ATI RN Comprehensive Predictor Proctored Exam with
NGN: The Ultimate 565+ Question Bank with Detailed
Rationales
Section 1: Fundamentals & Safety (Questions 1-20)
1. A nurse is preparing to administer a blood transfusion. Which gauge IV catheter
is most appropriate?
A. 28-gauge
B. 24-gauge
C. 22-gauge
D. 18-gauge
Answer: D. 18-gauge
*Rationale: Blood products require a large bore catheter (20-18 gauge) to prevent
hemolysis of red blood cells and allow for a steady flow rate.*
2. A nurse is applying restraints to a client who is agitated. Which action is correct?
A. Tie the restraints to the side rail for easy access.
B. Remove the restraints every 4 hours for range of motion.
C. Document the client’s behavior leading up to restraint application.
D. Use a square knot to ensure the restraints do not tighten.
Answer: C. Document the client’s behavior leading up to restraint application.
Rationale: Restraints should only be used as a last resort. The nurse must document the
behavior that warranted the restraint, less restrictive measures attempted, and the time of
application. Restraints should be removed every 2 hours (not 4) for ROM.
3. A nurse is teaching a client about using a patient-controlled analgesia (PCA)
pump. Which statement indicates understanding?
A. "I will ask my wife to press the button if I am sleeping."
B. "I should only press the button when my pain is severe."
C. "I will not overdose myself because the machine has a lockout."
D. "I will need to take oral pain medication instead."
,Answer: C. "I will not overdose myself because the machine has a lockout."
Rationale: The primary benefit of PCA is patient safety via a lockout mechanism that
prevents administration of a dose before the previous dose has taken effect. Only the
patient should press the button.
4. A nurse is caring for a client with a nasogastric (NG) tube set to low intermittent
suction. The nurse notes the suction is not working. What should the nurse do
first?
A. Irrigate the tube with sterile water.
B. Reposition the client.
C. Check the connection to the suction apparatus.
D. Notify the provider.
Answer: C. Check the connection to the suction apparatus.
Rationale: The nurse should always assess the equipment and connections first to rule out
a simple disconnection before attempting irrigation or notifying the provider.
5. A nurse is caring for a client who has a new diagnosis of diabetes mellitus. The
client states, "I can't do this. I hate needles." Which is the priority nursing
diagnosis?
A. Deficient knowledge
B. Fear
C. Ineffective denial
D. Ineffective coping
Answer: B. Fear
Rationale: The client’s statement expresses fear regarding injections. While knowledge
deficit may exist, the emotional response (fear) is the priority according to Maslow’s
hierarchy (psychological safety).
6. A nurse is preparing to administer a heparin injection. Which site is preferred?
A. Dorsogluteal
B. Ventrogluteal
C. Deltoid
D. Abdomen
Answer: D. Abdomen
Rationale: The abdomen (2 inches away from umbilicus) is the preferred site for
subcutaneous heparin because it provides the largest area for rotation and consistent
absorption. Do not aspirate or massage.
7. A nurse is assessing a client who has a long leg cast. Which finding indicates
compartment syndrome?
A. Capillary refill of 2 seconds
,B. Toes that are warm to touch
C. Pallor and paresthesia
D. Pedal pulse 2+
Answer: C. Pallor and paresthesia
Rationale: The 5 P’s of compartment syndrome: Pain (unrelieved by meds), Pallor,
Paresthesia (tingling), Paralysis, and Pulselessness (late sign). Paresthesia and pallor are
early indicators.
8. A nurse is providing discharge teaching for a client with a new tracheostomy.
Which statement indicates a need for further teaching?
A. "I should avoid getting water in my stoma while showering."
B. "I will clean the inner cannula with hydrogen peroxide."
C. "I will cut four layers of gauze to place around the stoma."
D. "I can use a soft toothbrush to clean my teeth."
Answer: C. "I will cut four layers of gauze to place around the stoma."
Rationale: Cutting gauze can cause loose fibers to be inhaled into the stoma (aspiration
risk). Non-cuffed, pre-cut tracheostomy gauze should be used.
9. A nurse is caring for a client on fall precautions. Which action is most
important?
A. Placing the bed in the lowest position.
B. Turning on the bed alarm.
C. Locking the bed brakes.
D. Placing the call light within reach.
Answer: A. Placing the bed in the lowest position.
Rationale: While all are important, placing the bed in the lowest position minimizes the
distance if the client attempts to get out of bed unsafely, reducing injury risk.
