Comprehensive ATI Exit Exam - (latest 2025) - Qs &
Ans to Pass the Exam - (NGN style Qs & Case
Scenario's), Pass with Confidence
Item ID: ATI-COMP-EXIT-001
Item Type: NGN - Extended Multiple Response (EMR) within Case Scenario
Case Scenario Context: New unfolding case - Ms. Maya Patel, 28-year-old G2P1 at 38 weeks
gestation, admitted for induction of labor.
Question Stem & Clinical Data:
The nurse receives the following data at shift change: Cervix 6 cm/90% effaced/-2 station,
contractions q3 min. FHR baseline 150 with variable decelerations to 120 x 15 sec. IV Lactated
Ringer’s @ 125 mL/h. Patient reports “I feel dizzy when I lay flat.” VS: BP 98/58, HR 112, RR
22, SpO₂ 96%, T 37.1 °C. Urine output 15 mL/hr x 2 hrs.
Which findings require immediate follow-up? (Select all.)
A. Variable decelerations to 120 bpm
B. Systolic BP 98 mmHg
C. Urine output 15 mL/hr
D. FHR baseline 150 bpm
E. Patient report of dizziness when supine
F. Temperature 37.1 °C
(Correct Answer: B, C, E)
Rationale (Pass with Confidence | Latest 2025):
Correct Answer: B, C, E
Clinical Judgment & Knowledge Synthesis: Recognize Cues - Hypotension (B) and oliguria (C)
signal maternal hypovolemia that can reduce uteroplacental perfusion; supine dizziness (E)
indicates aortocaval compression compounding perfusion risk. Variables (A) are common at -2
station; baseline 150 is normal; low-grade fever is not acute.
Distractor Analysis: Choosing (A) overreacts to benign variables; selecting (D) misinterprets
normal baseline; ignoring (E) misses positional shock risk.
Item ID: ATI-COMP-EXIT-002
Item Type: NGN - Matrix/Grid within Case Scenario
Case Scenario Context: Continue Ms. Patel - MD orders fluid bolus 500 mL LR and position
change.
Question Stem & Clinical Data:
Evaluate each order for Indicated, Non-essential, or Contraindicated at this time.
A. Increase LR to 500 mL bolus over 20 min
B. Position in left lateral tilt 30°
C. Apply high-flow O₂ 10 L via NRB
D. Start second IV with 18-gauge catheter
E. Administer furosemide 20 mg IV push
(Correct Answer: Indicated: A, B, D | Contraindicated: E | Non-essential: C)
Rationale:
Correct Answer: As above
,Clinical Judgment & Knowledge Synthesis: Generate Solutions - Fluid (A) restores intravascular
volume; left tilt (B) relieves aortocaval compression; second IV (D) prepares for possible
postpartum hemorrhage. Furosemide (E) would worsen hypovolemia; high-flow O₂ (C) not
needed with SpO₂ 96 %.
Distractor Analysis: Choosing (C) as Indicated wastes resources; selecting (E) as Indicated
creates harm.
Item ID: ATI-COMP-EXIT-003
Item Type: NGN - Bowtie within Case Scenario
Case Scenario Context: Continue Ms. Patel - 30 min later patient now 8 cm, FHR late
decelerations noted.
Question Stem & Clinical Data:
Late decelerations x 3, lowest FHR 110 bpm, returns to baseline 150. BP now 100/60, urine 40
mL/h.
Bowtie format:
Left (Potential Complications) | Center (Primary Problem) | Right (Immediate Nursing Actions)
A. Uterine rupture
B. Maternal hypotension
C. Placental insufficiency
D. Umbilical cord prolapse
E. Maternal fever
(Correct Answer: Left—C | Center—C | Right—Turn off oxytocin, Position left side, Administer
O₂ 8 L NRB, Notify provider, Prepare for possible delivery)
Rationale:
Correct Answer: As above
Clinical Judgment & Knowledge Synthesis: Analyze Cues & Prioritize Actions - Late decels
reflect uteroplacental insufficiency (C); stopping oxytocin reduces uterine tone; left side + O₂
improves perfusion; rapid notification enables delivery if pattern persists.
