ATI RN Comprehensive Predictor 2026
, ATI RN Comprehensive Predictor 2026
Next Generation NCLEX (NGN) Clinical Judgment Case Scenarios
Comprehensive Predictor Exit Exam Review | Integrated Clinical Cases | 2026–2027 Edition
Table of Contents
Section Content Area
I Review of NCLEX Test-Taking Strategies
II Nursing Leadership & Management
III Community Health Nursing
IV Pharmacology in Nursing
V Fundamentals of Nursing
VI Adult Medical-Surgical Nursing
VII Mental Health Nursing
VIII Maternal & Newborn Nursing
IX Nursing Care of Children
X Comprehensive Mixed Practice Cases
Features Included
• Next Generation NCLEX (NGN) Clinical Judgment Case Scenarios
• ATI Comprehensive Predictor–Style Questions
• Clinical Reasoning & Decision-Making Exercises
• Prioritization, Delegation & Patient Safety
• Bow-Tie, Matrix, SATA & Extended Response Questions
• Detailed Rationales for Every Question
• Comprehensive Final Practice Cases
, • Designed for ATI Comprehensive Predictor & NCLEX-RN Success
Section I: Management of Care
Leadership, Delegation, and Prioritization
Question 1 Priority Client
The nurse receives change-of-shift report on four clients. Which client should the nurse assess first?
A. A client with chronic kidney disease who reports generalized itching
B. A client 8 hours after abdominal surgery who reports incisional pain rated 7/10
C. A client with heart failure whose oxygen saturation decreased from 94% to 86% while receiving oxygen
D. A client scheduled for discharge who needs clarification about a low-sodium diet
Correct Answer: C
Rationale:
A falling oxygen saturation despite supplemental oxygen indicates worsening respiratory compromise. The
nurse should immediately assess the client’s airway, breathing, lung sounds, respiratory effort, and oxygen-
delivery system.
Why the other options are less appropriate:
• A: Pruritus is common with advanced kidney disease but is not immediately life-threatening.
• B: Postoperative pain requires treatment, but impaired oxygenation takes priority.
• D: Discharge teaching can safely be delayed until the unstable client is assessed.
Priority Alert:
Use airway, breathing, and circulation first. An unexpected decline in oxygenation takes priority over pain,
teaching, and chronic symptoms.
Question 2 Delegation
Which task is appropriate for the RN to delegate to an experienced unlicensed assistive personnel?
A. Determine whether a client is ready to ambulate after receiving an opioid
B. Measure and document urine output from an indwelling catheter
C. Teach a client how to use an incentive spirometer
D. Evaluate a client’s response to a blood transfusion
Correct Answer: B
Rationale:
Measuring and documenting urine output is a routine, predictable data-collection task that can be delegated
to trained assistive personnel. The RN remains responsible for interpreting the findings.
, Why the other options are less appropriate:
• A: Determining readiness requires assessment and clinical judgment.
• C: Initial teaching is an RN responsibility.
• D: Evaluation of treatment effectiveness cannot be delegated.
Delegation Rule:
Delegate routine tasks with predictable outcomes. The RN retains assessment, teaching, evaluation, and
clinical decision-making responsibilities.
Question 3 Client Assignment
Which client is most appropriate for assignment to a newly licensed RN?
A. A client with diabetic ketoacidosis receiving a continuous insulin infusion
B. A client 24 hours after an uncomplicated laparoscopic cholecystectomy
C. A client with septic shock receiving norepinephrine
D. A client admitted with an acute stroke who is receiving alteplase
Correct Answer: B
Rationale:
The postoperative client is stable and has predictable care needs. This assignment allows the newly licensed
nurse to provide routine assessment, pain management, mobility assistance, and discharge preparation.
Why the other options are less appropriate:
• A: Continuous insulin requires frequent laboratory interpretation and dosage adjustment.
• C: Vasopressor therapy requires experienced critical-care assessment.
• D: Thrombolytic therapy requires frequent neurologic and bleeding assessments.
Leadership Insight:
Newly licensed nurses should receive stable clients with expected outcomes. Assign unstable clients and high-
risk therapies to experienced nurses.
Question 4 Error Prevention
A nurse sees another nurse preparing to administer a medication to the wrong client. Which action should the
observing nurse take first?
