ATI CRITICAL THINKING EXAM| 2025/2026
COMPLETE QUESTIONS WITH CORRECT
DETAILED ANSWERS
Key test-taking strategies for ATI Critical Thinking: Always apply ABCs, Maslow's hierarchy,
and safety first. Prioritize actual problems over potential problems. Remember delegation rules:
RNs assess, teach, and manage unstable clients. When in doubt — assess before implementing.
Good luck!
DOMAIN 1: NURSING PROCESS — ASSESSMENT
1. A nurse is caring for a client with heart failure who reports sudden onset of severe dyspnea
and pink frothy sputum. What is the nurse's priority action?
A. Administer prescribed oral furosemide
B. Place the client in high Fowler's position and notify the provider immediately
(correct answer)
C. Obtain a 12-lead ECG
D. Increase the IV fluid rate
RATIONALE: Sudden severe dyspnea with pink frothy sputum indicates acute pulmonary
edema — a life-threatening emergency. High Fowler's position reduces venous return and
improves breathing. Notifying the provider immediately is critical. Increasing IV fluids
would worsen fluid overload. This is a priority airway and breathing emergency.
2. A nurse is assessing a post-operative client 4 hours after abdominal surgery. Which finding
requires immediate intervention?
, A. Pain level of 5/10 at the incision site
B. Urine output of 35 mL/hour
C. Respiratory rate of 8 breaths per minute (correct answer)
D. Temperature of 37.8°C (100°F)
RATIONALE: A respiratory rate of 8 breaths per minute is critically low (normal 12-20
breaths/min) and may indicate opioid-induced respiratory depression — a life-threatening
emergency requiring immediate intervention. Airway and breathing (ABCs) always take
priority. The other findings warrant monitoring but are not immediately life-threatening.
3. A nurse is caring for a client receiving a blood transfusion who develops chills, back pain, and
hemoglobinuria 15 minutes into the transfusion. What is the priority nursing action?
A. Slow the transfusion rate to 25 mL/hour
B. Administer diphenhydramine IV
C. Stop the transfusion immediately and maintain IV access with normal saline
(correct answer)
D. Notify the blood bank
RATIONALE: These symptoms (chills, back pain, hemoglobinuria) indicate an acute
hemolytic transfusion reaction — the most dangerous type, potentially fatal. The
transfusion must be stopped IMMEDIATELY. IV access is maintained with NS (not the
blood tubing) to provide emergency treatment. Slowing the rate is never appropriate for a
hemolytic reaction.
4. A nurse is assessing a client with diabetes mellitus who reports shakiness, diaphoresis, and
confusion. The client's blood glucose is 48 mg/dL. What is the priority intervention?
A. Administer glucagon IM
B. Call the provider for insulin orders
, C. Give 15 grams of fast-acting carbohydrate orally if the client can swallow safely
(correct answer)
D. Prepare an IV dextrose infusion
RATIONALE: The client shows signs of hypoglycemia (blood glucose 48 mg/dL). The Rule
of 15 applies: give 15g fast-acting carbohydrate (4 oz juice, glucose tablets) if the client is
conscious and can swallow safely. IV dextrose (D50W) is used for unconscious clients.
Administering insulin would worsen hypoglycemia. Oral treatment is first-line for
conscious, swallowing-capable clients.
5. A nurse receives a shift report on four clients. Which client should the nurse assess first?
A. A client with COPD whose oxygen saturation is 90% on 2L nasal cannula
B. A client with a head injury whose level of consciousness has decreased in the past
hour (correct answer)
C. A client with a hip fracture who is requesting pain medication
D. A client post-appendectomy reporting incisional pain of 6/10
RATIONALE: A decreasing level of consciousness in a head injury client indicates possible
increasing intracranial pressure (ICP) — a neurological emergency requiring immediate
assessment. Changes in neurological status represent acute deterioration. The COPD
client's SpO2 of 90% is acceptable for COPD (target 88-92%). Pain management and
stable post-operative clients are lower priority.
6. A nurse is assessing a client admitted with chest pain. Which assessment finding is most
important to report to the provider immediately?
A. Blood pressure of 138/88 mmHg
B. Heart rate of 92 beats per minute
C. ST-segment elevation on the 12-lead ECG (correct answer)
, D. Serum cholesterol of 210 mg/dL
RATIONALE: ST-segment elevation is a hallmark of ST-Elevation Myocardial Infarction
(STEMI) — a cardiac emergency requiring immediate intervention (PCI or thrombolytics)
to restore coronary perfusion. Time is muscle in MI — every minute of delay increases
myocardial damage. Elevated BP and mild tachycardia require monitoring but not
immediate emergency response.
7. A nurse is assessing a client who is 8 hours postpartum. Which finding requires immediate
intervention?
A. Uterine fundus firm at the umbilicus
B. Lochia rubra with small clots
C. Uterine fundus boggy and displaced to the right with saturating perineal pad
every 15 minutes (correct answer)
D. Moderate perineal edema
RATIONALE: A boggy, displaced uterus with heavy bleeding indicates uterine atony with
possible bladder distension — a leading cause of postpartum hemorrhage. The nurse must
immediately massage the fundus, have the client void, and notify the provider. Saturation
of a pad every 15 minutes represents hemorrhage. Firm fundus at umbilicus and rubra
lochia with small clots are expected normal findings.
8. A nurse is assessing a client with a suspected pulmonary embolism. Which finding is most
consistent with this diagnosis?
