ATI Critical Thinking Practice Test 1 — 2026/2027
ATI CRITICAL THINKING PRACTICE TEST 1
2026/2027 | 40 Questions | Exam Prep
Instructions: Select the best answer for each question. SATA items require selecting all correct responses.
Ordered items require sequencing. Answers and rationales follow each question.
SECTION I: CLINICAL JUDGMENT & DECISION-MAKING / CJMM
1. A nurse is caring for a patient who is 2 hours postoperative following a total knee
replacement. The patient reports pain as 8/10, has a heart rate of 110 bpm, blood pressure of
160/95 mmHg, and respiratory rate of 22 breaths/min. Which finding should the nurse
recognize as the MOST critical clinical cue requiring immediate action?
A. Pain level of 8/10
B. Heart rate of 110 bpm
C. Blood pressure of 160/95 mmHg
D. Respiratory rate of 22 breaths/min
Correct Answer: C. Blood pressure of 160/95 mmHg
Rationale: According to the NCSBN Clinical Judgment Measurement Model (CJMM), the nurse must first
recognize and analyze cues to prioritize hypotheses. A blood pressure of 160/95 mmHg in a postoperative
patient is the most critical finding because it significantly increases the risk of surgical site bleeding,
hematoma formation, and cerebrovascular events. While pain at 8/10 (A), tachycardia of 110 bpm (B), and
tachypnea of 22 breaths/min (D) require attention, they may be secondary to the elevated blood pressure
or the stress response to pain and surgery. Hypertension in the immediate postoperative period is an acute
finding that warrants prompt intervention, such as administering prescribed antihypertensive medications
and assessing for bleeding at the surgical site.
2. A nurse in the emergency department receives a laboratory report for a patient with
suspected sepsis. The lactate level is 4.8 mmol/L, WBC is 16,000/mm3, procalcitonin is 2.5
ng/mL, and C-reactive protein (CRP) is 45 mg/L. Using the CJMM 'Analyze Cues' layer, which
finding is MOST strongly associated with tissue hypoperfusion and septic shock?
A. WBC of 16,000/mm3
B. Lactate of 4.8 mmol/L
C. Procalcitonin of 2.5 ng/mL
D. CRP of 45 mg/L
Correct Answer: B. Lactate of 4.8 mmol/L
Rationale: Lactate is the most direct indicator of tissue hypoperfusion and anaerobic metabolism. A
lactate level of 4.8 mmol/L (normal <2.0 mmol/L) indicates severe tissue hypoxia and is a hallmark of
septic shock. The Surviving Sepsis Campaign (2021) guidelines identify lactate ≥2 mmol/L as a key
criterion for initiating the sepsis bundle, and lactate ≥4 mmol/L indicates a high risk of mortality requiring
aggressive fluid resuscitation and vasopressor support. WBC elevation (A) and CRP (D) are nonspecific
inflammatory markers. Procalcitonin (C) is more specific for bacterial infection but does not directly reflect
tissue perfusion status. The nurse must recognize elevated lactate as a critical cue requiring immediate
escalation of care.
3. A nurse on the medical-surgical unit has four patients. Which patient should the nurse
assess FIRST based on the CJMM 'Prioritize Hypotheses' framework?
A. A patient with type 2 diabetes whose blood glucose is 250 mg/dL and is awaiting lunch
B. A patient with heart failure who reports new-onset dyspnea at rest and has gained 3 pounds overnight
C. A patient recovering from appendectomy who is requesting pain medication 4 hours postoperative
D. A patient with pneumonia who has a temperature of 38.3°C (100.9°F) and a productive cough
1
, ATI Critical Thinking Practice Test 1 — 2026/2027
Correct Answer: B. A patient with heart failure who reports new-onset dyspnea at rest and
has gained 3 pounds overnight
Rationale: Using the CJMM Prioritize Hypotheses framework, the nurse must identify the patient whose
condition is most unstable and poses the greatest risk of clinical deterioration. The heart failure patient
with new-onset dyspnea at rest and a 3-pound overnight weight gain (B) is exhibiting signs of acute
decompensated heart failure and fluid overload, which can rapidly progress to pulmonary edema and
respiratory failure. This requires immediate assessment, oxygen therapy, diuretic administration, and
vital sign monitoring. While hyperglycemia (A), postoperative pain (C), and fever with productive cough
(D) all require nursing attention, they are not immediately life-threatening compared to acute respiratory
compromise from heart failure exacerbation.
