2026 ATI RN Predictor Exit Exam Practice Questions
| NGN & Case Scenarios with Rationales, Exams of
Nursing
Section 1: Management of Care, Delegation, & Safety (Questions 1-40)
1. A charge nurse is assigning clients on a medical-surgical unit. Which client should be
assigned to the LPN?
A) A client with new-onset chest pain and ST-segment elevation
B) A client receiving a continuous IV insulin drip for DKA
C) A client with a urinary tract infection (UTI) receiving oral antibiotics
D) A client who is 2 hours post-cardiac arrest with unstable vitals
Answer: C
Rationale: LPNs are licensed to care for stable clients with predictable outcomes.
Administering oral antibiotics for a UTI is within their scope of practice. Options A, B,
and D require the assessment and critical thinking skills of an RN (unstable cardiac,
titratable drips, post-code management).
2. A nurse on a pediatric unit receives a hand-off report for 4 clients. Which client should
the nurse assess first?
A) A 2-year-old with a fever of 38.5°C (101.3°F) who is crying
B) *A 4-year-old with stridor and a barking cough*
C) A 10-year-old who is requesting pain medication for a headache
D) A 12-year-old post-appendectomy who is sleeping
Answer: B
Rationale: Stridor and barking cough indicate potential upper airway obstruction (croup
or epiglottitis), which can rapidly progress to respiratory failure. This is the highest
priority. Fever and crying are non-urgent. Pain medication and stable postoperative
patients can wait.
3. A nurse is preparing to administer a blood transfusion of packed red blood cells
(PRBCs). Which IV site and solution are appropriate?
A) 24-gauge catheter; Lactated Ringers solution
B) 22-gauge catheter; 5% Dextrose in Water (D5W)
C) *20-gauge catheter; 0.9% Normal Saline*
D) 18-gauge catheter; 0.45% Normal Saline
,Answer: C
*Rationale: PRBCs require a large bore (20-gauge or larger) to prevent hemolysis. Only
0.9% Normal Saline is compatible with blood products; Lactated Ringers contains
calcium which can clot the blood, and D5W causes hemolysis.*
4. A client is placed on Contact Precautions for Clostridioides difficile (C. diff). Which
action by the UAP requires immediate intervention?
A) Wearing a gown and gloves before entering the room
B) Placing a "Contact Precautions" sign on the door
C) Using alcohol-based hand rub after removing gloves
D) Disposing of soiled linens in a leak-proof bag
Answer: C
Rationale: C. diff spores are NOT killed by alcohol-based hand rub. The UAP must wash
hands with soap and water (friction and rinsing removes the spores). Option C
significantly increases the risk of transmission to other patients and staff.
5. A nurse is providing discharge teaching to a client prescribed warfarin. Which
statement indicates a need for further teaching?
A) "I will use a soft toothbrush to brush my teeth."
B) "I will eat large amounts of green leafy vegetables every day."
C) "I will report any black, tarry stools to my doctor."
D) "I will wear a medical alert bracelet."
Answer: B
Rationale: Green leafy vegetables are high in Vitamin K, which reverses the effects of
warfarin. Consistency in intake is key, but eating "large amounts" daily will lower the INR
and decrease the therapeutic effect, increasing clot risk.
6. A client is receiving a blood transfusion of PRBCs. Fifteen minutes after the transfusion
begins, the client reports chills and low back pain. BP is 90/50 (down from 120/80). What
is the priority action?
A) Slow the infusion rate and administer acetaminophen
B) Stop the transfusion and hang 0.9% Normal Saline
C) Flush the IV line with heparin to keep it open
D) Increase the infusion rate to finish the bag quickly
Answer: B
Rationale: Chills, fever, and back pain are classic signs of an acute hemolytic transfusion
reaction (ABO incompatibility). The priority is to STOP the transfusion immediately,
,maintain IV access with saline (keep the line open for emergency meds), and notify the
provider.
7. A charge nurse is making assignments. Which client should be assigned to the most
experienced RN?
A) A client with pneumonia requiring IV antibiotics
B) A client with stable angina
C) A client with DKA on an insulin drip
D) A client with a urinary tract infection
Answer: C
Rationale: DKA on an insulin drip requires complex titration of medications based on
frequent glucose monitoring. This unstable client requires the critical thinking and
assessment skills of the most experienced RN. The other clients are stable and could be
assigned to an LPN or less experienced RN.
8. A nurse manager is reviewing protocols for the use of belt restraints. Which guideline
should be included?
A) Apply restraints tightly to prevent the patient from moving
B) Document the client's condition every 15 minutes
C) Obtain a verbal order from the provider within 2 hours
D) Keep restraints on for 8 hours before reassessment
Answer: B
Rationale: Restrained patients require frequent monitoring (every 15 minutes) to assess
circulation, nutrition, hydration, elimination, and to prevent complications such as
aspiration or injury from struggling.
