ATI Comprehensive Predictor Updated 2026 |
Comprehensive Nursing Exam Study Guide, Practice
Exam Questions and Answers, NCLEX Readiness Test
Bank, Medical-Surgical Nursing Review, Pharmacology
Concepts, Maternal Newborn Care, Pediatric Nursing,
Mental Health Nursing, Leadership and Management,
Prioritization and Clinical Judgment, and Detailed
Rationales for Exam Success
Question 1: A nurse is providing discharge teaching to a client who has a new
prescription for warfarin. Which of the following over-the-counter medications
should the nurse instruct the client to avoid?
A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
CORRECT ANSWER: B. Ibuprofen
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can
increase the risk of gastrointestinal bleeding and interfere with platelet aggregation.
When combined with warfarin, an anticoagulant, this significantly elevates the client's
risk for hemorrhage. Acetaminophen is the preferred analgesic for clients on warfarin,
though dosage should be monitored.
Question 2: A client who is 24 hours post-operative following a total hip
arthroplasty reports sudden onset chest pain and shortness of breath. Which of the
following actions should the nurse take first?
A. Administer prescribed PRN oxygen via nasal cannula.
B. Check the client's oxygen saturation.
C. Place the client in a high-Fowler's position.
D. Notify the provider immediately.
CORRECT ANSWER: C. Place the client in a high-Fowler's position.
Rationale: The client is displaying classic signs of a pulmonary embolism, a life-
threatening complication. The immediate priority is to position the client in high-
Fowler's to maximize lung expansion and facilitate breathing. This is the first step before
proceeding with further assessments like checking oxygen saturation or notifying the
provider, which occur after the immediate airway/breathing intervention.
Question 3: A nurse is caring for a client with a nasogastric (NG) tube connected to
continuous low-intermittent suction. Which of the following findings indicates the
NG tube is correctly placed?
A. The client reports a sore throat.
B. The pH of aspirated fluid is 4.
C. The nurse auscultates a whooshing sound over the epigastrium during an air bolus
injection.
D. The drainage is bright green.
,CORRECT ANSWER: B. The pH of aspirated fluid is 4.
Rationale: Gastric fluid typically has a pH of 1 to 4. Measuring the pH of aspirated fluid
is a reliable, evidence-based method to confirm placement, with a pH of 4 or less
strongly indicating gastric placement. Auscultation of an air bolus is no longer
considered a reliable method for confirming placement, and assessing the appearance
of drainage is not definitive.
Question 4: A nurse is preparing to administer an enteral feeding via a gastrostomy
tube. Before initiating the feeding, the nurse should aspirate for residual volume. If
the residual is greater than 250 mL, which of the following actions is most
appropriate?
A. Discard the residual and continue the feeding at the prescribed rate.
B. Reinstill the residual and continue the feeding as prescribed.
C. Reinstill the residual and hold the feeding.
D. Discard the residual and notify the provider.
CORRECT ANSWER: C. Reinstill the residual and hold the feeding.
Rationale: High gastric residual volumes (often defined as >250 mL) indicate delayed
gastric emptying and an increased risk for aspiration. The standard of care is to reinstill
the residual (to prevent electrolyte loss) and hold the feeding for 30-60 minutes before
rechecking. The provider should be notified if the high residuals persist.
Question 5: A nurse in a long-term care facility is planning care for a client with a
diagnosis of Alzheimer's disease who wanders at night. Which of the following
interventions should the nurse implement to ensure the client's safety?
A. Apply a vest restraint during the night.
B. Place a bed alarm on the client's bed.
C. Administer a prescribed sedative at bedtime.
D. Close the client's door to prevent them from exiting the room.
CORRECT ANSWER: B. Place a bed alarm on the client's bed.
Rationale: A bed or chair alarm is a least-restrictive intervention that alerts staff when
the client attempts to get up, allowing for supervision and preventing falls. Restraints
and sedatives should be avoided and are only used as a last resort. Closing the door is a
fire hazard and does not prevent the client from falling.
Question 6: A nurse is monitoring a client who is receiving a blood transfusion.
Which of the following findings indicates a hemolytic transfusion reaction?
A. Urticaria and wheezing
B. Low back pain and chills
C. Bradycardia and hypertension
D. Flushing and headache
CORRECT ANSWER: B. Low back pain and chills
Rationale: An acute hemolytic transfusion reaction occurs when the recipient's
antibodies attack the donor's red blood cells. This results in the release of hemoglobin
and inflammatory mediators, causing classic signs such as low back pain, chills, fever,
flushing, tachycardia, and hypotension. Urticaria is a sign of a mild allergic reaction.
