ATI RN COMPREHENSIVE PREDICTOR 2026
,Table of Contents
ATI RN Comprehensive Predictor 2026 Proctored Exam
Comprehensive Mixed Review with NGN Clinical Judgment Case Studies
Question
Section Content
Numbers
1 Nursing Leadership, Management & Delegation 1–20
2 Fundamentals of Nursing & Patient Safety 21–40
3 Pharmacology & Medication Administration 41–60
4 Adult Medical-Surgical Nursing I 61–80
5 Adult Medical-Surgical Nursing II 81–100
6 Renal & Urinary Disorders 101–120
7 Gastrointestinal Disorders 121–130
8 Maternity & Newborn Nursing 131–140
9 Pediatric Nursing 141–150
10 Mental Health Nursing 151–160
11 Leadership, Delegation & Prioritization 161–170
NGN Clinical Judgment Case Study 1 – Acute ST-Elevation Myocardial Infarction
12 171–176
(STEMI)
13 NGN Clinical Judgment Case Study 2 – Septic Shock 177–182
14 NGN Clinical Judgment Case Study 3 – Acute Ischemic Stroke 183–188
NGN Clinical Judgment Case Study 4 – Septic Shock Secondary to Perforated
15 189–194
Diverticulitis
16 NGN Clinical Judgment Case Study 5 – Diabetic Ketoacidosis (DKA) 195–200
17 Mixed Comprehensive Predictor Review – Part I 201–210
18 Mixed Comprehensive Predictor Review – Part II 211–220
, Question
Section Content
Numbers
19 Mixed Comprehensive Predictor Review – Part III 221–230
20 Mixed Comprehensive Predictor Review – Part IV 231–240
21 Mixed Comprehensive Predictor Review – Part V 241–250
Exam Features
250 Premium ATI RN Comprehensive Predictor Questions
Next Generation NCLEX (NGN) Clinical Judgment Case Studies
Prioritization & Delegation
Select-All-That-Apply (SATA) Questions
Clinical Judgment (Recognize Cues → Analyze Cues → Prioritize Hypotheses → Generate Solutions →
Take Action → Evaluate Outcomes)
Detailed Rationales
Why the Other Options Are Incorrect
Clinical Pearl
ATI Success Tip
Randomized & Unpredictable Answer Distribution (A–D)
High-Level NCLEX/ATI Critical Thinking Questions
Comprehensive Coverage of All Major ATI RN Predictor Blueprint Topics
Question 1
1. During morning assessment, a nurse finds that an older adult client who was alert one hour ago is now
confused, restless, and attempting to climb out of bed. Which nursing action has the highest priority?
A. Apply soft wrist restraints immediately.
B. Assess airway, breathing, circulation, and obtain a blood glucose level.
C. Notify the healthcare provider before performing an assessment.
D. Ask the unlicensed assistive personnel (UAP) to remain with the client.
Answer: B
,Rationale: An acute change in mental status may indicate hypoxia, hypoglycemia, stroke, infection, or another
life-threatening condition. The nurse should first assess the client using the ABC approach and identify
reversible causes before implementing other interventions.
Why the other options are incorrect:
• A: Restraints are a last resort after less restrictive interventions fail.
• C: Assessment precedes provider notification.
• D: Observation is helpful but does not replace immediate assessment.
Clinical Pearl: Acute confusion is never considered a normal finding in older adults.
ATI Success Tip: Unexpected neurological changes always require immediate assessment before
intervention.
2. A nurse prepares to administer a scheduled dose of digoxin. Which assessment finding requires the nurse to
withhold the medication?
A. Apical pulse of 54 beats/min
B. Blood pressure of 132/76 mm Hg
C. Respiratory rate of 18 breaths/min
D. Temperature of 37°C (98.6°F)
Answer: A
Rationale: Digoxin slows cardiac conduction. An apical pulse below 60 beats/min in an adult should be
reported before administration.
Why the other options are incorrect:
• B: Blood pressure is within an acceptable range.
• C: Respiratory rate is normal.
• D: Temperature is normal.
Clinical Pearl: Always count the apical pulse for one full minute before administering digoxin.
ATI Success Tip: Digoxin + HR <60 = Hold the medication and notify the provider.
