ATI PN EXIT Exam 2026 Master Review |
Nursing Study Guide | NCLEX PN Prep | Digital,
Exams of Nursing
Section 1: Management of Care (Questions 1-90)
1. A charge nurse is assigning staff for the shift. Which client should be assigned to an
RN rather than a PN (LPN)?
A) A client with stable CHF receiving daily Lasix
B) A client requiring a blood transfusion for symptomatic anemia
C) A client with a new diagnosis of diabetes needing insulin instruction
D) A client with a PEG tube requiring intermittent feedings
Answer: C
Rationale: Client education (specifically initial instruction) falls under the scope of the
RN, as it requires complex assessment and evaluation of learning. PNs can reinforce
teaching but cannot perform initial patient teaching. Hanging blood requires RN
monitoring, but stable clients with PEG feedings or stable CHF are within PN scope .
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A) A post-op day 2 client requesting pain medication for 4/10 pain
B) *A client with COPD with a new onset of confusion and BP 88/50*
C) A client with diabetes requesting a PRN snack due to hunger
D) A client with a fractured tibia asking for help to the bathroom
Answer: B
Rationale: New onset confusion combined with hypotension is a classic sign of shock
(sepsis, hemorrhage, or dehydration). This represents a change in neurological status
and hemodynamic instability, which is the priority. Airway, breathing, and circulation
(ABCs) come first .
3. A nurse is planning care for a client who is scheduled for a surgical procedure. Which
of the following actions is the priority?
A) Ensure the client has signed the informed consent form
B) Review the client's laboratory results
,C) Verify the client's allergies
D) Administer preoperative medication as prescribed
Answer: A
Rationale: Informed consent is a legal requirement before any invasive procedure. The
nurse's priority is to ensure consent is signed and witnessed, as failure to do so could
result in legal liability and cancellation of the procedure. The nurse does not obtain
consent but verifies it is present .
4. A PN is caring for four clients. Which client should the PN assess FIRST?
A) Post-op day 2 client requesting pain medication for 4/10 pain
B) *Client with COPD with new onset of confusion and BP 88/50*
C) Client with diabetes requesting PRN snack due to hunger
D) Client with fractured tibia asking for help to the bathroom
Answer: B
Rationale: New onset confusion plus hypotension indicates potential shock or hypoxia.
This represents an acute change in neurological status and hemodynamic instability.
The ABCs (airway, breathing, circulation) framework prioritizes this client .
5. A nurse is delegating tasks to an assistive personnel (AP). Which of the following
tasks is appropriate for the nurse to delegate?
A) Administering an enema
B) Inserting an indwelling urinary catheter
C) Measuring a client's vital signs
D) Teaching a client how to use an incentive spirometer
Answer: C
Rationale: Measuring vital signs is within the AP's scope of practice. The RN cannot
delegate tasks requiring nursing judgment, sterile technique (catheter insertion), or
client education .
6. A nurse is preparing a client for transfer to a long-term care facility. Which of the
following information should the nurse include in the transfer report? (Select all that
apply)
☐ A) The client's advance directive status
☐ B) The client's recent laboratory values
☐ C) The client's current medications
,☐ D) The client's preferred activities
☐ E) All of the above
Answer: E
Rationale: A comprehensive transfer report should include advance directive status,
recent lab values, current medications, and preferred activities to ensure continuity of
care and respect for the client's wishes .
7. A nurse is caring for a client who is being discharged with a prescription for warfarin.
Which of the following instructions should the nurse include?
A) "Take ibuprofen for mild pain"
B) "Increase your intake of green leafy vegetables"
C) "Notify your provider if you notice bleeding gums"
D) "You can stop taking the medication if you feel well"
Answer: C
Rationale: Bleeding gums, easy bruising, dark tarry stools, or hematuria are signs of
excessive anticoagulation and should be reported immediately. Ibuprofen increases
bleeding risk. Green leafy vegetables contain vitamin K, which antagonizes warfarin .
8. A nurse is admitting a client who has a history of falls. Which of the following
interventions is the priority?
