Comprehensive
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◆ Clinical Judgment & Priority Questions
◆ NGN Case Studies: DKA · Preeclampsia · STEMI · Asthma
◆ Detailed Rationales for Every Answer
◆ Fully Mapped to NCLEX & ATI Competencies
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ATI RN Practice Exam – Clinical Judgment & Priority Set
Question 1
A nurse is reviewing the medical record of a client who has bipolar disorder and is taking
lithium.
Exhibit 1 – Vital Signs
Blood pressure: 100/60 mm Hg
Heart rate: 88/min
Respiratory rate: 18/min
Temperature: 37.8°C (100°F)
Exhibit 2 – Medication Administration Record
Lithium carbonate 900 mg PO daily
Ibuprofen 400 mg PO every 6 hr PRN pain
Exhibit 3 – Nurse’s Notes
Client reports nausea, diarrhea, and hand tremors. States, “I feel very weak.”
Lithium level: 1.8 mEq/L
Which of the following should the nurse report to the provider?
A. Temperature
B. Ibuprofen use
C. Hand tremors
D. Lithium level
Correct Answer: D. Lithium level
,Rationale:
Therapeutic lithium range is 0.6–1.2 mEq/L. A level of 1.8 mEq/L indicates toxicity. Early signs
include nausea, vomiting, diarrhea, tremors, and weakness. Lithium toxicity can progress to
seizures and coma. Immediate provider notification is required. Ibuprofen can increase lithium
levels, but the critical value requiring reporting is the elevated lithium level.
Question 2
A nurse is providing discharge teaching for a client who has heart failure.
Which statement indicates understanding?
A. “I will weigh myself once a week.”
B. “I will report a weight gain of 2 pounds in one day.”
C. “I will limit my potassium intake.”
D. “I can stop taking my diuretic when I feel better.”
Correct Answer: B. “I will report a weight gain of 2 pounds in one day.”
Rationale:
Rapid weight gain (2 lb in 24 hr or 5 lb in a week) indicates fluid retention and worsening heart
failure. Clients should weigh daily. Diuretics should not be stopped without provider approval.
Potassium restriction depends on medications.
Question 3
A nurse is assessing a newborn with a blood glucose level of 28 mg/dL. Which manifestation
should the nurse expect?
A. Bounding pulse
B. Jitteriness
C. Hyperthermia
D. Bulging fontanel
Correct Answer: B. Jitteriness
Rationale:
Neonatal hypoglycemia presents with jitteriness, tremors, lethargy, weak cry, and poor feeding.
Severe hypoglycemia can cause seizures. Normal newborn glucose is above 40 mg/dL.
, Question 4
A nurse is caring for a client receiving IV vancomycin. Which finding should be reported
immediately?
A. Flushing of the neck and face
B. Blood pressure 118/70 mm Hg
C. Urine output 45 mL/hr
D. Mild nausea
Correct Answer: A. Flushing of the neck and face
Rationale:
Flushing during vancomycin infusion suggests “Red Man Syndrome,” a histamine reaction due
to rapid infusion. The infusion should be slowed immediately.
Question 5
A nurse is assessing a client 2 hours after a thyroidectomy. Which finding requires immediate
intervention?
A. Hoarseness
B. Neck swelling
C. Pain rated 6/10
D. Temperature 37.2°C
Correct Answer: B. Neck swelling
Rationale:
Neck swelling may indicate hemorrhage and airway compression. This is a life-threatening
emergency. Hoarseness may occur from nerve irritation but is less emergent.
Question 6
A nurse is caring for a client with hyperkalemia (K+ 6.2 mEq/L). Which medication should the
nurse anticipate administering first?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Regular insulin IV
D. Potassium chloride