RN 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: A 67-year-old cisgender female is post-op day 2 after an open reduction
internal fixation (ORIF) of the right femur. She has a history of heart failure with
preserved ejection fraction (HFpEF), CKD stage 3b, and type 2 diabetes. Current
medications include metformin 500 mg BID, empagliflozin 10 mg daily, carvedilol 6.25
mg BID, and enoxaparin 40 mg subcut daily. Morning labs show K 5.8 mEq/L, SCr 2.3
mg/dL (baseline 1.9), BUN 48 mg/dL, eGFR 22 mL/min/1.73 m², glucose 268 mg/dL,
and HbA1c 7.9%. Vital signs: BP 142/88 mm Hg, HR 88 bpm, RR 22/min, SpO₂ 94% on 2
L NC, temperature 37.1 °C. She reports nausea and “just not feeling right.”
Question:
Identify the priority concern, the most urgent action, and the parameter you will monitor
to evaluate improvement. (Drag the three correct labels to the bowtie.)
Options:
Priority Concern
A. Hyperkalemia
,B. Acute kidney injury
C. Uncontrolled hyperglycemia
D. Surgical site infection
Most Urgent Action
E. Hold empagliflozin and metformin
F. Administer 10 units regular insulin IV push
G. Obtain blood cultures
H. Give 1 g calcium gluconate IV
Parameter to Monitor
I. Serum creatinine every 6 h
J. Cardiac telemetry for T-wave narrowing
K. Serum potassium every 2 h
L. C-reactive protein daily
Correct Choices: A, H, K
Rationale (Revised & Verified):
● Correct Answer: Priority Concern: A (Hyperkalemia); Most Urgent Action: H
(Calcium gluconate); Parameter: K (K every 2 h).
● Analysis: 2026 KDIGO/ACCF guidelines list K ≥5.5 mEq/L in CKD as urgent.
Calcium gluconate stabilizes cardiac membranes within 3 min. Insulin-glucose
, shifts K but does not protect against arrhythmia; thus calcium is first. Metformin
& SGLT2 hold is necessary but not the most urgent action.
● Distractor Breakdown: B distractor ignores K level >5.5; E is correct later but not
first; F omits cardiac protection; G premature without fever; I too frequent for
stage 3b; J wrong ECG change (peaked T not narrow); L too late.
Item ID: V3-002
Item Type: Traditional MCQ
Scenario: A 34-year-old primigravida at 39 4/7 weeks presents in latent labor. Cervix 3
cm/80% effaced/−1 station. FHR baseline 165 bpm with minimal variability and
recurrent late decelerations. Maternal temperature 38.4 °C, WBC 15 k/µL, CRP 12 mg/L.
Question:
Which intrapartum nursing action is most critical?
Options:
A. Initiate high-dose oxytocin to expedite vaginal delivery
B. Prepare for emergent cesarean birth
C. Place internal fetal scalp electrode for enhanced monitoring
D. Administer 8 g magnesium sulfate IV load for neuroprotection
Correct Answer: B
Rationale (Revised & Verified):
● Correct Answer: B
Actual exam With Questions And Revised
Correct Answers & Rationales ()
100% Guaranteed Pass
Item ID: V3-001
Item Type: NGN - Bowtie
Scenario: A 67-year-old cisgender female is post-op day 2 after an open reduction
internal fixation (ORIF) of the right femur. She has a history of heart failure with
preserved ejection fraction (HFpEF), CKD stage 3b, and type 2 diabetes. Current
medications include metformin 500 mg BID, empagliflozin 10 mg daily, carvedilol 6.25
mg BID, and enoxaparin 40 mg subcut daily. Morning labs show K 5.8 mEq/L, SCr 2.3
mg/dL (baseline 1.9), BUN 48 mg/dL, eGFR 22 mL/min/1.73 m², glucose 268 mg/dL,
and HbA1c 7.9%. Vital signs: BP 142/88 mm Hg, HR 88 bpm, RR 22/min, SpO₂ 94% on 2
L NC, temperature 37.1 °C. She reports nausea and “just not feeling right.”
Question:
Identify the priority concern, the most urgent action, and the parameter you will monitor
to evaluate improvement. (Drag the three correct labels to the bowtie.)
Options:
Priority Concern
A. Hyperkalemia
,B. Acute kidney injury
C. Uncontrolled hyperglycemia
D. Surgical site infection
Most Urgent Action
E. Hold empagliflozin and metformin
F. Administer 10 units regular insulin IV push
G. Obtain blood cultures
H. Give 1 g calcium gluconate IV
Parameter to Monitor
I. Serum creatinine every 6 h
J. Cardiac telemetry for T-wave narrowing
K. Serum potassium every 2 h
L. C-reactive protein daily
Correct Choices: A, H, K
Rationale (Revised & Verified):
● Correct Answer: Priority Concern: A (Hyperkalemia); Most Urgent Action: H
(Calcium gluconate); Parameter: K (K every 2 h).
● Analysis: 2026 KDIGO/ACCF guidelines list K ≥5.5 mEq/L in CKD as urgent.
Calcium gluconate stabilizes cardiac membranes within 3 min. Insulin-glucose
, shifts K but does not protect against arrhythmia; thus calcium is first. Metformin
& SGLT2 hold is necessary but not the most urgent action.
● Distractor Breakdown: B distractor ignores K level >5.5; E is correct later but not
first; F omits cardiac protection; G premature without fever; I too frequent for
stage 3b; J wrong ECG change (peaked T not narrow); L too late.
Item ID: V3-002
Item Type: Traditional MCQ
Scenario: A 34-year-old primigravida at 39 4/7 weeks presents in latent labor. Cervix 3
cm/80% effaced/−1 station. FHR baseline 165 bpm with minimal variability and
recurrent late decelerations. Maternal temperature 38.4 °C, WBC 15 k/µL, CRP 12 mg/L.
Question:
Which intrapartum nursing action is most critical?
Options:
A. Initiate high-dose oxytocin to expedite vaginal delivery
B. Prepare for emergent cesarean birth
C. Place internal fetal scalp electrode for enhanced monitoring
D. Administer 8 g magnesium sulfate IV load for neuroprotection
Correct Answer: B
Rationale (Revised & Verified):
● Correct Answer: B
