1
NGN ATI Fundamentals Proctored Exam Retake
Actual Exam 2026/2027 | 100 Questions with
100% Verified Answers | Next Generation
NCLEX Updates | A+ Grade | Pass Guaranteed
MANAGEMENT OF CARE (15 Questions)
NGN Unfolding Case Study: Margaret Chen - Confusion and Dehydration
Scenario Part 1 (Initial Assessment):
Margaret Chen, a 78-year-old female, is admitted from home with weakness, confusion, and
dehydration. Her daughter reports that Margaret lives alone and was found on the floor after a
fall 2 days ago. She has been unable to get to the kitchen for food/water. Medical history
includes hypertension, type 2 diabetes, and osteoarthritis. Current medications: Metformin
500mg BID, Lisinopril 10mg daily, Acetaminophen 650mg PRN. Vital signs: Temp 38.1°C
(100.6°F), HR 98, BP 92/58, RR 22, O2 Sat 94% on room air. Weight: 52 kg (admission weight,
down from 58 kg 3 months ago). Skin turgor poor, mucous membranes dry. Patient is oriented to
person only, restless, picking at bed linens. Glucose 198 mg/dL. Creatinine 1.4 mg/dL (elevated
from baseline 0.9).
Q1 (Recognize Cues - Multiple Choice): Based on the initial assessment, which finding is most
concerning and requires immediate nursing action?
A. Elevated blood glucose of 198 mg/dL
B. Poor skin turgor and dry mucous membranes
C. Blood pressure of 92/58 mmHg with altered mental status [CORRECT]
D. Weight loss of 6 kg over 3 months
Correct Answer: C
Rationale: This question tests clinical judgment using the Recognize Cues step. The combination
of hypotension (92/58) and altered mental status (oriented to person only, restless) indicates
hypoperfusion and potential septic or hypovolemic shock. While all findings are concerning, this
combination represents an immediate threat to physiological stability using the ABCs
framework. The altered mental status in an elderly patient with hypotension suggests inadequate
cerebral perfusion.
,2
Why others are incorrect: Option A (elevated glucose) is expected in a stressed, dehydrated
diabetic patient and can be addressed after stabilization. Option B (poor skin turgor) confirms
dehydration but is not immediately life-threatening. Option D (weight loss) is significant for
nutritional status but chronic rather than acute.
Retake Success Tip: Always prioritize physiological instability over chronic conditions.
Hypotension + altered mental status = shock until proven otherwise.
Scenario Part 2 (4 Hours Later - Progress Note):
Margaret has received 2L of IV normal saline. Repeat vital signs: Temp 38.3°C, HR 88, BP
108/72, RR 20, O2 Sat 96% on 2L NC. She is now oriented to person and place but still confused
about time and situation. She attempts to get out of bed without calling for assistance. She has a
2.5 cm reddened area on her sacrum that blanches with pressure. Urinalysis shows positive
leukocyte esterase, nitrites, and >100 WBCs. Blood cultures drawn. New orders: Continue IV
fluids, obtain wound culture, start empiric antibiotics.
Q2 (Analyze Cues - Cloze/Drop-down): Complete the sentence below by choosing from the
dropdown options.
Based on the assessment findings, the patient is experiencing __________ as evidenced by
__________ and __________.
Dropdown Options:
First blank: [delirium / dementia / depression / urinary tract infection]
Second blank: [acute onset confusion with fluctuating consciousness / gradual memory decline /
persistent sad mood / sudden fever and urinary symptoms]
Third blank: [reversible underlying cause identified / progressive deterioration / anhedonia /
chronic condition]
Correct Answers: delirium, acute onset confusion with fluctuating consciousness, reversible
underlying cause identified
Rationale: This tests the Analyze Cues step of clinical judgment. Margaret demonstrates classic
delirium: acute onset (daughter reports normal baseline), fluctuating level of consciousness
(improved orientation after fluids but still confused), and identifiable underlying causes
(dehydration, possible UTI/sepsis). The key differentiator is that delirium has acute onset,
fluctuates throughout the day, and has reversible causes, while dementia has gradual onset and
progressive decline.
Clinical judgment application: The nurse must recognize that Margaret's confusion is not
baseline dementia (common error in elderly patients) but acute delirium requiring treatment of
underlying causes. The improvement with hydration supports this analysis.
