ATI Comprehensive Predictor Exam Updated 2026 – Complete Nursing
School Exit Exam Practice Test, Verified Questions with Detailed
Rationales, NGN Next Generation NCLEX Preparation, Medical-Surgical
Nursing, Pharmacology, Maternal Newborn, Pediatric, Mental Health,
Leadership & Critical Thinking Review for NCLEX-RN Success and High-
Score Readiness
Question 1: A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. The client reports sudden onset of shortness of breath and chest pain. Which
action should the nurse take first?
A. Administer prescribed oxygen via nasal cannula
B. Notify the provider immediately
C. Assess the client's oxygen saturation level
D. Elevate the head of the bed to 45 degrees
CORRECT ANSWER: C. Assess the client's oxygen saturation level
Rationale: The nurse must first assess the client to gather objective data before implementing
interventions or notifying the provider. Assessing oxygen saturation provides critical information
about the severity of the respiratory compromise and guides subsequent actions. This follows
the nursing process: assessment precedes intervention.
Question 2: A nurse is preparing to administer digoxin 0.125 mg PO to a client with heart
failure. The client's apical pulse is 58 beats per minute. Which action should the nurse
take?
A. Administer the medication as prescribed
B. Hold the medication and notify the provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes
CORRECT ANSWER: B. Hold the medication and notify the provider
Rationale: Digoxin is contraindicated when the apical pulse is below 60 beats per minute in
adults due to the risk of severe bradycardia and heart block. The nurse must hold the dose and
notify the provider for further instructions, as administering digoxin with a low heart rate can
cause life-threatening dysrhythmias.
Question 3: A nurse is caring for a client who has a new prescription for warfarin. Which
statement by the client indicates a need for further teaching?
A. "I will use an electric razor when shaving."
B. "I will avoid eating large amounts of green leafy vegetables."
C. "I will take ibuprofen for headaches as needed."
D. "I will report any unusual bruising or bleeding."
CORRECT ANSWER: C. "I will take ibuprofen for headaches as needed."
Rationale: Ibuprofen and other NSAIDs increase the risk of bleeding when taken with warfarin
by inhibiting platelet function and irritating the gastric mucosa. The client should use
acetaminophen for pain relief instead. Statements A, B, and D reflect appropriate
understanding of warfarin therapy.
,Question 4: A nurse is assessing a client who is receiving a blood transfusion. Which
finding indicates a possible hemolytic transfusion reaction?
A. Temperature of 37.8°C (100°F)
B. Flushing and itching of the skin
C. Low back pain and chills
D. Mild shortness of breath
CORRECT ANSWER: C. Low back pain and chills
Rationale: Low back pain, chills, fever, and hypotension are classic signs of an acute hemolytic
transfusion reaction, which occurs due to ABO incompatibility. This is a medical emergency
requiring immediate cessation of the transfusion. Flushing and itching suggest a mild allergic
reaction, while low-grade fever may indicate febrile non-hemolytic reaction.
Question 5: A nurse is caring for a client with a chest tube connected to a closed drainage
system. The nurse notes continuous bubbling in the water seal chamber. What is the
priority action?
A. Clamp the chest tube immediately
B. Document the finding as expected
C. Assess the system for an air leak
D. Increase the suction pressure
CORRECT ANSWER: C. Assess the system for an air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which could be at a connection site or within the pleural space. The nurse must assess the
entire system to locate and address the leak. Clamping a chest tube without a provider order
can cause tension pneumothorax and is contraindicated.
Question 6: A nurse is teaching a client with type 1 diabetes mellitus about sick-day
management. Which instruction should the nurse include?
A. "Hold your insulin if you are unable to eat."
B. "Check your blood glucose every 4 hours."
C. "Avoid drinking fluids to prevent nausea."
D. "Test your urine for ketones only if you feel dizzy."
CORRECT ANSWER: B. "Check your blood glucose every 4 hours."
Rationale: During illness, clients with type 1 diabetes should monitor blood glucose every 3-4
hours because stress hormones can elevate glucose levels even with reduced oral intake.
Insulin should never be withheld, as this increases the risk of diabetic ketoacidosis. Clients
should maintain hydration and test for ketones when blood glucose exceeds 240 mg/dL.
Question 7: A nurse is caring for a client who is experiencing an acute asthma attack.
Which medication should the nurse anticipate administering first?
