ATI Comprehensive Predictor Exam Prep – Real Practice Questions,
Answers & Detailed Rationales (Updated 2026) | NCLEX-Style
Comprehensive Nursing Review, Medical-Surgical Nursing,
Pharmacology, Pediatrics, Maternal-Newborn, Mental Health, Leadership
& Management, Prioritization & Delegation, Clinical Judgment, Patient
Safety & ATI Predictor Success Strategies
Question 1: A nurse is caring for a client who has just returned from surgery and
has a new prescription for morphine 2 mg IV push for pain. Which action should
the nurse take first?
A. Assess the client's pain level using a 0-10 scale
B. Check the client's respiratory rate and oxygen saturation
C. Verify the medication order with another nurse
D. Administer the morphine slowly over 2 minutes
CORRECT ANSWER: B. Check the client's respiratory rate and oxygen saturation
Rationale: Before administering an opioid analgesic such as morphine, the nurse must
first assess baseline respiratory status because opioids can cause respiratory
depression. While pain assessment and order verification are important, patient safety
requires evaluating respiratory function prior to administration to prevent life-
threatening complications.
Question 2: A nurse is preparing to administer digoxin 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 digoxin as prescribed
B. Hold the dose and notify the provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes
CORRECT ANSWER: B. Hold the dose and notify the provider
Rationale: Digoxin should be withheld if the apical pulse is below 60 beats per minute in
adults due to the risk of bradycardia and digoxin toxicity. The nurse must hold the
medication and contact the healthcare provider for further instructions rather than
administering the drug or adjusting the dose independently.
,Question 3: A nurse is assessing a client with suspected pulmonary embolism.
Which finding should the nurse recognize as the most urgent?
A. Pleuritic chest pain
B. Tachycardia with heart rate of 118/min
C. Oxygen saturation of 88% on room air
D. Cough with blood-tinged sputum
CORRECT ANSWER: C. Oxygen saturation of 88% on room air
Rationale: An oxygen saturation of 88% indicates significant hypoxemia and impaired
gas exchange, which is life-threatening and requires immediate intervention such as
supplemental oxygen and further assessment. While other findings are associated with
pulmonary embolism, hypoxemia poses the most immediate risk to the client's airway
and breathing.
Question 4: A nurse is teaching a client with type 1 diabetes about sick-day
management. Which statement by the client indicates understanding?
A. "I will stop taking my insulin if I cannot eat."
B. "I will check my blood glucose every 4 hours when I am ill."
C. "I will avoid drinking fluids to prevent nausea."
D. "I will only test my urine for ketones if my blood sugar is low."
CORRECT ANSWER: B. "I will check my blood glucose every 4 hours when I am ill."
Rationale: During illness, clients with type 1 diabetes should monitor blood glucose every
3-4 hours because stress hormones can cause hyperglycemia even with reduced oral
intake. Insulin should never be withheld, hydration is essential, and ketone testing is
indicated when blood glucose exceeds 240 mg/dL, not when it is low.
Question 5: A nurse is caring for a postpartum client who is 2 hours after delivery.
The nurse notes the uterine fundus is boggy and displaced to the right. Which
action should the nurse take first?
A. Administer oxytocin as prescribed
B. Assist the client to void
C. Massage the fundus vigorously
D. Notify the provider immediately
,CORRECT ANSWER: B. Assist the client to void
Rationale: A boggy, displaced fundus often indicates a distended bladder, which prevents
adequate uterine contraction and increases the risk of postpartum hemorrhage. The
priority intervention is to assist the client to empty her bladder, which often allows the
uterus to contract and return to midline position before initiating fundal massage or
medications.
Question 6: A nurse is reviewing the laboratory results of a client receiving
warfarin therapy. Which finding requires immediate intervention?
A. INR of 2.5
B. Platelet count of 150,000/mm³
C. Hemoglobin of 10 g/dL
D. PT of 45 seconds
CORRECT ANSWER: D. PT of 45 seconds
Rationale: A prothrombin time (PT) of 45 seconds is significantly elevated and indicates
excessive anticoagulation, placing the client at high risk for bleeding. While the
therapeutic INR for most conditions is 2.0-3.0 (option A), the markedly prolonged PT
requires immediate assessment for bleeding and possible administration of vitamin K or
other reversal agents.
Question 7: A nurse is caring for a client with a chest tube connected to a closed
drainage system. Which finding indicates the system is functioning properly?
