RN ATI Comprehensive Exit Exam (Version 1 )
Actual exam With Questions And Revised Correct
Answers & Rationales () 100%
Guaranteed Pass
Item ID: V1-001
Item Type: Traditional MCQ
Scenario: A 68-year-old female with a history of heart failure with reduced ejection
fraction (HFrEF, EF 30 %) is admitted with acute decompensation. Vital signs: BP 92/58
mmHg, HR 104 bpm, RR 24/min, SpO₂ 90 % on 4 L nasal cannula. Home medications
include metoprolol XL 50 mg daily, furosemide 40 mg daily, and digoxin 0.25 mg daily.
Labs: Na 132 mEq/L, K 3.2 mEq/L, creatinine 1.6 mg/dL (baseline 1.1), BNP 1 850
pg/mL.
Question:
Which action should the nurse implement first?
Options/Components:
1. Increase furosemide to 80 mg IV push now
2. Obtain a 12-lead ECG within 15 minutes
3. Hold digoxin and call prescriber for K 3.2 mEq/L
4. Administer 500 mL 0.9 % saline over 30 minutes
Rationale (Revised & Verified):
,The correct answer is 2.
The 2026 ACC/AHA heart failure guidelines prioritize rapid identification of reversible
causes of decompensation; obtaining a 12-lead ECG within 15 minutes of admission
screens for ischemia, arrhythmia, or acute ST changes that may precipitate
decompensation. Option 1 is incorrect because aggressive diuresis without assessing
perfusion status may worsen hypotension. Option 3 is important but not first;
hypokalemia <3.5 mEq/L increases digoxin toxicity risk, yet ECG data guide urgency.
Option 4 is contraindicated because the patient is fluid-overloaded (BNP 1 850) and not
in hypovolemic shock.
Item ID: V1-002
Item Type: NGN – Bowtie
Scenario: A 54-year-old male post right hemicolectomy 6 h ago has sudden onset
dyspnea and chest pain. Vital signs: BP 88/50 mmHg, HR 120, RR 30, SpO₂ 88 % on 6 L
O₂. ABG: pH 7.48, PaCO₂ 28 mmHg, PaO₂ 58 mmHg. D-dimer 4 500 ng/mL FEU.
Question:
Complete the bowtie by selecting the most likely nursing diagnosis, the immediate
intervention, and the expected outcome.
Options/Components:
Left side (Diagnosis):
A. Impaired gas exchange related to pulmonary embolism
,B. Acute pain related to surgical incision
C. Deficient fluid volume related to bleeding
D. Anxiety related to hospitalization
Center (Immediate Intervention):
E. Administer alteplase 100 mg IV over 2 h
F. Apply sequential compression devices
G. Increase O₂ to 10 L via non-rebreather
H. Provide 500 mL lactated Ringer’s bolus
Right side (Expected Outcome):
I. SpO₂ ≥94 % within 30 minutes
J. Pain score ≤3/10 within 1 h
K. HR <100 bpm within 2 h
L. Patient verbalizes coping strategies
Correct Options: A–E–I
Rationale (Revised & Verified):
The correct bowtie path is A–E–I. The patient presents with high-probability pulmonary
embolism (hemodynamic instability, hypoxemia, elevated D-dimer). 2026 AHA
guidelines recommend systemic thrombolysis for massive PE with SBP <90 mmHg.
Alteplase 100 mg IV over 2 h is standard dosing. Expected outcome I reflects adequate
oxygenation post-reperfusion. Option B is incorrect because pain is not the
, life-threatening priority. Option C is unsupported; no bleeding data exist. Option F is late,
not immediate. Option G may not correct V/Q mismatch. Option H risks fluid overload.
Item ID: V1-003
Item Type: Traditional MCQ
Scenario: A 17-year-old primigravida at 39 weeks gestation is admitted in active labor.
Cervical exam: 6 cm, 0 station, intact membranes. FHR baseline 165 bpm with minimal
variability and recurrent late decelerations. Maternal temperature 38.2 °C, WBC 15
000/mm³.
Question:
Which nursing action is most appropriate?
Options/Components:
1. Place client in left lateral position and apply O₂ 10 L via face mask
2. Encourage ambulation to improve uteroplacental perfusion
3. Start amoxicillin 2 g IV for suspected chorioamnionitis
4. Prepare for immediate cesarean birth
Rationale (Revised & Verified):
The correct answer is 1.
