ATI COMPREHENSIVE PRACTICE EXAM 2026/2027| Questions
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
EXAMINATION OVERVIEW
This comprehensive practice examination consists of 100 questions aligned with the
NCLEX-RN Client Needs Categories and ATI's Clinical Judgment Measurement Model.
The exam includes traditional multiple-choice questions and alternate item formats to
assess clinical reasoning across the nursing process.
Time Allotment: 180 minutes
Passing Standard: Demonstration of clinical judgment across all client need categories
QUESTIONS 1-100 (Mixed Order)
Question 1 - Multiple Choice (Management of Care)
A charge nurse on a medical-surgical unit receives report on four patients. Which
patient requires the most immediate assessment?
A) 68-year-old with heart failure, BP 142/88 mmHg, reports dyspnea when walking to
bathroom
B) 55-year-old post-appendectomy, pain 6/10, requesting PRN medication
C) 72-year-old with pneumonia, SpO2 89% on room air, respiratory rate 28/min
,D) 45-year-old with new-onset diabetes, blood glucose 186 mg/dL, anxious about insulin
injections
Correct Answer: C
Rationale: The 72-year-old with pneumonia and SpO2 89% on room air requires
immediate assessment. Hypoxemia (SpO2 <90%) indicates severe gas exchange
impairment. The respiratory rate of 28/min demonstrates compensatory tachypnea.
This patient is at risk for respiratory failure and requires immediate oxygen therapy and
provider notification. Option A shows stable hypertension with expected exertional
dyspnea in heart failure. Option B represents expected postoperative pain managed
with PRN medication. Option D shows mildly elevated glucose with psychosocial needs,
not an immediate physiological threat.
Teaching Point: Always prioritize airway and breathing (ABCs) using the Maslow's
hierarchy and ABC framework. Hypoxemia takes precedence over pain, anxiety, or stable
chronic conditions.
Question 2 - Multiple Choice (Pharmacological Therapies)
A patient is prescribed metoprolol 25 mg PO twice daily for hypertension. Which
assessment finding indicates the medication is achieving the desired therapeutic
effect?
A) Blood pressure decreased from 168/98 to 138/84 mmHg
B) Heart rate increased from 72 to 88 bpm
C) Report of increased energy and decreased fatigue
D) Weight gain of 3 pounds over one week
,Correct Answer: A
Rationale: Metoprolol is a cardioselective beta-1 blocker indicated for hypertension. The
desired therapeutic effect is reduced blood pressure through decreased cardiac output
and renin release. A reduction from 168/98 to 138/84 mmHg demonstrates effective
antihypertensive action. Option B (increased HR) is opposite of expected
effect—beta-blockers decrease heart rate. Option C may occur as secondary benefit but
is not the primary therapeutic indicator. Option D (weight gain) suggests fluid retention
or heart failure exacerbation, not therapeutic effect.
Teaching Point: Beta-blockers reduce blood pressure and heart rate. Monitor for
bradycardia (<60 bpm) and hypotension as adverse effects, not therapeutic goals.
Question 3 - Multiple Response (Select All That Apply) - Safety and Infection Control
A nurse is caring for a patient with Clostridioides difficile infection. Which infection
control measures are appropriate? Select all that apply.
A) Place patient in a private room with contact precautions
B) Use soap and water for hand hygiene before and after patient contact
C) Wear an N95 respirator when entering the room
D) Use disposable equipment or dedicate equipment to the patient
E) Administer prophylactic antibiotics to exposed staff members
F) Continue contact precautions for 48 hours after diarrhea resolves
Correct Answers: A, B, D, F
Rationale:
, ● A: Private room with contact precautions is required for C. difficile due to spore
transmission via fecal-oral route.
● B: Soap and water is superior to alcohol-based hand sanitizer for C. difficile
spores; alcohol does not kill spores effectively.
● D: Dedicated equipment prevents environmental contamination with spores.
● F: Contact precautions continue for 48 hours after diarrhea resolves per CDC
guidelines.
C is incorrect: N95 respirators are for airborne precautions (TB, measles, varicella); C.
difficile requires contact precautions only. E is incorrect: Prophylactic antibiotics are not
recommended for healthcare workers and contribute to resistance.
Teaching Point: C. difficile spores are resistant to alcohol-based hand sanitizers. Soap
and water with friction is required for hand hygiene.
Question 4 - Fill-in-the-Blank (Calculations)
A pediatric patient weighs 22 pounds and is prescribed amoxicillin 45 mg/kg/day
divided in two doses. The available suspension is 250 mg/5 mL. How many mL should
the nurse administer per dose? (Round to the nearest tenth)
Correct Answer: 4.5 mL
Rationale:
● Convert weight: 22 pounds ÷ 2.2 = 10 kg
● Calculate daily dose: 45 mg/kg × 10 kg = 450 mg/day
● Calculate per dose: 450 mg ÷ 2 doses = 225 mg/dose
● Calculate volume: (225 mg ÷ 250 mg) × 5 mL = 4.5 mL
Teaching Point: Always convert pounds to kilograms first (divide by 2.2). Verify pediatric
doses carefully—medication errors are common in weight-based calculations.