A. Continuous bubbling in the water seal chamber
B. Intermittent tidaling in the water seal chamber
C. No drainage in the collection chamber after 8 hours
D. Constant suction pressure of -40 cm H₂O
CORRECT ANSWER: B. Intermittent tidaling in the water seal chamber
Rationale: Tidaling (fluctuation of fluid level with respiration) in the water seal chamber
indicates the chest tube is patent and responding to intrapleural pressure changes.
Continuous bubbling suggests an air leak, absence of drainage may indicate obstruction,
and typical suction pressure is -20 cm H₂O, not -40 cm H₂O.
, Question 8: A nurse is assessing a newborn 1 hour after birth. Which finding
requires immediate intervention?
A. Heart rate of 150/min
B. Respiratory rate of 68/min with grunting
C. Temperature of 36.8°C (98.2°F)
D. Acrocyanosis of hands and feet
CORRECT ANSWER: B. Respiratory rate of 68/min with grunting
Rationale: Grunting is a sign of respiratory distress in newborns, indicating the infant is
attempting to maintain functional residual capacity. A respiratory rate above 60/min
with grunting requires immediate assessment and intervention. Normal newborn heart
rate is 110-160/min, temperature 36.5-37.5°C, and acrocyanosis is expected in the first
24-48 hours.
Question 9: A nurse is preparing to administer a blood transfusion to a client.
Which action is the priority before starting the transfusion?
A. Prime the IV tubing with normal saline
B. Verify the blood product with another registered nurse
C. Obtain baseline vital signs
D. Ensure the client has signed the consent form
CORRECT ANSWER: B. Verify the blood product with another registered nurse
Rationale: The most critical safety step before initiating a blood transfusion is the two-
nurse verification of the blood product against the client's identification, blood type, and
crossmatch results to prevent a potentially fatal hemolytic transfusion reaction. While
other actions are important, verification is the priority to ensure client safety.
Question 10: A nurse is caring for a client with increased intracranial pressure
(ICP). Which position should the nurse maintain?
A. Supine with head flat
B. Trendelenburg position
C. Head of bed elevated 30-45 degrees with neck in neutral alignment
D. Prone with head turned to the side
Answers & Detailed Rationales (Updated 2026) | NCLEX-Style
Comprehensive Nursing Review, Medical-Surgical Nursing,
Pharmacology, Pediatrics, Maternal-Newborn, Mental Health, Leadership
& Management, Prioritization & Delegation, Clinical Judgment, Patient
Safety & ATI Predictor Success Strategies
Question 1: A nurse is caring for a client who has just returned from surgery and
has a new prescription for morphine 2 mg IV push for pain. Which action should
the nurse take first?
A. Assess the client's pain level using a 0-10 scale
B. Check the client's respiratory rate and oxygen saturation
C. Verify the medication order with another nurse
D. Administer the morphine slowly over 2 minutes
CORRECT ANSWER: B. Check the client's respiratory rate and oxygen saturation
Rationale: Before administering an opioid analgesic such as morphine, the nurse must
first assess baseline respiratory status because opioids can cause respiratory
depression. While pain assessment and order verification are important, patient safety
requires evaluating respiratory function prior to administration to prevent life-
threatening complications.
Question 2: A nurse is preparing to administer digoxin 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 digoxin as prescribed
B. Hold the dose and notify the provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes
CORRECT ANSWER: B. Hold the dose and notify the provider
Rationale: Digoxin should be withheld if the apical pulse is below 60 beats per minute in
adults due to the risk of bradycardia and digoxin toxicity. The nurse must hold the
medication and contact the healthcare provider for further instructions rather than
administering the drug or adjusting the dose independently.
,Question 3: A nurse is assessing a client with suspected pulmonary embolism.
Which finding should the nurse recognize as the most urgent?
A. Pleuritic chest pain
B. Tachycardia with heart rate of 118/min
C. Oxygen saturation of 88% on room air
D. Cough with blood-tinged sputum
CORRECT ANSWER: C. Oxygen saturation of 88% on room air
Rationale: An oxygen saturation of 88% indicates significant hypoxemia and impaired
gas exchange, which is life-threatening and requires immediate intervention such as
supplemental oxygen and further assessment. While other findings are associated with
pulmonary embolism, hypoxemia poses the most immediate risk to the client's airway
and breathing.
