ATI RN Fundamentals – Proctored 2026 actual
Exam (3 Versions) | Verified Questions &
Answers | NGN-Style
Q001: 001
Type: NGN - Bowtie
Scenario Context: 77-year-old female, POD #1 right hemicolectomy, PCA fentanyl 25
mcg/h basal, history of heart failure with EF 30%.
Question: Identify the priority assessment finding that would prompt the nurse to pause
the fentanyl infusion and call the provider immediately.
Options:
A. Respiratory rate 7/min
B. Pain score 6/10
C. SpO₂ 93% on 2 L O₂
D. Pupils 2 mm, equal
(Correct: A)
Rationale:
● Answer: A
● Why (2026 Standard): Fentanyl basal rate can cause opioid-induced respiratory
depression; RR <8 necessitates immediate naloxone per 2026 ASPMN guidelines.
, ● Errors: B—pain acceptable post-op; C—SpO₂ tolerable with HF; D—miotic but
not critical.
Q002: 002
Type: NGN - Extended Multiple Response
Scenario Context: Same patient (Q001).
Question: Select all nursing actions within the first 5 minutes after stopping the fentanyl
infusion.
Options:
A. Stimulate patient by calling name
B. Administer naloxone 0.4 mg IV push
C. Increase basal rate to 30 mcg/h
D. Apply high-flow O₂ non-rebreather
E. Notify respiratory therapy
F. Document pain score first
(Correct: A, B, D, E)
Rationale:
● Answer: A, B, D, E
● Why (2026 Standard): Rapid response sequence per 2026 ISMP opioid emergency
bundle.
● Errors: C worsens depression; F done after stabilization.
Q003: 003
,Type: Traditional
Scenario Context: New patient: 29-year-old with cellulitis receiving cefazolin 1 g IV q8h;
serum creatinine 2.8 mg/dL.
Question: Which action is most appropriate before the next scheduled dose?
Options:
A. Give full dose now
B. Reduce dose by 50%
C. Extend interval to q24h
D. Switch to oral route
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): CrCl <30 mL/min mandates 50% dose reduction of
cefazolin per 2026 Sanford Guide.
● Errors: A risks neurotoxicity; C/D inadequate.
Q004: 004
Type: NGN - Drag-and-Drop
Scenario Context: 65 kg patient with new-onset diabetes; sliding-scale insulin aspart 6
units SC now. Available: 100 units/mL vial.
Question: Drag steps to prepare 6 units correctly.
, Options (drag order):
1.Wipe rubber top with alcohol
2.Inject 6 units air into vial
3.Withdraw 6 units insulin
4.Check expiration and clarity
5.Roll vial gently
(Correct sequence: 4→5→1→2→3)
Rationale:
● Answer: 4→5→1→2→3
● Why (2026 Standard): 2026 ADA injection sequence prevents dosing errors.
● Errors: Any other order risks contamination or wrong dose.
Q005: 005
Type: NGN - Matrix
Scenario Context: 82-year-old on warfarin for mechanical mitral valve; INR 4.8, no
bleeding.
Question: Match intervention to urgency level.
Matrix Rows:
A. Hold next warfarin dose
B. Administer 1 mg oral vitamin K
C. Check for occult blood in stool
Matrix Columns:
1. Urgent (<1 h)
2. Today (<4 h)
Exam (3 Versions) | Verified Questions &
Answers | NGN-Style
Q001: 001
Type: NGN - Bowtie
Scenario Context: 77-year-old female, POD #1 right hemicolectomy, PCA fentanyl 25
mcg/h basal, history of heart failure with EF 30%.
Question: Identify the priority assessment finding that would prompt the nurse to pause
the fentanyl infusion and call the provider immediately.
Options:
A. Respiratory rate 7/min
B. Pain score 6/10
C. SpO₂ 93% on 2 L O₂
D. Pupils 2 mm, equal
(Correct: A)
Rationale:
● Answer: A
● Why (2026 Standard): Fentanyl basal rate can cause opioid-induced respiratory
depression; RR <8 necessitates immediate naloxone per 2026 ASPMN guidelines.
, ● Errors: B—pain acceptable post-op; C—SpO₂ tolerable with HF; D—miotic but
not critical.
Q002: 002
Type: NGN - Extended Multiple Response
Scenario Context: Same patient (Q001).
Question: Select all nursing actions within the first 5 minutes after stopping the fentanyl
infusion.
Options:
A. Stimulate patient by calling name
B. Administer naloxone 0.4 mg IV push
C. Increase basal rate to 30 mcg/h
D. Apply high-flow O₂ non-rebreather
E. Notify respiratory therapy
F. Document pain score first
(Correct: A, B, D, E)
Rationale:
● Answer: A, B, D, E
● Why (2026 Standard): Rapid response sequence per 2026 ISMP opioid emergency
bundle.
● Errors: C worsens depression; F done after stabilization.
Q003: 003
,Type: Traditional
Scenario Context: New patient: 29-year-old with cellulitis receiving cefazolin 1 g IV q8h;
serum creatinine 2.8 mg/dL.
Question: Which action is most appropriate before the next scheduled dose?
Options:
A. Give full dose now
B. Reduce dose by 50%
C. Extend interval to q24h
D. Switch to oral route
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): CrCl <30 mL/min mandates 50% dose reduction of
cefazolin per 2026 Sanford Guide.
● Errors: A risks neurotoxicity; C/D inadequate.
Q004: 004
Type: NGN - Drag-and-Drop
Scenario Context: 65 kg patient with new-onset diabetes; sliding-scale insulin aspart 6
units SC now. Available: 100 units/mL vial.
Question: Drag steps to prepare 6 units correctly.
, Options (drag order):
1.Wipe rubber top with alcohol
2.Inject 6 units air into vial
3.Withdraw 6 units insulin
4.Check expiration and clarity
5.Roll vial gently
(Correct sequence: 4→5→1→2→3)
Rationale:
● Answer: 4→5→1→2→3
● Why (2026 Standard): 2026 ADA injection sequence prevents dosing errors.
● Errors: Any other order risks contamination or wrong dose.
Q005: 005
Type: NGN - Matrix
Scenario Context: 82-year-old on warfarin for mechanical mitral valve; INR 4.8, no
bleeding.
Question: Match intervention to urgency level.
Matrix Rows:
A. Hold next warfarin dose
B. Administer 1 mg oral vitamin K
C. Check for occult blood in stool
Matrix Columns:
1. Urgent (<1 h)
2. Today (<4 h)