A. Ipratropium bromide
B. Fluticasone propionate
C. Albuterol sulfate
D. Montelukast
,CORRECT ANSWER: C. Albuterol sulfate
Rationale: Albuterol, a short-acting beta-2 agonist, is the first-line medication for acute asthma
exacerbations because it provides rapid bronchodilation. Ipratropium may be added for
moderate to severe attacks, but albuterol is prioritized. Fluticasone and montelukast are
maintenance medications and do not provide immediate relief during an acute attack.
Question 8: A nurse is preparing to administer a scheduled dose of enoxaparin to a client
who is postoperative. Which action should the nurse take?
A. Aspirate before injecting the medication
B. Massage the injection site after administration
C. Administer the medication into the abdomen
D. Use a 22-gauge needle for the injection
CORRECT ANSWER: C. Administer the medication into the abdomen
Rationale: Enoxaparin, a low-molecular-weight heparin, should be administered
subcutaneously into the abdomen, at least 2 inches from the umbilicus, to ensure consistent
absorption. Aspiration is not recommended for subcutaneous injections, and massaging the
site can increase bruising. A 25- to 27-gauge needle is appropriate for subcutaneous
administration.
Question 9: A nurse is caring for a client with a suspected stroke. Which assessment
finding should the nurse report to the provider immediately?
A. Facial droop on the right side
B. Slurred speech
C. Sudden severe headache
D. Weakness in the left arm
CORRECT ANSWER: C. Sudden severe headache
Rationale: A sudden severe headache may indicate a hemorrhagic stroke, which requires
immediate intervention to prevent further neurological damage. While facial droop, slurred
speech, and weakness are classic stroke signs (FAST assessment), a thunderclap headache
specifically suggests intracranial bleeding and warrants urgent evaluation and possible
neurosurgical consultation.
Question 10: A nurse is caring for a client who is receiving total parenteral nutrition (TPN)
through a central venous catheter. Which action should the nurse take to reduce the risk of
infection?
A. Change the TPN tubing every 72 hours
B. Use sterile technique when accessing the catheter
C. Administer prophylactic antibiotics daily
D. Flush the catheter with heparin before each use
CORRECT ANSWER: B. Use sterile technique when accessing the catheter
Rationale: Central venous catheters used for TPN are high-risk for catheter-related
bloodstream infections. Using strict sterile technique during all catheter access procedures is
the most effective intervention to prevent infection. TPN tubing should be changed every 24
hours, not 72. Prophylactic antibiotics are not indicated and may promote resistance.
, Question 11: A nurse is assessing a client who has a potassium level of 2.9 mEq/L. Which
electrocardiogram (ECG) change should the nurse anticipate?
A. Peaked T waves
B. Widened QRS complex
C. U waves
D. Shortened QT interval
CORRECT ANSWER: C. U waves
Rationale: Hypokalemia (potassium <3.5 mEq/L) commonly causes U waves on ECG, along
with flattened T waves, ST depression, and prolonged QT interval. Peaked T waves and widened
QRS are associated with hyperkalemia. Recognizing these ECG changes is critical for early
intervention to prevent life-threatening dysrhythmias.
Question 12: A nurse is caring for a client who is 30 minutes postoperative following a
thyroidectomy. Which assessment finding requires immediate intervention?
A. Hoarseness of voice
B. Tingling around the mouth
C. Mild neck swelling
D. Temperature of 37.5°C (99.5°F)
CORRECT ANSWER: B. Tingling around the mouth
Rationale: Tingling around the mouth, fingers, or toes indicates hypocalcemia due to
accidental removal or damage to the parathyroid glands during thyroidectomy. This can
progress to tetany, laryngospasm, or seizures if untreated. Hoarseness may indicate recurrent
laryngeal nerve injury but is less urgent. Mild swelling and low-grade fever are expected
postoperatively.
Question 13: A nurse is teaching a client about dietary modifications for hypertension.
Which food choice by the client indicates understanding?
A. Canned soup
B. Pickled vegetables
C. Fresh fruits and vegetables
D. Processed cheese
CORRECT ANSWER: C. Fresh fruits and vegetables
Rationale: Fresh fruits and vegetables are naturally low in sodium and rich in potassium, which
supports blood pressure control. Canned soups, pickled vegetables, and processed cheeses
are high in sodium and should be limited in a hypertension diet. The DASH diet emphasizes
whole foods and reduced sodium intake.
Question 14: A nurse is caring for a client with a closed head injury. Which assessment
finding indicates increasing intracranial pressure (ICP)?