Question 5 - Multiple Choice (Prioritization - Physiological Adaptation)
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
EXAMINATION OVERVIEW
This comprehensive practice examination consists of 100 questions aligned with the
NCLEX-RN Client Needs Categories and ATI's Clinical Judgment Measurement Model.
The exam includes traditional multiple-choice questions and alternate item formats to
assess clinical reasoning across the nursing process.
Time Allotment: 180 minutes
Passing Standard: Demonstration of clinical judgment across all client need categories
QUESTIONS 1-100 (Mixed Order)
Question 1 - Multiple Choice (Management of Care)
A charge nurse on a medical-surgical unit receives report on four patients. Which
patient requires the most immediate assessment?
A) 68-year-old with heart failure, BP 142/88 mmHg, reports dyspnea when walking to
bathroom
B) 55-year-old post-appendectomy, pain 6/10, requesting PRN medication
C) 72-year-old with pneumonia, SpO2 89% on room air, respiratory rate 28/min
,D) 45-year-old with new-onset diabetes, blood glucose 186 mg/dL, anxious about insulin
injections
Correct Answer: C
Rationale: The 72-year-old with pneumonia and SpO2 89% on room air requires
immediate assessment. Hypoxemia (SpO2 <90%) indicates severe gas exchange
impairment. The respiratory rate of 28/min demonstrates compensatory tachypnea.
This patient is at risk for respiratory failure and requires immediate oxygen therapy and
provider notification. Option A shows stable hypertension with expected exertional
dyspnea in heart failure. Option B represents expected postoperative pain managed
with PRN medication. Option D shows mildly elevated glucose with psychosocial needs,
not an immediate physiological threat.
Teaching Point: Always prioritize airway and breathing (ABCs) using the Maslow's
hierarchy and ABC framework. Hypoxemia takes precedence over pain, anxiety, or stable
chronic conditions.
Question 2 - Multiple Choice (Pharmacological Therapies)
A patient is prescribed metoprolol 25 mg PO twice daily for hypertension. Which
assessment finding indicates the medication is achieving the desired therapeutic
effect?
A) Blood pressure decreased from 168/98 to 138/84 mmHg
B) Heart rate increased from 72 to 88 bpm
C) Report of increased energy and decreased fatigue
D) Weight gain of 3 pounds over one week
,Correct Answer: A
Rationale: Metoprolol is a cardioselective beta-1 blocker indicated for hypertension. The
desired therapeutic effect is reduced blood pressure through decreased cardiac output
and renin release. A reduction from 168/98 to 138/84 mmHg demonstrates effective
antihypertensive action. Option B (increased HR) is opposite of expected
effect—beta-blockers decrease heart rate. Option C may occur as secondary benefit but
is not the primary therapeutic indicator. Option D (weight gain) suggests fluid retention
or heart failure exacerbation, not therapeutic effect.
Teaching Point: Beta-blockers reduce blood pressure and heart rate. Monitor for
bradycardia (<60 bpm) and hypotension as adverse effects, not therapeutic goals.
Question 3 - Multiple Response (Select All That Apply) - Safety and Infection Control
A nurse is caring for a patient with Clostridioides difficile infection. Which infection
control measures are appropriate? Select all that apply.
A) Place patient in a private room with contact precautions
B) Use soap and water for hand hygiene before and after patient contact
C) Wear an N95 respirator when entering the room
D) Use disposable equipment or dedicate equipment to the patient
E) Administer prophylactic antibiotics to exposed staff members
F) Continue contact precautions for 48 hours after diarrhea resolves
Correct Answers: A, B, D, F
Rationale:
, ● A: Private room with contact precautions is required for C. difficile due to spore
transmission via fecal-oral route.
● B: Soap and water is superior to alcohol-based hand sanitizer for C. difficile
spores; alcohol does not kill spores effectively.
● D: Dedicated equipment prevents environmental contamination with spores.
● F: Contact precautions continue for 48 hours after diarrhea resolves per CDC
guidelines.
C is incorrect: N95 respirators are for airborne precautions (TB, measles, varicella); C.
difficile requires contact precautions only. E is incorrect: Prophylactic antibiotics are not
recommended for healthcare workers and contribute to resistance.
Teaching Point: C. difficile spores are resistant to alcohol-based hand sanitizers. Soap
and water with friction is required for hand hygiene.
Question 4 - Fill-in-the-Blank (Calculations)
A pediatric patient weighs 22 pounds and is prescribed amoxicillin 45 mg/kg/day
divided in two doses. The available suspension is 250 mg/5 mL. How many mL should
the nurse administer per dose? (Round to the nearest tenth)
Correct Answer: 4.5 mL
Rationale:
● Convert weight: 22 pounds ÷ 2.2 = 10 kg
● Calculate daily dose: 45 mg/kg × 10 kg = 450 mg/day
● Calculate per dose: 450 mg ÷ 2 doses = 225 mg/dose
● Calculate volume: (225 mg ÷ 250 mg) × 5 mL = 4.5 mL
Teaching Point: Always convert pounds to kilograms first (divide by 2.2). Verify pediatric
doses carefully—medication errors are common in weight-based calculations.
Question 5 - Multiple Choice (Prioritization - Physiological Adaptation)
