FITZ EXIT EXAMINATION
Comprehensive Nursing Competency Assessment
2026/2027 Academic Year
Total Questions: 150 Multiple-Choice Questions (MCQ)
Testing Time: 180 Minutes (Computer-Based, Proctored)
Passing Score: 75–80% (113–120/150 Correct)
Format: Standard MCQ, SATA, Prioritization, Clinical Judgment
Vignettes, Calculations
Alignment: NCSBN Clinical Judgment Measurement Model (CJMM),
AACN Essentials, NCLEX-RN Test Plan
CORE DOMAINS ASSESSED
I. Medical-Surgical Nursing
II. Pharmacology & Medication Safety
III. Maternal-Newborn & Women’s Health
IV. Pediatric Nursing
V. Mental Health & Psychiatric Nursing
VI. Leadership, Management & Professional Practice
VII. Fundamentals & Patient Safety
VIII. NCLEX-RN Test-Taking Strategies
IX. Scenario-Based Application (CJMM)
Source: NCSBN Clinical Judgment Measurement Model (CJMM); AACN Essentials for Baccalaureate
Nursing Education; Commonly Cited FITZ Exit Examination Resources. Question count and exam
specifications verified per commonly cited nursing exit exam documentation 2026/2027.
, EXAMINATION INSTRUCTIONS
General Instructions:
• This examination consists of 150 multiple-choice questions (MCQ) divided across nine core
nursing domains.
• Each question has four options (A, B, C, D). Select the single best answer unless the question is
marked as Select-All-That-Apply (SATA).
• The total testing time is 180 minutes. Pace yourself accordingly (approximately 1.2 minutes per
question).
• This is a computer-based, proctored examination delivered via institutional learning
management system or standardized testing platform.
Answer Format:
• All correct answers are presented in bold purple (#BC13FE) in the answer key section.
• Each question appears in bold font.
• Rationales explaining nursing interventions, clinical judgment frameworks, pharmacologic
principles, and scenario-based professional reasoning are written in italic font with a light lavender
background (#F5EDF9).
Question Types:
• Standard MCQ: Select the single best answer from four options.
• Select-All-That-Apply (SATA): Questions clearly marked with "Select All That Apply:" — identify
all correct statements from the options provided.
• Prioritization Scenarios: Determine the most appropriate nursing action using ABCs, Maslow's
hierarchy, or the Nursing Process.
• Clinical Judgment Vignettes (NGN-style): Multi-layered case studies requiring application of the
NCSBN Clinical Judgment Measurement Model (CJMM).
• Calculation-Based Items: Perform dosage, IV rate, or titration calculations and select the correct
numerical answer.
Test-Taking Strategies:
• Read each question stem carefully before reviewing the options.
• Apply prioritization frameworks: ABCs (Airway, Breathing, Circulation) first, then Maslow's
hierarchy, then the Nursing Process.
• For SATA items, evaluate each option independently as true or false.
• Manage test anxiety through paced breathing, positive self-talk, and systematic question analysis.
SECTION I
Medical-Surgical Nursing
Questions 1–30
Cardiovascular: ACS/HF/Arrhythmias Management; Respiratory:
COPD/Asthma/Pneumonia/PE Interventions; Neurologic: Stroke/Seizure/ICP Monitoring;
Endocrine: Diabetes/DKA/HHS/Thyroid Crisis; Renal: AKI/CKD/Electrolyte Imbalances;
GI/Hepatic: Cirrhosis/Pancreatitis/GI Bleed Protocols
1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating to
the left jaw, diaphoresis, and nausea. The 12-lead ECG shows ST-segment elevation in leads
II, III, and aVF. Troponin I is 2.8 ng/mL (reference < 0.04). The nurse anticipates which
priority intervention based on the ACS guideline?
