ATI COMPREHENSIVE PRACTICE EXAM 2026/2027| Questions
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
1. Multiple Choice
A 68-year-old post-operative patient has a chest tube that accidentally becomes
disconnected from the drainage system. The nurse finds the tube open to air.
Which action should the nurse take first?
A. Clamp the chest tube immediately
B. Place the end of the tube in a sterile container of normal saline
C. Apply an occlusive dressing over the insertion site
D. Reconnect the tube to a new drainage system
Correct Answer: B
Rationale: Submerging the tube 2 cm below the surface of sterile saline restores
water-seal and prevents air entry. Clamping can cause tension pneumothorax.
Teaching Point: Never clamp a chest tube when an air-leak is suspected; maintain
water-seal or occlusive environment.
2. Select All That Apply
The nurse is reviewing the lab results of a 4-day-old breast-fed newborn. Which
findings require immediate follow-up? (Select all that apply.)
A. Total bilirubin 18 mg/dL
B. Weight loss 6 % from birth weight
C. Glucose 40 mg/dL
D. Sodium 128 mEq/L
E. Hemoglobin 18 g/dL
Correct Answers: A, C, D
,Rationale: Bilirubin >15 mg/dL at 96 h, glucose <45 mg/dL, and Na <130 mEq/L are
outside safe limits. 6 % weight loss is acceptable; Hgb 18 g/dL is normal neonatal
polycythemia.
Teaching Point: Early identification of hyperbilirubinemia prevents kernicterus.
3. Drag and Drop (Ordered Response)
A 72-year-old with COPD is in respiratory distress. Place the nursing actions in
the correct order:
4. Apply high-flow oxygen via non-rebreather
5. Raise head of bed to high-Fowler position
6. Check SpO₂ and respiratory rate
7. Auscultate lung fields
8. Obtain ABG per protocol
Correct Order: 3 → 2 → 4 → 1 → 5
Rationale: Follow airway-vital signs-position-oxygen-labs sequence.
4. Fill-in-the-Blank
A patient is prescribed 1.5 L of 0.45 % saline to run over 8 hours. The drop factor
is 15 gtt/mL. Calculate the infusion rate in gtt/min. (Round to nearest whole
number.)
Correct Answer: 47 gtt/min
Rationale: 1500 mL × 15 gtt/mL ÷ 480 min = 46.875 → 47 gtt/min.
5. Multiple Choice
The nurse is delegating tasks on a medical floor. Which task is appropriate to
assign to an unlicensed assistive personnel (UAP)?
A. Measure abdominal girth of a patient with ascites
B. Check gag reflex of a stroke patient before lunch
C. Teach the use of an incentive spirometer
D. Perform a sterile dressing change
Correct Answer: A
,Rationale: Abdominal girth is a standard measurement; gag reflex, teaching, and sterile
procedures require licensed personnel.
Teaching Point: UAP scope includes vital signs, height/weight/girth, ADLs, and simple
non-invasive tasks.
6. Select All That Apply
A patient with heart failure is receiving digoxin. Which findings suggest toxicity?
(Select all that apply.)
A. Anorexia
B. Visual halos
C. Serum digoxin 1.8 ng/mL
D. New-onset atrial fibrillation
E. Bigeminy on cardiac monitor
Correct Answers: A, B, E
Rationale: GI upset, visual disturbances, and ventricular ectopy are classic signs.
Therapeutic range 0.8–2 ng/mL; 1.8 ng/mL is high-normal but not toxic alone.
7. Multiple Choice
A pregnant client at 30 weeks reports no fetal movement in 8 hours. Which
nursing action is priority?
A. Have her drink a cold glass of water and count movements
B. Perform a non-stress test immediately
C. Check maternal glucose level
D. Palpate fetal position
Correct Answer: B
Rationale: Absence of perceived movement >6 hours requires immediate fetal
assessment (kick counts not sufficient).
Teaching Point: Decreased fetal movement is a red flag; timely evaluation prevents
stillbirth.
, 8. Hot Spot (Textual)
A patient with left-sided stroke has neglect syndrome. The nurse asks the patient
to identify objects on a tray. Which side of the tray will the patient most likely
ignore? (Answer: left)
9. Multiple Choice
A patient with diabetes has a foot ulcer. The provider orders wet-to-dry dressing
changes BID. What is the primary purpose of this dressing?
A. Provide thermal insulation
B. Debride necrotic tissue mechanically
C. Increase granulation tissue formation
D. Reduce edema
Correct Answer: B
Rationale: Wet-to-dry dressings adhere to dead tissue and remove it when pulled off.
10. Select All That Apply
During a blood transfusion, the patient reports chills and flank pain. Which
actions are required immediately? (Select all that apply.)
A. Stop the transfusion
B. Check vitals
C. Notify provider
D. Send remaining blood to lab
E. Start normal saline at KVO through new tubing
Correct Answers: A, B, C, D, E
Rationale: Classic hemolytic reaction protocol—stop, vitals, notify, return blood, maintain
line with new tubing/saline.
11. Multiple Choice
A patient with a serum sodium of 128 mEq/L is receiving 3 % saline at 30 mL/h.
Which assessment finding best indicates improvement?
