ATI RN Comprehensive Exit Exam | 2025–2026
Edition – 180 NGN Questions with Verified Answers
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results on admission: pH 7.25, PaCO2 65 mm Hg,
PaO2 50 mm Hg, HCO3- 26 mEq/L. The patient has been on home oxygen at 2 L/min via nasal
cannula. Which intervention should the nurse initiate first?
A. Increase oxygen flow rate to 6 L/min via nasal cannula.
B. Prepare for noninvasive positive pressure ventilation (NPPV).
C. Administer albuterol nebulizer treatment.
D. Place the patient in a high Fowler's position.
Answer: B
Rationale: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2, normal HCO3-),
indicating acute hypercapnic respiratory failure. NPPV (e.g., BiPAP) is the first-line intervention to
improve ventilation and reduce PaCO2. Increasing oxygen can suppress hypoxic drive; albuterol and
positioning are supportive but not primary.
2. A patient with end-stage renal disease on hemodialysis develops hyperkalemia (serum K+ 6.8
mEq/L) and is in ventricular bigeminy. Which order should the nurse question?
A. Intravenous calcium gluconate 10% 10 mL over 2 minutes.
B. Intravenous regular insulin 10 units with 50 mL of 50% dextrose.
C. Sodium polystyrene sulfonate 30 g orally.
D. Intravenous sodium bicarbonate 1 amp (50 mEq) over 5 minutes.
Answer: C
Rationale: Sodium polystyrene sulfonate (Kayexalate) works slowly over hours and is not appropriate for
acute life-threatening hyperkalemia with cardiac instability. Calcium gluconate stabilizes the cardiac
membrane immediately, insulin+dextrose shifts potassium intracellularly within 15-30 minutes, and
bicarbonate also shifts potassium (though less effective in dialysis patients).
3. A patient with a history of hypertension and type 2 diabetes is admitted with chest pain. Cardiac
troponin I is elevated, and ECG shows ST-segment depression in leads V3-V5. Which combination
of medications should the nurse anticipate administering to reduce mortality?
A. Aspirin, clopidogrel, and enoxaparin.
B. Aspirin, metoprolol, and atorvastatin.
C. Aspirin, morphine, and nitroglycerin.
D. Aspirin, lisinopril, and furosemide.
Answer: B
Rationale: The patient has non-ST-elevation myocardial infarction (NSTEMI). Aspirin reduces mortality;
beta-blockers (metoprolol) reduce myocardial oxygen demand; high-dose statin (atorvastatin) stabilizes
plaque and reduces recurrent events. While antiplatelet and anticoagulant therapy is important, the
Page 1
,combination in B is proven to reduce mortality long-term. Morphine and nitroglycerin relieve symptoms
but do not reduce mortality.
4. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. Which laboratory
result indicates that the medication is having the desired therapeutic effect?
A. Serum sodium 135 mEq/L.
B. Serum potassium 4.5 mEq/L.
C. Urine sodium 40 mEq/L.
D. Serum albumin 3.0 g/dL.
Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic that antagonizes aldosterone, promoting
sodium and water excretion while retaining potassium. An increased urine sodium (e.g., >20 mEq/L)
indicates effective natriuresis and diuresis. Serum sodium and potassium may normalize but are not
direct measures of drug effect. Albumin reflects synthetic function, not diuretic response.
5. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mm Hg
and cerebral perfusion pressure (CPP) of 55 mm Hg. Which nursing action should be implemented
first?
A. Administer mannitol 0.5 g/kg intravenously.
B. Elevate the head of bed to 30 degrees.
C. Increase sedation with propofol.
D. Notify the provider for possible decompressive craniectomy.
Answer: B
Rationale: Normal ICP is 5-15 mm Hg; CPP (MAP - ICP) should be 60-70 mm Hg. With ICP 22 and
CPP 55, CPP is compromised. Elevating the head of bed to 30 degrees promotes venous drainage and
lowers ICP, potentially improving CPP without pharmacologic intervention. Mannitol and sedation are
subsequent steps, and surgery is reserved for refractory intracranial hypertension.
