ATI RN Critical Thinking Entrance Exit
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
[SECTION 1: Questions 1-10] - Clinical Judgment & Reasoning (Recognizing Cues,
Analyzing Cues, Prioritizing Hypotheses)
Q1: A 68-year-old male with a history of hypertension and type 2 diabetes presents to the
ED with acute onset of crushing substernal chest pain radiating to the left jaw, diaphoresis,
and nausea. BP is 160/95 mmHg, HR 110 bpm, RR 22/min, SpO2 94% on room air. ECG
shows ST-segment elevation in leads II, III, and aVF. Which action should the nurse
prioritize first?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a 12-lead ECG immediately
C. Prepare for emergent cardiac catheterization
D. Administer aspirin 324 mg chewed
C. Prepare for emergent cardiac catheterization [CORRECT]
Correct Answer: C
Rationale: The patient exhibits classic signs of an ST-elevation myocardial infarction
(STEMI) with ST-segment elevation in inferior leads (II, III, aVF), chest pain, and autonomic
symptoms. According to NCSBN CJMM and ATI Critical Thinking framework, the priority is
,immediate reperfusion therapy. Cardiac catheterization is the gold standard for STEMI
management, and delays increase mortality. Option A (nitroglycerin) is contraindicated if
systolic BP <90 mmHg or right ventricular involvement is suspected. Option B (ECG) is
already completed. Option D (aspirin) is important but secondary to reperfusion. This
aligns with QSEN competencies in patient-centered care and evidence-based practice.
Q2: A postoperative patient on the surgical unit has a respiratory rate of 8/min, oxygen
saturation of 89% on 2L nasal cannula, and is lethargic. The patient received morphine 4
mg IV 30 minutes ago for pain. Which action should the nurse take first?
A. Administer naloxone 0.4 mg IV
B. Increase oxygen to 6L via non-rebreather mask
C. Stimulate the patient to take deep breaths
D. Document findings and recheck in 15 minutes
A. Administer naloxone 0.4 mg IV [CORRECT]
Correct Answer: A
Rationale: The patient shows signs of opioid-induced respiratory depression (RR 8/min,
SpO2 89%, lethargy) after morphine administration. Using the ABC (Airway, Breathing,
Circulation) prioritization framework, respiratory compromise is immediately
life-threatening. Naloxone is the specific antidote for opioid overdose and should be
administered promptly. Option B (oxygen) is supportive but does not address the root
cause. Option C (stimulation) is ineffective for severe respiratory depression. Option D
(delay) risks respiratory arrest. This follows ATI’s emphasis on recognizing cues and
analyzing their clinical significance in critical situations.
Q3: A 45-year-old female with a history of heart failure presents with sudden onset of
severe dyspnea, orthopnea, and pink frothy sputum. BP is 180/100 mmHg, HR 120 bpm,
and crackles are heard in all lung fields. Which medication should the nurse anticipate
administering first?
,A. Furosemide 40 mg IV
B. Morphine sulfate 2 mg IV
C. Nitroprusside 0.3 mcg/kg/min
D. Digoxin 0.25 mg IV
A. Furosemide 40 mg IV [CORRECT]
Correct Answer: A
Rationale: The patient is experiencing acute decompensated heart failure with pulmonary
edema, evidenced by pink frothy sputum, severe dyspnea, and crackles. The priority is
reducing preload and afterload to improve cardiac output. Furosemide, a loop diuretic, is
first-line therapy to rapidly decrease fluid overload. Option B (morphine) is used for anxiety
and preload reduction but is secondary to diuresis. Option C (nitroprusside) is a
vasodilator for afterload reduction but requires close BP monitoring. Option D (digoxin) is
for rate control in atrial fibrillation, not acute pulmonary edema. This aligns with NCSBN’s
Clinical Judgment Measurement Model (CJMM) in analyzing cues and prioritizing
interventions.
Q4: A 72-year-old male with COPD is on 2L nasal cannula. He becomes confused, drowsy,
and has a respiratory rate of 10/min. ABG results show pH 7.30, PaCO2 60 mmHg, PaO2
55 mmHg, HCO3 28 mEq/L. Which action should the nurse take first?
