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ATI RN Comprehensive Predictor Exit Exam 2025–2026
| 100+ Real NGN Questions + In-Depth Rationales | Full
Proctored Prep Guide
Question 1
A 68-year-old male client with a history of chronic obstructive pulmonary disease
(COPD) is admitted with worsening shortness of breath and productive cough. He is on
2L/min nasal cannula oxygen. Upon assessment, you note decreased breath sounds in the
lower lobes, a respiratory rate of 28/min, and use of accessory muscles. Arterial blood
gas (ABG) results show pH 7.30, PaCO₂ 60 mmHg, HCO₃⁻ 27 mEq/L, and PaO₂ 58
mmHg. Which nursing intervention is most appropriate at this time?
A. Increase the oxygen flow rate to 6 L/min
B. Administer PRN morphine sulfate for respiratory distress
, 2
C. Notify the healthcare provider and prepare for possible non-invasive ventilation
D. Encourage the client to rest and continue current treatment
E. Place the client in a supine position to promote perfusion
Correct Answer: C
Rationale:
The ABG results show respiratory acidosis with hypoxemia, indicating inadequate gas
exchange. Clients with COPD retain CO₂, but this client's symptoms and ABGs suggest
acute respiratory failure. Increasing oxygen beyond prescribed amounts in COPD may
suppress their hypoxic drive. Morphine can further depress respiration. The priority is to
notify the provider for possible BiPAP initiation (non-invasive ventilation) to avoid
intubation. The supine position worsens ventilation; high Fowler's is preferred. Early
intervention can prevent deterioration and reduce ICU transfers.
Question 2
A nurse is caring for a 29-year-old female postoperative client who underwent an open
cholecystectomy 8 hours ago. The client suddenly reports chest pain and shortness of
breath. Vital signs are BP 102/68 mmHg, HR 118 bpm, RR 32/min, SpO₂ 89% on room
air. The nurse notes unilateral swelling in the left leg. What should the nurse do first?
A. Obtain a 12-lead ECG
B. Apply oxygen via non-rebreather mask and notify the provider immediately
C. Administer prescribed pain medication
, 3
D. Position the client in high Fowler’s and monitor vitals
E. Request a Doppler ultrasound of the lower extremities
Correct Answer: B
Rationale:
The client displays classic signs of pulmonary embolism (PE): sudden dyspnea, chest
pain, hypoxia, tachypnea, and unilateral leg swelling (DVT origin). The first priority
is to ensure oxygenation, so applying high-flow oxygen is essential, followed by urgent
provider notification. A Doppler ultrasound and ECG may be ordered but are not first-
line during an acute decompensation. Pain management is secondary. High Fowler’s
helps with breathing but doesn’t address the urgent need for oxygen and provider action.
Question 3
A 45-year-old client with type 2 diabetes is admitted for a non-healing foot ulcer. The
nurse notes purulent drainage, surrounding erythema, and foul odor. Vital signs: T
100.9°F, HR 106 bpm, BP 130/76 mmHg, RR 20/min. WBC count is 14,500/mm³. The
provider prescribes IV antibiotics and a wound culture. What action should the nurse take
first?
A. Administer the IV antibiotic as ordered
B. Apply a sterile dressing to the wound
C. Educate the client on foot care practices
D. Obtain the wound culture before starting antibiotics
E. Assess the client’s blood glucose level
, 4
Correct Answer: D
Rationale:
Before administering antibiotics, a wound culture must be collected to avoid
contamination and ensure accurate identification of the pathogen. Administering
antibiotics first may result in false-negative culture results. Although administering
antibiotics is urgent, doing so before obtaining cultures is inappropriate. Dressing the
wound, education, and glucose monitoring are important but not the immediate priority in
this timeline. Culturing first preserves the integrity of the sample and enhances targeted
antibiotic therapy.
Question 4
An elderly client with dementia becomes increasingly agitated during morning care. He
attempts to get out of bed unassisted and strikes out at staff. Which is the most
appropriate nursing intervention?
