ATI PN Comprehensive Predictor Exit Exam | NGN | 2026/2027 Updated
ATI PN COMPREHENSIVE PREDICTOR EXIT EXAM
Next Generation NCLEX (NGN) Clinical Judgment Integration | 2026/2027 Updated | Case Studies and SATA
200 Questions with Comprehensive Rationales
Section 1: NGN Case Studies with Extended Scenarios (Q1-40)
Case 1: Heart Failure Exacerbation
Q1: A 68-year-old client with a history of heart failure is admitted with dyspnea, weight gain of 6 lb over 3 days, and bilateral
ankle edema. The nurse notes the client has been taking furosemide 40 mg PO daily but reports sometimes forgetting doses.
Which of the following findings should the nurse recognize as the most critical cue requiring immediate action?
A. Crackles in bilateral lung bases [CORRECT]
B. Weight gain of 6 lb in 3 days
C. Bilateral ankle edema 2+
D. Potassium level of 3.6 mEq/L
Correct Answer: A
Rationale: Crackles in bilateral lung bases indicate pulmonary edema, a life-threatening complication of heart failure that requires
immediate intervention such as oxygen administration, positioning, and notifying the provider. Weight gain and peripheral edema are
important but less acute findings. A potassium of 3.6 mEq/L is within normal limits and does not require immediate action.
Q2: The nurse reviews the client's medication list: furosemide 40 mg PO daily, lisinopril 10 mg PO daily, metoprolol 25 mg
PO BID, and aspirin 81 mg PO daily. The client's blood pressure is 88/54 mm Hg and heart rate is 52 bpm. Which action
should the nurse take first?
A. Administer the scheduled furosemide
B. Hold metoprolol and contact the provider [CORRECT]
C. Encourage increased oral fluid intake
D. Request a potassium supplement
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that lowers both heart rate and blood pressure. A heart rate of 52 bpm and blood pressure of
88/54 mm Hg indicate excessive beta-blockade; the nurse should hold metoprolol and notify the provider. Administering furosemide
would further lower blood pressure. The client is fluid-overloaded, so increasing fluids would worsen the condition.
Q3: The provider orders IV furosemide 80 mg to be given over 20 minutes. The available concentration is furosemide 10
mg/mL. How many mL should the nurse administer?
A. 4 mL
B. 8 mL [CORRECT]
C. 10 mL
D. 20 mL
Correct Answer: B
Rationale: Using the formula: Desired dose (80 mg) / Have concentration (10 mg/mL) = 8 mL. The nurse should administer 8 mL of
furosemide IV over 20 minutes. Administering IV furosemide too rapidly can cause ototoxicity.
Q4: After receiving IV furosemide, the client's urinary output increases to 800 mL over 2 hours. The nurse should monitor for
which of the following complications?
A. Hypokalemia and dehydration [CORRECT]
B. Hyperkalemia and fluid overload
C. Hyponatremia and bradycardia
D. Hypocalcemia and hypertension
Correct Answer: A
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, ATI PN Comprehensive Predictor Exit Exam | NGN | 2026/2027 Updated
Rationale: Furosemide is a loop diuretic that causes potassium loss through increased urinary excretion, leading to hypokalemia.
The large diuresis also places the client at risk for dehydration. Hyperkalemia would not occur with furosemide; it is associated with
potassium-sparing diuretics.
Q5: The nurse is providing discharge teaching to the client with heart failure. Which statement by the client indicates that the
teaching has been effective?
A. I will drink at least 3 liters of fluid daily to stay hydrated
B. I will weigh myself daily and report a weight gain of more than 2 lb in a day [CORRECT]
C. I will take my metoprolol only when I feel short of breath
D. I will substitute salt with a salt substitute to reduce my sodium intake
Correct Answer: B
Rationale: Daily weight monitoring is a critical self-management strategy for heart failure clients. A weight gain of more than 2 lb in
a day indicates fluid retention requiring intervention. Fluid restriction, not increased intake, is typically recommended. Metoprolol
must be taken daily. Salt substitutes often contain potassium and can cause hyperkalemia with ACE inhibitors.