Question 4: A nurse is teaching a client with type 1 diabetes about sick-day
management. Which statement by the client indicates understanding?
A. "I will stop taking my insulin if I cannot eat."
B. "I will check my blood glucose every 4 hours when I am ill."
C. "I will avoid drinking fluids to prevent nausea."
D. "I will only test my urine for ketones if my blood sugar is low."
CORRECT ANSWER: B. "I will check my blood glucose every 4 hours when I am ill."
Rationale: During illness, clients with type 1 diabetes should monitor blood glucose every
3-4 hours because stress hormones can cause hyperglycemia even with reduced oral
intake. Insulin should never be withheld, hydration is essential, and ketone testing is
indicated when blood glucose exceeds 240 mg/dL, not when it is low.
Question 5: A nurse is caring for a postpartum client who is 2 hours after delivery.
The nurse notes the uterine fundus is boggy and displaced to the right. Which
action should the nurse take first?
A. Administer oxytocin as prescribed
B. Assist the client to void
C. Massage the fundus vigorously
D. Notify the provider immediately
,CORRECT ANSWER: B. Assist the client to void
Rationale: A boggy, displaced fundus often indicates a distended bladder, which prevents
adequate uterine contraction and increases the risk of postpartum hemorrhage. The
priority intervention is to assist the client to empty her bladder, which often allows the
uterus to contract and return to midline position before initiating fundal massage or
medications.
Question 6: A nurse is reviewing the laboratory results of a client receiving
warfarin therapy. Which finding requires immediate intervention?
A. INR of 2.5
B. Platelet count of 150,000/mm³
C. Hemoglobin of 10 g/dL
D. PT of 45 seconds
CORRECT ANSWER: D. PT of 45 seconds
Rationale: A prothrombin time (PT) of 45 seconds is significantly elevated and indicates
excessive anticoagulation, placing the client at high risk for bleeding. While the
therapeutic INR for most conditions is 2.0-3.0 (option A), the markedly prolonged PT
requires immediate assessment for bleeding and possible administration of vitamin K or
other reversal agents.
Question 7: A nurse is caring for a client with a chest tube connected to a closed
drainage system. Which finding indicates the system is functioning properly?
A. Continuous bubbling in the water seal chamber
B. Intermittent tidaling in the water seal chamber
C. No drainage in the collection chamber after 8 hours
D. Constant suction pressure of -40 cm H₂O
CORRECT ANSWER: B. Intermittent tidaling in the water seal chamber
Rationale: Tidaling (fluctuation of fluid level with respiration) in the water seal chamber
indicates the chest tube is patent and responding to intrapleural pressure changes.
Continuous bubbling suggests an air leak, absence of drainage may indicate obstruction,
and typical suction pressure is -20 cm H₂O, not -40 cm H₂O.
, Question 8: A nurse is assessing a newborn 1 hour after birth. Which finding
requires immediate intervention?
A. Heart rate of 150/min
B. Respiratory rate of 68/min with grunting
C. Temperature of 36.8°C (98.2°F)
D. Acrocyanosis of hands and feet
CORRECT ANSWER: B. Respiratory rate of 68/min with grunting
Rationale: Grunting is a sign of respiratory distress in newborns, indicating the infant is
attempting to maintain functional residual capacity. A respiratory rate above 60/min
with grunting requires immediate assessment and intervention. Normal newborn heart
rate is 110-160/min, temperature 36.5-37.5°C, and acrocyanosis is expected in the first
24-48 hours.
Question 9: A nurse is preparing to administer a blood transfusion to a client.
Which action is the priority before starting the transfusion?
A. Prime the IV tubing with normal saline
B. Verify the blood product with another registered nurse
C. Obtain baseline vital signs
D. Ensure the client has signed the consent form
CORRECT ANSWER: B. Verify the blood product with another registered nurse
Rationale: The most critical safety step before initiating a blood transfusion is the two-
nurse verification of the blood product against the client's identification, blood type, and
crossmatch results to prevent a potentially fatal hemolytic transfusion reaction. While
other actions are important, verification is the priority to ensure client safety.
Question 10: A nurse is caring for a client with increased intracranial pressure
(ICP). Which position should the nurse maintain?
A. Supine with head flat
B. Trendelenburg position
C. Head of bed elevated 30-45 degrees with neck in neutral alignment
D. Prone with head turned to the side
