ATI Comprehensive Exit Exam with NGN
(2023/2024) - 100 Question Simulation
NGN-Style Item Types (Questions 1-20)
1. Bowel Management & Pharmacology
A client with a spinal cord injury is prescribed psyllium (Metamucil) for chronic constipation. The
nurse is providing education.
Nurse: "It's important to drink plenty of fluids with this medication."
Client: "Why is that? I don't like drinking a lot of water."
Instruction: Select the nurse's statements that explain the rationale for increased fluid
intake. Select all that apply.
• A. "It helps prevent the medication from forming a blockage in your intestines." ✓
• B. "Fluids will help soften the stool directly, making the medication work better."
• C. "The medication absorbs water to create bulk, which helps stimulate a bowel
movement." ✓
• D. "It will help flush the medication through your kidneys more quickly."
• E. "Adequate hydration is necessary for the medication to form a gel and work
effectively." ✓
2. Clinical Judgment: Hypoglycemia
A nurse is caring for a client with diabetes who is confused, diaphoretic, and tachycardic. The
client's blood glucose is 48 mg/dL.
Instruction: For each action below, drag and drop to indicate whether it is an Indicated action,
a Non-Essential action, or a Contraindicated action.
Non-
Action Indicated Contraindicated
Essential
Administer 1 mg of intramuscular
✓
glucagon.
, Non-
Action Indicated Contraindicated
Essential
Provide 4 oz of fruit juice to drink. ✓
Apply the patient's oxygen at 2 L/min via
✓
nasal cannula.
Recheck the blood glucose in 15 minutes. ✓
Assist the client to ambulate to the
✓
bathroom.
3. Diabetes Management: Trend Analysis
A nurse is reviewing the chart for a client with Type 1 Diabetes. Use the data below to answer
the question.
Blood Glucose Breakfast Insulin Given Lunch
Time
(mg/dL) (0700) (Regular) (1200)
0700 210 100% of meal 8 units --
0900 180 -- -- --
1100 155 -- -- --
1200 140 -- -- 100% of meal
1400 165 -- -- --
1600 190 -- -- --
Instruction: Which statement best describes the trend of the client's blood glucose from 0700
to 1600?
, • A. The blood glucose is consistently decreasing, indicating the insulin dose is too high.
• B. The blood glucose is unstable, showing significant hyperglycemia and hypoglycemia.
• C. The blood glucose is stable within the target range throughout the day.
• D. The blood glucose is rising after the initial decrease, indicating the need for a
potential insulin adjustment. ✓
4. Unfolding Case: Post-Op Complication (Questions 4a, 4b, 4c)
A client is 24 hours post-op following an open cholecystectomy.
4a. The nurse assesses the client and notes an oxygen saturation of 88% on room air, complaints
of sudden shortness of breath, and pleuritic chest pain. Which action should the nurse
take first?
• A. Notify the surgeon immediately.
• B. Administer oxygen via nasal cannula. ✓
• C. Administer a prescribed stat dose of enoxaparin (Lovenox).
• D. Assist the client to ambulate in the hallway.
4b. The nurse suspects a pulmonary embolism. Which additional finding is most consistent with
this complication?
• A. Bradycardia
• B. Jugular vein distension
• C. Unilateral leg edema and pain ✓
• D. Expiratory wheezing
4c. The client is started on a heparin infusion. The nurse should ensure which medication is
readily available at the bedside?
• A. Vitamin K
• B. Protamine sulfate ✓
• C. Naloxone
• D. Calcium gluconate
5. Extended Drag and Drop: Heart Failure
A nurse is teaching a client with heart failure about a 2-gram sodium diet.
, Instruction: Drag the food items the client should CHOOSE to the box on the left. Drag the food
items the client should AVOID to the box on the right.
CHOOSE (Low Sodium) AVOID (High Sodium)
Fresh steamed broccoli ✓ Canned soup ✓
Grilled chicken breast (unsalted) ✓ Pickles ✓
Oatmeal with fresh berries ✓ Processed cheese slices ✓
Baked potato (no salt) ✓ Frozen pizza ✓
6. Matrix: Pre-operative Assessment
A nurse is preparing a client for surgery. For each client finding, indicate if it suggests a risk
for Respiratory Complications, Cardiovascular Complications, or Infection.
Client Finding Respiratory Cardiovascular Infection
History of smoking 1 pack per day for 20
✓
years.
Type 2 Diabetes with an HbA1c of 9.2%. ✓
Blood pressure of 168/94 mmHg. ✓
BMI of 38. ✓
A small, non-blistering sunburn on the
shoulder.
7. Highlight Text: COPD Education
Instruction: Read the client's statement below. Highlight the phrase(s) that require immediate
follow-up by the nurse.
