1
ATI RN Comprehensive Exit Exam 2025-2026 | 200
NGN-Style Questions & Detailed Rationales | Verified
Study Guide
1. A 68-year-old man with community-acquired pneumonia is admitted to the
medical-surgical unit. He is scheduled to receive the first dose of IV ceftriaxone in
15 minutes. Current assessment: temperature 39.0°C (102.2°F), HR 118/min, RR
28/min, BP 118/72 mmHg, SpO₂ 95% on room air. The provider’s orders include
blood cultures and a sputum culture, and IV ceftriaxone. Which action should the
nurse take first?
A. Administer the antibiotic as prescribed immediately to start treatment.
B. Obtain a sputum culture (and blood cultures) prior to administering the
antibiotic.
C. Apply oxygen at 2 L/min via nasal cannula to improve oxygenation.
D. Notify the provider of the elevated temperature and tachycardia.
, 2
Correct Answer: B – Obtain a sputum culture (and blood cultures) prior to
administering the antibiotic.
Rationale: When cultures are ordered, specimens should be collected before
antibiotics are given so results reflect the causative organism and guide targeted
therapy. Although the client is febrile and tachycardic, his SpO₂ is acceptable
(95%); therefore, obtaining cultures first is the priority. If objective evidence of
hypoxemia or respiratory distress were present, oxygen or other immediate
interventions would take precedence. Always draw cultures before antibiotic
administration unless the patient is unstable and requires immediate therapy.
2. A 23-year-old woman with newly diagnosed type 1 diabetes demonstrates
insulin self-administration to the nurse. She stores insulin vials at home, rotates
injection sites, and plans exercise and meals. Which client statement indicates
correct understanding of safe insulin storage and injection practices?
A. “I will store my opened insulin vial in the freezer to keep it fresh.”
B. “I will rotate injection sites within the same anatomical area (for example,
within my abdomen).”
C. “I should inject rapid-acting insulin into my thigh right before running a
marathon.”
D. “If I skip a meal, I should double my next insulin dose to catch up.”
, 3
Correct Answer: B – “I will rotate injection sites within the same anatomical area
(for example, within my abdomen).”
Rationale: Best practice is to rotate injection sites within the same anatomical
region to promote consistent absorption while avoiding repeated injections in the
exact spot (which can cause lipohypertrophy). Opened insulin should be
refrigerated (not frozen); freezing destroys its potency. Injecting immediately
before strenuous exercise into a muscle (thigh) can increase absorption and risk
hypoglycemia — patients should plan timing and site accordingly. Doubling doses
after skipping a meal is unsafe and increases hypoglycemia risk.
3. A 55-year-old client with stage 4 chronic kidney disease (CKD) is started on
epoetin alfa to manage anemia of CKD. The nurse monitors CBCs and metabolic
labs. Which laboratory change would indicate that epoetin alfa therapy is effective?
A. Decreased serum creatinine.
B. Increased hemoglobin concentration.
C. Increased serum potassium.
D. Decreased BUN.
Correct Answer: B – Increased hemoglobin concentration.
Rationale: Epoetin alfa stimulates erythropoiesis; an increased hemoglobin and
hematocrit are direct indicators of therapeutic effectiveness. Epoetin does not
, 4
improve kidney function (creatinine, BUN) nor directly change potassium levels;
increased potassium would be an adverse finding to monitor but is not an efficacy
marker.
4. A 72-year-old man with severe COPD received IV morphine earlier for palliative
dyspnea management. On reassessment the nurse documents RR 8/min, SpO₂ 88%
on room air, decreased level of consciousness, and pinpoint pupils. Which finding
requires immediate intervention and what should the nurse do first?
A. Oxygen saturation of 88% — increase oxygen flow to 4 L/min.
B. Productive cough with thick sputum — encourage coughing and suction.
C. Respiratory rate of 8/min after morphine — stop opioid infusion and prepare to
administer naloxone per protocol.
D. Clubbing of the fingers — document and notify the provider.
Correct Answer: C – Respiratory rate of 8/min after morphine — stop opioid
infusion and prepare to administer naloxone per protocol.