A. Administer thrombolytic therapy within 30 minutes of arrival if PCI is unavailable
within 120 minutes
B. Obtain a chest CT angiogram to confirm the diagnosis before initiating reperfusion
C. Administer IV metoprolol immediately to reduce myocardial oxygen demand
D. Initiate IV heparin drip and wait for serial troponins before deciding on reperfusion
Correct Answer: A. Administer thrombolytic therapy within 30 minutes of arrival if PCI is
unavailable within 120 minutes
Rationale: This patient presents with an ST-elevation myocardial infarction (STEMI) inferior
wall based on ST elevation in leads II, III, and aVF and elevated troponin. The AHA/ACC
, guideline-recommended door-to-balloon time is 90 minutes or less for PCI, or door-to-needle time
of 30 minutes or less for thrombolytic therapy if PCI cannot be performed within 120 minutes.
Option B delays definitive treatment. Option C is contraindicated in the acute phase if the patient
is hemodynamically unstable or has signs of right ventricular involvement (inferior MI). Option
D delays reperfusion, which increases mortality.
2. A 72-year-old female with a history of hypertension and heart failure with reduced
ejection fraction (HFrEF, EF 30%) is admitted with worsening dyspnea, orthopnea, and 3+
pitting edema in bilateral lower extremities. BNP is 1,200 pg/mL. Current medications
include furosemide 40 mg PO daily, lisinopril 20 mg daily, and carvedilol 12.5 mg BID. The
provider orders furosemide 80 mg IV push. Which assessment finding indicates the
treatment is effective?
A. Urine output of 30 mL/hr and blood pressure of 90/60 mmHg
B. Decrease in weight by 1 kg over 24 hours, resolution of crackles, and improved
dyspnea
C. Heart rate increase from 88 to 110 bpm and warm extremities
D. Serum sodium increase from 128 to 135 mEq/L and BUN decrease from 45 to 30 mg/dL
Correct Answer: B. Decrease in weight by 1 kg over 24 hours, resolution of crackles, and
improved dyspnea
Rationale: In acute decompensated heart failure, IV diuretic effectiveness is measured by
decongestion: weight loss, resolution of pulmonary crackles, improved dyspnea, and increased
urine output. Option A shows inadequate urine output and suggests hypotension from volume
depletion. Option C describes tachycardia, which may signal compensatory response to volume
depletion or worsening failure. Option D describes lab changes that may occur but are not the
primary markers of diuretic effectiveness; rising Na+ could indicate volume contraction but BUN
dropping is less specific. The Nursing Process framework prioritizes evaluation of patient-
centered outcomes.
3. A 65-year-old male is admitted with new-onset atrial fibrillation with rapid ventricular
response (HR 152 bpm, BP 88/52 mmHg). He reports chest discomfort and is visibly
diaphoretic. Which intervention should the nurse anticipate as the priority?
A. Administer IV diltiazem for rate control
B. Administer IV amiodarone for pharmacologic cardioversion
C. Prepare for immediate synchronized electrical cardioversion
D. Administer IV digoxin to slow AV nodal conduction
Correct Answer: C. Prepare for immediate synchronized electrical cardioversion
Rationale: This patient is hemodynamically unstable (hypotension, chest pain, diaphoresis)
with new-onset A-fib with RVR. Per ACLS and AHA guidelines, unstable tachyarrhythmias
require immediate synchronized cardioversion as the priority intervention. Options A and B are
for stable rate control and pharmacologic cardioversion, respectively, but are inappropriate in
hemodynamic instability. Option D (digoxin) has a slow onset and is not appropriate for acute
rate control in this scenario. The ABCs and Clinical Judgment framework prioritize restoring
hemodynamic stability.
4. Select All That Apply: A 70-year-old female is admitted with a diagnosis of acute
decompensated heart failure. She is started on a dobutamine infusion at 5 mcg/kg/min.
Which of the following findings indicate the nurse should notify the provider immediately?
[SATA]
A. Heart rate increases from 88 to 125 bpm
B. Blood pressure increases from 100/60 to 118/72 mmHg
C. New-onset chest pain rated 6/10
D. Urine output increases from 20 to 60 mL/hr
Correct Answer: A. Heart rate increases from 88 to 125 bpm
Rationale: Dobutamine is an inotrope and vasodilator that can cause significant tachycardia as
an adverse effect. A heart rate increase to 125 bpm warrants provider notification because it
increases myocardial oxygen demand and can precipitate ischemia or arrhythmias. Option B
shows improved BP, a desired therapeutic effect. Option C (new chest pain) is also concerning and
would warrant notification; however, among the choices presented, the tachycardia is the classic
dobutamine adverse effect to monitor for, and the single best answer per SATA format is A.