A. Bilateral crackles in the lung bases
B. Sudden onset of dyspnea, tachycardia, and pleuritic chest pain (correct answer)
C. Productive cough with yellow sputum
D. Gradual onset of exertional dyspnea over weeks
COMPLETE QUESTIONS WITH CORRECT
DETAILED ANSWERS
Key test-taking strategies for ATI Critical Thinking: Always apply ABCs, Maslow's hierarchy,
and safety first. Prioritize actual problems over potential problems. Remember delegation rules:
RNs assess, teach, and manage unstable clients. When in doubt — assess before implementing.
Good luck!
DOMAIN 1: NURSING PROCESS — ASSESSMENT
1. A nurse is caring for a client with heart failure who reports sudden onset of severe dyspnea
and pink frothy sputum. What is the nurse's priority action?
A. Administer prescribed oral furosemide
B. Place the client in high Fowler's position and notify the provider immediately
(correct answer)
C. Obtain a 12-lead ECG
D. Increase the IV fluid rate
RATIONALE: Sudden severe dyspnea with pink frothy sputum indicates acute pulmonary
edema — a life-threatening emergency. High Fowler's position reduces venous return and
improves breathing. Notifying the provider immediately is critical. Increasing IV fluids
would worsen fluid overload. This is a priority airway and breathing emergency.
2. A nurse is assessing a post-operative client 4 hours after abdominal surgery. Which finding
requires immediate intervention?
, A. Pain level of 5/10 at the incision site
B. Urine output of 35 mL/hour
C. Respiratory rate of 8 breaths per minute (correct answer)
D. Temperature of 37.8°C (100°F)
RATIONALE: A respiratory rate of 8 breaths per minute is critically low (normal 12-20
breaths/min) and may indicate opioid-induced respiratory depression — a life-threatening
emergency requiring immediate intervention. Airway and breathing (ABCs) always take
priority. The other findings warrant monitoring but are not immediately life-threatening.
3. A nurse is caring for a client receiving a blood transfusion who develops chills, back pain, and
hemoglobinuria 15 minutes into the transfusion. What is the priority nursing action?
A. Slow the transfusion rate to 25 mL/hour
B. Administer diphenhydramine IV
C. Stop the transfusion immediately and maintain IV access with normal saline
(correct answer)
D. Notify the blood bank
RATIONALE: These symptoms (chills, back pain, hemoglobinuria) indicate an acute
hemolytic transfusion reaction — the most dangerous type, potentially fatal. The
transfusion must be stopped IMMEDIATELY. IV access is maintained with NS (not the
blood tubing) to provide emergency treatment. Slowing the rate is never appropriate for a
hemolytic reaction.
4. A nurse is assessing a client with diabetes mellitus who reports shakiness, diaphoresis, and
confusion. The client's blood glucose is 48 mg/dL. What is the priority intervention?
A. Administer glucagon IM
B. Call the provider for insulin orders
, C. Give 15 grams of fast-acting carbohydrate orally if the client can swallow safely
(correct answer)
D. Prepare an IV dextrose infusion
RATIONALE: The client shows signs of hypoglycemia (blood glucose 48 mg/dL). The Rule
of 15 applies: give 15g fast-acting carbohydrate (4 oz juice, glucose tablets) if the client is
conscious and can swallow safely. IV dextrose (D50W) is used for unconscious clients.
Administering insulin would worsen hypoglycemia. Oral treatment is first-line for
conscious, swallowing-capable clients.
5. A nurse receives a shift report on four clients. Which client should the nurse assess first?
A. A client with COPD whose oxygen saturation is 90% on 2L nasal cannula
B. A client with a head injury whose level of consciousness has decreased in the past
hour (correct answer)
C. A client with a hip fracture who is requesting pain medication
D. A client post-appendectomy reporting incisional pain of 6/10
RATIONALE: A decreasing level of consciousness in a head injury client indicates possible
increasing intracranial pressure (ICP) — a neurological emergency requiring immediate
assessment. Changes in neurological status represent acute deterioration. The COPD
client's SpO2 of 90% is acceptable for COPD (target 88-92%). Pain management and
stable post-operative clients are lower priority.
6. A nurse is assessing a client admitted with chest pain. Which assessment finding is most
important to report to the provider immediately?
A. Blood pressure of 138/88 mmHg
B. Heart rate of 92 beats per minute
C. ST-segment elevation on the 12-lead ECG (correct answer)
, D. Serum cholesterol of 210 mg/dL
RATIONALE: ST-segment elevation is a hallmark of ST-Elevation Myocardial Infarction
(STEMI) — a cardiac emergency requiring immediate intervention (PCI or thrombolytics)
to restore coronary perfusion. Time is muscle in MI — every minute of delay increases
myocardial damage. Elevated BP and mild tachycardia require monitoring but not
immediate emergency response.
7. A nurse is assessing a client who is 8 hours postpartum. Which finding requires immediate
intervention?
A. Uterine fundus firm at the umbilicus
B. Lochia rubra with small clots
C. Uterine fundus boggy and displaced to the right with saturating perineal pad
every 15 minutes (correct answer)
D. Moderate perineal edema
RATIONALE: A boggy, displaced uterus with heavy bleeding indicates uterine atony with
possible bladder distension — a leading cause of postpartum hemorrhage. The nurse must
immediately massage the fundus, have the client void, and notify the provider. Saturation
of a pad every 15 minutes represents hemorrhage. Firm fundus at umbilicus and rubra
lochia with small clots are expected normal findings.
8. A nurse is assessing a client with a suspected pulmonary embolism. Which finding is most
consistent with this diagnosis?
A. Bilateral crackles in the lung bases
B. Sudden onset of dyspnea, tachycardia, and pleuritic chest pain (correct answer)
C. Productive cough with yellow sputum
D. Gradual onset of exertional dyspnea over weeks