4. A nurse is applying the CJMM 'Generate Solutions' layer for a patient with a stage III
pressure injury on the coccyx. Which intervention reflects the HIGHEST level of clinical
judgment?
A. Reposition the patient every 2 hours and apply a foam dressing
B. Consult the wound care specialist and initiate a nutrition referral for protein supplementation
C. Document the wound assessment and notify the healthcare provider
D. Clean the wound with normal saline and apply antibiotic ointment
Correct Answer: B. Consult the wound care specialist and initiate a nutrition referral for
protein supplementation
Rationale: The CJMM Generate Solutions layer requires the nurse to go beyond basic interventions and
synthesize clinical data to develop comprehensive, evidence-based care plans. Consulting a wound care
specialist (B) demonstrates advanced clinical judgment by recognizing that a stage III pressure injury
requires specialized expertise and that impaired nutrition (protein deficiency) is a primary contributing
factor to delayed wound healing. The ATI nurse's touch framework emphasizes protein intake of 1.25–1.5
g/kg/day for wound healing. While repositioning (A), documentation (C), and wound care (D) are all
appropriate, option B reflects the highest level of clinical reasoning by addressing both the wound and the
systemic factor impeding healing.
5. Select all that apply. A nurse is evaluating the effectiveness of interventions for a patient
with acute confusion secondary to a urinary tract infection. Which findings indicate that the
'Evaluate Outcomes' layer of the CJMM has been met? [Select All That Apply]
A. The patient correctly states the current date, time, and location
B. The patient's urine culture shows sensitivity to the prescribed antibiotic
C. The patient is able to follow simple commands and converse coherently
D. The patient's temperature has decreased from 38.8°C to 37.2°C
E. The patient refuses to take the prescribed antibiotic due to nausea
Correct Answer: A. The patient correctly states the current date, time, and location, C. The
patient is able to follow simple commands and converse coherently, D. The patient's
temperature has decreased from 38.8°C to 37.2°C
Rationale: The CJMM Evaluate Outcomes layer requires the nurse to determine whether the patient's
condition has improved in response to nursing and medical interventions. Improvement in orientation (A,
correctly stating date, time, and location) and coherent conversation (C, following commands and
speaking logically) directly indicate resolution of acute confusion—the primary clinical concern.
Temperature normalization (D, from 38.8°C to 37.2°C) indicates the underlying infection is responding to
treatment. While a positive urine culture sensitivity (B) is useful laboratory data, it does not reflect a
clinical outcome or improvement in the patient's cognitive status. The patient refusing antibiotics (E)
indicates a negative outcome requiring further intervention, not goal achievement.
6. A nurse is using the NCSBN Clinical Judgment Measurement Model (CJMM) to care for a
patient with chest pain. Place the CJMM cognitive steps in the correct order (1 = first, 6 =
last). [Ordered Response]
1. Recognize clinical cues such as chest pain, diaphoresis, and shortness of breath
2
, ATI Critical Thinking Practice Test 1 — 2026/2027
2. Generate solutions including oxygen, nitroglycerin, and aspirin administration
3. Prioritize hypotheses such as acute coronary syndrome vs pulmonary embolism
4. Take action by implementing the chosen interventions and monitoring the patient
5. Evaluate outcomes including pain relief and changes in vital signs
6. Analyze cues by interpreting vital signs, ECG findings, and cardiac biomarkers
Correct Answer: 1 → 6 → 3 → 2 → 4 → 5
Rationale: The NCSBN CJMM follows six sequential cognitive steps: Recognize Cues (1) involves
identifying relevant clinical data such as chest pain, diaphoresis, and dyspnea. Analyze Cues (6) requires
interpreting and clustering data to determine clinical significance (e.g., analyzing ECG, troponin levels).
Prioritize Hypotheses (3) involves ranking possible diagnoses by likelihood and urgency (e.g., acute MI is
the most urgent hypothesis for substernal chest pain with diaphoresis). Generate Solutions (2) involves
developing evidence-based interventions tailored to the prioritized hypothesis. Take Action (4) is the
implementation of the selected interventions. Evaluate Outcomes (5) is the final step, where the nurse
reassesses the patient to determine the effectiveness of interventions and whether further action is needed.
SECTION II: PRIORITIZATION FRAMEWORKS
7. A nurse is caring for multiple patients on the medical-surgical unit. Using the ABC (Airway-
Breathing-Circulation) framework, which patient should the nurse see FIRST?
