NGN ATI PN COMPREHENSIVE PREDICTOR
2026 EXIT EXAM: PRACTICE TEST /NGN
CASE STUDY: POSTPARTUM HEMORRHAGE
*Questions 1-6 are based on the following scenario.*
Scenario: A nurse is assisting in the care of a client who is 1 hour postpartum.
Exhibit 1: Nurses' Notes
1200: Large amount of lochia rubra noted on perineal pad. Fundus boggy at two fingerbreadths
above the umbilicus. Oxytocin 20 units being administered via continuous IV infusion.
1215: Large amount of lochia rubra with several large clots noted. Client reports feeling anxious.
Skin cool and clammy. Provider notified.
Exhibit 2: Vital Signs
1200: Temperature 37.5° C (99.5° F), Heart rate 92/min, Respiratory rate 20/min, Blood pressure
110/70 mm Hg.
1215: Temperature 37.5° C (99.5° F), Heart rate 120/min, Respiratory rate 24/min, Blood
pressure 88/52 mm Hg.
1. Select the 6 actions the nurse should take.
A. Weigh the perineal pads.
B. Insert an indwelling urinary catheter.
C. Administer methylergonovine.
D. Provide emotional support.
E. Administer oxygen at 12 L/min via nonrebreather face mask.
F. Firmly massage the uterine fundus.
Correct Answers: A, C, D, E, F, B (Order may vary but all are correct)
Rationale: The client is experiencing a postpartum hemorrhage (boggy fundus, increased lochia,
tachycardia, hypotension). F. Firmly massage the uterine fundus is the priority to promote uterine
tone. C. Administer methylergonovine is a uterotonic medication. E. Administer oxygen at 12 L/min via
nonrebreather face mask addresses hypoxia from hypovolemia. A. Weigh the perineal pads provides an
,accurate assessment of blood loss. D. Provide emotional support is crucial for a client experiencing
anxiety and shock. B. Insert an indwelling urinary catheter will drain the bladder, which can impede
uterine contraction, and allow for accurate output monitoring .
NGN Case Study: Preoperative Assessment
*Questions 2-4 are based on the following scenario.*
Scenario: A nurse is collecting data from a client who is scheduled for surgery.
Exhibit 1: Vital Signs
0630: Temperature 36.9° C (98.5° F), Heart rate 74/min, Respiratory rate 20/min, Blood pressure
122/76 mm Hg, Oxygen saturation 96% on room air.
0730: Temperature 36.9° C (98.5° F), Heart rate 76/min, Respiratory rate 20/min, Blood pressure
128/78 mm Hg, Oxygen saturation 95% on room air.
Exhibit 2: Nurses' Notes
0630: Client reports restlessness and inability to sleep more than 3 to 4 hr per night for the last
week. Client states, "I am allergic to avocados and bananas." Client denies any other allergies.
Family history: mother had a severe reaction to anesthesia.
2. The nurse is reviewing the laboratory results. Which of the following results should be reported to
the provider prior to the procedure?
A. Hemoglobin 10.2 g/dL
B. Sodium 138 mEq/L
C. White blood cell count 8,000/mm³
D. Potassium 4.0 mEq/L
Correct Answer: A. Hemoglobin 10.2 g/dL
Rationale: A hemoglobin level of 10.2 g/dL is below the expected reference range for an adult
(approximately 12-16 g/dL). This finding indicates anemia and should be reported to the provider as the
client may require blood products during or after the procedure .
3. The nurse is reviewing the client's history. Which of the following findings should be reported to the
provider?
A. Restlessness
B. Allergy to avocados
C. Family history of reaction to anesthesia
, D. Inability to sleep
Correct Answers: B and C
Rationale: B. Allergy to avocados and bananas can indicate a potential cross-sensitivity to latex, a
common allergen in the operating room. This must be reported so that latex-safe supplies can be
used. C. Family history of malignant hyperthermia is a life-threatening genetic condition triggered by
certain anesthetic agents. The surgical team must be prepared to manage this potential emergency .
4. The client is being prepared for surgery and asks why they cannot eat or drink. Which of the
following is the most appropriate response?
A. "It prevents you from having to use the bathroom during the surgery."
B. "It reduces the risk of stomach contents entering your lungs during anesthesia."
C. "It is a standard hospital policy that we must enforce for all patients."
D. "It helps your blood pressure stay stable during the procedure."
Correct Answer: B. "It reduces the risk of stomach contents entering your lungs during
anesthesia."
Rationale: The primary reason for NPO (nothing by mouth) status before surgery is to ensure the
stomach is empty, which significantly decreases the risk of aspiration (inhaling stomach contents into
the lungs) while under general anesthesia .
NGN Case Study: End-of-Life Care & Airway Management
*Questions 5-7 are based on the following scenario.*
Scenario: A practical nurse (PN) is caring for a client in a long-term care facility. During the 0700
assessment, the PN notes the following:
Unresponsive to verbal stimuli.
Respirations: 8/min and shallow.
Pulse: 42 bpm and weak.
Oxygen saturation: 84% on room air.
History: Advanced dementia and do-not-resuscitate (DNR) / allow natural death (AND) orders.
