ATI RN LEADERSHIP PROCTORED EXAM LATEST 2023
ACTUAL EXAM-250 questions and answers with rationale
1.A nurse in the emergency department is implementing a plan of care for a conscious client who has a suspected
cervical cord injury. Which of the following immediate interventions should the nurse implement? (Select all that
apply.)
A. Hypotension
B. Polyuria
C. Hyperthermia
D. Absence of bowel sounds
E. Weakened gag reflex
Rationale:Hypotension is correct. Lack of sympathetic input can cause a decrease in blood pressure. The
nurse should maintain the client's SBP at 90 mm Hg or above to adequately perfuse the spinal
cord.Polyuria is incorrect. The nurse should check the client for bladder distention and inability
to urinate due to ineffective function of the bladder muscles.Hyperthermia is incorrect. The nurse
should monitor the client for hypothermia caused by a lack of lack of sympathetic input.Absence
of bowel sounds is correct. Spinal shock leads to decreased peristalsis, which could cause the
client to develop a paralytic ileus.Weakened gag reflex is correct. The nurse should monitor the
client for difficulty swallowing, or coughing and drooling noted with oral intake.
2.A nurse reports an incident of suspected child abuse. One of the parents of the child becomes upset and demands
to know the reason for the nurse's action. Which of the following responses by the nurse is appropriate?
A. "As a nurse, I am required by law to report suspected child abuse."
Rationale:A nurse is required by law to report suspected child abuse. Therefore, this is a truthful, non-
accusatory response.
B. "I am unable to discuss this, but I can contact my supervisor to speak with you."
Rationale:This response defers to another authority figure, rather than providing the parent with an answer.
C. "The provider will be coming to explain the situation."
Rationale:This response does not answer the parent's concern. Although the provider will speak with the
family, the nurse should address the parent's question.
D. "I reported the incident to my supervisor who decided to contact the authorities."
Rationale:Although a nurse supervisor can assist with the process, the nurse is mandated to report
suspected child abuse.
3.A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the
nurse anticipate?
, A. Initiate a low-residue diet.
Rationale:One of the manifestations of acute pancreatitis is abdominal pain. The nurse should anticipate
the provider will prescribe withholding of foods and fluids. This serves to manage the client's
pain by limiting gastrointestinal activity and stimulation of the pancreas.
B. Pantoprazole 80 mg IV bolus twice daily
Rationale:The nurse should anticipate a provider's prescription for a proton pump inhibitor to decrease
gastric acid production, which ultimately decrease pancreatic secretions. C. Ambulate twice daily.
Rationale:The nurse should anticipate a provider prescription for bed rest during the acute stage of
pancreatitis. Bed rest decreases the metabolic rate and the secretion of pancreatic enzymes.
D. Pancrelipase 500 units/kg PO three times daily with meals
Rationale:The nurse should identify that pancrelipase, an enzyme replacement medication, is used in the
treatment of clients who have chronic pancreatitis. It is not used in the treatment of acute
pancreatitis.
4.A nurse is caring for a client who is dying. The client says, "My mother died in the hospital, but I did not get there
before she died." Which of the following statements should the nurse make?
A. "We will call your family in time for them to get here."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
B. "I wonder if you are fearful of dying alone."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
C. "I will make sure a staff member is in your room at all times."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
D. "I will tell your family of your concern so that they can be here."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
5.A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is
digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the
nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
0.5 tablet(s)
the provider prescribed 0.125 mg, it makes sense to administer 1/2 tab. The nurse
should administer digoxin tab PO daily.
,6.A nurse is reviewing information about the Health Insurance Portability and Accountability Act (HIPAA) with a newly
licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?
A. "Information about a client can be disclosed to family members at any time."
Rationale:This statement reflects a need for further teaching. Privacy relates to the client's rights over the
use and disclosure of his or her own personal health information.
B. "HIPAA established regulations of individually identifiable health information in verbal, electronic, or written
form."
Rationale:This statement reflects an understanding of HIPAA. All health care organizations that use
electronic transactions and code sets, such as health care claims and claim payments, must
comply with HIPAA standards.
C. "A client's address would be an example of personally identifiable information."
Rationale:This statement reflects an understanding of HIPAA. Identifiers for the information include a
client's name, address, phone number, driver's license number, and so forth.
D. "HIPAA is a federal law, not a state law."
Rationale:This statement reflects an understanding of HIPAA, which is a federal law that was passed in
1996.
7.A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following
room assignments should the nurse make for the client?
A. A room with air exhaust directly to the outdoor environment
Rationale:A room with air exhaust directly to the outside environment eliminates contamination of other
client-care areas. This type of ventilation system is referred to as an airborne infection isolation
room.
