2026 ATI COMPREHENSIVE EXIT EXAM RETAKE
QUESTION 1: PRIORITIZATION - ABCDE FRAMEWORK
• EHR Update / Clinical Stem: A nurse receives shift report on four patients. The nurse
must prioritize assessments for the start of the shift.
• Question / Lead-In: Which patient should the nurse assess FIRST based on the ABCDE
prioritization framework?
• Options:
A. A patient with a new tracheostomy who has thick secretions and audible stridor
B. A patient with a postoperative fever of 38.5°C and tachycardia
C. A patient requesting pain medication for a 6/10 headache
D. A patient with a blood pressure of 148/92 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Airway is the first priority in the ABCDE
framework. Stridor is a high-pitched sound indicating partial airway obstruction,
which can progress to complete airway obstruction. Patients with new
tracheostomies are at high risk for mucus plugging. This patient requires
immediate suctioning and airway assessment.
o Distractor Pitfalls: B (Fever) is urgent but not immediately life-threatening. C
(Pain) is a comfort issue, not a priority over airway. D (Hypertension) is important
but does not threaten the airway or breathing immediately.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 2: DELEGATION - UAP SCOPE OF PRACTICE
• EHR Update / Clinical Stem: A registered nurse (RN) is working on a medical-surgical
unit with a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP).
The RN is delegating tasks.
1
,• Question / Lead-In: Which task is appropriate for the RN to delegate to the UAP?
• Options:
A. Measuring and recording the patient's intake and output
B. Administering oral medications to a stable patient
C. Assessing a patient's lung sounds
D. Changing a sterile wound dressing
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: UAPs can measure and record intake and output,
take vital signs, assist with activities of daily living, and report abnormalities to
the RN. This is within their scope of practice. Intake and output measurement
does not require nursing judgment or assessment.
o Distractor Pitfalls: B (Oral medications) is not within UAP scope; this can be
delegated to LPN. C (Assessment) is an RN or LPN task, not UAP. D (Sterile
wound dressing) requires sterile technique and should be performed by RN or
LPN.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 3: DELEGATION - LPN SCOPE OF PRACTICE
• EHR Update / Clinical Stem: The RN is delegating tasks to the LPN on the medical-
surgical unit.
• Question / Lead-In: Which task can the RN appropriately delegate to the LPN?
• Options:
A. Administer a routine oral antibiotic to a stable patient
B. Perform an initial admission assessment on a new patient
C. Administer IV push morphine to a patient in severe pain
D. Develop a plan of care for a patient with a new diagnosis
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: LPNs can administer oral medications, including
antibiotics, to stable patients with predictable outcomes. This is within the LPN
scope of practice in most states. The RN remains responsible for overall patient
care and assessment.
2
, o Distractor Pitfalls: B (Initial assessment) is an RN responsibility. C (IV push
morphine) is typically not within LPN scope in acute care settings. D (Plan of
care) is an RN responsibility requiring comprehensive assessment and critical
thinking.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 4: PRIORITIZATION - URGENT VS. STABLE
• EHR Update / Clinical Stem: A nurse is caring for four patients. Which patient should
the nurse assess NEXT after receiving shift report?
• Question / Lead-In: Which patient requires the most immediate assessment?
• Options:
A. A patient with chest pain radiating to the left arm with diaphoresis
B. A patient with a surgical wound infection and temperature of 38.2°C
C. A patient requesting a PRN analgesic for postoperative pain
D. A patient with a blood pressure of 150/95 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Chest pain radiating to the left arm with diaphoresis
is concerning for acute myocardial infarction (STEMI/NSTEMI). This is an
emergent situation requiring immediate assessment, ECG, and possible
intervention. Time is muscle in acute coronary syndrome.
o Distractor Pitfalls: B (Wound infection) is urgent but not immediately life-
threatening. C (Pain management) is important but lower priority. D
(Hypertension) is stable and not immediately dangerous at this level.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 5: DELEGATION - ASSESSMENT TASKS
• EHR Update / Clinical Stem: An RN is assigning patient care tasks to team members on
a busy medical-surgical unit.
• Question / Lead-In: Which task should the RN perform personally rather than
delegating to an LPN or UAP?
3
, • Options:
A. Assessing a patient with new-onset confusion
B. Taking a patient's vital signs
C. Administering a subcutaneous insulin injection
D. Assisting a patient with ambulation using a gait belt
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: New-onset confusion is a change in neurological
status requiring comprehensive RN assessment. This could indicate stroke,
infection, metabolic disturbance, or other serious conditions. Assessment and
clinical judgment are RN responsibilities that cannot be delegated.
o Distractor Pitfalls: B (Vital signs) can be delegated to UAP. C (Insulin injection)
can be delegated to LPN. D (Ambulation) can be delegated to UAP with proper
instruction.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 6: MANAGEMENT OF CARE - PATIENT ASSIGNMENT
• EHR Update / Clinical Stem: The charge nurse is making patient assignments for the
shift. The unit has RNs, LPNs, and UAPs available.
• Question / Lead-In: Which patient should the charge nurse assign to the most
experienced RN?
• Options:
A. A patient who is 24 hours post-cardiac arrest receiving multiple vasopressors
B. A patient who is 2 days post-appendectomy with stable vital signs
C. A patient requiring discharge teaching on insulin administration
D. A patient with a urinary tract infection receiving oral antibiotics
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: The patient who is 24 hours post-cardiac arrest on
multiple vasopressors is the most unstable and requires the most experienced RN.
This patient requires complex critical care nursing judgment, medication titration,
and hemodynamic monitoring.
