ATI PN COMPREHENSIVE EXIT EXAM RETAKE (NGN
FORMAT)
2026/2027 Version | Complete Solution
180 Questions | Aligned with NCLEX-PN Test Plan & NCSBN
Clinical Judgment Model
CASE STUDY 1: Mrs. Evans - Chronic Heart Failure in Long-Term Care
Setting: Skilled Nursing Facility
Background: Mrs. Evans is a 78-year-old resident with CHF, hypertension, and mild
dementia. Orders: Furosemide 40mg PO daily, Lisinopril 10mg PO daily, Daily weights,
2g sodium diet.
Exhibit - CNA Report Sheet (0700):
● "Mrs. Evans refused breakfast. Says she's too tired to eat."
● "She seems more short of breath than usual when I helped her to the bathroom."
● "I couldn't get her daily weight because she didn't want to get out of bed."
● "Her pillow was wet with sweat this morning."
● "She kept coughing while I was in the room."
Q1 (Recognize Cues - Matrix Multiple Response): Which information from the CNA
report requires immediate follow-up by the PN? Select all that apply.
A. [Refused breakfast [CORRECT]]
B. [Increased shortness of breath [CORRECT]]
C. [Pillow wet with sweat (diaphoresis) [CORRECT]]
D. [Mild dementia]
,E. [Persistent coughing [CORRECT]]
F. [Resident is tired]
Correct Answer: A, B, C, E
Rationale: [NCJMM: RECOGNIZE CUES] The PN must identify objective cues of CHF
decompensation: (A) Anorexia from GI congestion; (B) Progressive dyspnea indicates
worsening pulmonary edema; (C) Diaphoresis suggests sympathetic response to poor
cardiac output; (E) Cough from pulmonary congestion/orthopnea. Why others are
wrong: (D) Chronic baseline condition, not acute change; (F) Non-specific symptom
requiring correlation with objective data.
Q2 (Analyze Cues/Prioritize Hypotheses - Extended Multiple Choice): The PN gathers
additional data: BP 168/94, HR 112, RR 28, SpO2 87% on room air, 2+ peripheral edema,
bilateral crackles in lung bases. What is the priority hypothesis the PN should report to
the RN?
A. Urinary tract infection causing confusion
B. Acute exacerbation of heart failure with pulmonary edema [CORRECT]
C. Community-acquired pneumonia
D. Medication toxicity from lisinopril
Correct Answer: B
Rationale: [NCJMM: ANALYZE CUES / PRIORITIZE HYPOTHESES] The cluster of cues
(hypertension, tachycardia, tachypnea, hypoxemia, crackles, edema, diaphoresis) in a
patient with known CHF indicates acute decompensation with fluid overload. This
requires immediate RN notification and possible physician intervention. Why others are
wrong: (A) No fever, dysuria, or specific UTI symptoms; (C) No fever or productive cough
described; (D) No angioedema, hyperkalemia, or renal dysfunction indicators.
,Q3 (Take Action - Ordered Response): Place the PN's immediate actions in priority order.
1. Apply supplemental oxygen 2L NC and reassess SpO2
2. Notify the supervising RN of assessment findings
3. Elevate head of bed to high Fowler's position
4. Attempt to obtain accurate weight and strict intake/output
5. Document all findings and interventions
Correct Order: 3, 1, 2, 4, 5
Rationale: [NCJMM: TAKE ACTION] (3) Positioning improves ventilation and reduces
preload immediately; (1) Oxygenation addresses hypoxemia (SpO2 87%); (2) Report to
RN for orders and higher-level intervention; (4) Data collection for ongoing management;
(5) Documentation completes the cycle. Safety and physiological stability come before
reporting and documentation.
Q4 (Take Action - Extended Multiple Choice): The RN instructs the PN to administer the
scheduled furosemide 40mg PO. Which pre-administration assessment is essential for
the PN to perform?
