correct Answer: C
Rationale: Repositioning is a non-pharmacological pain relief intervention that should be attempted first because it carries no risk of adverse
effects, can be implemented immediately, and often provides significant relief. A back massage is another non-invasive intervention that can
promote relaxation and reduce muscle tension contributing to pain. Pharmacological interventions (acetaminophen) should be considered
Page 4
ASSESSMENT
Comprehensive Practice Exam with Detailed Rationales | 180 Questions and Answers
40
Section 1: Safe, Effective Care Environment
Q1: A practical nurse (PN) is caring for a group of clients on a medical-surgical unit. Which of the following tasks
should the PN delegate to an unlicensed assistive personnel (UAP)?
A. Obtain a blood pressure reading on a client who is 2 hours post-procedure
B. Perform an initial admission assessment on a newly assigned client
C. Administer an oral analgesic to a client reporting pain at a level of 6/10 [CORRECT]
D. Evaluate the effectiveness of a new medication regimen for a client with hypertension
Correct Answer: C
Rationale: The PN may delegate vital sign measurement to a UAP, as obtaining blood pressure is within the UAP scope of practice and does
not require clinical judgment. Performing an initial admission assessment and evaluating medication effectiveness are RN responsibilities that
require clinical expertise. Administering oral medications is within the PN scope, not a delegatable UAP task.
Q2: A client who is scheduled for a colonoscopy has signed an informed consent form. The client tells the PN, 'I do
not really understand what this procedure involves.' What is the most appropriate action by the PN?
A. Explain the procedure in detail to the client using simple terms
B. Notify the provider who will perform the procedure immediately [CORRECT]
C. Tell the client that the provider has already explained the procedure adequately
D. Have the client sign a new consent form after providing additional information
Correct Answer: B
Rationale: The provider is responsible for obtaining informed consent and ensuring the client understands the procedure, risks, benefits, and
alternatives. The PN's role is to witness the signature and verify the client's understanding. When a client indicates a lack of understanding,
the PN must notify the provider so the provider can re-educate the client. The PN should not independently explain the procedure in detail, as
this exceeds the PN scope for informed consent.
Q3: A PN is reviewing the medical record of a client who has an advance directive. Which of the following
statements by the client indicates a need for further clarification regarding the advance directive?
A. 'This document tells my family what my wishes are if I cannot speak for myself.'
B. 'My healthcare proxy can make decisions for me even when I am able to communicate.' [CORRECT]
C. 'I can change this document at any time as long as I am competent to do so.'
D. 'This document goes into effect only if I am unable to make my own decisions.'
Correct Answer: B
Rationale: A healthcare proxy or durable power of attorney for healthcare only makes decisions when the client is no longer able to
communicate or make decisions for themselves. If the client is competent and able to communicate, the client retains the right to make their
own healthcare decisions. The other statements accurately reflect the purpose and characteristics of an advance directive, including the ability
to modify it and its activation only upon loss of decision-making capacity.
Q4: A PN is caring for a client who has a prescription for wrist restraints. Which of the following actions should
the PN take?
Page 1
, A. Apply the restraints tightly to prevent the client from removing an IV line
B. Secure the restraints to the side rails of the bed for easy access
C. Remove the restraints every 2 hours to assess skin integrity and circulation [CORRECT]
D. Tie the restraint knots where the client cannot reach them but keep them visible
Correct Answer: C
Rationale: Restraints must be removed at least every 2 hours to assess the client's skin integrity, circulation, range of motion, and need for
continued restraint use. Restraints should never be applied tightly, as this can compromise circulation and cause injury. They should be
secured to the bed frame (not side rails, which could cause entrapment if rails are lowered), and knots should be quick-release type for
safety. The client's condition must be continually reassessed, and restraints discontinued as soon as the client is safe.
Q5: A PN is preparing to administer medications to a client. Which of the following actions implements the 'Three
Checks' of medication administration?
A. Verifying the medication against the medication administration record (MAR) at the bedside, during preparation,
and after administration
B. Comparing the medication label to the MAR when removing it from storage, when preparing it, and when
returning it to storage
C. Checking the medication with the MAR when retrieving it from the dispensing system, when preparing the dose,
and at the bedside prior to administering [CORRECT]
D. Confirming the medication with the pharmacy, the charge nurse, and the client prior to administration
Correct Answer: C
Rationale: The Three Checks system requires the nurse to verify the medication against the MAR at three critical points: when removing the
medication from the dispensing system, when preparing the dose, and again at the bedside immediately before administering it to the client.
