FULL 100 NGN PRACTICE QUESTIONS
ATI RN Comprehensive Predictor Exit Exam Level
(Original)
Section 1: Cardiac (Questions 1–10)
1. A client with acute MI develops crackles in mid-lung fields, HR 110, BP 145/88.
What is the priority?
• A) Morphine 2 mg IV
• B) Furosemide 40 mg IV
• C) Oxygen via non-rebreather
• D) Nitroglycerin 0.4 mg SL
Correct: C
Rationale: Oxygenation is always first. Crackles indicate pulmonary congestion;
hypoxemia kills first.
2. Post-cardiac cath with femoral access. The nurse finds the groin site with a
large expanding hematoma. First action?
• A) Apply firm manual pressure 1 inch above site
• B) Call the provider
• C) Check pedal pulses
• D) Apply ice pack
Correct: A
Rationale: Expanding hematoma indicates arterial bleed. Manual pressure
occludes the artery above the puncture site.
3–5. NGN Case Study (Heart Failure)
A 68-year-old female with HFpEF presents with DOE, fatigue, JVD, and 2+ edema.
EF 55%. VS: HR 102, BP 160/92, RR 22.
,3. Which 3 medications are expected? (Select all)
• A) Metoprolol
• B) Digoxin
• C) Furosemide
• D) Lisinopril
• E) Amiodarone
Correct: A, C, D
Rationale: Beta-blocker, diuretic, ACEi are first-line for HFpEF. Digoxin is for
HFrEF.
4. Which lab finding indicates worsening HF?
• A) BNP 120 → 450 pg/mL
• B) Sodium 138 → 135
• C) Creatinine 0.9 → 1.1
• D) Hemoglobin 12 → 11.5
Correct: A
Rationale: Rising BNP indicates increased ventricular wall stress from worsening
HF.
5. Patient reports dry cough 2 weeks after starting lisinopril. Action?
• A) Switch to losartan
• B) Add codeine
• C) Continue lisinopril, cough subsides
• D) Stop lisinopril immediately
Correct: A
Rationale: ACEi-induced cough is managed by switching to ARB (losartan).
6. Post-MI patient on aspirin, clopidogrel, heparin. Melena noted. Next action?
• A) Hold heparin
, • B) Check platelet count
• C) Hold all antiplatelets
• D) Notify provider, hold heparin
Correct: D
Rationale: Melena suggests GI bleed. Notify provider and hold heparin first
(shortest half-life).
7. Which EKG finding is most concerning in a patient with chest pain?
• A) ST elevation in V2–V4
• B) T wave inversion in lead III
• C) Prolonged PR interval
• D) Wide QRS > 0.12 sec
Correct: A
Rationale: ST elevation in contiguous leads = STEMI, requiring immediate
reperfusion.
8. Patient on amiodarone. Which assessment is priority?
• A) Lung sounds
• B) Thyroid function
• C) Liver enzymes
• D) Corneal deposits
Correct: A
Rationale: Pulmonary toxicity (cough, dyspnea) is the most serious and
potentially fatal adverse effect.
9. Bow-Tie: Patient with atrial fibrillation, HR 140, BP 110/70.
Assessment Intervention Monitor
Apical HR Diltiazem IV BP
, Assessment Intervention Monitor
Radial pulse Digoxin HR
JVD Cardioversion Rhythm
Correct: Apical HR → Diltiazem IV → HR
Rationale: Rate control first if stable. Diltiazem is first-line for AF with RVR.
10. Patient with pacemaker. Which finding requires immediate action?
• A) HR 72, paced
• B) Dizziness with hiccups
• C) Pacemaker spike before QRS
• D) Incision site slightly red
Correct: B
Rationale: Hiccup + dizziness = lead perforation or diaphragmatic pacing.
Emergency.
Section 2: Respiratory (Questions 11–20)
11. Patient with pneumonia, RR 32, SpO₂ 88% on 4L NC, lethargic. Next action?
• A) Increase O₂ to 6L NC
• B) BiPAP
• C) Intubate
• D) ABG stat
Correct: B
Rationale: Lethargy + hypoxemia on moderate O₂ → impending failure. BiPAP first
unless unconscious.
