ATI RN Med-Surg & Mental Health Proctored
Exam Bundle (2023–2025) | NGN Updated
Questins & Answers with Rationales
1. A nurse is assessing a client with heart failure who has been prescribed digoxin. Which
finding is most indicative of digoxin toxicity?
A) Heart rate of 62/min
B) Serum potassium level of 4.0 mEq/L
C) Yellow-tinged vision
D) Dry cough
Rationale: Yellow-tinged (or halos around lights) vision is a classic sign of digoxin
toxicity. Bradycardia can occur but is not as specific. Hypokalemia predisposes to
toxicity, but a level of 4.0 is normal. Dry cough is associated with ACE inhibitors.
2. A client with major depressive disorder is started on phenelzine, an MAOI. Which food
item should the nurse instruct the client to avoid?
A) Broiled chicken
B) Aged cheddar cheese
C) Green beans
D) White rice
Rationale: MAOIs such as phenelzine can cause hypertensive crisis when combined with
tyramine-rich foods (e.g., aged cheeses, cured meats, fermented products). Chicken,
green beans, and rice are low in tyramine.
3. A nurse is caring for a post-op client who develops chest pain, dyspnea, and
hemoptysis. Which complication should the nurse suspect?
A) Atelectasis
B) Pulmonary embolism
C) Pneumothorax
D) Wound dehiscence
Rationale: Pulmonary embolism presents with sudden chest pain, dyspnea, tachypnea,
and hemoptysis. Atelectasis causes low-grade fever and crackles; pneumothorax
presents with absent breath sounds; wound dehiscence involves surgical site separation.
4. A client with bipolar disorder is prescribed lithium. Which serum level indicates toxicity?
A) 0.8 mEq/L
B) 1.2 mEq/L
C) 1.8 mEq/L
D) 0.4 mEq/L
Rationale: Therapeutic lithium level is 0.6–1.2 mEq/L. Levels above 1.5 mEq/L are
, potentially toxic; 1.8 mEq/L indicates toxicity with symptoms such as coarse tremor,
ataxia, and confusion.
5. A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about
pursed-lip breathing. What is the primary purpose of this technique?
A) Increase oxygen intake
B) Strengthen diaphragm muscles
C) Prevent airway collapse during exhalation
D) Clear mucus from airways
Rationale: Pursed-lip breathing creates back pressure, keeping small airways open
during exhalation, which helps prevent air trapping. It does not directly strengthen the
diaphragm or clear mucus.
6. A client with schizophrenia tells the nurse, “The FBI is poisoning my food.” Which
response by the nurse is most therapeutic?
A) “That is not true; you are safe here.”
B) “I understand you believe that, but I don’t see any FBI agents.”
C) “It must be frightening to feel that someone wants to harm you.”
D) “Let’s talk about something else.”
Rationale: Acknowledging the client’s feeling without reinforcing the delusion validates
their emotion. Arguing or dismissing increases anxiety. Changing the topic is
nontherapeutic.
7. A nurse is monitoring a client receiving a blood transfusion. Fifteen minutes after
initiation, the client reports chills and low back pain. What is the priority action?
A) Slow the infusion rate
B) Administer acetaminophen
C) Stop the transfusion
D) Notify the provider after flushing the line
Rationale: Chills and back pain suggest an acute hemolytic reaction. The nurse must
stop the transfusion immediately, keep the IV line open with saline, and notify the
provider. Slowing or flushing worsens the reaction.
8. A client with generalized anxiety disorder is prescribed buspirone. Which statement
indicates a need for further teaching?
A) “I can take this medication with food.”
B) “It may take several weeks to feel the full effect.”
C) “I will not drink alcohol while taking this.”
D) “I should feel relief within 30 minutes of taking it.”
Rationale: Buspirone is not a PRN anxiolytic; it requires 2–4 weeks for therapeutic effect.
It does not provide immediate relief like benzodiazepines.
9. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which finding requires
immediate intervention?
