ATI PN Comprehensive Predictor 2026 – NGN
Practice Exam A | NGN Clinical Judgment
Case Studies, Verified Answers, &
Comprehensive Rationales
1.
A nurse is caring for a client with heart failure who suddenly
develops crackles, dyspnea, and oxygen saturation of 84%.
What is the priority action?
A. Obtain a stat chest x-ray
B. Increase IV fluids
C. Initiate high-flow oxygen via non-rebreather mask
D. Administer oral furosemide
Rationale:
The client is showing acute hypoxemia and pulmonary edema
signs. The priority is airway and oxygenation. A non-
rebreather mask delivers the highest oxygen concentration
quickly. Diagnostics and diuretics are important but not
immediate priorities compared to oxygenation.
2.
A client with diabetic ketoacidosis is receiving IV insulin.
Which finding requires immediate intervention?
,A. Blood glucose 250 mg/dL
B. Potassium level 3.0 mEq/L
C. Urine output 40 mL/hr
D. pH 7.30
B. Potassium level 3.0 mEq/L
Rationale:
Insulin drives potassium into cells, worsening hypokalemia. A
potassium level of 3.0 is dangerous and can lead to
dysrhythmias. Insulin should be held and potassium replaced
first.
3.
A postoperative client suddenly becomes confused,
tachycardic, and hypotensive. Which complication does the
nurse suspect first?
A. Myocardial infarction
B. Pulmonary embolism
C. Hemorrhagic shock
D. Stroke
Rationale:
Postoperative hypotension with tachycardia and acute
confusion strongly suggests internal bleeding leading to
hypovolemic shock. This is the most immediate life-
threatening concern.
4.
,Which action best prevents catheter-associated urinary tract
infection (CAUTI)?
A. Emptying drainage bag every 12 hours
B. Irrigating catheter daily
C. Maintaining a closed drainage system
D. Changing catheter weekly
Rationale:
Maintaining a closed sterile system is the most effective
evidence-based prevention strategy. Routine irrigation and
frequent changes increase infection risk.
5.
A client with tuberculosis is placed in airborne isolation.
Which nursing action is appropriate?
A. Wear surgical mask only
B. Place client in a negative-pressure room
C. Allow visitors without restrictions
D. Discontinue isolation after 24 hours of antibiotics
B. Place client in a negative-pressure room
Rationale:
Airborne pathogens require negative-pressure ventilation to
prevent spread. Surgical masks are insufficient; N95
respirators are required for staff.
6.
, A client receiving heparin has a platelet count of
90,000/mm³. What is the priority action?
A. Continue infusion
B. Increase dose
C. Stop heparin immediately
D. Administer vitamin K
Rationale:
This suggests heparin-induced thrombocytopenia (HIT).
Heparin must be discontinued immediately to prevent
thrombosis.
7.
A nurse is assessing a client with increased intracranial
pressure (ICP). Which finding is most concerning?
A. Headache
B. Restlessness
C. Irregular respirations (Cheyne-Stokes)
D. Nausea
Rationale:
Abnormal respiratory patterns indicate brainstem
involvement and impending herniation, which is life-
threatening.
8.
A newborn has a positive Babinski reflex. What does this
indicate?
Practice Exam A | NGN Clinical Judgment
Case Studies, Verified Answers, &
Comprehensive Rationales
1.
A nurse is caring for a client with heart failure who suddenly
develops crackles, dyspnea, and oxygen saturation of 84%.
What is the priority action?
A. Obtain a stat chest x-ray
B. Increase IV fluids
C. Initiate high-flow oxygen via non-rebreather mask
D. Administer oral furosemide
Rationale:
The client is showing acute hypoxemia and pulmonary edema
signs. The priority is airway and oxygenation. A non-
rebreather mask delivers the highest oxygen concentration
quickly. Diagnostics and diuretics are important but not
immediate priorities compared to oxygenation.
2.
A client with diabetic ketoacidosis is receiving IV insulin.
Which finding requires immediate intervention?
,A. Blood glucose 250 mg/dL
B. Potassium level 3.0 mEq/L
C. Urine output 40 mL/hr
D. pH 7.30
B. Potassium level 3.0 mEq/L
Rationale:
Insulin drives potassium into cells, worsening hypokalemia. A
potassium level of 3.0 is dangerous and can lead to
dysrhythmias. Insulin should be held and potassium replaced
first.
3.
A postoperative client suddenly becomes confused,
tachycardic, and hypotensive. Which complication does the
nurse suspect first?
A. Myocardial infarction
B. Pulmonary embolism
C. Hemorrhagic shock
D. Stroke
Rationale:
Postoperative hypotension with tachycardia and acute
confusion strongly suggests internal bleeding leading to
hypovolemic shock. This is the most immediate life-
threatening concern.
4.
,Which action best prevents catheter-associated urinary tract
infection (CAUTI)?
A. Emptying drainage bag every 12 hours
B. Irrigating catheter daily
C. Maintaining a closed drainage system
D. Changing catheter weekly
Rationale:
Maintaining a closed sterile system is the most effective
evidence-based prevention strategy. Routine irrigation and
frequent changes increase infection risk.
5.
A client with tuberculosis is placed in airborne isolation.
Which nursing action is appropriate?
A. Wear surgical mask only
B. Place client in a negative-pressure room
C. Allow visitors without restrictions
D. Discontinue isolation after 24 hours of antibiotics
B. Place client in a negative-pressure room
Rationale:
Airborne pathogens require negative-pressure ventilation to
prevent spread. Surgical masks are insufficient; N95
respirators are required for staff.
6.
, A client receiving heparin has a platelet count of
90,000/mm³. What is the priority action?
A. Continue infusion
B. Increase dose
C. Stop heparin immediately
D. Administer vitamin K
Rationale:
This suggests heparin-induced thrombocytopenia (HIT).
Heparin must be discontinued immediately to prevent
thrombosis.
7.
A nurse is assessing a client with increased intracranial
pressure (ICP). Which finding is most concerning?
A. Headache
B. Restlessness
C. Irregular respirations (Cheyne-Stokes)
D. Nausea
Rationale:
Abnormal respiratory patterns indicate brainstem
involvement and impending herniation, which is life-
threatening.
8.
A newborn has a positive Babinski reflex. What does this
indicate?
