NGN NURSING ATI RN EXAM QUESTIONS AND
CORRECT ANSWERS 2026
1. A nurse in the emergency department assesses a client who is disoriented,
tremulous, and reports seeing insects crawling on the walls. The client has a
history of heavy alcohol use. Vital signs: HR 130, BP 165/100, temperature 99.2°F
(37.3°C). Which NGN-appropriate action should the nurse take first?
A. Administer IV lorazepam as ordered
B. Place the client in a seclusion room
C. Obtain a urine drug screen
D. Encourage oral intake of thiamine-rich foods
Correct Answer: A
Explanation: The client is exhibiting signs of alcohol withdrawal delirium (delirium
tremens), which is a medical emergency. First-line treatment is benzodiazepines
(e.g., lorazepam) to prevent seizure and autonomic instability. Seclusion is not a
first action; drug screen and thiamine are important but not immediate priority
over sedation.
2. A nurse is caring for a postoperative client who received IV morphine 2 mg for
severe pain 30 minutes ago. The client now has a respiratory rate of 8
breaths/min, oxygen saturation 85%, and is difficult to arouse. Which medication
should the nurse prepare to administer?
A. Flumazenil
B. Naloxone
C. Atropine
D. Epinephrine
Correct Answer: B
Explanation: Naloxone is a competitive opioid antagonist used to reverse opioid-
induced respiratory depression. Flumazenil reverses benzodiazepines. Atropine
treats bradycardia. Epinephrine is for anaphylaxis or cardiac arrest.
,3. A client with heart failure is receiving furosemide 40 mg IV daily. Which
assessment finding indicates the need for immediate provider notification?
A. Weight decrease of 1 kg over 2 days
B. Serum potassium 3.0 mEq/L
C. Trace pedal edema
D. Urine output of 150 mL over 4 hours
Correct Answer: B
*Explanation: Hypokalemia (K <3.5) from loop diuretics increases risk of digitalis
toxicity and cardiac dysrhythmias. A weight loss of 1 kg in 2 days is expected.
Trace edema is not urgent. Urine output 150 mL/4h is ~38 mL/hr, acceptable.*
4. An older adult client is admitted with new-onset confusion, fever, and urinary
frequency. The nurse reviews the NGN unfolding case and notes a history of
dementia. Which action should the nurse prioritize?
A. Obtain a urine culture and sensitivity
B. Administer PRN haloperidol for agitation
C. Restrain the client to prevent falls
D. Start IV fluids at 150 mL/hr
Correct Answer: A
Explanation: New confusion + fever + urinary frequency suggests urinary tract
infection (UTI) as a reversible cause of delirium in older adults. Obtain culture
before antibiotics. Haloperidol may worsen outcomes if infection untreated.
Restraints increase harm. IV rate may be excessive in elderly.
5. A nurse is evaluating an NGN case study: A client with chronic kidney disease
(CKD) stage 4 has hemoglobin 8.2 g/dL, ferritin 800 ng/mL, and transferrin
saturation 18%. Which intervention is most appropriate?
A. Oral ferrous sulfate
B. IV iron sucrose
C. Erythropoiesis-stimulating agent (ESA)
D. Blood transfusion
Correct Answer: C
Explanation: ESA (e.g., epoetin alfa) is indicated for anemia of CKD when Hb <10,
, with adequate iron stores (ferritin >100, TSAT >20% here iron is sufficient). IV iron
is added if TSAT low. Transfusion reserved for severe anemia or instability.
6. A client on a medical-surgical unit has a new tracheostomy. The nurse hears a
high-pitched noise during inspiration and notes decreased oxygen saturation.
The client’s work of breathing is increased. What is the nurse’s priority action?
A. Deflate the tracheostomy cuff
B. Remove inner cannula and inspect for mucus plug
C. Call a rapid response team
D. Increase oxygen flow to 15 L/min
Correct Answer: B
Explanation: High-pitched inspiratory noise (stridor) with desaturation and
increased WOB suggests partial airway obstruction, often a mucus plug. Removing
and inspecting inner cannula is immediate first step. Deflating cuff does not clear
obstruction. Rapid response may be needed if unsuccessful.
7. A nurse is preparing to administer IV potassium chloride. Which action is
essential for safe administration?
