N ATI Comprehensive Exit Exam (Version 3 ) Actual
exam With Questions And Revised Correct Answers
& Rationales () 100% Guaranteed Pass
Item ID: V3-001
Item Type: NGN - Bowtie
Scenario:
Mr. Ortega, 58, is post-PCI day 1 for anterior STEMI. He is on heparin 18 units/kg/hr,
ticagrelor 90 mg bid, metoprolol 25 mg po q12h, and simvastatin 40 mg hs. 0800 labs:
Na 128 mEq/L, K 5.9 mEq/L, creatinine 1.9 mg/dL (baseline 0.9), troponin-I trending
down but still elevated, INR 1.4, aPTT 92 sec, platelet count 89 k/µL (was 220 k
pre-procedure). He reports new severe low-back pain and 1 episode of dark amber
urine. Urinalysis shows ≥ 50 RBCs/hpf, no WBCs, no protein.
Question:
Complete the bowtie by selecting the MOST likely complication, the ONE priority nursing
action, and the TWO lab values you will monitor most frequently over the next 4 h.
Options:
A. Heparin-induced thrombocytopenia with thrombosis (HITT)
B. Retroperitoneal hemorrhage
C. Stent thrombosis
D. Cholesterol emboli syndrome
,E. Stop heparin infusion immediately
F. Administer protamine 10 mg IV push
G. Obtain CT abdomen/pelvis without contrast
H. Give 1 unit platelets now
I. aPTT
J. Hemoglobin/hematocrit
K. Platelet count
L. Serum lactate
Correct Choices: B, E, I, J
Rationale (Revised & Verified):
● Correct Answer: B, E, I, J
● Analysis: 2026 AHA/ACC PCI guidelines emphasize that unexplained back pain,
drop in platelets > 50 %, and dark urine (hematuria) in an anticoagulated patient
signal retroperitoneal bleed. Priority is stop heparin (E) to limit further bleeding.
aPTT (I) evaluates residual heparin effect; H/H (J) quantifies blood loss.
● Distractor Breakdown: A (HITT) would present at day 5–10 or earlier with prior
exposure; no thrombosis signs here. C would show chest pain/ST elevation. D
causes livedo, eosinophilia, eosinophiluria—absent here. F is unsafe without
knowing total heparin dose; G delays bedside action; H is ineffective in
heparin-related bleeding; K already known; L not yet indicated.
Item ID: V3-002
, Item Type: Traditional MCQ
Scenario:
Ms. Leong, 32, G2P1 at 39 wks, is admitted for scheduled repeat C-section. Spinal
placed at T10; 10 min later BP 78/42, HR 120, she reports nausea and “ringing in my
ears.” Current med: bupivacaine 0.75 % 1.8 mL + fentanyl 15 µg. IVF: Lactated Ringer’s 1
L wide open. Fetal HR 90 w/ absent variability.
Question:
Which intervention should the RN perform FIRST?
Options:
A. Administer ephedrine 25 mg IV push
B. Turn patient to full left lateral position
C. Increase O2 via non-rebreather to 15 L/min
D. Bolus 500 mL 5 % albumin
Correct Answer: B
Rationale (Revised & Verified):
● Correct Answer: B
● Analysis: 2026 AWHONN intra-partum guidelines prioritize left uterine
displacement to relieve aortocaval compression, the most common cause of
spinal hypotension.
● Distractor Breakdown: A is second-line after position/O2; C supports but doesn’t
fix etiology; D colloid is slower and unnecessary before simple positioning.
exam With Questions And Revised Correct Answers
& Rationales () 100% Guaranteed Pass
Item ID: V3-001
Item Type: NGN - Bowtie
Scenario:
Mr. Ortega, 58, is post-PCI day 1 for anterior STEMI. He is on heparin 18 units/kg/hr,
ticagrelor 90 mg bid, metoprolol 25 mg po q12h, and simvastatin 40 mg hs. 0800 labs:
Na 128 mEq/L, K 5.9 mEq/L, creatinine 1.9 mg/dL (baseline 0.9), troponin-I trending
down but still elevated, INR 1.4, aPTT 92 sec, platelet count 89 k/µL (was 220 k
pre-procedure). He reports new severe low-back pain and 1 episode of dark amber
urine. Urinalysis shows ≥ 50 RBCs/hpf, no WBCs, no protein.
Question:
Complete the bowtie by selecting the MOST likely complication, the ONE priority nursing
action, and the TWO lab values you will monitor most frequently over the next 4 h.
Options:
A. Heparin-induced thrombocytopenia with thrombosis (HITT)
B. Retroperitoneal hemorrhage
C. Stent thrombosis
D. Cholesterol emboli syndrome
,E. Stop heparin infusion immediately
F. Administer protamine 10 mg IV push
G. Obtain CT abdomen/pelvis without contrast
H. Give 1 unit platelets now
I. aPTT
J. Hemoglobin/hematocrit
K. Platelet count
L. Serum lactate
Correct Choices: B, E, I, J
Rationale (Revised & Verified):
● Correct Answer: B, E, I, J
● Analysis: 2026 AHA/ACC PCI guidelines emphasize that unexplained back pain,
drop in platelets > 50 %, and dark urine (hematuria) in an anticoagulated patient
signal retroperitoneal bleed. Priority is stop heparin (E) to limit further bleeding.
aPTT (I) evaluates residual heparin effect; H/H (J) quantifies blood loss.
● Distractor Breakdown: A (HITT) would present at day 5–10 or earlier with prior
exposure; no thrombosis signs here. C would show chest pain/ST elevation. D
causes livedo, eosinophilia, eosinophiluria—absent here. F is unsafe without
knowing total heparin dose; G delays bedside action; H is ineffective in
heparin-related bleeding; K already known; L not yet indicated.
Item ID: V3-002
, Item Type: Traditional MCQ
Scenario:
Ms. Leong, 32, G2P1 at 39 wks, is admitted for scheduled repeat C-section. Spinal
placed at T10; 10 min later BP 78/42, HR 120, she reports nausea and “ringing in my
ears.” Current med: bupivacaine 0.75 % 1.8 mL + fentanyl 15 µg. IVF: Lactated Ringer’s 1
L wide open. Fetal HR 90 w/ absent variability.
Question:
Which intervention should the RN perform FIRST?
Options:
A. Administer ephedrine 25 mg IV push
B. Turn patient to full left lateral position
C. Increase O2 via non-rebreather to 15 L/min
D. Bolus 500 mL 5 % albumin
Correct Answer: B
Rationale (Revised & Verified):
● Correct Answer: B
● Analysis: 2026 AWHONN intra-partum guidelines prioritize left uterine
displacement to relieve aortocaval compression, the most common cause of
spinal hypotension.
● Distractor Breakdown: A is second-line after position/O2; C supports but doesn’t
fix etiology; D colloid is slower and unnecessary before simple positioning.
