RN ATI Comprehensive Exit Exam (Version 1) Actual
exam With Questions And Revised Correct Answers &
Rationales (2026/2027) 100% Guaranteed Pass
Item ID: V1-001
Item Type: NGN - Bowtie
Scenario: A 68-year-old female with heart failure (EF 30%), COPD (FEV1 48%), and
T2DM (HbA1c 8.2%) is admitted with 3 kg weight gain in 3 days, JVD to angle of jaw,
bilateral crackles to mid-scapula, BP 168/94, HR 112 irregularly irregular, RR 28, SpO2
88% on 2 L NC, Na 128 mEq/L, K 3.2 mEq/L, BUN 48 mg/dL, creatinine 1.8 mg/dL,
serum glucose 238 mg/dL. Current meds: metformin 1000 mg BID, furosemide 40 mg
PO daily, digoxin 0.25 mg PO daily, simvastatin 40 mg HS, warfarin 5 mg daily.
Question: Complete the bowtie by selecting the most likely nursing diagnosis on the left,
the immediate priority action in the center, and the primary expected outcome on the
right.
Options/Components:
Left (Nursing Diagnosis)
Excess Fluid Volume
Impaired Gas Exchange
,Decreased Cardiac Output
Risk for Falls
Center (Priority Action)
A. Administer furosemide 80 mg IV push
B. Initiate high-flow nasal cannula at 60 L/min
C. Obtain 12-lead ECG and electrolyte panel
D. Place on continuous cardiac monitoring
Right (Expected Outcome)
X. Lung fields clear to auscultation within 6 h
Y. SpO2 ≥ 94% on room air within 4 h
Z. HR 60–100 with regular rhythm within 2 h
W. BUN < 20 mg/dL within 24 h
Correct Bowtie Configuration: Left-1, Center-A, Right-X
Rationale (Revised & Verified): The correct answer is Left-1, Center-A, Right-X. The
patient presents with acute decompensated heart failure evidenced by rapid weight
,gain, JVD, and pulmonary edema. Excess Fluid Volume (1) is the most accurate nursing
diagnosis. The priority action per 2026 AHA/ACC guidelines is prompt loop diuretic
escalation; therefore administering furosemide 80 mg IV push (A) is first-line to achieve
diuresis. The primary expected outcome is clearance of pulmonary edema, so lung
fields clear to auscultation (X) is the measurable cue. Impaired Gas Exchange (2) is
partially present but is a consequence of fluid overload, not the root diagnosis. Initiating
high-flow oxygen (B) is adjunctive, not priority. Decreased Cardiac Output (3) is not yet
supported by hypotension. Risk for Falls (4) is irrelevant acutely. Options C and D are
important assessments but do not treat the underlying fluid overload. Outcomes Y, Z,
and W are desirable but secondary to pulmonary clearance.
Item ID: V1-002
Item Type: Traditional MCQ
Scenario: A 34-year-old G2P1 at 39 weeks is admitted in active labor. Cervix 8 cm, 0
station, vertex, membrane ruptured 2 h ago, clear fluid. FHR baseline 150 with
moderate variability, recurrent late decels to 90 bpm lasting 30 s after 5 contractions. IV
of Lactated Ringer’s infusing at 125 mL/h. Maternal BP 110/70, temp 37 °C.
Question: Which action should the nurse implement first?
Options/Components:
Position patient in left-lateral tilt
Increase maintenance IV rate to 250 mL/h
Administer 8 L oxygen via non-rebreather
, Notify provider for possible stat delivery
Correct Option: 1
Rationale (Revised & Verified): The correct answer is 1. Recurrent late decelerations
reflect uteroplacental insufficiency; immediate left-lateral tilt (1) relieves aortocaval
compression and improves placental perfusion within seconds, aligning with 2026
AWHONN fetal monitoring standards. Increasing IV rate (2) is indicated only if maternal
hypotension is present; current BP is normal. High-flow oxygen (3) is no longer
recommended routinely because it can reduce fetal PO2 by left-shifting the maternal
oxyhemoglobin curve. Notifying provider (4) is necessary but not the first action; initial
intrauterine resuscitation must precede the call.
Item ID: V1-003
Item Type: NGN - Extended Multiple Response
Scenario: A 5-year-old with acute lymphoblastic leukemia is receiving methotrexate 500
mg/m² IV as part of induction. Pre-medication labs: WBC 1.8 × 10³/μL, ANC 800,
platelets 42 × 10³/μL, ALT 98 U/L, creatinine 0.6 mg/dL. During infusion child reports
“my throat feels funny,” develops facial erythema, voice change, and urticaria on chest.
Vital signs: BP 88/50, HR 140, RR 30, SpO2 93%.
Question: Which interventions are indicated? Select all that apply.