6. A patient receiving IV heparin for deep vein thrombosis has an activated partial thromboplastin
time (aPTT) of 120 seconds (therapeutic range 60-80 seconds). The nurse notes the patient has
developed ecchymosis on the abdomen and is passing dark urine. Which action should the nurse
take?
A. Administer vitamin K intramuscularly.
B. Stop the heparin infusion and give protamine sulfate.
C. Decrease the heparin infusion rate by 50%.
D. Monitor the aPTT and repeat in 6 hours.
Answer: B
Rationale: An aPTT of 120 seconds indicates supratherapeutic anticoagulation. Ecchymosis and dark
urine suggest bleeding (hematuria). Heparin should be stopped immediately, and protamine sulfate is
the specific reversal agent. Vitamin K reverses warfarin, not heparin. Decreasing the rate is insufficient,
and monitoring delays intervention.
Page 2
,7. A patient with schizophrenia is started on clozapine. Which statement by the patient indicates
that the nurse's teaching about adverse effects has been effective?
A. I will report any sore throat or fever to my doctor right away.
B. I need to avoid sunlight and use sunscreen.
C. I should stop taking the medication if I feel drowsy.
D. I can take over-the-counter antacids if I get heartburn.
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis (potentially fatal decrease in white blood cells),
which presents with sore throat, fever, and other signs of infection. Patients must have regular WBC
monitoring and report these symptoms immediately. Sun sensitivity is more associated with other
antipsychotics; drowsiness is common but not a reason to stop; antacids may decrease absorption.
8. A patient with a positive urine culture (E. coli >100,000 CFU/mL) and symptoms of dysuria,
frequency, and suprapubic pain is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for 3
days. The patient has a history of sulfa allergy (rash). What is the nurse's priority action?
A. Administer the first dose with a full glass of water.
B. Hold the medication and notify the prescriber.
C. Give a test dose and monitor for 30 minutes.
D. Administer an antihistamine before giving TMP-SMX.
Answer: B
Rationale: Sulfa allergy is a contraindication to TMP-SMX due to risk of cross-hypersensitivity reactions,
which can range from rash to Stevens-Johnson syndrome. The nurse should hold the medication and
contact the prescriber for an alternative antibiotic (e.g., nitrofurantoin or a fluoroquinolone).
Administering despite known allergy is unsafe.
9. A patient receiving a blood transfusion develops sudden hypotension, tachycardia, and lower
back pain. The nurse notes the urine is dark red. Which action should the nurse take first?
A. Slow the transfusion rate and notify the provider.
B. Stop the transfusion and maintain IV access with normal saline.
C. Administer diphenhydramine and acetaminophen.
D. Obtain a blood specimen for type and crossmatch.
Answer: B
Rationale: This presentation indicates an acute hemolytic transfusion reaction (ABO incompatibility).
Immediate action is to stop the transfusion to prevent further hemolysis, then maintain IV access with
normal saline for potential hypotension. Slowing the transfusion or giving medications does not address
the reaction. Type and crossmatch is not the first step.
10. A patient with a history of opioid use disorder is admitted for elective surgery. The patient is
prescribed buprenorphine/naloxone for maintenance therapy. Which is the most appropriate plan
for perioperative pain management?
A. Discontinue buprenorphine/naloxone 72 hours before surgery and use full opioid agonists.
B. Continue buprenorphine/naloxone and use non-opioid analgesics only.
Page 3
, C. Continue buprenorphine/naloxone and add a short-acting full opioid agonist as needed.
D. Discontinue buprenorphine/naloxone and use regional anesthesia only.
Answer: C
Rationale: Buprenorphine has high affinity for mu-opioid receptors, which can block the effects of
additional opioids. Current guidelines recommend continuing buprenorphine/naloxone and adding a
short-acting full opioid agonist (e.g., fentanyl) at higher doses to overcome the blockade.
Discontinuation risks relapse and withdrawal. Using only non-opioids may be insufficient for surgical
pain.
11. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas (ABG) results show pH 7.30, PaCO2 60 mm Hg, PaO2
50 mm Hg, HCO3- 26 mEq/L. The nurse notes the patient is drowsy and has a respiratory rate of
10 breaths per minute. Which intervention should the nurse anticipate first?
A. Initiate noninvasive positive pressure ventilation (NPPV) with bi-level positive airway pressure (BiPAP).
B. Administer oxygen via nasal cannula at 2 L/min to maintain SpO2 >90%.
C. Prepare for endotracheal intubation and mechanical ventilation.
D. Administer intravenous sodium bicarbonate to correct acidosis.
Answer: C
Rationale: The patient has acute-on-chronic respiratory acidosis with hypoxemia and a critically low
respiratory rate, indicating impending respiratory arrest. BiPAP may be used in milder cases but is
contraindicated with a RR of 10 and drowsiness. Oxygen alone will not address the hypercapnia.
Bicarbonate is not indicated for acute respiratory acidosis. Endotracheal intubation and mechanical
ventilation are necessary to secure the airway and provide ventilatory support.
12. A patient receiving a continuous infusion of heparin for deep vein thrombosis has a platelet
count that drops from 200,000/mm³ to 50,000/mm³ over 48 hours. The nurse suspects
heparin-induced thrombocytopenia (HIT). Which of the following actions is most appropriate?
A. Immediately discontinue the heparin infusion and start warfarin therapy.
B. Stop the heparin infusion and initiate a direct thrombin inhibitor such as argatroban.
C. Continue the heparin infusion and monitor platelet counts daily.
D. Administer a platelet transfusion to raise the platelet count.
Answer: B
Rationale: HIT is a life-threatening complication of heparin therapy characterized by a significant drop
in platelet count. The standard of care is to discontinue all heparin products and start an alternative
anticoagulant such as a direct thrombin inhibitor (e.g., argatroban or lepirudin). Warfarin should not be
initiated until platelets have recovered and the patient is adequately anticoagulated with a non-heparin
agent, as warfarin can worsen thrombotic complications. Platelet transfusions are generally avoided
unless severe bleeding occurs. Continuing heparin would exacerbate HIT.
Page 4
Edition – 180 NGN Questions with Verified Answers
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results on admission: pH 7.25, PaCO2 65 mm Hg,
PaO2 50 mm Hg, HCO3- 26 mEq/L. The patient has been on home oxygen at 2 L/min via nasal
cannula. Which intervention should the nurse initiate first?
A. Increase oxygen flow rate to 6 L/min via nasal cannula.
B. Prepare for noninvasive positive pressure ventilation (NPPV).
C. Administer albuterol nebulizer treatment.
D. Place the patient in a high Fowler's position.
Answer: B
Rationale: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2, normal HCO3-),
indicating acute hypercapnic respiratory failure. NPPV (e.g., BiPAP) is the first-line intervention to
improve ventilation and reduce PaCO2. Increasing oxygen can suppress hypoxic drive; albuterol and
positioning are supportive but not primary.
2. A patient with end-stage renal disease on hemodialysis develops hyperkalemia (serum K+ 6.8
mEq/L) and is in ventricular bigeminy. Which order should the nurse question?
A. Intravenous calcium gluconate 10% 10 mL over 2 minutes.
B. Intravenous regular insulin 10 units with 50 mL of 50% dextrose.
C. Sodium polystyrene sulfonate 30 g orally.
D. Intravenous sodium bicarbonate 1 amp (50 mEq) over 5 minutes.
Answer: C
Rationale: Sodium polystyrene sulfonate (Kayexalate) works slowly over hours and is not appropriate for
acute life-threatening hyperkalemia with cardiac instability. Calcium gluconate stabilizes the cardiac
membrane immediately, insulin+dextrose shifts potassium intracellularly within 15-30 minutes, and
bicarbonate also shifts potassium (though less effective in dialysis patients).
3. A patient with a history of hypertension and type 2 diabetes is admitted with chest pain. Cardiac
troponin I is elevated, and ECG shows ST-segment depression in leads V3-V5. Which combination
of medications should the nurse anticipate administering to reduce mortality?