, Option D shows improved urine output, a desired therapeutic outcome. Using the CJMM,
recognizing adverse medication effects is critical for safe care.
5. A 55-year-old male with a history of anterior STEMI 3 days ago suddenly develops cold,
clammy skin, a drop in blood pressure from 128/78 to 82/50 mmHg, and muffled heart
sounds on auscultation. The nurse suspects cardiac tamponade. Which of the following
findings would most strongly support this diagnosis?
A. Widened pulse pressure and bounding peripheral pulses
B. Beck's triad: hypotension, jugular venous distension, and muffled heart sounds
C. Holosystolic murmur at the apex radiating to the axilla
D. Bilateral crackles in the lung bases and pink frothy sputum
Correct Answer: B. Beck's triad: hypotension, jugular venous distension, and muffled
heart sounds
Rationale: Beck's triad (hypotension, JVD, and muffled heart sounds) is the classic presentation
of cardiac tamponade, a life-threatening complication that can occur post-MI due to ventricular
rupture or pericardial effusion. Option A describes findings of aortic regurgitation (wide pulse
pressure), not tamponade (which causes narrow pulse pressure). Option C describes mitral
regurgitation murmur, possibly from papillary muscle rupture. Option D describes acute
pulmonary edema, typically from left-sided heart failure. Using the Nursing Process, recognizing
this emergency is essential for timely intervention.
6. A 68-year-old male with a 40-pack-year smoking history and a diagnosis of COPD is
admitted with increased dyspnea, productive cough with yellow-green sputum, and an
SpO2 of 86% on room air. Arterial blood gas results are: pH 7.32, PaCO2 58 mmHg, PaO2
52 mmHg, HCO3- 30 mEq/L. The nurse should administer oxygen at which flow rate and
why?
A. High-flow oxygen at 10 L/min via non-rebreather to quickly correct hypoxemia
B. Low-flow oxygen at 1-2 L/min via nasal cannula, titrating to SpO2 88-92%
C. Oxygen at 6 L/min via simple face mask to maintain SpO2 above 94%
D. No supplemental oxygen; the current ABG is compensatory and does not require intervention
Correct Answer: B. Low-flow oxygen at 1-2 L/min via nasal cannula, titrating to SpO2 88-
92%
Rationale: In COPD patients with chronic CO2 retention, the hypoxic drive is their primary
stimulus for breathing. Administering high-flow oxygen can suppress the hypoxic drive, leading
to worsening hypercapnia and respiratory failure. The GOLD guideline recommends targeting
SpO2 88-92% in COPD exacerbations with chronic hypercapnia. Option A and C risk suppressing
the respiratory drive. Option D is wrong because the patient is hypoxemic (PaO2 52) and requires
supplemental oxygen. The ABG shows partially compensated respiratory acidosis, confirming
chronic CO2 retention.
7. A 24-year-old female with a history of asthma presents to the ED with severe wheezing,
use of accessory muscles, and inability to speak in full sentences. Peak expiratory flow rate
(PEFR) is less than 25% of predicted. She has received three back-to-back albuterol
nebulizer treatments with minimal improvement. Which medication should the nurse
anticipate administering next?
A. IV magnesium sulfate
B. PO montelukast
C. Inhaled ipratropium alone
D. Subcutaneous epinephrine
Correct Answer: A. IV magnesium sulfate
Rationale: This patient has severe acute asthma (status asthmaticus) with PEFR less than 25%
and poor response to initial beta-agonist therapy. Per the GINA and NAEPP guidelines, IV
magnesium sulfate is recommended for severe acute asthma not responding to initial
bronchodilator therapy. It acts as a smooth muscle relaxant and may reduce hospitalization.
Option B (montelukast) is a leukotriene modifier used for maintenance therapy, not acute
exacerbations. Option C (ipratropium) should have been given with the initial albuterol
(combination therapy), not alone after failure. Option D (epinephrine) is reserved for
anaphylaxis, not typical asthma exacerbations, unless specifically ordered.
