ATI Fundamentals Proctored Exam Prep – Real Practice Questions, Answers &
Detailed Rationales (Updated 2026) | Nursing Fundamentals, Infection
Control & Patient Safety, Vital Signs & Health Assessment, Basic Nursing Skills,
Hygiene & Mobility Care, Documentation & Therapeutic Communication, Medication
Administration Basics, Prioritization, Delegation & NCLEX-Style Clinical Judgment
Question 1: A nurse is caring for a client who has just returned from surgery. Which
assessment finding requires immediate intervention?
A. Blood pressure of 110/70 mm Hg
B. Respiratory rate of 18 breaths per minute
C. Oxygen saturation of 92% on room air
D. Pain rating of 4 on a scale of 0 to 10
CORRECT ANSWER: C. Oxygen saturation of 92% on room air
Rationale: An oxygen saturation level below 95% (or below the client’s baseline)
indicates hypoxemia and requires immediate intervention, such as administering
supplemental oxygen and assessing airway patency. The other findings are within
normal limits or expected post-operatively.
Question 2: A nurse is preparing to administer insulin glargine to a client with type 1
diabetes. Which action should the nurse take?
A. Mix the insulin glargine with regular insulin in the same syringe
B. Administer the insulin glargine at the same time every day
C. Shake the vial vigorously before drawing up the dose
D. Administer the insulin glargine only when blood glucose is above 200 mg/dL
CORRECT ANSWER: B. Administer the insulin glargine at the same time every day
Rationale: Insulin glargine is a long-acting insulin that provides a steady level of insulin
over 24 hours. It must be administered at the same time each day to maintain
consistent blood glucose control. It should not be mixed with other insulins, shaken, or
used as a sliding scale alone.
Question 3: A nurse is teaching a client about proper use of an incentive
spirometer. Which statement by the client indicates understanding?
A. "I should exhale forcefully into the mouthpiece."
B. "I should hold my breath for 5 seconds after inhaling."
C. "I should use the device only when I feel short of breath."
D. "I should keep the indicator between the two marks while inhaling."
CORRECT ANSWER: B. "I should hold my breath for 5 seconds after inhaling."
Rationale: Holding the breath for 3 to 5 seconds after maximal inhalation helps keep the
alveoli open and prevents atelectasis. Exhaling should be done slowly through the
mouthpiece or after removing it, not forcefully into it. The device should be used
regularly, not just when symptomatic.
,Question 4: A nurse is assessing a client with heart failure. Which finding indicates
right-sided heart failure?
A. Crackles in the lung bases
B. Jugular vein distention
C. Orthopnea
D. Dry, hacking cough
CORRECT ANSWER: B. Jugular vein distention
Rationale: Right-sided heart failure results in systemic venous congestion, leading to
jugular vein distention, peripheral edema, and hepatomegaly. Crackles, orthopnea, and
dry cough are signs of left-sided heart failure, which causes pulmonary congestion.
Question 5: A nurse is caring for a client receiving total parenteral nutrition (TPN).
Which action is priority?
A. Monitor blood glucose levels every 6 hours
B. Change the TPN tubing every 72 hours
C. Weigh the client daily
D. Assess the insertion site for redness
CORRECT ANSWER: A. Monitor blood glucose levels every 6 hours
Rationale: TPN solutions contain high concentrations of dextrose, placing the client at
high risk for hyperglycemia. Monitoring blood glucose is a priority to prevent
complications. While tubing changes, weighing, and site assessment are important,
glucose monitoring is critical for immediate safety.
Question 6: A nurse is preparing to insert an indwelling urinary catheter in a female
client. Which action is correct?
A. Inflate the balloon before inserting the catheter
B. Insert the catheter 2 to 3 inches until urine flows
C. Use sterile technique throughout the procedure
D. Cleanse the meatus from back to front
CORRECT ANSWER: C. Use sterile technique throughout the procedure
Rationale: Insertion of an indwelling urinary catheter is a sterile procedure to prevent
infection. For females, the catheter is inserted 2 to 3 inches, but if no urine flows, it may
need to go further (up to 5-7 cm). The balloon is inflated only after urine return is seen.