A. Increase oxygen to 4L via nasal cannula
B. Administer albuterol nebulizer treatment
C. Prepare for non-invasive ventilation (BiPAP)
D. Administer naloxone 0.4 mg IV
C. Prepare for non-invasive ventilation (BiPAP) [CORRECT]
Correct Answer: C
Rationale: The patient has acute hypercapnic respiratory failure (pH 7.30, PaCO2 60
mmHg) secondary to COPD exacerbation, evidenced by confusion, drowsiness, and low
respiratory rate. Increasing oxygen (Option A) risks worsening hypercapnia in COPD
, patients. Albuterol (Option B) is for bronchospasm, not hypercapnia. Naloxone (Option D)
is for opioid overdose, not indicated here. BiPAP improves ventilation and reduces
PaCO2, addressing the root cause. This follows ATI’s problem-solving framework in
analyzing lab data and prioritizing interventions based on clinical cues.
Q5: A 30-year-old female in the third trimester of pregnancy presents with sudden onset of
severe abdominal pain, vaginal bleeding, and uterine rigidity. Fetal heart rate is 100 bpm
with minimal variability. Which condition should the nurse suspect first?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Uterine rupture
B. Abruptio placentae [CORRECT]
Correct Answer: B
Rationale: The classic triad of abruptio placentae is painful vaginal bleeding, uterine
rigidity, and fetal distress (FHR 100 bpm, minimal variability). Placenta previa (Option A)
typically presents with painless bleeding. Preterm labor (Option C) involves regular
contractions without bleeding. Uterine rupture (Option D) is rare and usually associated
with a history of cesarean section. Recognizing these cues is critical for timely intervention,
such as emergency delivery. This aligns with NCSBN’s emphasis on prioritizing
hypotheses based on clinical presentation.
Q6: A 55-year-old male with a history of alcohol use disorder is admitted for withdrawal. He
is tremulous, diaphoretic, and has a blood alcohol level of 0.15%. Which medication should
the nurse anticipate administering first?
A. Lorazepam 2 mg IV
B. Thiamine 100 mg IV
C. Haloperidol 5 mg IM
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
[SECTION 1: Questions 1-10] - Clinical Judgment & Reasoning (Recognizing Cues,
Analyzing Cues, Prioritizing Hypotheses)
Q1: A 68-year-old male with a history of hypertension and type 2 diabetes presents to the
ED with acute onset of crushing substernal chest pain radiating to the left jaw, diaphoresis,
and nausea. BP is 160/95 mmHg, HR 110 bpm, RR 22/min, SpO2 94% on room air. ECG
shows ST-segment elevation in leads II, III, and aVF. Which action should the nurse
prioritize first?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a 12-lead ECG immediately
C. Prepare for emergent cardiac catheterization
D. Administer aspirin 324 mg chewed
C. Prepare for emergent cardiac catheterization [CORRECT]
Correct Answer: C
Rationale: The patient exhibits classic signs of an ST-elevation myocardial infarction
(STEMI) with ST-segment elevation in inferior leads (II, III, aVF), chest pain, and autonomic
symptoms. According to NCSBN CJMM and ATI Critical Thinking framework, the priority is
,immediate reperfusion therapy. Cardiac catheterization is the gold standard for STEMI
management, and delays increase mortality. Option A (nitroglycerin) is contraindicated if
systolic BP <90 mmHg or right ventricular involvement is suspected. Option B (ECG) is
already completed. Option D (aspirin) is important but secondary to reperfusion. This
aligns with QSEN competencies in patient-centered care and evidence-based practice.
Q2: A postoperative patient on the surgical unit has a respiratory rate of 8/min, oxygen
saturation of 89% on 2L nasal cannula, and is lethargic. The patient received morphine 4
mg IV 30 minutes ago for pain. Which action should the nurse take first?