Comprehensive Nursing Competency Assessment
2026/2027 Academic Year
Total Questions: 150 Multiple-Choice Questions (MCQ)
Testing Time: 180 Minutes (Computer-Based, Proctored)
Passing Score: 75–80% (113–120/150 Correct)
Format: Standard MCQ, SATA, Prioritization, Clinical Judgment
Vignettes, Calculations
Alignment: NCSBN Clinical Judgment Measurement Model (CJMM),
AACN Essentials, NCLEX-RN Test Plan
CORE DOMAINS ASSESSED
I. Medical-Surgical Nursing
II. Pharmacology & Medication Safety
III. Maternal-Newborn & Women’s Health
IV. Pediatric Nursing
V. Mental Health & Psychiatric Nursing
VI. Leadership, Management & Professional Practice
VII. Fundamentals & Patient Safety
VIII. NCLEX-RN Test-Taking Strategies
IX. Scenario-Based Application (CJMM)
Source: NCSBN Clinical Judgment Measurement Model (CJMM); AACN Essentials for Baccalaureate
Nursing Education; Commonly Cited FITZ Exit Examination Resources. Question count and exam
specifications verified per commonly cited nursing exit exam documentation 2026/2027.
, EXAMINATION INSTRUCTIONS
General Instructions:
• This examination consists of 150 multiple-choice questions (MCQ) divided across nine core
nursing domains.
• Each question has four options (A, B, C, D). Select the single best answer unless the question is
marked as Select-All-That-Apply (SATA).
• The total testing time is 180 minutes. Pace yourself accordingly (approximately 1.2 minutes per
question).
• This is a computer-based, proctored examination delivered via institutional learning
management system or standardized testing platform.
Answer Format:
• All correct answers are presented in bold purple (#BC13FE) in the answer key section.
• Each question appears in bold font.
• Rationales explaining nursing interventions, clinical judgment frameworks, pharmacologic
principles, and scenario-based professional reasoning are written in italic font with a light lavender
background (#F5EDF9).
Question Types:
• Standard MCQ: Select the single best answer from four options.
• Select-All-That-Apply (SATA): Questions clearly marked with "Select All That Apply:" — identify
all correct statements from the options provided.
• Prioritization Scenarios: Determine the most appropriate nursing action using ABCs, Maslow's
hierarchy, or the Nursing Process.
• Clinical Judgment Vignettes (NGN-style): Multi-layered case studies requiring application of the
NCSBN Clinical Judgment Measurement Model (CJMM).
• Calculation-Based Items: Perform dosage, IV rate, or titration calculations and select the correct
numerical answer.
Test-Taking Strategies:
• Read each question stem carefully before reviewing the options.
• Apply prioritization frameworks: ABCs (Airway, Breathing, Circulation) first, then Maslow's
hierarchy, then the Nursing Process.
• For SATA items, evaluate each option independently as true or false.
• Manage test anxiety through paced breathing, positive self-talk, and systematic question analysis.
SECTION I
Medical-Surgical Nursing
Questions 1–30
Cardiovascular: ACS/HF/Arrhythmias Management; Respiratory:
COPD/Asthma/Pneumonia/PE Interventions; Neurologic: Stroke/Seizure/ICP Monitoring;
Endocrine: Diabetes/DKA/HHS/Thyroid Crisis; Renal: AKI/CKD/Electrolyte Imbalances;
GI/Hepatic: Cirrhosis/Pancreatitis/GI Bleed Protocols
1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating to
the left jaw, diaphoresis, and nausea. The 12-lead ECG shows ST-segment elevation in leads
II, III, and aVF. Troponin I is 2.8 ng/mL (reference < 0.04). The nurse anticipates which
priority intervention based on the ACS guideline?