Case 2: Postpartum Hemorrhage
Q6: A 28-year-old G2 P2 client delivered a 9 lb 2 oz infant vaginally 30 minutes ago. The nurse notes that the fundus is
boggy, located 2 fingerbreadths above the umbilicus, and deviated to the right. Which action should the nurse take first?
A. Assess vital signs and notify the provider
B. Massage the fundus until firm and express clots [CORRECT]
C. Administer oxytocin per standing order
D. Have the client empty her bladder
Correct Answer: B
Rationale: A boggy, above-the-umbilicus, and laterally deviated fundus indicates uterine atony, the most common cause of
postpartum hemorrhage. The first action is to massage the fundus until it becomes firm, which promotes uterine contraction and
controls bleeding. While vital signs, oxytocin, and bladder emptying are important, fundal massage is the immediate first action.
Q7: The client's estimated blood loss is 800 mL. Which finding is an early sign of hypovolemic shock that the nurse should
monitor for?
A. Decreased blood pressure and increased heart rate
B. Restlessness and tachycardia [CORRECT]
C. Oliguria and cool, clammy skin
D. Confusion and bradycardia
Correct Answer: B
Rationale: Restlessness and tachycardia are early compensatory signs of hypovolemic shock. The body activates the sympathetic
nervous system in response to decreased perfusion, causing anxiety and increased heart rate before blood pressure drops. Decreased
blood pressure is a late sign.
Q8: The provider orders methylergonovine 0.2 mg IM. The nurse reviews the client's history and notes a blood pressure of
158/98 mm Hg. Which action should the nurse take?
A. Administer the medication as ordered and recheck BP in 30 minutes
B. Hold the medication and contact the provider [CORRECT]
C. Administer the medication subcutaneously instead of intramuscularly
D. Give the medication with a glass of orange juice
Correct Answer: B
Rationale: Methylergonovine is contraindicated in clients with hypertension because it causes vasoconstriction, which can further
elevate blood pressure and increase the risk of stroke. The nurse should hold the medication and notify the provider, who may order
an alternative such as carboprost or misoprostol.
Q9: After stabilization, the nurse is providing discharge teaching. The client asks, 'When should I call my doctor?' Which
response is most appropriate?
A. Call if your bleeding soaks more than one perineal pad in the first hour [CORRECT]
B. Call if your lochia turns from rubra to serosa before day 3
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, ATI PN Comprehensive Predictor Exit Exam | NGN | 2026/2027 Updated
C. Call if you pass a few small clots the size of a grape
D. Call if you experience afterpains during breastfeeding
Correct Answer: A
Rationale: Soaking more than one perineal pad per hour indicates excessive bleeding and requires immediate medical evaluation.
Lochia transitioning before day 3 is within normal range. Passing small clots is normal. Afterpains during breastfeeding are expected
due to oxytocin release.
Q10: The nurse is documenting the postpartum hemorrhage event. Which information is essential to include?
A. Time of delivery, Apgar scores, and newborn weight
B. Estimated blood loss, interventions performed, and client response [CORRECT]
C. Client's dietary preferences and visitor information
D. Complete prenatal history and genetic screening results
Correct Answer: B
Rationale: Documentation of a postpartum hemorrhage must include estimated blood loss, all interventions performed, and the
client's response. This provides a clear clinical picture for continuity of care. While prenatal history is relevant, it is not the priority
documentation during an acute hemorrhage event.
Case 3: Pediatric Asthma Exacerbation
Q11: A 7-year-old child is brought to the emergency department with severe wheezing, chest tightness, and difficulty
speaking in full sentences. The child has a history of asthma and has been using an albuterol inhaler at home without relief.
Which finding indicates the child is in imminent respiratory failure?
A. Nasal flaring and intercostal retractions
B. Oxygen saturation of 94% on room air
C. Ability to speak only in two-word phrases [CORRECT]
D. Heart rate of 110 bpm
Correct Answer: C
Rationale: The inability to speak in full sentences, limited to only two-word phrases, indicates severe airway obstruction and
impending respiratory failure. While nasal flaring and retractions indicate increased work of breathing, the speech limitation is a
more reliable indicator of severity.
Q12: The provider orders albuterol 2.5 mg and ipratropium bromide 0.5 mg via nebulizer. The child's parent asks why two
different medications are being given. Which response is most appropriate?