9. A nurse is preparing to administer a PPD (tuberculin skin test). At what angle should
the nurse insert the needle?
A) 5 to 15 degrees
B) 45 degrees
C) 60 degrees
D) 90 degrees
Answer: A
*Rationale: PPD is an intradermal injection. The needle should be inserted at a 5- to 15-
degree angle, bevel up, to create a small bleb (wheal) just under the epidermis. Angles
greater than 45 degrees would enter the subcutaneous tissue.*
10. A home health nurse is caring for a child who has Lyme disease. Which action is
appropriate?
, A) Ensure the state health department has been notified
B) Administer antitoxin
C) Educate the family to avoid sharing personal belongings
D) Assess for skin necrosis
Answer: A
Rationale: Lyme disease is a reportable infectious disease in many states. The nurse must
notify the state health department to ensure proper surveillance and follow-up. Lyme
disease is not contagious through sharing personal belongings, and skin necrosis is not a
typical complication.
11. A nurse is inserting an IV catheter for a 7-year-old child. How should the nurse prepare
the child?
A) Tell the child the IV will feel like a bee sting
B) Tell the child they will feel discomfort during the catheter insertion
C) Hide the supplies from the child to reduce anxiety
D) Tell the child it won't hurt at all
Answer: B
Rationale: Children should be told the truth about procedures in age-appropriate terms.
Telling the child they will feel discomfort prepares them honestly without exaggerating
the pain. The nurse should use developmentally appropriate explanations.
12. A nurse is preparing to administer a transfusion of packed RBCs. What is the correct
procedure for priming the tubing?
A) Prime with 5% Dextrose in water
B) Prime with Lactated Ringer's solution
C) Prime with 0.9% sodium chloride
D) Prime with the blood product directly
Answer: C
Rationale: Only 0.9% normal saline (NS) is compatible with blood products. Dextrose
solutions cause hemolysis of RBCs. Lactated Ringer's contains calcium, which can cause
clotting in the tubing and microaggregate formation.
13. In triage after a disaster, which type of injury should a nurse assign the highest
priority?
A) A patient with a simple fracture of the radius
B) A patient with minor abrasions
C) *A patient with 95% full-thickness body burns*
D) A patient with a sprained ankle
| NGN & Case Scenarios with Rationales, Exams of
Nursing
Section 1: Management of Care, Delegation, & Safety (Questions 1-40)
1. A charge nurse is assigning clients on a medical-surgical unit. Which client should be
assigned to the LPN?
A) A client with new-onset chest pain and ST-segment elevation
B) A client receiving a continuous IV insulin drip for DKA
C) A client with a urinary tract infection (UTI) receiving oral antibiotics
D) A client who is 2 hours post-cardiac arrest with unstable vitals
Answer: C
Rationale: LPNs are licensed to care for stable clients with predictable outcomes.
Administering oral antibiotics for a UTI is within their scope of practice. Options A, B,
and D require the assessment and critical thinking skills of an RN (unstable cardiac,
titratable drips, post-code management).
2. A nurse on a pediatric unit receives a hand-off report for 4 clients. Which client should
the nurse assess first?
A) A 2-year-old with a fever of 38.5°C (101.3°F) who is crying
B) *A 4-year-old with stridor and a barking cough*
C) A 10-year-old who is requesting pain medication for a headache
D) A 12-year-old post-appendectomy who is sleeping
Answer: B
Rationale: Stridor and barking cough indicate potential upper airway obstruction (croup
or epiglottitis), which can rapidly progress to respiratory failure. This is the highest
priority. Fever and crying are non-urgent. Pain medication and stable postoperative
patients can wait.
3. A nurse is preparing to administer a blood transfusion of packed red blood cells
(PRBCs). Which IV site and solution are appropriate?
A) 24-gauge catheter; Lactated Ringers solution
B) 22-gauge catheter; 5% Dextrose in Water (D5W)
C) *20-gauge catheter; 0.9% Normal Saline*
D) 18-gauge catheter; 0.45% Normal Saline
,Answer: C
*Rationale: PRBCs require a large bore (20-gauge or larger) to prevent hemolysis. Only
0.9% Normal Saline is compatible with blood products; Lactated Ringers contains
calcium which can clot the blood, and D5W causes hemolysis.*
4. A client is placed on Contact Precautions for Clostridioides difficile (C. diff). Which
action by the UAP requires immediate intervention?
