ATI ASSESSMENT TECHNOLOGIES INSTITUTE
ATI Critical Thinking
Proctored Exam
Official Practice Exam · 2026/2027 Edition
Questions: 50 Minutes: 60 Passing Score: 80% Format: NGN
TABLE OF CONTENTS
Section 1: Analysis & Interpretation (Q1-Q15)
Section 2: Evaluation & Explanation (Q16-Q28)
Section 3: Inference & Deduction (Q29-Q40)
Section 4: Clinical Judgment & Application (Q41-Q50)
INSTRUCTIONS
Read each question carefully. Select the one best answer from the four options provided. This exam assesses your
ability to analyze clinical data, evaluate evidence, draw valid inferences, and apply clinical judgment in patient care
scenarios. Each question includes a rationale explaining the correct answer and why the most commonly chosen
incorrect answer is wrong. A passing score of 80% or higher is required. Manage your time carefully - you have 60
minutes to complete all 50 questions.
ATI Critical Thinking — 2026/2027 | Passing Score: 80% | Page 1 of 27
, Section 1: Analysis & Interpretation - 2026/2027
Q1 Question 1 of 50
A 72-year-old male with heart failure is admitted with worsening dyspnea, bilateral crackles,
and a weight gain of 6 pounds over 3 days. His BNP level is 1,200 pg/mL and his oxygen
saturation is 89% on room air. When analyzing these findings, the nurse should interpret that
this patient is experiencing which physiological process?
A. Fluid volume excess secondary to decreased cardiac output and venous congestion
B. Fluid volume deficit resulting from excessive diuretic therapy and renal losses
C. Impaired gas exchange due to alveolar hypoventilation from CNS depression
D. Decreased cardiac output from hypovolemia and inadequate intravascular volume
Correct Answer: A
Rationale:
The weight gain, bilateral crackles, elevated BNP, and dyspnea all indicate fluid volume excess caused by
the heart's inability to effectively pump blood forward, leading to venous congestion and fluid backup into
the lungs. Fluid volume deficit would present with weight loss, dry mucous membranes, and decreased
BNP.
Q2 Question 2 of 50
A nurse reviews a patient's morning laboratory results and notes a serum potassium of 5.9
mEq/L, BUN of 35 mg/dL, and creatinine of 2.8 mg/dL. The patient is taking lisinopril 20 mg
daily and spironolactone 50 mg daily. The nurse's analysis of these findings should lead to
which conclusion?
A. The patient has developed acute kidney injury with hyperkalemia likely exacerbated by
current medications
B. The laboratory values are within expected ranges for a patient on these medications
C. The elevated potassium is solely due to dietary intake and requires nutritional counseling
D. The BUN and creatinine elevation indicates dehydration requiring increased fluid intake
Correct Answer: A
Rationale:
The elevated BUN and creatinine indicate renal impairment, and both lisinopril (ACE inhibitor) and
spironolactone (potassium-sparing diuretic) can cause hyperkalemia, especially in the setting of renal
dysfunction. This combination requires immediate physician notification and medication review, as the
hyperkalemia is potentially life-threatening.
ATI Critical Thinking — 2026/2027 | Passing Score: 80% | Page 2 of 27
, Q3 Question 3 of 50
A 45-year-old female presents with fatigue, pallor, and a hemoglobin of 7.8 g/dL. Her MCV is
72 fL, MCHC is 28%, and her serum ferritin is 8 ng/mL. When interpreting these laboratory
values, the nurse should recognize these findings as most consistent with which condition?
A. Iron deficiency anemia with microcytic hypochromic red blood cell characteristics
B. Vitamin B12 deficiency anemia with macrocytic red blood cell morphology
C. Autoimmune hemolytic anemia with normocytic normochromic presentation
D. Thalassemia minor with microcytic red blood cells and elevated ferritin levels
Correct Answer: A
Rationale:
The low hemoglobin, decreased MCV (microcytic), decreased MCHC (hypochromic), and severely depleted
ferritin levels are the hallmark laboratory findings of iron deficiency anemia. Vitamin B12 deficiency
produces macrocytic (high MCV) cells, and thalassemia shows microcytosis but typically with normal or
elevated ferritin.
Q4 Question 4 of 50
A 68-year-old male with COPD has an arterial blood gas (ABG) result showing pH 7.33,
PaCO2 58 mmHg, PaO2 62 mmHg, and HCO3 32 mEq/L. The nurse should interpret these
ABG values as indicating which acid-base imbalance?
A. Partially compensated respiratory acidosis with renal bicarbonate retention
B. Uncompensated respiratory acidosis with elevated carbon dioxide retention
C. Fully compensated metabolic acidosis with secondary respiratory compensation
D. Respiratory alkalosis with metabolic compensation through bicarbonate excretion
Correct Answer: A
Rationale:
The low pH (acidosis), elevated PaCO2 (respiratory cause), and elevated HCO3 (kidneys compensating by
retaining bicarbonate) indicate partially compensated respiratory acidosis. In COPD, chronic CO2 retention
leads to this pattern as the kidneys slowly compensate by conserving bicarbonate. Full compensation would
show a normal pH.
