NGN ATI RN Comprehensive Exit Retake Exam (Versions
1–4) QUESTIONS AND ANSWERS WITH RATIONALES/
GRADED A+/2026\2027 UPDATE /100%CORRECT
Total Questions: 155
Time Limit: 5 hours
Format: NGN (partial credit, multiple answer, case studies, trend, hot spot)
DOMAIN WEIGHTING (2026/27)
Domain %
Management of Care (Safety, Delegation, Ethics) 20%
Safety & Infection Control 12%
Health Promotion & Maintenance 10%
Psychosocial Integrity 8%
Basic Care & Comfort 8%
Pharmacological & Parenteral Therapies 14%
Reduction of Risk Potential 12%
Physiological Adaptation 16%
SECTION A: NGN CASE STUDY – CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
,(Questions 1–12)
Case Presentation
A 68-year-old male with a 50-pack-year smoking history presents with increasing dyspnea, chronic cough
with purulent sputum, and oxygen saturation of 88% on room air. He uses home oxygen at 2 L/min via
nasal cannula. Medications: ipratropium bromide MDI, albuterol nebulizer, prednisone 40 mg daily for
exacerbation. Vital signs: HR 102, RR 28, BP 138/88, temp 37.8°C. ABG: pH 7.32, PaCO₂ 58, PaO₂ 60,
HCO₃ 30.
Question 1 (Multiple choice – select one)
What is the most appropriate initial intervention?
A. Increase oxygen to 4 L/min via nasal cannula
B. Obtain a sputum culture
C. Administer ipratropium bromide MDI
D. Assist with positioning in high-Fowler’s with pursed-lip breathing
Answer: D
Rationale:
• A (incorrect) – Increasing O₂ in a chronic CO₂ retainer may worsen hypercapnia and cause
narcosis.
• B (incorrect) – Important but not initial; airway and breathing come first.
• C (incorrect) – Bronchodilator is indicated but after positioning and oxygenation assessment.
• D (correct) – High-Fowler’s optimizes diaphragmatic excursion; pursed-lip breathing reduces air
trapping and dyspnea.
Question 2 (Bow-tie / drop-down selection)
Complete the sentence.
The nurse should first assess for _______ then implement _______.
Drop-down 1 options: (jugular venous distention, sputum color, ability to speak in full sentences, pedal
edema)
Drop-down 2 options: (nebulizer treatment, chest physiotherapy, oxygen titration to SpO₂ 88–92%,
STAT CXR)
Answer: ability to speak in full sentences → oxygen titration to SpO₂ 88–92%
Rationale:
• Speech ability assesses respiratory muscle fatigue/severity.
• Target SpO₂ 88–92% in COPD with hypercapnia risk prevents O₂-induced hypoventilation.
,(Questions 3–12 continue with labs, pharmacology, discharge teaching, NGN hot spot, matrix grid –
similar detail. For brevity, below is a representative set of standalone questions covering all versions.)
SECTION B: TRADITIONAL & NGN-STANDALONE QUESTIONS
(Questions 13–155)
Management of Care (Delegation, Ethics, Legal)
Question 13
A nurse manager is delegating tasks to an LPN/LVN and a UAP. Which task is appropriate for the LPN?
A. Initiate blood transfusion
B. Perform initial admission assessment
C. Administer enteral feeding via PEG tube
D. Insert a Foley catheter for urinary retention
Answer: C
Rationale:
• A (incorrect) – RN must initiate blood transfusion.
• B (incorrect) – Admission assessment requires RN.
• C (correct) – LPN can administer continuous enteral feedings in stable patient.
• D (incorrect) – LPN can insert Foley, but “for urinary retention” requires assessment and order;
not best answer here (enteral feeding is more stable task).
Question 14 (NGN Multiple select – select all that apply)
A nurse receives a report on 4 patients. Which patients should the nurse see FIRST?
A. Post-op day 1 hip replacement, pain 4/10, HR 88
B. Chest tube patient with 200 mL bloody drainage in last hour
C. New-onset atrial fibrillation with HR 140, BP 90/60
D. NPO patient requesting ice chips
Answer: B, C
Rationale:
• A (no) – Stable pain.
• B (yes) – Possible active bleeding (200 mL/hr post-op chest tube = hemothorax risk).
• C (yes) – Unstable AF with hypotension → risk of decreased cardiac output.
, • D (no) – Non-urgent comfort measure.
Safety & Infection Control
Question 15
A patient with active pulmonary tuberculosis is placed in which type of room?
A. Positive pressure with 6 ACH
B. Negative pressure with 12 ACH
C. Standard room with HEPA filter
D. Protective environment
Answer: B
Rationale:
• A – Positive pressure protects immunocompromised.
• B (correct) – Airborne precautions need negative pressure, ≥12 ACH.
• C – Not sufficient.
• D – For stem cell transplant.
Question 16 (Hot spot – select the correct patient assignment)
A charge nurse is assigning rooms. Which patient can share a room with a patient with MRSA in a
wound?
A. Post-op splenectomy
B. Patient with C. diff
C. Patient with pneumonia (no infection)
D. Patient with vancomycin-resistant Enterococcus (VRE)
Answer: D
Rationale: Both MRSA and VRE require contact precautions; same room is allowed (same isolation type).
Others (splenectomy – immunocompromised; C. diff – different contact but different room advised;
pneumonia – no, would expose).
Health Promotion & Maintenance
Question 17
A nurse teaches a pregnant patient at 28 weeks gestation about warning signs. Which statement
indicates understanding?