A) Serum glucose 350 mg/dL
, B) Serum potassium 2.8 mEq/L
C) Deep, rapid respirations
D) Urine ketones positive
Rationale: Hypokalemia (2.8) in DKA is life-threatening because insulin therapy drives
potassium into cells, risking cardiac dysrhythmias. Hyperglycemia, Kussmaul breathing,
and ketones are expected in DKA.
10. A client with posttraumatic stress disorder (PTSD) reports recurrent nightmares and
avoiding driving after a car accident. Which intervention should the nurse implement
first?
A) Encourage the client to drive short distances
B) Teach relaxation techniques for anxiety
C) Establish a trusting therapeutic relationship
D) Refer for cognitive processing therapy
Rationale: Establishing trust is foundational before any exposure or cognitive therapy.
Without rapport, the client will likely refuse or avoid further interventions.
11. A nurse is assessing a client with cirrhosis. Which finding is most concerning for hepatic
encephalopathy?
A) Spider angiomas
B) Asterixis (liver flap)
C) Palmar erythema
D) Ascites
Rationale: Asterixis is a flapping tremor indicating increased ammonia and early hepatic
encephalopathy. The others are signs of chronic liver disease but not acute neurologic
change.
12. A client with borderline personality disorder has a history of self-cutting. Which
short-term goal is most appropriate?
A) The client will refrain from self-harm for 48 hours.
B) The client will understand the underlying cause of self-harm.
C) The client will agree to no-harm contracts weekly.
D) The client will develop one alternative coping strategy within 1 week.
Rationale: A short-term, measurable, behaviorally focused goal is most realistic.
Long-term insight or contracts without skill building are less effective for BPD.
13. A nurse is providing discharge teaching to a client after a myocardial infarction. Which
statement indicates understanding?
A) “I will avoid all physical activity for 6 weeks.”
B) “I can stop my statin if my cholesterol is normal.”
C) “I will take nitroglycerin for chest pain unrelieved by rest.”
D) “I should expect chest pain with mild exertion.”
Rationale: Nitroglycerin is taken for angina; if unrelieved, emergency care is needed.
, Activity restriction is not complete; statins continue even with normal lipids; chest pain is
not expected.
14. A client with panic disorder is hyperventilating. What is the priority nursing action?
A) Administer oxygen at 2 L/min
B) Have the client breathe into a paper bag
C) Stay with the client and speak calmly
D) Encourage deep, slow breathing
Rationale: Staying with the client provides safety and reduces fear. Encouraging slow,
diaphragmatic breathing helps correct hyperventilation; paper bag use is outdated and
may be dangerous. Oxygen is not indicated.
15. A nurse is assessing a client with acute pancreatitis. Which lab finding is most specific to
this condition?
A) Elevated serum amylase
B) Elevated serum bilirubin
C) Decreased serum calcium
D) Elevated alkaline phosphatase
Rationale: Serum amylase rises within 24 hours of onset and is a sensitive marker for
acute pancreatitis. Bilirubin and alkaline phosphatase suggest biliary obstruction;
hypocalcemia occurs but is not specific.
16. A client with obsessive-compulsive disorder (OCD) spends 3 hours daily washing hands.
Which nursing intervention is most therapeutic?
A) Set a limit that handwashing is allowed only once per hour.
B) Distract the client whenever handwashing begins.
C) Allow time for handwashing initially, then gradually reduce the time.
D) Tell the client that the behavior is irrational.
Rationale: Gradual reduction (response prevention with shaping) is part of exposure
therapy; abrupt stopping increases anxiety. Distraction and confrontation are not
effective.
17. A nurse is caring for a client with acute kidney injury (AKI) in the oliguric phase. Which
finding requires immediate notification of the provider?
A) Serum potassium 6.5 mEq/L
B) Blood urea nitrogen (BUN) 40 mg/dL
C) Urine output 30 mL/hour
D) Weight gain of 1 kg in 24 hours
Rationale: Hyperkalemia (6.5) can cause cardiac arrest and requires emergent
intervention (e.g., insulin, calcium gluconate). Oliguric phase expected BUN elevation
and modest weight gain are managed but not immediately life-threatening.
18. A client with alcohol use disorder is admitted for detoxification. Which medication is the
nurse most likely to administer to prevent seizures and delirium tremens?