B. A room with another nonsurgical client
Rationale:A two-bed room with another nonsurgical client exposes the other client to tuberculosis. A client
who has tuberculosis should have a private room.
C. A room in the ICU
Rationale:A client who has active tuberculosis and no other comorbidities is not critically ill.
D. A room that is within view of the nurses' station
Rationale:The client's room should be well ventilated and private, but it is not necessary for it to be close to
the nurses' station.
8.A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse
identify as an associated risk factor? A. Hypocalcemia
, Rationale:Hypercalcemia is a risk factor associated with urolithiasis.
B. BMI less than 25
Rationale:Obesity, or having a BMI that is greater than 29, has been found to be a risk factor for the
development of urolithiasis.
C. Family history
Rationale:Family history is strongly correlated with the formation of urolithiasis. A nurse should assess a
client who has kidney stones for familial tendencies toward stone formation.
D. Diuretic use
Rationale:Medications such as antacids, vitamin D, laxatives, and aspirin have been associated with the
formation of urolithiasis. However, there is no indication that the use of diuretics place a client at
an increased risk for stone formation.
9.A nurse is conducting a primary survey of a client who has sustained life-threatening injuries due to a motor-vehicle
crash. Identify the sequence of actions the nurse should take. (Move the actions into the box on the right, placing
them in the selected order of performance. Use all the steps.) C. Open the airway using a jaw-thrust maneuver.
D. Determine effectiveness of ventilator efforts.
B. Establish IV access.
A. Perform a Glasgow Coma Scale assessment.
E. Remove clothing for a thorough assessment.
10.A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the
following sets of values should the nurse expect?
A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
Rationale:The nurse should expect a client who has renal failure to have metabolic acidosis, which is
characterized by a low HCO3-, a low pH, and a low or normal PaCO2. Expected reference
ranges for these laboratory values are as follows: pH 7.35 to 7.45, HCO3- 21 to 28 mEq/L, and
PaCO2 35 to 45 mm Hg.
B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg
Rationale:
These values indicate respiratory acidosis, which is associated with respiratory disorders, such
as pulmonary edema and pneumonia.
C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg
Rationale:These values indicate respiratory alkalosis, which is associated with hyperventilation.
ACTUAL EXAM-250 questions and answers with rationale
1.A nurse in the emergency department is implementing a plan of care for a conscious client who has a suspected
cervical cord injury. Which of the following immediate interventions should the nurse implement? (Select all that
apply.)
A. Hypotension
B. Polyuria
C. Hyperthermia
D. Absence of bowel sounds
E. Weakened gag reflex
Rationale:Hypotension is correct. Lack of sympathetic input can cause a decrease in blood pressure. The
nurse should maintain the client's SBP at 90 mm Hg or above to adequately perfuse the spinal
cord.Polyuria is incorrect. The nurse should check the client for bladder distention and inability
to urinate due to ineffective function of the bladder muscles.Hyperthermia is incorrect. The nurse
should monitor the client for hypothermia caused by a lack of lack of sympathetic input.Absence
of bowel sounds is correct. Spinal shock leads to decreased peristalsis, which could cause the
client to develop a paralytic ileus.Weakened gag reflex is correct. The nurse should monitor the
client for difficulty swallowing, or coughing and drooling noted with oral intake.
2.A nurse reports an incident of suspected child abuse. One of the parents of the child becomes upset and demands
to know the reason for the nurse's action. Which of the following responses by the nurse is appropriate?
A. "As a nurse, I am required by law to report suspected child abuse."
Rationale:A nurse is required by law to report suspected child abuse. Therefore, this is a truthful, non-
accusatory response.
B. "I am unable to discuss this, but I can contact my supervisor to speak with you."
Rationale:This response defers to another authority figure, rather than providing the parent with an answer.
C. "The provider will be coming to explain the situation."
Rationale:This response does not answer the parent's concern. Although the provider will speak with the
family, the nurse should address the parent's question.
D. "I reported the incident to my supervisor who decided to contact the authorities."
Rationale:Although a nurse supervisor can assist with the process, the nurse is mandated to report
suspected child abuse.
3.A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the
nurse anticipate?
, A. Initiate a low-residue diet.
Rationale:One of the manifestations of acute pancreatitis is abdominal pain. The nurse should anticipate
the provider will prescribe withholding of foods and fluids. This serves to manage the client's
pain by limiting gastrointestinal activity and stimulation of the pancreas.