A. Both medications work the same way to open the airways
B. Albuterol opens the airways quickly while ipratropium provides longer-lasting relief by a different pathway
[CORRECT]
C. Ipratropium is given to prevent an allergic reaction to albuterol
D. The albuterol treats the inflammation while ipratropium reduces mucus production
Correct Answer: B
Rationale: Albuterol is a short-acting beta-2 agonist that provides rapid bronchodilation. Ipratropium is an anticholinergic that
works through a different mechanism to provide additional and sustained bronchodilation. The combination is more effective than
either medication alone for severe exacerbations.
Q13: After the first nebulizer treatment, the nurse notes decreased wheezing but increased use of accessory muscles. Which
interpretation is correct?
A. The child is improving and should be discharged home
B. The airway is opening but the child is tiring out and may need mechanical ventilation [CORRECT]
C. The treatment was ineffective and a different medication should be tried
D. The child is having a paradoxical reaction to albuterol
Correct Answer: B
Rationale: Decreased wheezing with increased accessory muscle use is a dangerous sign known as a 'silent chest.' It suggests the
child's airflow has become so severely limited that there is not enough air movement to produce wheezing. The increased work of
breathing indicates the child is fatiguing and may require intubation.
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, ATI PN Comprehensive Predictor Exit Exam | NGN | 2026/2027 Updated
Q14: The child is prescribed prednisolone 2 mg/kg PO. The child weighs 55 lb. How many mg of prednisolone should the
nurse administer?
A. 25 mg
B. 50 mg [CORRECT]
C. 75 mg
D. 100 mg
Correct Answer: B
Rationale: First convert pounds to kilograms: 55 lb / 2.2 = 25 kg. Then calculate: 25 kg x 2 mg/kg = 50 mg. Systemic corticosteroids
are a cornerstone of acute asthma management, reducing airway inflammation and preventing relapse. Accurate weight-based
dosage calculations are essential for pediatric medications.
Q15: The nurse is providing discharge education to the parents. Which statement by a parent indicates a need for further
teaching?
A. I will give my child the prescribed prednisolone for the full 5-day course
B. I will use the albuterol rescue inhaler every 4 hours even when my child is not wheezing [CORRECT]
C. I will make sure my child takes the daily controller medication as prescribed
D. I will bring my child back if symptoms do not improve or worsen after treatment
Correct Answer: B
Rationale: Albuterol is a rescue medication and should only be used as needed for acute symptoms, not on a scheduled basis. Using it
every 4 hours when the child is asymptomatic is inappropriate and could cause side effects such as tachycardia and tremors.
Case 4: Acute Exacerbation of Schizophrenia
Q16: A 32-year-old client with schizophrenia is brought to the psychiatric emergency department. The client is muttering,
appears to be responding to internal stimuli, and is pacing agitatedly. Which nursing intervention is the priority?
A. Encourage the client to sit down and discuss their feelings
B. Administer a PRN antipsychotic medication as ordered
C. Provide a quiet, low-stimulation environment [CORRECT]
D. Ask the client directly what they are hearing
Correct Answer: C
Rationale: Safety is the priority. Providing a quiet, low-stimulation environment reduces external stimuli that may escalate agitation
and psychotic symptoms. This is the first step before engaging the client therapeutically. While medication may be needed,
environmental modification should precede pharmacological intervention.
Q17: The client tells the nurse, 'The voices are telling me that the staff are poisoning my food.' The nurse responds, 'It must
be frightening to hear voices saying that about your food.' Which therapeutic communication technique is the nurse
demonstrating?
A. Reflecting [CORRECT]
B. Clarifying
C. Restating
D. Validating
Correct Answer: A
Rationale: The nurse is using reflecting, which directs the client's feelings back to them to encourage exploration of emotions. This
technique acknowledges the client's experience without confirming or denying the content of the delusion. Clarifying involves asking
questions; restating involves repeating the main idea.
Q18: The provider orders haloperidol 5 mg IM. The nurse should monitor the client for which potentially serious adverse
effects?
