1
Legit ATI RN Comprehensive Predictor 2026: 200 NGN
Questions with Rationales
ATI RN Comprehensive Predictor Practice Exam
100 Questions with Detailed Rationales
NGN Case Study: Diabetic Ketoacidosis
Scenario: A 24-year-old female with type 1 diabetes presents with nausea,
vomiting, abdominal pain, and confusion. She reports not taking insulin for 2 days.
Vitals Labs
BP 90/60 Glucose 620 mg/dL
HR 130 pH 7.20
RR 32 (Kussmaul) HCO₃ 12 mEq/L
Temp 37.8°C Ketones large
Potassium 5.8 mEq/L
Question 6 - What is the priority intervention?
A) IV regular insulin bolus
B) IV fluids 0.9% NS
C) IV potassium replacement
D) Sodium bicarbonate infusion
,2
Answer: B
Rationale: Fluid resuscitation is the priority in DKA to correct dehydration,
improve tissue perfusion, and lower blood glucose. Initial fluid is 0.9% normal
saline at 15-20 mL/kg/hr. Insulin is initiated after fluid resuscitation, as insulin
without fluids can cause cardiovascular collapse .
Question 7 - The patient's potassium is 5.8 mEq/L. Why is this concerning?
A) Hyperkalemia causes cardiac arrhythmias
B) Insulin administration will lower potassium
C) The patient needs immediate potassium replacement
D) Fluids will increase potassium further
Answer: B
Rationale: Although initial potassium may be elevated due to acidosis, insulin
therapy and fluid resuscitation will rapidly shift potassium intracellularly, causing
hypokalemia. Potassium replacement is typically initiated when potassium falls
below 5.3 mEq/L during DKA treatment .
Question 8 - The patient develops a headache and vision changes during
treatment. What complication is suspected?
A) Hypoglycemia
B) Cerebral edema
C) Hyperkalemia
D) Allergic reaction
Answer: B
Rationale: Cerebral edema is a rare but life-threatening complication of DKA
treatment, especially in children and young adults. Early signs include headache,
,3
confusion, altered mental status, and vision changes. Immediate intervention is
required .
Question 9 - When should the nurse initiate IV insulin infusion?
A) Immediately upon arrival
B) After the first liter of IV fluids
C) When potassium is < 3.5 mEq/L
D) When glucose is < 250 mg/dL
Answer: B
Rationale: Insulin should be initiated after initial fluid resuscitation (typically 1 liter
of 0.9% NS) to prevent rapid fluid shifts and cardiovascular collapse. Insulin
infusion is started at 0.1 units/kg/hr without a bolus in most protocols .
Question 10 - Which finding indicates the patient is transitioning out of DKA?
A) Blood glucose 250 mg/dL
B) pH 7.35
C) Anion gap normalized
D) All of the above
Answer: D
Rationale: Resolution of DKA is indicated by blood glucose < 200-250 mg/dL, pH >
7.30, HCO₃ > 15, and normalized anion gap. Transition to subcutaneous insulin
occurs when the patient is stable and able to eat .
NGN Case Study: Acute Myocardial Infarction
Scenario: A 68-year-old male presents to the ED with crushing chest pain radiating
to the left arm, diaphoresis, and shortness of breath for the past 45 minutes.
, 4
Vital Signs ECG Findings
BP 150/90 ST-segment elevation in leads V2-V4
HR 110
RR 24
SpO₂ 94% RA
Question 1 - What is the priority intervention?
A) Administer aspirin 324 mg chewed
B) Obtain cardiac enzymes
C) Start IV access
D) Administer morphine sulfate
Answer: A
Rationale: Aspirin 324 mg chewed is the priority intervention for suspected MI
because it inhibits platelet aggregation and reduces mortality. Aspirin should be
given immediately upon suspicion of MI, even before confirming diagnosis .
Question 2 - Which medication does the nurse anticipate administering first?
