2026 ATI RN Fundamentals – Proctored actual Exam (3
Versions) | Verified Questions & Answers | NGN-Style
Q001: 001
Type: NGN – Extended Multiple Response
Scenario Context: 77-year-old male, POD1 right hemicolectomy, history of CHF (EF
35%), on 2 L NC, reports sudden dyspnea; SpO₂ drops from 94% to 88%.
Question: Which findings require immediate follow-up to prevent respiratory failure?
Select ALL that apply.
A. Respiratory rate 32/min
B. Absent breath sounds right lower lobe
C. Fine crackles bilateral bases
D. PaCO₂ 52 mmHg
E. Heart rate 118/min
F. Patient unable to speak in full sentences
(Correct: A, B, D, F)
Rationale:
● Answer: A, B, D, F
● Why (2026 Standard): Tachypnea >30, silent lung suggests
atelectasis/pneumothorax, hypercapnia >50 with accessory muscle use flags
impending respiratory failure; speech limitation shows severe distress.
, ● Errors: C is chronic CHF finding; E is compensatory.
Q002: 002
Type: Traditional
Scenario Context: Same patient, stat portable CXR shows right lower lobe collapse.
Question: Priority nursing action before respiratory therapy arrives?
Options:
A. Increase O₂ to 6 L via NC
B. Encourage incentive spirometry
C. Position right side up
D. Administer albuterol 2.5 mg neb
(Correct: B)
Rationale:
● Answer: Incentive spirometry re-expands collapsed alveioli, first-line nursing
intervention per 2026 ATS post-op guidelines.
● Errors: A may increase CO₂ retention in COPD-CHF overlap; C ineffective; D not
ordered.
Q003: 003
Type: NGN – Matrix
Scenario Context: 29-year-old primigravida at 16 weeks, admitted with hyperemesis
gravidarum, has lost 4 kg in 10 days, Na 130 mEq/L, ketones 2+.
,Matrix: Match intervention to strength of evidence for effectiveness (1 = Strong, 2 =
Weak, 3 = Contraindicated).
Interventions:
A. Start D5NS at 125 mL/h
B. Offer ginger capsules 250 mg TID
C. Insert NG tube to low suction
D. Give metoclopramide 10 mg IV q8h
Options Grid:
A–3
B–2
C–3
D–1
(Correct: A-3, B-2, C-3, D-1)
Rationale:
● Answer: D5NS risks rapid Na correction; ginger has limited evidence; NG suction
worsens electrolytes; metoclopramide Level-A 2026 ACOG.
● Errors: Any other mapping misclassifies evidence.
Q004: 004
Type: NGN – Bowtie
, Scenario Context: 8-year-old, 18 kg, febrile 39.8 °C, new-onset generalized tonic-clonic
seizure lasting 3 min, stops en-route to ED.
Bowtie: Identify risk (left), Immediate nursing action (knot), Monitor parameter (right).
(Correct: Risk – Recurrent febrile seizure; Knot – Place side-lying, ensure airway, give
O₂ 2 L, time next seizure; Right – Continuous pulse oximetry, temperature q15 min, neuro
checks)
Rationale:
● Answer: 2026 AAP guidelines prioritize airway protection and seizure
observation.
● Errors: Giving antipyretics first delays seizure monitoring.
Q005: 005
Type: Traditional
Scenario Context: Same child, now afebrile, parents ask about preventing future seizures.
Question: Most evidence-based teaching?
Options:
A. Daily low-dose diazepam
B. Aggressive antipyretic use PRN
C. Avoid childhood vaccines
D. Restrict swimming for 1 year
(Correct: B)
Versions) | Verified Questions & Answers | NGN-Style
Q001: 001
Type: NGN – Extended Multiple Response
Scenario Context: 77-year-old male, POD1 right hemicolectomy, history of CHF (EF
35%), on 2 L NC, reports sudden dyspnea; SpO₂ drops from 94% to 88%.
Question: Which findings require immediate follow-up to prevent respiratory failure?
Select ALL that apply.
A. Respiratory rate 32/min
B. Absent breath sounds right lower lobe
C. Fine crackles bilateral bases
D. PaCO₂ 52 mmHg
E. Heart rate 118/min
F. Patient unable to speak in full sentences
(Correct: A, B, D, F)
Rationale:
● Answer: A, B, D, F
● Why (2026 Standard): Tachypnea >30, silent lung suggests
atelectasis/pneumothorax, hypercapnia >50 with accessory muscle use flags
impending respiratory failure; speech limitation shows severe distress.
, ● Errors: C is chronic CHF finding; E is compensatory.
Q002: 002
Type: Traditional
Scenario Context: Same patient, stat portable CXR shows right lower lobe collapse.
Question: Priority nursing action before respiratory therapy arrives?
Options:
A. Increase O₂ to 6 L via NC
B. Encourage incentive spirometry
C. Position right side up
D. Administer albuterol 2.5 mg neb
(Correct: B)
Rationale:
● Answer: Incentive spirometry re-expands collapsed alveioli, first-line nursing
intervention per 2026 ATS post-op guidelines.
● Errors: A may increase CO₂ retention in COPD-CHF overlap; C ineffective; D not
ordered.
Q003: 003
Type: NGN – Matrix
Scenario Context: 29-year-old primigravida at 16 weeks, admitted with hyperemesis
gravidarum, has lost 4 kg in 10 days, Na 130 mEq/L, ketones 2+.
,Matrix: Match intervention to strength of evidence for effectiveness (1 = Strong, 2 =
Weak, 3 = Contraindicated).
Interventions:
A. Start D5NS at 125 mL/h
B. Offer ginger capsules 250 mg TID
C. Insert NG tube to low suction
D. Give metoclopramide 10 mg IV q8h
Options Grid:
A–3
B–2
C–3
D–1
(Correct: A-3, B-2, C-3, D-1)
Rationale:
● Answer: D5NS risks rapid Na correction; ginger has limited evidence; NG suction
worsens electrolytes; metoclopramide Level-A 2026 ACOG.
● Errors: Any other mapping misclassifies evidence.
Q004: 004
Type: NGN – Bowtie
, Scenario Context: 8-year-old, 18 kg, febrile 39.8 °C, new-onset generalized tonic-clonic
seizure lasting 3 min, stops en-route to ED.
Bowtie: Identify risk (left), Immediate nursing action (knot), Monitor parameter (right).
(Correct: Risk – Recurrent febrile seizure; Knot – Place side-lying, ensure airway, give
O₂ 2 L, time next seizure; Right – Continuous pulse oximetry, temperature q15 min, neuro
checks)
Rationale:
● Answer: 2026 AAP guidelines prioritize airway protection and seizure
observation.
● Errors: Giving antipyretics first delays seizure monitoring.
Q005: 005
Type: Traditional
Scenario Context: Same child, now afebrile, parents ask about preventing future seizures.
Question: Most evidence-based teaching?
Options:
A. Daily low-dose diazepam
B. Aggressive antipyretic use PRN
C. Avoid childhood vaccines
D. Restrict swimming for 1 year
(Correct: B)