Rationale: Respiratory depression (RR <10 and decreased LOC) following opioid
administration is life-threatening; immediate actions include stopping the opioid,
stimulating the client, initiating oxygen, and preparing naloxone as ordered. While
low SpO₂ is important to treat (oxygen), the immediate priority is reversing opioid-
ATI RN Comprehensive Exit Exam 2025-2026 | 200
NGN-Style Questions & Detailed Rationales | Verified
Study Guide
1. A 68-year-old man with community-acquired pneumonia is admitted to the
medical-surgical unit. He is scheduled to receive the first dose of IV ceftriaxone in
15 minutes. Current assessment: temperature 39.0°C (102.2°F), HR 118/min, RR
28/min, BP 118/72 mmHg, SpO₂ 95% on room air. The provider’s orders include
blood cultures and a sputum culture, and IV ceftriaxone. Which action should the
nurse take first?
A. Administer the antibiotic as prescribed immediately to start treatment.
B. Obtain a sputum culture (and blood cultures) prior to administering the
antibiotic.
C. Apply oxygen at 2 L/min via nasal cannula to improve oxygenation.
D. Notify the provider of the elevated temperature and tachycardia.
, 2
Correct Answer: B – Obtain a sputum culture (and blood cultures) prior to
administering the antibiotic.
Rationale: When cultures are ordered, specimens should be collected before
antibiotics are given so results reflect the causative organism and guide targeted
therapy. Although the client is febrile and tachycardic, his SpO₂ is acceptable
(95%); therefore, obtaining cultures first is the priority. If objective evidence of
hypoxemia or respiratory distress were present, oxygen or other immediate
interventions would take precedence. Always draw cultures before antibiotic
administration unless the patient is unstable and requires immediate therapy.
2. A 23-year-old woman with newly diagnosed type 1 diabetes demonstrates
insulin self-administration to the nurse. She stores insulin vials at home, rotates
injection sites, and plans exercise and meals. Which client statement indicates
correct understanding of safe insulin storage and injection practices?
A. “I will store my opened insulin vial in the freezer to keep it fresh.”
B. “I will rotate injection sites within the same anatomical area (for example,
within my abdomen).”
C. “I should inject rapid-acting insulin into my thigh right before running a
marathon.”
D. “If I skip a meal, I should double my next insulin dose to catch up.”
, 3
Correct Answer: B – “I will rotate injection sites within the same anatomical area
(for example, within my abdomen).”
Rationale: Best practice is to rotate injection sites within the same anatomical
region to promote consistent absorption while avoiding repeated injections in the
exact spot (which can cause lipohypertrophy). Opened insulin should be
refrigerated (not frozen); freezing destroys its potency. Injecting immediately
before strenuous exercise into a muscle (thigh) can increase absorption and risk
hypoglycemia — patients should plan timing and site accordingly. Doubling doses
after skipping a meal is unsafe and increases hypoglycemia risk.
3. A 55-year-old client with stage 4 chronic kidney disease (CKD) is started on
epoetin alfa to manage anemia of CKD. The nurse monitors CBCs and metabolic
labs. Which laboratory change would indicate that epoetin alfa therapy is effective?
A. Decreased serum creatinine.
B. Increased hemoglobin concentration.
C. Increased serum potassium.
D. Decreased BUN.
Correct Answer: B – Increased hemoglobin concentration.
Rationale: Epoetin alfa stimulates erythropoiesis; an increased hemoglobin and
hematocrit are direct indicators of therapeutic effectiveness. Epoetin does not
, 4
improve kidney function (creatinine, BUN) nor directly change potassium levels;
increased potassium would be an adverse finding to monitor but is not an efficacy
marker.
4. A 72-year-old man with severe COPD received IV morphine earlier for palliative
dyspnea management. On reassessment the nurse documents RR 8/min, SpO₂ 88%
on room air, decreased level of consciousness, and pinpoint pupils. Which finding
requires immediate intervention and what should the nurse do first?
A. Oxygen saturation of 88% — increase oxygen flow to 4 L/min.
B. Productive cough with thick sputum — encourage coughing and suction.
C. Respiratory rate of 8/min after morphine — stop opioid infusion and prepare to
administer naloxone per protocol.
D. Clubbing of the fingers — document and notify the provider.
Correct Answer: C – Respiratory rate of 8/min after morphine — stop opioid
infusion and prepare to administer naloxone per protocol.
Rationale: Respiratory depression (RR <10 and decreased LOC) following opioid
administration is life-threatening; immediate actions include stopping the opioid,
stimulating the client, initiating oxygen, and preparing naloxone as ordered. While
low SpO₂ is important to treat (oxygen), the immediate priority is reversing opioid-
