Fundamentals ATI exam review 2024 exam test
questions and answers verified A+
1. A nurse is preparing to administer a blood transfusion to a patient with type A-positive blood.
The laboratory sends type O-negative packed red blood cells due to a shortage of type A-positive
units. Which of the following actions should the nurse take?
A. Administer the O-negative blood because it is the universal donor type and compatible with any recipient.
B. Refuse to administer the blood and notify the provider that crossmatch is required before transfusion.
C. Administer the blood slowly and monitor the patient for signs of transfusion reaction every 15 minutes.
D. Request type A-negative blood instead, as it is more compatible than O-negative for an A-positive recipient.
Answer: B
Rationale: O-negative blood is the universal donor for red blood cells, but crossmatching is still required
to ensure compatibility beyond ABO and Rh. The nurse must not administer blood without a completed
crossmatch; the provider must be notified to order the correct product. Option A is incorrect because
crossmatch is required. Option C is unsafe without crossmatch. Option D is incorrect because
A-negative is not universal and also requires crossmatch.
2. A nurse is caring for a patient who has a peripheral intravenous (IV) catheter and is receiving a
continuous infusion of lactated Ringer's solution. The patient suddenly develops dyspnea, crackles
in the lung bases, and a bounding pulse. Which of the following actions should the nurse take first?
A. Slow the IV infusion rate to keep-vein-open (KVO).
B. Place the patient in high-Fowler's position.
C. Administer a prescribed diuretic by IV push.
D. Notify the provider of the patient's condition.
Answer: B
Rationale: The patient is showing signs of fluid volume overload (dyspnea, crackles, bounding pulse). The
first action is to place the patient in high-Fowler's position to facilitate breathing and reduce venous
return. Slowing the infusion (A) is appropriate but not the first action. Diuretics (C) require a
prescription and are not the first action. Notification (D) can occur after immediate interventions.
3. A nurse is evaluating a patient's understanding of a new prescription for a low-sodium diet.
Which of the following patient statements indicates a correct understanding?
A. "I can use canned vegetables as long as I rinse them before eating."
B. "I should avoid using salt substitutes because they contain potassium."
C. "I can eat fresh fish and poultry without restriction."
D. "I will limit my intake of processed meats like bacon and ham."
Answer: D
Rationale: Processed meats are high in sodium and should be limited on a low-sodium diet. Option A is
incorrect because rinsing canned vegetables reduces but does not eliminate sodium; fresh or frozen
without added salt are preferred. Option B is incorrect; salt substitutes (often potassium chloride) may
Page 1
,be used unless contraindicated (e.g., renal impairment). Option C is incorrect because fresh fish and
poultry are naturally low in sodium but should be prepared without added salt. However, D is the best
answer as it directly addresses a major source of dietary sodium.
4. A nurse is preparing to administer a tuberculin skin test (TST) to a patient. Which of the
following actions should the nurse take?
A. Inject the tuberculin antigen into the deltoid muscle at a 90-degree angle.
B. Use a 1 mL tuberculin syringe with a 25- to 27-gauge needle.
C. Massage the site after injection to distribute the antigen.
D. Read the result within 24 hours of administration.
Answer: B
Rationale: A TST (Mantoux test) requires intradermal injection using a tuberculin syringe (1 mL) and a
fine-gauge needle (25-27G) to ensure accurate dose and minimal tissue trauma. Option A is incorrect
because the injection is intradermal, not intramuscular, and the angle should be 5-15 degrees. Option C
is incorrect because massage can cause the antigen to spread and alter the result. Option D is incorrect
because the result should be read 48-72 hours after administration.
5. A nurse is caring for a patient who has a nasogastric (NG) tube set to low intermittent suction.
The nurse notes that the NG tube has stopped draining. Which of the following actions should the
nurse take first?