A. Stop the medication administration immediately
B. Notify the nurse manager
C. Complete a safety-event report
D. Document the near miss in the client’s medical record
Correct Answer: A
, Rationale:
The immediate priority is preventing harm. The nurse should stop the unsafe action before the medication
reaches the client. Reporting and follow-up should occur after safety is secured.
Why the other options are less appropriate:
• B: The manager may need notification, but preventing the error comes first.
• C: A safety report is completed after immediate risk is addressed.
• D: Safety reports and near misses generally are not documented as such in the clinical record.
Patient Safety Tip:
Intervene first when harm is imminent. Reporting, documentation, and quality review follow the immediate
safety action.
Question 5 Scope of Practice
Which nursing activity must be performed by the RN?
A. Obtain a routine capillary blood glucose level
B. Assist a stable client with oral hygiene
C. Perform the initial assessment of a newly admitted client
D. Transport a client to the radiology department
Correct Answer: C
Rationale:
The initial nursing assessment requires comprehensive data collection, interpretation, identification of priority
problems, and development of the plan of care. These responsibilities require RN-level judgment.
Why the other options are less appropriate:
• A: A trained UAP may obtain routine glucose readings according to policy.
• B: Hygiene assistance may be delegated.
• D: Stable-client transport may be assigned to assistive personnel.
Remember This:
The RN performs initial assessments, develops nursing plans, provides initial teaching, and evaluates outcomes.
Question 6 Urgent Communication
The nurse receives a laboratory report showing a potassium level of 2.5 mEq/L. Which action should the nurse
take first?
A. Encourage the client to eat a banana
B. Document the result in the medical record
C. Repeat the laboratory test in 4 hours
D. Assess the client and notify the provider promptly
, Correct Answer: D
Rationale:
Severe hypokalemia can cause muscle weakness and life-threatening cardiac dysrhythmias. The nurse should
assess the client, review the cardiac rhythm when available, and promptly report the critical result.
Why the other options are less appropriate:
• A: Dietary potassium is insufficient for severe hypokalemia.
• B: Documentation does not replace immediate clinical action.
• C: Delaying intervention increases the risk of complications.
Communication Tip:
Before contacting the provider, gather focused assessment findings, recent trends, current medications, and
relevant laboratory values for an organized SBAR report.
Question 7 Acute Change
Which client should the nurse evaluate immediately?
A. A client with COPD who has become restless and confused
B. A client with osteoarthritis requesting a warm compress
C. A client with chronic constipation requesting prune juice
D. A client awaiting transportation for a scheduled ultrasound
Correct Answer: A
Rationale:
Restlessness and confusion can be early signs of hypoxemia. An acute mental-status change in a client with
respiratory disease requires immediate assessment of oxygenation and ventilation.
Why the other options are less appropriate:
• B: This is a comfort request for a chronic condition.
• C: Constipation is not the most urgent problem.
• D: Transportation delays are lower priority than clinical deterioration.
Clinical Pearl:
Do not dismiss sudden confusion as anxiety or age-related behavior. Acute changes often signal hypoxia,
hypoglycemia, infection, or neurologic deterioration.
Question 8 Informed Refusal
A competent client who previously signed surgical consent tells the nurse, “I have changed my mind. I do not
want the procedure.” Which action should the nurse take?
,A. Ask the client’s family to convince the client to continue
B. Administer the prescribed preoperative sedative
C. Stop the preparation and notify the surgeon
D. Explain that signed consent cannot be withdrawn
Correct Answer: C
Rationale:
A competent client may withdraw consent at any time before the procedure. The nurse should stop
preparation, protect the client from unwanted treatment, and notify the surgeon.
Why the other options are less appropriate:
• A: Family pressure may interfere with voluntary decision-making.
• B: Sedation could impair the client’s ability to make decisions.
• D: Consent is voluntary and may be withdrawn.
Legal Insight:
Informed consent is an ongoing process, not merely a signature. A competent client maintains the right to
refuse or withdraw consent.
Question 9 LPN/LVN Assignment
Which client should the charge nurse assign to an LPN/LVN?
A. A newly admitted client reporting crushing chest pain
B. A stable client with hypertension who requires scheduled oral medications
C. A client who developed sudden unilateral weakness
D. A client requiring initial teaching about insulin administration
Correct Answer: B
Rationale:
An LPN/LVN may care for stable clients with predictable outcomes and administer routine medications
according to jurisdiction and facility policy.