A. Request a prescription for a PRN antipsychotic
B. Apply wrist restraints per facility policy
C. Attempt redirection using calm communication and validate his feelings
D. Leave the client alone for 15 minutes to cool off
E. Ask a family member to stay with the client all day
Correct Answer: C
ATI RN Comprehensive Predictor Exit Exam 2025–2026
| 100+ Real NGN Questions + In-Depth Rationales | Full
Proctored Prep Guide
Question 1
A 68-year-old male client with a history of chronic obstructive pulmonary disease
(COPD) is admitted with worsening shortness of breath and productive cough. He is on
2L/min nasal cannula oxygen. Upon assessment, you note decreased breath sounds in the
lower lobes, a respiratory rate of 28/min, and use of accessory muscles. Arterial blood
gas (ABG) results show pH 7.30, PaCO₂ 60 mmHg, HCO₃⁻ 27 mEq/L, and PaO₂ 58
mmHg. Which nursing intervention is most appropriate at this time?
A. Increase the oxygen flow rate to 6 L/min
B. Administer PRN morphine sulfate for respiratory distress
, 2
C. Notify the healthcare provider and prepare for possible non-invasive ventilation
D. Encourage the client to rest and continue current treatment
E. Place the client in a supine position to promote perfusion
Correct Answer: C
Rationale:
The ABG results show respiratory acidosis with hypoxemia, indicating inadequate gas
exchange. Clients with COPD retain CO₂, but this client's symptoms and ABGs suggest
acute respiratory failure. Increasing oxygen beyond prescribed amounts in COPD may
suppress their hypoxic drive. Morphine can further depress respiration. The priority is to
notify the provider for possible BiPAP initiation (non-invasive ventilation) to avoid
intubation. The supine position worsens ventilation; high Fowler's is preferred. Early
intervention can prevent deterioration and reduce ICU transfers.
Question 2
A nurse is caring for a 29-year-old female postoperative client who underwent an open
cholecystectomy 8 hours ago. The client suddenly reports chest pain and shortness of
breath. Vital signs are BP 102/68 mmHg, HR 118 bpm, RR 32/min, SpO₂ 89% on room
air. The nurse notes unilateral swelling in the left leg. What should the nurse do first?
A. Obtain a 12-lead ECG
B. Apply oxygen via non-rebreather mask and notify the provider immediately
C. Administer prescribed pain medication
, 3
D. Position the client in high Fowler’s and monitor vitals
E. Request a Doppler ultrasound of the lower extremities
Correct Answer: B
Rationale:
The client displays classic signs of pulmonary embolism (PE): sudden dyspnea, chest
pain, hypoxia, tachypnea, and unilateral leg swelling (DVT origin). The first priority
is to ensure oxygenation, so applying high-flow oxygen is essential, followed by urgent
provider notification. A Doppler ultrasound and ECG may be ordered but are not first-
line during an acute decompensation. Pain management is secondary. High Fowler’s
helps with breathing but doesn’t address the urgent need for oxygen and provider action.
Question 3
A 45-year-old client with type 2 diabetes is admitted for a non-healing foot ulcer. The
nurse notes purulent drainage, surrounding erythema, and foul odor. Vital signs: T
100.9°F, HR 106 bpm, BP 130/76 mmHg, RR 20/min. WBC count is 14,500/mm³. The
provider prescribes IV antibiotics and a wound culture. What action should the nurse take
first?
A. Administer the IV antibiotic as ordered
B. Apply a sterile dressing to the wound
C. Educate the client on foot care practices
D. Obtain the wound culture before starting antibiotics
E. Assess the client’s blood glucose level
, 4
Correct Answer: D
Rationale:
Before administering antibiotics, a wound culture must be collected to avoid
contamination and ensure accurate identification of the pathogen. Administering
antibiotics first may result in false-negative culture results. Although administering
antibiotics is urgent, doing so before obtaining cultures is inappropriate. Dressing the
wound, education, and glucose monitoring are important but not the immediate priority in
this timeline. Culturing first preserves the integrity of the sample and enhances targeted
antibiotic therapy.
Question 4
An elderly client with dementia becomes increasingly agitated during morning care. He
attempts to get out of bed unassisted and strikes out at staff. Which is the most
appropriate nursing intervention?
A. Request a prescription for a PRN antipsychotic
B. Apply wrist restraints per facility policy
C. Attempt redirection using calm communication and validate his feelings
D. Leave the client alone for 15 minutes to cool off
E. Ask a family member to stay with the client all day
Correct Answer: C