A. Irrigate the NG tube with 30 mL of normal saline.
B. Reposition the patient and check the tube placement.
C. Advance the NG tube 2 to 3 inches and reassess.
D. Replace the NG tube with a new one of the same size.
Answer: B
Rationale: The first action for an NG tube that has stopped draining is to reposition the patient and check
tube placement, as the tube may be against the stomach wall or kinked. Irrigation (A) should only be
done after verifying placement and with a provider order. Advancing the tube (C) could cause
complications if placement is incorrect. Replacement (D) is not the first step.
6. A nurse is assessing a patient who has a chest tube connected to a dry suction water seal
drainage system. The nurse notes continuous bubbling in the water seal chamber. Which of the
following is the priority action?
A. Clamp the chest tube near the insertion site.
B. Check the system for an air leak.
C. Increase the suction pressure until bubbling stops.
D. Notify the provider of the finding.
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system. The nurse
should first check for visible leaks (e.g., loose connections, dislodged tube). Clamping (A) is dangerous
and can cause tension pneumothorax. Increasing suction (C) does not fix the leak and may worsen it.
Notification (D) is appropriate after assessment.
Page 2
,7. A nurse is teaching a patient about the use of a patient-controlled analgesia (PCA) pump. Which
of the following statements by the patient indicates a correct understanding?
A. "I will ask my family to press the button for me if I am sleeping."
B. "I can press the button as often as I need to control my pain."
C. "The pump will deliver a continuous dose of medication even if I don't press the button."
D. "I can use the PCA pump to administer my antibiotic medication."
Answer: B
Rationale: PCA pumps allow patients to self-administer analgesic doses within programmed limits. The
patient should press the button whenever pain is felt; the pump has a lockout interval to prevent
overdose. Option A is incorrect because only the patient should press the button; family members
pressing it can lead to overdose. Option C is incorrect because not all PCA pumps have a continuous
infusion; it depends on settings. Option D is incorrect because PCA pumps are used for analgesics, not
antibiotics.
8. A nurse is preparing to insert an indwelling urinary catheter for a female patient. Which of the
following techniques should the nurse use to maintain sterile technique?
A. Open the catheter kit and place the sterile field on the patient's bed.
B. Clean the labia and meatus with antiseptic swabs using a circular motion from the meatus outward.
C. Hold the catheter with the dominant hand after donning sterile gloves.
D. Inflate the catheter balloon before insertion to verify patency.
Answer: B
Rationale: Cleaning the labia and meatus from the meatus outward (center to periphery) reduces the risk
of introducing microorganisms into the urethra. Option A is incorrect because the sterile field should be
placed on a dry, clean surface, not the bed, which may be contaminated. Option C is incorrect; the
dominant hand should remain sterile and handle the catheter, but the catheter is typically held with the
sterile gloved hand. Option D is incorrect; the balloon should be inflated after insertion to secure the
catheter, not before.
9. A nurse is caring for a patient who has a surgical wound and a prescription for a wet-to-damp
normal saline dressing. Which of the following actions should the nurse take?
A. Apply the dressing dry and then moisten it with saline after placement.
B. Wring out the saline-soaked gauze so it is not dripping wet before applying.
C. Pack the wound tightly with gauze to ensure contact with all wound surfaces.
D. Change the dressing every 8 hours regardless of wound condition.
Answer: B
Rationale: Wet-to-damp dressings require that the gauze be moist but not dripping wet to provide a moist
wound environment without maceration. Option A is incorrect because the dressing should be moistened
before application. Option C is incorrect because packing should be loose to allow for wound healing
and drainage. Option D is incorrect because frequency depends on wound condition and provider order;
typically every 4-6 hours initially.
Page 3
, 10. A nurse is assessing a patient who has a stage 3 pressure ulcer on the sacrum. Which of the
following findings should the nurse expect?
A. Intact skin with non-blanchable erythema.
B. Full-thickness skin loss with visible subcutaneous fat.
C. Full-thickness skin loss with exposed bone or muscle.
D. Partial-thickness skin loss with a shallow open ulcer.
Answer: B
Rationale: Stage 3 pressure ulcers involve full-thickness skin loss with visible subcutaneous fat; bone,
tendon, or muscle are not exposed. Option A describes stage 1. Option C describes stage 4. Option D
describes stage 2.
