ATI RN Fundamentals – Proctored Exam (3
Versions) | 2026 Verified Questions &
Answers | NGN-Style
Q001:
Type: NGN - Extended Multiple Response
Scenario Context: A 68-year-old male patient, Mr. Chen, was admitted 2 days ago for
dehydration secondary to vomiting. He has an IV of 0.9% NaCl at 100 mL/hr, a Foley
catheter, and is on fall precautions. His most recent vital signs: T 37.2°C, P 88, R 18, BP
112/68. He reports feeling dizzy when he sits up.
Question: Which of the following assessment findings require IMMEDIATE follow-up
by the nurse? (Select all that apply)
Options:
A. Urine output of 35 mL in the last 2 hours
B. Patient reports dry mouth and requests water
C. Orthostatic blood pressure change from 112/68 to 98/58 mmHg
D. Dizziness reported during position change
E. IV insertion site is warm and slightly puffy
F. Patient refuses to use the bedpan and insists on walking to bathroom independently
Correct: A, C, E, F
Rationale:
● Answer: A, C, E, F
● Why (2026 Standard): In a dehydrated patient on fluid replacement, urine output
should be at least 0.5 mL/kg/hr (approx. 30-50 mL/hr). 35 mL in 2 hours indicates
inadequate perfusion requiring immediate provider notification per new sepsis and
dehydration protocols. Orthostatic hypotension (>20 mmHg systolic or >10 mmHg
diastolic drop) is a critical red flag in fall-risk patients. A warm, puffy IV site
indicates infiltration/phebitis requiring immediate intervention per INS 2026
, standards. Independent toileting by a dizzy patient violates fall protocols and
creates imminent injury risk.
● Errors: B is expected in dehydration and not immediate. D is a symptom of
orthostatic changes already captured in C, making it secondary.
Q002:
Type: NGN - Matrix
Scenario Context: Ms. Rodriguez, 34, is 1 day postoperative laparoscopic
cholecystectomy. She has a Jackson-Pratt drain with 80 mL serosanguineous output,
morphine PCA, and is NPO until bowel sounds return.
Question: Identify whether each nursing action is Indicated, Contraindicated, or
Non-Essential at this time.
Options:
A. Irrigate the JP drain with 30 mL sterile saline q8h
B. Encourage incentive spirometry use every 2 hours while awake
C. Assess bowel sounds in all 4 quadrants q4h
D. Ambulate patient in hallway 100 feet TID
E. Offer clear liquids to increase PO intake
Correct: A=Contraindicated, B=Indicated, C=Indicated, D=Indicated, E=Contraindicated
Rationale:
● Answer: A=Contraindicated, B=Indicated, C=Indicated, D=Indicated,
E=Contraindicated
● Why (2026 Standard): JP drains should never be irrigated without specific
physician order due to risk of disrupting healing tissue. Incentive spirometry
prevents post-op atelectasis—critical priority. Bowel sound assessment is essential
when NPO to determine readiness for diet advancement. Early ambulation
prevents complications. Offering liquids when NPO violates provider orders and
aspiration precautions per AORN 2026 guidelines.
● Errors: A irrigation is dangerous and not standard protocol. E would be
appropriate only after bowel sounds and order changes.
Q003:
Type: Traditional
Scenario Context: A nurse is preparing to administer digoxin 0.25 mg PO to a
76-year-old female with heart failure. Her apical pulse is 56 beats/min.
,Question: What is the nurse's priority action?
Options:
A. Administer the medication and recheck pulse in 1 hour
B. Hold the medication and notify the provider immediately
C. Give half the prescribed dose and document the pulse
D. Recheck the pulse in 15 minutes and administer if >60
Correct: B
Rationale:
● Answer: B
● Why (2026 Standard): Digoxin has a narrow therapeutic index. Per 2026 drug
safety protocols, hold digoxin if apical pulse is <60 beats/min in adults and notify
provider before administration. This prevents toxicity and severe bradycardia.
● Errors: A risks toxicity. C violates provider order and pharmacy protocols. D
delays necessary provider communication and could worsen condition.
Q004:
Type: NGN - Bowtie
Scenario Context: James O'Connell, 45, presents to ED with severe shortness of breath,
chest pain, and confusion. He has a history of COPD and is on 2L NC O2 at home. His
SpO2 is 82%, RR 32, and he appears cyanotic.