A. “Swelling of my feet is a sign of preeclampsia.”
B. “Leaking fluid from my vagina needs immediate evaluation.”
1–4) QUESTIONS AND ANSWERS WITH RATIONALES/
GRADED A+/2026\2027 UPDATE /100%CORRECT
Total Questions: 155
Time Limit: 5 hours
Format: NGN (partial credit, multiple answer, case studies, trend, hot spot)
DOMAIN WEIGHTING (2026/27)
Domain %
Management of Care (Safety, Delegation, Ethics) 20%
Safety & Infection Control 12%
Health Promotion & Maintenance 10%
Psychosocial Integrity 8%
Basic Care & Comfort 8%
Pharmacological & Parenteral Therapies 14%
Reduction of Risk Potential 12%
Physiological Adaptation 16%
SECTION A: NGN CASE STUDY – CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
,(Questions 1–12)
Case Presentation
A 68-year-old male with a 50-pack-year smoking history presents with increasing dyspnea, chronic cough
with purulent sputum, and oxygen saturation of 88% on room air. He uses home oxygen at 2 L/min via
nasal cannula. Medications: ipratropium bromide MDI, albuterol nebulizer, prednisone 40 mg daily for
exacerbation. Vital signs: HR 102, RR 28, BP 138/88, temp 37.8°C. ABG: pH 7.32, PaCO₂ 58, PaO₂ 60,
HCO₃ 30.
Question 1 (Multiple choice – select one)
What is the most appropriate initial intervention?
A. Increase oxygen to 4 L/min via nasal cannula
B. Obtain a sputum culture
C. Administer ipratropium bromide MDI
D. Assist with positioning in high-Fowler’s with pursed-lip breathing
Answer: D
Rationale:
• A (incorrect) – Increasing O₂ in a chronic CO₂ retainer may worsen hypercapnia and cause
narcosis.
• B (incorrect) – Important but not initial; airway and breathing come first.
• C (incorrect) – Bronchodilator is indicated but after positioning and oxygenation assessment.
• D (correct) – High-Fowler’s optimizes diaphragmatic excursion; pursed-lip breathing reduces air
trapping and dyspnea.
Question 2 (Bow-tie / drop-down selection)
Complete the sentence.
The nurse should first assess for _______ then implement _______.
Drop-down 1 options: (jugular venous distention, sputum color, ability to speak in full sentences, pedal
edema)
Drop-down 2 options: (nebulizer treatment, chest physiotherapy, oxygen titration to SpO₂ 88–92%,
STAT CXR)
Answer: ability to speak in full sentences → oxygen titration to SpO₂ 88–92%
Rationale:
• Speech ability assesses respiratory muscle fatigue/severity.
• Target SpO₂ 88–92% in COPD with hypercapnia risk prevents O₂-induced hypoventilation.
,(Questions 3–12 continue with labs, pharmacology, discharge teaching, NGN hot spot, matrix grid –
similar detail. For brevity, below is a representative set of standalone questions covering all versions.)
SECTION B: TRADITIONAL & NGN-STANDALONE QUESTIONS
(Questions 13–155)
Management of Care (Delegation, Ethics, Legal)
Question 13
A nurse manager is delegating tasks to an LPN/LVN and a UAP. Which task is appropriate for the LPN?
A. Initiate blood transfusion
B. Perform initial admission assessment
C. Administer enteral feeding via PEG tube
D. Insert a Foley catheter for urinary retention
Answer: C
Rationale:
• A (incorrect) – RN must initiate blood transfusion.
• B (incorrect) – Admission assessment requires RN.
• C (correct) – LPN can administer continuous enteral feedings in stable patient.
• D (incorrect) – LPN can insert Foley, but “for urinary retention” requires assessment and order;
not best answer here (enteral feeding is more stable task).
Question 14 (NGN Multiple select – select all that apply)
A nurse receives a report on 4 patients. Which patients should the nurse see FIRST?
A. Post-op day 1 hip replacement, pain 4/10, HR 88
B. Chest tube patient with 200 mL bloody drainage in last hour
C. New-onset atrial fibrillation with HR 140, BP 90/60
D. NPO patient requesting ice chips
Answer: B, C
Rationale:
• A (no) – Stable pain.
• B (yes) – Possible active bleeding (200 mL/hr post-op chest tube = hemothorax risk).
• C (yes) – Unstable AF with hypotension → risk of decreased cardiac output.
, • D (no) – Non-urgent comfort measure.
Safety & Infection Control
Question 15
A patient with active pulmonary tuberculosis is placed in which type of room?
A. Positive pressure with 6 ACH
B. Negative pressure with 12 ACH
C. Standard room with HEPA filter
D. Protective environment
Answer: B
Rationale:
• A – Positive pressure protects immunocompromised.
• B (correct) – Airborne precautions need negative pressure, ≥12 ACH.
• C – Not sufficient.
• D – For stem cell transplant.
Question 16 (Hot spot – select the correct patient assignment)
A charge nurse is assigning rooms. Which patient can share a room with a patient with MRSA in a
wound?
A. Post-op splenectomy
B. Patient with C. diff
C. Patient with pneumonia (no infection)
D. Patient with vancomycin-resistant Enterococcus (VRE)
Answer: D
Rationale: Both MRSA and VRE require contact precautions; same room is allowed (same isolation type).
Others (splenectomy – immunocompromised; C. diff – different contact but different room advised;
pneumonia – no, would expose).
Health Promotion & Maintenance
Question 17
A nurse teaches a pregnant patient at 28 weeks gestation about warning signs. Which statement
indicates understanding?
A. “Swelling of my feet is a sign of preeclampsia.”
B. “Leaking fluid from my vagina needs immediate evaluation.”