This three-point verification system reduces the risk of medication errors by catching discrepancies at multiple stages of the administration
process. Checking after administration or with the charge nurse and pharmacy does not constitute the standard Three Checks protocol.
Q6: A PN receives a telephone order from a provider for a new medication. Which of the following actions should
the PN take first?
A. Administer the medication immediately to avoid a delay in treatment
B. Read back the order to the provider for verification and document as a telephone order [CORRECT]
C. Ask the charge nurse to cosign the order before administering the medication
D. Wait for the provider to come to the unit to write the order in person
Correct Answer: B
Rationale: When receiving a telephone order, the PN must first read back the complete order to the provider for verification to ensure
accuracy. The order should then be documented as a telephone order with the provider's name, date, time, and the notation that it was
verified. Many facilities require a second nurse to listen and cosign. The PN should not administer the medication until the order has been
properly verified and documented. Waiting for the provider to arrive would delay necessary treatment.
Q7: A PN is assigned to care for four clients. Which of the following clients should the PN assess first?
A. A client who is 1 day post-appendectomy with a temperature of 37.2 degrees C (99.0 degrees F)
B. A client with heart failure who reports shortness of breath after ambulating 10 feet [CORRECT]
C. A client with diabetes mellitus who has a blood glucose level of 180 mg/dL
D. A client who is scheduled for a chest x-ray in 2 hours and needs to be prepared
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the client with heart failure reporting shortness of breath
should be assessed first because breathing difficulties indicate a potential respiratory compromise that requires immediate intervention. The
client's shortness of breath on minimal exertion may signal worsening heart failure or pulmonary edema. The post-appendectomy client's
temperature is within normal limits. A blood glucose of 180 mg/dL, while elevated, does not require immediate intervention. The chest x-ray
preparation is a routine task that can wait.
Page 2
,Q8: A client tells a PN, 'I do not want to take my medication anymore.' Which of the following responses by the PN
demonstrates therapeutic communication?
A. 'You need to take your medication so you can get better and go home.'
B. 'Why do you not want to take your medication? That is very important for your recovery.'
C. 'Can you tell me more about what is making you not want to take your medication?' [CORRECT]
D. 'Your doctor prescribed this medication for a reason, so you really should take it.'
Correct Answer: C
Rationale: Using a broad opening and inviting the client to elaborate is a therapeutic communication technique that encourages the client to
express their concerns without feeling judged. Asking 'why' questions (option B) can make the client feel defensive and is considered
non-therapeutic. Giving advice (options A and D) and using 'should' statements are also non-therapeutic because they impose the nurse's
perspective rather than exploring the client's feelings and concerns.
Q9: A PN is reviewing the laboratory results of a client who is receiving heparin therapy. The client's activated
partial thromboplastin time (aPTT) is 85 seconds. Which of the following actions should the PN take?
A. Administer the next dose of heparin as scheduled
B. Hold the heparin infusion and notify the provider [CORRECT]
C. Increase the heparin infusion rate as prescribed
D. Document the finding and continue monitoring every 4 hours
Correct Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5 times the control value, or approximately 46 to 70
seconds for most facilities. An aPTT of 85 seconds is above the therapeutic range, indicating that the client is at increased risk for bleeding.
The PN should hold the heparin infusion and notify the provider immediately. The provider may order a bolus of protamine sulfate, the
antidote for heparin, depending on the clinical situation. Continuing or increasing the heparin would be unsafe.
Q10: A PN is caring for a client who has a do-not-resuscitate (DNR) order. The client's family member requests
that 'everything possible' be done when the client's heart stops. What is the most appropriate response by the PN?
A. Explain to the family that the DNR order must be followed regardless of their wishes
B. Inform the family that the DNR can be revoked at any time by the client if they are competent
C. Contact the charge nurse and provider to facilitate a discussion with the family about the DNR order [CORRECT]
D. Tell the family that their wishes cannot be honored because the legal document is already in place
Correct Answer: C
Rationale: The PN should involve the charge nurse and provider to facilitate a discussion with the family about the DNR order. This complex
ethical situation requires collaboration with the healthcare team to address the family's concerns while respecting the client's documented
wishes. The PN should not independently counsel the family about legal aspects of the DNR. A DNR order can be revoked by a competent
client at any time, but the PN should not assume the client wants to revoke it based solely on the family's request. The provider should lead
any discussions about modifying the DNR status.