11. A patient with chronic kidney disease (CKD) stage 4 is scheduled for an elective surgery. The
nurse reviews the medication list and notes that the patient is taking metformin. According to
current guidelines, what is the most appropriate preoperative action regarding metformin?
A. Continue metformin as prescribed, monitoring blood glucose levels.
B. Hold metformin 24 hours before surgery and resume after normal renal function is confirmed.
C. Switch to insulin therapy 48 hours before surgery.
D. Administer metformin with a small amount of water on the morning of surgery.
Answer: B
Rationale: Metformin is contraindicated in patients with impaired renal function (eGFR <30 mL/min)
and should be held 24-48 hours before surgery due to risk of lactic acidosis. Resuming only after
confirming normal renal function is standard. Continuing or switching to insulin is not indicated unless
glucose control is inadequate.
12. A nurse is assessing a patient who has been receiving total parenteral nutrition (TPN) for 7
days. The patient's serum glucose is 450 mg/dL, and they are confused and lethargic. Which
intervention should the nurse implement first?
A. Decrease the TPN infusion rate by half.
B. Administer regular insulin per sliding scale.
C. Discontinue the TPN and notify the provider.
D. Check serum potassium and phosphate levels.
Answer: C
Rationale: Hyperglycemia with altered mental status suggests hyperosmolar hyperglycemic state (HHS)
or hyperglycemic crisis. Immediate discontinuation of TPN is critical to stop glucose infusion.
Decreasing rate or giving insulin alone is insufficient; checking electrolytes is important but not the first
priority.
13. A nurse is evaluating a patient's understanding of a low-sodium diet. The patient's 24-hour
urine sodium is 40 mEq/L, and serum sodium is 135 mEq/L. Which statement by the patient
indicates correct understanding?
A. I should avoid canned soups and deli meats.
B. I can use salt substitutes freely because they contain potassium.
Page 4
questions and answers verified A+
1. A nurse is preparing to administer a blood transfusion to a patient with type A-positive blood.
The laboratory sends type O-negative packed red blood cells due to a shortage of type A-positive
units. Which of the following actions should the nurse take?
A. Administer the O-negative blood because it is the universal donor type and compatible with any recipient.
B. Refuse to administer the blood and notify the provider that crossmatch is required before transfusion.
C. Administer the blood slowly and monitor the patient for signs of transfusion reaction every 15 minutes.
D. Request type A-negative blood instead, as it is more compatible than O-negative for an A-positive recipient.
Answer: B
Rationale: O-negative blood is the universal donor for red blood cells, but crossmatching is still required
to ensure compatibility beyond ABO and Rh. The nurse must not administer blood without a completed
crossmatch; the provider must be notified to order the correct product. Option A is incorrect because
crossmatch is required. Option C is unsafe without crossmatch. Option D is incorrect because
A-negative is not universal and also requires crossmatch.
2. A nurse is caring for a patient who has a peripheral intravenous (IV) catheter and is receiving a
continuous infusion of lactated Ringer's solution. The patient suddenly develops dyspnea, crackles
in the lung bases, and a bounding pulse. Which of the following actions should the nurse take first?
A. Slow the IV infusion rate to keep-vein-open (KVO).
B. Place the patient in high-Fowler's position.
C. Administer a prescribed diuretic by IV push.
D. Notify the provider of the patient's condition.
Answer: B
Rationale: The patient is showing signs of fluid volume overload (dyspnea, crackles, bounding pulse). The
first action is to place the patient in high-Fowler's position to facilitate breathing and reduce venous
return. Slowing the infusion (A) is appropriate but not the first action. Diuretics (C) require a
prescription and are not the first action. Notification (D) can occur after immediate interventions.
3. A nurse is evaluating a patient's understanding of a new prescription for a low-sodium diet.
Which of the following patient statements indicates a correct understanding?
