ATI RN Comprehensive Predictor Exit Exam with
NGN 180
1. A patient with a history of chronic heart failure presents with dyspnea, orthopnea, and bilateral
lower extremity edema. The nurse notes jugular venous distention and crackles in the lung bases.
Which intervention should the nurse prioritize first?
A. Administer intravenous furosemide 40 mg
B. Place the patient in a high Fowler's position
C. Draw blood for BNP level
D. Obtain a STAT electrocardiogram
Answer: B
Rationale: Airway and breathing are the priority. High Fowler's position optimizes ventilation and
reduces preload, providing immediate relief. While furosemide and BNP are important, they are not the
first action in acute decompensation.
2. A nurse is reviewing laboratory results for a patient receiving heparin therapy. The patient's
aPTT is 90 seconds (therapeutic range 60-80 seconds). What is the nurse's priority action?
A. Administer protamine sulfate
B. Hold the heparin infusion and notify the provider
C. Decrease the heparin infusion rate by 50%
D. Continue the current infusion and monitor for bleeding
Answer: B
Rationale: An aPTT of 90 seconds indicates supratherapeutic anticoagulation, increasing bleeding risk.
The nurse should hold the infusion and notify the provider for dose adjustment. Protamine is reserved
for serious bleeding, not an elevated aPTT alone.
3. A nurse is caring for a patient with a chest tube connected to a dry suction water seal drainage
system. The nurse notes continuous bubbling in the water seal chamber. What is the most likely
cause?
A. An air leak in the system
B. The suction is set too high
C. The chest tube is obstructed
D. The patient has a pneumothorax
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which may be from the
insertion site, tubing connections, or within the system. Intermittent bubbling during exhalation is
normal with a pneumothorax. Suction level does not cause continuous bubbling.
Page 1
,4. A nurse is assessing a patient who is 12 hours post-operative following a total hip arthroplasty.
Which finding requires immediate intervention?
A. Serosanguinous drainage on the dressing
B. Patient reports pain of 4 on a 0-10 scale
C. Toes on the operative leg are pale and cool with capillary refill >4 seconds
D. Urine output of 40 mL over the past 2 hours
Answer: C
Rationale: Pale, cool toes with delayed capillary refill may indicate compromised circulation, possibly
from a hematoma or vascular injury, requiring immediate intervention. The other findings are expected
postoperatively.
5. A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
notes serum potassium of 5.8 mEq/L. Which action should the nurse take?
A. Administer intravenous regular insulin as prescribed
B. Administer oral potassium supplements
C. Prepare for hemodialysis
D. Administer sodium polystyrene sulfonate
Answer: A
Rationale: In DKA, hyperkalemia is often due to intracellular shift from acidosis. Insulin therapy will
correct hyperkalemia by promoting cellular uptake. Potassium supplements are contraindicated unless
levels drop. Dialysis is not first-line.
6. A nurse is preparing to administer a blood transfusion to a patient. The patient's vital signs are:
BP 100/60, HR 90, RR 18, temp 37.2°C. Which action is most important for the nurse to take?
A. Prime the blood tubing with 0.9% sodium chloride
B. Obtain a signed informed consent from the patient
C. Verify the patient's blood type and crossmatch results
D. Premedicate with acetaminophen and diphenhydramine
Answer: C
Rationale: Verification of blood type and crossmatch is critical to prevent hemolytic transfusion
reactions. Priming with saline is correct but not the most important step. Consent is typically obtained
by the provider. Premedication is not routine.
7. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
pneumonia. The nurse notes the patient is confused, with a respiratory rate of 8 breaths per
minute. Arterial blood gas results: pH 7.28, PaCO2 55 mm Hg, PaO2 60 mm Hg, HCO3- 24
mEq/L. Which intervention should the nurse implement first?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Initiate noninvasive positive pressure ventilation (NIPPV)
C. Prepare for endotracheal intubation
D. Administer albuterol via nebulizer
Answer: B
Page 2
,Rationale: The patient has acute respiratory acidosis with hypoxemia and altered mental status, indicating impending
respiratory failure. NIPPV can improve ventilation and oxygenation without intubation. High-flow oxygen may suppress
hypoxic drive; intubation is reserved if NIPPV fails.