A) Naltrexone
Exam Bundle (2023–2025) | NGN Updated
Questins & Answers with Rationales
1. A nurse is assessing a client with heart failure who has been prescribed digoxin. Which
finding is most indicative of digoxin toxicity?
A) Heart rate of 62/min
B) Serum potassium level of 4.0 mEq/L
C) Yellow-tinged vision
D) Dry cough
Rationale: Yellow-tinged (or halos around lights) vision is a classic sign of digoxin
toxicity. Bradycardia can occur but is not as specific. Hypokalemia predisposes to
toxicity, but a level of 4.0 is normal. Dry cough is associated with ACE inhibitors.
2. A client with major depressive disorder is started on phenelzine, an MAOI. Which food
item should the nurse instruct the client to avoid?
A) Broiled chicken
B) Aged cheddar cheese
C) Green beans
D) White rice
Rationale: MAOIs such as phenelzine can cause hypertensive crisis when combined with
tyramine-rich foods (e.g., aged cheeses, cured meats, fermented products). Chicken,
green beans, and rice are low in tyramine.
3. A nurse is caring for a post-op client who develops chest pain, dyspnea, and
hemoptysis. Which complication should the nurse suspect?
A) Atelectasis
B) Pulmonary embolism
C) Pneumothorax
D) Wound dehiscence
Rationale: Pulmonary embolism presents with sudden chest pain, dyspnea, tachypnea,
and hemoptysis. Atelectasis causes low-grade fever and crackles; pneumothorax
presents with absent breath sounds; wound dehiscence involves surgical site separation.
4. A client with bipolar disorder is prescribed lithium. Which serum level indicates toxicity?
A) 0.8 mEq/L
B) 1.2 mEq/L
C) 1.8 mEq/L
D) 0.4 mEq/L
Rationale: Therapeutic lithium level is 0.6–1.2 mEq/L. Levels above 1.5 mEq/L are
, potentially toxic; 1.8 mEq/L indicates toxicity with symptoms such as coarse tremor,
ataxia, and confusion.
5. A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about
pursed-lip breathing. What is the primary purpose of this technique?
A) Increase oxygen intake
B) Strengthen diaphragm muscles
C) Prevent airway collapse during exhalation
D) Clear mucus from airways
Rationale: Pursed-lip breathing creates back pressure, keeping small airways open
during exhalation, which helps prevent air trapping. It does not directly strengthen the
diaphragm or clear mucus.
6. A client with schizophrenia tells the nurse, “The FBI is poisoning my food.” Which
response by the nurse is most therapeutic?
A) “That is not true; you are safe here.”
B) “I understand you believe that, but I don’t see any FBI agents.”
C) “It must be frightening to feel that someone wants to harm you.”
D) “Let’s talk about something else.”
Rationale: Acknowledging the client’s feeling without reinforcing the delusion validates
their emotion. Arguing or dismissing increases anxiety. Changing the topic is
nontherapeutic.
7. A nurse is monitoring a client receiving a blood transfusion. Fifteen minutes after
initiation, the client reports chills and low back pain. What is the priority action?
A) Slow the infusion rate
B) Administer acetaminophen
C) Stop the transfusion
D) Notify the provider after flushing the line
Rationale: Chills and back pain suggest an acute hemolytic reaction. The nurse must
stop the transfusion immediately, keep the IV line open with saline, and notify the
provider. Slowing or flushing worsens the reaction.
8. A client with generalized anxiety disorder is prescribed buspirone. Which statement
indicates a need for further teaching?
A) “I can take this medication with food.”
B) “It may take several weeks to feel the full effect.”
C) “I will not drink alcohol while taking this.”
D) “I should feel relief within 30 minutes of taking it.”
Rationale: Buspirone is not a PRN anxiolytic; it requires 2–4 weeks for therapeutic effect.
It does not provide immediate relief like benzodiazepines.
9. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which finding requires
immediate intervention?
A) Serum glucose 350 mg/dL
, B) Serum potassium 2.8 mEq/L
C) Deep, rapid respirations
D) Urine ketones positive
Rationale: Hypokalemia (2.8) in DKA is life-threatening because insulin therapy drives
potassium into cells, risking cardiac dysrhythmias. Hyperglycemia, Kussmaul breathing,
and ketones are expected in DKA.