A) Nitroglycerin sublingual
B) Heparin IV bolus
C) Ticagrelor
D) Metoprolol
Legit ATI RN Comprehensive Predictor 2026: 200 NGN
Questions with Rationales
ATI RN Comprehensive Predictor Practice Exam
100 Questions with Detailed Rationales
NGN Case Study: Diabetic Ketoacidosis
Scenario: A 24-year-old female with type 1 diabetes presents with nausea,
vomiting, abdominal pain, and confusion. She reports not taking insulin for 2 days.
Vitals Labs
BP 90/60 Glucose 620 mg/dL
HR 130 pH 7.20
RR 32 (Kussmaul) HCO₃ 12 mEq/L
Temp 37.8°C Ketones large
Potassium 5.8 mEq/L
Question 6 - What is the priority intervention?
A) IV regular insulin bolus
B) IV fluids 0.9% NS
C) IV potassium replacement
D) Sodium bicarbonate infusion
,2
Answer: B
Rationale: Fluid resuscitation is the priority in DKA to correct dehydration,
improve tissue perfusion, and lower blood glucose. Initial fluid is 0.9% normal
saline at 15-20 mL/kg/hr. Insulin is initiated after fluid resuscitation, as insulin
without fluids can cause cardiovascular collapse .
Question 7 - The patient's potassium is 5.8 mEq/L. Why is this concerning?
A) Hyperkalemia causes cardiac arrhythmias
B) Insulin administration will lower potassium
C) The patient needs immediate potassium replacement
D) Fluids will increase potassium further
Answer: B
Rationale: Although initial potassium may be elevated due to acidosis, insulin
therapy and fluid resuscitation will rapidly shift potassium intracellularly, causing
hypokalemia. Potassium replacement is typically initiated when potassium falls
below 5.3 mEq/L during DKA treatment .
Question 8 - The patient develops a headache and vision changes during
treatment. What complication is suspected?
A) Hypoglycemia
B) Cerebral edema
C) Hyperkalemia
D) Allergic reaction
Answer: B
Rationale: Cerebral edema is a rare but life-threatening complication of DKA
treatment, especially in children and young adults. Early signs include headache,
,3
confusion, altered mental status, and vision changes. Immediate intervention is
required .
Question 9 - When should the nurse initiate IV insulin infusion?
A) Immediately upon arrival
B) After the first liter of IV fluids
C) When potassium is < 3.5 mEq/L
D) When glucose is < 250 mg/dL
Answer: B
Rationale: Insulin should be initiated after initial fluid resuscitation (typically 1 liter
of 0.9% NS) to prevent rapid fluid shifts and cardiovascular collapse. Insulin
infusion is started at 0.1 units/kg/hr without a bolus in most protocols .
Question 10 - Which finding indicates the patient is transitioning out of DKA?
A) Blood glucose 250 mg/dL
B) pH 7.35
C) Anion gap normalized
D) All of the above
Answer: D
Rationale: Resolution of DKA is indicated by blood glucose < 200-250 mg/dL, pH >
7.30, HCO₃ > 15, and normalized anion gap. Transition to subcutaneous insulin
occurs when the patient is stable and able to eat .
NGN Case Study: Acute Myocardial Infarction
Scenario: A 68-year-old male presents to the ED with crushing chest pain radiating
to the left arm, diaphoresis, and shortness of breath for the past 45 minutes.
, 4
Vital Signs ECG Findings
BP 150/90 ST-segment elevation in leads V2-V4
HR 110
RR 24
SpO₂ 94% RA
Question 1 - What is the priority intervention?
A) Administer aspirin 324 mg chewed
B) Obtain cardiac enzymes
C) Start IV access
D) Administer morphine sulfate
Answer: A
Rationale: Aspirin 324 mg chewed is the priority intervention for suspected MI
because it inhibits platelet aggregation and reduces mortality. Aspirin should be
given immediately upon suspicion of MI, even before confirming diagnosis .
Question 2 - Which medication does the nurse anticipate administering first?
A) Nitroglycerin sublingual
B) Heparin IV bolus
C) Ticagrelor
D) Metoprolol
