RN ATI Comprehensive Exit Exam (Version 3) Actual
exam With Questions And Revised Correct Answers &
Rationales (2026/2027) 100% Guaranteed Pass
Item ID: V3-001
Item Type: NGN - Bowtie
Scenario: A 67-year-old admitted for acute decompensated HF (EF 25%) on continuous
dobutamine 5 µg/kg/min develops new atrial fibrillation with RVR 170 bpm, BP 88/52
mmHg, and acute pulmonary edema on portable CXR. Home meds include apixaban 5
mg bid, metoprolol XL 200 mg, and furosemide 80 mg po bid. K 5.8 mEq/L, creatinine
2.3 mg/dL (baseline 1.4), lactate 3.4 mmol/L, andBNP 2,400 pg/mL.
Question: Place an X on the five most urgent evidence-based actions to stabilize this
patient within the first 30 minutes.
Options:
A. Administer IV push diltiazem 0.25 mg/kg
B. Increase dobutamine to 10 µg/kg/min
C. Obtain stat bedside cardiac echocao
D. Give 0.9% NaCl 500 mL bolus
E. Prepare for immediate synchronized cardioversion
F. Hold apixaban and check anti-Xa level
G. Initiate high-flow nasal cannula at 60 L/min
H. Give calcium gluconate 1 g IV
Correct Choices: C, E, G, H, F
Rationale (Revised & Verified):
● Correct Answer: C, E, G, H, F
, ● Analysis: 2026 AHA/ACC/HRS AF Guideline rates immediate electrical
cardioversion Class I when AF with RVR causes acute
decompensation/hypotension. HF guideline (2026 update) stresses early
bedside echo to rule out mechanical complication. High-flow oxygen reduces LV
afterload and improves oxygenation. Hyperkalemia (K 5.8) in renal dysfunction
increases cardioversion risk; stabilize myocardium with calcium. Apixaban
should be held until coagulation status verified because cardioversion within 48 h
of last dose raises bleeding risk.
● Distractor Breakdown: A—Calcium-channel blocker can precipitate pulseless
electrical activity in hypoperfused HF. B—Further β-1 agonism may provoke
arrhythmia without improving perfusion. D—Volume loading worsens pulmonary
edema and RV strain.
Item ID: V3-002
Item Type: Traditional MCQ
Scenario: A 19-year-old primigravida at 29 weeks gestation presents with severe
headache, epigastric pain, and scotomas. BP 174/108 mmHg, platelets 82,000/µL, AST
210 IU/L, ALT 245 IU/L, creatinine 1.3 mg/dL, and urine protein 3+.
Question: Which initial order is most critical for maternal safety?
Options:
A. Start labetalol 20 mg IV then continuous infusion
B. Give betamethasone 12 mg IM
C. Begin magnesium sulfate 6 g IV load
D. Start oxytocin induction
Correct Answer: C
Rationale (Revised & Verified):
● Correct Answer: C
● Analysis: 2026 ACOG Practice Bulletin #222 update designates magnesium
sulfate seizure prophylaxis as first priority for severe preeclampsia with HELLP
features; eclampsia risk outweighs all others. Loading dose 6 g over 20–30 min
followed by 2 g/h is standard.
● Distractor Breakdown: A—Antihypertensive needed but does not prevent seizure.
B—Fetal lung maturation is important yet secondary to maternal stabilization.
, D—Delivery is definitive therapy but only after seizure prophylaxis and maternal
stabilization.
Item ID: V3-003
Item Type: NGN - Matrix
Scenario: A 54-year-old with cirrhosis (Child–Pugh B) and prior variceal bleed is
admitted after 2 days of coffee-ground emesis. Current vitals: BP 94/60, HR 112, Hgb
7.1 g/dL, INR 2.4, platelets 55,000/µL. Endoscopy shows gastric varices with active
spurting.
Question: Select “Indicated,” “Contraindicated,” or “Insufficient Evidence” for each
intervention at this time.
Options:
A. Octreotide 50 µg IV bolus then 50 µg/h
B. Propranolol 20 mg PO now
C. IV ceftriaxone 1 g daily
D. Platelet transfusion to >50,000
E. Insert Sengstaken-Blakemore tube
Correct Matrix:
A. Indicated
B. Contraindicated
C. Indicated
D. Insufficient Evidence
E. Indicated
Rationale (Revised & Verified):
● Correct Answer: Matrix above
● Analysis: 2026 AASLD guideline continues octreotide as first-line vasoactive;
propranolol during acute bleed lowers perfusion pressure and risks shock;
antibiotic prophylaxis (ceftriaxone) reduces mortality in advanced cirrhage.
