ATI RN Comprehensive Exit Exam |
2025–2026 Edition – 180 NGN Questions
with Verified Answers
EXAM
This expertly developed resource contains 180 Next Generation NCLEX (NGN)-
style questions from the ATI RN Comprehensive Exit Exam, fully updated for the
20 25–2026 cycle. All questions include verified correct answers and detailed
rationales, designed to reinforce clinical reasoning and real-world application of
nursing knowledge. Structured to reflect NCLEX-RN standards, this guide
prepares RN students for both the ATI Exit Exam and licensure success.
Question 1 – Prioritization (Medical-Surgical)
Scenario: A nurse is caring for four patients on a medical-surgical unit.
Which patient should the nurse assess first?
• A) A 68-year-old with COPD and SpO₂ 89% on 2L nasal cannula
• B) A 45-year-old post-operative day 1 with pain rating 6/10
• C) A 72-year-old with new-onset confusion and hypotension
• D) A 55-year-old requesting discharge teaching for a new inhaler
✅ Correct Answer: C – New-onset confusion + hypotension suggests possible
sepsis, stroke, or metabolic emergency.
Rationale: Sudden mental status change with hemodynamic instability is the
highest priority. Airway/Breathing are stable in A; pain in B and teaching in D are
lower priority.
,Question 2 – Delegation (Management of Care)
Scenario: A charge nurse is assigning tasks to an LPN/LVN.
Which task is appropriate to delegate?
• A) Initial admission assessment of a patient with pneumonia
• B) Teaching a patient how to use an insulin pen
• C) Administering a scheduled enema to a constipated patient
• D) Creating a plan of care for a patient with heart failure
✅ Correct Answer: C – Enema administration is within LPN scope.
Rationale: LPNs cannot perform initial assessments (A), teach new skills (B), or
create initial care plans (D). Those require RN judgment.
Question 3 – NGN Case Study (Heart Failure Exacerbation)
Scenario: A 78-year-old female with HF presents with dyspnea, crackles in
bilateral lung bases, +3 edema in lower extremities, and weight gain of 5 lbs in 2
days. Vital signs: BP 165/90, HR 102, RR 28, SpO₂ 89% on room air.
Question (Select all that apply):
Which interventions should the nurse implement first?
• A) Place patient in high-Fowler’s position
• B) Administer IV furosemide as ordered
• C) Apply oxygen via nasal cannula to target SpO₂ >92%
• D) Restrict oral fluids to 1,500 mL/day
• E) Elevate lower extremities on pillows
,✅ Correct Answers: A, B, C – These address oxygenation, fluid overload, and
ventilation immediately.
Rationale: High-Fowler’s improves lung expansion; diuretics reduce preload;
oxygen corrects hypoxemia. Fluid restriction (D) is not emergent. Elevating legs
(E) worsens venous return in decompensated HF.
Question 4 – Pharmacology (Anticoagulants)
Scenario: A patient is receiving warfarin for atrial fibrillation. INR is 5.2. The
patient has no signs of bleeding.
Which medication should the nurse anticipate administering?
• A) Protamine sulfate
• B) Vitamin K
• C) Aminocaproic acid
• D) Tranexamic acid
✅ Correct Answer: B – Vitamin K
Rationale: For asymptomatic elevated INR (>4.5–5), Vitamin K reverses warfarin
effect. Protamine (A) is for heparin. Aminocaproic/tranexamic acid (C/D) treat
active bleeding, not INR correction.
Question 5 – NGN Drag and Drop (Sepsis)
Scenario: A patient with suspected sepsis arrives in the ED. Vital signs: BP 85/50,
HR 120, RR 24, temp 39.4°C (103°F), lactate 4.2 mmol/L.
, Question: Place the following interventions in the correct order of priority (drag
and drop):
1. Administer broad-spectrum antibiotics
2. Obtain blood cultures
3. Give 30 mL/kg IV crystalloid bolus
4. Measure central venous pressure
✅ Correct Order: 2 → 3 → 1 → 4
Rationale: Blood cultures (2) must be obtained before antibiotics (1). Fluid
resuscitation (3) is given immediately after cultures. CVP monitoring (4) occurs
after initial fluid bolus.
Question 6 – Therapeutic Communication (Mental Health)
Scenario: A nurse is caring for a client with major depressive disorder who says,
“There’s no point in trying anymore.”
Which response is most therapeutic?
• A) “You have so much to live for. Think about your family.”
• B) “Why do you feel that way?”
• C) “Tell me more about what you mean by ‘no point.’”
• D) “Everyone feels sad sometimes. This will pass.”
✅ Correct Answer: C – Encourages exploration of feelings without judgment.
Rationale: Option A dismisses feelings. B asks “why” (defensive). D offers false
reassurance. C uses open-ended exploration, the most therapeutic approach.
