ATI RN COMPREHENSIVE PREDICTOR
Case Study Breakdown Pack
2026/2027 | 8 Clinical Scenarios with NGN-Style Analysis
PURPOSE: Each case walks you through the ATI/NCLEX Next Generation Nursing (NGN)
critical thinking process: Recognize cues → Analyze → Prioritize → Generate solutions →
Evaluate outcomes.
CASE 01: POST-OP HIP ARTHROPLASTY WITH CALF PAIN
📋 CLINICAL SCENARIO
A 68-year-old male is 2 days’ post right total hip arthroplasty. During morning assessment, he
reports pain and redness in his left calf. Vital signs: T 37.8°C, HR 96, RR 18, BP 128/78. He is
on aspirin 81 mg daily and wears sequential compression devices (SCDs) on both lower
extremities.
TEST QUESTION STEM: Which of the following actions should the nurse take FIRST?
A. Apply a warm pack to the calf to reduce discomfort
B. Remove the SCD from the affected extremity and elevate the leg
C. Notify the provider and anticipate orders for Doppler ultrasound
D. Administer the prescribed PRN ibuprofen for pain
✅ CORRECT ANSWER: C
Pain and erythema in the calf post-arthroplasty = suspected DVT → notify provider immediately
and prepare for diagnostic imaging. Massage is contraindicated. Anti-inflammatory NSAIDs do
not treat DVT. SCDs can remain unless ordered otherwise.
⚡ PRIORITY FRAMEWORK
Airway → Breathing → Circulation → Safety → Pain (ABCsP): This is a circulation/safety
priority.
📚 NCLEX CATEGORY: Safe and Effective Care Environment / Safety and Infection Control
🔄 FOLLOW-UP CRITICAL THINKING QUESTIONS
1. What medication would you anticipate? → Anticoagulant (heparin infusion or enoxaparin)
2. What complication is most feared? → Pulmonary embolism (sudden dyspnea, pleuritic chest
pain, tachycardia)
, 3. What assessment finding would worsen urgency? → New onset tachypnea (assess for PE
first)
CASE 02: PREECLAMPSIA – MAGNESIUM SULFATE TOXICITY
📋 CLINICAL SCENARIO
A 29-year-old primigravida at 36 weeks’ gestation is admitted with blood pressure of 158/106
mm Hg, 3+ proteinuria, and severe headache. She is started on magnesium sulfate IV infusion.
Two hours later, the nurse notes: respirations 10/min, deep tendon reflexes absent, urine output
20 mL in the past hour.
TEST QUESTION STEM: The nurse should take which of the following actions FIRST?
A. Increase the magnesium sulfate infusion rate
B. Discontinue the magnesium sulfate and administer calcium gluconate IV
C. Reposition the client to the left lateral position
D. Insert a Foley catheter to obtain an accurate urine output
✅ CORRECT ANSWER: B
Respirations <12/min + absent DTRs + urine output <30 mL/hr = magnesium toxicity. STOP the
infusion immediately and give calcium gluconate IV (antidote). This is a life-threatening
emergency.
⚡ PRIORITY FRAMEWORK
Toxicity signs: No urine, No reflexes, No breathing (3 Nos = magnesium toxicity emergency)
📚 NCLEX CATEGORY: Physiological Integrity / Pharmacological and Parenteral Therapies
🔄 FOLLOW-UP CRITICAL THINKING QUESTIONS
1. What is the antidote for magnesium sulfate toxicity? → Calcium gluconate IV
2. What DTR finding warns of impending toxicity? → DTRs diminished or absent (loss
of patellar reflex = early warning at 7–10 mEq/L)
Case Study Breakdown Pack
2026/2027 | 8 Clinical Scenarios with NGN-Style Analysis
PURPOSE: Each case walks you through the ATI/NCLEX Next Generation Nursing (NGN)
critical thinking process: Recognize cues → Analyze → Prioritize → Generate solutions →
Evaluate outcomes.
CASE 01: POST-OP HIP ARTHROPLASTY WITH CALF PAIN
📋 CLINICAL SCENARIO
A 68-year-old male is 2 days’ post right total hip arthroplasty. During morning assessment, he
reports pain and redness in his left calf. Vital signs: T 37.8°C, HR 96, RR 18, BP 128/78. He is
on aspirin 81 mg daily and wears sequential compression devices (SCDs) on both lower
extremities.
TEST QUESTION STEM: Which of the following actions should the nurse take FIRST?
A. Apply a warm pack to the calf to reduce discomfort
B. Remove the SCD from the affected extremity and elevate the leg
C. Notify the provider and anticipate orders for Doppler ultrasound
D. Administer the prescribed PRN ibuprofen for pain
✅ CORRECT ANSWER: C
Pain and erythema in the calf post-arthroplasty = suspected DVT → notify provider immediately
and prepare for diagnostic imaging. Massage is contraindicated. Anti-inflammatory NSAIDs do
not treat DVT. SCDs can remain unless ordered otherwise.
⚡ PRIORITY FRAMEWORK
Airway → Breathing → Circulation → Safety → Pain (ABCsP): This is a circulation/safety
priority.
📚 NCLEX CATEGORY: Safe and Effective Care Environment / Safety and Infection Control
🔄 FOLLOW-UP CRITICAL THINKING QUESTIONS
1. What medication would you anticipate? → Anticoagulant (heparin infusion or enoxaparin)
2. What complication is most feared? → Pulmonary embolism (sudden dyspnea, pleuritic chest
pain, tachycardia)
, 3. What assessment finding would worsen urgency? → New onset tachypnea (assess for PE
first)
CASE 02: PREECLAMPSIA – MAGNESIUM SULFATE TOXICITY
📋 CLINICAL SCENARIO
A 29-year-old primigravida at 36 weeks’ gestation is admitted with blood pressure of 158/106
mm Hg, 3+ proteinuria, and severe headache. She is started on magnesium sulfate IV infusion.
Two hours later, the nurse notes: respirations 10/min, deep tendon reflexes absent, urine output
20 mL in the past hour.
TEST QUESTION STEM: The nurse should take which of the following actions FIRST?
A. Increase the magnesium sulfate infusion rate
B. Discontinue the magnesium sulfate and administer calcium gluconate IV
C. Reposition the client to the left lateral position
D. Insert a Foley catheter to obtain an accurate urine output
✅ CORRECT ANSWER: B
Respirations <12/min + absent DTRs + urine output <30 mL/hr = magnesium toxicity. STOP the
infusion immediately and give calcium gluconate IV (antidote). This is a life-threatening
emergency.
⚡ PRIORITY FRAMEWORK
Toxicity signs: No urine, No reflexes, No breathing (3 Nos = magnesium toxicity emergency)
📚 NCLEX CATEGORY: Physiological Integrity / Pharmacological and Parenteral Therapies
🔄 FOLLOW-UP CRITICAL THINKING QUESTIONS
1. What is the antidote for magnesium sulfate toxicity? → Calcium gluconate IV
2. What DTR finding warns of impending toxicity? → DTRs diminished or absent (loss
of patellar reflex = early warning at 7–10 mEq/L)