A. Tardive dyskinesia and neuroleptic malignant syndrome [CORRECT]
B. Serotonin syndrome and QT prolongation
C. Agranulocytosis and seizures
D. Hepatotoxicity and Stevens-Johnson syndrome
Correct Answer: A
4
ATI PN COMPREHENSIVE PREDICTOR EXIT EXAM
Next Generation NCLEX (NGN) Clinical Judgment Integration | 2026/2027 Updated | Case Studies and SATA
200 Questions with Comprehensive Rationales
Section 1: NGN Case Studies with Extended Scenarios (Q1-40)
Case 1: Heart Failure Exacerbation
Q1: A 68-year-old client with a history of heart failure is admitted with dyspnea, weight gain of 6 lb over 3 days, and bilateral
ankle edema. The nurse notes the client has been taking furosemide 40 mg PO daily but reports sometimes forgetting doses.
Which of the following findings should the nurse recognize as the most critical cue requiring immediate action?
A. Crackles in bilateral lung bases [CORRECT]
B. Weight gain of 6 lb in 3 days
C. Bilateral ankle edema 2+
D. Potassium level of 3.6 mEq/L
Correct Answer: A
Rationale: Crackles in bilateral lung bases indicate pulmonary edema, a life-threatening complication of heart failure that requires
immediate intervention such as oxygen administration, positioning, and notifying the provider. Weight gain and peripheral edema are
important but less acute findings. A potassium of 3.6 mEq/L is within normal limits and does not require immediate action.
Q2: The nurse reviews the client's medication list: furosemide 40 mg PO daily, lisinopril 10 mg PO daily, metoprolol 25 mg
PO BID, and aspirin 81 mg PO daily. The client's blood pressure is 88/54 mm Hg and heart rate is 52 bpm. Which action
should the nurse take first?
A. Administer the scheduled furosemide
B. Hold metoprolol and contact the provider [CORRECT]
C. Encourage increased oral fluid intake
D. Request a potassium supplement
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that lowers both heart rate and blood pressure. A heart rate of 52 bpm and blood pressure of
88/54 mm Hg indicate excessive beta-blockade; the nurse should hold metoprolol and notify the provider. Administering furosemide
would further lower blood pressure. The client is fluid-overloaded, so increasing fluids would worsen the condition.
Q3: The provider orders IV furosemide 80 mg to be given over 20 minutes. The available concentration is furosemide 10
mg/mL. How many mL should the nurse administer?
A. 4 mL
B. 8 mL [CORRECT]
C. 10 mL
D. 20 mL
Correct Answer: B
Rationale: Using the formula: Desired dose (80 mg) / Have concentration (10 mg/mL) = 8 mL. The nurse should administer 8 mL of
furosemide IV over 20 minutes. Administering IV furosemide too rapidly can cause ototoxicity.
Q4: After receiving IV furosemide, the client's urinary output increases to 800 mL over 2 hours. The nurse should monitor for
which of the following complications?
A. Hypokalemia and dehydration [CORRECT]
B. Hyperkalemia and fluid overload
C. Hyponatremia and bradycardia
D. Hypocalcemia and hypertension
Correct Answer: A
1
, ATI PN Comprehensive Predictor Exit Exam | NGN | 2026/2027 Updated
Rationale: Furosemide is a loop diuretic that causes potassium loss through increased urinary excretion, leading to hypokalemia.
The large diuresis also places the client at risk for dehydration. Hyperkalemia would not occur with furosemide; it is associated with
potassium-sparing diuretics.
Q5: The nurse is providing discharge teaching to the client with heart failure. Which statement by the client indicates that the
teaching has been effective?
A. I will drink at least 3 liters of fluid daily to stay hydrated
B. I will weigh myself daily and report a weight gain of more than 2 lb in a day [CORRECT]
C. I will take my metoprolol only when I feel short of breath
D. I will substitute salt with a salt substitute to reduce my sodium intake
Correct Answer: B
Rationale: Daily weight monitoring is a critical self-management strategy for heart failure clients. A weight gain of more than 2 lb in
a day indicates fluid retention requiring intervention. Fluid restriction, not increased intake, is typically recommended. Metoprolol
must be taken daily. Salt substitutes often contain potassium and can cause hyperkalemia with ACE inhibitors.
Case 2: Postpartum Hemorrhage
Q6: A 28-year-old G2 P2 client delivered a 9 lb 2 oz infant vaginally 30 minutes ago. The nurse notes that the fundus is
boggy, located 2 fingerbreadths above the umbilicus, and deviated to the right. Which action should the nurse take first?