A. Pupils equal and reactive to light
B. Blood pressure 110/70 mm Hg
C. Heart rate 98 beats per minute
D. Widening pulse pressure
School Exit Exam Practice Test, Verified Questions with Detailed
Rationales, NGN Next Generation NCLEX Preparation, Medical-Surgical
Nursing, Pharmacology, Maternal Newborn, Pediatric, Mental Health,
Leadership & Critical Thinking Review for NCLEX-RN Success and High-
Score Readiness
Question 1: A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. The client reports sudden onset of shortness of breath and chest pain. Which
action should the nurse take first?
A. Administer prescribed oxygen via nasal cannula
B. Notify the provider immediately
C. Assess the client's oxygen saturation level
D. Elevate the head of the bed to 45 degrees
CORRECT ANSWER: C. Assess the client's oxygen saturation level
Rationale: The nurse must first assess the client to gather objective data before implementing
interventions or notifying the provider. Assessing oxygen saturation provides critical information
about the severity of the respiratory compromise and guides subsequent actions. This follows
the nursing process: assessment precedes intervention.
Question 2: A nurse is preparing to administer digoxin 0.125 mg PO to a client with heart
failure. The client's apical pulse is 58 beats per minute. Which action should the nurse
take?
A. Administer the medication as prescribed
B. Hold the medication and notify the provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes
CORRECT ANSWER: B. Hold the medication and notify the provider
Rationale: Digoxin is contraindicated when the apical pulse is below 60 beats per minute in
adults due to the risk of severe bradycardia and heart block. The nurse must hold the dose and
notify the provider for further instructions, as administering digoxin with a low heart rate can
cause life-threatening dysrhythmias.
Question 3: A nurse is caring for a client who has a new prescription for warfarin. Which
statement by the client indicates a need for further teaching?
A. "I will use an electric razor when shaving."
B. "I will avoid eating large amounts of green leafy vegetables."
C. "I will take ibuprofen for headaches as needed."
D. "I will report any unusual bruising or bleeding."
CORRECT ANSWER: C. "I will take ibuprofen for headaches as needed."
Rationale: Ibuprofen and other NSAIDs increase the risk of bleeding when taken with warfarin
by inhibiting platelet function and irritating the gastric mucosa. The client should use
acetaminophen for pain relief instead. Statements A, B, and D reflect appropriate
understanding of warfarin therapy.
,Question 4: A nurse is assessing a client who is receiving a blood transfusion. Which
finding indicates a possible hemolytic transfusion reaction?
A. Temperature of 37.8°C (100°F)
B. Flushing and itching of the skin
C. Low back pain and chills
D. Mild shortness of breath
CORRECT ANSWER: C. Low back pain and chills
Rationale: Low back pain, chills, fever, and hypotension are classic signs of an acute hemolytic
transfusion reaction, which occurs due to ABO incompatibility. This is a medical emergency
requiring immediate cessation of the transfusion. Flushing and itching suggest a mild allergic
reaction, while low-grade fever may indicate febrile non-hemolytic reaction.
Question 5: A nurse is caring for a client with a chest tube connected to a closed drainage
system. The nurse notes continuous bubbling in the water seal chamber. What is the
priority action?
A. Clamp the chest tube immediately
B. Document the finding as expected
C. Assess the system for an air leak
D. Increase the suction pressure
CORRECT ANSWER: C. Assess the system for an air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which could be at a connection site or within the pleural space. The nurse must assess the
entire system to locate and address the leak. Clamping a chest tube without a provider order
can cause tension pneumothorax and is contraindicated.
Question 6: A nurse is teaching a client with type 1 diabetes mellitus about sick-day
management. Which instruction should the nurse include?
A. "Hold your insulin if you are unable to eat."
B. "Check your blood glucose every 4 hours."
C. "Avoid drinking fluids to prevent nausea."
D. "Test your urine for ketones only if you feel dizzy."
CORRECT ANSWER: B. "Check your blood glucose every 4 hours."
Rationale: During illness, clients with type 1 diabetes should monitor blood glucose every 3-4
hours because stress hormones can elevate glucose levels even with reduced oral intake.
Insulin should never be withheld, as this increases the risk of diabetic ketoacidosis. Clients
should maintain hydration and test for ketones when blood glucose exceeds 240 mg/dL.
Question 7: A nurse is caring for a client who is experiencing an acute asthma attack.
Which medication should the nurse anticipate administering first?