A) Place a fall risk identification wristband on the client
B) Instruct the client to call for assistance before getting out of bed
C) Ensure the bed alarm is functioning
D) Keep the client's personal belongings within reach
Answer: B
Rationale: Instructing the client to call for assistance is the most direct and proactive
intervention to prevent falls. While other measures are important, client education and
engagement is the priority .
9. A nurse is caring for a client who is receiving continuous enteral feedings through a
nasogastric tube. Which of the following actions should the nurse take to prevent
aspiration?
A) Flush the tube with 30 mL of water every 4 hours
B) *Elevate the head of the bed to 30-45 degrees*
, C) Check gastric residual volume every 2 hours
D) Change the feeding bag every 24 hours
Answer: B
*Rationale: Elevating the head of the bed to 30-45 degrees is the most effective
intervention to prevent aspiration during enteral feedings. This uses gravity to keep
gastric contents in the stomach .*
10. A nurse is preparing to administer a blood transfusion to a client. Which of the
following actions is most important to take prior to starting the transfusion?
A) Verify the client's blood type with a second nurse
B) Assess the client's baseline vital signs
C) Obtain the client's signed consent for the transfusion
D) Prime the blood tubing with normal saline
Answer: A
Rationale: Verification of blood type and client identification with a second licensed
nurse is the most critical safety step to prevent ABO incompatibility, which can be fatal .
11. A nurse is caring for a client who is post-operative following a total knee
replacement. The client refuses to use the patient-controlled analgesia (PCA) pump
because "I don't want to become addicted." Which of the following responses by the
nurse is appropriate?
A) "You have a right to refuse pain medication, but you will be in pain"
B) "Addiction rarely occurs when pain medication is used appropriately for acute pain"
C) "I will call the provider to change your prescription to oral medication"
D) "You should try to bear the pain without medication"
Answer: B
Rationale: The nurse should provide accurate information about pain management and
addiction risk. Addiction is rare with short-term use for acute pain. The nurse should
address the client's concern without being dismissive .
12. A nurse is reviewing a client's informed consent for a surgical procedure. Which of
the following clients is capable of giving informed consent?
A) A 17-year-old client who is married
B) A client who is under the influence of narcotic pain medication
Nursing Study Guide | NCLEX PN Prep | Digital,
Exams of Nursing
Section 1: Management of Care (Questions 1-90)
1. A charge nurse is assigning staff for the shift. Which client should be assigned to an
RN rather than a PN (LPN)?
A) A client with stable CHF receiving daily Lasix
B) A client requiring a blood transfusion for symptomatic anemia
C) A client with a new diagnosis of diabetes needing insulin instruction
D) A client with a PEG tube requiring intermittent feedings
Answer: C
Rationale: Client education (specifically initial instruction) falls under the scope of the
RN, as it requires complex assessment and evaluation of learning. PNs can reinforce
teaching but cannot perform initial patient teaching. Hanging blood requires RN
monitoring, but stable clients with PEG feedings or stable CHF are within PN scope .
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A) A post-op day 2 client requesting pain medication for 4/10 pain
B) *A client with COPD with a new onset of confusion and BP 88/50*
C) A client with diabetes requesting a PRN snack due to hunger
D) A client with a fractured tibia asking for help to the bathroom
Answer: B
Rationale: New onset confusion combined with hypotension is a classic sign of shock
(sepsis, hemorrhage, or dehydration). This represents a change in neurological status
and hemodynamic instability, which is the priority. Airway, breathing, and circulation
(ABCs) come first .
3. A nurse is planning care for a client who is scheduled for a surgical procedure. Which
of the following actions is the priority?
A) Ensure the client has signed the informed consent form
B) Review the client's laboratory results
,C) Verify the client's allergies
D) Administer preoperative medication as prescribed
Answer: A
Rationale: Informed consent is a legal requirement before any invasive procedure. The
nurse's priority is to ensure consent is signed and witnessed, as failure to do so could
result in legal liability and cancellation of the procedure. The nurse does not obtain
consent but verifies it is present .
4. A PN is caring for four clients. Which client should the PN assess FIRST?
A) Post-op day 2 client requesting pain medication for 4/10 pain
B) *Client with COPD with new onset of confusion and BP 88/50*
C) Client with diabetes requesting PRN snack due to hunger
D) Client with fractured tibia asking for help to the bathroom
Answer: B
Rationale: New onset confusion plus hypotension indicates potential shock or hypoxia.