Why the other options are less appropriate:
• A: Acute chest pain requires immediate RN assessment.
• C: Sudden weakness may indicate stroke and requires rapid RN evaluation.
• D: Initial education requires RN assessment and teaching.
Assignment Rule:
Assign stable, predictable clients to the LPN/LVN. The RN manages new admissions, unstable conditions, initial
teaching, and complex evaluation.
Question 10 Cardiac Priority
, The nurse is caring for four clients. Which client should the nurse assess first?
A. A client asking for a prescribed sleep medication
B. A client reporting sudden chest pressure radiating to the jaw
C. A client waiting for discharge transportation
D. A client requesting assistance to change position
Correct Answer: B
Rationale:
Sudden chest pressure radiating to the jaw is consistent with acute coronary syndrome. Rapid assessment and
intervention are necessary to restore perfusion and limit myocardial damage.
Why the other options are less appropriate:
• A: A sleep medication is nonurgent.
• C: Transportation can be delayed.
• D: Repositioning is important but does not outrank suspected myocardial ischemia.
Exam Strategy:
Treat new chest pain as cardiac ischemia until proven otherwise. Prioritize rapid assessment, vital signs, cardiac
monitoring, and emergency interventions.
Question 11 Time Management
After receiving shift report, which action should the nurse perform first?
A. Assess a client who returned from the post-anesthesia care unit 20 minutes ago
B. Review discharge instructions with a client leaving in 3 hours
C. Restock supplies needed later in the shift
D. Return a routine telephone call from a client’s family member
Correct Answer: A
Rationale:
A recently postoperative client requires immediate assessment for airway obstruction, respiratory depression,
bleeding, hemodynamic instability, pain, and changes in consciousness.
Why the other options are less appropriate:
• B: Discharge education can be completed after priority assessments.
• C: Restocking is a nonclinical task.
• D: A routine family call can wait.
Time-Management Tip:
At the start of a shift, first assess clients who are newly admitted, newly postoperative, unstable, or
experiencing an acute change.
, ATI RN Comprehensive Predictor 2026
Next Generation NCLEX (NGN) Clinical Judgment Case Scenarios
Comprehensive Predictor Exit Exam Review | Integrated Clinical Cases | 2026–2027 Edition
Table of Contents
Section Content Area
I Review of NCLEX Test-Taking Strategies
II Nursing Leadership & Management
III Community Health Nursing
IV Pharmacology in Nursing
V Fundamentals of Nursing
VI Adult Medical-Surgical Nursing
VII Mental Health Nursing
VIII Maternal & Newborn Nursing
IX Nursing Care of Children
X Comprehensive Mixed Practice Cases
Features Included
• Next Generation NCLEX (NGN) Clinical Judgment Case Scenarios
• ATI Comprehensive Predictor–Style Questions
• Clinical Reasoning & Decision-Making Exercises
• Prioritization, Delegation & Patient Safety
• Bow-Tie, Matrix, SATA & Extended Response Questions
• Detailed Rationales for Every Question
• Comprehensive Final Practice Cases
, • Designed for ATI Comprehensive Predictor & NCLEX-RN Success
Section I: Management of Care
Leadership, Delegation, and Prioritization
Question 1 Priority Client
The nurse receives change-of-shift report on four clients. Which client should the nurse assess first?
A. A client with chronic kidney disease who reports generalized itching
B. A client 8 hours after abdominal surgery who reports incisional pain rated 7/10
C. A client with heart failure whose oxygen saturation decreased from 94% to 86% while receiving oxygen
D. A client scheduled for discharge who needs clarification about a low-sodium diet
Correct Answer: C
Rationale:
A falling oxygen saturation despite supplemental oxygen indicates worsening respiratory compromise. The
nurse should immediately assess the client’s airway, breathing, lung sounds, respiratory effort, and oxygen-
delivery system.
Why the other options are less appropriate:
• A: Pruritus is common with advanced kidney disease but is not immediately life-threatening.
• B: Postoperative pain requires treatment, but impaired oxygenation takes priority.
• D: Discharge teaching can safely be delayed until the unstable client is assessed.