A. Increased thirst
B. Urine output 0.5 mL/kg/h
C. GCS score rises from 13 to 15
D. Serum osmolality 280 mOsm/kg
Correct Answer: C
with Detailed Rationales & Teaching Points| Actual ATI-Style
Questions | Comprehensive Content Review | Pass Guarantee
1. Multiple Choice
A 68-year-old post-operative patient has a chest tube that accidentally becomes
disconnected from the drainage system. The nurse finds the tube open to air.
Which action should the nurse take first?
A. Clamp the chest tube immediately
B. Place the end of the tube in a sterile container of normal saline
C. Apply an occlusive dressing over the insertion site
D. Reconnect the tube to a new drainage system
Correct Answer: B
Rationale: Submerging the tube 2 cm below the surface of sterile saline restores
water-seal and prevents air entry. Clamping can cause tension pneumothorax.
Teaching Point: Never clamp a chest tube when an air-leak is suspected; maintain
water-seal or occlusive environment.
2. Select All That Apply
The nurse is reviewing the lab results of a 4-day-old breast-fed newborn. Which
findings require immediate follow-up? (Select all that apply.)
A. Total bilirubin 18 mg/dL
B. Weight loss 6 % from birth weight
C. Glucose 40 mg/dL
D. Sodium 128 mEq/L
E. Hemoglobin 18 g/dL
Correct Answers: A, C, D
,Rationale: Bilirubin >15 mg/dL at 96 h, glucose <45 mg/dL, and Na <130 mEq/L are
outside safe limits. 6 % weight loss is acceptable; Hgb 18 g/dL is normal neonatal
polycythemia.
Teaching Point: Early identification of hyperbilirubinemia prevents kernicterus.
3. Drag and Drop (Ordered Response)
A 72-year-old with COPD is in respiratory distress. Place the nursing actions in
the correct order:
4. Apply high-flow oxygen via non-rebreather
5. Raise head of bed to high-Fowler position
6. Check SpO₂ and respiratory rate
7. Auscultate lung fields
8. Obtain ABG per protocol
Correct Order: 3 → 2 → 4 → 1 → 5
Rationale: Follow airway-vital signs-position-oxygen-labs sequence.
4. Fill-in-the-Blank
A patient is prescribed 1.5 L of 0.45 % saline to run over 8 hours. The drop factor
is 15 gtt/mL. Calculate the infusion rate in gtt/min. (Round to nearest whole
number.)
Correct Answer: 47 gtt/min
Rationale: 1500 mL × 15 gtt/mL ÷ 480 min = 46.875 → 47 gtt/min.
5. Multiple Choice
The nurse is delegating tasks on a medical floor. Which task is appropriate to
assign to an unlicensed assistive personnel (UAP)?
A. Measure abdominal girth of a patient with ascites
B. Check gag reflex of a stroke patient before lunch
C. Teach the use of an incentive spirometer
D. Perform a sterile dressing change
Correct Answer: A
,Rationale: Abdominal girth is a standard measurement; gag reflex, teaching, and sterile
procedures require licensed personnel.
Teaching Point: UAP scope includes vital signs, height/weight/girth, ADLs, and simple
non-invasive tasks.
6. Select All That Apply
A patient with heart failure is receiving digoxin. Which findings suggest toxicity?
(Select all that apply.)
A. Anorexia
B. Visual halos
C. Serum digoxin 1.8 ng/mL
D. New-onset atrial fibrillation
E. Bigeminy on cardiac monitor
Correct Answers: A, B, E
Rationale: GI upset, visual disturbances, and ventricular ectopy are classic signs.
Therapeutic range 0.8–2 ng/mL; 1.8 ng/mL is high-normal but not toxic alone.
7. Multiple Choice
A pregnant client at 30 weeks reports no fetal movement in 8 hours. Which
nursing action is priority?
A. Have her drink a cold glass of water and count movements
B. Perform a non-stress test immediately
C. Check maternal glucose level
D. Palpate fetal position
Correct Answer: B
Rationale: Absence of perceived movement >6 hours requires immediate fetal
assessment (kick counts not sufficient).
Teaching Point: Decreased fetal movement is a red flag; timely evaluation prevents
stillbirth.
, 8. Hot Spot (Textual)
A patient with left-sided stroke has neglect syndrome. The nurse asks the patient
to identify objects on a tray. Which side of the tray will the patient most likely
ignore? (Answer: left)
9. Multiple Choice
A patient with diabetes has a foot ulcer. The provider orders wet-to-dry dressing
changes BID. What is the primary purpose of this dressing?
A. Provide thermal insulation
B. Debride necrotic tissue mechanically
C. Increase granulation tissue formation
D. Reduce edema
Correct Answer: B
Rationale: Wet-to-dry dressings adhere to dead tissue and remove it when pulled off.
10. Select All That Apply
During a blood transfusion, the patient reports chills and flank pain. Which
actions are required immediately? (Select all that apply.)
A. Stop the transfusion
B. Check vitals
C. Notify provider
D. Send remaining blood to lab
E. Start normal saline at KVO through new tubing
Correct Answers: A, B, C, D, E
Rationale: Classic hemolytic reaction protocol—stop, vitals, notify, return blood, maintain
line with new tubing/saline.
11. Multiple Choice
A patient with a serum sodium of 128 mEq/L is receiving 3 % saline at 30 mL/h.
Which assessment finding best indicates improvement?
A. Increased thirst
B. Urine output 0.5 mL/kg/h
C. GCS score rises from 13 to 15
D. Serum osmolality 280 mOsm/kg
Correct Answer: C
