RN ATI Comprehensive Exit Exam (Version 1 )
Actual exam With Questions And Revised Correct
Answers & Rationales () 100%
Guaranteed Pass
Item ID: V1-001
Item Type: NGN - Bowtie
Scenario: A 67-year-old man with COPD, heart failure with preserved ejection fraction
(HFpEF), and type 2 DM is admitted with acute exacerbation of COPD. On 4 L O₂ nasal
cannula he is alert, RR 28, SpO₂ 91 %, BP 162/94, HR 114 irregularly irregular, temp 37.8
°C, and audible wheezes. Home meds: metformin 1 g BID, sitagliptin 100 mg daily,
diltiazem CD 240 mg daily, inhaled tiotropium+formoterol, and apixaban 5 mg BID. ABG
on room air 2 h ago: pH 7.29, PaCO₂ 68 mmHg, PaO₂ 52 mmHg, HCO₃⁻ 31 mEq/L. CBC
shows WBC 14.8 k/µL with left shift; BMP Na 138, K 4.0, Cl 98, CO₂ 32, BUN 24, Cr 1.1,
glucose 198 mg/dL. Chest X-ray reveals hyperinflation plus right-middle-lobe infiltrate.
Question: Identify the priority action in the first 60 min, the most important parameter to
monitor, and the greatest risk to avoid.
Options/Components:
1. Priority action: Increase O₂ to 6 L via nasal cannula to raise SpO₂ ≥ 94 %
2. Priority action: Initiate non-invasive positive-pressure ventilation (NIPPV) with
BiPAP
3. Most important parameter to monitor: Oxygen saturation by pulse oximetry
4. Most important parameter to monitor: Arterial blood gases & mental status
5. Greatest risk to avoid: Hypercapnic respiratory acidosis with somnolence
,Greatest risk to avoid: Oxygen-induced hypercapnia with respiratory depression
Correct Options: 2, 4, and 6
6. Rationale (Revised & Verified): The correct answers are 2, 4, and 6. Current 2026
GOLD/ATS guidelines recommend NIPPV as first-line therapy for COPD
exacerbations with acute hypercapnic respiratory acidosis (pH < 7.35 and PaCO₂
> 45 mmHg) because it unloads respiratory muscles, improves V/Q matching,
and decreases intubation risk. Monitoring serial ABGs and mental status directly
gauges CO₂ narcosis, the primary threat. Excessive supplemental O₂ can abolish
hypoxic respiratory drive, worsen V/Q mismatch, and precipitate dangerous
hypercapnia; therefore titrating O₂ to SpO₂ 88-92 % is preferred. Option 1 is
incorrect because raising SpO₂ ≥ 94 % in a chronic hypercapnic patient risks
suppressing ventilatory drive. Option 3 is insufficient because SpO₂ alone does
not detect rising PaCO₂ or acidosis. Option 5 is partially true but too general;
option 6 specifies the mechanism and is therefore superior.
Item ID: V1-002
Item Type: Traditional MCQ
Scenario: A 34-year-old G2P1 at 39 weeks gestation is admitted in active labor. Cervix 6
cm, vertex at 0 station, membrane intact. FHR baseline 145 with moderate variability;
recurrent late decelerations begin with three contractions over 10 min.
Question: Which nursing action is most appropriate at this time?
Options:
1. Continue observation for another 30 min
2. Position the patient supine with left tilt and increase IV fluids
3. Perform amnioinfusion and discontinue oxytocin if running
Administer 100 % O₂ by tight face mask and prepare for urgent cesarean
Correct Answer: 3
, 4. Rationale (Revised & Verified): The correct answer is 3. Recurrent late
decelerations reflect uteroplacental insufficiency; amnioinfusion relieves cord
compression and improves fetal oxygenation while stopping oxytocin reduces
uterine hyperstimulation—both are Level A 2026 ACOG measures. Option 1
delays necessary intervention. Option 2’s supine position can further
compromise perfusion; lateral recumbent is preferred. Option 4 is appropriate
only if conservative measures fail and delivery is imminent, not as first-line
management at 6 cm dilation.
Item ID: V1-003
Item Type: NGN - Extended Multiple Response
Scenario: A 6-year-old girl with sickle cell disease (HbSS) presents to the ED with severe
pain in bilateral legs and a 39.8 °C fever. HR 150, RR 32, BP 88/50, SpO₂ 91 % on room
air. Labs: Hgb 6.2 g/dL, retic 18 %, WBC 24 k/µL, platelets 410 k/µL, LDH 1200 IU/L, total
bilirubin 4.2 mg/dL. Peripheral smear shows 40 % sickled cells. She last received her
penicillin 3 days ago.
Question: Which orders should the nurse implement first? (Select 3.)