10. A client with posttraumatic stress disorder (PTSD) reports recurrent nightmares and
avoiding driving after a car accident. Which intervention should the nurse implement
first?
A) Encourage the client to drive short distances
B) Teach relaxation techniques for anxiety
C) Establish a trusting therapeutic relationship
D) Refer for cognitive processing therapy
Rationale: Establishing trust is foundational before any exposure or cognitive therapy.
Without rapport, the client will likely refuse or avoid further interventions.
11. A nurse is assessing a client with cirrhosis. Which finding is most concerning for hepatic
encephalopathy?
A) Spider angiomas
B) Asterixis (liver flap)
C) Palmar erythema
D) Ascites
Rationale: Asterixis is a flapping tremor indicating increased ammonia and early hepatic
encephalopathy. The others are signs of chronic liver disease but not acute neurologic
change.
12. A client with borderline personality disorder has a history of self-cutting. Which
short-term goal is most appropriate?
A) The client will refrain from self-harm for 48 hours.
B) The client will understand the underlying cause of self-harm.
C) The client will agree to no-harm contracts weekly.
D) The client will develop one alternative coping strategy within 1 week.
Rationale: A short-term, measurable, behaviorally focused goal is most realistic.
Long-term insight or contracts without skill building are less effective for BPD.
13. A nurse is providing discharge teaching to a client after a myocardial infarction. Which
statement indicates understanding?
A) “I will avoid all physical activity for 6 weeks.”
B) “I can stop my statin if my cholesterol is normal.”
C) “I will take nitroglycerin for chest pain unrelieved by rest.”
D) “I should expect chest pain with mild exertion.”
Rationale: Nitroglycerin is taken for angina; if unrelieved, emergency care is needed.
, Activity restriction is not complete; statins continue even with normal lipids; chest pain is
not expected.
14. A client with panic disorder is hyperventilating. What is the priority nursing action?
A) Administer oxygen at 2 L/min
B) Have the client breathe into a paper bag
C) Stay with the client and speak calmly
D) Encourage deep, slow breathing
Rationale: Staying with the client provides safety and reduces fear. Encouraging slow,
diaphragmatic breathing helps correct hyperventilation; paper bag use is outdated and
may be dangerous. Oxygen is not indicated.
15. A nurse is assessing a client with acute pancreatitis. Which lab finding is most specific to
this condition?
A) Elevated serum amylase
B) Elevated serum bilirubin
C) Decreased serum calcium
D) Elevated alkaline phosphatase
Rationale: Serum amylase rises within 24 hours of onset and is a sensitive marker for
acute pancreatitis. Bilirubin and alkaline phosphatase suggest biliary obstruction;
hypocalcemia occurs but is not specific.
16. A client with obsessive-compulsive disorder (OCD) spends 3 hours daily washing hands.
Which nursing intervention is most therapeutic?
A) Set a limit that handwashing is allowed only once per hour.
B) Distract the client whenever handwashing begins.
C) Allow time for handwashing initially, then gradually reduce the time.
D) Tell the client that the behavior is irrational.
Rationale: Gradual reduction (response prevention with shaping) is part of exposure
therapy; abrupt stopping increases anxiety. Distraction and confrontation are not
effective.
17. A nurse is caring for a client with acute kidney injury (AKI) in the oliguric phase. Which
finding requires immediate notification of the provider?
A) Serum potassium 6.5 mEq/L
B) Blood urea nitrogen (BUN) 40 mg/dL
C) Urine output 30 mL/hour
D) Weight gain of 1 kg in 24 hours
Rationale: Hyperkalemia (6.5) can cause cardiac arrest and requires emergent
intervention (e.g., insulin, calcium gluconate). Oliguric phase expected BUN elevation
and modest weight gain are managed but not immediately life-threatening.
18. A client with alcohol use disorder is admitted for detoxification. Which medication is the
nurse most likely to administer to prevent seizures and delirium tremens?
A) Naltrexone
