ATI PN Comprehensive Predictor
Exit Level 3 Exam
180 NGN-Style Practice Questions
With Answers & Rationales
Latest 2026 Update
Covering All Major Content Areas:
• Fundamentals of Nursing (Q1–Q30)
• Pharmacology (Q31–Q55)
• Medical-Surgical Nursing (Q56–Q100)
• Maternal-Newborn Nursing (Q101–Q130)
• Pediatric Nursing (Q131–Q155)
• Mental Health Nursing (Q156–Q180)
Correct answers are highlighted in green with detailed rationales.
NGN-Style questions incorporate clinical judgment and critical thinking.
,SECTION 1: FUNDAMENTALS OF NURSING
Question 1: A nurse is assessing a client's vital signs. The client's blood
pressure is 158/94 mm Hg. Which of the following actions should the
nurse take first?
A. Administer an antihypertensive medication
B. Retake the blood pressure in the same arm after 2 minutes ✓
C. Notify the provider immediately
D. Document the finding and continue the assessment
Rationale:
When a single blood pressure reading is elevated, the nurse should first verify
the reading by retaking the measurement after allowing the client to rest for 1
to 2 minutes. This helps rule out factors such as anxiety, incorrect cuff size, or
improper positioning that may have caused a falsely elevated reading. Only
after confirming the reading should the nurse proceed with further actions such
as notifying the provider or administering medications. Premature intervention
based on a single reading could lead to unnecessary treatment.
Question 2: A client is on fall precautions. Which of the following
interventions should the nurse implement? (Select all that apply.)
A. Keep the bed in the lowest position ✓
B. Raise all four side rails
C. Place a fall risk bracelet on the client
D. Ensure the call light is within reach
Rationale:
Keeping the bed in the lowest position reduces the distance and potential
injury if a client attempts to get out of bed. A fall risk bracelet alerts all staff to
the client's risk status. The call light within reach enables the client to request
assistance. Raising all four side rails is considered a restraint and can actually
increase fall risk if the client attempts to climb over them. Two side rails may be
used for comfort, but four-point rail restraint requires a provider order and can
increase agitation and injury risk.
Question 3: A nurse is preparing to administer a medication via the Z-track
method. Which of the following is the correct technique?
A. Pull the skin laterally before injection and release after
, withdrawing the needle ✓
B. Massage the site vigorously after injection
C. Inject the medication at a 45-degree angle
D. Aspirate for 10 seconds before injecting
Rationale:
The Z-track method involves pulling the skin and subcutaneous tissue laterally
before inserting the needle, holding the skin in place during injection, and
waiting 10 seconds before withdrawing the needle. The skin is then released,
creating a zigzag path that seals the medication within the muscle and
prevents leakage into subcutaneous tissue. This method is used for
medications that are irritating to tissue, such as iron preparations.
Massaging the site (B) is contraindicated with the Z-track method, a 90-
degree angle (C) is used for IM injections, and prolonged aspiration (D) is not
standard practice.
Question 4: A nurse is caring for a client who has a stage 3 pressure injury.
Which of the following findings should the nurse expect?
A. Intact skin with non-blanchable redness
B. Full-thickness skin loss with visible subcutaneous fat ✓
C. Full-thickness tissue loss with exposed bone or muscle
D. Partial-thickness skin loss with a pink wound bed
Rationale:
A stage 3 pressure injury involves full-thickness skin loss in which
subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed.
Slough may be present but does not obscure the depth of tissue loss.
Undermining and tunneling may be present. Stage 1 (A) involves intact skin
with non-blanchable erythema. Stage 4 (C) involves full-thickness loss with
exposed bone, tendon, or muscle. Stage 2 (D) involves partial-thickness loss
presenting as a shallow open ulcer with a red-pink wound bed.
, Question 5: A client is receiving continuous enteral feeding via a
nasogastric tube. Which of the following actions should the nurse take to
prevent aspiration?
A. Place the client in a supine position during feeding
B. Elevate the head of the bed to at least 30 degrees ✓
C. Administer bolus feedings rather than continuous
D. Check residual volumes every 8 hours only
Rationale:
To prevent aspiration in clients receiving enteral feedings, the head of the bed
should be elevated to at least 30 to 45 degrees during feeding and for at least
30 to 60 minutes after feeding. This position uses gravity to reduce the risk of
gastric contents refluxing into the esophagus and being aspirated. The supine
position (A) increases aspiration risk. Bolus feedings (C) actually increase
aspiration risk compared to continuous feedings. Residual volumes should be
checked every 4 to 6 hours (D), not just every 8 hours.
Question 6: A nurse is teaching a client about using an incentive
spirometer. Which of the following instructions should the nurse include?
A. Inhale slowly and deeply to elevate the cylinder ✓
B. Exhale forcefully into the device
C. Use the device once every 8 hours
D. Hold breath for 2 seconds after exhalation
Rationale:
An incentive spirometer is used to promote deep breathing and prevent
atelectasis. The client should inhale slowly and deeply to elevate the cylinder
or piston to the target level, hold the breath for 3 to 5 seconds at maximum
inhalation, and then exhale normally. Exhaling into the device (B) is incorrect
as the spirometer measures inspiratory effort. Use should be every 1 to 2
hours (C), not once every 8 hours. Breath holding occurs after inhalation, not
exhalation (D).
Question 7: A nurse is performing a pain assessment on a client who is
nonverbal. Which of the following assessment tools is most appropriate?