Question: Complete the bowtie by selecting: (1) The Priority Nursing Diagnosis, (2) the
Immediate Nursing Action, (3) a Potential Complication to Monitor.
Options:
A. Impaired Gas Exchange
B. Acute Pain
C. Administer 15L non-rebreather mask
D. Increase home O2 to 4L NC
E. Oxygen Toxicity
F. Respiratory Alkalosis
Correct: A, C, E
Rationale:
, ● Answer: A, C, E
● Why (2026 Standard): For COPD exacerbation with severe hypoxia, Impaired Gas
Exchange is priority diagnosis. Per emergency oxygenation guidelines, 15L NRB
is indicated for SpO2 <85% regardless of CO2 retention concerns—"treat hypoxia
first." Oxygen toxicity is a valid complication from high-flow oxygen, requiring
close ABG monitoring.
● Errors: B is secondary to hypoxia. D is inadequate for severe hypoxia. F is
unlikely; respiratory acidosis is more common in COPD.
Q005:
Type: Traditional
Scenario Context: A patient is prescribed 500 mL of 0.9% NaCl to infuse over 4 hours.
The IV tubing drop factor is 15 gtt/mL.
Question: What is the correct drip rate in gtt/min?
Options:
A. 19 gtt/min
B. 31 gtt/min
C. 47 gtt/min
D. 60 gtt/min
Correct: B
Rationale:
● Answer: B
● Why (2026 Standard): Calculation: (500 mL × 15 gtt/mL) ÷ (4 hours × 60 min) =
7,500 ÷ 240 = 31.25 gtt/min, rounded to 31 gtt/min. Per new ISMP 2026
guidelines, round to nearest whole number and verify with smart pump
programming.
● Errors: A uses wrong time conversion. C calculates for 2-hour infusion. D
calculates for 1-hour infusion.
Q006:
Type: NGN - Extended Multiple Response
Scenario Context: An 82-year-old resident in a long-term care facility, Mrs. Kowalski,
has a stage 2 pressure injury on her coccyx. She is incontinent of urine, has limited
mobility, and is on a regular diet. Her family asks about prevention strategies.
Versions) | 2026 Verified Questions &
Answers | NGN-Style
Q001:
Type: NGN - Extended Multiple Response
Scenario Context: A 68-year-old male patient, Mr. Chen, was admitted 2 days ago for
dehydration secondary to vomiting. He has an IV of 0.9% NaCl at 100 mL/hr, a Foley
catheter, and is on fall precautions. His most recent vital signs: T 37.2°C, P 88, R 18, BP
112/68. He reports feeling dizzy when he sits up.
Question: Which of the following assessment findings require IMMEDIATE follow-up
by the nurse? (Select all that apply)
Options:
A. Urine output of 35 mL in the last 2 hours
B. Patient reports dry mouth and requests water
C. Orthostatic blood pressure change from 112/68 to 98/58 mmHg
D. Dizziness reported during position change
E. IV insertion site is warm and slightly puffy
F. Patient refuses to use the bedpan and insists on walking to bathroom independently
Correct: A, C, E, F
Rationale:
● Answer: A, C, E, F
● Why (2026 Standard): In a dehydrated patient on fluid replacement, urine output
should be at least 0.5 mL/kg/hr (approx. 30-50 mL/hr). 35 mL in 2 hours indicates
inadequate perfusion requiring immediate provider notification per new sepsis and
dehydration protocols. Orthostatic hypotension (>20 mmHg systolic or >10 mmHg
diastolic drop) is a critical red flag in fall-risk patients. A warm, puffy IV site
indicates infiltration/phebitis requiring immediate intervention per INS 2026
, standards. Independent toileting by a dizzy patient violates fall protocols and
creates imminent injury risk.
● Errors: B is expected in dehydration and not immediate. D is a symptom of
orthostatic changes already captured in C, making it secondary.
Q002:
Type: NGN - Matrix
Scenario Context: Ms. Rodriguez, 34, is 1 day postoperative laparoscopic
cholecystectomy. She has a Jackson-Pratt drain with 80 mL serosanguineous output,
morphine PCA, and is NPO until bowel sounds return.
Question: Identify whether each nursing action is Indicated, Contraindicated, or
Non-Essential at this time.