A) Wearing a gown and gloves before entering the room
B) Placing a "Contact Precautions" sign on the door
C) Using alcohol-based hand rub after removing gloves
D) Disposing of soiled linens in a leak-proof bag
Answer: C
Rationale: C. diff spores are NOT killed by alcohol-based hand rub. The UAP must wash
hands with soap and water (friction and rinsing removes the spores). Option C
significantly increases the risk of transmission to other patients and staff.
5. A nurse is providing discharge teaching to a client prescribed warfarin. Which
statement indicates a need for further teaching?
A) "I will use a soft toothbrush to brush my teeth."
B) "I will eat large amounts of green leafy vegetables every day."
C) "I will report any black, tarry stools to my doctor."
D) "I will wear a medical alert bracelet."
Answer: B
Rationale: Green leafy vegetables are high in Vitamin K, which reverses the effects of
warfarin. Consistency in intake is key, but eating "large amounts" daily will lower the INR
and decrease the therapeutic effect, increasing clot risk.
6. A client is receiving a blood transfusion of PRBCs. Fifteen minutes after the transfusion
begins, the client reports chills and low back pain. BP is 90/50 (down from 120/80). What
is the priority action?
A) Slow the infusion rate and administer acetaminophen
B) Stop the transfusion and hang 0.9% Normal Saline
C) Flush the IV line with heparin to keep it open
D) Increase the infusion rate to finish the bag quickly
Answer: B
Rationale: Chills, fever, and back pain are classic signs of an acute hemolytic transfusion
reaction (ABO incompatibility). The priority is to STOP the transfusion immediately,
,maintain IV access with saline (keep the line open for emergency meds), and notify the
provider.
7. A charge nurse is making assignments. Which client should be assigned to the most
experienced RN?
A) A client with pneumonia requiring IV antibiotics
B) A client with stable angina
C) A client with DKA on an insulin drip
D) A client with a urinary tract infection
Answer: C
Rationale: DKA on an insulin drip requires complex titration of medications based on
frequent glucose monitoring. This unstable client requires the critical thinking and
assessment skills of the most experienced RN. The other clients are stable and could be
assigned to an LPN or less experienced RN.
8. A nurse manager is reviewing protocols for the use of belt restraints. Which guideline
should be included?
A) Apply restraints tightly to prevent the patient from moving
B) Document the client's condition every 15 minutes
C) Obtain a verbal order from the provider within 2 hours
D) Keep restraints on for 8 hours before reassessment
Answer: B
Rationale: Restrained patients require frequent monitoring (every 15 minutes) to assess
circulation, nutrition, hydration, elimination, and to prevent complications such as
aspiration or injury from struggling.
9. A nurse is preparing to administer a PPD (tuberculin skin test). At what angle should
the nurse insert the needle?
A) 5 to 15 degrees
B) 45 degrees
C) 60 degrees
D) 90 degrees
Answer: A
*Rationale: PPD is an intradermal injection. The needle should be inserted at a 5- to 15-
degree angle, bevel up, to create a small bleb (wheal) just under the epidermis. Angles
greater than 45 degrees would enter the subcutaneous tissue.*
10. A home health nurse is caring for a child who has Lyme disease. Which action is
appropriate?
, A) Ensure the state health department has been notified
B) Administer antitoxin
C) Educate the family to avoid sharing personal belongings
D) Assess for skin necrosis
Answer: A
Rationale: Lyme disease is a reportable infectious disease in many states. The nurse must
notify the state health department to ensure proper surveillance and follow-up. Lyme
disease is not contagious through sharing personal belongings, and skin necrosis is not a
typical complication.
11. A nurse is inserting an IV catheter for a 7-year-old child. How should the nurse prepare
the child?
A) Tell the child the IV will feel like a bee sting
B) Tell the child they will feel discomfort during the catheter insertion
C) Hide the supplies from the child to reduce anxiety
D) Tell the child it won't hurt at all
Answer: B
Rationale: Children should be told the truth about procedures in age-appropriate terms.
Telling the child they will feel discomfort prepares them honestly without exaggerating
the pain. The nurse should use developmentally appropriate explanations.
12. A nurse is preparing to administer a transfusion of packed RBCs. What is the correct
procedure for priming the tubing?
A) Prime with 5% Dextrose in water
B) Prime with Lactated Ringer's solution
C) Prime with 0.9% sodium chloride
D) Prime with the blood product directly
Answer: C
Rationale: Only 0.9% normal saline (NS) is compatible with blood products. Dextrose
solutions cause hemolysis of RBCs. Lactated Ringer's contains calcium, which can cause
clotting in the tubing and microaggregate formation.
13. In triage after a disaster, which type of injury should a nurse assign the highest
priority?
A) A patient with a simple fracture of the radius
B) A patient with minor abrasions
C) *A patient with 95% full-thickness body burns*
D) A patient with a sprained ankle