A. Administer naloxone 0.4 mg IV
B. Increase oxygen to 6L via non-rebreather mask
C. Stimulate the patient to take deep breaths
D. Document findings and recheck in 15 minutes
A. Administer naloxone 0.4 mg IV [CORRECT]
Correct Answer: A
Rationale: The patient shows signs of opioid-induced respiratory depression (RR 8/min,
SpO2 89%, lethargy) after morphine administration. Using the ABC (Airway, Breathing,
Circulation) prioritization framework, respiratory compromise is immediately
life-threatening. Naloxone is the specific antidote for opioid overdose and should be
administered promptly. Option B (oxygen) is supportive but does not address the root
cause. Option C (stimulation) is ineffective for severe respiratory depression. Option D
(delay) risks respiratory arrest. This follows ATI’s emphasis on recognizing cues and
analyzing their clinical significance in critical situations.
Q3: A 45-year-old female with a history of heart failure presents with sudden onset of
severe dyspnea, orthopnea, and pink frothy sputum. BP is 180/100 mmHg, HR 120 bpm,
and crackles are heard in all lung fields. Which medication should the nurse anticipate
administering first?
,A. Furosemide 40 mg IV
B. Morphine sulfate 2 mg IV
C. Nitroprusside 0.3 mcg/kg/min
D. Digoxin 0.25 mg IV
A. Furosemide 40 mg IV [CORRECT]
Correct Answer: A
Rationale: The patient is experiencing acute decompensated heart failure with pulmonary
edema, evidenced by pink frothy sputum, severe dyspnea, and crackles. The priority is
reducing preload and afterload to improve cardiac output. Furosemide, a loop diuretic, is
first-line therapy to rapidly decrease fluid overload. Option B (morphine) is used for anxiety
and preload reduction but is secondary to diuresis. Option C (nitroprusside) is a
vasodilator for afterload reduction but requires close BP monitoring. Option D (digoxin) is
for rate control in atrial fibrillation, not acute pulmonary edema. This aligns with NCSBN’s
Clinical Judgment Measurement Model (CJMM) in analyzing cues and prioritizing
interventions.
Q4: A 72-year-old male with COPD is on 2L nasal cannula. He becomes confused, drowsy,
and has a respiratory rate of 10/min. ABG results show pH 7.30, PaCO2 60 mmHg, PaO2
55 mmHg, HCO3 28 mEq/L. Which action should the nurse take first?
A. Increase oxygen to 4L via nasal cannula
B. Administer albuterol nebulizer treatment
C. Prepare for non-invasive ventilation (BiPAP)
D. Administer naloxone 0.4 mg IV
C. Prepare for non-invasive ventilation (BiPAP) [CORRECT]
Correct Answer: C
Rationale: The patient has acute hypercapnic respiratory failure (pH 7.30, PaCO2 60
mmHg) secondary to COPD exacerbation, evidenced by confusion, drowsiness, and low
respiratory rate. Increasing oxygen (Option A) risks worsening hypercapnia in COPD
, patients. Albuterol (Option B) is for bronchospasm, not hypercapnia. Naloxone (Option D)
is for opioid overdose, not indicated here. BiPAP improves ventilation and reduces
PaCO2, addressing the root cause. This follows ATI’s problem-solving framework in
analyzing lab data and prioritizing interventions based on clinical cues.
Q5: A 30-year-old female in the third trimester of pregnancy presents with sudden onset of
severe abdominal pain, vaginal bleeding, and uterine rigidity. Fetal heart rate is 100 bpm
with minimal variability. Which condition should the nurse suspect first?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Uterine rupture
B. Abruptio placentae [CORRECT]
Correct Answer: B
Rationale: The classic triad of abruptio placentae is painful vaginal bleeding, uterine
rigidity, and fetal distress (FHR 100 bpm, minimal variability). Placenta previa (Option A)
typically presents with painless bleeding. Preterm labor (Option C) involves regular
contractions without bleeding. Uterine rupture (Option D) is rare and usually associated
with a history of cesarean section. Recognizing these cues is critical for timely intervention,
such as emergency delivery. This aligns with NCSBN’s emphasis on prioritizing
hypotheses based on clinical presentation.
Q6: A 55-year-old male with a history of alcohol use disorder is admitted for withdrawal. He
is tremulous, diaphoretic, and has a blood alcohol level of 0.15%. Which medication should
the nurse anticipate administering first?
A. Lorazepam 2 mg IV
B. Thiamine 100 mg IV
C. Haloperidol 5 mg IM