A. Numeric Rating Scale
B. Visual Analog Scale
C. FACES Pain Scale
Exit Level 3 Exam
180 NGN-Style Practice Questions
With Answers & Rationales
Latest 2026 Update
Covering All Major Content Areas:
• Fundamentals of Nursing (Q1–Q30)
• Pharmacology (Q31–Q55)
• Medical-Surgical Nursing (Q56–Q100)
• Maternal-Newborn Nursing (Q101–Q130)
• Pediatric Nursing (Q131–Q155)
• Mental Health Nursing (Q156–Q180)
Correct answers are highlighted in green with detailed rationales.
NGN-Style questions incorporate clinical judgment and critical thinking.
,SECTION 1: FUNDAMENTALS OF NURSING
Question 1: A nurse is assessing a client's vital signs. The client's blood
pressure is 158/94 mm Hg. Which of the following actions should the
nurse take first?
A. Administer an antihypertensive medication
B. Retake the blood pressure in the same arm after 2 minutes ✓
C. Notify the provider immediately
D. Document the finding and continue the assessment
Rationale:
When a single blood pressure reading is elevated, the nurse should first verify
the reading by retaking the measurement after allowing the client to rest for 1
to 2 minutes. This helps rule out factors such as anxiety, incorrect cuff size, or
improper positioning that may have caused a falsely elevated reading. Only
after confirming the reading should the nurse proceed with further actions such
as notifying the provider or administering medications. Premature intervention
based on a single reading could lead to unnecessary treatment.
Question 2: A client is on fall precautions. Which of the following
interventions should the nurse implement? (Select all that apply.)
A. Keep the bed in the lowest position ✓
B. Raise all four side rails
C. Place a fall risk bracelet on the client
D. Ensure the call light is within reach
Rationale:
Keeping the bed in the lowest position reduces the distance and potential
injury if a client attempts to get out of bed. A fall risk bracelet alerts all staff to
the client's risk status. The call light within reach enables the client to request
assistance. Raising all four side rails is considered a restraint and can actually
increase fall risk if the client attempts to climb over them. Two side rails may be
used for comfort, but four-point rail restraint requires a provider order and can
increase agitation and injury risk.
Question 3: A nurse is preparing to administer a medication via the Z-track
method. Which of the following is the correct technique?
A. Pull the skin laterally before injection and release after
, withdrawing the needle ✓
B. Massage the site vigorously after injection
C. Inject the medication at a 45-degree angle
D. Aspirate for 10 seconds before injecting
Rationale:
The Z-track method involves pulling the skin and subcutaneous tissue laterally
before inserting the needle, holding the skin in place during injection, and
waiting 10 seconds before withdrawing the needle. The skin is then released,
creating a zigzag path that seals the medication within the muscle and
prevents leakage into subcutaneous tissue. This method is used for
medications that are irritating to tissue, such as iron preparations.
Massaging the site (B) is contraindicated with the Z-track method, a 90-
degree angle (C) is used for IM injections, and prolonged aspiration (D) is not
standard practice.
Question 4: A nurse is caring for a client who has a stage 3 pressure injury.
Which of the following findings should the nurse expect?
A. Intact skin with non-blanchable redness
B. Full-thickness skin loss with visible subcutaneous fat ✓
C. Full-thickness tissue loss with exposed bone or muscle
D. Partial-thickness skin loss with a pink wound bed
Rationale:
A stage 3 pressure injury involves full-thickness skin loss in which
subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed.
Slough may be present but does not obscure the depth of tissue loss.
Undermining and tunneling may be present. Stage 1 (A) involves intact skin
with non-blanchable erythema. Stage 4 (C) involves full-thickness loss with
exposed bone, tendon, or muscle. Stage 2 (D) involves partial-thickness loss
presenting as a shallow open ulcer with a red-pink wound bed.
, Question 5: A client is receiving continuous enteral feeding via a
nasogastric tube. Which of the following actions should the nurse take to
prevent aspiration?
A. Place the client in a supine position during feeding
B. Elevate the head of the bed to at least 30 degrees ✓
C. Administer bolus feedings rather than continuous
D. Check residual volumes every 8 hours only
Rationale:
To prevent aspiration in clients receiving enteral feedings, the head of the bed
should be elevated to at least 30 to 45 degrees during feeding and for at least
30 to 60 minutes after feeding. This position uses gravity to reduce the risk of
gastric contents refluxing into the esophagus and being aspirated. The supine
position (A) increases aspiration risk. Bolus feedings (C) actually increase
aspiration risk compared to continuous feedings. Residual volumes should be
checked every 4 to 6 hours (D), not just every 8 hours.
Question 6: A nurse is teaching a client about using an incentive
spirometer. Which of the following instructions should the nurse include?
A. Inhale slowly and deeply to elevate the cylinder ✓
B. Exhale forcefully into the device
C. Use the device once every 8 hours
D. Hold breath for 2 seconds after exhalation
Rationale:
An incentive spirometer is used to promote deep breathing and prevent
atelectasis. The client should inhale slowly and deeply to elevate the cylinder
or piston to the target level, hold the breath for 3 to 5 seconds at maximum
inhalation, and then exhale normally. Exhaling into the device (B) is incorrect
as the spirometer measures inspiratory effort. Use should be every 1 to 2
hours (C), not once every 8 hours. Breath holding occurs after inhalation, not
exhalation (D).
Question 7: A nurse is performing a pain assessment on a client who is
nonverbal. Which of the following assessment tools is most appropriate?
A. Numeric Rating Scale
B. Visual Analog Scale
C. FACES Pain Scale