A. Aspirin, clopidogrel, and enoxaparin.
B. Aspirin, metoprolol, and atorvastatin.
C. Aspirin, morphine, and nitroglycerin.
D. Aspirin, lisinopril, and furosemide.
Answer: B
Rationale: The patient has non-ST-elevation myocardial infarction (NSTEMI). Aspirin reduces mortality;
beta-blockers (metoprolol) reduce myocardial oxygen demand; high-dose statin (atorvastatin) stabilizes
plaque and reduces recurrent events. While antiplatelet and anticoagulant therapy is important, the
Page 1
,combination in B is proven to reduce mortality long-term. Morphine and nitroglycerin relieve symptoms
but do not reduce mortality.
4. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. Which laboratory
result indicates that the medication is having the desired therapeutic effect?
A. Serum sodium 135 mEq/L.
B. Serum potassium 4.5 mEq/L.
C. Urine sodium 40 mEq/L.
D. Serum albumin 3.0 g/dL.
Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic that antagonizes aldosterone, promoting
sodium and water excretion while retaining potassium. An increased urine sodium (e.g., >20 mEq/L)
indicates effective natriuresis and diuresis. Serum sodium and potassium may normalize but are not
direct measures of drug effect. Albumin reflects synthetic function, not diuretic response.
5. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mm Hg
and cerebral perfusion pressure (CPP) of 55 mm Hg. Which nursing action should be implemented
first?
A. Administer mannitol 0.5 g/kg intravenously.
B. Elevate the head of bed to 30 degrees.
C. Increase sedation with propofol.
D. Notify the provider for possible decompressive craniectomy.
Answer: B
Rationale: Normal ICP is 5-15 mm Hg; CPP (MAP - ICP) should be 60-70 mm Hg. With ICP 22 and
CPP 55, CPP is compromised. Elevating the head of bed to 30 degrees promotes venous drainage and
lowers ICP, potentially improving CPP without pharmacologic intervention. Mannitol and sedation are
subsequent steps, and surgery is reserved for refractory intracranial hypertension.
6. A patient receiving IV heparin for deep vein thrombosis has an activated partial thromboplastin
time (aPTT) of 120 seconds (therapeutic range 60-80 seconds). The nurse notes the patient has
developed ecchymosis on the abdomen and is passing dark urine. Which action should the nurse
take?
A. Administer vitamin K intramuscularly.
B. Stop the heparin infusion and give protamine sulfate.
C. Decrease the heparin infusion rate by 50%.
D. Monitor the aPTT and repeat in 6 hours.
Answer: B
Rationale: An aPTT of 120 seconds indicates supratherapeutic anticoagulation. Ecchymosis and dark
urine suggest bleeding (hematuria). Heparin should be stopped immediately, and protamine sulfate is
the specific reversal agent. Vitamin K reverses warfarin, not heparin. Decreasing the rate is insufficient,
and monitoring delays intervention.
Page 2
,7. A patient with schizophrenia is started on clozapine. Which statement by the patient indicates
that the nurse's teaching about adverse effects has been effective?
A. I will report any sore throat or fever to my doctor right away.
B. I need to avoid sunlight and use sunscreen.
C. I should stop taking the medication if I feel drowsy.
D. I can take over-the-counter antacids if I get heartburn.
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis (potentially fatal decrease in white blood cells),
which presents with sore throat, fever, and other signs of infection. Patients must have regular WBC
monitoring and report these symptoms immediately. Sun sensitivity is more associated with other
antipsychotics; drowsiness is common but not a reason to stop; antacids may decrease absorption.
8. A patient with a positive urine culture (E. coli >100,000 CFU/mL) and symptoms of dysuria,
frequency, and suprapubic pain is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for 3
days. The patient has a history of sulfa allergy (rash). What is the nurse's priority action?
A. Administer the first dose with a full glass of water.
B. Hold the medication and notify the prescriber.
C. Give a test dose and monitor for 30 minutes.
D. Administer an antihistamine before giving TMP-SMX.
Answer: B
Rationale: Sulfa allergy is a contraindication to TMP-SMX due to risk of cross-hypersensitivity reactions,
which can range from rash to Stevens-Johnson syndrome. The nurse should hold the medication and
contact the prescriber for an alternative antibiotic (e.g., nitrofurantoin or a fluoroquinolone).