Distractor Analysis: Selecting rupture (A) ignores intact pattern; choosing hypotension (B) is
invalid as BP normalized.
Item ID: ATI-COMP-EXIT-004
Item Type: Complex Stand-Alone
Case Scenario Context: Stand-Alone Item.
Question Stem & Clinical Data:
A 55-year-old with decompensated HF (EF 25 %) is prescribed dapagliflozin 10 mg daily. Which
counseling point is essential for 2025?
A. Expect mild weight gain
B. Hold if nausea occurs
C. Report any genital discomfort or swelling
D. Expect increased thirst and polyuria
(Correct Answer: D)
Rationale:
Correct Answer: D
,Clinical Judgment & Knowledge Synthesis: SGLT2 inhibitors promote osmotic diuresis; patients
should anticipate polyuria and increased thirst but continue drug because mortality benefit is
proven in HF regardless of diabetes.
Distractor Analysis: (A) is false—weight loss typical; (B) is unsafe; (C) important but less critical
than adherence counseling.
Item ID: ATI-COMP-EXIT-005
Item Type: NGN - Drag-and-Drop Sequencing within Case Scenario
Case Scenario Context: Continue Ms. Patel - late decels resolve, fully dilated, +2 station, begins
pushing. After 30 min FHR sudden prolonged deceleration to 60 x 3 min.
Question Stem & Clinical Data:
Drag the nursing actions into priority order.
A. Apply O₂ 10 L NRB
B. Call for help/provider
C. Check for cord prolapse
D. Assist knee-chest position
E. Prepare for emergent delivery
(Correct Answer: Sequence: B, C, D, A, E)
Rationale:
Correct Answer: As above
Clinical Judgment & Knowledge Synthesis: Take rapid systematic actions - summon team (B),
rule out mechanical cause (C), relieve pressure (D), then oxygenate (A), prepare for delivery
(E).
Distractor Analysis: Delaying (B) wastes time; checking cord after positioning misses diagnosis.
Item ID: ATI-COMP-EXIT-006
Item Type: NGN - Trend Matrix within Case Scenario
Case Scenario Context: New unfolding case - Mr. Elijah Ramirez, 68-year-old COPD (GOLD 3)
admitted with community-acquired pneumonia.
Question Stem & Clinical Data:
Morning labs on room air: pH 7.32, PaCO₂ 58 mmHg, PaO₂ 52 mmHg, HCO₃ 30 mEq/L. Day 2
after starting BiPAP at night. Repeat ABG: pH 7.36, PaCO₂ 50 mmHg, PaO₂ 60 mmHg, HCO₃
29.
Matrix: For each parameter, identify if Improved, Unchanged, or Worsened.
A. pH
B. PaCO₂
C. PaO₂
D. HCO₃
(Correct Answer: A-Improved, B-Improved, C-Improved, D-Unchanged)
Rationale:
Correct Answer: As above
Clinical Judgment & Knowledge Synthesis: BiPAP improves alveolar ventilation → ↓CO₂
retention & ↑O₂; compensatory HCO₃ remains stable.
Distractor Analysis: Misclassifying HCO₃ as Worsened misunderstands chronic compensation
stability.
Item ID: ATI-COMP-EXIT-007
, Item Type: NGN - Extended Multiple Response within Case Scenario
Case Scenario Context: Continue Mr. Ramirez - now day 3, receiving prednisone 40 mg daily,
Clarithromycin, and BiPAP at night.
Question Stem & Clinical Data:
Which findings indicate medication effectiveness & safety? (Select all.)