Recurrent late decelerations with minimal variability and tachycardia indicate
uteroplacental insufficiency; initial intrauterine resuscitation includes maternal
repositioning and supplemental oxygen per AWHONN 2026 guidelines. Option 2
Actual exam With Questions And Revised Correct
Answers & Rationales () 100%
Guaranteed Pass
Item ID: V1-001
Item Type: Traditional MCQ
Scenario: A 68-year-old female with a history of heart failure with reduced ejection
fraction (HFrEF, EF 30 %) is admitted with acute decompensation. Vital signs: BP 92/58
mmHg, HR 104 bpm, RR 24/min, SpO₂ 90 % on 4 L nasal cannula. Home medications
include metoprolol XL 50 mg daily, furosemide 40 mg daily, and digoxin 0.25 mg daily.
Labs: Na 132 mEq/L, K 3.2 mEq/L, creatinine 1.6 mg/dL (baseline 1.1), BNP 1 850
pg/mL.
Question:
Which action should the nurse implement first?
Options/Components:
1. Increase furosemide to 80 mg IV push now
2. Obtain a 12-lead ECG within 15 minutes
3. Hold digoxin and call prescriber for K 3.2 mEq/L
4. Administer 500 mL 0.9 % saline over 30 minutes
Rationale (Revised & Verified):
,The correct answer is 2.
The 2026 ACC/AHA heart failure guidelines prioritize rapid identification of reversible
causes of decompensation; obtaining a 12-lead ECG within 15 minutes of admission
screens for ischemia, arrhythmia, or acute ST changes that may precipitate
decompensation. Option 1 is incorrect because aggressive diuresis without assessing
perfusion status may worsen hypotension. Option 3 is important but not first;
hypokalemia <3.5 mEq/L increases digoxin toxicity risk, yet ECG data guide urgency.
Option 4 is contraindicated because the patient is fluid-overloaded (BNP 1 850) and not
in hypovolemic shock.
Item ID: V1-002
Item Type: NGN – Bowtie
Scenario: A 54-year-old male post right hemicolectomy 6 h ago has sudden onset
dyspnea and chest pain. Vital signs: BP 88/50 mmHg, HR 120, RR 30, SpO₂ 88 % on 6 L
O₂. ABG: pH 7.48, PaCO₂ 28 mmHg, PaO₂ 58 mmHg. D-dimer 4 500 ng/mL FEU.
Question:
Complete the bowtie by selecting the most likely nursing diagnosis, the immediate
intervention, and the expected outcome.
Options/Components:
Left side (Diagnosis):
A. Impaired gas exchange related to pulmonary embolism
,B. Acute pain related to surgical incision
C. Deficient fluid volume related to bleeding
D. Anxiety related to hospitalization
Center (Immediate Intervention):
E. Administer alteplase 100 mg IV over 2 h
F. Apply sequential compression devices
G. Increase O₂ to 10 L via non-rebreather
H. Provide 500 mL lactated Ringer’s bolus
Right side (Expected Outcome):
I. SpO₂ ≥94 % within 30 minutes
J. Pain score ≤3/10 within 1 h
K. HR <100 bpm within 2 h
L. Patient verbalizes coping strategies
Correct Options: A–E–I
Rationale (Revised & Verified):
The correct bowtie path is A–E–I. The patient presents with high-probability pulmonary
embolism (hemodynamic instability, hypoxemia, elevated D-dimer). 2026 AHA
guidelines recommend systemic thrombolysis for massive PE with SBP <90 mmHg.
Alteplase 100 mg IV over 2 h is standard dosing. Expected outcome I reflects adequate
oxygenation post-reperfusion. Option B is incorrect because pain is not the
, life-threatening priority. Option C is unsupported; no bleeding data exist. Option F is late,
not immediate. Option G may not correct V/Q mismatch. Option H risks fluid overload.
Item ID: V1-003
Item Type: Traditional MCQ
Scenario: A 17-year-old primigravida at 39 weeks gestation is admitted in active labor.
Cervical exam: 6 cm, 0 station, intact membranes. FHR baseline 165 bpm with minimal
variability and recurrent late decelerations. Maternal temperature 38.2 °C, WBC 15
000/mm³.
Question:
Which nursing action is most appropriate?
Options/Components:
1. Place client in left lateral position and apply O₂ 10 L via face mask
2. Encourage ambulation to improve uteroplacental perfusion
3. Start amoxicillin 2 g IV for suspected chorioamnionitis
4. Prepare for immediate cesarean birth
Rationale (Revised & Verified):
The correct answer is 1.
Recurrent late decelerations with minimal variability and tachycardia indicate
uteroplacental insufficiency; initial intrauterine resuscitation includes maternal
repositioning and supplemental oxygen per AWHONN 2026 guidelines. Option 2