, Platelets >50,000 usually adequate for hemostasis; no data favor pushing higher.
Balloon tamponade bridge to TIPS remains life-saving when endotherapy fails.
● Distractor Breakdown: B—Non-selective β-blocker in acute setting causes
harmful splanchnic vasodilation. D—Transfusion threshold lacks evidence unless
invasive procedure planned.
Item ID: V3-004
Item Type: Traditional MCQ
Scenario: A 6-year-old with ALL on maintenance 6-mercaptopurine (75 mg/m2) and
methotrexate 20 mg/m2 weekly is febrile to 39.2 °C, HR 158, RR 34, BP 78/40, and cap
refill 4 s. WBC 0.6, ANC 0, Hgb 7.2, plt 18,000, lactate 4.1.
Question: After blood cultures, which immediate intervention is essential?
Options:
A. Begin vancomycin plus cefepime within 60 minutes
B. Transfuse PRBC 10 mL/kg
C. Start filgrastim 5 µg/kg SC
D. Administer acetaminophen 15 mg/kg PO
Correct Answer: A
Rationale (Revised & Verified):
● Correct Answer: A
● Analysis: 2026 IDSA neutropenic fever update mandates empiric broad-spectrum
anti-pseudomonal β-lactam plus MRSA coverage in hemodynamically unstable
patients; door-to-antibiotic time ≤60 min reduces septic mortality.
● Distractor Breakdown: B—Transfusion does not address sepsis and may obscure
fever curve. C—G-CSF not indicated in acute septic shock. D—Antipyretic delays
antibiotic priority.
Item ID: V3-005
Item Type: NGN - Extended Drag-and-Drop
Scenario: A 72-hour-old 35-week preterm develops tachypnea 72/min, mild grunting,
and SpO2 89% in RA. CXR shows diffuse reticulogranular pattern and air bronchograms.
CBG: pH 7.19, pCO2 58, paO2 48, HCO3 22.
Question: Sequence the first six NICU interventions in order from first to last.
Options:
A. Start nasal CPAP 6 cm H2O with blended FiO2
exam With Questions And Revised Correct Answers &
Rationales (2026/2027) 100% Guaranteed Pass
Item ID: V3-001
Item Type: NGN - Bowtie
Scenario: A 67-year-old admitted for acute decompensated HF (EF 25%) on continuous
dobutamine 5 µg/kg/min develops new atrial fibrillation with RVR 170 bpm, BP 88/52
mmHg, and acute pulmonary edema on portable CXR. Home meds include apixaban 5
mg bid, metoprolol XL 200 mg, and furosemide 80 mg po bid. K 5.8 mEq/L, creatinine
2.3 mg/dL (baseline 1.4), lactate 3.4 mmol/L, andBNP 2,400 pg/mL.
Question: Place an X on the five most urgent evidence-based actions to stabilize this
patient within the first 30 minutes.
Options:
A. Administer IV push diltiazem 0.25 mg/kg
B. Increase dobutamine to 10 µg/kg/min
C. Obtain stat bedside cardiac echocao
D. Give 0.9% NaCl 500 mL bolus
E. Prepare for immediate synchronized cardioversion
F. Hold apixaban and check anti-Xa level
G. Initiate high-flow nasal cannula at 60 L/min
H. Give calcium gluconate 1 g IV
Correct Choices: C, E, G, H, F
Rationale (Revised & Verified):
● Correct Answer: C, E, G, H, F
, ● Analysis: 2026 AHA/ACC/HRS AF Guideline rates immediate electrical
cardioversion Class I when AF with RVR causes acute
decompensation/hypotension. HF guideline (2026 update) stresses early
bedside echo to rule out mechanical complication. High-flow oxygen reduces LV
afterload and improves oxygenation. Hyperkalemia (K 5.8) in renal dysfunction
increases cardioversion risk; stabilize myocardium with calcium. Apixaban
should be held until coagulation status verified because cardioversion within 48 h
of last dose raises bleeding risk.
● Distractor Breakdown: A—Calcium-channel blocker can precipitate pulseless
electrical activity in hypoperfused HF. B—Further β-1 agonism may provoke
arrhythmia without improving perfusion. D—Volume loading worsens pulmonary
edema and RV strain.