(2023/2024) - 100 Question Simulation
NGN-Style Item Types (Questions 1-20)
1. Bowel Management & Pharmacology
A client with a spinal cord injury is prescribed psyllium (Metamucil) for chronic constipation. The
nurse is providing education.
Nurse: "It's important to drink plenty of fluids with this medication."
Client: "Why is that? I don't like drinking a lot of water."
Instruction: Select the nurse's statements that explain the rationale for increased fluid
intake. Select all that apply.
• A. "It helps prevent the medication from forming a blockage in your intestines." ✓
• B. "Fluids will help soften the stool directly, making the medication work better."
• C. "The medication absorbs water to create bulk, which helps stimulate a bowel
movement." ✓
• D. "It will help flush the medication through your kidneys more quickly."
• E. "Adequate hydration is necessary for the medication to form a gel and work
effectively." ✓
2. Clinical Judgment: Hypoglycemia
A nurse is caring for a client with diabetes who is confused, diaphoretic, and tachycardic. The
client's blood glucose is 48 mg/dL.
Instruction: For each action below, drag and drop to indicate whether it is an Indicated action,
a Non-Essential action, or a Contraindicated action.
Non-
Action Indicated Contraindicated
Essential
Administer 1 mg of intramuscular
✓
glucagon.
, Non-
Action Indicated Contraindicated
Essential
Provide 4 oz of fruit juice to drink. ✓
Apply the patient's oxygen at 2 L/min via
✓
nasal cannula.
Recheck the blood glucose in 15 minutes. ✓
Assist the client to ambulate to the
✓
bathroom.
3. Diabetes Management: Trend Analysis
A nurse is reviewing the chart for a client with Type 1 Diabetes. Use the data below to answer
the question.
Blood Glucose Breakfast Insulin Given Lunch
Time
(mg/dL) (0700) (Regular) (1200)
0700 210 100% of meal 8 units --
0900 180 -- -- --
1100 155 -- -- --
1200 140 -- -- 100% of meal
1400 165 -- -- --
1600 190 -- -- --
Instruction: Which statement best describes the trend of the client's blood glucose from 0700
to 1600?
, • A. The blood glucose is consistently decreasing, indicating the insulin dose is too high.
• B. The blood glucose is unstable, showing significant hyperglycemia and hypoglycemia.
• C. The blood glucose is stable within the target range throughout the day.
• D. The blood glucose is rising after the initial decrease, indicating the need for a
potential insulin adjustment. ✓
4. Unfolding Case: Post-Op Complication (Questions 4a, 4b, 4c)
A client is 24 hours post-op following an open cholecystectomy.
4a. The nurse assesses the client and notes an oxygen saturation of 88% on room air, complaints
of sudden shortness of breath, and pleuritic chest pain. Which action should the nurse
take first?
• A. Notify the surgeon immediately.
• B. Administer oxygen via nasal cannula. ✓
• C. Administer a prescribed stat dose of enoxaparin (Lovenox).
• D. Assist the client to ambulate in the hallway.
4b. The nurse suspects a pulmonary embolism. Which additional finding is most consistent with
this complication?
• A. Bradycardia
• B. Jugular vein distension
• C. Unilateral leg edema and pain ✓
• D. Expiratory wheezing
4c. The client is started on a heparin infusion. The nurse should ensure which medication is
readily available at the bedside?
• A. Vitamin K
• B. Protamine sulfate ✓
• C. Naloxone
• D. Calcium gluconate
5. Extended Drag and Drop: Heart Failure
A nurse is teaching a client with heart failure about a 2-gram sodium diet.
, Instruction: Drag the food items the client should CHOOSE to the box on the left. Drag the food
items the client should AVOID to the box on the right.
CHOOSE (Low Sodium) AVOID (High Sodium)
Fresh steamed broccoli ✓ Canned soup ✓
Grilled chicken breast (unsalted) ✓ Pickles ✓
Oatmeal with fresh berries ✓ Processed cheese slices ✓
Baked potato (no salt) ✓ Frozen pizza ✓
6. Matrix: Pre-operative Assessment
A nurse is preparing a client for surgery. For each client finding, indicate if it suggests a risk
for Respiratory Complications, Cardiovascular Complications, or Infection.
Client Finding Respiratory Cardiovascular Infection
History of smoking 1 pack per day for 20
✓
years.
Type 2 Diabetes with an HbA1c of 9.2%. ✓
Blood pressure of 168/94 mmHg. ✓
BMI of 38. ✓
A small, non-blistering sunburn on the
shoulder.
7. Highlight Text: COPD Education
Instruction: Read the client's statement below. Highlight the phrase(s) that require immediate
follow-up by the nurse.
