RN ATI Comprehensive Exit Exam (Version 2 )
Actual exam With Questions And Revised Correct
Answers & Rationales () 100%
Guaranteed Pass
Item ID: V2-001
Item Type: NGN – Extended Multiple Response
Scenario: A 68-year-old woman is admitted 2 days post right total hip replacement. She
reports sudden right-calf pain, erythema 4 cm × 8 cm, and a “pulling” sensation. Vital
signs: T 37.9 °C, HR 94, BP 138/82, RR 20, SpO₂ 96 % on room air. Current meds:
enoxaparin 40 mg SQ daily, acetaminophen 1 g q6h, ondansetron PRN. She is alert,
denies chest pain or dyspnea.
Question: Which assessment findings require immediate follow-up to reduce the risk of
pulmonary embolism? (Select all that apply.)
Options:
A. New-onset bilateral wheezes
B. Unilateral calf circumference 2 cm larger than morning baseline
C. Platelet count drop from 250 k to 95 k since surgery
D. Patient report of “stabbing” pain on inspiration
E. D-dimer 850 ng/mL (ref < 500)
,Correct Choices: A, B, C, D
Rationale (Revised & Verified):
● Correct Answer: A, B, C, D
● Analysis: Wheezes may herald bronchospasm from micro-emboli; increasing calf
girth signals propagating DVT; platelet decline suggests heparin-induced
thrombocytopenia that paradoxically increases clot risk; pleuritic pain indicates
possible pulmonary infarction. Early escalation permits imaging and
anticoagulation adjustment per ACCP 2024 VTE guidelines.
● Distractor Breakdown: E—D-dimer elevation is expected post-op and lacks added
immediate urgency; it is not an “immediate follow-up” trigger in this context.
Item ID: V2-002
Item Type: Traditional MCQ
Scenario: A 5-year-old with acute lymphoblastic leukemia is receiving high-dose
methotrexate. Twenty-four hours post-infusion his serum methotrexate level is 22
µmol/L (target < 5 µmol/L). Urine pH is 6.0.
Question: Which intervention is priority?
Options:
A. Increase leucovorin dose and frequency
B. Start hemodialysis immediately
C. Restrict oral fluids to 500 mL/m²/day
D. Administer IV sodium bicarbonate to raise urine pH to ≥ 8
,Rationale (Revised & Verified):
● Correct Answer: D
● Analysis: Alkalinization enhances methotrexate solubility and renal elimination,
preventing crystalluria and nephrotoxicity. 2024 Oncologic Emergencies protocol
lists urine pH ≥ 8 as first-line.
● Distractor Breakdown: A—leucovorin rescues normal cells but does not
accelerate drug clearance; B—reserved for levels > 50 µmol/L or renal failure;
C—fluid restriction concentrates drug and worsens toxicity.
Item ID: V2-003
Item Type: NGN – Matrix
Scenario: A 32-year-old at 28 weeks gestation presents with BP 162/104, HR 92, RR 18,
2+ proteinuria, normal reflexes, no epigastric pain.
Question: Match the expected nursing action to its primary purpose.
Matrix:
Action: Administer labetalol 20 mg IV
Purpose: Lower maternal BP to < 160/110 to reduce stroke risk
Action: Obtain baseline magnesium level
Purpose: Anticipate need for magnesium sulfate seizure prophylaxis
Action: Position in left lateral tilt
Purpose: Improve uteroplacental perfusion
Correct Matches: All as above
, Rationale (Revised & Verified):
● Correct Answer: All matches accurate per ACOG 2025 preeclampsia algorithm.
● Analysis: Acute BP control targets 140–150/90–100; baseline Mg level guides
safe dosing; lateral tilt relieves aortocaval compression.
● Distractor Breakdown: Any other pairing misaligns physiologic rationale.
Item ID: V2-004
Item Type: Traditional MCQ
Scenario: A 55-year-old with cirrhosis develops tense ascites and dyspnea. Paracentesis
is planned. INR 1.9, platelets 68 k, creatinine 1.4 mg/dL.
Question: Which pre-procedure order should the nurse question?
Options:
A. Give 25 % albumin 100 g IV post-procedure
B. Hold spironolactone morning of procedure
C. Infuse 2 units FFP now
D. Provide informed consent form for paracentesis
Rationale (Revised & Verified):
● Correct Answer: C
● Analysis: Routine prophylactic FFP is not indicated for INR < 2; risk-benefit favors
proceeding without correction per AASLD 2024.
● Distractor Breakdown: A—albumin prevents post-paracentesis circulatory
dysfunction; B—avoids hypotension; D—standard.