Priority Alert:
Use airway, breathing, and circulation first. An unexpected decline in oxygenation takes priority over pain,
teaching, and chronic symptoms.
Question 2 Delegation
Which task is appropriate for the RN to delegate to an experienced unlicensed assistive personnel?
A. Determine whether a client is ready to ambulate after receiving an opioid
B. Measure and document urine output from an indwelling catheter
C. Teach a client how to use an incentive spirometer
D. Evaluate a client’s response to a blood transfusion
Correct Answer: B
Rationale:
Measuring and documenting urine output is a routine, predictable data-collection task that can be delegated
to trained assistive personnel. The RN remains responsible for interpreting the findings.
, Why the other options are less appropriate:
• A: Determining readiness requires assessment and clinical judgment.
• C: Initial teaching is an RN responsibility.
• D: Evaluation of treatment effectiveness cannot be delegated.
Delegation Rule:
Delegate routine tasks with predictable outcomes. The RN retains assessment, teaching, evaluation, and
clinical decision-making responsibilities.
Question 3 Client Assignment
Which client is most appropriate for assignment to a newly licensed RN?
A. A client with diabetic ketoacidosis receiving a continuous insulin infusion
B. A client 24 hours after an uncomplicated laparoscopic cholecystectomy
C. A client with septic shock receiving norepinephrine
D. A client admitted with an acute stroke who is receiving alteplase
Correct Answer: B
Rationale:
The postoperative client is stable and has predictable care needs. This assignment allows the newly licensed
nurse to provide routine assessment, pain management, mobility assistance, and discharge preparation.
Why the other options are less appropriate:
• A: Continuous insulin requires frequent laboratory interpretation and dosage adjustment.
• C: Vasopressor therapy requires experienced critical-care assessment.
• D: Thrombolytic therapy requires frequent neurologic and bleeding assessments.
Leadership Insight:
Newly licensed nurses should receive stable clients with expected outcomes. Assign unstable clients and high-
risk therapies to experienced nurses.
Question 4 Error Prevention
A nurse sees another nurse preparing to administer a medication to the wrong client. Which action should the
observing nurse take first?
A. Stop the medication administration immediately
B. Notify the nurse manager
C. Complete a safety-event report
D. Document the near miss in the client’s medical record
Correct Answer: A
, Rationale:
The immediate priority is preventing harm. The nurse should stop the unsafe action before the medication
reaches the client. Reporting and follow-up should occur after safety is secured.
Why the other options are less appropriate:
• B: The manager may need notification, but preventing the error comes first.
• C: A safety report is completed after immediate risk is addressed.
• D: Safety reports and near misses generally are not documented as such in the clinical record.
Patient Safety Tip:
Intervene first when harm is imminent. Reporting, documentation, and quality review follow the immediate
safety action.
Question 5 Scope of Practice
Which nursing activity must be performed by the RN?
A. Obtain a routine capillary blood glucose level
B. Assist a stable client with oral hygiene
C. Perform the initial assessment of a newly admitted client
D. Transport a client to the radiology department
Correct Answer: C
Rationale:
The initial nursing assessment requires comprehensive data collection, interpretation, identification of priority
problems, and development of the plan of care. These responsibilities require RN-level judgment.
Why the other options are less appropriate:
• A: A trained UAP may obtain routine glucose readings according to policy.
• B: Hygiene assistance may be delegated.
• D: Stable-client transport may be assigned to assistive personnel.
Remember This:
The RN performs initial assessments, develops nursing plans, provides initial teaching, and evaluates outcomes.
Question 6 Urgent Communication
The nurse receives a laboratory report showing a potassium level of 2.5 mEq/L. Which action should the nurse
take first?
A. Encourage the client to eat a banana
B. Document the result in the medical record
C. Repeat the laboratory test in 4 hours
D. Assess the client and notify the provider promptly
, Correct Answer: D
Rationale:
Severe hypokalemia can cause muscle weakness and life-threatening cardiac dysrhythmias. The nurse should
assess the client, review the cardiac rhythm when available, and promptly report the critical result.
Why the other options are less appropriate:
• A: Dietary potassium is insufficient for severe hypokalemia.
• B: Documentation does not replace immediate clinical action.
• C: Delaying intervention increases the risk of complications.