2025–2026 Edition – 180 NGN Questions
with Verified Answers
EXAM
This expertly developed resource contains 180 Next Generation NCLEX (NGN)-
style questions from the ATI RN Comprehensive Exit Exam, fully updated for the
20 25–2026 cycle. All questions include verified correct answers and detailed
rationales, designed to reinforce clinical reasoning and real-world application of
nursing knowledge. Structured to reflect NCLEX-RN standards, this guide
prepares RN students for both the ATI Exit Exam and licensure success.
Question 1 – Prioritization (Medical-Surgical)
Scenario: A nurse is caring for four patients on a medical-surgical unit.
Which patient should the nurse assess first?
• A) A 68-year-old with COPD and SpO₂ 89% on 2L nasal cannula
• B) A 45-year-old post-operative day 1 with pain rating 6/10
• C) A 72-year-old with new-onset confusion and hypotension
• D) A 55-year-old requesting discharge teaching for a new inhaler
✅ Correct Answer: C – New-onset confusion + hypotension suggests possible
sepsis, stroke, or metabolic emergency.
Rationale: Sudden mental status change with hemodynamic instability is the
highest priority. Airway/Breathing are stable in A; pain in B and teaching in D are
lower priority.
,Question 2 – Delegation (Management of Care)
Scenario: A charge nurse is assigning tasks to an LPN/LVN.
Which task is appropriate to delegate?
• A) Initial admission assessment of a patient with pneumonia
• B) Teaching a patient how to use an insulin pen
• C) Administering a scheduled enema to a constipated patient
• D) Creating a plan of care for a patient with heart failure
✅ Correct Answer: C – Enema administration is within LPN scope.
Rationale: LPNs cannot perform initial assessments (A), teach new skills (B), or
create initial care plans (D). Those require RN judgment.
Question 3 – NGN Case Study (Heart Failure Exacerbation)
Scenario: A 78-year-old female with HF presents with dyspnea, crackles in
bilateral lung bases, +3 edema in lower extremities, and weight gain of 5 lbs in 2
days. Vital signs: BP 165/90, HR 102, RR 28, SpO₂ 89% on room air.
Question (Select all that apply):
Which interventions should the nurse implement first?
• A) Place patient in high-Fowler’s position
• B) Administer IV furosemide as ordered
• C) Apply oxygen via nasal cannula to target SpO₂ >92%
• D) Restrict oral fluids to 1,500 mL/day
• E) Elevate lower extremities on pillows
,✅ Correct Answers: A, B, C – These address oxygenation, fluid overload, and
ventilation immediately.
Rationale: High-Fowler’s improves lung expansion; diuretics reduce preload;
oxygen corrects hypoxemia. Fluid restriction (D) is not emergent. Elevating legs
(E) worsens venous return in decompensated HF.
Question 4 – Pharmacology (Anticoagulants)
Scenario: A patient is receiving warfarin for atrial fibrillation. INR is 5.2. The
patient has no signs of bleeding.
Which medication should the nurse anticipate administering?
• A) Protamine sulfate
• B) Vitamin K
• C) Aminocaproic acid
• D) Tranexamic acid
✅ Correct Answer: B – Vitamin K
Rationale: For asymptomatic elevated INR (>4.5–5), Vitamin K reverses warfarin
effect. Protamine (A) is for heparin. Aminocaproic/tranexamic acid (C/D) treat
active bleeding, not INR correction.
Question 5 – NGN Drag and Drop (Sepsis)
Scenario: A patient with suspected sepsis arrives in the ED. Vital signs: BP 85/50,
HR 120, RR 24, temp 39.4°C (103°F), lactate 4.2 mmol/L.
, Question: Place the following interventions in the correct order of priority (drag
and drop):
1. Administer broad-spectrum antibiotics
2. Obtain blood cultures
3. Give 30 mL/kg IV crystalloid bolus
4. Measure central venous pressure
✅ Correct Order: 2 → 3 → 1 → 4
Rationale: Blood cultures (2) must be obtained before antibiotics (1). Fluid
resuscitation (3) is given immediately after cultures. CVP monitoring (4) occurs
after initial fluid bolus.
Question 6 – Therapeutic Communication (Mental Health)
Scenario: A nurse is caring for a client with major depressive disorder who says,
“There’s no point in trying anymore.”
Which response is most therapeutic?
• A) “You have so much to live for. Think about your family.”
• B) “Why do you feel that way?”
• C) “Tell me more about what you mean by ‘no point.’”
• D) “Everyone feels sad sometimes. This will pass.”
✅ Correct Answer: C – Encourages exploration of feelings without judgment.
Rationale: Option A dismisses feelings. B asks “why” (defensive). D offers false
reassurance. C uses open-ended exploration, the most therapeutic approach.