ATI Critical Thinking — 2026/2027 | Passing Score: 80% | Page 3 of 27
ATI Critical Thinking
Proctored Exam
Official Practice Exam · 2026/2027 Edition
Questions: 50 Minutes: 60 Passing Score: 80% Format: NGN
TABLE OF CONTENTS
Section 1: Analysis & Interpretation (Q1-Q15)
Section 2: Evaluation & Explanation (Q16-Q28)
Section 3: Inference & Deduction (Q29-Q40)
Section 4: Clinical Judgment & Application (Q41-Q50)
INSTRUCTIONS
Read each question carefully. Select the one best answer from the four options provided. This exam assesses your
ability to analyze clinical data, evaluate evidence, draw valid inferences, and apply clinical judgment in patient care
scenarios. Each question includes a rationale explaining the correct answer and why the most commonly chosen
incorrect answer is wrong. A passing score of 80% or higher is required. Manage your time carefully - you have 60
minutes to complete all 50 questions.
ATI Critical Thinking — 2026/2027 | Passing Score: 80% | Page 1 of 27
, Section 1: Analysis & Interpretation - 2026/2027
Q1 Question 1 of 50
A 72-year-old male with heart failure is admitted with worsening dyspnea, bilateral crackles,
and a weight gain of 6 pounds over 3 days. His BNP level is 1,200 pg/mL and his oxygen
saturation is 89% on room air. When analyzing these findings, the nurse should interpret that
this patient is experiencing which physiological process?
A. Fluid volume excess secondary to decreased cardiac output and venous congestion
B. Fluid volume deficit resulting from excessive diuretic therapy and renal losses
C. Impaired gas exchange due to alveolar hypoventilation from CNS depression
D. Decreased cardiac output from hypovolemia and inadequate intravascular volume
Correct Answer: A
Rationale:
The weight gain, bilateral crackles, elevated BNP, and dyspnea all indicate fluid volume excess caused by
the heart's inability to effectively pump blood forward, leading to venous congestion and fluid backup into
the lungs. Fluid volume deficit would present with weight loss, dry mucous membranes, and decreased
BNP.
Q2 Question 2 of 50
A nurse reviews a patient's morning laboratory results and notes a serum potassium of 5.9
mEq/L, BUN of 35 mg/dL, and creatinine of 2.8 mg/dL. The patient is taking lisinopril 20 mg
daily and spironolactone 50 mg daily. The nurse's analysis of these findings should lead to
which conclusion?
A. The patient has developed acute kidney injury with hyperkalemia likely exacerbated by
current medications
B. The laboratory values are within expected ranges for a patient on these medications
C. The elevated potassium is solely due to dietary intake and requires nutritional counseling
D. The BUN and creatinine elevation indicates dehydration requiring increased fluid intake
Correct Answer: A
Rationale:
The elevated BUN and creatinine indicate renal impairment, and both lisinopril (ACE inhibitor) and
spironolactone (potassium-sparing diuretic) can cause hyperkalemia, especially in the setting of renal
dysfunction. This combination requires immediate physician notification and medication review, as the
hyperkalemia is potentially life-threatening.
ATI Critical Thinking — 2026/2027 | Passing Score: 80% | Page 2 of 27
, Q3 Question 3 of 50
A 45-year-old female presents with fatigue, pallor, and a hemoglobin of 7.8 g/dL. Her MCV is
72 fL, MCHC is 28%, and her serum ferritin is 8 ng/mL. When interpreting these laboratory
values, the nurse should recognize these findings as most consistent with which condition?
A. Iron deficiency anemia with microcytic hypochromic red blood cell characteristics
B. Vitamin B12 deficiency anemia with macrocytic red blood cell morphology
C. Autoimmune hemolytic anemia with normocytic normochromic presentation
D. Thalassemia minor with microcytic red blood cells and elevated ferritin levels
Correct Answer: A
Rationale:
The low hemoglobin, decreased MCV (microcytic), decreased MCHC (hypochromic), and severely depleted
ferritin levels are the hallmark laboratory findings of iron deficiency anemia. Vitamin B12 deficiency
produces macrocytic (high MCV) cells, and thalassemia shows microcytosis but typically with normal or
elevated ferritin.
Q4 Question 4 of 50
A 68-year-old male with COPD has an arterial blood gas (ABG) result showing pH 7.33,
PaCO2 58 mmHg, PaO2 62 mmHg, and HCO3 32 mEq/L. The nurse should interpret these
ABG values as indicating which acid-base imbalance?
A. Partially compensated respiratory acidosis with renal bicarbonate retention
B. Uncompensated respiratory acidosis with elevated carbon dioxide retention
C. Fully compensated metabolic acidosis with secondary respiratory compensation
D. Respiratory alkalosis with metabolic compensation through bicarbonate excretion
Correct Answer: A
Rationale:
The low pH (acidosis), elevated PaCO2 (respiratory cause), and elevated HCO3 (kidneys compensating by
retaining bicarbonate) indicate partially compensated respiratory acidosis. In COPD, chronic CO2 retention
leads to this pattern as the kidneys slowly compensate by conserving bicarbonate. Full compensation would
show a normal pH.
ATI Critical Thinking — 2026/2027 | Passing Score: 80% | Page 3 of 27