A. Give as a slow IV push over 10 minutes
B. Mix in a 250 mL bag and infuse via gravity drip
C. Use an infusion pump with concentration no more than 10 mEq/hour
peripheral
D. Add to a running IVPB antibiotic for convenience
Correct Answer: C
*Explanation: IV potassium must be given via infusion pump, peripheral max rate
usually 10 mEq/hr (central line up to 20 mEq/hr). Never give IV push. Gravity drip
unsafe. Do not mix with antibiotics.*
8. A client with diabetes mellitus type 2 is prescribed metformin and scheduled for
IV contrast for a CT scan. Which NGN finding requires the most immediate action
by the nurse?
, A. Serum creatinine 1.4 mg/dL
B. Hemoglobin A1C 7.8%
C. Blood glucose 210 mg/dL
D. Weight gain of 2 kg in 1 month
Correct Answer: A
*Explanation: Metformin + IV contrast in renal impairment (Cr elevated) increases
risk of lactic acidosis. Hold metformin 48 hours before/after contrast. A1C
elevation is chronic. Hyperglycemia not emergent here. Weight gain suggests
possible fluid retention but not urgent.*
9. A nurse is caring for a client receiving continuous enteral nutrition via nasogastric
tube. The nurse notes a residual volume of 350 mL. What is the most appropriate
action?
A. Discard the residual and continue feeding at the same rate
B. Hold feeding and reassess residual in 1 hour
C. Increase the feeding rate to compensate
D. Administer prokinetic medication as ordered
Correct Answer: B
*Explanation: Gastric residual >250-300 mL suggests delayed gastric emptying
and aspiration risk. Hold feeding, reassess. Discarding residual loses electrolytes.
Increasing rate worsens risk. Prokinetics are not first immediate action.*
10. A client with pneumonia has an order for ceftriaxone IV. The client reports a
previous rash after penicillin. Which action should the nurse take?
A. Administer ceftriaxone as ordered with close monitoring
B. Hold the medication and notify the provider
C. Premedicate with diphenhydramine and administer
D. Request a change to a macrolide antibiotic
Correct Answer: A
*Explanation: Cross-reactivity between penicillins and cephalosporins is low
(approx 1-2%). Mild rash history is not an absolute contraindication; administer
with monitoring. Holding is unnecessary unless severe reaction history
(anaphylaxis, SJS).*
CORRECT ANSWERS 2026
1. A nurse in the emergency department assesses a client who is disoriented,
tremulous, and reports seeing insects crawling on the walls. The client has a
history of heavy alcohol use. Vital signs: HR 130, BP 165/100, temperature 99.2°F
(37.3°C). Which NGN-appropriate action should the nurse take first?
A. Administer IV lorazepam as ordered
B. Place the client in a seclusion room
C. Obtain a urine drug screen
D. Encourage oral intake of thiamine-rich foods
Correct Answer: A
Explanation: The client is exhibiting signs of alcohol withdrawal delirium (delirium
tremens), which is a medical emergency. First-line treatment is benzodiazepines
(e.g., lorazepam) to prevent seizure and autonomic instability. Seclusion is not a
first action; drug screen and thiamine are important but not immediate priority
over sedation.
2. A nurse is caring for a postoperative client who received IV morphine 2 mg for
severe pain 30 minutes ago. The client now has a respiratory rate of 8
breaths/min, oxygen saturation 85%, and is difficult to arouse. Which medication
should the nurse prepare to administer?
A. Flumazenil
B. Naloxone
C. Atropine
D. Epinephrine
Correct Answer: B
Explanation: Naloxone is a competitive opioid antagonist used to reverse opioid-
induced respiratory depression. Flumazenil reverses benzodiazepines. Atropine
treats bradycardia. Epinephrine is for anaphylaxis or cardiac arrest.
,3. A client with heart failure is receiving furosemide 40 mg IV daily. Which
assessment finding indicates the need for immediate provider notification?
A. Weight decrease of 1 kg over 2 days
B. Serum potassium 3.0 mEq/L
C. Trace pedal edema
D. Urine output of 150 mL over 4 hours
Correct Answer: B
*Explanation: Hypokalemia (K <3.5) from loop diuretics increases risk of digitalis
toxicity and cardiac dysrhythmias. A weight loss of 1 kg in 2 days is expected.
Trace edema is not urgent. Urine output 150 mL/4h is ~38 mL/hr, acceptable.*
4. An older adult client is admitted with new-onset confusion, fever, and urinary
frequency. The nurse reviews the NGN unfolding case and notes a history of
dementia. Which action should the nurse prioritize?
