1
2025 ATI Exit Exam Predictor Test Bank — 200+
NCLEX-Style Questions with Detailed Rationales | A+
Guaranteed Pass!
QUESTION 1
A 68-year-old male client with a 20-year history of chronic obstructive pulmonary disease
(COPD) presents to the emergency department complaining of worsening shortness of breath,
productive cough with yellow sputum, fatigue, and confusion over the past 48 hours. On
examination, the client is using accessory muscles to breathe, has diminished breath sounds
bilaterally, and appears drowsy but oriented. Arterial blood gases reveal: pH 7.32, PaCO₂ 55 mm
Hg, HCO₃⁻ 26 mEq/L, and PaO₂ 65 mm Hg on 2 L/min oxygen via nasal cannula. What is the
nurse’s priority intervention at this time?
A. Increase oxygen flow to 6 L/min via nasal cannula
B. Administer a bronchodilator as prescribed
,2
C. Encourage the client to lie supine and rest
D. Restrict fluid intake to reduce secretions
Correct Answer: B. Administer a bronchodilator as prescribed
Rationale: The client is in acute respiratory acidosis, likely from a COPD exacerbation, as
indicated by hypercapnia (PaCO₂ 55), low-normal pH, and hypoxemia. The priority is to
administer a bronchodilator (e.g., albuterol) to relieve bronchoconstriction, promote gas
exchange, and lower CO₂ levels. Increasing O₂ above 2–3 L/min may suppress respiratory drive
in CO₂ retainers. Lying flat worsens ventilation. Fluid restriction is not appropriate unless there’s
fluid overload. Rapid bronchodilation improves airflow and supports ventilation during an acute
COPD crisis.
(Saunders 10th Ed., pp. 462–463; ATI Adult Medical-Surgical RN COPD Content)
QUESTION 2
A 55-year-old female is 12 hours post-thyroidectomy. She reports a tingling sensation around her
mouth and in her fingertips. On assessment, the nurse notes positive Chvostek’s and Trousseau’s
signs. The surgical dressing is dry, and the client is hemodynamically stable. Which action
should the nurse take immediately?
A. Notify the provider of a positive Chvostek’s sign
B. Apply ice packs to the neck
,3
C. Prepare to administer IV calcium gluconate
D. Encourage the client to ambulate to reduce stiffness
Correct Answer: C. Prepare to administer IV calcium gluconate
Rationale: This client is showing clinical signs of hypocalcemia, including perioral numbness
and positive Chvostek’s and Trousseau’s signs. Hypocalcemia is a life-threatening
complication of thyroidectomy due to potential injury or removal of the parathyroid glands. If
untreated, it can progress to laryngospasm or seizures. The nurse must anticipate and prepare to
administer IV calcium gluconate immediately. While the provider must be notified,
intervention is urgent. Ice packs and ambulation do not address the underlying electrolyte
imbalance.
(Saunders 10th Ed., p. 823; ATI Endocrine Module – Thyroidectomy Complications)
QUESTION 3
A nurse is providing discharge teaching to a client newly prescribed digoxin for heart failure.
During the session, the client says, “If I forget to take my digoxin, I’ll just take two the next day
to catch up.” Which response by the nurse is most appropriate?
A. “That’s a good way to make sure you don’t miss your medication.”
B. “Doubling the dose once in a while won’t hurt if you forget.”
C. “Never double your dose. Call your provider if you miss a dose.”
D. “It’s okay as long as you check your blood pressure first.”
, 4
Correct Answer: C. “Never double your dose. Call your provider if you miss a dose.”
Rationale: Clients taking digoxin must be educated that missing a dose should never be
followed by doubling the next dose due to the narrow therapeutic index and high risk of
toxicity. Symptoms of digoxin toxicity include nausea, vomiting, bradycardia, and yellow vision.
The nurse must reinforce the importance of daily pulse monitoring and consistent timing. The
provider should be contacted for missed doses.
(Saunders 10th Ed., pp. 593–595; ATI Pharmacology – Cardiac Glycosides)
QUESTION 4
A client undergoing chemotherapy for breast cancer reports frequent nosebleeds, new bruising,
and fatigue. Lab values reveal: WBC 3,000/mm³, Hemoglobin 10 g/dL, Platelet count
45,000/mm³. Which nursing action is the highest priority?
A. Administer prescribed antiemetics
B. Initiate neutropenic precautions
C. Begin bleeding precautions immediately
D. Encourage increased caloric intake
Correct Answer: C. Begin bleeding precautions immediately
Rationale: The client has thrombocytopenia (platelets < 50,000/mm³) due to chemotherapy-
induced bone marrow suppression. This puts the client at high risk for spontaneous bleeding,
which can be life-threatening. The priority is to implement bleeding precautions, such as
2025 ATI Exit Exam Predictor Test Bank — 200+
NCLEX-Style Questions with Detailed Rationales | A+
Guaranteed Pass!