A. A patient with a deep vein thrombosis who reports calf pain and swelling
B. A patient with COPD who has oxygen saturations of 88% on room air and audible wheezing
C. A patient with a urinary tract infection who has a temperature of 38.5°C and dysuria
D. A patient with hypokalemia who has muscle weakness and a potassium level of 3.0 mEq/L
Correct Answer: B. A patient with COPD who has oxygen saturations of 88% on room air and
audible wheezing
Rationale: The ABC framework prioritizes Airway, Breathing, and Circulation as the foundation of
patient assessment. The COPD patient with oxygen saturations of 88% (B) has a breathing compromise
that takes highest priority. Oxygen saturation below 90% indicates significant hypoxemia requiring
immediate intervention such as supplemental oxygen, bronchodilator administration, and potential
escalation of care. The DVT patient (A) has a circulation-related concern but it is not immediately life-
threatening. The UTI patient (C) has an infection requiring treatment but is stable. The hypokalemia
patient (D) has an electrolyte imbalance that requires monitoring and replacement but is not immediately
life-threatening at a potassium of 3.0 mEq/L unless cardiac arrhythmias are present.
8. A nurse is prioritizing care for four patients using Maslow's Hierarchy of Needs. Which
patient's need falls under the HIGHEST priority level according to this framework?
A. A patient who expresses anxiety about an upcoming surgical procedure
B. A patient with a new diagnosis of diabetes who needs education about insulin administration
C. A patient with severe dehydration who has dry mucous membranes, tachycardia, and hypotension
D. A patient who is grieving the loss of a spouse and has been withdrawn from social activities
Correct Answer: C. A patient with severe dehydration who has dry mucous membranes,
tachycardia, and hypotension
Rationale: Maslow's Hierarchy of Needs prioritizes physiological needs as the highest level, followed by
safety and security, love and belonging, esteem, and self-actualization. Severe dehydration with dry
mucous membranes, tachycardia, and hypotension (C) represents a physiological need that is immediately
life-threatening and takes the highest priority. Anxiety about surgery (A) is a safety and security need.
Diabetes education (B) is a knowledge need that falls under esteem or self-actualization after basic needs
are met. Grief and social withdrawal (D) represent love and belonging needs. While all patients require
nursing care, physiological needs must be addressed first according to this framework.
9. A nurse receives the following morning laboratory results for four patients. Which result
requires the nurse to contact the healthcare provider FIRST?
3
ATI CRITICAL THINKING PRACTICE TEST 1
2026/2027 | 40 Questions | Exam Prep
Instructions: Select the best answer for each question. SATA items require selecting all correct responses.
Ordered items require sequencing. Answers and rationales follow each question.
SECTION I: CLINICAL JUDGMENT & DECISION-MAKING / CJMM
1. A nurse is caring for a patient who is 2 hours postoperative following a total knee
replacement. The patient reports pain as 8/10, has a heart rate of 110 bpm, blood pressure of
160/95 mmHg, and respiratory rate of 22 breaths/min. Which finding should the nurse
recognize as the MOST critical clinical cue requiring immediate action?
A. Pain level of 8/10
B. Heart rate of 110 bpm
C. Blood pressure of 160/95 mmHg
D. Respiratory rate of 22 breaths/min
Correct Answer: C. Blood pressure of 160/95 mmHg
Rationale: According to the NCSBN Clinical Judgment Measurement Model (CJMM), the nurse must first
recognize and analyze cues to prioritize hypotheses. A blood pressure of 160/95 mmHg in a postoperative
patient is the most critical finding because it significantly increases the risk of surgical site bleeding,
hematoma formation, and cerebrovascular events. While pain at 8/10 (A), tachycardia of 110 bpm (B), and
tachypnea of 22 breaths/min (D) require attention, they may be secondary to the elevated blood pressure
or the stress response to pain and surgery. Hypertension in the immediate postoperative period is an acute
finding that warrants prompt intervention, such as administering prescribed antihypertensive medications
and assessing for bleeding at the surgical site.
2. A nurse in the emergency department receives a laboratory report for a patient with
suspected sepsis. The lactate level is 4.8 mmol/L, WBC is 16,000/mm3, procalcitonin is 2.5
ng/mL, and C-reactive protein (CRP) is 45 mg/L. Using the CJMM 'Analyze Cues' layer, which
finding is MOST strongly associated with tissue hypoperfusion and septic shock?