Actual exam With Questions And Revised Correct
Answers & Rationales () 100%
Guaranteed Pass
Item ID: V2-001
Item Type: NGN – Extended Multiple Response
Scenario: A 68-year-old woman is admitted 2 days post right total hip replacement. She
reports sudden right-calf pain, erythema 4 cm × 8 cm, and a “pulling” sensation. Vital
signs: T 37.9 °C, HR 94, BP 138/82, RR 20, SpO₂ 96 % on room air. Current meds:
enoxaparin 40 mg SQ daily, acetaminophen 1 g q6h, ondansetron PRN. She is alert,
denies chest pain or dyspnea.
Question: Which assessment findings require immediate follow-up to reduce the risk of
pulmonary embolism? (Select all that apply.)
Options:
A. New-onset bilateral wheezes
B. Unilateral calf circumference 2 cm larger than morning baseline
C. Platelet count drop from 250 k to 95 k since surgery
D. Patient report of “stabbing” pain on inspiration
E. D-dimer 850 ng/mL (ref < 500)
,Correct Choices: A, B, C, D
Rationale (Revised & Verified):
● Correct Answer: A, B, C, D
● Analysis: Wheezes may herald bronchospasm from micro-emboli; increasing calf
girth signals propagating DVT; platelet decline suggests heparin-induced
thrombocytopenia that paradoxically increases clot risk; pleuritic pain indicates
possible pulmonary infarction. Early escalation permits imaging and
anticoagulation adjustment per ACCP 2024 VTE guidelines.
● Distractor Breakdown: E—D-dimer elevation is expected post-op and lacks added
immediate urgency; it is not an “immediate follow-up” trigger in this context.
Item ID: V2-002
Item Type: Traditional MCQ
Scenario: A 5-year-old with acute lymphoblastic leukemia is receiving high-dose
methotrexate. Twenty-four hours post-infusion his serum methotrexate level is 22
µmol/L (target < 5 µmol/L). Urine pH is 6.0.
Question: Which intervention is priority?
Options:
A. Increase leucovorin dose and frequency
B. Start hemodialysis immediately
C. Restrict oral fluids to 500 mL/m²/day
D. Administer IV sodium bicarbonate to raise urine pH to ≥ 8
,Rationale (Revised & Verified):
● Correct Answer: D
● Analysis: Alkalinization enhances methotrexate solubility and renal elimination,
preventing crystalluria and nephrotoxicity. 2024 Oncologic Emergencies protocol
lists urine pH ≥ 8 as first-line.
● Distractor Breakdown: A—leucovorin rescues normal cells but does not
accelerate drug clearance; B—reserved for levels > 50 µmol/L or renal failure;
C—fluid restriction concentrates drug and worsens toxicity.
Item ID: V2-003
Item Type: NGN – Matrix
Scenario: A 32-year-old at 28 weeks gestation presents with BP 162/104, HR 92, RR 18,
2+ proteinuria, normal reflexes, no epigastric pain.
Question: Match the expected nursing action to its primary purpose.
Matrix:
Action: Administer labetalol 20 mg IV
Purpose: Lower maternal BP to < 160/110 to reduce stroke risk
Action: Obtain baseline magnesium level
Purpose: Anticipate need for magnesium sulfate seizure prophylaxis
Action: Position in left lateral tilt
Purpose: Improve uteroplacental perfusion
Correct Matches: All as above
, Rationale (Revised & Verified):
● Correct Answer: All matches accurate per ACOG 2025 preeclampsia algorithm.
● Analysis: Acute BP control targets 140–150/90–100; baseline Mg level guides
safe dosing; lateral tilt relieves aortocaval compression.
● Distractor Breakdown: Any other pairing misaligns physiologic rationale.
Item ID: V2-004
Item Type: Traditional MCQ
Scenario: A 55-year-old with cirrhosis develops tense ascites and dyspnea. Paracentesis
is planned. INR 1.9, platelets 68 k, creatinine 1.4 mg/dL.
Question: Which pre-procedure order should the nurse question?
Options:
A. Give 25 % albumin 100 g IV post-procedure
B. Hold spironolactone morning of procedure
C. Infuse 2 units FFP now
D. Provide informed consent form for paracentesis
Rationale (Revised & Verified):
● Correct Answer: C
● Analysis: Routine prophylactic FFP is not indicated for INR < 2; risk-benefit favors
proceeding without correction per AASLD 2024.
● Distractor Breakdown: A—albumin prevents post-paracentesis circulatory
dysfunction; B—avoids hypotension; D—standard.