8. A nurse is evaluating the effectiveness of teaching about a low-sodium diet for a patient with
hypertension. Which patient statement indicates understanding?
A. I will use soy sauce to flavor my food instead of salt.
B. I can eat canned vegetables as long as I rinse them.
C. I should avoid processed meats like ham and bacon.
D. I can have unlimited amounts of fresh fruits and vegetables.
Answer: C
Rationale: Processed meats are high in sodium and should be avoided. Soy sauce is also high in sodium.
Rinsing canned vegetables reduces but does not eliminate sodium. While fresh fruits and vegetables are
low in sodium, 'unlimited' is not accurate for overall health.
9. A nurse is caring for a patient with a central venous catheter (CVC) who develops sudden onset
of chest pain, dyspnea, and hypotension. The nurse suspects an air embolism. Which action should
the nurse take first?
A. Place the patient in Trendelenburg position on the left side
B. Administer oxygen via face mask at 10 L/min
C. Clamp the CVC immediately
D. Notify the provider
Answer: A
Rationale: Trendelenburg with left lateral positioning traps air in the right ventricle and prevents
embolization to the pulmonary system. Clamping the catheter is important but not the first action.
Oxygen and notification follow positioning.
10. A nurse is assessing a patient with suspected deep vein thrombosis (DVT). Which finding is
most consistent with this diagnosis?
A. Unilateral calf swelling and warmth
B. Bilateral lower extremity edema
C. Pitting edema that resolves with elevation
D. Cool, pale extremity with diminished pulses
Answer: A
Rationale: Unilateral calf swelling, warmth, and tenderness are classic signs of DVT. Bilateral edema
suggests systemic causes like heart failure. Pitting edema that resolves with elevation is typical of
venous insufficiency. Cool, pale extremity with diminished pulses indicates arterial occlusion.
Page 3
, 11. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory failure. Arterial blood gas (ABG) results on admission: pH 7.25, PaCO2 65 mm Hg,
PaO2 55 mm Hg, HCO3- 24 mEq/L. The nurse prepares to initiate noninvasive positive pressure
ventilation (NIPPV). Which finding would indicate the need for immediate endotracheal
intubation?
A. Respiratory rate of 28 breaths/min
B. PaO2 of 60 mm Hg after 30 minutes of NIPPV
C. Decreased level of consciousness with inability to protect airway
D. Use of accessory muscles and paradoxical breathing
Answer: C
Rationale: A decreased level of consciousness with inability to protect the airway is a contraindication to
NIPPV and indicates the need for endotracheal intubation to secure the airway. NIPPV requires an
awake, cooperative patient. Options A, B, and D may be present but do not alone mandate immediate
intubation.
12. A community health nurse is evaluating the effectiveness of a tuberculosis (TB) contact
investigation. Which outcome indicates successful implementation of targeted testing and
treatment?
A. All identified contacts completed a full course of isoniazid preventive therapy within 12 months
B. Contacts with positive tuberculin skin tests were treated with rifampin for 4 months
C. No new cases of active TB were identified among contacts during a 2-year follow-up
D. Contacts were tested with interferon-gamma release assay (IGRA) at baseline and 8 weeks
Answer: A
Rationale: Completion of preventive therapy by all contacts is the primary goal of contact investigation to
prevent progression to active TB. Option B is incorrect because rifampin is not standard preventive
therapy; isoniazid is preferred. Option C is desirable but may not reflect full adherence. Option D
describes testing, not treatment completion.
13. A nurse is caring for a client with a chest tube connected to a dry suction water seal drainage
system. The client's drainage has been 100 mL/hr for the past 3 hours. Which action should the
nurse take?
A. Clamp the chest tube and notify the healthcare provider immediately
B. Increase the suction pressure to -25 cm H2O to facilitate drainage
C. Document the output and continue to monitor hourly
D. Strip the chest tube to maintain patency
Answer: C
Rationale: Drainage of up to 100-150 mL/hr initially is not unusual after chest tube insertion; the
appropriate action is to document and monitor. Clamping (A) can cause tension pneumothorax.
Increasing suction (B) may damage tissue. Stripping (D) is no longer recommended due to risk of high
negative pressure.