A. Assess vital signs and notify the provider
B. Massage the fundus until firm and express clots [CORRECT]
C. Administer oxytocin per standing order
D. Have the client empty her bladder
Correct Answer: B
Rationale: A boggy, above-the-umbilicus, and laterally deviated fundus indicates uterine atony, the most common cause of
postpartum hemorrhage. The first action is to massage the fundus until it becomes firm, which promotes uterine contraction and
controls bleeding. While vital signs, oxytocin, and bladder emptying are important, fundal massage is the immediate first action.
Q7: The client's estimated blood loss is 800 mL. Which finding is an early sign of hypovolemic shock that the nurse should
monitor for?
A. Decreased blood pressure and increased heart rate
B. Restlessness and tachycardia [CORRECT]
C. Oliguria and cool, clammy skin
D. Confusion and bradycardia
Correct Answer: B
Rationale: Restlessness and tachycardia are early compensatory signs of hypovolemic shock. The body activates the sympathetic
nervous system in response to decreased perfusion, causing anxiety and increased heart rate before blood pressure drops. Decreased
blood pressure is a late sign.
Q8: The provider orders methylergonovine 0.2 mg IM. The nurse reviews the client's history and notes a blood pressure of
158/98 mm Hg. Which action should the nurse take?
A. Administer the medication as ordered and recheck BP in 30 minutes
B. Hold the medication and contact the provider [CORRECT]
C. Administer the medication subcutaneously instead of intramuscularly
D. Give the medication with a glass of orange juice
Correct Answer: B
Rationale: Methylergonovine is contraindicated in clients with hypertension because it causes vasoconstriction, which can further
elevate blood pressure and increase the risk of stroke. The nurse should hold the medication and notify the provider, who may order
an alternative such as carboprost or misoprostol.
Q9: After stabilization, the nurse is providing discharge teaching. The client asks, 'When should I call my doctor?' Which
response is most appropriate?
A. Call if your bleeding soaks more than one perineal pad in the first hour [CORRECT]
B. Call if your lochia turns from rubra to serosa before day 3
2
, ATI PN Comprehensive Predictor Exit Exam | NGN | 2026/2027 Updated
C. Call if you pass a few small clots the size of a grape
D. Call if you experience afterpains during breastfeeding
Correct Answer: A
Rationale: Soaking more than one perineal pad per hour indicates excessive bleeding and requires immediate medical evaluation.
Lochia transitioning before day 3 is within normal range. Passing small clots is normal. Afterpains during breastfeeding are expected
due to oxytocin release.
Q10: The nurse is documenting the postpartum hemorrhage event. Which information is essential to include?
A. Time of delivery, Apgar scores, and newborn weight
B. Estimated blood loss, interventions performed, and client response [CORRECT]
C. Client's dietary preferences and visitor information
D. Complete prenatal history and genetic screening results
Correct Answer: B
Rationale: Documentation of a postpartum hemorrhage must include estimated blood loss, all interventions performed, and the
client's response. This provides a clear clinical picture for continuity of care. While prenatal history is relevant, it is not the priority
documentation during an acute hemorrhage event.
Case 3: Pediatric Asthma Exacerbation
Q11: A 7-year-old child is brought to the emergency department with severe wheezing, chest tightness, and difficulty
speaking in full sentences. The child has a history of asthma and has been using an albuterol inhaler at home without relief.
Which finding indicates the child is in imminent respiratory failure?
A. Nasal flaring and intercostal retractions
B. Oxygen saturation of 94% on room air
C. Ability to speak only in two-word phrases [CORRECT]
D. Heart rate of 110 bpm
Correct Answer: C
Rationale: The inability to speak in full sentences, limited to only two-word phrases, indicates severe airway obstruction and
impending respiratory failure. While nasal flaring and retractions indicate increased work of breathing, the speech limitation is a
more reliable indicator of severity.
Q12: The provider orders albuterol 2.5 mg and ipratropium bromide 0.5 mg via nebulizer. The child's parent asks why two
different medications are being given. Which response is most appropriate?
