ATI COMPREHENSIVE PRACTICE EXAM 2026/2027| Questions
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
SAFE AND EFFECTIVE CARE ENVIRONMENT: MANAGEMENT OF CARE
1. The nurse is caring for four patients on a medical-surgical unit. Which patient
requires immediate assessment?
● A. 45-year-old post-appendectomy, pain 3/10, stable vital signs
● B. 68-year-old with CHF, weight gain 2 lbs from yesterday, lungs clear
● C. 72-year-old post-CVA, new onset confusion and slurred speech
● D. 35-year-old with pneumonia, temp 38.2°C, O₂ sat 94% on 2L NC
Correct Answer: C
Rationale: New onset confusion and slurred speech in a post-stroke patient suggests
recurrent CVA or extension—neurological changes are priority. Pain control, mild weight
gain, and low-grade fever are expected findings.
Teaching Point: Always prioritize neurological changes, airway compromise, and
hemodynamic instability using Maslow's hierarchy and ABCs.
2. A nurse delegates morning vital signs to unlicensed assistive personnel (UAP). Which
finding must the nurse be notified of immediately?
● A. BP 142/88 in a 55-year-old with hypertension
● B. HR 58 in a 42-year-old athlete
● C. RR 28 and shallow in a 70-year-old post-op abdominal surgery
● D. Temp 37.8°C in a 30-year-old with influenza
Correct Answer: C
,Rationale: Tachypnea and shallow breathing post-abdominal surgery suggests
respiratory compromise, possible atelectasis, or impending respiratory failure. Requires
immediate nursing assessment.
Teaching Point: UAP must report abnormal vital signs immediately; nurses must
validate and interpret data for clinical significance.
3. The charge nurse is making assignments. Which task is appropriate for an LPN?
● A. Developing a teaching plan for a newly diagnosed diabetic
● B. Administering blood transfusion to a patient with anemia
● C. Performing sterile dressing change on a post-op wound
● D. Completing discharge planning for a patient going home
Correct Answer: C
Rationale: LPNs can perform sterile dressing changes under RN supervision. Teaching,
blood administration, and discharge planning require RN scope of practice.
Teaching Point: Know scope of practice: LPNs provide direct care under RN direction;
RNs perform assessments, teaching, and complex procedures.
4. During a code blue, the nurse notes the following rhythm on the monitor: organized
electrical activity, rate 40, no palpable pulse. The priority intervention is:
● A. Administer atropine 1 mg IV
● B. Begin high-quality CPR
● C. Prepare for transcutaneous pacing
● D. Give epinephrine 1 mg IV
Correct Answer: B
Rationale: Pulseless electrical activity (PEA) requires immediate CPR per ACLS.
Medications and pacing are ineffective without perfusion.
Teaching Point: In cardiac arrest, high-quality CPR is the foundation of all resuscitation
efforts.
,5. A patient with a new ileostomy expresses concern about odor. Which intervention is
most appropriate?
● A. Recommend avoiding all vegetables
● B. Suggest using deodorant drops in the pouch
● C. Advise emptying the pouch only when completely full
● D. Instruct to change the entire appliance system daily
Correct Answer: B
Rationale: Deodorant drops or tablets are designed for ostomy pouches. Vegetables
should be reintroduced gradually; pouches should be emptied at 1/3–1/2 full; wafer
changes every 3–7 days.
Teaching Point: Ostomy teaching includes pouch management, skin protection, odor
control, and dietary modifications.
6. A nurse is reviewing medication orders. Which order requires clarification?
● A. Morphine 2 mg IV q4h PRN pain
● B. Warfarin 5 mg PO daily, hold if INR >4
● C. Insulin sliding scale q6h and HS
● D. Digoxin 0.25 mg PO daily, no parameters
Correct Answer: D
Rationale: Digoxin requires apical pulse parameters (hold if <60 in adult) and serum
level monitoring. No parameters is unsafe.
Teaching Point: Cardiac glycosides have narrow therapeutic index; always verify
parameters for administration.
7. A patient with a PICC line develops sudden dyspnea, chest pain, and tachycardia. The
nurse suspects:
● A. Catheter-related bloodstream infection
● B. Pneumothorax from insertion
● C. Air embolism
● D. Pulmonary embolism from thrombosis
, Correct Answer: D
Rationale: PICC lines increase DVT/PE risk; classic triad of dyspnea, chest pain,
tachycardia suggests PE. Air embolism would occur at insertion or with line break.
Teaching Point: Upper extremity DVT and PE are complications of central venous
access; maintain line patency and assess for symptoms.
8. The nurse is caring for a patient with a do-not-resuscitate (DNR) order who develops
acute respiratory distress. The appropriate action is:
● A. Initiate full resuscitation regardless of DNR status
● B. Provide comfort measures and notify provider
● C. Ask the family to revoke the DNR
● D. Transfer to ICU for aggressive management
Correct Answer: B
Rationale: DNR does not mean do-not-treat; provide comfort, treat reversible causes,
and honor patient wishes. Family cannot revoke without patient capacity.
Teaching Point: DNR orders apply to cardiac arrest; patients still deserve appropriate
medical care for other conditions.
9. A new graduate nurse is struggling with time management. The preceptor should
suggest:
● A. Completing all documentation at end of shift
● B. Clustering care activities for each patient
● C. Delegating all patient education to senior nurses
● D. Focusing on one patient at a time exclusively
Correct Answer: B
Rationale: Clustering care improves efficiency and reduces patient interruptions.
Documentation should be real-time; education is within scope; exclusive focus neglects
other patients.