A. Check the resident's potassium level from yesterday's labs
B. Ask the resident about dizziness, lightheadedness, or hearing changes [CORRECT]
C. Hold the medication if blood pressure is below 140/90
D. Crush the tablet and mix with food to ensure absorption
Correct Answer: B
Rationale: [NCJMM: TAKE ACTION / SAFETY] Furosemide causes orthostatic
hypotension (dizziness) and ototoxicity (hearing changes, tinnitus). Pre-assessment for
these adverse effects is within PN scope and essential for safe administration. Why
others are wrong: (A) Reviewing labs is important but not the immediate
pre-administration patient assessment; (C) PN cannot independently hold medications
based on arbitrary parameters—requires specific PRN parameters or provider
, notification; (D) Crushing not indicated and potentially unsafe without checking
crushability.
Q5 (Evaluate Outcomes - Cloze/Drop-Down): Three hours after furosemide
administration, which finding best indicates therapeutic effectiveness?
The PN should document: __________ as a positive outcome.
A. Decreased blood pressure to 130/80
B. Increased urine output with reduced respiratory rate and improved SpO2 [CORRECT]
C. Improved appetite and request for lunch
D. Decreased heart rate to 88 bpm
Correct Answer: B
Rationale: [NCJMM: EVALUATE OUTCOMES] The primary therapeutic goal of
furosemide in CHF is diuresis to reduce pulmonary congestion. Expected outcomes:
increased urine output, decreased RR (less compensatory), improved oxygenation.
These directly address the pathophysiology. Why others wrong: (A, D) May occur but are
secondary effects; (C) Appetite improvement is subjective and slower to manifest.
Q6 (Client Education - Multiple Choice): The PN is reinforcing low-sodium diet teaching.
Which statement by Mrs. Evans indicates understanding?
A. "I can use sea salt instead of table salt because it's healthier."
B. "I'll stop eating fresh fruits since they have too much sodium."
C. "I should check labels and choose foods with less than 140mg sodium per serving."
[CORRECT]
D. "Canned soups are fine if I add extra water."
Correct Answer: C
FORMAT)
2026/2027 Version | Complete Solution
180 Questions | Aligned with NCLEX-PN Test Plan & NCSBN
Clinical Judgment Model
CASE STUDY 1: Mrs. Evans - Chronic Heart Failure in Long-Term Care
Setting: Skilled Nursing Facility
Background: Mrs. Evans is a 78-year-old resident with CHF, hypertension, and mild
dementia. Orders: Furosemide 40mg PO daily, Lisinopril 10mg PO daily, Daily weights,
2g sodium diet.
Exhibit - CNA Report Sheet (0700):
● "Mrs. Evans refused breakfast. Says she's too tired to eat."
● "She seems more short of breath than usual when I helped her to the bathroom."
● "I couldn't get her daily weight because she didn't want to get out of bed."
● "Her pillow was wet with sweat this morning."
● "She kept coughing while I was in the room."
Q1 (Recognize Cues - Matrix Multiple Response): Which information from the CNA
report requires immediate follow-up by the PN? Select all that apply.
A. [Refused breakfast [CORRECT]]
B. [Increased shortness of breath [CORRECT]]
C. [Pillow wet with sweat (diaphoresis) [CORRECT]]
D. [Mild dementia]
,E. [Persistent coughing [CORRECT]]
F. [Resident is tired]
Correct Answer: A, B, C, E
Rationale: [NCJMM: RECOGNIZE CUES] The PN must identify objective cues of CHF
decompensation: (A) Anorexia from GI congestion; (B) Progressive dyspnea indicates
worsening pulmonary edema; (C) Diaphoresis suggests sympathetic response to poor
cardiac output; (E) Cough from pulmonary congestion/orthopnea. Why others are
wrong: (D) Chronic baseline condition, not acute change; (F) Non-specific symptom
requiring correlation with objective data.