Page 4
NGN 180
1. A patient with a history of chronic heart failure presents with dyspnea, orthopnea, and bilateral
lower extremity edema. The nurse notes jugular venous distention and crackles in the lung bases.
Which intervention should the nurse prioritize first?
A. Administer intravenous furosemide 40 mg
B. Place the patient in a high Fowler's position
C. Draw blood for BNP level
D. Obtain a STAT electrocardiogram
Answer: B
Rationale: Airway and breathing are the priority. High Fowler's position optimizes ventilation and
reduces preload, providing immediate relief. While furosemide and BNP are important, they are not the
first action in acute decompensation.
2. A nurse is reviewing laboratory results for a patient receiving heparin therapy. The patient's
aPTT is 90 seconds (therapeutic range 60-80 seconds). What is the nurse's priority action?
A. Administer protamine sulfate
B. Hold the heparin infusion and notify the provider
C. Decrease the heparin infusion rate by 50%
D. Continue the current infusion and monitor for bleeding
Answer: B
Rationale: An aPTT of 90 seconds indicates supratherapeutic anticoagulation, increasing bleeding risk.
The nurse should hold the infusion and notify the provider for dose adjustment. Protamine is reserved
for serious bleeding, not an elevated aPTT alone.
3. A nurse is caring for a patient with a chest tube connected to a dry suction water seal drainage
system. The nurse notes continuous bubbling in the water seal chamber. What is the most likely
cause?
A. An air leak in the system
B. The suction is set too high
C. The chest tube is obstructed
D. The patient has a pneumothorax
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which may be from the
insertion site, tubing connections, or within the system. Intermittent bubbling during exhalation is
normal with a pneumothorax. Suction level does not cause continuous bubbling.
Page 1
,4. A nurse is assessing a patient who is 12 hours post-operative following a total hip arthroplasty.
Which finding requires immediate intervention?
A. Serosanguinous drainage on the dressing
B. Patient reports pain of 4 on a 0-10 scale
C. Toes on the operative leg are pale and cool with capillary refill >4 seconds
D. Urine output of 40 mL over the past 2 hours
Answer: C
Rationale: Pale, cool toes with delayed capillary refill may indicate compromised circulation, possibly
from a hematoma or vascular injury, requiring immediate intervention. The other findings are expected
postoperatively.
5. A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
notes serum potassium of 5.8 mEq/L. Which action should the nurse take?
A. Administer intravenous regular insulin as prescribed
B. Administer oral potassium supplements
C. Prepare for hemodialysis
D. Administer sodium polystyrene sulfonate
Answer: A
Rationale: In DKA, hyperkalemia is often due to intracellular shift from acidosis. Insulin therapy will
correct hyperkalemia by promoting cellular uptake. Potassium supplements are contraindicated unless
levels drop. Dialysis is not first-line.
6. A nurse is preparing to administer a blood transfusion to a patient. The patient's vital signs are:
BP 100/60, HR 90, RR 18, temp 37.2°C. Which action is most important for the nurse to take?
A. Prime the blood tubing with 0.9% sodium chloride
B. Obtain a signed informed consent from the patient
C. Verify the patient's blood type and crossmatch results
D. Premedicate with acetaminophen and diphenhydramine
Answer: C
Rationale: Verification of blood type and crossmatch is critical to prevent hemolytic transfusion
reactions. Priming with saline is correct but not the most important step. Consent is typically obtained
by the provider. Premedication is not routine.
7. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
pneumonia. The nurse notes the patient is confused, with a respiratory rate of 8 breaths per
minute. Arterial blood gas results: pH 7.28, PaCO2 55 mm Hg, PaO2 60 mm Hg, HCO3- 24
mEq/L. Which intervention should the nurse implement first?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Initiate noninvasive positive pressure ventilation (NIPPV)
C. Prepare for endotracheal intubation
D. Administer albuterol via nebulizer
Answer: B
Page 2
,Rationale: The patient has acute respiratory acidosis with hypoxemia and altered mental status, indicating impending
respiratory failure. NIPPV can improve ventilation and oxygenation without intubation. High-flow oxygen may suppress
hypoxic drive; intubation is reserved if NIPPV fails.