Teaching Point: Effective time management includes prioritization, clustering, and
appropriate delegation.
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
SAFE AND EFFECTIVE CARE ENVIRONMENT: MANAGEMENT OF CARE
1. The nurse is caring for four patients on a medical-surgical unit. Which patient
requires immediate assessment?
● A. 45-year-old post-appendectomy, pain 3/10, stable vital signs
● B. 68-year-old with CHF, weight gain 2 lbs from yesterday, lungs clear
● C. 72-year-old post-CVA, new onset confusion and slurred speech
● D. 35-year-old with pneumonia, temp 38.2°C, O₂ sat 94% on 2L NC
Correct Answer: C
Rationale: New onset confusion and slurred speech in a post-stroke patient suggests
recurrent CVA or extension—neurological changes are priority. Pain control, mild weight
gain, and low-grade fever are expected findings.
Teaching Point: Always prioritize neurological changes, airway compromise, and
hemodynamic instability using Maslow's hierarchy and ABCs.
2. A nurse delegates morning vital signs to unlicensed assistive personnel (UAP). Which
finding must the nurse be notified of immediately?
● A. BP 142/88 in a 55-year-old with hypertension
● B. HR 58 in a 42-year-old athlete
● C. RR 28 and shallow in a 70-year-old post-op abdominal surgery
● D. Temp 37.8°C in a 30-year-old with influenza
Correct Answer: C
,Rationale: Tachypnea and shallow breathing post-abdominal surgery suggests
respiratory compromise, possible atelectasis, or impending respiratory failure. Requires
immediate nursing assessment.
Teaching Point: UAP must report abnormal vital signs immediately; nurses must
validate and interpret data for clinical significance.
3. The charge nurse is making assignments. Which task is appropriate for an LPN?
● A. Developing a teaching plan for a newly diagnosed diabetic
● B. Administering blood transfusion to a patient with anemia
● C. Performing sterile dressing change on a post-op wound
● D. Completing discharge planning for a patient going home
Correct Answer: C
Rationale: LPNs can perform sterile dressing changes under RN supervision. Teaching,
blood administration, and discharge planning require RN scope of practice.
Teaching Point: Know scope of practice: LPNs provide direct care under RN direction;
RNs perform assessments, teaching, and complex procedures.
4. During a code blue, the nurse notes the following rhythm on the monitor: organized
electrical activity, rate 40, no palpable pulse. The priority intervention is:
● A. Administer atropine 1 mg IV
● B. Begin high-quality CPR
● C. Prepare for transcutaneous pacing
● D. Give epinephrine 1 mg IV
Correct Answer: B
Rationale: Pulseless electrical activity (PEA) requires immediate CPR per ACLS.
Medications and pacing are ineffective without perfusion.
Teaching Point: In cardiac arrest, high-quality CPR is the foundation of all resuscitation
efforts.
,5. A patient with a new ileostomy expresses concern about odor. Which intervention is
most appropriate?
● A. Recommend avoiding all vegetables
● B. Suggest using deodorant drops in the pouch
● C. Advise emptying the pouch only when completely full
● D. Instruct to change the entire appliance system daily
Correct Answer: B
Rationale: Deodorant drops or tablets are designed for ostomy pouches. Vegetables
should be reintroduced gradually; pouches should be emptied at 1/3–1/2 full; wafer
changes every 3–7 days.
Teaching Point: Ostomy teaching includes pouch management, skin protection, odor
control, and dietary modifications.
6. A nurse is reviewing medication orders. Which order requires clarification?
● A. Morphine 2 mg IV q4h PRN pain
● B. Warfarin 5 mg PO daily, hold if INR >4
● C. Insulin sliding scale q6h and HS
● D. Digoxin 0.25 mg PO daily, no parameters
Correct Answer: D
Rationale: Digoxin requires apical pulse parameters (hold if <60 in adult) and serum
level monitoring. No parameters is unsafe.
Teaching Point: Cardiac glycosides have narrow therapeutic index; always verify
parameters for administration.
7. A patient with a PICC line develops sudden dyspnea, chest pain, and tachycardia. The
nurse suspects:
● A. Catheter-related bloodstream infection
● B. Pneumothorax from insertion
● C. Air embolism
● D. Pulmonary embolism from thrombosis
, Correct Answer: D
Rationale: PICC lines increase DVT/PE risk; classic triad of dyspnea, chest pain,
tachycardia suggests PE. Air embolism would occur at insertion or with line break.
Teaching Point: Upper extremity DVT and PE are complications of central venous
access; maintain line patency and assess for symptoms.
8. The nurse is caring for a patient with a do-not-resuscitate (DNR) order who develops
acute respiratory distress. The appropriate action is:
● A. Initiate full resuscitation regardless of DNR status
● B. Provide comfort measures and notify provider
● C. Ask the family to revoke the DNR
● D. Transfer to ICU for aggressive management
Correct Answer: B
Rationale: DNR does not mean do-not-treat; provide comfort, treat reversible causes,
and honor patient wishes. Family cannot revoke without patient capacity.
Teaching Point: DNR orders apply to cardiac arrest; patients still deserve appropriate
medical care for other conditions.
9. A new graduate nurse is struggling with time management. The preceptor should
suggest:
● A. Completing all documentation at end of shift
● B. Clustering care activities for each patient
● C. Delegating all patient education to senior nurses
● D. Focusing on one patient at a time exclusively
Correct Answer: B
Rationale: Clustering care improves efficiency and reduces patient interruptions.
Documentation should be real-time; education is within scope; exclusive focus neglects
other patients.
Teaching Point: Effective time management includes prioritization, clustering, and
appropriate delegation.