Cleansing should be from front to back.
Question 7: A client is prescribed warfarin. Which laboratory value should the
nurse monitor to determine therapeutic effectiveness?
A. Partial thromboplastin time (PTT)
B. International Normalized Ratio (INR)
,C. Platelet count
D. Hemoglobin
CORRECT ANSWER: B. International Normalized Ratio (INR)
Rationale: Warfarin affects the extrinsic pathway of coagulation, measured by the
Prothrombin Time (PT) and standardized as the INR. The therapeutic INR range is
typically 2.0 to 3.0. PTT is used to monitor heparin therapy.
Question 8: A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD). Which oxygen delivery method is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Nasal cannula at 2 L/min
D. Venturi mask at 10 L/min
CORRECT ANSWER: C. Nasal cannula at 2 L/min
Rationale: Clients with COPD often rely on hypoxic drive to stimulate breathing. High
concentrations of oxygen can suppress this drive, leading to respiratory arrest. Low-flow
oxygen via nasal cannula (1-2 L/min) is safest to maintain SpO2 around 88-92%.
Question 9: A nurse is assessing a client for signs of dehydration. Which finding is
expected?
A. Bradycardia
B. Hypertension
C. Tenting of skin turgor
D. Increased urine output
CORRECT ANSWER: C. Tenting of skin turgor
Rationale: Dehydration leads to fluid volume deficit, causing poor skin turgor (tenting),
tachycardia, hypotension, and decreased urine output with concentrated urine.
Bradycardia and hypertension are not associated with dehydration.
Question 10: A nurse is teaching a client about digoxin toxicity. Which symptom
should the client report immediately?
A. Increased appetite
B. Yellow halos around lights
C. Dry mouth
D. Frequent urination
CORRECT ANSWER: B. Yellow halos around lights
Rationale: Visual disturbances, such as seeing yellow or green halos around lights, are
classic signs of digoxin toxicity. Other signs include nausea, vomiting, bradycardia, and
confusion. Increased appetite and dry mouth are not typical signs of toxicity.
, Question 11: A nurse is caring for a client with a nasogastric (NG) tube connected to
low intermittent suction. The client complains of nausea. What is the nurse’s first
action?
A. Administer an antiemetic
B. Irrigate the NG tube with normal saline
C. Check the patency of the NG tube
D. Increase the suction pressure
CORRECT ANSWER: C. Check the patency of the NG tube
Rationale: Nausea in a client with an NG tube suggests the tube may be clogged or
displaced, preventing gastric decompression. The nurse should first check for patency
by aspirating contents or irrigating. Increasing suction can damage mucosa, and
antiemetics do not address the underlying mechanical issue.
Question 12: Which action by the nurse demonstrates proper body mechanics
when lifting a client?
A. Bending at the waist
B. Keeping the feet close together
C. Holding the client away from the body
D. Using leg muscles to lift
CORRECT ANSWER: D. Using leg muscles to lift
Rationale: Proper body mechanics involve widening the stance, bending at the knees
(not the waist), keeping the load close to the center of gravity, and using the strong leg
muscles to lift. This prevents back injury.
Question 13: A nurse is caring for a client with a potassium level of 6.5 mEq/L.
Which ECG change is expected?
A. U waves
B. Tall, peaked T waves
C. ST segment depression
D. Prolonged QT interval
CORRECT ANSWER: B. Tall, peaked T waves
Rationale: Hyperkalemia (high potassium) causes tall, peaked T waves, widened QRS
complexes, and flattened P waves on an ECG. U waves and ST depression are
associated with hypokalemia.
Question 14: A nurse is preparing to administer a unit of packed red blood cells
(PRBCs). Which solution should be used to prime the tubing?