,Question 7: A nurse is providing education to a client who is starting on an MAOI
antidepressant. Which of the following foods should the nurse instruct the client to
avoid?
A. Broiled chicken
B. Aged cheddar cheese
C. Apples
D. Pasta
CORRECT ANSWER: B. Aged cheddar cheese
Rationale: MAOIs (e.g., phenelzine) inhibit the breakdown of tyramine, an amino acid
found in aged, fermented, or pickled foods. Consuming high-tyramine foods (like aged
cheese, cured meats, and red wine) can precipitate a hypertensive crisis. The nurse
must provide a strict list of foods to avoid.
Question 8: A nurse is assessing a client who has just undergone a thoracentesis.
Which of the following findings requires immediate intervention?
A. Blood-tinged sputum
B. Heart rate of 88/min
C. Pulse oximetry reading of 94%
D. Tracheal deviation to the unaffected side
CORRECT ANSWER: D. Tracheal deviation to the unaffected side
Rationale: Tracheal deviation is a late sign of a tension pneumothorax, a life-
threatening complication of thoracentesis where air accumulates in the pleural space,
shifting the mediastinum. This is a medical emergency requiring immediate chest tube
insertion. The other options are expected or non-critical findings.
Question 9: A nurse is evaluating a client's understanding of a low-sodium diet.
Which client statement indicates a need for further teaching?
A. "I will use lemon juice to flavor my fish."
B. "I can have a turkey sandwich on rye bread."
C. "I will avoid canned soups."
D. "I can eat low-sodium crackers as a snack."
CORRECT ANSWER: B. "I can have a turkey sandwich on rye bread."
Rationale: Processed meats like turkey, ham, and salami, as well as rye bread, contain
high amounts of sodium. This statement indicates a need for further teaching because
the client does not recognize these as high-sodium foods. Canned soups and salted
snacks are also high in sodium, but the client correctly identifies the need to avoid
them.
Question 10: A nurse is preparing to administer an intramuscular (IM) injection of a
viscous medication. Which gauge needle is most appropriate?
A. 18-gauge
B. 21-gauge
C. 25-gauge
D. 27-gauge
CORRECT ANSWER: B. 21-gauge
, Rationale: The gauge of a needle refers to its diameter, with smaller numbers indicating
larger lumens. For viscous medications, a larger lumen is needed to allow the
medication to flow easily. A 21-gauge needle is appropriate for this purpose. Smaller
gauges (25, 27) are used for subcutaneous or intradermal injections or less viscous
solutions.
Question 11: A client with heart failure is prescribed digoxin and furosemide. Which
of the following findings should indicate to the nurse that the client is experiencing
digoxin toxicity?
A. Constipation
B. Heart rate of 62/min
C. Yellow-tinged vision
D. Increased urine output
CORRECT ANSWER: C. Yellow-tinged vision
Rationale: Yellow or green halos around visual fields, along with nausea, vomiting, and
bradycardia, are classic signs of digoxin toxicity. Furosemide can cause potassium loss,
and hypokalemia increases the risk for digoxin toxicity, making this assessment crucial.
A heart rate of 62 is within normal limits.
Question 12: A nurse is providing care for a client who is postoperative following an
open cholecystectomy. Which of the following interventions is a priority to prevent
a pulmonary complication?
A. Administer prescribed opioid analgesics as needed.
B. Encourage the use of an incentive spirometer every hour.
C. Maintain the client on bed rest.
D. Provide a diet high in protein.
CORRECT ANSWER: B. Encourage the use of an incentive spirometer every hour.
Rationale: The priority is to prevent atelectasis and pneumonia, which are common
postoperative complications due to shallow breathing from pain and anesthesia. The
incentive spirometer promotes deep breathing and lung expansion. While pain
management is important, the specific nursing intervention for pulmonary prevention is
the incentive spirometer.
Question 13: A nurse is assessing a client with suspected appendicitis. Which of
the following findings should the nurse expect?
A. Pain in the right lower quadrant with rebound tenderness
B. Pain in the left upper quadrant that radiates to the back
C. Intermittent, colicky pain in the periumbilical area
D. Dull, constant pain in the right upper quadrant
CORRECT ANSWER: A. Pain in the right lower quadrant with rebound tenderness
Rationale: Classic appendicitis presents with visceral pain that migrates to the right
lower quadrant, where it becomes somatic and localized at McBurney's point. Rebound
tenderness (pain upon release of pressure) is a common peritoneal sign. Periumbilical
pain is early appendicitis or other conditions.