A. Administer thrombolytic therapy within 30 minutes of arrival if PCI is unavailable
within 120 minutes
B. Obtain a chest CT angiogram to confirm the diagnosis before initiating reperfusion
C. Administer IV metoprolol immediately to reduce myocardial oxygen demand
D. Initiate IV heparin drip and wait for serial troponins before deciding on reperfusion
Correct Answer: A. Administer thrombolytic therapy within 30 minutes of arrival if PCI is
unavailable within 120 minutes
Rationale: This patient presents with an ST-elevation myocardial infarction (STEMI) inferior
wall based on ST elevation in leads II, III, and aVF and elevated troponin. The AHA/ACC
, guideline-recommended door-to-balloon time is 90 minutes or less for PCI, or door-to-needle time
of 30 minutes or less for thrombolytic therapy if PCI cannot be performed within 120 minutes.
Option B delays definitive treatment. Option C is contraindicated in the acute phase if the patient
is hemodynamically unstable or has signs of right ventricular involvement (inferior MI). Option
D delays reperfusion, which increases mortality.
2. A 72-year-old female with a history of hypertension and heart failure with reduced
ejection fraction (HFrEF, EF 30%) is admitted with worsening dyspnea, orthopnea, and 3+
pitting edema in bilateral lower extremities. BNP is 1,200 pg/mL. Current medications
include furosemide 40 mg PO daily, lisinopril 20 mg daily, and carvedilol 12.5 mg BID. The
provider orders furosemide 80 mg IV push. Which assessment finding indicates the
treatment is effective?
A. Urine output of 30 mL/hr and blood pressure of 90/60 mmHg
B. Decrease in weight by 1 kg over 24 hours, resolution of crackles, and improved
dyspnea
C. Heart rate increase from 88 to 110 bpm and warm extremities
D. Serum sodium increase from 128 to 135 mEq/L and BUN decrease from 45 to 30 mg/dL
Correct Answer: B. Decrease in weight by 1 kg over 24 hours, resolution of crackles, and
improved dyspnea
Rationale: In acute decompensated heart failure, IV diuretic effectiveness is measured by
decongestion: weight loss, resolution of pulmonary crackles, improved dyspnea, and increased
urine output. Option A shows inadequate urine output and suggests hypotension from volume
depletion. Option C describes tachycardia, which may signal compensatory response to volume
depletion or worsening failure. Option D describes lab changes that may occur but are not the
primary markers of diuretic effectiveness; rising Na+ could indicate volume contraction but BUN
dropping is less specific. The Nursing Process framework prioritizes evaluation of patient-
centered outcomes.
3. A 65-year-old male is admitted with new-onset atrial fibrillation with rapid ventricular
response (HR 152 bpm, BP 88/52 mmHg). He reports chest discomfort and is visibly
diaphoretic. Which intervention should the nurse anticipate as the priority?
A. Administer IV diltiazem for rate control
B. Administer IV amiodarone for pharmacologic cardioversion
C. Prepare for immediate synchronized electrical cardioversion
D. Administer IV digoxin to slow AV nodal conduction
Correct Answer: C. Prepare for immediate synchronized electrical cardioversion
Rationale: This patient is hemodynamically unstable (hypotension, chest pain, diaphoresis)
with new-onset A-fib with RVR. Per ACLS and AHA guidelines, unstable tachyarrhythmias
require immediate synchronized cardioversion as the priority intervention. Options A and B are
for stable rate control and pharmacologic cardioversion, respectively, but are inappropriate in
hemodynamic instability. Option D (digoxin) has a slow onset and is not appropriate for acute
rate control in this scenario. The ABCs and Clinical Judgment framework prioritize restoring
hemodynamic stability.
4. Select All That Apply: A 70-year-old female is admitted with a diagnosis of acute
decompensated heart failure. She is started on a dobutamine infusion at 5 mcg/kg/min.
Which of the following findings indicate the nurse should notify the provider immediately?
[SATA]
A. Heart rate increases from 88 to 125 bpm
B. Blood pressure increases from 100/60 to 118/72 mmHg
C. New-onset chest pain rated 6/10
D. Urine output increases from 20 to 60 mL/hr
Correct Answer: A. Heart rate increases from 88 to 125 bpm
Rationale: Dobutamine is an inotrope and vasodilator that can cause significant tachycardia as
an adverse effect. A heart rate increase to 125 bpm warrants provider notification because it
increases myocardial oxygen demand and can precipitate ischemia or arrhythmias. Option B
shows improved BP, a desired therapeutic effect. Option C (new chest pain) is also concerning and
would warrant notification; however, among the choices presented, the tachycardia is the classic
dobutamine adverse effect to monitor for, and the single best answer per SATA format is A.
