Ultimate ATI RN Comprehensive Predictor 2026 Study Guide: 150 NCLEX-Style Practice Questions with
Answers & Rationales Covering Med-Surg, Pharmacology, Pediatrics, Mental Health, Leadership,
Fundamentals, and Priority Nursing Care Concepts
Question 1
A nurse is caring for a client with heart failure. Which lab value requires immediate intervention?
A) Potassium 4.0 mEq/L
B) BNP 100 pg/mL
C) Creatinine 1.2 mg/dL
D) Potassium 5.9 mEq/L
Correct Answer: D
Rationale: Hyperkalemia (K+ >5.0 mEq/L) increases the risk of life-threatening cardiac arrhythmias, especially in heart
failure patients taking ACE inhibitors or ARBs. Normal potassium is 3.5-5.0. BNP 100 is mildly elevated but not
emergent. Creatinine 1.2 is within normal range.
,Question 2
A toddler is prescribed amoxicillin for otitis media. The parent asks why the full bottle must be finished. Best
response?
A) To prevent superinfection
B) To reduce antibiotic resistance
C) To ensure complete eradication of bacteria
D) To decrease fever faster
Correct Answer: C
Rationale: Completing the full course of antibiotics ensures complete eradication of the causative bacteria. Stopping
early may leave residual bacteria, leading to recurrence and contributing to antibiotic resistance.
,Question 3
A nurse manager observes a staff nurse documenting "patient angry and uncooperative." What action is best?
A) Praise the nurse for detail
B) Tell the nurse to use only objective terms
C) File a disciplinary report
D) Ignore it as minor
Correct Answer: B
Rationale: Documentation must be objective, factual, and non-judgmental. The nurse should document specific
behaviors (e.g., "patient stated, 'I am angry' and refused to participate in care") rather than subjective labels.
, Question 4
Which client should a charge nurse assign to an LPN?
A) New MI with chest pain
B) Post-op day 3 hip replacement, stable
C) New stroke with dysphagia
D) Septic shock on vasopressors
Correct Answer: B
Rationale: LPNs can care for stable clients with predictable outcomes and unchanged conditions. Unstable patients
(new MI, new stroke, septic shock) require RN assessment and management.
Question 5
A client with schizophrenia says, "The FBI is poisoning my food." Best therapeutic response?
A) "That’s not true, the FBI isn't here."
B) "You seem frightened. Tell me more about that."
C) "Let's talk about something else."
D) "I will check your food for poison."
Correct Answer: B
Rationale: This response acknowledges the client's feelings without reinforcing the delusion. It uses therapeutic
communication techniques of validation and open-ended exploration. Option A argues with the delusion; option D
reinforces it.
Question 6
A nurse administers digoxin to a patient with HR 52. Next action?
A) Give the medication as ordered
B) Hold the dose and reassess in 30 minutes
C) Hold the dose and notify the provider
D) Give atropine first
Correct Answer: C
Rationale: Digoxin is typically held for heart rate <60 bpm in adults (or per facility protocol) to prevent digoxin toxicity.
The provider should be notified for further orders.
Question 7
A preschooler is admitted with dehydration. Which IV fluid is preferred?
A) D5W
B) 0.9% NS with 20 mEq KCl/L
C) 0.45% NS
D) 3% NS
Correct Answer: B
Rationale: Isotonic saline (0.9% NS) with potassium (after urine output is confirmed) corrects dehydration and
electrolyte losses. D5W is hypotonic; 0.45% NS is hypotonic; 3% NS is hypertonic and used for severe hyponatremia
only.
Question 8
Answers & Rationales Covering Med-Surg, Pharmacology, Pediatrics, Mental Health, Leadership,
Fundamentals, and Priority Nursing Care Concepts
Question 1
A nurse is caring for a client with heart failure. Which lab value requires immediate intervention?
A) Potassium 4.0 mEq/L
B) BNP 100 pg/mL
C) Creatinine 1.2 mg/dL
D) Potassium 5.9 mEq/L
Correct Answer: D
Rationale: Hyperkalemia (K+ >5.0 mEq/L) increases the risk of life-threatening cardiac arrhythmias, especially in heart
failure patients taking ACE inhibitors or ARBs. Normal potassium is 3.5-5.0. BNP 100 is mildly elevated but not
emergent. Creatinine 1.2 is within normal range.
,Question 2
A toddler is prescribed amoxicillin for otitis media. The parent asks why the full bottle must be finished. Best
response?
A) To prevent superinfection
B) To reduce antibiotic resistance
C) To ensure complete eradication of bacteria
D) To decrease fever faster
Correct Answer: C
Rationale: Completing the full course of antibiotics ensures complete eradication of the causative bacteria. Stopping
early may leave residual bacteria, leading to recurrence and contributing to antibiotic resistance.
,Question 3
A nurse manager observes a staff nurse documenting "patient angry and uncooperative." What action is best?
A) Praise the nurse for detail
B) Tell the nurse to use only objective terms
C) File a disciplinary report
D) Ignore it as minor
Correct Answer: B
Rationale: Documentation must be objective, factual, and non-judgmental. The nurse should document specific
behaviors (e.g., "patient stated, 'I am angry' and refused to participate in care") rather than subjective labels.
, Question 4
Which client should a charge nurse assign to an LPN?
A) New MI with chest pain
B) Post-op day 3 hip replacement, stable
C) New stroke with dysphagia
D) Septic shock on vasopressors
Correct Answer: B
Rationale: LPNs can care for stable clients with predictable outcomes and unchanged conditions. Unstable patients
(new MI, new stroke, septic shock) require RN assessment and management.
Question 5
A client with schizophrenia says, "The FBI is poisoning my food." Best therapeutic response?
A) "That’s not true, the FBI isn't here."
B) "You seem frightened. Tell me more about that."
C) "Let's talk about something else."
D) "I will check your food for poison."
Correct Answer: B
Rationale: This response acknowledges the client's feelings without reinforcing the delusion. It uses therapeutic
communication techniques of validation and open-ended exploration. Option A argues with the delusion; option D
reinforces it.
Question 6
A nurse administers digoxin to a patient with HR 52. Next action?
A) Give the medication as ordered
B) Hold the dose and reassess in 30 minutes
C) Hold the dose and notify the provider
D) Give atropine first
Correct Answer: C
Rationale: Digoxin is typically held for heart rate <60 bpm in adults (or per facility protocol) to prevent digoxin toxicity.
The provider should be notified for further orders.
Question 7
A preschooler is admitted with dehydration. Which IV fluid is preferred?
A) D5W
B) 0.9% NS with 20 mEq KCl/L
C) 0.45% NS
D) 3% NS
Correct Answer: B
Rationale: Isotonic saline (0.9% NS) with potassium (after urine output is confirmed) corrects dehydration and
electrolyte losses. D5W is hypotonic; 0.45% NS is hypotonic; 3% NS is hypertonic and used for severe hyponatremia
only.
Question 8
