1
ATI RN Comprehensive Predictor Exit Exam 2025–
2026 | 160 NGN-Style Practice Questions with Detailed
Answers & Rationales
1 — Crohn’s disease — acute exacerbation
A 28-year-old female (height 165 cm, weight 62 kg) with a 5-year history of
Crohn’s disease is admitted for a flare. She reports 12 watery stools/day, crampy
abdominal pain (8/10), and decreased oral intake for 48 hours. Current meds:
mesalamine PO, prednisone 10 mg daily. VS: T 37.8°C, HR 110, BP 102/64, RR
18, SpO₂ 98% RA. Labs: Na 134 mEq/L, K 3.3 mEq/L, Hgb 10.2 g/dL, albumin
2.6 g/dL. Provider orders: start IV fluids, bowel rest, begin loperamide PRN, and
consult GI for biologic therapy. Which nursing action should the nurse perform
first?
A. Administer loperamide 4 mg now to reduce stool frequency.
B. Give a bolus of 0.9% sodium chloride 1 L IV now.
C. Encourage high-fiber foods to bulk stools once tolerating PO.
D. Hold all meds until GI performs endoscopy.
Correct Answer: B
Rationale: The patient has signs of volume depletion (tachycardia, low-normal BP,
decreased intake) and hypokalemia (K 3.3), and is at risk for further hemodynamic
compromise. Fluid resuscitation with isotonic saline is the immediate priority to
restore circulating volume and perfusion. Loperamide (A) is contraindicated in
severe inflammatory bowel disease flares because it can precipitate toxic
megacolon or worsen obstruction; it is not the first action. Encouraging high-fiber
foods (C) is inappropriate during an acute flare — low-residue diet is indicated
,2
once stabilized. Holding all meds (D) is not indicated; essential meds and
supportive care should continue while awaiting GI.
2 — Diabetic ketoacidosis (DKA) — priorities
A 40-year-old male with known type 1 diabetes is brought to the ED with 24 hours
of polyuria, polydipsia, progressive weakness, and Kussmaul respirations. VS: T
36.7°C, HR 120, BP 98/58, RR 30, SpO₂ 96% RA. Point-of-care glucose 520
mg/dL. Labs from ED: Na 135, K 3.6, venous pH 7.12, HCO₃⁻ 10 mmol/L, serum
ketones positive. Provider writes orders: start regular insulin infusion, draw labs
q1–2 hr, begin IV fluids, place Foley. Which action should the nurse complete
first?
A. Begin regular insulin infusion per sliding scale.
B. Start 0.9% sodium chloride 1 L IV bolus immediately.
C. Insert the Foley catheter to monitor urine output.
D. Administer 50 mEq potassium chloride IV push now.
Correct Answer: B
Rationale: In DKA the initial priority is volume resuscitation with isotonic
crystalloid (0.9% NS) to restore intravascular volume and improve perfusion.
Insulin infusion (A) should follow initial fluid resuscitation and after confirming or
addressing potassium status because insulin drives potassium intracellularly and
can cause hypokalemia. Foley insertion (C) is useful for accurate urine output but
is not the immediate priority. IV KCl (D) is not indicated now because K is 3.6 —
potassium replacement would be considered if K <3.3 or if levels fall after starting
insulin; also KCl should never be given IV push.
3 — Levothyroxine teaching and interactions (detailed)
A 52-year-old female diagnosed with primary hypothyroidism is discharged on
levothyroxine 75 mcg PO daily. She asks about timing, side effects, and
interactions. Which statement by the client indicates need for further teaching?
A. “I’ll take levothyroxine first thing in the morning on an empty stomach.”
,3
B. “If I feel better in a few weeks I can stop taking it until my next clinic
visit.”
C. “I’ll avoid taking calcium or iron supplements within 4 hours of my pill.”
D. “I should inform my provider if I start taking an antidepressant or
ampregnant.”
Correct Answer: B
Rationale: Levothyroxine is generally lifelong therapy for primary
hypothyroidism; stopping it when feeling better is incorrect and can lead to
recurrence of hypothyroid symptoms or complications (e.g., hyperlipidemia,
myxedema in severe cases). A is correct — take on an empty stomach, 30–60
minutes before breakfast for consistent absorption. C is correct — calcium, iron,
and some antacids interfere with absorption and should be separated by at least 4
hours. D is correct — changes such as pregnancy or starting certain meds (e.g.,
SSRIs, amiodarone, or estrogens) can alter requirements.
4 — Total parenteral nutrition (TPN) — monitoring specifics
A 65-year-old male with postoperative ileus is started on TPN via a tunneled
central venous catheter. Initial infusion begins tonight. Which of these nursing
interventions is the most important immediately after initiation?