A. "I can use canned vegetables as long as I rinse them before eating."
B. "I should avoid using salt substitutes because they contain potassium."
C. "I can eat fresh fish and poultry without restriction."
D. "I will limit my intake of processed meats like bacon and ham."
Answer: D
Rationale: Processed meats are high in sodium and should be limited on a low-sodium diet. Option A is
incorrect because rinsing canned vegetables reduces but does not eliminate sodium; fresh or frozen
without added salt are preferred. Option B is incorrect; salt substitutes (often potassium chloride) may
Page 1
,be used unless contraindicated (e.g., renal impairment). Option C is incorrect because fresh fish and
poultry are naturally low in sodium but should be prepared without added salt. However, D is the best
answer as it directly addresses a major source of dietary sodium.
4. A nurse is preparing to administer a tuberculin skin test (TST) to a patient. Which of the
following actions should the nurse take?
A. Inject the tuberculin antigen into the deltoid muscle at a 90-degree angle.
B. Use a 1 mL tuberculin syringe with a 25- to 27-gauge needle.
C. Massage the site after injection to distribute the antigen.
D. Read the result within 24 hours of administration.
Answer: B
Rationale: A TST (Mantoux test) requires intradermal injection using a tuberculin syringe (1 mL) and a
fine-gauge needle (25-27G) to ensure accurate dose and minimal tissue trauma. Option A is incorrect
because the injection is intradermal, not intramuscular, and the angle should be 5-15 degrees. Option C
is incorrect because massage can cause the antigen to spread and alter the result. Option D is incorrect
because the result should be read 48-72 hours after administration.
5. A nurse is caring for a patient who has a nasogastric (NG) tube set to low intermittent suction.
The nurse notes that the NG tube has stopped draining. Which of the following actions should the
nurse take first?
A. Irrigate the NG tube with 30 mL of normal saline.
B. Reposition the patient and check the tube placement.
C. Advance the NG tube 2 to 3 inches and reassess.
D. Replace the NG tube with a new one of the same size.
Answer: B
Rationale: The first action for an NG tube that has stopped draining is to reposition the patient and check
tube placement, as the tube may be against the stomach wall or kinked. Irrigation (A) should only be
done after verifying placement and with a provider order. Advancing the tube (C) could cause
complications if placement is incorrect. Replacement (D) is not the first step.
6. A nurse is assessing a patient who has a chest tube connected to a dry suction water seal
drainage system. The nurse notes continuous bubbling in the water seal chamber. Which of the
following is the priority action?
A. Clamp the chest tube near the insertion site.
B. Check the system for an air leak.
C. Increase the suction pressure until bubbling stops.
D. Notify the provider of the finding.
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system. The nurse
should first check for visible leaks (e.g., loose connections, dislodged tube). Clamping (A) is dangerous
and can cause tension pneumothorax. Increasing suction (C) does not fix the leak and may worsen it.
Notification (D) is appropriate after assessment.
Page 2
,7. A nurse is teaching a patient about the use of a patient-controlled analgesia (PCA) pump. Which
of the following statements by the patient indicates a correct understanding?
A. "I will ask my family to press the button for me if I am sleeping."
B. "I can press the button as often as I need to control my pain."
C. "The pump will deliver a continuous dose of medication even if I don't press the button."
D. "I can use the PCA pump to administer my antibiotic medication."
Answer: B
Rationale: PCA pumps allow patients to self-administer analgesic doses within programmed limits. The
patient should press the button whenever pain is felt; the pump has a lockout interval to prevent
overdose. Option A is incorrect because only the patient should press the button; family members
pressing it can lead to overdose. Option C is incorrect because not all PCA pumps have a continuous
infusion; it depends on settings. Option D is incorrect because PCA pumps are used for analgesics, not
antibiotics.
8. A nurse is preparing to insert an indwelling urinary catheter for a female patient. Which of the
following techniques should the nurse use to maintain sterile technique?