A. Peak expiratory flow improved 20 %
B. Serum K 3.2 mEq/L
C. Patient able to expectorate thinner sputum
D. Blood glucose 180 mg/dL
E. HR 88 bpm (baseline 96)
F. Nighttime awakening reduced from 5 to 2
(Correct Answer: A, C, E, F)
Rationale:
Correct Answer: A, C, E, F
Clinical Judgment & Knowledge Synthesis: Recognize Cues - Improved flow (A) and symptom
reduction (F) show bronchodilation; thinner sputum (C) reflects infection control; HR decrease
(E) indicates reduced work of breathing. Hypokalemia (B) and hyperglycemia (D) are adverse
effects, not effectiveness.
Distractor Analysis: Selecting (D) confuses adverse effect with efficacy; ignoring (E) misses
physiologic improvement.
Item ID: ATI-COMP-EXIT-008
Item Type: Complex Stand-Alone
Case Scenario Context: Stand-Alone Item.
Question Stem & Clinical Data:
A 72-year-old on apixaban 5 mg BID for atrial fibrillation is scheduled for colonoscopy with
possible polypectomy. Which instruction aligns with 2025 anticoagulation guidelines?
A. Stop apixaban 3 days pre-procedure regardless of renal function
B. Bridge with enoxaparin starting 5 days pre-procedure
C. Continue apixaban if only diagnostic scope planned
D. Stop apixaban 2 days pre if CrCl ≥ 30 and resume 6 h post if no intervention
(Correct Answer: D)
Rationale:
Correct Answer: D
Clinical Judgment & Knowledge Synthesis: Apixaban half-life ~12 h; withholding 2 days
sufficient for normal renal function; early re-start reduces thrombosis; bridging unnecessary and
increases bleeding.
Distractor Analysis: (A) over-withholds; (B) introduces unnecessary risk; (C) dangerous if
polypectomy occurs.
Item ID: ATI-COMP-EXIT-009
Item Type: NGN - Matrix/Grid within Case Scenario
Case Scenario Context: Continue Mr. Ramirez - day 4, being discharged home on oral
prednisone taper, Clarithromycin 7-day total, and home BiPAP.
Question Stem & Clinical Data:
For each discharge teaching point, mark Essential, Helpful, or Unnecessary.
Ans to Pass the Exam - (NGN style Qs & Case
Scenario's), Pass with Confidence
Item ID: ATI-COMP-EXIT-001
Item Type: NGN - Extended Multiple Response (EMR) within Case Scenario
Case Scenario Context: New unfolding case - Ms. Maya Patel, 28-year-old G2P1 at 38 weeks
gestation, admitted for induction of labor.
Question Stem & Clinical Data:
The nurse receives the following data at shift change: Cervix 6 cm/90% effaced/-2 station,
contractions q3 min. FHR baseline 150 with variable decelerations to 120 x 15 sec. IV Lactated
Ringer’s @ 125 mL/h. Patient reports “I feel dizzy when I lay flat.” VS: BP 98/58, HR 112, RR
22, SpO₂ 96%, T 37.1 °C. Urine output 15 mL/hr x 2 hrs.
Which findings require immediate follow-up? (Select all.)
A. Variable decelerations to 120 bpm
B. Systolic BP 98 mmHg
C. Urine output 15 mL/hr
D. FHR baseline 150 bpm
E. Patient report of dizziness when supine
F. Temperature 37.1 °C
(Correct Answer: B, C, E)
Rationale (Pass with Confidence | Latest 2025):
Correct Answer: B, C, E
Clinical Judgment & Knowledge Synthesis: Recognize Cues - Hypotension (B) and oliguria (C)
signal maternal hypovolemia that can reduce uteroplacental perfusion; supine dizziness (E)
indicates aortocaval compression compounding perfusion risk. Variables (A) are common at -2
station; baseline 150 is normal; low-grade fever is not acute.
Distractor Analysis: Choosing (A) overreacts to benign variables; selecting (D) misinterprets
normal baseline; ignoring (E) misses positional shock risk.
Item ID: ATI-COMP-EXIT-002
Item Type: NGN - Matrix/Grid within Case Scenario
Case Scenario Context: Continue Ms. Patel - MD orders fluid bolus 500 mL LR and position
change.
