2026 ATI RN Fundamentals – Proctored Actual
Exam (3 Versions) | Verified Questions &
Answers | NGN-Style
Q001: 001
Type: NGN – Extended Multiple Response
Scenario Context: 68-year-old female, 2 days post-op total knee replacement, PCA
hydromorphone, history of COPD, on 2 L O₂ nasal cannula.
Question: Which assessments require immediate follow-up to prevent complications?
Select ALL that apply.
Options:
A. SpO₂ 89 % on 2 L
B. Pain rating 8/10 at rest
C. Dressing dry/intact
D. Urine output 15 mL/hr × 3 hr
E. BP 98/56, HR 112
F. Patient refuses incentive spirometry
(Correct: A, D, E, F)
Rationale:
, ● Answer: A, D, E, F
● Why (2026 Standard): SpO₂ < 90 % indicates hypoxemia; COPD patient at risk for
acute respiratory failure. Oliguria < 30 mL/hr signals possible hypovolemia or
acute kidney injury. Hypotension + tachycardia suggest hypovolemia or sepsis.
Refusal of IS increases atelectasis/pneumonia risk.
● Errors: B is expected post-op; C is normal finding.
Q002: 002
Type: Traditional
Scenario Context: Same patient, evening shift.
Question: The nurse evaluates PCA dosing history: 18 attempts, 6 deliveries, total 1.2 mg
hydromorphone in 4 h. What is the priority nursing action?
Options:
A. Increase basal rate
B. Assess level of sedation and respirations
C. Request PRN naloxone order
D. Educate patient to press button more often
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): High attempt-to-delivery ratio suggests inadequate
analgesia or misunderstanding, but safety first—rule over-sedation/respiratory
depression per 2026 AHRQ PCA guidelines.
● Errors: A risks respiratory depression; C not indicated without respiratory
compromise; D may worsen misuse.
,Q003: 003
Type: NGN – Matrix
Scenario Context: New admit: 54-year-old male, cirrhosis, ascites, Na 128 mEq/L,
scheduled for paracentesis.
Matrix: Match each intervention to Evidence of Effectiveness (1), Potential Harm (2), or
Neither (3).
Interventions:
A. Administer spironolactone 100 mg PO daily
B. Restrict fluids to 1.2 L/day
C. Infuse 25 % albumin 100 mL post-paracentesis
D. Encourage 3 g sodium diet
Options Grid:
A–1
B–2
C–1
D–3
(Correct: A-1, B-2, C-1, D-3)
Rationale:
, ● Answer: Spironolactone effective for ascites; fluid restriction risks hypovolemia;
albumin repletion prevents post-procedure hypotension; 3 g diet exceeds 2026 ≤ 2
g Na restriction.
● Errors: Any other mapping misclassifies evidence or harm.
Q004: 004
Type: NGN – Bowtie
Scenario Context: 30-week gestation, preeclampsia on magnesium sulfate 2 g/h IV.
Urgent call from bedside: respirations 10/min, absent DTRs, urine output 80 mL/4 h.
Bowtie: Identify the risk (left), Immediate action (knot), Monitor parameter (right).
(Correct: Left – Magnesium toxicity; Knot – Stop infusion/give calcium gluconate 1 g IV;
Right – Respiratory rate & DTRs q15 min)
Rationale:
● Answer: 2026 ACOG thresholds: resp < 12, absent DTRs, UO < 30 mL/h indicate
toxicity; antidote is calcium gluconate.
● Errors: Continuing infusion or giving furosemide worsens toxicity.
Q005: 005
Type: Traditional
Scenario Context: Same patient after calcium gluconate.
Question: Which laboratory value best reflects renal clearance of magnesium?
Options:
A. Serum creatinine 1.4 mg/dL
B. BUN 22 mg/dL
Exam (3 Versions) | Verified Questions &
Answers | NGN-Style
Q001: 001
Type: NGN – Extended Multiple Response
Scenario Context: 68-year-old female, 2 days post-op total knee replacement, PCA
hydromorphone, history of COPD, on 2 L O₂ nasal cannula.
Question: Which assessments require immediate follow-up to prevent complications?
Select ALL that apply.
Options:
A. SpO₂ 89 % on 2 L
B. Pain rating 8/10 at rest
C. Dressing dry/intact
D. Urine output 15 mL/hr × 3 hr
E. BP 98/56, HR 112
F. Patient refuses incentive spirometry
(Correct: A, D, E, F)
Rationale:
, ● Answer: A, D, E, F
● Why (2026 Standard): SpO₂ < 90 % indicates hypoxemia; COPD patient at risk for
acute respiratory failure. Oliguria < 30 mL/hr signals possible hypovolemia or
acute kidney injury. Hypotension + tachycardia suggest hypovolemia or sepsis.
Refusal of IS increases atelectasis/pneumonia risk.
● Errors: B is expected post-op; C is normal finding.
Q002: 002
Type: Traditional
Scenario Context: Same patient, evening shift.
Question: The nurse evaluates PCA dosing history: 18 attempts, 6 deliveries, total 1.2 mg
hydromorphone in 4 h. What is the priority nursing action?
Options:
A. Increase basal rate
B. Assess level of sedation and respirations
C. Request PRN naloxone order
D. Educate patient to press button more often
(Correct: B)
Rationale:
● Answer: B
● Why (2026 Standard): High attempt-to-delivery ratio suggests inadequate
analgesia or misunderstanding, but safety first—rule over-sedation/respiratory
depression per 2026 AHRQ PCA guidelines.
● Errors: A risks respiratory depression; C not indicated without respiratory
compromise; D may worsen misuse.
,Q003: 003
Type: NGN – Matrix
Scenario Context: New admit: 54-year-old male, cirrhosis, ascites, Na 128 mEq/L,
scheduled for paracentesis.
Matrix: Match each intervention to Evidence of Effectiveness (1), Potential Harm (2), or
Neither (3).
Interventions:
A. Administer spironolactone 100 mg PO daily
B. Restrict fluids to 1.2 L/day
C. Infuse 25 % albumin 100 mL post-paracentesis
D. Encourage 3 g sodium diet
Options Grid:
A–1
B–2
C–1
D–3
(Correct: A-1, B-2, C-1, D-3)
Rationale:
, ● Answer: Spironolactone effective for ascites; fluid restriction risks hypovolemia;
albumin repletion prevents post-procedure hypotension; 3 g diet exceeds 2026 ≤ 2
g Na restriction.
● Errors: Any other mapping misclassifies evidence or harm.
Q004: 004
Type: NGN – Bowtie
Scenario Context: 30-week gestation, preeclampsia on magnesium sulfate 2 g/h IV.
Urgent call from bedside: respirations 10/min, absent DTRs, urine output 80 mL/4 h.
Bowtie: Identify the risk (left), Immediate action (knot), Monitor parameter (right).
(Correct: Left – Magnesium toxicity; Knot – Stop infusion/give calcium gluconate 1 g IV;
Right – Respiratory rate & DTRs q15 min)
Rationale:
● Answer: 2026 ACOG thresholds: resp < 12, absent DTRs, UO < 30 mL/h indicate
toxicity; antidote is calcium gluconate.
● Errors: Continuing infusion or giving furosemide worsens toxicity.
Q005: 005
Type: Traditional
Scenario Context: Same patient after calcium gluconate.
Question: Which laboratory value best reflects renal clearance of magnesium?
Options:
A. Serum creatinine 1.4 mg/dL
B. BUN 22 mg/dL