A. Open the catheter kit and place the sterile field on the patient's bed.
B. Clean the labia and meatus with antiseptic swabs using a circular motion from the meatus outward.
C. Hold the catheter with the dominant hand after donning sterile gloves.
D. Inflate the catheter balloon before insertion to verify patency.
Answer: B
Rationale: Cleaning the labia and meatus from the meatus outward (center to periphery) reduces the risk
of introducing microorganisms into the urethra. Option A is incorrect because the sterile field should be
placed on a dry, clean surface, not the bed, which may be contaminated. Option C is incorrect; the
dominant hand should remain sterile and handle the catheter, but the catheter is typically held with the
sterile gloved hand. Option D is incorrect; the balloon should be inflated after insertion to secure the
catheter, not before.
9. A nurse is caring for a patient who has a surgical wound and a prescription for a wet-to-damp
normal saline dressing. Which of the following actions should the nurse take?
A. Apply the dressing dry and then moisten it with saline after placement.
B. Wring out the saline-soaked gauze so it is not dripping wet before applying.
C. Pack the wound tightly with gauze to ensure contact with all wound surfaces.
D. Change the dressing every 8 hours regardless of wound condition.
Answer: B
Rationale: Wet-to-damp dressings require that the gauze be moist but not dripping wet to provide a moist
wound environment without maceration. Option A is incorrect because the dressing should be moistened
before application. Option C is incorrect because packing should be loose to allow for wound healing
and drainage. Option D is incorrect because frequency depends on wound condition and provider order;
typically every 4-6 hours initially.
Page 3
, 10. A nurse is assessing a patient who has a stage 3 pressure ulcer on the sacrum. Which of the
following findings should the nurse expect?
A. Intact skin with non-blanchable erythema.
B. Full-thickness skin loss with visible subcutaneous fat.
C. Full-thickness skin loss with exposed bone or muscle.
D. Partial-thickness skin loss with a shallow open ulcer.
Answer: B
Rationale: Stage 3 pressure ulcers involve full-thickness skin loss with visible subcutaneous fat; bone,
tendon, or muscle are not exposed. Option A describes stage 1. Option C describes stage 4. Option D
describes stage 2.
11. A patient with chronic kidney disease (CKD) stage 4 is scheduled for an elective surgery. The
nurse reviews the medication list and notes that the patient is taking metformin. According to
current guidelines, what is the most appropriate preoperative action regarding metformin?
A. Continue metformin as prescribed, monitoring blood glucose levels.
B. Hold metformin 24 hours before surgery and resume after normal renal function is confirmed.
C. Switch to insulin therapy 48 hours before surgery.
D. Administer metformin with a small amount of water on the morning of surgery.
Answer: B
Rationale: Metformin is contraindicated in patients with impaired renal function (eGFR <30 mL/min)
and should be held 24-48 hours before surgery due to risk of lactic acidosis. Resuming only after
confirming normal renal function is standard. Continuing or switching to insulin is not indicated unless
glucose control is inadequate.
12. A nurse is assessing a patient who has been receiving total parenteral nutrition (TPN) for 7
days. The patient's serum glucose is 450 mg/dL, and they are confused and lethargic. Which
intervention should the nurse implement first?
A. Decrease the TPN infusion rate by half.
B. Administer regular insulin per sliding scale.
C. Discontinue the TPN and notify the provider.
D. Check serum potassium and phosphate levels.
Answer: C
Rationale: Hyperglycemia with altered mental status suggests hyperosmolar hyperglycemic state (HHS)
or hyperglycemic crisis. Immediate discontinuation of TPN is critical to stop glucose infusion.
Decreasing rate or giving insulin alone is insufficient; checking electrolytes is important but not the first
priority.
13. A nurse is evaluating a patient's understanding of a low-sodium diet. The patient's 24-hour
urine sodium is 40 mEq/L, and serum sodium is 135 mEq/L. Which statement by the patient
indicates correct understanding?
A. I should avoid canned soups and deli meats.
B. I can use salt substitutes freely because they contain potassium.
Page 4