A. Obtain a urine culture and sensitivity
B. Administer PRN haloperidol for agitation
C. Restrain the client to prevent falls
D. Start IV fluids at 150 mL/hr
Correct Answer: A
Explanation: New confusion + fever + urinary frequency suggests urinary tract
infection (UTI) as a reversible cause of delirium in older adults. Obtain culture
before antibiotics. Haloperidol may worsen outcomes if infection untreated.
Restraints increase harm. IV rate may be excessive in elderly.
5. A nurse is evaluating an NGN case study: A client with chronic kidney disease
(CKD) stage 4 has hemoglobin 8.2 g/dL, ferritin 800 ng/mL, and transferrin
saturation 18%. Which intervention is most appropriate?
A. Oral ferrous sulfate
B. IV iron sucrose
C. Erythropoiesis-stimulating agent (ESA)
D. Blood transfusion
Correct Answer: C
Explanation: ESA (e.g., epoetin alfa) is indicated for anemia of CKD when Hb <10,
, with adequate iron stores (ferritin >100, TSAT >20% here iron is sufficient). IV iron
is added if TSAT low. Transfusion reserved for severe anemia or instability.
6. A client on a medical-surgical unit has a new tracheostomy. The nurse hears a
high-pitched noise during inspiration and notes decreased oxygen saturation.
The client’s work of breathing is increased. What is the nurse’s priority action?
A. Deflate the tracheostomy cuff
B. Remove inner cannula and inspect for mucus plug
C. Call a rapid response team
D. Increase oxygen flow to 15 L/min
Correct Answer: B
Explanation: High-pitched inspiratory noise (stridor) with desaturation and
increased WOB suggests partial airway obstruction, often a mucus plug. Removing
and inspecting inner cannula is immediate first step. Deflating cuff does not clear
obstruction. Rapid response may be needed if unsuccessful.
7. A nurse is preparing to administer IV potassium chloride. Which action is
essential for safe administration?
A. Give as a slow IV push over 10 minutes
B. Mix in a 250 mL bag and infuse via gravity drip
C. Use an infusion pump with concentration no more than 10 mEq/hour
peripheral
D. Add to a running IVPB antibiotic for convenience
Correct Answer: C
*Explanation: IV potassium must be given via infusion pump, peripheral max rate
usually 10 mEq/hr (central line up to 20 mEq/hr). Never give IV push. Gravity drip
unsafe. Do not mix with antibiotics.*
8. A client with diabetes mellitus type 2 is prescribed metformin and scheduled for
IV contrast for a CT scan. Which NGN finding requires the most immediate action
by the nurse?
, A. Serum creatinine 1.4 mg/dL
B. Hemoglobin A1C 7.8%
C. Blood glucose 210 mg/dL
D. Weight gain of 2 kg in 1 month
Correct Answer: A
*Explanation: Metformin + IV contrast in renal impairment (Cr elevated) increases
risk of lactic acidosis. Hold metformin 48 hours before/after contrast. A1C
elevation is chronic. Hyperglycemia not emergent here. Weight gain suggests
possible fluid retention but not urgent.*
9. A nurse is caring for a client receiving continuous enteral nutrition via nasogastric
tube. The nurse notes a residual volume of 350 mL. What is the most appropriate
action?
A. Discard the residual and continue feeding at the same rate
B. Hold feeding and reassess residual in 1 hour
C. Increase the feeding rate to compensate
D. Administer prokinetic medication as ordered
Correct Answer: B
*Explanation: Gastric residual >250-300 mL suggests delayed gastric emptying
and aspiration risk. Hold feeding, reassess. Discarding residual loses electrolytes.
Increasing rate worsens risk. Prokinetics are not first immediate action.*
10. A client with pneumonia has an order for ceftriaxone IV. The client reports a
previous rash after penicillin. Which action should the nurse take?
A. Administer ceftriaxone as ordered with close monitoring
B. Hold the medication and notify the provider
C. Premedicate with diphenhydramine and administer
D. Request a change to a macrolide antibiotic
Correct Answer: A
*Explanation: Cross-reactivity between penicillins and cephalosporins is low
(approx 1-2%). Mild rash history is not an absolute contraindication; administer
with monitoring. Holding is unnecessary unless severe reaction history
(anaphylaxis, SJS).*