A. Lactated Ringer’s
B. Dextrose 5% in water
Detailed Rationales (Updated 2026) | Nursing Fundamentals, Infection
Control & Patient Safety, Vital Signs & Health Assessment, Basic Nursing Skills,
Hygiene & Mobility Care, Documentation & Therapeutic Communication, Medication
Administration Basics, Prioritization, Delegation & NCLEX-Style Clinical Judgment
Question 1: A nurse is caring for a client who has just returned from surgery. Which
assessment finding requires immediate intervention?
A. Blood pressure of 110/70 mm Hg
B. Respiratory rate of 18 breaths per minute
C. Oxygen saturation of 92% on room air
D. Pain rating of 4 on a scale of 0 to 10
CORRECT ANSWER: C. Oxygen saturation of 92% on room air
Rationale: An oxygen saturation level below 95% (or below the client’s baseline)
indicates hypoxemia and requires immediate intervention, such as administering
supplemental oxygen and assessing airway patency. The other findings are within
normal limits or expected post-operatively.
Question 2: A nurse is preparing to administer insulin glargine to a client with type 1
diabetes. Which action should the nurse take?
A. Mix the insulin glargine with regular insulin in the same syringe
B. Administer the insulin glargine at the same time every day
C. Shake the vial vigorously before drawing up the dose
D. Administer the insulin glargine only when blood glucose is above 200 mg/dL
CORRECT ANSWER: B. Administer the insulin glargine at the same time every day
Rationale: Insulin glargine is a long-acting insulin that provides a steady level of insulin
over 24 hours. It must be administered at the same time each day to maintain
consistent blood glucose control. It should not be mixed with other insulins, shaken, or
used as a sliding scale alone.
Question 3: A nurse is teaching a client about proper use of an incentive
spirometer. Which statement by the client indicates understanding?
A. "I should exhale forcefully into the mouthpiece."
B. "I should hold my breath for 5 seconds after inhaling."
C. "I should use the device only when I feel short of breath."
D. "I should keep the indicator between the two marks while inhaling."
CORRECT ANSWER: B. "I should hold my breath for 5 seconds after inhaling."
Rationale: Holding the breath for 3 to 5 seconds after maximal inhalation helps keep the
alveoli open and prevents atelectasis. Exhaling should be done slowly through the
mouthpiece or after removing it, not forcefully into it. The device should be used
regularly, not just when symptomatic.
,Question 4: A nurse is assessing a client with heart failure. Which finding indicates
right-sided heart failure?
A. Crackles in the lung bases
B. Jugular vein distention
C. Orthopnea
D. Dry, hacking cough
CORRECT ANSWER: B. Jugular vein distention
Rationale: Right-sided heart failure results in systemic venous congestion, leading to
jugular vein distention, peripheral edema, and hepatomegaly. Crackles, orthopnea, and
dry cough are signs of left-sided heart failure, which causes pulmonary congestion.
Question 5: A nurse is caring for a client receiving total parenteral nutrition (TPN).
Which action is priority?
A. Monitor blood glucose levels every 6 hours
B. Change the TPN tubing every 72 hours
C. Weigh the client daily
D. Assess the insertion site for redness
CORRECT ANSWER: A. Monitor blood glucose levels every 6 hours
Rationale: TPN solutions contain high concentrations of dextrose, placing the client at
high risk for hyperglycemia. Monitoring blood glucose is a priority to prevent
complications. While tubing changes, weighing, and site assessment are important,
glucose monitoring is critical for immediate safety.
Question 6: A nurse is preparing to insert an indwelling urinary catheter in a female
client. Which action is correct?
A. Inflate the balloon before inserting the catheter
B. Insert the catheter 2 to 3 inches until urine flows
C. Use sterile technique throughout the procedure
D. Cleanse the meatus from back to front
CORRECT ANSWER: C. Use sterile technique throughout the procedure
Rationale: Insertion of an indwelling urinary catheter is a sterile procedure to prevent
infection. For females, the catheter is inserted 2 to 3 inches, but if no urine flows, it may
need to go further (up to 5-7 cm). The balloon is inflated only after urine return is seen.