A. Monitor blood glucose q4–6 hours and more frequently in the first 24
hours.
B. Clamp the TPN line every 8 hours to prevent infection.
C. Allow the client to add enteral sips as tolerated while on TPN.
D. Weigh the client weekly to assess nutritional status.
Correct Answer: A
Rationale: TPN contains high glucose concentrations and places the patient at risk
for hyperglycemia; blood glucose should be monitored frequently (often q4–6 hr or
more frequently initially) and insulin started per protocol if needed. Clamping the
line (B) is not a recommended practice for infection control and may create
thrombotic risk; aseptic technique and sterile dressing changes are key. Allowing
, 4
oral intake (C) is possible when tolerated but not the most important immediate
action. Weekly weights (D) are useful but not urgent on initiation.
5 — Loop diuretic and electrolyte emergency
A 73-year-old female with chronic heart failure is on furosemide 80 mg PO daily.
She presents to the clinic with weakness and palpitations. VS: T 36.9°C, HR 96
irregular, BP 110/70, RR 18. Labs: Na 137, K 2.8 mEq/L, Mg 1.6 mg/dL, BUN 26
mg/dL, Creat 1.1 mg/dL. Which action should the nurse take first?
A. Start oral potassium chloride replacement as outpatient.
B. Notify provider immediately and prepare for IV potassium replacement
per protocol.
C. Instruct the client to eat bananas and potatoes and return in 2 days.
D. Increase the furosemide dose to reduce fluid overload.
Correct Answer: B
Rationale: A potassium of 2.8 mEq/L is severe hypokalemia that predisposes to
life-threatening arrhythmias; IV potassium replacement and urgent notification of
the provider are indicated. Oral replacement (A) is too slow for severe
hypokalemia with symptoms. Dietary measures (C) are insufficient alone.
Increasing furosemide (D) would worsen hypokalemia.
6 — Prioritization: respiratory compromise
You are assigned to four clients on evening shift. Which client should the nurse
assess first?
A. 68-year-old with community-acquired pneumonia — SpO₂ 88% on room
air, increased work of breathing.
B. 75-year-old COPD patient with productive cough and baseline SpO₂ 90%
on 2 L NC.
C. 22-year-old with asthma requesting an inhaler refill for maintenance
therapy.
ATI RN Comprehensive Predictor Exit Exam 2025–
2026 | 160 NGN-Style Practice Questions with Detailed
Answers & Rationales
1 — Crohn’s disease — acute exacerbation
A 28-year-old female (height 165 cm, weight 62 kg) with a 5-year history of
Crohn’s disease is admitted for a flare. She reports 12 watery stools/day, crampy
abdominal pain (8/10), and decreased oral intake for 48 hours. Current meds:
mesalamine PO, prednisone 10 mg daily. VS: T 37.8°C, HR 110, BP 102/64, RR
18, SpO₂ 98% RA. Labs: Na 134 mEq/L, K 3.3 mEq/L, Hgb 10.2 g/dL, albumin
2.6 g/dL. Provider orders: start IV fluids, bowel rest, begin loperamide PRN, and
consult GI for biologic therapy. Which nursing action should the nurse perform
first?
A. Administer loperamide 4 mg now to reduce stool frequency.
B. Give a bolus of 0.9% sodium chloride 1 L IV now.
C. Encourage high-fiber foods to bulk stools once tolerating PO.
D. Hold all meds until GI performs endoscopy.
Correct Answer: B
Rationale: The patient has signs of volume depletion (tachycardia, low-normal BP,
decreased intake) and hypokalemia (K 3.3), and is at risk for further hemodynamic
compromise. Fluid resuscitation with isotonic saline is the immediate priority to
restore circulating volume and perfusion. Loperamide (A) is contraindicated in
severe inflammatory bowel disease flares because it can precipitate toxic
megacolon or worsen obstruction; it is not the first action. Encouraging high-fiber
foods (C) is inappropriate during an acute flare — low-residue diet is indicated
,2
once stabilized. Holding all meds (D) is not indicated; essential meds and
supportive care should continue while awaiting GI.
2 — Diabetic ketoacidosis (DKA) — priorities
A 40-year-old male with known type 1 diabetes is brought to the ED with 24 hours
of polyuria, polydipsia, progressive weakness, and Kussmaul respirations. VS: T
36.7°C, HR 120, BP 98/58, RR 30, SpO₂ 96% RA. Point-of-care glucose 520
mg/dL. Labs from ED: Na 135, K 3.6, venous pH 7.12, HCO₃⁻ 10 mmol/L, serum
ketones positive. Provider writes orders: start regular insulin infusion, draw labs
q1–2 hr, begin IV fluids, place Foley. Which action should the nurse complete
first?