B. Pantoprazole 80 mg IV bolus twice daily
Rationale:The nurse should anticipate a provider's prescription for a proton pump inhibitor to decrease
gastric acid production, which ultimately decrease pancreatic secretions. C. Ambulate twice daily.
Rationale:The nurse should anticipate a provider prescription for bed rest during the acute stage of
pancreatitis. Bed rest decreases the metabolic rate and the secretion of pancreatic enzymes.
D. Pancrelipase 500 units/kg PO three times daily with meals
Rationale:The nurse should identify that pancrelipase, an enzyme replacement medication, is used in the
treatment of clients who have chronic pancreatitis. It is not used in the treatment of acute
pancreatitis.
4.A nurse is caring for a client who is dying. The client says, "My mother died in the hospital, but I did not get there
before she died." Which of the following statements should the nurse make?
A. "We will call your family in time for them to get here."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
B. "I wonder if you are fearful of dying alone."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
C. "I will make sure a staff member is in your room at all times."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
D. "I will tell your family of your concern so that they can be here."
Rationale:The nurse dismisses the client’s concerns and gives false reassurance.
5.A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is
digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the
nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
0.5 tablet(s)
the provider prescribed 0.125 mg, it makes sense to administer 1/2 tab. The nurse
should administer digoxin tab PO daily.
,6.A nurse is reviewing information about the Health Insurance Portability and Accountability Act (HIPAA) with a newly
licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?
A. "Information about a client can be disclosed to family members at any time."
Rationale:This statement reflects a need for further teaching. Privacy relates to the client's rights over the
use and disclosure of his or her own personal health information.
B. "HIPAA established regulations of individually identifiable health information in verbal, electronic, or written
form."
Rationale:This statement reflects an understanding of HIPAA. All health care organizations that use
electronic transactions and code sets, such as health care claims and claim payments, must
comply with HIPAA standards.
C. "A client's address would be an example of personally identifiable information."
Rationale:This statement reflects an understanding of HIPAA. Identifiers for the information include a
client's name, address, phone number, driver's license number, and so forth.
D. "HIPAA is a federal law, not a state law."
Rationale:This statement reflects an understanding of HIPAA, which is a federal law that was passed in
1996.
7.A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following
room assignments should the nurse make for the client?
A. A room with air exhaust directly to the outdoor environment
Rationale:A room with air exhaust directly to the outside environment eliminates contamination of other
client-care areas. This type of ventilation system is referred to as an airborne infection isolation
room.
B. A room with another nonsurgical client
Rationale:A two-bed room with another nonsurgical client exposes the other client to tuberculosis. A client
who has tuberculosis should have a private room.
C. A room in the ICU
Rationale:A client who has active tuberculosis and no other comorbidities is not critically ill.
D. A room that is within view of the nurses' station
Rationale:The client's room should be well ventilated and private, but it is not necessary for it to be close to
the nurses' station.
8.A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse
identify as an associated risk factor? A. Hypocalcemia
, Rationale:Hypercalcemia is a risk factor associated with urolithiasis.
B. BMI less than 25
Rationale:Obesity, or having a BMI that is greater than 29, has been found to be a risk factor for the
development of urolithiasis.
C. Family history
Rationale:Family history is strongly correlated with the formation of urolithiasis. A nurse should assess a
client who has kidney stones for familial tendencies toward stone formation.
D. Diuretic use
Rationale:Medications such as antacids, vitamin D, laxatives, and aspirin have been associated with the
formation of urolithiasis. However, there is no indication that the use of diuretics place a client at
an increased risk for stone formation.
9.A nurse is conducting a primary survey of a client who has sustained life-threatening injuries due to a motor-vehicle
crash. Identify the sequence of actions the nurse should take. (Move the actions into the box on the right, placing
them in the selected order of performance. Use all the steps.) C. Open the airway using a jaw-thrust maneuver.
D. Determine effectiveness of ventilator efforts.
B. Establish IV access.
A. Perform a Glasgow Coma Scale assessment.
E. Remove clothing for a thorough assessment.
10.A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the
following sets of values should the nurse expect?
A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
Rationale:The nurse should expect a client who has renal failure to have metabolic acidosis, which is
characterized by a low HCO3-, a low pH, and a low or normal PaCO2. Expected reference
ranges for these laboratory values are as follows: pH 7.35 to 7.45, HCO3- 21 to 28 mEq/L, and
PaCO2 35 to 45 mm Hg.
B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg
Rationale:
These values indicate respiratory acidosis, which is associated with respiratory disorders, such
as pulmonary edema and pneumonia.
C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg
Rationale:These values indicate respiratory alkalosis, which is associated with hyperventilation.