QUESTION 1
A 68-year-old male client with a 20-year history of chronic obstructive pulmonary disease
(COPD) presents to the emergency department complaining of worsening shortness of breath,
productive cough with yellow sputum, fatigue, and confusion over the past 48 hours. On
examination, the client is using accessory muscles to breathe, has diminished breath sounds
bilaterally, and appears drowsy but oriented. Arterial blood gases reveal: pH 7.32, PaCO₂ 55 mm
Hg, HCO₃⁻ 26 mEq/L, and PaO₂ 65 mm Hg on 2 L/min oxygen via nasal cannula. What is the
nurse’s priority intervention at this time?
A. Increase oxygen flow to 6 L/min via nasal cannula
B. Administer a bronchodilator as prescribed
,2
C. Encourage the client to lie supine and rest
D. Restrict fluid intake to reduce secretions
Correct Answer: B. Administer a bronchodilator as prescribed
Rationale: The client is in acute respiratory acidosis, likely from a COPD exacerbation, as
indicated by hypercapnia (PaCO₂ 55), low-normal pH, and hypoxemia. The priority is to
administer a bronchodilator (e.g., albuterol) to relieve bronchoconstriction, promote gas
exchange, and lower CO₂ levels. Increasing O₂ above 2–3 L/min may suppress respiratory drive
in CO₂ retainers. Lying flat worsens ventilation. Fluid restriction is not appropriate unless there’s
fluid overload. Rapid bronchodilation improves airflow and supports ventilation during an acute
COPD crisis.
(Saunders 10th Ed., pp. 462–463; ATI Adult Medical-Surgical RN COPD Content)
QUESTION 2
A 55-year-old female is 12 hours post-thyroidectomy. She reports a tingling sensation around her
mouth and in her fingertips. On assessment, the nurse notes positive Chvostek’s and Trousseau’s
signs. The surgical dressing is dry, and the client is hemodynamically stable. Which action
should the nurse take immediately?
A. Notify the provider of a positive Chvostek’s sign
B. Apply ice packs to the neck
,3
C. Prepare to administer IV calcium gluconate
D. Encourage the client to ambulate to reduce stiffness
Correct Answer: C. Prepare to administer IV calcium gluconate
Rationale: This client is showing clinical signs of hypocalcemia, including perioral numbness
and positive Chvostek’s and Trousseau’s signs. Hypocalcemia is a life-threatening
complication of thyroidectomy due to potential injury or removal of the parathyroid glands. If
untreated, it can progress to laryngospasm or seizures. The nurse must anticipate and prepare to
administer IV calcium gluconate immediately. While the provider must be notified,
intervention is urgent. Ice packs and ambulation do not address the underlying electrolyte
imbalance.
(Saunders 10th Ed., p. 823; ATI Endocrine Module – Thyroidectomy Complications)
QUESTION 3
A nurse is providing discharge teaching to a client newly prescribed digoxin for heart failure.
During the session, the client says, “If I forget to take my digoxin, I’ll just take two the next day
to catch up.” Which response by the nurse is most appropriate?
A. “That’s a good way to make sure you don’t miss your medication.”
B. “Doubling the dose once in a while won’t hurt if you forget.”
C. “Never double your dose. Call your provider if you miss a dose.”
D. “It’s okay as long as you check your blood pressure first.”
, 4
Correct Answer: C. “Never double your dose. Call your provider if you miss a dose.”
Rationale: Clients taking digoxin must be educated that missing a dose should never be
followed by doubling the next dose due to the narrow therapeutic index and high risk of
toxicity. Symptoms of digoxin toxicity include nausea, vomiting, bradycardia, and yellow vision.
The nurse must reinforce the importance of daily pulse monitoring and consistent timing. The
provider should be contacted for missed doses.
(Saunders 10th Ed., pp. 593–595; ATI Pharmacology – Cardiac Glycosides)
QUESTION 4
A client undergoing chemotherapy for breast cancer reports frequent nosebleeds, new bruising,
and fatigue. Lab values reveal: WBC 3,000/mm³, Hemoglobin 10 g/dL, Platelet count
45,000/mm³. Which nursing action is the highest priority?
A. Administer prescribed antiemetics
B. Initiate neutropenic precautions
C. Begin bleeding precautions immediately
D. Encourage increased caloric intake
Correct Answer: C. Begin bleeding precautions immediately
Rationale: The client has thrombocytopenia (platelets < 50,000/mm³) due to chemotherapy-
induced bone marrow suppression. This puts the client at high risk for spontaneous bleeding,
which can be life-threatening. The priority is to implement bleeding precautions, such as