Q11: A PN is documenting client care in the medical record. Which of the following entries demonstrates objective
documentation?
A. The client appears to be in a great deal of pain
B. The client seems anxious about the upcoming procedure
C. The client's surgical incision is 5 cm in length with no drainage or erythema [CORRECT]
D. The client states they feel much better than yesterday
Correct Answer: C
Rationale: Objective documentation includes measurable, observable, and factual data that any healthcare provider would assess the same
way. A surgical incision described with specific measurements (5 cm) and observable findings (no drainage or erythema) is objective. Stating
the client 'appears' to be in pain or 'seems' anxious represents subjective interpretation. While a client's direct quote about feeling better is
factual, it is a subjective statement from the client rather than an objective clinical observation.
Page 3
, Q12: A PN is preparing to transfer a client from the bed to a wheelchair using a mechanical lift. Which of the
following actions should the PN take?
A. Place the sling under the client while the client is sitting on the edge of the bed
B. Ensure the client's arms are positioned inside the sling straps during transfer
C. Roll the client to one side to position the sling beneath them before lifting [CORRECT]
D. Leave the side rails down during the transfer to allow easier access
Correct Answer: C
Rationale: When using a mechanical lift, the client should be rolled to one side so the sling can be positioned beneath them before the lift is
applied. This ensures proper sling placement and client safety. The client's arms should be positioned outside the sling straps (not inside) to
prevent injury during the lift. Side rails should be raised when the client is in bed and not being actively transferred. The sling cannot be
properly placed while the client is sitting on the edge of the bed.
Q13: A PN is caring for a client who is receiving continuous enteral feedings via a nasogastric tube. The PN should
monitor for which of the following potential complications?
A. Hypertension and bradycardia
B. Aspiration pneumonia and diarrhea [CORRECT]
C. Hyperglycemia and polyuria
D. Joint pain and muscle weakness
Correct Answer: B
Rationale: Continuous enteral feedings via nasogastric tube carry a risk of aspiration, particularly if the tube becomes displaced or if the
client has impaired gag reflexes. Aspiration of gastric contents can lead to aspiration pneumonia, a serious and potentially life-threatening
complication. Diarrhea is another common complication of enteral feedings, often related to formula osmolarity, rate of administration, or
bacterial contamination. Hypertension, bradycardia, hyperglycemia, and joint pain are not typical complications associated with enteral
feedings.
Q14: A PN is reviewing the assignment sheet for the shift. Which of the following clients is most appropriate to
assign to a new graduate PN?
A. A client who is 6 hours postoperative following a thoracotomy with a chest tube
B. A client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula
[CORRECT]
C. A client who was just admitted with acute chest pain and has an ST-elevation on ECG
D. A client with a new tracheostomy who requires frequent suctioning and tracheostomy care
Correct Answer: B
Rationale: A client with stable COPD receiving low-flow oxygen is the most appropriate assignment for a new graduate PN. This client is
stable, the oxygen therapy is routine, and the PN scope includes managing stable clients with predictable outcomes. A client 6 hours
post-thoracotomy with a chest tube, a client with acute STEMI, and a client with a new tracheostomy requiring frequent suctioning all
represent higher-acuity situations that require more experienced nursing assessment and intervention, and would be more appropriate for an
experienced PN or RN assignment.
Q15: A PN is caring for a client who reports pain at a level of 4 on a 0-10 scale. Which of the following
non-pharmacological interventions should the PN implement first?
A. Apply a heating pad to the affected area
B. Administer the prescribed PRN acetaminophen
C. Reposition the client and provide a back massage [CORRECT]
D. Offer the client a diversional activity such as watching television
Correct Answer: C
Rationale: Repositioning is a non-pharmacological pain relief intervention that should be attempted first because it carries no risk of adverse
effects, can be implemented immediately, and often provides significant relief. A back massage is another non-invasive intervention that can
promote relaxation and reduce muscle tension contributing to pain. Pharmacological interventions (acetaminophen) should be considered
Page 4