5. Which of the following actions should the PN take first?
A. Reposition the client to facilitate airway clearance.
2026 EXIT EXAM: PRACTICE TEST /NGN
CASE STUDY: POSTPARTUM HEMORRHAGE
*Questions 1-6 are based on the following scenario.*
Scenario: A nurse is assisting in the care of a client who is 1 hour postpartum.
Exhibit 1: Nurses' Notes
1200: Large amount of lochia rubra noted on perineal pad. Fundus boggy at two fingerbreadths
above the umbilicus. Oxytocin 20 units being administered via continuous IV infusion.
1215: Large amount of lochia rubra with several large clots noted. Client reports feeling anxious.
Skin cool and clammy. Provider notified.
Exhibit 2: Vital Signs
1200: Temperature 37.5° C (99.5° F), Heart rate 92/min, Respiratory rate 20/min, Blood pressure
110/70 mm Hg.
1215: Temperature 37.5° C (99.5° F), Heart rate 120/min, Respiratory rate 24/min, Blood
pressure 88/52 mm Hg.
1. Select the 6 actions the nurse should take.
A. Weigh the perineal pads.
B. Insert an indwelling urinary catheter.
C. Administer methylergonovine.
D. Provide emotional support.
E. Administer oxygen at 12 L/min via nonrebreather face mask.
F. Firmly massage the uterine fundus.
Correct Answers: A, C, D, E, F, B (Order may vary but all are correct)
Rationale: The client is experiencing a postpartum hemorrhage (boggy fundus, increased lochia,
tachycardia, hypotension). F. Firmly massage the uterine fundus is the priority to promote uterine
tone. C. Administer methylergonovine is a uterotonic medication. E. Administer oxygen at 12 L/min via
nonrebreather face mask addresses hypoxia from hypovolemia. A. Weigh the perineal pads provides an
,accurate assessment of blood loss. D. Provide emotional support is crucial for a client experiencing
anxiety and shock. B. Insert an indwelling urinary catheter will drain the bladder, which can impede
uterine contraction, and allow for accurate output monitoring .
NGN Case Study: Preoperative Assessment
*Questions 2-4 are based on the following scenario.*
Scenario: A nurse is collecting data from a client who is scheduled for surgery.
Exhibit 1: Vital Signs
0630: Temperature 36.9° C (98.5° F), Heart rate 74/min, Respiratory rate 20/min, Blood pressure
122/76 mm Hg, Oxygen saturation 96% on room air.
0730: Temperature 36.9° C (98.5° F), Heart rate 76/min, Respiratory rate 20/min, Blood pressure
128/78 mm Hg, Oxygen saturation 95% on room air.
Exhibit 2: Nurses' Notes
0630: Client reports restlessness and inability to sleep more than 3 to 4 hr per night for the last
week. Client states, "I am allergic to avocados and bananas." Client denies any other allergies.
Family history: mother had a severe reaction to anesthesia.
2. The nurse is reviewing the laboratory results. Which of the following results should be reported to
the provider prior to the procedure?
A. Hemoglobin 10.2 g/dL
B. Sodium 138 mEq/L
C. White blood cell count 8,000/mm³
D. Potassium 4.0 mEq/L
Correct Answer: A. Hemoglobin 10.2 g/dL
Rationale: A hemoglobin level of 10.2 g/dL is below the expected reference range for an adult
(approximately 12-16 g/dL). This finding indicates anemia and should be reported to the provider as the
client may require blood products during or after the procedure .
3. The nurse is reviewing the client's history. Which of the following findings should be reported to the
provider?
A. Restlessness
B. Allergy to avocados
C. Family history of reaction to anesthesia
, D. Inability to sleep
Correct Answers: B and C
Rationale: B. Allergy to avocados and bananas can indicate a potential cross-sensitivity to latex, a
common allergen in the operating room. This must be reported so that latex-safe supplies can be
used. C. Family history of malignant hyperthermia is a life-threatening genetic condition triggered by
certain anesthetic agents. The surgical team must be prepared to manage this potential emergency .
4. The client is being prepared for surgery and asks why they cannot eat or drink. Which of the
following is the most appropriate response?
A. "It prevents you from having to use the bathroom during the surgery."
B. "It reduces the risk of stomach contents entering your lungs during anesthesia."
C. "It is a standard hospital policy that we must enforce for all patients."
D. "It helps your blood pressure stay stable during the procedure."
Correct Answer: B. "It reduces the risk of stomach contents entering your lungs during
anesthesia."
Rationale: The primary reason for NPO (nothing by mouth) status before surgery is to ensure the
stomach is empty, which significantly decreases the risk of aspiration (inhaling stomach contents into
the lungs) while under general anesthesia .
NGN Case Study: End-of-Life Care & Airway Management
*Questions 5-7 are based on the following scenario.*
Scenario: A practical nurse (PN) is caring for a client in a long-term care facility. During the 0700
assessment, the PN notes the following:
Unresponsive to verbal stimuli.
Respirations: 8/min and shallow.
Pulse: 42 bpm and weak.
Oxygen saturation: 84% on room air.
History: Advanced dementia and do-not-resuscitate (DNR) / allow natural death (AND) orders.
5. Which of the following actions should the PN take first?
A. Reposition the client to facilitate airway clearance.