Comprehensive Nursing Exam Study Guide, Practice
Exam Questions and Answers, NCLEX Readiness Test
Bank, Medical-Surgical Nursing Review, Pharmacology
Concepts, Maternal Newborn Care, Pediatric Nursing,
Mental Health Nursing, Leadership and Management,
Prioritization and Clinical Judgment, and Detailed
Rationales for Exam Success
Question 1: A nurse is providing discharge teaching to a client who has a new
prescription for warfarin. Which of the following over-the-counter medications
should the nurse instruct the client to avoid?
A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
CORRECT ANSWER: B. Ibuprofen
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can
increase the risk of gastrointestinal bleeding and interfere with platelet aggregation.
When combined with warfarin, an anticoagulant, this significantly elevates the client's
risk for hemorrhage. Acetaminophen is the preferred analgesic for clients on warfarin,
though dosage should be monitored.
Question 2: A client who is 24 hours post-operative following a total hip
arthroplasty reports sudden onset chest pain and shortness of breath. Which of the
following actions should the nurse take first?
A. Administer prescribed PRN oxygen via nasal cannula.
B. Check the client's oxygen saturation.
C. Place the client in a high-Fowler's position.
D. Notify the provider immediately.
CORRECT ANSWER: C. Place the client in a high-Fowler's position.
Rationale: The client is displaying classic signs of a pulmonary embolism, a life-
threatening complication. The immediate priority is to position the client in high-
Fowler's to maximize lung expansion and facilitate breathing. This is the first step before
proceeding with further assessments like checking oxygen saturation or notifying the
provider, which occur after the immediate airway/breathing intervention.
Question 3: A nurse is caring for a client with a nasogastric (NG) tube connected to
continuous low-intermittent suction. Which of the following findings indicates the
NG tube is correctly placed?
A. The client reports a sore throat.
B. The pH of aspirated fluid is 4.
C. The nurse auscultates a whooshing sound over the epigastrium during an air bolus
injection.
D. The drainage is bright green.
,CORRECT ANSWER: B. The pH of aspirated fluid is 4.
Rationale: Gastric fluid typically has a pH of 1 to 4. Measuring the pH of aspirated fluid
is a reliable, evidence-based method to confirm placement, with a pH of 4 or less
strongly indicating gastric placement. Auscultation of an air bolus is no longer
considered a reliable method for confirming placement, and assessing the appearance
of drainage is not definitive.
Question 4: A nurse is preparing to administer an enteral feeding via a gastrostomy
tube. Before initiating the feeding, the nurse should aspirate for residual volume. If
the residual is greater than 250 mL, which of the following actions is most
appropriate?
A. Discard the residual and continue the feeding at the prescribed rate.
B. Reinstill the residual and continue the feeding as prescribed.
C. Reinstill the residual and hold the feeding.
D. Discard the residual and notify the provider.
CORRECT ANSWER: C. Reinstill the residual and hold the feeding.
Rationale: High gastric residual volumes (often defined as >250 mL) indicate delayed
gastric emptying and an increased risk for aspiration. The standard of care is to reinstill
the residual (to prevent electrolyte loss) and hold the feeding for 30-60 minutes before
rechecking. The provider should be notified if the high residuals persist.
Question 5: A nurse in a long-term care facility is planning care for a client with a
diagnosis of Alzheimer's disease who wanders at night. Which of the following
interventions should the nurse implement to ensure the client's safety?
A. Apply a vest restraint during the night.
B. Place a bed alarm on the client's bed.
C. Administer a prescribed sedative at bedtime.
D. Close the client's door to prevent them from exiting the room.
CORRECT ANSWER: B. Place a bed alarm on the client's bed.
Rationale: A bed or chair alarm is a least-restrictive intervention that alerts staff when
the client attempts to get up, allowing for supervision and preventing falls. Restraints
and sedatives should be avoided and are only used as a last resort. Closing the door is a
fire hazard and does not prevent the client from falling.
Question 6: A nurse is monitoring a client who is receiving a blood transfusion.
Which of the following findings indicates a hemolytic transfusion reaction?
A. Urticaria and wheezing
B. Low back pain and chills
C. Bradycardia and hypertension
D. Flushing and headache
CORRECT ANSWER: B. Low back pain and chills
Rationale: An acute hemolytic transfusion reaction occurs when the recipient's
antibodies attack the donor's red blood cells. This results in the release of hemoglobin
and inflammatory mediators, causing classic signs such as low back pain, chills, fever,
flushing, tachycardia, and hypotension. Urticaria is a sign of a mild allergic reaction.