Q2 (Analyze Cues/Prioritize Hypotheses - Extended Multiple Choice): The PN gathers
additional data: BP 168/94, HR 112, RR 28, SpO2 87% on room air, 2+ peripheral edema,
bilateral crackles in lung bases. What is the priority hypothesis the PN should report to
the RN?
A. Urinary tract infection causing confusion
B. Acute exacerbation of heart failure with pulmonary edema [CORRECT]
C. Community-acquired pneumonia
D. Medication toxicity from lisinopril
Correct Answer: B
Rationale: [NCJMM: ANALYZE CUES / PRIORITIZE HYPOTHESES] The cluster of cues
(hypertension, tachycardia, tachypnea, hypoxemia, crackles, edema, diaphoresis) in a
patient with known CHF indicates acute decompensation with fluid overload. This
requires immediate RN notification and possible physician intervention. Why others are
wrong: (A) No fever, dysuria, or specific UTI symptoms; (C) No fever or productive cough
described; (D) No angioedema, hyperkalemia, or renal dysfunction indicators.
,Q3 (Take Action - Ordered Response): Place the PN's immediate actions in priority order.
1. Apply supplemental oxygen 2L NC and reassess SpO2
2. Notify the supervising RN of assessment findings
3. Elevate head of bed to high Fowler's position
4. Attempt to obtain accurate weight and strict intake/output
5. Document all findings and interventions
Correct Order: 3, 1, 2, 4, 5
Rationale: [NCJMM: TAKE ACTION] (3) Positioning improves ventilation and reduces
preload immediately; (1) Oxygenation addresses hypoxemia (SpO2 87%); (2) Report to
RN for orders and higher-level intervention; (4) Data collection for ongoing management;
(5) Documentation completes the cycle. Safety and physiological stability come before
reporting and documentation.
Q4 (Take Action - Extended Multiple Choice): The RN instructs the PN to administer the
scheduled furosemide 40mg PO. Which pre-administration assessment is essential for
the PN to perform?
A. Check the resident's potassium level from yesterday's labs
B. Ask the resident about dizziness, lightheadedness, or hearing changes [CORRECT]
C. Hold the medication if blood pressure is below 140/90
D. Crush the tablet and mix with food to ensure absorption
Correct Answer: B
Rationale: [NCJMM: TAKE ACTION / SAFETY] Furosemide causes orthostatic
hypotension (dizziness) and ototoxicity (hearing changes, tinnitus). Pre-assessment for
these adverse effects is within PN scope and essential for safe administration. Why
others are wrong: (A) Reviewing labs is important but not the immediate
pre-administration patient assessment; (C) PN cannot independently hold medications
based on arbitrary parameters—requires specific PRN parameters or provider
, notification; (D) Crushing not indicated and potentially unsafe without checking
crushability.
Q5 (Evaluate Outcomes - Cloze/Drop-Down): Three hours after furosemide
administration, which finding best indicates therapeutic effectiveness?
The PN should document: __________ as a positive outcome.
A. Decreased blood pressure to 130/80
B. Increased urine output with reduced respiratory rate and improved SpO2 [CORRECT]
C. Improved appetite and request for lunch
D. Decreased heart rate to 88 bpm
Correct Answer: B
Rationale: [NCJMM: EVALUATE OUTCOMES] The primary therapeutic goal of
furosemide in CHF is diuresis to reduce pulmonary congestion. Expected outcomes:
increased urine output, decreased RR (less compensatory), improved oxygenation.
These directly address the pathophysiology. Why others wrong: (A, D) May occur but are
secondary effects; (C) Appetite improvement is subjective and slower to manifest.
Q6 (Client Education - Multiple Choice): The PN is reinforcing low-sodium diet teaching.
Which statement by Mrs. Evans indicates understanding?
A. "I can use sea salt instead of table salt because it's healthier."
B. "I'll stop eating fresh fruits since they have too much sodium."
C. "I should check labels and choose foods with less than 140mg sodium per serving."
[CORRECT]
D. "Canned soups are fine if I add extra water."
Correct Answer: C
