ATI Comprehensive
Practice
Assessment A -
Version 3.1 well
written one year
2025 /2026
updated graded A+
Advanced Clinical Decision-Making and
Comprehensive Nursing Practice Examination
,Exam Title: ATI RN Comprehensive Online Practice Assessment A – Advanced Clinical Decision-
Making,
Complex Pharmacological Management, Multisystem Prioritization, Delegation, and Evidence-Based
Nursing Practice for Pre-Licensure RN Candidates (Version 3.1 – Detailed & Complicated)
Difficulty Level: Advanced / Complex / High-Level Clinical Judgment
Target Audience: Senior nursing students, pre-licensure RN candidates preparing for the ATI
Comprehensive Predictor, ATI Capstone Proctored Assessment, and NCLEX-RN examination
Exam Format: 150 multiple-choice questions with one correct answer per question
Content Areas: Fundamentals of Nursing, Pharmacology, Medical-Surgical Nursing, MaternalNewborn
Nursing, Pediatrics, Mental Health Nursing, Leadership and Management, Community Health
Instructions: Select the single best answer for each question. Base your responses on current
evidence-based nursing practice, the NCLEX-RN Test Plan, and ATI Nursing Education standards.
Prioritize client safety, the nursing process, and clinical judgment in all responses. Questions may
involve complex clinical scenarios requiring synthesis of multiple data points and prioritization of care.
SECTION 1: FUNDAMENTALS OF NURSING (Questions 1–25)
Question 1
A nurse is caring for a client who has a stage III pressure injury on the sacrum with 80% yellow slough
and 20% red granulation tissue. The wound measures 4 cm × 3 cm × 2 cm and has a moderate
amount of purulent drainage with a foul odor. The client's temperature is 38.5°C (101.3°F), WBC count
is 14,500/mm³, and serum albumin is 2.8 g/dL. Which of the following interventions should the nurse
implement first?
A) Initiate wound culture and sensitivity
,B) Apply a hydrocolloid dressing to promote autolytic debridement
C) Consult the wound care team for sharp debridement
D) Begin systemic antibiotic therapy as prescribed
Correct Answer: D
Rationale: The client exhibits signs of systemic infection (fever, elevated WBC), which requires
immediate systemic antibiotic therapy as the priority intervention to prevent sepsis. Wound culture (A)
is important but should be obtained before initiating antibiotics, not as the first intervention.
Hydrocolloid dressings (B) are not appropriate for infected wounds with purulent drainage. Sharp
debridement (C) may be needed but is not the immediate priority.
Question 2
A nurse is caring for a client who has a nasogastric (NG) tube attached to low intermittent suction
following a partial gastrectomy. The client reports sudden onset of severe abdominal pain and nausea.
The nurse assesses a rigid, board-like abdomen, tachycardia of 110/min, and hypotension of 88/52
mm Hg. Which of the following actions should the nurse take first?
A) Increase the rate of IV fluids
B) Place the client in a supine position
C) Notify the provider immediately
D) Check the NG tube for patency
Correct Answer: C
Rationale: The client is exhibiting signs of a potential perforation or peritonitis (rigid abdomen,
tachycardia, hypotension), which is a surgical emergency. The nurse should notify the provider
immediately. Increasing IV fluids (A) may be appropriate but is not the first action. Supine position (B)
may worsen pain. Checking NG tube patency (D) is a lower priority in this emergent situation.
Question 3
A nurse is preparing to administer a cleansing enema to an adult client. Which of the following actions
should the nurse take to minimize the risk of bowel perforation?
A) Insert the rectal tube 7.5 to 10 cm (3 to 4 inches)
B) Use a solution temperature of 43.3°C to 46.1°C (110°F to 115°F)
C) Position the client in a right lateral position
, D) Advance the tube while the client bears down
Correct Answer: A
Rationale: Inserting the rectal tube 7.5 to 10 cm (3 to 4 inches) is the correct depth to prevent
perforation. Solution temperature should be 37.8°C to 40.6°C (100°F to 105°F) (B) to prevent injury.
The client should be in a left lateral (Sims) position (C). The tube should be advanced gently during
insertion, not while the client bears down (D).
Question 4
A nurse is calculating the intake and output for a client over a 12-hour shift. The client received 1,200
mL of 0.9% sodium chloride IV, 480 mL of oral fluids, and had 250 mL of urine output, 120 mL of
wound drainage, and 90 mL of gastric output. What is the client's net fluid balance?
A) 1,220 mL positive
B) 1,220 mL negative
C) 1,100 mL positive
D) 1,100 mL negative
Correct Answer: A
Rationale: Total intake = 1,200 mL + 480 mL = 1,680 mL. Total output = 250 mL + 120 mL + 90 mL =
460 mL. Net balance = 1,680 mL - 460 mL = 1,220 mL positive.
Question 5
A nurse is preparing to perform sterile wound irrigation for a client who has a deep, tunneling wound.
Which of the following actions should the nurse take to ensure proper irrigation?