Question Stem & Clinical Data:
Evaluate each order for Indicated, Non-essential, or Contraindicated at this time.
A. Increase LR to 500 mL bolus over 20 min
B. Position in left lateral tilt 30°
C. Apply high-flow O₂ 10 L via NRB
D. Start second IV with 18-gauge catheter
E. Administer furosemide 20 mg IV push
(Correct Answer: Indicated: A, B, D | Contraindicated: E | Non-essential: C)
Rationale:
Correct Answer: As above
,Clinical Judgment & Knowledge Synthesis: Generate Solutions - Fluid (A) restores intravascular
volume; left tilt (B) relieves aortocaval compression; second IV (D) prepares for possible
postpartum hemorrhage. Furosemide (E) would worsen hypovolemia; high-flow O₂ (C) not
needed with SpO₂ 96 %.
Distractor Analysis: Choosing (C) as Indicated wastes resources; selecting (E) as Indicated
creates harm.
Item ID: ATI-COMP-EXIT-003
Item Type: NGN - Bowtie within Case Scenario
Case Scenario Context: Continue Ms. Patel - 30 min later patient now 8 cm, FHR late
decelerations noted.
Question Stem & Clinical Data:
Late decelerations x 3, lowest FHR 110 bpm, returns to baseline 150. BP now 100/60, urine 40
mL/h.
Bowtie format:
Left (Potential Complications) | Center (Primary Problem) | Right (Immediate Nursing Actions)
A. Uterine rupture
B. Maternal hypotension
C. Placental insufficiency
D. Umbilical cord prolapse
E. Maternal fever
(Correct Answer: Left—C | Center—C | Right—Turn off oxytocin, Position left side, Administer
O₂ 8 L NRB, Notify provider, Prepare for possible delivery)
Rationale:
Correct Answer: As above
Clinical Judgment & Knowledge Synthesis: Analyze Cues & Prioritize Actions - Late decels
reflect uteroplacental insufficiency (C); stopping oxytocin reduces uterine tone; left side + O₂
improves perfusion; rapid notification enables delivery if pattern persists.
Distractor Analysis: Selecting rupture (A) ignores intact pattern; choosing hypotension (B) is
invalid as BP normalized.
Item ID: ATI-COMP-EXIT-004
Item Type: Complex Stand-Alone
Case Scenario Context: Stand-Alone Item.
Question Stem & Clinical Data:
A 55-year-old with decompensated HF (EF 25 %) is prescribed dapagliflozin 10 mg daily. Which
counseling point is essential for 2025?
A. Expect mild weight gain
B. Hold if nausea occurs
C. Report any genital discomfort or swelling
D. Expect increased thirst and polyuria
(Correct Answer: D)
Rationale:
Correct Answer: D
,Clinical Judgment & Knowledge Synthesis: SGLT2 inhibitors promote osmotic diuresis; patients
should anticipate polyuria and increased thirst but continue drug because mortality benefit is
proven in HF regardless of diabetes.
Distractor Analysis: (A) is false—weight loss typical; (B) is unsafe; (C) important but less critical
than adherence counseling.
Item ID: ATI-COMP-EXIT-005
Item Type: NGN - Drag-and-Drop Sequencing within Case Scenario
Case Scenario Context: Continue Ms. Patel - late decels resolve, fully dilated, +2 station, begins
pushing. After 30 min FHR sudden prolonged deceleration to 60 x 3 min.
Question Stem & Clinical Data:
Drag the nursing actions into priority order.
A. Apply O₂ 10 L NRB
B. Call for help/provider
C. Check for cord prolapse
D. Assist knee-chest position
E. Prepare for emergent delivery
(Correct Answer: Sequence: B, C, D, A, E)
Rationale:
Correct Answer: As above
Clinical Judgment & Knowledge Synthesis: Take rapid systematic actions - summon team (B),
rule out mechanical cause (C), relieve pressure (D), then oxygenate (A), prepare for delivery
(E).