A. Ipratropium bromide
B. Fluticasone propionate
C. Albuterol sulfate
D. Montelukast
,CORRECT ANSWER: C. Albuterol sulfate
Rationale: Albuterol, a short-acting beta-2 agonist, is the first-line medication for acute asthma
exacerbations because it provides rapid bronchodilation. Ipratropium may be added for
moderate to severe attacks, but albuterol is prioritized. Fluticasone and montelukast are
maintenance medications and do not provide immediate relief during an acute attack.
Question 8: A nurse is preparing to administer a scheduled dose of enoxaparin to a client
who is postoperative. Which action should the nurse take?
A. Aspirate before injecting the medication
B. Massage the injection site after administration
C. Administer the medication into the abdomen
D. Use a 22-gauge needle for the injection
CORRECT ANSWER: C. Administer the medication into the abdomen
Rationale: Enoxaparin, a low-molecular-weight heparin, should be administered
subcutaneously into the abdomen, at least 2 inches from the umbilicus, to ensure consistent
absorption. Aspiration is not recommended for subcutaneous injections, and massaging the
site can increase bruising. A 25- to 27-gauge needle is appropriate for subcutaneous
administration.
Question 9: A nurse is caring for a client with a suspected stroke. Which assessment
finding should the nurse report to the provider immediately?
A. Facial droop on the right side
B. Slurred speech
C. Sudden severe headache
D. Weakness in the left arm
CORRECT ANSWER: C. Sudden severe headache
Rationale: A sudden severe headache may indicate a hemorrhagic stroke, which requires
immediate intervention to prevent further neurological damage. While facial droop, slurred
speech, and weakness are classic stroke signs (FAST assessment), a thunderclap headache
specifically suggests intracranial bleeding and warrants urgent evaluation and possible
neurosurgical consultation.
Question 10: A nurse is caring for a client who is receiving total parenteral nutrition (TPN)
through a central venous catheter. Which action should the nurse take to reduce the risk of
infection?
A. Change the TPN tubing every 72 hours
B. Use sterile technique when accessing the catheter
C. Administer prophylactic antibiotics daily
D. Flush the catheter with heparin before each use
CORRECT ANSWER: B. Use sterile technique when accessing the catheter
Rationale: Central venous catheters used for TPN are high-risk for catheter-related
bloodstream infections. Using strict sterile technique during all catheter access procedures is
the most effective intervention to prevent infection. TPN tubing should be changed every 24
hours, not 72. Prophylactic antibiotics are not indicated and may promote resistance.
, Question 11: A nurse is assessing a client who has a potassium level of 2.9 mEq/L. Which
electrocardiogram (ECG) change should the nurse anticipate?
A. Peaked T waves
B. Widened QRS complex
C. U waves
D. Shortened QT interval
CORRECT ANSWER: C. U waves
Rationale: Hypokalemia (potassium <3.5 mEq/L) commonly causes U waves on ECG, along
with flattened T waves, ST depression, and prolonged QT interval. Peaked T waves and widened
QRS are associated with hyperkalemia. Recognizing these ECG changes is critical for early
intervention to prevent life-threatening dysrhythmias.
Question 12: A nurse is caring for a client who is 30 minutes postoperative following a
thyroidectomy. Which assessment finding requires immediate intervention?
A. Hoarseness of voice
B. Tingling around the mouth
C. Mild neck swelling
D. Temperature of 37.5°C (99.5°F)
CORRECT ANSWER: B. Tingling around the mouth
Rationale: Tingling around the mouth, fingers, or toes indicates hypocalcemia due to
accidental removal or damage to the parathyroid glands during thyroidectomy. This can
progress to tetany, laryngospasm, or seizures if untreated. Hoarseness may indicate recurrent
laryngeal nerve injury but is less urgent. Mild swelling and low-grade fever are expected
postoperatively.
Question 13: A nurse is teaching a client about dietary modifications for hypertension.
Which food choice by the client indicates understanding?
A. Canned soup
B. Pickled vegetables
C. Fresh fruits and vegetables
D. Processed cheese
CORRECT ANSWER: C. Fresh fruits and vegetables
Rationale: Fresh fruits and vegetables are naturally low in sodium and rich in potassium, which
supports blood pressure control. Canned soups, pickled vegetables, and processed cheeses
are high in sodium and should be limited in a hypertension diet. The DASH diet emphasizes
whole foods and reduced sodium intake.
Question 14: A nurse is caring for a client with a closed head injury. Which assessment
finding indicates increasing intracranial pressure (ICP)?
A. Pupils equal and reactive to light
B. Blood pressure 110/70 mm Hg
C. Heart rate 98 beats per minute
D. Widening pulse pressure