A. Begin regular insulin infusion per sliding scale.
B. Start 0.9% sodium chloride 1 L IV bolus immediately.
C. Insert the Foley catheter to monitor urine output.
D. Administer 50 mEq potassium chloride IV push now.
Correct Answer: B
Rationale: In DKA the initial priority is volume resuscitation with isotonic
crystalloid (0.9% NS) to restore intravascular volume and improve perfusion.
Insulin infusion (A) should follow initial fluid resuscitation and after confirming or
addressing potassium status because insulin drives potassium intracellularly and
can cause hypokalemia. Foley insertion (C) is useful for accurate urine output but
is not the immediate priority. IV KCl (D) is not indicated now because K is 3.6 —
potassium replacement would be considered if K <3.3 or if levels fall after starting
insulin; also KCl should never be given IV push.
3 — Levothyroxine teaching and interactions (detailed)
A 52-year-old female diagnosed with primary hypothyroidism is discharged on
levothyroxine 75 mcg PO daily. She asks about timing, side effects, and
interactions. Which statement by the client indicates need for further teaching?
A. “I’ll take levothyroxine first thing in the morning on an empty stomach.”
,3
B. “If I feel better in a few weeks I can stop taking it until my next clinic
visit.”
C. “I’ll avoid taking calcium or iron supplements within 4 hours of my pill.”
D. “I should inform my provider if I start taking an antidepressant or
ampregnant.”
Correct Answer: B
Rationale: Levothyroxine is generally lifelong therapy for primary
hypothyroidism; stopping it when feeling better is incorrect and can lead to
recurrence of hypothyroid symptoms or complications (e.g., hyperlipidemia,
myxedema in severe cases). A is correct — take on an empty stomach, 30–60
minutes before breakfast for consistent absorption. C is correct — calcium, iron,
and some antacids interfere with absorption and should be separated by at least 4
hours. D is correct — changes such as pregnancy or starting certain meds (e.g.,
SSRIs, amiodarone, or estrogens) can alter requirements.
4 — Total parenteral nutrition (TPN) — monitoring specifics
A 65-year-old male with postoperative ileus is started on TPN via a tunneled
central venous catheter. Initial infusion begins tonight. Which of these nursing
interventions is the most important immediately after initiation?
A. Monitor blood glucose q4–6 hours and more frequently in the first 24
hours.
B. Clamp the TPN line every 8 hours to prevent infection.
C. Allow the client to add enteral sips as tolerated while on TPN.
D. Weigh the client weekly to assess nutritional status.
Correct Answer: A
Rationale: TPN contains high glucose concentrations and places the patient at risk
for hyperglycemia; blood glucose should be monitored frequently (often q4–6 hr or
more frequently initially) and insulin started per protocol if needed. Clamping the
line (B) is not a recommended practice for infection control and may create
thrombotic risk; aseptic technique and sterile dressing changes are key. Allowing
, 4
oral intake (C) is possible when tolerated but not the most important immediate
action. Weekly weights (D) are useful but not urgent on initiation.
5 — Loop diuretic and electrolyte emergency
A 73-year-old female with chronic heart failure is on furosemide 80 mg PO daily.
She presents to the clinic with weakness and palpitations. VS: T 36.9°C, HR 96
irregular, BP 110/70, RR 18. Labs: Na 137, K 2.8 mEq/L, Mg 1.6 mg/dL, BUN 26
mg/dL, Creat 1.1 mg/dL. Which action should the nurse take first?
A. Start oral potassium chloride replacement as outpatient.
B. Notify provider immediately and prepare for IV potassium replacement
per protocol.
C. Instruct the client to eat bananas and potatoes and return in 2 days.
D. Increase the furosemide dose to reduce fluid overload.
Correct Answer: B
Rationale: A potassium of 2.8 mEq/L is severe hypokalemia that predisposes to
life-threatening arrhythmias; IV potassium replacement and urgent notification of
the provider are indicated. Oral replacement (A) is too slow for severe
hypokalemia with symptoms. Dietary measures (C) are insufficient alone.
Increasing furosemide (D) would worsen hypokalemia.
6 — Prioritization: respiratory compromise
You are assigned to four clients on evening shift. Which client should the nurse
assess first?
A. 68-year-old with community-acquired pneumonia — SpO₂ 88% on room
air, increased work of breathing.
B. 75-year-old COPD patient with productive cough and baseline SpO₂ 90%
on 2 L NC.
C. 22-year-old with asthma requesting an inhaler refill for maintenance
therapy.