10. A nurse is assessing a client’s IV site. The site is warm, edematous, and the
infusion has slowed. The nurse suspects:
A. Infiltration
B. Phlebitis
C. Air embolism
D. Fluid overload
Answer: B. Phlebitis
Rationale: Phlebitis presents with warmth, redness, tenderness, and swelling at the
insertion site. Infiltration is cool and pale.
11. A nurse is teaching a client about advance directives. Which statement is
correct?
A. "Once signed, advance directives cannot be changed."
, B. "The living will designates a person to make decisions for me."
C. "I can change my advance directives at any time."
D. "A health care proxy is only valid during surgery."
Answer: C. "I can change my advance directives at any time."
Rationale: A competent client can change or revoke advance directives at any time. A
living will outlines treatment wishes; a durable power of attorney (health care proxy)
designates a decision-maker.
12. A nurse is caring for a client who is postoperative day 1. The client reports pain
of 8 on a scale of 0-10. What is the nurse’s priority action?
A. Reposition the client.
B. Administer prescribed analgesic.
C. Check the surgical incision.
D. Distract the client with conversation.
Answer: B. Administer prescribed analgesic.
Rationale: The priority is to manage the severe pain. According to the pain management
standard, the nurse should administer the analgesic first, then evaluate for effectiveness,
and then assess for complications if pain persists.
13. A nurse is preparing a client for a colonoscopy. Which medication does the
nurse expect to be prescribed to cleanse the bowel?
A. Bisacodyl
B. Polyethylene glycol (GoLYTELY)
C. Magnesium hydroxide (Milk of Magnesia)
D. Docusate sodium (Colace)
Answer: B. Polyethylene glycol (GoLYTELY)
Rationale: Polyethylene glycol is an osmotic laxative used for "bowel prep" to completely
evacuate the bowel for visualization. It is a large volume solution.
14. A nurse is inserting an indwelling urinary catheter for a female client. After
cleaning the labia, where should the nurse insert the catheter?
A. Into the clitoris
B. Into the urethral meatus
C. Into the vaginal orifice
D. Into the introitus
Answer: B. Into the urethral meatus
Rationale: The urethral meatus is located below the clitoris and above the vaginal
opening. The nurse must identify the correct anatomical structure to avoid contamination.
15. A client with a history of falls is being discharged. Which home modification
should the nurse recommend?
NGN: The Ultimate 565+ Question Bank with Detailed
Rationales
Section 1: Fundamentals & Safety (Questions 1-20)
1. A nurse is preparing to administer a blood transfusion. Which gauge IV catheter
is most appropriate?
A. 28-gauge
B. 24-gauge
C. 22-gauge
D. 18-gauge
Answer: D. 18-gauge
*Rationale: Blood products require a large bore catheter (20-18 gauge) to prevent
hemolysis of red blood cells and allow for a steady flow rate.*
2. A nurse is applying restraints to a client who is agitated. Which action is correct?
A. Tie the restraints to the side rail for easy access.
B. Remove the restraints every 4 hours for range of motion.
C. Document the client’s behavior leading up to restraint application.
D. Use a square knot to ensure the restraints do not tighten.
Answer: C. Document the client’s behavior leading up to restraint application.
Rationale: Restraints should only be used as a last resort. The nurse must document the
behavior that warranted the restraint, less restrictive measures attempted, and the time of
application. Restraints should be removed every 2 hours (not 4) for ROM.
3. A nurse is teaching a client about using a patient-controlled analgesia (PCA)
pump. Which statement indicates understanding?
A. "I will ask my wife to press the button if I am sleeping."
B. "I should only press the button when my pain is severe."
C. "I will not overdose myself because the machine has a lockout."
D. "I will need to take oral pain medication instead."
,Answer: C. "I will not overdose myself because the machine has a lockout."
Rationale: The primary benefit of PCA is patient safety via a lockout mechanism that
prevents administration of a dose before the previous dose has taken effect. Only the
patient should press the button.
4. A nurse is caring for a client with a nasogastric (NG) tube set to low intermittent
suction. The nurse notes the suction is not working. What should the nurse do
first?
A. Irrigate the tube with sterile water.
B. Reposition the client.
C. Check the connection to the suction apparatus.
D. Notify the provider.
Answer: C. Check the connection to the suction apparatus.
Rationale: The nurse should always assess the equipment and connections first to rule out
a simple disconnection before attempting irrigation or notifying the provider.
5. A nurse is caring for a client who has a new diagnosis of diabetes mellitus. The
client states, "I can't do this. I hate needles." Which is the priority nursing
diagnosis?