12. Which ABG finding is expected in early COPD exacerbation?
ATI RN Comprehensive Predictor Exit Exam Level
(Original)
Section 1: Cardiac (Questions 1–10)
1. A client with acute MI develops crackles in mid-lung fields, HR 110, BP 145/88.
What is the priority?
• A) Morphine 2 mg IV
• B) Furosemide 40 mg IV
• C) Oxygen via non-rebreather
• D) Nitroglycerin 0.4 mg SL
Correct: C
Rationale: Oxygenation is always first. Crackles indicate pulmonary congestion;
hypoxemia kills first.
2. Post-cardiac cath with femoral access. The nurse finds the groin site with a
large expanding hematoma. First action?
• A) Apply firm manual pressure 1 inch above site
• B) Call the provider
• C) Check pedal pulses
• D) Apply ice pack
Correct: A
Rationale: Expanding hematoma indicates arterial bleed. Manual pressure
occludes the artery above the puncture site.
3–5. NGN Case Study (Heart Failure)
A 68-year-old female with HFpEF presents with DOE, fatigue, JVD, and 2+ edema.
EF 55%. VS: HR 102, BP 160/92, RR 22.
,3. Which 3 medications are expected? (Select all)
• A) Metoprolol
• B) Digoxin
• C) Furosemide
• D) Lisinopril
• E) Amiodarone
Correct: A, C, D
Rationale: Beta-blocker, diuretic, ACEi are first-line for HFpEF. Digoxin is for
HFrEF.
4. Which lab finding indicates worsening HF?
• A) BNP 120 → 450 pg/mL
• B) Sodium 138 → 135
• C) Creatinine 0.9 → 1.1
• D) Hemoglobin 12 → 11.5
Correct: A
Rationale: Rising BNP indicates increased ventricular wall stress from worsening
HF.
5. Patient reports dry cough 2 weeks after starting lisinopril. Action?
• A) Switch to losartan
• B) Add codeine
• C) Continue lisinopril, cough subsides
• D) Stop lisinopril immediately
Correct: A
Rationale: ACEi-induced cough is managed by switching to ARB (losartan).
6. Post-MI patient on aspirin, clopidogrel, heparin. Melena noted. Next action?
• A) Hold heparin
, • B) Check platelet count
• C) Hold all antiplatelets
• D) Notify provider, hold heparin
Correct: D
Rationale: Melena suggests GI bleed. Notify provider and hold heparin first
(shortest half-life).
7. Which EKG finding is most concerning in a patient with chest pain?
• A) ST elevation in V2–V4
• B) T wave inversion in lead III
• C) Prolonged PR interval
• D) Wide QRS > 0.12 sec
Correct: A
Rationale: ST elevation in contiguous leads = STEMI, requiring immediate
reperfusion.
8. Patient on amiodarone. Which assessment is priority?
• A) Lung sounds
• B) Thyroid function
• C) Liver enzymes
• D) Corneal deposits
Correct: A
Rationale: Pulmonary toxicity (cough, dyspnea) is the most serious and
potentially fatal adverse effect.
9. Bow-Tie: Patient with atrial fibrillation, HR 140, BP 110/70.
Assessment Intervention Monitor
Apical HR Diltiazem IV BP
, Assessment Intervention Monitor
Radial pulse Digoxin HR
JVD Cardioversion Rhythm
Correct: Apical HR → Diltiazem IV → HR
Rationale: Rate control first if stable. Diltiazem is first-line for AF with RVR.
10. Patient with pacemaker. Which finding requires immediate action?
• A) HR 72, paced
• B) Dizziness with hiccups
• C) Pacemaker spike before QRS
• D) Incision site slightly red
Correct: B
Rationale: Hiccup + dizziness = lead perforation or diaphragmatic pacing.
Emergency.
Section 2: Respiratory (Questions 11–20)
11. Patient with pneumonia, RR 32, SpO₂ 88% on 4L NC, lethargic. Next action?
• A) Increase O₂ to 6L NC
• B) BiPAP
• C) Intubate
• D) ABG stat
Correct: B
Rationale: Lethargy + hypoxemia on moderate O₂ → impending failure. BiPAP first
unless unconscious.
12. Which ABG finding is expected in early COPD exacerbation?