Item ID: V3-002
Item Type: Traditional MCQ
Scenario: A 19-year-old primigravida at 29 weeks gestation presents with severe
headache, epigastric pain, and scotomas. BP 174/108 mmHg, platelets 82,000/µL, AST
210 IU/L, ALT 245 IU/L, creatinine 1.3 mg/dL, and urine protein 3+.
Question: Which initial order is most critical for maternal safety?
Options:
A. Start labetalol 20 mg IV then continuous infusion
B. Give betamethasone 12 mg IM
C. Begin magnesium sulfate 6 g IV load
D. Start oxytocin induction
Correct Answer: C
Rationale (Revised & Verified):
● Correct Answer: C
● Analysis: 2026 ACOG Practice Bulletin #222 update designates magnesium
sulfate seizure prophylaxis as first priority for severe preeclampsia with HELLP
features; eclampsia risk outweighs all others. Loading dose 6 g over 20–30 min
followed by 2 g/h is standard.
● Distractor Breakdown: A—Antihypertensive needed but does not prevent seizure.
B—Fetal lung maturation is important yet secondary to maternal stabilization.
, D—Delivery is definitive therapy but only after seizure prophylaxis and maternal
stabilization.
Item ID: V3-003
Item Type: NGN - Matrix
Scenario: A 54-year-old with cirrhosis (Child–Pugh B) and prior variceal bleed is
admitted after 2 days of coffee-ground emesis. Current vitals: BP 94/60, HR 112, Hgb
7.1 g/dL, INR 2.4, platelets 55,000/µL. Endoscopy shows gastric varices with active
spurting.
Question: Select “Indicated,” “Contraindicated,” or “Insufficient Evidence” for each
intervention at this time.
Options:
A. Octreotide 50 µg IV bolus then 50 µg/h
B. Propranolol 20 mg PO now
C. IV ceftriaxone 1 g daily
D. Platelet transfusion to >50,000
E. Insert Sengstaken-Blakemore tube
Correct Matrix:
A. Indicated
B. Contraindicated
C. Indicated
D. Insufficient Evidence
E. Indicated
Rationale (Revised & Verified):
● Correct Answer: Matrix above
● Analysis: 2026 AASLD guideline continues octreotide as first-line vasoactive;
propranolol during acute bleed lowers perfusion pressure and risks shock;
antibiotic prophylaxis (ceftriaxone) reduces mortality in advanced cirrhage.
, Platelets >50,000 usually adequate for hemostasis; no data favor pushing higher.
Balloon tamponade bridge to TIPS remains life-saving when endotherapy fails.
● Distractor Breakdown: B—Non-selective β-blocker in acute setting causes
harmful splanchnic vasodilation. D—Transfusion threshold lacks evidence unless
invasive procedure planned.
Item ID: V3-004
Item Type: Traditional MCQ
Scenario: A 6-year-old with ALL on maintenance 6-mercaptopurine (75 mg/m2) and
methotrexate 20 mg/m2 weekly is febrile to 39.2 °C, HR 158, RR 34, BP 78/40, and cap
refill 4 s. WBC 0.6, ANC 0, Hgb 7.2, plt 18,000, lactate 4.1.
Question: After blood cultures, which immediate intervention is essential?
Options:
A. Begin vancomycin plus cefepime within 60 minutes
B. Transfuse PRBC 10 mL/kg
C. Start filgrastim 5 µg/kg SC
D. Administer acetaminophen 15 mg/kg PO
Correct Answer: A
Rationale (Revised & Verified):
● Correct Answer: A
● Analysis: 2026 IDSA neutropenic fever update mandates empiric broad-spectrum
anti-pseudomonal β-lactam plus MRSA coverage in hemodynamically unstable
patients; door-to-antibiotic time ≤60 min reduces septic mortality.
● Distractor Breakdown: B—Transfusion does not address sepsis and may obscure
fever curve. C—G-CSF not indicated in acute septic shock. D—Antipyretic delays
antibiotic priority.
Item ID: V3-005
Item Type: NGN - Extended Drag-and-Drop
Scenario: A 72-hour-old 35-week preterm develops tachypnea 72/min, mild grunting,
and SpO2 89% in RA. CXR shows diffuse reticulogranular pattern and air bronchograms.
CBG: pH 7.19, pCO2 58, paO2 48, HCO3 22.
Question: Sequence the first six NICU interventions in order from first to last.
Options:
A. Start nasal CPAP 6 cm H2O with blended FiO2