4
QUESTION 1: PRIORITIZATION - ABCDE FRAMEWORK
• EHR Update / Clinical Stem: A nurse receives shift report on four patients. The nurse
must prioritize assessments for the start of the shift.
• Question / Lead-In: Which patient should the nurse assess FIRST based on the ABCDE
prioritization framework?
• Options:
A. A patient with a new tracheostomy who has thick secretions and audible stridor
B. A patient with a postoperative fever of 38.5°C and tachycardia
C. A patient requesting pain medication for a 6/10 headache
D. A patient with a blood pressure of 148/92 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Airway is the first priority in the ABCDE
framework. Stridor is a high-pitched sound indicating partial airway obstruction,
which can progress to complete airway obstruction. Patients with new
tracheostomies are at high risk for mucus plugging. This patient requires
immediate suctioning and airway assessment.
o Distractor Pitfalls: B (Fever) is urgent but not immediately life-threatening. C
(Pain) is a comfort issue, not a priority over airway. D (Hypertension) is important
but does not threaten the airway or breathing immediately.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 2: DELEGATION - UAP SCOPE OF PRACTICE
• EHR Update / Clinical Stem: A registered nurse (RN) is working on a medical-surgical
unit with a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP).
The RN is delegating tasks.
1
,• Question / Lead-In: Which task is appropriate for the RN to delegate to the UAP?
• Options:
A. Measuring and recording the patient's intake and output
B. Administering oral medications to a stable patient
C. Assessing a patient's lung sounds
D. Changing a sterile wound dressing
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: UAPs can measure and record intake and output,
take vital signs, assist with activities of daily living, and report abnormalities to
the RN. This is within their scope of practice. Intake and output measurement
does not require nursing judgment or assessment.
o Distractor Pitfalls: B (Oral medications) is not within UAP scope; this can be
delegated to LPN. C (Assessment) is an RN or LPN task, not UAP. D (Sterile
wound dressing) requires sterile technique and should be performed by RN or
LPN.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 3: DELEGATION - LPN SCOPE OF PRACTICE
• EHR Update / Clinical Stem: The RN is delegating tasks to the LPN on the medical-
surgical unit.
• Question / Lead-In: Which task can the RN appropriately delegate to the LPN?
• Options:
A. Administer a routine oral antibiotic to a stable patient
B. Perform an initial admission assessment on a new patient
C. Administer IV push morphine to a patient in severe pain
D. Develop a plan of care for a patient with a new diagnosis
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: LPNs can administer oral medications, including
antibiotics, to stable patients with predictable outcomes. This is within the LPN
scope of practice in most states. The RN remains responsible for overall patient
care and assessment.
2
, o Distractor Pitfalls: B (Initial assessment) is an RN responsibility. C (IV push
morphine) is typically not within LPN scope in acute care settings. D (Plan of
care) is an RN responsibility requiring comprehensive assessment and critical
thinking.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 4: PRIORITIZATION - URGENT VS. STABLE
• EHR Update / Clinical Stem: A nurse is caring for four patients. Which patient should
the nurse assess NEXT after receiving shift report?
• Question / Lead-In: Which patient requires the most immediate assessment?
• Options:
A. A patient with chest pain radiating to the left arm with diaphoresis
B. A patient with a surgical wound infection and temperature of 38.2°C
C. A patient requesting a PRN analgesic for postoperative pain
D. A patient with a blood pressure of 150/95 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Chest pain radiating to the left arm with diaphoresis
is concerning for acute myocardial infarction (STEMI/NSTEMI). This is an
emergent situation requiring immediate assessment, ECG, and possible
intervention. Time is muscle in acute coronary syndrome.
o Distractor Pitfalls: B (Wound infection) is urgent but not immediately life-
threatening. C (Pain management) is important but lower priority. D
(Hypertension) is stable and not immediately dangerous at this level.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 5: DELEGATION - ASSESSMENT TASKS
• EHR Update / Clinical Stem: An RN is assigning patient care tasks to team members on
a busy medical-surgical unit.
• Question / Lead-In: Which task should the RN perform personally rather than
delegating to an LPN or UAP?
3
, • Options:
A. Assessing a patient with new-onset confusion
B. Taking a patient's vital signs
C. Administering a subcutaneous insulin injection
D. Assisting a patient with ambulation using a gait belt
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: New-onset confusion is a change in neurological
status requiring comprehensive RN assessment. This could indicate stroke,
infection, metabolic disturbance, or other serious conditions. Assessment and
clinical judgment are RN responsibilities that cannot be delegated.
o Distractor Pitfalls: B (Vital signs) can be delegated to UAP. C (Insulin injection)
can be delegated to LPN. D (Ambulation) can be delegated to UAP with proper
instruction.
o NGN Math Scoring: Single-answer. Correct = +1; Incorrect = 0.
QUESTION 6: MANAGEMENT OF CARE - PATIENT ASSIGNMENT
• EHR Update / Clinical Stem: The charge nurse is making patient assignments for the
shift. The unit has RNs, LPNs, and UAPs available.
• Question / Lead-In: Which patient should the charge nurse assign to the most
experienced RN?
• Options:
A. A patient who is 24 hours post-cardiac arrest receiving multiple vasopressors
B. A patient who is 2 days post-appendectomy with stable vital signs
C. A patient requiring discharge teaching on insulin administration
D. A patient with a urinary tract infection receiving oral antibiotics
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: The patient who is 24 hours post-cardiac arrest on
multiple vasopressors is the most unstable and requires the most experienced RN.
This patient requires complex critical care nursing judgment, medication titration,
and hemodynamic monitoring.
4