Distractor Analysis: Delaying (B) wastes time; checking cord after positioning misses diagnosis.
Item ID: ATI-COMP-EXIT-006
Item Type: NGN - Trend Matrix within Case Scenario
Case Scenario Context: New unfolding case - Mr. Elijah Ramirez, 68-year-old COPD (GOLD 3)
admitted with community-acquired pneumonia.
Question Stem & Clinical Data:
Morning labs on room air: pH 7.32, PaCO₂ 58 mmHg, PaO₂ 52 mmHg, HCO₃ 30 mEq/L. Day 2
after starting BiPAP at night. Repeat ABG: pH 7.36, PaCO₂ 50 mmHg, PaO₂ 60 mmHg, HCO₃
29.
Matrix: For each parameter, identify if Improved, Unchanged, or Worsened.
A. pH
B. PaCO₂
C. PaO₂
D. HCO₃
(Correct Answer: A-Improved, B-Improved, C-Improved, D-Unchanged)
Rationale:
Correct Answer: As above
Clinical Judgment & Knowledge Synthesis: BiPAP improves alveolar ventilation → ↓CO₂
retention & ↑O₂; compensatory HCO₃ remains stable.
Distractor Analysis: Misclassifying HCO₃ as Worsened misunderstands chronic compensation
stability.
Item ID: ATI-COMP-EXIT-007
, Item Type: NGN - Extended Multiple Response within Case Scenario
Case Scenario Context: Continue Mr. Ramirez - now day 3, receiving prednisone 40 mg daily,
Clarithromycin, and BiPAP at night.
Question Stem & Clinical Data:
Which findings indicate medication effectiveness & safety? (Select all.)
A. Peak expiratory flow improved 20 %
B. Serum K 3.2 mEq/L
C. Patient able to expectorate thinner sputum
D. Blood glucose 180 mg/dL
E. HR 88 bpm (baseline 96)
F. Nighttime awakening reduced from 5 to 2
(Correct Answer: A, C, E, F)
Rationale:
Correct Answer: A, C, E, F
Clinical Judgment & Knowledge Synthesis: Recognize Cues - Improved flow (A) and symptom
reduction (F) show bronchodilation; thinner sputum (C) reflects infection control; HR decrease
(E) indicates reduced work of breathing. Hypokalemia (B) and hyperglycemia (D) are adverse
effects, not effectiveness.
Distractor Analysis: Selecting (D) confuses adverse effect with efficacy; ignoring (E) misses
physiologic improvement.
Item ID: ATI-COMP-EXIT-008
Item Type: Complex Stand-Alone
Case Scenario Context: Stand-Alone Item.
Question Stem & Clinical Data:
A 72-year-old on apixaban 5 mg BID for atrial fibrillation is scheduled for colonoscopy with
possible polypectomy. Which instruction aligns with 2025 anticoagulation guidelines?
A. Stop apixaban 3 days pre-procedure regardless of renal function
B. Bridge with enoxaparin starting 5 days pre-procedure
C. Continue apixaban if only diagnostic scope planned
D. Stop apixaban 2 days pre if CrCl ≥ 30 and resume 6 h post if no intervention
(Correct Answer: D)
Rationale:
Correct Answer: D
Clinical Judgment & Knowledge Synthesis: Apixaban half-life ~12 h; withholding 2 days
sufficient for normal renal function; early re-start reduces thrombosis; bridging unnecessary and
increases bleeding.
Distractor Analysis: (A) over-withholds; (B) introduces unnecessary risk; (C) dangerous if
polypectomy occurs.
Item ID: ATI-COMP-EXIT-009
Item Type: NGN - Matrix/Grid within Case Scenario
Case Scenario Context: Continue Mr. Ramirez - day 4, being discharged home on oral
prednisone taper, Clarithromycin 7-day total, and home BiPAP.
Question Stem & Clinical Data:
For each discharge teaching point, mark Essential, Helpful, or Unnecessary.