,3
Scenario Part 3 (Provider Orders and Nursing Care):
Margaret's orders now include: Strict intake/output, bladder scan if no void in 6 hours, fall
precautions with bed alarm, wound culture of sacral area, Vancomycin 1g IV q12h (pharmacy to
verify renal dosing), Diet: Regular with assist. Margaret continues to try to get out of bed without
assistance, stating she "needs to go home to feed the cat."
Q3 (Prioritize Hypotheses/Generate Solutions - Bow-Tie Item): Complete the bow-tie by
selecting the appropriate options.
Center Box (Priority Problem): Margaret is at highest immediate risk for which complication?
Options: [Urinary tract infection] [Pressure injury] [Fall with injury] [Medication adverse
reaction]
Left Side (Nursing Actions - Select 2): Which two actions should the nurse implement FIRST?
Options: [Apply soft wrist restraints] [Place bed in lowest position with wheels locked and bed
alarm activated] [Request geriatric psychiatry consultation] [Encourage family member to sit
with patient] [Administer PRN lorazepam for agitation]
Right Side (Evaluation Parameters - Select 2): Which two parameters should the nurse monitor
to evaluate effectiveness of interventions?
Options: [Number of unassisted bed exits] [Patient's orientation to person/place/time] [Blood
pressure trends] [White blood cell count] [Sacral skin integrity]
Correct Answers:
Center Box: Fall with injury
Left Side: Place bed in lowest position with wheels locked and bed alarm activated; Encourage
family member to sit with patient
Right Side: Number of unassisted bed exits; Patient's orientation to person/place/time
Rationale: This tests Prioritize Hypotheses and Generate Solutions steps. While Margaret has
multiple issues (UTI, pressure injury risk, fall risk), the immediate safety priority is fall with
injury due to her continued attempts to get out of bed unsafely and her altered mental status.
Action rationale: Environmental modifications (low bed, alarm) and supervision (family
presence) are least restrictive, evidence-based fall prevention strategies. Restraints (Option A)
are last resort per CMS regulations and can increase injury risk. Sedation (lorazepam) may
worsen delirium and increase fall risk. Psych consult is important but not immediate.
Evaluation rationale: The nurse must evaluate if fall prevention works (unassisted exits) and if
underlying delirium improves (orientation). While BP, WBC, and skin integrity are important,
they don't directly evaluate fall prevention effectiveness.
, 4
Q4 (Delegation - Multiple Choice): The nurse is caring for Margaret and three other patients.
Which task is most appropriate to delegate to the LPN/LVN?
A. Perform the initial head-to-toe assessment on a newly admitted patient
B. Administer the first dose of IV Vancomycin to Margaret [CORRECT]
C. Develop the plan of care for a patient being discharged tomorrow
D. Evaluate the effectiveness of patient teaching regarding wound care
Correct Answer: B
Rationale: This tests delegation principles and scope of practice. LPNs can administer
medications (including IV medications in many states) for stable patients with predictable
outcomes. Margaret is now hemodynamically stable (BP 108/72), making this appropriate for
LPN scope.
Why others are incorrect: Initial assessments (Option A) require RN education and scope. Care
planning (Option C) and evaluation of teaching (Option D) require RN-level critical thinking and
judgment. These cannot be delegated to LPNs.
Retake Success Tip: Remember the "Three Es" of RN-only tasks: Evaluation, Education
(planning/developing), and initial Examination/Assessment. LPNs perform stable, predictable
care; UAPs perform routine, non-invasive tasks.
Q5 (Prioritization - Multiple Choice): The nurse receives report on four patients. Which patient
should the nurse assess FIRST?
A. A patient with diabetes who needs discharge teaching
B. A patient scheduled for physical therapy in 30 minutes
C. A patient with chest pain rated 8/10 and blood pressure of 88/52 [CORRECT]
D. A patient requesting a PRN laxative
Correct Answer: C
Rationale: This tests prioritization using ABCs and physiological stability. Chest pain with
hypotension indicates potential myocardial infarction, cardiogenic shock, or other life-
threatening cardiovascular event. This patient is unstable and requires immediate assessment.
Prioritization framework: Use ABCs first (Airway, Breathing, Circulation), then safety, then
acute vs. chronic, then stable vs. unstable. Option C involves circulation (BP) and potential
cardiac issue (chest pain). Options A, B, and D are important but not immediate threats to
physiological stability.