A. Deficient knowledge
B. Fear
C. Ineffective denial
D. Ineffective coping
Answer: B. Fear
Rationale: The client’s statement expresses fear regarding injections. While knowledge
deficit may exist, the emotional response (fear) is the priority according to Maslow’s
hierarchy (psychological safety).
6. A nurse is preparing to administer a heparin injection. Which site is preferred?
A. Dorsogluteal
B. Ventrogluteal
C. Deltoid
D. Abdomen
Answer: D. Abdomen
Rationale: The abdomen (2 inches away from umbilicus) is the preferred site for
subcutaneous heparin because it provides the largest area for rotation and consistent
absorption. Do not aspirate or massage.
7. A nurse is assessing a client who has a long leg cast. Which finding indicates
compartment syndrome?
A. Capillary refill of 2 seconds
,B. Toes that are warm to touch
C. Pallor and paresthesia
D. Pedal pulse 2+
Answer: C. Pallor and paresthesia
Rationale: The 5 P’s of compartment syndrome: Pain (unrelieved by meds), Pallor,
Paresthesia (tingling), Paralysis, and Pulselessness (late sign). Paresthesia and pallor are
early indicators.
8. A nurse is providing discharge teaching for a client with a new tracheostomy.
Which statement indicates a need for further teaching?
A. "I should avoid getting water in my stoma while showering."
B. "I will clean the inner cannula with hydrogen peroxide."
C. "I will cut four layers of gauze to place around the stoma."
D. "I can use a soft toothbrush to clean my teeth."
Answer: C. "I will cut four layers of gauze to place around the stoma."
Rationale: Cutting gauze can cause loose fibers to be inhaled into the stoma (aspiration
risk). Non-cuffed, pre-cut tracheostomy gauze should be used.
9. A nurse is caring for a client on fall precautions. Which action is most
important?
A. Placing the bed in the lowest position.
B. Turning on the bed alarm.
C. Locking the bed brakes.
D. Placing the call light within reach.
Answer: A. Placing the bed in the lowest position.
Rationale: While all are important, placing the bed in the lowest position minimizes the
distance if the client attempts to get out of bed unsafely, reducing injury risk.
10. A nurse is assessing a client’s IV site. The site is warm, edematous, and the
infusion has slowed. The nurse suspects:
A. Infiltration
B. Phlebitis
C. Air embolism
D. Fluid overload
Answer: B. Phlebitis
Rationale: Phlebitis presents with warmth, redness, tenderness, and swelling at the
insertion site. Infiltration is cool and pale.
11. A nurse is teaching a client about advance directives. Which statement is
correct?
A. "Once signed, advance directives cannot be changed."
, B. "The living will designates a person to make decisions for me."
C. "I can change my advance directives at any time."
D. "A health care proxy is only valid during surgery."
Answer: C. "I can change my advance directives at any time."
Rationale: A competent client can change or revoke advance directives at any time. A
living will outlines treatment wishes; a durable power of attorney (health care proxy)
designates a decision-maker.
12. A nurse is caring for a client who is postoperative day 1. The client reports pain
of 8 on a scale of 0-10. What is the nurse’s priority action?
A. Reposition the client.
B. Administer prescribed analgesic.
C. Check the surgical incision.
D. Distract the client with conversation.
Answer: B. Administer prescribed analgesic.
Rationale: The priority is to manage the severe pain. According to the pain management
standard, the nurse should administer the analgesic first, then evaluate for effectiveness,
and then assess for complications if pain persists.
13. A nurse is preparing a client for a colonoscopy. Which medication does the
nurse expect to be prescribed to cleanse the bowel?
A. Bisacodyl
B. Polyethylene glycol (GoLYTELY)
C. Magnesium hydroxide (Milk of Magnesia)
D. Docusate sodium (Colace)
Answer: B. Polyethylene glycol (GoLYTELY)
Rationale: Polyethylene glycol is an osmotic laxative used for "bowel prep" to completely
evacuate the bowel for visualization. It is a large volume solution.
14. A nurse is inserting an indwelling urinary catheter for a female client. After
cleaning the labia, where should the nurse insert the catheter?
A. Into the clitoris
B. Into the urethral meatus
C. Into the vaginal orifice
D. Into the introitus
Answer: B. Into the urethral meatus
Rationale: The urethral meatus is located below the clitoris and above the vaginal
opening. The nurse must identify the correct anatomical structure to avoid contamination.
15. A client with a history of falls is being discharged. Which home modification
should the nurse recommend?
