ATI RN Proctored Exam 2023

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Sample questions from ATI RN Proctored Exam 2023

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client in the emergency department has pneumonia, new confusion, and urine output of 15 mL/hr. Vital signs are temperature 39.1 C, heart rate 124/min, respiratory rate 30/min, blood pressure 82/46 mm Hg, and oxygen saturation 93% on 2 L/min. Lactate is 4.6 mmol/L. Which prescribed intervention should the nurse initiate first?

   • A.Infuse an isotonic crystalloid bolus
   • B.Administer acetaminophen for fever
   • C.Collect a clean-catch urine specimen
   • D.Teach the client about incentive spirometry

   Rationale: The client has sepsis with severe hypoperfusion, making prompt isotonic fluid resuscitation the priority among these options. Acetaminophen improves comfort but does not restore perfusion, and collecting urine must not delay stabilization. Incentive spirometry teaching is inappropriate during hemodynamic instability and confusion. Prioritize circulation while rapidly coordinating cultures, antibiotics, and further sepsis treatment.

2. 2.A 74-year-old client on a telemetry unit has heart failure and chronic kidney disease. Morning laboratory results show potassium 6.7 mEq/L, and the ECG shows widening QRS complexes. The client reports weakness and has a blood pressure of 104/62 mm Hg. Which prescribed medication should the nurse administer first?

   • A.Oral sodium zirconium cyclosilicate
   • B.IV regular insulin with dextrose
   • C.IV calcium gluconate
   • D.IV furosemide

   Rationale: IV calcium gluconate stabilizes the cardiac membrane when hyperkalemia causes dangerous ECG changes. Insulin with dextrose shifts potassium into cells but does not provide the immediate membrane protection of calcium. Sodium zirconium cyclosilicate and furosemide can promote potassium removal but are not the first response to widening QRS complexes. Treat imminent dysrhythmia risk first, then shift and remove potassium.

3. 3.A 22-year-old client in the emergency department has diabetic ketoacidosis. Laboratory results are glucose 486 mg/dL, bicarbonate 12 mEq/L, pH 7.20, and potassium 3.1 mEq/L. An isotonic fluid infusion is running. Which action should the nurse take before starting the prescribed insulin infusion?

   • A.Administer sodium bicarbonate
   • B.Begin prescribed potassium replacement
   • C.Restrict further IV fluids
   • D.Administer subcutaneous long-acting insulin only

   Rationale: Potassium must be replaced before insulin is started because insulin will further lower serum potassium and can precipitate lethal dysrhythmias. Bicarbonate is not routinely indicated at this pH, and fluid restriction would worsen dehydration without another specific indication. Long-acting insulin alone does not adequately treat acute diabetic ketoacidosis. In diabetic ketoacidosis, evaluate potassium before initiating insulin and follow the replacement protocol.

4. 4.A 31-year-old client arrives at the emergency department after a motor vehicle crash. The client has severe dyspnea, absent breath sounds on the right, distended neck veins, heart rate 138/min, and blood pressure 76/40 mm Hg. Which action should the nurse prioritize?

   • A.Prepare for transport to computed tomography
   • B.Place the client supine and elevate both legs
   • C.Obtain a sputum specimen
   • D.Activate emergency assistance and prepare for immediate chest decompression

   Answer and rationale are in the full material.

5. 5.A 67-year-old client arrives at a stroke center with right arm weakness and aphasia that began 50 minutes ago. Blood pressure is 178/96 mm Hg, glucose is 108 mg/dL, and oxygen saturation is 96% on room air. Which action is the priority?

   • A.Administer oral aspirin immediately
   • B.Lower systolic blood pressure to below 140 mm Hg
   • C.Expedite a noncontrast head CT
   • D.Give water to assess swallowing

   Answer and rationale are in the full material.