,Question 7: A nurse is providing education to a client who is starting on an MAOI
antidepressant. Which of the following foods should the nurse instruct the client to
avoid?
A. Broiled chicken
B. Aged cheddar cheese
C. Apples
D. Pasta
CORRECT ANSWER: B. Aged cheddar cheese
Rationale: MAOIs (e.g., phenelzine) inhibit the breakdown of tyramine, an amino acid
found in aged, fermented, or pickled foods. Consuming high-tyramine foods (like aged
cheese, cured meats, and red wine) can precipitate a hypertensive crisis. The nurse
must provide a strict list of foods to avoid.
Question 8: A nurse is assessing a client who has just undergone a thoracentesis.
Which of the following findings requires immediate intervention?
A. Blood-tinged sputum
B. Heart rate of 88/min
C. Pulse oximetry reading of 94%
D. Tracheal deviation to the unaffected side
CORRECT ANSWER: D. Tracheal deviation to the unaffected side
Rationale: Tracheal deviation is a late sign of a tension pneumothorax, a life-
threatening complication of thoracentesis where air accumulates in the pleural space,
shifting the mediastinum. This is a medical emergency requiring immediate chest tube
insertion. The other options are expected or non-critical findings.
Question 9: A nurse is evaluating a client's understanding of a low-sodium diet.
Which client statement indicates a need for further teaching?
A. "I will use lemon juice to flavor my fish."
B. "I can have a turkey sandwich on rye bread."
C. "I will avoid canned soups."
D. "I can eat low-sodium crackers as a snack."
CORRECT ANSWER: B. "I can have a turkey sandwich on rye bread."
Rationale: Processed meats like turkey, ham, and salami, as well as rye bread, contain
high amounts of sodium. This statement indicates a need for further teaching because
the client does not recognize these as high-sodium foods. Canned soups and salted
snacks are also high in sodium, but the client correctly identifies the need to avoid
them.
Question 10: A nurse is preparing to administer an intramuscular (IM) injection of a
viscous medication. Which gauge needle is most appropriate?
A. 18-gauge
B. 21-gauge
C. 25-gauge
D. 27-gauge
CORRECT ANSWER: B. 21-gauge
, Rationale: The gauge of a needle refers to its diameter, with smaller numbers indicating
larger lumens. For viscous medications, a larger lumen is needed to allow the
medication to flow easily. A 21-gauge needle is appropriate for this purpose. Smaller
gauges (25, 27) are used for subcutaneous or intradermal injections or less viscous
solutions.
Question 11: A client with heart failure is prescribed digoxin and furosemide. Which
of the following findings should indicate to the nurse that the client is experiencing
digoxin toxicity?
A. Constipation
B. Heart rate of 62/min
C. Yellow-tinged vision
D. Increased urine output
CORRECT ANSWER: C. Yellow-tinged vision
Rationale: Yellow or green halos around visual fields, along with nausea, vomiting, and
bradycardia, are classic signs of digoxin toxicity. Furosemide can cause potassium loss,
and hypokalemia increases the risk for digoxin toxicity, making this assessment crucial.
A heart rate of 62 is within normal limits.
Question 12: A nurse is providing care for a client who is postoperative following an
open cholecystectomy. Which of the following interventions is a priority to prevent
a pulmonary complication?
A. Administer prescribed opioid analgesics as needed.
B. Encourage the use of an incentive spirometer every hour.
C. Maintain the client on bed rest.
D. Provide a diet high in protein.
CORRECT ANSWER: B. Encourage the use of an incentive spirometer every hour.
Rationale: The priority is to prevent atelectasis and pneumonia, which are common
postoperative complications due to shallow breathing from pain and anesthesia. The
incentive spirometer promotes deep breathing and lung expansion. While pain
management is important, the specific nursing intervention for pulmonary prevention is
the incentive spirometer.
Question 13: A nurse is assessing a client with suspected appendicitis. Which of
the following findings should the nurse expect?
A. Pain in the right lower quadrant with rebound tenderness
B. Pain in the left upper quadrant that radiates to the back
C. Intermittent, colicky pain in the periumbilical area
D. Dull, constant pain in the right upper quadrant
CORRECT ANSWER: A. Pain in the right lower quadrant with rebound tenderness
Rationale: Classic appendicitis presents with visceral pain that migrates to the right
lower quadrant, where it becomes somatic and localized at McBurney's point. Rebound
tenderness (pain upon release of pressure) is a common peritoneal sign. Periumbilical
pain is early appendicitis or other conditions.