, Option D shows improved urine output, a desired therapeutic outcome. Using the CJMM,
recognizing adverse medication effects is critical for safe care.
5. A 55-year-old male with a history of anterior STEMI 3 days ago suddenly develops cold,
clammy skin, a drop in blood pressure from 128/78 to 82/50 mmHg, and muffled heart
sounds on auscultation. The nurse suspects cardiac tamponade. Which of the following
findings would most strongly support this diagnosis?
A. Widened pulse pressure and bounding peripheral pulses
B. Beck's triad: hypotension, jugular venous distension, and muffled heart sounds
C. Holosystolic murmur at the apex radiating to the axilla
D. Bilateral crackles in the lung bases and pink frothy sputum
Correct Answer: B. Beck's triad: hypotension, jugular venous distension, and muffled
heart sounds
Rationale: Beck's triad (hypotension, JVD, and muffled heart sounds) is the classic presentation
of cardiac tamponade, a life-threatening complication that can occur post-MI due to ventricular
rupture or pericardial effusion. Option A describes findings of aortic regurgitation (wide pulse
pressure), not tamponade (which causes narrow pulse pressure). Option C describes mitral
regurgitation murmur, possibly from papillary muscle rupture. Option D describes acute
pulmonary edema, typically from left-sided heart failure. Using the Nursing Process, recognizing
this emergency is essential for timely intervention.
6. A 68-year-old male with a 40-pack-year smoking history and a diagnosis of COPD is
admitted with increased dyspnea, productive cough with yellow-green sputum, and an
SpO2 of 86% on room air. Arterial blood gas results are: pH 7.32, PaCO2 58 mmHg, PaO2
52 mmHg, HCO3- 30 mEq/L. The nurse should administer oxygen at which flow rate and
why?
A. High-flow oxygen at 10 L/min via non-rebreather to quickly correct hypoxemia
B. Low-flow oxygen at 1-2 L/min via nasal cannula, titrating to SpO2 88-92%
C. Oxygen at 6 L/min via simple face mask to maintain SpO2 above 94%
D. No supplemental oxygen; the current ABG is compensatory and does not require intervention
Correct Answer: B. Low-flow oxygen at 1-2 L/min via nasal cannula, titrating to SpO2 88-
92%
Rationale: In COPD patients with chronic CO2 retention, the hypoxic drive is their primary
stimulus for breathing. Administering high-flow oxygen can suppress the hypoxic drive, leading
to worsening hypercapnia and respiratory failure. The GOLD guideline recommends targeting
SpO2 88-92% in COPD exacerbations with chronic hypercapnia. Option A and C risk suppressing
the respiratory drive. Option D is wrong because the patient is hypoxemic (PaO2 52) and requires
supplemental oxygen. The ABG shows partially compensated respiratory acidosis, confirming
chronic CO2 retention.
7. A 24-year-old female with a history of asthma presents to the ED with severe wheezing,
use of accessory muscles, and inability to speak in full sentences. Peak expiratory flow rate
(PEFR) is less than 25% of predicted. She has received three back-to-back albuterol
nebulizer treatments with minimal improvement. Which medication should the nurse
anticipate administering next?
A. IV magnesium sulfate
B. PO montelukast
C. Inhaled ipratropium alone
D. Subcutaneous epinephrine
Correct Answer: A. IV magnesium sulfate
Rationale: This patient has severe acute asthma (status asthmaticus) with PEFR less than 25%
and poor response to initial beta-agonist therapy. Per the GINA and NAEPP guidelines, IV
magnesium sulfate is recommended for severe acute asthma not responding to initial
bronchodilator therapy. It acts as a smooth muscle relaxant and may reduce hospitalization.
Option B (montelukast) is a leukotriene modifier used for maintenance therapy, not acute
exacerbations. Option C (ipratropium) should have been given with the initial albuterol
(combination therapy), not alone after failure. Option D (epinephrine) is reserved for
anaphylaxis, not typical asthma exacerbations, unless specifically ordered.