A. Both medications work the same way to open the airways
B. Albuterol opens the airways quickly while ipratropium provides longer-lasting relief by a different pathway
[CORRECT]
C. Ipratropium is given to prevent an allergic reaction to albuterol
D. The albuterol treats the inflammation while ipratropium reduces mucus production
Correct Answer: B
Rationale: Albuterol is a short-acting beta-2 agonist that provides rapid bronchodilation. Ipratropium is an anticholinergic that
works through a different mechanism to provide additional and sustained bronchodilation. The combination is more effective than
either medication alone for severe exacerbations.
Q13: After the first nebulizer treatment, the nurse notes decreased wheezing but increased use of accessory muscles. Which
interpretation is correct?
A. The child is improving and should be discharged home
B. The airway is opening but the child is tiring out and may need mechanical ventilation [CORRECT]
C. The treatment was ineffective and a different medication should be tried
D. The child is having a paradoxical reaction to albuterol
Correct Answer: B
Rationale: Decreased wheezing with increased accessory muscle use is a dangerous sign known as a 'silent chest.' It suggests the
child's airflow has become so severely limited that there is not enough air movement to produce wheezing. The increased work of
breathing indicates the child is fatiguing and may require intubation.
3
, ATI PN Comprehensive Predictor Exit Exam | NGN | 2026/2027 Updated
Q14: The child is prescribed prednisolone 2 mg/kg PO. The child weighs 55 lb. How many mg of prednisolone should the
nurse administer?
A. 25 mg
B. 50 mg [CORRECT]
C. 75 mg
D. 100 mg
Correct Answer: B
Rationale: First convert pounds to kilograms: 55 lb / 2.2 = 25 kg. Then calculate: 25 kg x 2 mg/kg = 50 mg. Systemic corticosteroids
are a cornerstone of acute asthma management, reducing airway inflammation and preventing relapse. Accurate weight-based
dosage calculations are essential for pediatric medications.
Q15: The nurse is providing discharge education to the parents. Which statement by a parent indicates a need for further
teaching?
A. I will give my child the prescribed prednisolone for the full 5-day course
B. I will use the albuterol rescue inhaler every 4 hours even when my child is not wheezing [CORRECT]
C. I will make sure my child takes the daily controller medication as prescribed
D. I will bring my child back if symptoms do not improve or worsen after treatment
Correct Answer: B
Rationale: Albuterol is a rescue medication and should only be used as needed for acute symptoms, not on a scheduled basis. Using it
every 4 hours when the child is asymptomatic is inappropriate and could cause side effects such as tachycardia and tremors.
Case 4: Acute Exacerbation of Schizophrenia
Q16: A 32-year-old client with schizophrenia is brought to the psychiatric emergency department. The client is muttering,
appears to be responding to internal stimuli, and is pacing agitatedly. Which nursing intervention is the priority?
A. Encourage the client to sit down and discuss their feelings
B. Administer a PRN antipsychotic medication as ordered
C. Provide a quiet, low-stimulation environment [CORRECT]
D. Ask the client directly what they are hearing
Correct Answer: C
Rationale: Safety is the priority. Providing a quiet, low-stimulation environment reduces external stimuli that may escalate agitation
and psychotic symptoms. This is the first step before engaging the client therapeutically. While medication may be needed,
environmental modification should precede pharmacological intervention.
Q17: The client tells the nurse, 'The voices are telling me that the staff are poisoning my food.' The nurse responds, 'It must
be frightening to hear voices saying that about your food.' Which therapeutic communication technique is the nurse
demonstrating?
A. Reflecting [CORRECT]
B. Clarifying
C. Restating
D. Validating
Correct Answer: A
Rationale: The nurse is using reflecting, which directs the client's feelings back to them to encourage exploration of emotions. This
technique acknowledges the client's experience without confirming or denying the content of the delusion. Clarifying involves asking
questions; restating involves repeating the main idea.
Q18: The provider orders haloperidol 5 mg IM. The nurse should monitor the client for which potentially serious adverse
effects?
A. Tardive dyskinesia and neuroleptic malignant syndrome [CORRECT]
B. Serotonin syndrome and QT prolongation
C. Agranulocytosis and seizures
D. Hepatotoxicity and Stevens-Johnson syndrome
Correct Answer: A
4