Administering despite known allergy is unsafe.
9. A patient receiving a blood transfusion develops sudden hypotension, tachycardia, and lower
back pain. The nurse notes the urine is dark red. Which action should the nurse take first?
A. Slow the transfusion rate and notify the provider.
B. Stop the transfusion and maintain IV access with normal saline.
C. Administer diphenhydramine and acetaminophen.
D. Obtain a blood specimen for type and crossmatch.
Answer: B
Rationale: This presentation indicates an acute hemolytic transfusion reaction (ABO incompatibility).
Immediate action is to stop the transfusion to prevent further hemolysis, then maintain IV access with
normal saline for potential hypotension. Slowing the transfusion or giving medications does not address
the reaction. Type and crossmatch is not the first step.
10. A patient with a history of opioid use disorder is admitted for elective surgery. The patient is
prescribed buprenorphine/naloxone for maintenance therapy. Which is the most appropriate plan
for perioperative pain management?
A. Discontinue buprenorphine/naloxone 72 hours before surgery and use full opioid agonists.
B. Continue buprenorphine/naloxone and use non-opioid analgesics only.
Page 3
, C. Continue buprenorphine/naloxone and add a short-acting full opioid agonist as needed.
D. Discontinue buprenorphine/naloxone and use regional anesthesia only.
Answer: C
Rationale: Buprenorphine has high affinity for mu-opioid receptors, which can block the effects of
additional opioids. Current guidelines recommend continuing buprenorphine/naloxone and adding a
short-acting full opioid agonist (e.g., fentanyl) at higher doses to overcome the blockade.
Discontinuation risks relapse and withdrawal. Using only non-opioids may be insufficient for surgical
pain.
11. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas (ABG) results show pH 7.30, PaCO2 60 mm Hg, PaO2
50 mm Hg, HCO3- 26 mEq/L. The nurse notes the patient is drowsy and has a respiratory rate of
10 breaths per minute. Which intervention should the nurse anticipate first?
A. Initiate noninvasive positive pressure ventilation (NPPV) with bi-level positive airway pressure (BiPAP).
B. Administer oxygen via nasal cannula at 2 L/min to maintain SpO2 >90%.
C. Prepare for endotracheal intubation and mechanical ventilation.
D. Administer intravenous sodium bicarbonate to correct acidosis.
Answer: C
Rationale: The patient has acute-on-chronic respiratory acidosis with hypoxemia and a critically low
respiratory rate, indicating impending respiratory arrest. BiPAP may be used in milder cases but is
contraindicated with a RR of 10 and drowsiness. Oxygen alone will not address the hypercapnia.
Bicarbonate is not indicated for acute respiratory acidosis. Endotracheal intubation and mechanical
ventilation are necessary to secure the airway and provide ventilatory support.
12. A patient receiving a continuous infusion of heparin for deep vein thrombosis has a platelet
count that drops from 200,000/mm³ to 50,000/mm³ over 48 hours. The nurse suspects
heparin-induced thrombocytopenia (HIT). Which of the following actions is most appropriate?
A. Immediately discontinue the heparin infusion and start warfarin therapy.
B. Stop the heparin infusion and initiate a direct thrombin inhibitor such as argatroban.
C. Continue the heparin infusion and monitor platelet counts daily.
D. Administer a platelet transfusion to raise the platelet count.
Answer: B
Rationale: HIT is a life-threatening complication of heparin therapy characterized by a significant drop
in platelet count. The standard of care is to discontinue all heparin products and start an alternative
anticoagulant such as a direct thrombin inhibitor (e.g., argatroban or lepirudin). Warfarin should not be
initiated until platelets have recovered and the patient is adequately anticoagulated with a non-heparin
agent, as warfarin can worsen thrombotic complications. Platelet transfusions are generally avoided
unless severe bleeding occurs. Continuing heparin would exacerbate HIT.
Page 4