Options/Components:
Stop methotrexate infusion immediately
exam With Questions And Revised Correct Answers &
Rationales (2026/2027) 100% Guaranteed Pass
Item ID: V1-001
Item Type: NGN - Bowtie
Scenario: A 68-year-old female with heart failure (EF 30%), COPD (FEV1 48%), and
T2DM (HbA1c 8.2%) is admitted with 3 kg weight gain in 3 days, JVD to angle of jaw,
bilateral crackles to mid-scapula, BP 168/94, HR 112 irregularly irregular, RR 28, SpO2
88% on 2 L NC, Na 128 mEq/L, K 3.2 mEq/L, BUN 48 mg/dL, creatinine 1.8 mg/dL,
serum glucose 238 mg/dL. Current meds: metformin 1000 mg BID, furosemide 40 mg
PO daily, digoxin 0.25 mg PO daily, simvastatin 40 mg HS, warfarin 5 mg daily.
Question: Complete the bowtie by selecting the most likely nursing diagnosis on the left,
the immediate priority action in the center, and the primary expected outcome on the
right.
Options/Components:
Left (Nursing Diagnosis)
Excess Fluid Volume
Impaired Gas Exchange
,Decreased Cardiac Output
Risk for Falls
Center (Priority Action)
A. Administer furosemide 80 mg IV push
B. Initiate high-flow nasal cannula at 60 L/min
C. Obtain 12-lead ECG and electrolyte panel
D. Place on continuous cardiac monitoring
Right (Expected Outcome)
X. Lung fields clear to auscultation within 6 h
Y. SpO2 ≥ 94% on room air within 4 h
Z. HR 60–100 with regular rhythm within 2 h
W. BUN < 20 mg/dL within 24 h
Correct Bowtie Configuration: Left-1, Center-A, Right-X
Rationale (Revised & Verified): The correct answer is Left-1, Center-A, Right-X. The
patient presents with acute decompensated heart failure evidenced by rapid weight
,gain, JVD, and pulmonary edema. Excess Fluid Volume (1) is the most accurate nursing
diagnosis. The priority action per 2026 AHA/ACC guidelines is prompt loop diuretic
escalation; therefore administering furosemide 80 mg IV push (A) is first-line to achieve
diuresis. The primary expected outcome is clearance of pulmonary edema, so lung
fields clear to auscultation (X) is the measurable cue. Impaired Gas Exchange (2) is
partially present but is a consequence of fluid overload, not the root diagnosis. Initiating
high-flow oxygen (B) is adjunctive, not priority. Decreased Cardiac Output (3) is not yet
supported by hypotension. Risk for Falls (4) is irrelevant acutely. Options C and D are
important assessments but do not treat the underlying fluid overload. Outcomes Y, Z,
and W are desirable but secondary to pulmonary clearance.
Item ID: V1-002
Item Type: Traditional MCQ
Scenario: A 34-year-old G2P1 at 39 weeks is admitted in active labor. Cervix 8 cm, 0
station, vertex, membrane ruptured 2 h ago, clear fluid. FHR baseline 150 with
moderate variability, recurrent late decels to 90 bpm lasting 30 s after 5 contractions. IV
of Lactated Ringer’s infusing at 125 mL/h. Maternal BP 110/70, temp 37 °C.
Question: Which action should the nurse implement first?
Options/Components:
Position patient in left-lateral tilt
Increase maintenance IV rate to 250 mL/h
Administer 8 L oxygen via non-rebreather
, Notify provider for possible stat delivery
Correct Option: 1
Rationale (Revised & Verified): The correct answer is 1. Recurrent late decelerations
reflect uteroplacental insufficiency; immediate left-lateral tilt (1) relieves aortocaval
compression and improves placental perfusion within seconds, aligning with 2026
AWHONN fetal monitoring standards. Increasing IV rate (2) is indicated only if maternal
hypotension is present; current BP is normal. High-flow oxygen (3) is no longer
recommended routinely because it can reduce fetal PO2 by left-shifting the maternal
oxyhemoglobin curve. Notifying provider (4) is necessary but not the first action; initial
intrauterine resuscitation must precede the call.
Item ID: V1-003
Item Type: NGN - Extended Multiple Response
Scenario: A 5-year-old with acute lymphoblastic leukemia is receiving methotrexate 500
mg/m² IV as part of induction. Pre-medication labs: WBC 1.8 × 10³/μL, ANC 800,
platelets 42 × 10³/μL, ALT 98 U/L, creatinine 0.6 mg/dL. During infusion child reports
“my throat feels funny,” develops facial erythema, voice change, and urticaria on chest.
Vital signs: BP 88/50, HR 140, RR 30, SpO2 93%.
Question: Which interventions are indicated? Select all that apply.
Options/Components:
Stop methotrexate infusion immediately