NGN ATI Fundamentals Proctored Exam Retake
Actual Exam 2026/2027 | 100 Questions with
100% Verified Answers | Next Generation
NCLEX Updates | A+ Grade | Pass Guaranteed
MANAGEMENT OF CARE (15 Questions)
NGN Unfolding Case Study: Margaret Chen - Confusion and Dehydration
Scenario Part 1 (Initial Assessment):
Margaret Chen, a 78-year-old female, is admitted from home with weakness, confusion, and
dehydration. Her daughter reports that Margaret lives alone and was found on the floor after a
fall 2 days ago. She has been unable to get to the kitchen for food/water. Medical history
includes hypertension, type 2 diabetes, and osteoarthritis. Current medications: Metformin
500mg BID, Lisinopril 10mg daily, Acetaminophen 650mg PRN. Vital signs: Temp 38.1°C
(100.6°F), HR 98, BP 92/58, RR 22, O2 Sat 94% on room air. Weight: 52 kg (admission weight,
down from 58 kg 3 months ago). Skin turgor poor, mucous membranes dry. Patient is oriented to
person only, restless, picking at bed linens. Glucose 198 mg/dL. Creatinine 1.4 mg/dL (elevated
from baseline 0.9).
Q1 (Recognize Cues - Multiple Choice): Based on the initial assessment, which finding is most
concerning and requires immediate nursing action?
A. Elevated blood glucose of 198 mg/dL
B. Poor skin turgor and dry mucous membranes
C. Blood pressure of 92/58 mmHg with altered mental status [CORRECT]
D. Weight loss of 6 kg over 3 months
Correct Answer: C
Rationale: This question tests clinical judgment using the Recognize Cues step. The combination
of hypotension (92/58) and altered mental status (oriented to person only, restless) indicates
hypoperfusion and potential septic or hypovolemic shock. While all findings are concerning, this
combination represents an immediate threat to physiological stability using the ABCs
framework. The altered mental status in an elderly patient with hypotension suggests inadequate
cerebral perfusion.
,2
Why others are incorrect: Option A (elevated glucose) is expected in a stressed, dehydrated
diabetic patient and can be addressed after stabilization. Option B (poor skin turgor) confirms
dehydration but is not immediately life-threatening. Option D (weight loss) is significant for
nutritional status but chronic rather than acute.
Retake Success Tip: Always prioritize physiological instability over chronic conditions.
Hypotension + altered mental status = shock until proven otherwise.
Scenario Part 2 (4 Hours Later - Progress Note):
Margaret has received 2L of IV normal saline. Repeat vital signs: Temp 38.3°C, HR 88, BP
108/72, RR 20, O2 Sat 96% on 2L NC. She is now oriented to person and place but still confused
about time and situation. She attempts to get out of bed without calling for assistance. She has a
2.5 cm reddened area on her sacrum that blanches with pressure. Urinalysis shows positive
leukocyte esterase, nitrites, and >100 WBCs. Blood cultures drawn. New orders: Continue IV
fluids, obtain wound culture, start empiric antibiotics.
Q2 (Analyze Cues - Cloze/Drop-down): Complete the sentence below by choosing from the
dropdown options.
Based on the assessment findings, the patient is experiencing __________ as evidenced by
__________ and __________.
Dropdown Options:
First blank: [delirium / dementia / depression / urinary tract infection]
Second blank: [acute onset confusion with fluctuating consciousness / gradual memory decline /
persistent sad mood / sudden fever and urinary symptoms]
Third blank: [reversible underlying cause identified / progressive deterioration / anhedonia /
chronic condition]
Correct Answers: delirium, acute onset confusion with fluctuating consciousness, reversible
underlying cause identified
Rationale: This tests the Analyze Cues step of clinical judgment. Margaret demonstrates classic
delirium: acute onset (daughter reports normal baseline), fluctuating level of consciousness
(improved orientation after fluids but still confused), and identifiable underlying causes
(dehydration, possible UTI/sepsis). The key differentiator is that delirium has acute onset,
fluctuates throughout the day, and has reversible causes, while dementia has gradual onset and
progressive decline.
Clinical judgment application: The nurse must recognize that Margaret's confusion is not
baseline dementia (common error in elderly patients) but acute delirium requiring treatment of
underlying causes. The improvement with hydration supports this analysis.