Options:
1. Obtain blood cultures and give empiric ceftriaxone per protocol
2. Start 20 mL/kg normal-bolus then maintenance D5½NS
3. Administer weight-based morphine IV q3h prn pain
4. Apply O₂ via nasal cannula to keep SpO₂ ≥ 95 %
5. Transfuse 10 mL/kg packed RBCs immediately
Encourage oral hydration and PO acetaminophen
Correct Options: 1, 2, and 3
6. Rationale (Revised & Verified): The correct answers are 1, 2, and 3. Current 2026
NHLBI guidelines treat acute vaso-occlusive crisis with rapid analgesia (IV
Actual exam With Questions And Revised Correct
Answers & Rationales () 100%
Guaranteed Pass
Item ID: V1-001
Item Type: NGN - Bowtie
Scenario: A 67-year-old man with COPD, heart failure with preserved ejection fraction
(HFpEF), and type 2 DM is admitted with acute exacerbation of COPD. On 4 L O₂ nasal
cannula he is alert, RR 28, SpO₂ 91 %, BP 162/94, HR 114 irregularly irregular, temp 37.8
°C, and audible wheezes. Home meds: metformin 1 g BID, sitagliptin 100 mg daily,
diltiazem CD 240 mg daily, inhaled tiotropium+formoterol, and apixaban 5 mg BID. ABG
on room air 2 h ago: pH 7.29, PaCO₂ 68 mmHg, PaO₂ 52 mmHg, HCO₃⁻ 31 mEq/L. CBC
shows WBC 14.8 k/µL with left shift; BMP Na 138, K 4.0, Cl 98, CO₂ 32, BUN 24, Cr 1.1,
glucose 198 mg/dL. Chest X-ray reveals hyperinflation plus right-middle-lobe infiltrate.
Question: Identify the priority action in the first 60 min, the most important parameter to
monitor, and the greatest risk to avoid.
Options/Components:
1. Priority action: Increase O₂ to 6 L via nasal cannula to raise SpO₂ ≥ 94 %
2. Priority action: Initiate non-invasive positive-pressure ventilation (NIPPV) with
BiPAP
3. Most important parameter to monitor: Oxygen saturation by pulse oximetry
4. Most important parameter to monitor: Arterial blood gases & mental status
5. Greatest risk to avoid: Hypercapnic respiratory acidosis with somnolence
,Greatest risk to avoid: Oxygen-induced hypercapnia with respiratory depression
Correct Options: 2, 4, and 6
6. Rationale (Revised & Verified): The correct answers are 2, 4, and 6. Current 2026
GOLD/ATS guidelines recommend NIPPV as first-line therapy for COPD
exacerbations with acute hypercapnic respiratory acidosis (pH < 7.35 and PaCO₂
> 45 mmHg) because it unloads respiratory muscles, improves V/Q matching,
and decreases intubation risk. Monitoring serial ABGs and mental status directly
gauges CO₂ narcosis, the primary threat. Excessive supplemental O₂ can abolish
hypoxic respiratory drive, worsen V/Q mismatch, and precipitate dangerous
hypercapnia; therefore titrating O₂ to SpO₂ 88-92 % is preferred. Option 1 is
incorrect because raising SpO₂ ≥ 94 % in a chronic hypercapnic patient risks
suppressing ventilatory drive. Option 3 is insufficient because SpO₂ alone does
not detect rising PaCO₂ or acidosis. Option 5 is partially true but too general;
option 6 specifies the mechanism and is therefore superior.
Item ID: V1-002
Item Type: Traditional MCQ
Scenario: A 34-year-old G2P1 at 39 weeks gestation is admitted in active labor. Cervix 6
cm, vertex at 0 station, membrane intact. FHR baseline 145 with moderate variability;
recurrent late decelerations begin with three contractions over 10 min.
Question: Which nursing action is most appropriate at this time?
Options:
1. Continue observation for another 30 min
2. Position the patient supine with left tilt and increase IV fluids
3. Perform amnioinfusion and discontinue oxytocin if running
Administer 100 % O₂ by tight face mask and prepare for urgent cesarean
Correct Answer: 3
, 4. Rationale (Revised & Verified): The correct answer is 3. Recurrent late
decelerations reflect uteroplacental insufficiency; amnioinfusion relieves cord
compression and improves fetal oxygenation while stopping oxytocin reduces
uterine hyperstimulation—both are Level A 2026 ACOG measures. Option 1
delays necessary intervention. Option 2’s supine position can further
compromise perfusion; lateral recumbent is preferred. Option 4 is appropriate
only if conservative measures fail and delivery is imminent, not as first-line
management at 6 cm dilation.
Item ID: V1-003
Item Type: NGN - Extended Multiple Response
Scenario: A 6-year-old girl with sickle cell disease (HbSS) presents to the ED with severe
pain in bilateral legs and a 39.8 °C fever. HR 150, RR 32, BP 88/50, SpO₂ 91 % on room
air. Labs: Hgb 6.2 g/dL, retic 18 %, WBC 24 k/µL, platelets 410 k/µL, LDH 1200 IU/L, total
bilirubin 4.2 mg/dL. Peripheral smear shows 40 % sickled cells. She last received her
penicillin 3 days ago.
Question: Which orders should the nurse implement first? (Select 3.)
Options:
1. Obtain blood cultures and give empiric ceftriaxone per protocol
2. Start 20 mL/kg normal-bolus then maintenance D5½NS
3. Administer weight-based morphine IV q3h prn pain
4. Apply O₂ via nasal cannula to keep SpO₂ ≥ 95 %
5. Transfuse 10 mL/kg packed RBCs immediately
Encourage oral hydration and PO acetaminophen
Correct Options: 1, 2, and 3
6. Rationale (Revised & Verified): The correct answers are 1, 2, and 3. Current 2026
NHLBI guidelines treat acute vaso-occlusive crisis with rapid analgesia (IV