A. WBC of 16,000/mm3
B. Lactate of 4.8 mmol/L
C. Procalcitonin of 2.5 ng/mL
D. CRP of 45 mg/L
Correct Answer: B. Lactate of 4.8 mmol/L
Rationale: Lactate is the most direct indicator of tissue hypoperfusion and anaerobic metabolism. A
lactate level of 4.8 mmol/L (normal <2.0 mmol/L) indicates severe tissue hypoxia and is a hallmark of
septic shock. The Surviving Sepsis Campaign (2021) guidelines identify lactate ≥2 mmol/L as a key
criterion for initiating the sepsis bundle, and lactate ≥4 mmol/L indicates a high risk of mortality requiring
aggressive fluid resuscitation and vasopressor support. WBC elevation (A) and CRP (D) are nonspecific
inflammatory markers. Procalcitonin (C) is more specific for bacterial infection but does not directly reflect
tissue perfusion status. The nurse must recognize elevated lactate as a critical cue requiring immediate
escalation of care.
3. A nurse on the medical-surgical unit has four patients. Which patient should the nurse
assess FIRST based on the CJMM 'Prioritize Hypotheses' framework?
A. A patient with type 2 diabetes whose blood glucose is 250 mg/dL and is awaiting lunch
B. A patient with heart failure who reports new-onset dyspnea at rest and has gained 3 pounds overnight
C. A patient recovering from appendectomy who is requesting pain medication 4 hours postoperative
D. A patient with pneumonia who has a temperature of 38.3°C (100.9°F) and a productive cough
1
, ATI Critical Thinking Practice Test 1 — 2026/2027
Correct Answer: B. A patient with heart failure who reports new-onset dyspnea at rest and
has gained 3 pounds overnight
Rationale: Using the CJMM Prioritize Hypotheses framework, the nurse must identify the patient whose
condition is most unstable and poses the greatest risk of clinical deterioration. The heart failure patient
with new-onset dyspnea at rest and a 3-pound overnight weight gain (B) is exhibiting signs of acute
decompensated heart failure and fluid overload, which can rapidly progress to pulmonary edema and
respiratory failure. This requires immediate assessment, oxygen therapy, diuretic administration, and
vital sign monitoring. While hyperglycemia (A), postoperative pain (C), and fever with productive cough
(D) all require nursing attention, they are not immediately life-threatening compared to acute respiratory
compromise from heart failure exacerbation.
4. A nurse is applying the CJMM 'Generate Solutions' layer for a patient with a stage III
pressure injury on the coccyx. Which intervention reflects the HIGHEST level of clinical
judgment?
A. Reposition the patient every 2 hours and apply a foam dressing
B. Consult the wound care specialist and initiate a nutrition referral for protein supplementation
C. Document the wound assessment and notify the healthcare provider
D. Clean the wound with normal saline and apply antibiotic ointment
Correct Answer: B. Consult the wound care specialist and initiate a nutrition referral for
protein supplementation
Rationale: The CJMM Generate Solutions layer requires the nurse to go beyond basic interventions and
synthesize clinical data to develop comprehensive, evidence-based care plans. Consulting a wound care
specialist (B) demonstrates advanced clinical judgment by recognizing that a stage III pressure injury
requires specialized expertise and that impaired nutrition (protein deficiency) is a primary contributing
factor to delayed wound healing. The ATI nurse's touch framework emphasizes protein intake of 1.25–1.5
g/kg/day for wound healing. While repositioning (A), documentation (C), and wound care (D) are all
appropriate, option B reflects the highest level of clinical reasoning by addressing both the wound and the
systemic factor impeding healing.
5. Select all that apply. A nurse is evaluating the effectiveness of interventions for a patient
with acute confusion secondary to a urinary tract infection. Which findings indicate that the
'Evaluate Outcomes' layer of the CJMM has been met? [Select All That Apply]
A. The patient correctly states the current date, time, and location
B. The patient's urine culture shows sensitivity to the prescribed antibiotic
C. The patient is able to follow simple commands and converse coherently
D. The patient's temperature has decreased from 38.8°C to 37.2°C
E. The patient refuses to take the prescribed antibiotic due to nausea
Correct Answer: A. The patient correctly states the current date, time, and location, C. The
patient is able to follow simple commands and converse coherently, D. The patient's
temperature has decreased from 38.8°C to 37.2°C
Rationale: The CJMM Evaluate Outcomes layer requires the nurse to determine whether the patient's
condition has improved in response to nursing and medical interventions. Improvement in orientation (A,
correctly stating date, time, and location) and coherent conversation (C, following commands and
speaking logically) directly indicate resolution of acute confusion—the primary clinical concern.