Communication Tip:
Before contacting the provider, gather focused assessment findings, recent trends, current medications, and
relevant laboratory values for an organized SBAR report.
Question 7 Acute Change
Which client should the nurse evaluate immediately?
A. A client with COPD who has become restless and confused
B. A client with osteoarthritis requesting a warm compress
C. A client with chronic constipation requesting prune juice
D. A client awaiting transportation for a scheduled ultrasound
Correct Answer: A
Rationale:
Restlessness and confusion can be early signs of hypoxemia. An acute mental-status change in a client with
respiratory disease requires immediate assessment of oxygenation and ventilation.
Why the other options are less appropriate:
• B: This is a comfort request for a chronic condition.
• C: Constipation is not the most urgent problem.
• D: Transportation delays are lower priority than clinical deterioration.
Clinical Pearl:
Do not dismiss sudden confusion as anxiety or age-related behavior. Acute changes often signal hypoxia,
hypoglycemia, infection, or neurologic deterioration.
Question 8 Informed Refusal
A competent client who previously signed surgical consent tells the nurse, “I have changed my mind. I do not
want the procedure.” Which action should the nurse take?
,A. Ask the client’s family to convince the client to continue
B. Administer the prescribed preoperative sedative
C. Stop the preparation and notify the surgeon
D. Explain that signed consent cannot be withdrawn
Correct Answer: C
Rationale:
A competent client may withdraw consent at any time before the procedure. The nurse should stop
preparation, protect the client from unwanted treatment, and notify the surgeon.
Why the other options are less appropriate:
• A: Family pressure may interfere with voluntary decision-making.
• B: Sedation could impair the client’s ability to make decisions.
• D: Consent is voluntary and may be withdrawn.
Legal Insight:
Informed consent is an ongoing process, not merely a signature. A competent client maintains the right to
refuse or withdraw consent.
Question 9 LPN/LVN Assignment
Which client should the charge nurse assign to an LPN/LVN?
A. A newly admitted client reporting crushing chest pain
B. A stable client with hypertension who requires scheduled oral medications
C. A client who developed sudden unilateral weakness
D. A client requiring initial teaching about insulin administration
Correct Answer: B
Rationale:
An LPN/LVN may care for stable clients with predictable outcomes and administer routine medications
according to jurisdiction and facility policy.
Why the other options are less appropriate:
• A: Acute chest pain requires immediate RN assessment.
• C: Sudden weakness may indicate stroke and requires rapid RN evaluation.
• D: Initial education requires RN assessment and teaching.
Assignment Rule:
Assign stable, predictable clients to the LPN/LVN. The RN manages new admissions, unstable conditions, initial
teaching, and complex evaluation.
Question 10 Cardiac Priority
, The nurse is caring for four clients. Which client should the nurse assess first?
A. A client asking for a prescribed sleep medication
B. A client reporting sudden chest pressure radiating to the jaw
C. A client waiting for discharge transportation
D. A client requesting assistance to change position
Correct Answer: B
Rationale:
Sudden chest pressure radiating to the jaw is consistent with acute coronary syndrome. Rapid assessment and
intervention are necessary to restore perfusion and limit myocardial damage.
Why the other options are less appropriate:
• A: A sleep medication is nonurgent.
• C: Transportation can be delayed.
• D: Repositioning is important but does not outrank suspected myocardial ischemia.
Exam Strategy:
Treat new chest pain as cardiac ischemia until proven otherwise. Prioritize rapid assessment, vital signs, cardiac
monitoring, and emergency interventions.
Question 11 Time Management
After receiving shift report, which action should the nurse perform first?
A. Assess a client who returned from the post-anesthesia care unit 20 minutes ago
B. Review discharge instructions with a client leaving in 3 hours
C. Restock supplies needed later in the shift
D. Return a routine telephone call from a client’s family member
Correct Answer: A
Rationale:
A recently postoperative client requires immediate assessment for airway obstruction, respiratory depression,
bleeding, hemodynamic instability, pain, and changes in consciousness.
Why the other options are less appropriate:
• B: Discharge education can be completed after priority assessments.
• C: Restocking is a nonclinical task.
• D: A routine family call can wait.
Time-Management Tip:
At the start of a shift, first assess clients who are newly admitted, newly postoperative, unstable, or
experiencing an acute change.