,3
Scenario Part 3 (Provider Orders and Nursing Care):
Margaret's orders now include: Strict intake/output, bladder scan if no void in 6 hours, fall
precautions with bed alarm, wound culture of sacral area, Vancomycin 1g IV q12h (pharmacy to
verify renal dosing), Diet: Regular with assist. Margaret continues to try to get out of bed without
assistance, stating she "needs to go home to feed the cat."
Q3 (Prioritize Hypotheses/Generate Solutions - Bow-Tie Item): Complete the bow-tie by
selecting the appropriate options.
Center Box (Priority Problem): Margaret is at highest immediate risk for which complication?
Options: [Urinary tract infection] [Pressure injury] [Fall with injury] [Medication adverse
reaction]
Left Side (Nursing Actions - Select 2): Which two actions should the nurse implement FIRST?
Options: [Apply soft wrist restraints] [Place bed in lowest position with wheels locked and bed
alarm activated] [Request geriatric psychiatry consultation] [Encourage family member to sit
with patient] [Administer PRN lorazepam for agitation]
Right Side (Evaluation Parameters - Select 2): Which two parameters should the nurse monitor
to evaluate effectiveness of interventions?
Options: [Number of unassisted bed exits] [Patient's orientation to person/place/time] [Blood
pressure trends] [White blood cell count] [Sacral skin integrity]
Correct Answers:
Center Box: Fall with injury
Left Side: Place bed in lowest position with wheels locked and bed alarm activated; Encourage
family member to sit with patient
Right Side: Number of unassisted bed exits; Patient's orientation to person/place/time
Rationale: This tests Prioritize Hypotheses and Generate Solutions steps. While Margaret has
multiple issues (UTI, pressure injury risk, fall risk), the immediate safety priority is fall with
injury due to her continued attempts to get out of bed unsafely and her altered mental status.
Action rationale: Environmental modifications (low bed, alarm) and supervision (family
presence) are least restrictive, evidence-based fall prevention strategies. Restraints (Option A)
are last resort per CMS regulations and can increase injury risk. Sedation (lorazepam) may
worsen delirium and increase fall risk. Psych consult is important but not immediate.
Evaluation rationale: The nurse must evaluate if fall prevention works (unassisted exits) and if
underlying delirium improves (orientation). While BP, WBC, and skin integrity are important,
they don't directly evaluate fall prevention effectiveness.
, 4
Q4 (Delegation - Multiple Choice): The nurse is caring for Margaret and three other patients.
Which task is most appropriate to delegate to the LPN/LVN?
A. Perform the initial head-to-toe assessment on a newly admitted patient
B. Administer the first dose of IV Vancomycin to Margaret [CORRECT]
C. Develop the plan of care for a patient being discharged tomorrow
D. Evaluate the effectiveness of patient teaching regarding wound care
Correct Answer: B
Rationale: This tests delegation principles and scope of practice. LPNs can administer
medications (including IV medications in many states) for stable patients with predictable
outcomes. Margaret is now hemodynamically stable (BP 108/72), making this appropriate for
LPN scope.
Why others are incorrect: Initial assessments (Option A) require RN education and scope. Care
planning (Option C) and evaluation of teaching (Option D) require RN-level critical thinking and
judgment. These cannot be delegated to LPNs.
Retake Success Tip: Remember the "Three Es" of RN-only tasks: Evaluation, Education
(planning/developing), and initial Examination/Assessment. LPNs perform stable, predictable
care; UAPs perform routine, non-invasive tasks.
Q5 (Prioritization - Multiple Choice): The nurse receives report on four patients. Which patient
should the nurse assess FIRST?
A. A patient with diabetes who needs discharge teaching
B. A patient scheduled for physical therapy in 30 minutes
C. A patient with chest pain rated 8/10 and blood pressure of 88/52 [CORRECT]
D. A patient requesting a PRN laxative
Correct Answer: C
Rationale: This tests prioritization using ABCs and physiological stability. Chest pain with
hypotension indicates potential myocardial infarction, cardiogenic shock, or other life-
threatening cardiovascular event. This patient is unstable and requires immediate assessment.
Prioritization framework: Use ABCs first (Airway, Breathing, Circulation), then safety, then
acute vs. chronic, then stable vs. unstable. Option C involves circulation (BP) and potential
cardiac issue (chest pain). Options A, B, and D are important but not immediate threats to
physiological stability.