8. A nurse is evaluating the effectiveness of teaching about a low-sodium diet for a patient with
hypertension. Which patient statement indicates understanding?
A. I will use soy sauce to flavor my food instead of salt.
B. I can eat canned vegetables as long as I rinse them.
C. I should avoid processed meats like ham and bacon.
D. I can have unlimited amounts of fresh fruits and vegetables.
Answer: C
Rationale: Processed meats are high in sodium and should be avoided. Soy sauce is also high in sodium.
Rinsing canned vegetables reduces but does not eliminate sodium. While fresh fruits and vegetables are
low in sodium, 'unlimited' is not accurate for overall health.
9. A nurse is caring for a patient with a central venous catheter (CVC) who develops sudden onset
of chest pain, dyspnea, and hypotension. The nurse suspects an air embolism. Which action should
the nurse take first?
A. Place the patient in Trendelenburg position on the left side
B. Administer oxygen via face mask at 10 L/min
C. Clamp the CVC immediately
D. Notify the provider
Answer: A
Rationale: Trendelenburg with left lateral positioning traps air in the right ventricle and prevents
embolization to the pulmonary system. Clamping the catheter is important but not the first action.
Oxygen and notification follow positioning.
10. A nurse is assessing a patient with suspected deep vein thrombosis (DVT). Which finding is
most consistent with this diagnosis?
A. Unilateral calf swelling and warmth
B. Bilateral lower extremity edema
C. Pitting edema that resolves with elevation
D. Cool, pale extremity with diminished pulses
Answer: A
Rationale: Unilateral calf swelling, warmth, and tenderness are classic signs of DVT. Bilateral edema
suggests systemic causes like heart failure. Pitting edema that resolves with elevation is typical of
venous insufficiency. Cool, pale extremity with diminished pulses indicates arterial occlusion.
Page 3
, 11. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory failure. Arterial blood gas (ABG) results on admission: pH 7.25, PaCO2 65 mm Hg,
PaO2 55 mm Hg, HCO3- 24 mEq/L. The nurse prepares to initiate noninvasive positive pressure
ventilation (NIPPV). Which finding would indicate the need for immediate endotracheal
intubation?
A. Respiratory rate of 28 breaths/min
B. PaO2 of 60 mm Hg after 30 minutes of NIPPV
C. Decreased level of consciousness with inability to protect airway
D. Use of accessory muscles and paradoxical breathing
Answer: C
Rationale: A decreased level of consciousness with inability to protect the airway is a contraindication to
NIPPV and indicates the need for endotracheal intubation to secure the airway. NIPPV requires an
awake, cooperative patient. Options A, B, and D may be present but do not alone mandate immediate
intubation.
12. A community health nurse is evaluating the effectiveness of a tuberculosis (TB) contact
investigation. Which outcome indicates successful implementation of targeted testing and
treatment?
A. All identified contacts completed a full course of isoniazid preventive therapy within 12 months
B. Contacts with positive tuberculin skin tests were treated with rifampin for 4 months
C. No new cases of active TB were identified among contacts during a 2-year follow-up
D. Contacts were tested with interferon-gamma release assay (IGRA) at baseline and 8 weeks
Answer: A
Rationale: Completion of preventive therapy by all contacts is the primary goal of contact investigation to
prevent progression to active TB. Option B is incorrect because rifampin is not standard preventive
therapy; isoniazid is preferred. Option C is desirable but may not reflect full adherence. Option D
describes testing, not treatment completion.
13. A nurse is caring for a client with a chest tube connected to a dry suction water seal drainage
system. The client's drainage has been 100 mL/hr for the past 3 hours. Which action should the
nurse take?
A. Clamp the chest tube and notify the healthcare provider immediately
B. Increase the suction pressure to -25 cm H2O to facilitate drainage
C. Document the output and continue to monitor hourly
D. Strip the chest tube to maintain patency
Answer: C
Rationale: Drainage of up to 100-150 mL/hr initially is not unusual after chest tube insertion; the
appropriate action is to document and monitor. Clamping (A) can cause tension pneumothorax.
Increasing suction (B) may damage tissue. Stripping (D) is no longer recommended due to risk of high
negative pressure.
Page 4