Temperature normalization (D, from 38.8°C to 37.2°C) indicates the underlying infection is responding to
treatment. While a positive urine culture sensitivity (B) is useful laboratory data, it does not reflect a
clinical outcome or improvement in the patient's cognitive status. The patient refusing antibiotics (E)
indicates a negative outcome requiring further intervention, not goal achievement.
6. A nurse is using the NCSBN Clinical Judgment Measurement Model (CJMM) to care for a
patient with chest pain. Place the CJMM cognitive steps in the correct order (1 = first, 6 =
last). [Ordered Response]
1. Recognize clinical cues such as chest pain, diaphoresis, and shortness of breath
2
, ATI Critical Thinking Practice Test 1 — 2026/2027
2. Generate solutions including oxygen, nitroglycerin, and aspirin administration
3. Prioritize hypotheses such as acute coronary syndrome vs pulmonary embolism
4. Take action by implementing the chosen interventions and monitoring the patient
5. Evaluate outcomes including pain relief and changes in vital signs
6. Analyze cues by interpreting vital signs, ECG findings, and cardiac biomarkers
Correct Answer: 1 → 6 → 3 → 2 → 4 → 5
Rationale: The NCSBN CJMM follows six sequential cognitive steps: Recognize Cues (1) involves
identifying relevant clinical data such as chest pain, diaphoresis, and dyspnea. Analyze Cues (6) requires
interpreting and clustering data to determine clinical significance (e.g., analyzing ECG, troponin levels).
Prioritize Hypotheses (3) involves ranking possible diagnoses by likelihood and urgency (e.g., acute MI is
the most urgent hypothesis for substernal chest pain with diaphoresis). Generate Solutions (2) involves
developing evidence-based interventions tailored to the prioritized hypothesis. Take Action (4) is the
implementation of the selected interventions. Evaluate Outcomes (5) is the final step, where the nurse
reassesses the patient to determine the effectiveness of interventions and whether further action is needed.
SECTION II: PRIORITIZATION FRAMEWORKS
7. A nurse is caring for multiple patients on the medical-surgical unit. Using the ABC (Airway-
Breathing-Circulation) framework, which patient should the nurse see FIRST?
A. A patient with a deep vein thrombosis who reports calf pain and swelling
B. A patient with COPD who has oxygen saturations of 88% on room air and audible wheezing
C. A patient with a urinary tract infection who has a temperature of 38.5°C and dysuria
D. A patient with hypokalemia who has muscle weakness and a potassium level of 3.0 mEq/L
Correct Answer: B. A patient with COPD who has oxygen saturations of 88% on room air and
audible wheezing
Rationale: The ABC framework prioritizes Airway, Breathing, and Circulation as the foundation of
patient assessment. The COPD patient with oxygen saturations of 88% (B) has a breathing compromise
that takes highest priority. Oxygen saturation below 90% indicates significant hypoxemia requiring
immediate intervention such as supplemental oxygen, bronchodilator administration, and potential
escalation of care. The DVT patient (A) has a circulation-related concern but it is not immediately life-
threatening. The UTI patient (C) has an infection requiring treatment but is stable. The hypokalemia
patient (D) has an electrolyte imbalance that requires monitoring and replacement but is not immediately
life-threatening at a potassium of 3.0 mEq/L unless cardiac arrhythmias are present.
8. A nurse is prioritizing care for four patients using Maslow's Hierarchy of Needs. Which
patient's need falls under the HIGHEST priority level according to this framework?
A. A patient who expresses anxiety about an upcoming surgical procedure
B. A patient with a new diagnosis of diabetes who needs education about insulin administration
C. A patient with severe dehydration who has dry mucous membranes, tachycardia, and hypotension
D. A patient who is grieving the loss of a spouse and has been withdrawn from social activities
Correct Answer: C. A patient with severe dehydration who has dry mucous membranes,
tachycardia, and hypotension
Rationale: Maslow's Hierarchy of Needs prioritizes physiological needs as the highest level, followed by
safety and security, love and belonging, esteem, and self-actualization. Severe dehydration with dry
mucous membranes, tachycardia, and hypotension (C) represents a physiological need that is immediately
life-threatening and takes the highest priority. Anxiety about surgery (A) is a safety and security need.
Diabetes education (B) is a knowledge need that falls under esteem or self-actualization after basic needs
are met. Grief and social withdrawal (D) represent love and belonging needs. While all patients require
nursing care, physiological needs must be addressed first according to this framework.
9. A nurse receives the following morning laboratory results for four patients. Which result
requires the nurse to contact the healthcare provider FIRST?
3