Options:
A. Irrigate the JP drain with 30 mL sterile saline q8h
B. Encourage incentive spirometry use every 2 hours while awake
C. Assess bowel sounds in all 4 quadrants q4h
D. Ambulate patient in hallway 100 feet TID
E. Offer clear liquids to increase PO intake
Correct: A=Contraindicated, B=Indicated, C=Indicated, D=Indicated, E=Contraindicated
Rationale:
● Answer: A=Contraindicated, B=Indicated, C=Indicated, D=Indicated,
E=Contraindicated
● Why (2026 Standard): JP drains should never be irrigated without specific
physician order due to risk of disrupting healing tissue. Incentive spirometry
prevents post-op atelectasis—critical priority. Bowel sound assessment is essential
when NPO to determine readiness for diet advancement. Early ambulation
prevents complications. Offering liquids when NPO violates provider orders and
aspiration precautions per AORN 2026 guidelines.
● Errors: A irrigation is dangerous and not standard protocol. E would be
appropriate only after bowel sounds and order changes.
Q003:
Type: Traditional
Scenario Context: A nurse is preparing to administer digoxin 0.25 mg PO to a
76-year-old female with heart failure. Her apical pulse is 56 beats/min.
,Question: What is the nurse's priority action?
Options:
A. Administer the medication and recheck pulse in 1 hour
B. Hold the medication and notify the provider immediately
C. Give half the prescribed dose and document the pulse
D. Recheck the pulse in 15 minutes and administer if >60
Correct: B
Rationale:
● Answer: B
● Why (2026 Standard): Digoxin has a narrow therapeutic index. Per 2026 drug
safety protocols, hold digoxin if apical pulse is <60 beats/min in adults and notify
provider before administration. This prevents toxicity and severe bradycardia.
● Errors: A risks toxicity. C violates provider order and pharmacy protocols. D
delays necessary provider communication and could worsen condition.
Q004:
Type: NGN - Bowtie
Scenario Context: James O'Connell, 45, presents to ED with severe shortness of breath,
chest pain, and confusion. He has a history of COPD and is on 2L NC O2 at home. His
SpO2 is 82%, RR 32, and he appears cyanotic.
Question: Complete the bowtie by selecting: (1) The Priority Nursing Diagnosis, (2) the
Immediate Nursing Action, (3) a Potential Complication to Monitor.
Options:
A. Impaired Gas Exchange
B. Acute Pain
C. Administer 15L non-rebreather mask
D. Increase home O2 to 4L NC
E. Oxygen Toxicity
F. Respiratory Alkalosis
Correct: A, C, E
Rationale:
, ● Answer: A, C, E
● Why (2026 Standard): For COPD exacerbation with severe hypoxia, Impaired Gas
Exchange is priority diagnosis. Per emergency oxygenation guidelines, 15L NRB
is indicated for SpO2 <85% regardless of CO2 retention concerns—"treat hypoxia
first." Oxygen toxicity is a valid complication from high-flow oxygen, requiring
close ABG monitoring.
● Errors: B is secondary to hypoxia. D is inadequate for severe hypoxia. F is
unlikely; respiratory acidosis is more common in COPD.
Q005:
Type: Traditional
Scenario Context: A patient is prescribed 500 mL of 0.9% NaCl to infuse over 4 hours.
The IV tubing drop factor is 15 gtt/mL.
Question: What is the correct drip rate in gtt/min?
Options:
A. 19 gtt/min
B. 31 gtt/min
C. 47 gtt/min
D. 60 gtt/min
Correct: B
Rationale:
● Answer: B
● Why (2026 Standard): Calculation: (500 mL × 15 gtt/mL) ÷ (4 hours × 60 min) =
7,500 ÷ 240 = 31.25 gtt/min, rounded to 31 gtt/min. Per new ISMP 2026
guidelines, round to nearest whole number and verify with smart pump
programming.
● Errors: A uses wrong time conversion. C calculates for 2-hour infusion. D
calculates for 1-hour infusion.
Q006:
Type: NGN - Extended Multiple Response
Scenario Context: An 82-year-old resident in a long-term care facility, Mrs. Kowalski,
has a stage 2 pressure injury on her coccyx. She is incontinent of urine, has limited
mobility, and is on a regular diet. Her family asks about prevention strategies.