This represents an acute change in neurological status and hemodynamic instability.
The ABCs (airway, breathing, circulation) framework prioritizes this client .
5. A nurse is delegating tasks to an assistive personnel (AP). Which of the following
tasks is appropriate for the nurse to delegate?
A) Administering an enema
B) Inserting an indwelling urinary catheter
C) Measuring a client's vital signs
D) Teaching a client how to use an incentive spirometer
Answer: C
Rationale: Measuring vital signs is within the AP's scope of practice. The RN cannot
delegate tasks requiring nursing judgment, sterile technique (catheter insertion), or
client education .
6. A nurse is preparing a client for transfer to a long-term care facility. Which of the
following information should the nurse include in the transfer report? (Select all that
apply)
☐ A) The client's advance directive status
☐ B) The client's recent laboratory values
☐ C) The client's current medications
,☐ D) The client's preferred activities
☐ E) All of the above
Answer: E
Rationale: A comprehensive transfer report should include advance directive status,
recent lab values, current medications, and preferred activities to ensure continuity of
care and respect for the client's wishes .
7. A nurse is caring for a client who is being discharged with a prescription for warfarin.
Which of the following instructions should the nurse include?
A) "Take ibuprofen for mild pain"
B) "Increase your intake of green leafy vegetables"
C) "Notify your provider if you notice bleeding gums"
D) "You can stop taking the medication if you feel well"
Answer: C
Rationale: Bleeding gums, easy bruising, dark tarry stools, or hematuria are signs of
excessive anticoagulation and should be reported immediately. Ibuprofen increases
bleeding risk. Green leafy vegetables contain vitamin K, which antagonizes warfarin .
8. A nurse is admitting a client who has a history of falls. Which of the following
interventions is the priority?
A) Place a fall risk identification wristband on the client
B) Instruct the client to call for assistance before getting out of bed
C) Ensure the bed alarm is functioning
D) Keep the client's personal belongings within reach
Answer: B
Rationale: Instructing the client to call for assistance is the most direct and proactive
intervention to prevent falls. While other measures are important, client education and
engagement is the priority .
9. A nurse is caring for a client who is receiving continuous enteral feedings through a
nasogastric tube. Which of the following actions should the nurse take to prevent
aspiration?
A) Flush the tube with 30 mL of water every 4 hours
B) *Elevate the head of the bed to 30-45 degrees*
, C) Check gastric residual volume every 2 hours
D) Change the feeding bag every 24 hours
Answer: B
*Rationale: Elevating the head of the bed to 30-45 degrees is the most effective
intervention to prevent aspiration during enteral feedings. This uses gravity to keep
gastric contents in the stomach .*
10. A nurse is preparing to administer a blood transfusion to a client. Which of the
following actions is most important to take prior to starting the transfusion?
A) Verify the client's blood type with a second nurse
B) Assess the client's baseline vital signs
C) Obtain the client's signed consent for the transfusion
D) Prime the blood tubing with normal saline
Answer: A
Rationale: Verification of blood type and client identification with a second licensed
nurse is the most critical safety step to prevent ABO incompatibility, which can be fatal .
11. A nurse is caring for a client who is post-operative following a total knee
replacement. The client refuses to use the patient-controlled analgesia (PCA) pump
because "I don't want to become addicted." Which of the following responses by the
nurse is appropriate?
A) "You have a right to refuse pain medication, but you will be in pain"
B) "Addiction rarely occurs when pain medication is used appropriately for acute pain"
C) "I will call the provider to change your prescription to oral medication"
D) "You should try to bear the pain without medication"
Answer: B
Rationale: The nurse should provide accurate information about pain management and
addiction risk. Addiction is rare with short-term use for acute pain. The nurse should
address the client's concern without being dismissive .
12. A nurse is reviewing a client's informed consent for a surgical procedure. Which of
the following clients is capable of giving informed consent?
A) A 17-year-old client who is married
B) A client who is under the influence of narcotic pain medication