Cleansing should be from front to back.
Question 7: A client is prescribed warfarin. Which laboratory value should the
nurse monitor to determine therapeutic effectiveness?
A. Partial thromboplastin time (PTT)
B. International Normalized Ratio (INR)
,C. Platelet count
D. Hemoglobin
CORRECT ANSWER: B. International Normalized Ratio (INR)
Rationale: Warfarin affects the extrinsic pathway of coagulation, measured by the
Prothrombin Time (PT) and standardized as the INR. The therapeutic INR range is
typically 2.0 to 3.0. PTT is used to monitor heparin therapy.
Question 8: A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD). Which oxygen delivery method is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Nasal cannula at 2 L/min
D. Venturi mask at 10 L/min
CORRECT ANSWER: C. Nasal cannula at 2 L/min
Rationale: Clients with COPD often rely on hypoxic drive to stimulate breathing. High
concentrations of oxygen can suppress this drive, leading to respiratory arrest. Low-flow
oxygen via nasal cannula (1-2 L/min) is safest to maintain SpO2 around 88-92%.
Question 9: A nurse is assessing a client for signs of dehydration. Which finding is
expected?
A. Bradycardia
B. Hypertension
C. Tenting of skin turgor
D. Increased urine output
CORRECT ANSWER: C. Tenting of skin turgor
Rationale: Dehydration leads to fluid volume deficit, causing poor skin turgor (tenting),
tachycardia, hypotension, and decreased urine output with concentrated urine.
Bradycardia and hypertension are not associated with dehydration.
Question 10: A nurse is teaching a client about digoxin toxicity. Which symptom
should the client report immediately?
A. Increased appetite
B. Yellow halos around lights
C. Dry mouth
D. Frequent urination
CORRECT ANSWER: B. Yellow halos around lights
Rationale: Visual disturbances, such as seeing yellow or green halos around lights, are
classic signs of digoxin toxicity. Other signs include nausea, vomiting, bradycardia, and
confusion. Increased appetite and dry mouth are not typical signs of toxicity.
, Question 11: A nurse is caring for a client with a nasogastric (NG) tube connected to
low intermittent suction. The client complains of nausea. What is the nurse’s first
action?
A. Administer an antiemetic
B. Irrigate the NG tube with normal saline
C. Check the patency of the NG tube
D. Increase the suction pressure
CORRECT ANSWER: C. Check the patency of the NG tube
Rationale: Nausea in a client with an NG tube suggests the tube may be clogged or
displaced, preventing gastric decompression. The nurse should first check for patency
by aspirating contents or irrigating. Increasing suction can damage mucosa, and
antiemetics do not address the underlying mechanical issue.
Question 12: Which action by the nurse demonstrates proper body mechanics
when lifting a client?
A. Bending at the waist
B. Keeping the feet close together
C. Holding the client away from the body
D. Using leg muscles to lift
CORRECT ANSWER: D. Using leg muscles to lift
Rationale: Proper body mechanics involve widening the stance, bending at the knees
(not the waist), keeping the load close to the center of gravity, and using the strong leg
muscles to lift. This prevents back injury.
Question 13: A nurse is caring for a client with a potassium level of 6.5 mEq/L.
Which ECG change is expected?
A. U waves
B. Tall, peaked T waves
C. ST segment depression
D. Prolonged QT interval
CORRECT ANSWER: B. Tall, peaked T waves
Rationale: Hyperkalemia (high potassium) causes tall, peaked T waves, widened QRS
complexes, and flattened P waves on an ECG. U waves and ST depression are
associated with hypokalemia.
Question 14: A nurse is preparing to administer a unit of packed red blood cells
(PRBCs). Which solution should be used to prime the tubing?
A. Lactated Ringer’s
B. Dextrose 5% in water