A) Use a 10-mL syringe with a 19-gauge needle
B) Irrigate with sterile normal saline using a 30-mL syringe and an 18-gauge angiocatheter
C) Apply continuous pressure to force irrigation into the deepest area
D) Use sterile water as the irrigating solution
Practice
Assessment A -
Version 3.1 well
written one year
2025 /2026
updated graded A+
Advanced Clinical Decision-Making and
Comprehensive Nursing Practice Examination
,Exam Title: ATI RN Comprehensive Online Practice Assessment A – Advanced Clinical Decision-
Making,
Complex Pharmacological Management, Multisystem Prioritization, Delegation, and Evidence-Based
Nursing Practice for Pre-Licensure RN Candidates (Version 3.1 – Detailed & Complicated)
Difficulty Level: Advanced / Complex / High-Level Clinical Judgment
Target Audience: Senior nursing students, pre-licensure RN candidates preparing for the ATI
Comprehensive Predictor, ATI Capstone Proctored Assessment, and NCLEX-RN examination
Exam Format: 150 multiple-choice questions with one correct answer per question
Content Areas: Fundamentals of Nursing, Pharmacology, Medical-Surgical Nursing, MaternalNewborn
Nursing, Pediatrics, Mental Health Nursing, Leadership and Management, Community Health
Instructions: Select the single best answer for each question. Base your responses on current
evidence-based nursing practice, the NCLEX-RN Test Plan, and ATI Nursing Education standards.
Prioritize client safety, the nursing process, and clinical judgment in all responses. Questions may
involve complex clinical scenarios requiring synthesis of multiple data points and prioritization of care.
SECTION 1: FUNDAMENTALS OF NURSING (Questions 1–25)
Question 1
A nurse is caring for a client who has a stage III pressure injury on the sacrum with 80% yellow slough
and 20% red granulation tissue. The wound measures 4 cm × 3 cm × 2 cm and has a moderate
amount of purulent drainage with a foul odor. The client's temperature is 38.5°C (101.3°F), WBC count
is 14,500/mm³, and serum albumin is 2.8 g/dL. Which of the following interventions should the nurse
implement first?
A) Initiate wound culture and sensitivity
,B) Apply a hydrocolloid dressing to promote autolytic debridement
C) Consult the wound care team for sharp debridement
D) Begin systemic antibiotic therapy as prescribed
Correct Answer: D
Rationale: The client exhibits signs of systemic infection (fever, elevated WBC), which requires
immediate systemic antibiotic therapy as the priority intervention to prevent sepsis. Wound culture (A)
is important but should be obtained before initiating antibiotics, not as the first intervention.
Hydrocolloid dressings (B) are not appropriate for infected wounds with purulent drainage. Sharp
debridement (C) may be needed but is not the immediate priority.
Question 2
A nurse is caring for a client who has a nasogastric (NG) tube attached to low intermittent suction
following a partial gastrectomy. The client reports sudden onset of severe abdominal pain and nausea.
The nurse assesses a rigid, board-like abdomen, tachycardia of 110/min, and hypotension of 88/52
mm Hg. Which of the following actions should the nurse take first?
A) Increase the rate of IV fluids
B) Place the client in a supine position
C) Notify the provider immediately
D) Check the NG tube for patency
Correct Answer: C
Rationale: The client is exhibiting signs of a potential perforation or peritonitis (rigid abdomen,
tachycardia, hypotension), which is a surgical emergency. The nurse should notify the provider
immediately. Increasing IV fluids (A) may be appropriate but is not the first action. Supine position (B)
may worsen pain. Checking NG tube patency (D) is a lower priority in this emergent situation.
Question 3
A nurse is preparing to administer a cleansing enema to an adult client. Which of the following actions
should the nurse take to minimize the risk of bowel perforation?
A) Insert the rectal tube 7.5 to 10 cm (3 to 4 inches)
B) Use a solution temperature of 43.3°C to 46.1°C (110°F to 115°F)
C) Position the client in a right lateral position
, D) Advance the tube while the client bears down
Correct Answer: A
Rationale: Inserting the rectal tube 7.5 to 10 cm (3 to 4 inches) is the correct depth to prevent
perforation. Solution temperature should be 37.8°C to 40.6°C (100°F to 105°F) (B) to prevent injury.
The client should be in a left lateral (Sims) position (C). The tube should be advanced gently during
insertion, not while the client bears down (D).
Question 4
A nurse is calculating the intake and output for a client over a 12-hour shift. The client received 1,200
mL of 0.9% sodium chloride IV, 480 mL of oral fluids, and had 250 mL of urine output, 120 mL of
wound drainage, and 90 mL of gastric output. What is the client's net fluid balance?
A) 1,220 mL positive
B) 1,220 mL negative
C) 1,100 mL positive
D) 1,100 mL negative
Correct Answer: A
Rationale: Total intake = 1,200 mL + 480 mL = 1,680 mL. Total output = 250 mL + 120 mL + 90 mL =
460 mL. Net balance = 1,680 mL - 460 mL = 1,220 mL positive.
Question 5
A nurse is preparing to perform sterile wound irrigation for a client who has a deep, tunneling wound.
Which of the following actions should the nurse take to ensure proper irrigation?
A) Use a 10-mL syringe with a 19-gauge needle
B) Irrigate with sterile normal saline using a 30-mL syringe and an 18-gauge angiocatheter
C) Apply continuous pressure to force irrigation into the deepest area
D) Use sterile water as the irrigating solution