3. Which client should the nurse assess first after receiving change-of-shift report?
A. A client requesting pain medication for chronic arthritis.
B. A client with an oxygen saturation that decreased from 96% to 88%.
C. A client awaiting discharge instructions.
D. A client requesting assistance with bathing.
,Answer: B
Rationale: A sudden decline in oxygen saturation indicates impaired oxygenation and requires immediate
assessment.
Why the other options are incorrect:
• A: Chronic pain is important but not immediately life-threatening.
• C: Discharge teaching can safely wait.
• D: Hygiene needs are lower priority.
Clinical Pearl: Respiratory deterioration often occurs before cardiovascular collapse.
ATI Success Tip: Prioritize airway and breathing concerns first.
4. A nurse prepares to delegate ambulation of a stable postoperative client to an experienced UAP. Which
nursing responsibility cannot be delegated?
A. Assisting the client to the bathroom.
B. Obtaining routine vital signs.
C. Performing the initial assessment before ambulation.
D. Documenting intake and output.
Answer: C
Rationale: Assessment requires nursing judgment and cannot be delegated.
Why the other options are incorrect:
• A: Appropriate delegation.
• B: Routine vital signs may be delegated.
• D: Intake and output measurement may be delegated.
Clinical Pearl: Nurses delegate tasks—not assessment, teaching, or evaluation.
ATI Success Tip: Assessment, teaching, evaluation, and clinical judgment always remain the nurse's
responsibility.
5. A postoperative client suddenly reports shortness of breath and chest pain. Which nursing action is the
priority?
A. Encourage coughing and deep breathing.
B. Assess oxygen saturation and respiratory status immediately.
C. Administer the prescribed analgesic.
D. Notify the client's family.
,Answer: B
Rationale: These symptoms may indicate pulmonary embolism or another life-threatening complication
requiring immediate assessment.
Why the other options are incorrect:
• A: Appropriate only after assessment.
• C: Pain medication does not address the underlying emergency.
• D: Family notification is not the priority.
Clinical Pearl: Sudden dyspnea after surgery should always raise suspicion for pulmonary embolism.
ATI Success Tip: ABCs always guide prioritization.
6. Which finding requires immediate intervention in a client receiving IV morphine?
A. Pain decreased from 8/10 to 3/10.
B. Respiratory rate of 7 breaths/min.
C. Heart rate of 82 beats/min.
D. Blood pressure of 126/78 mm Hg.
Answer: B
Rationale: Respiratory depression is the most serious adverse effect of opioid therapy and requires immediate
intervention.
Why the other options are incorrect:
• A: Indicates effective pain relief.
• C: Heart rate is normal.
• D: Blood pressure is stable.
Clinical Pearl: Respiratory status is the most important assessment after opioid administration.
ATI Success Tip: RR less than 8/min is an emergency.
7. A client refuses a scheduled blood transfusion after receiving education about the risks and benefits. What
should the nurse do?
A. Begin the transfusion because it is prescribed.
B. Respect the client's decision and notify the healthcare provider.
C. Ask a family member to provide consent.
D. Delay the discussion until the provider arrives.
,Answer: B
Rationale: Competent adults have the legal right to refuse treatment after receiving adequate information.
Why the other options are incorrect:
• A: Violates client autonomy.
• C: Family cannot override a competent client's decision.
• D: The refusal should be communicated promptly.
Clinical Pearl: Respect for autonomy is a fundamental ethical principle.
ATI Success Tip: Clients may refuse any treatment if they have decision-making capacity.
8. A nurse notices that a prescribed medication dose is significantly higher than the usual therapeutic dose.
What should the nurse do first?
A. Administer half of the prescribed dose.
B. Hold the medication and verify the prescription.
C. Ask another nurse to administer the medication.
D. Administer the medication because the provider prescribed it.
Answer: B
Rationale: Nurses are responsible for questioning medication orders that appear unsafe before administration.
Why the other options are incorrect:
• A: Nurses should not independently change prescribed doses.
• C: Delegation does not resolve the safety concern.
• D: Unsafe medication orders require clarification.
Clinical Pearl: Every nurse is accountable for safe medication administration.
ATI Success Tip: When in doubt, stop and clarify the prescription.
9. Which client statement demonstrates an understanding of therapeutic communication?
A. "The nurse told me not to worry."
B. "The nurse asked me to explain what concerns me most."
C. "The nurse said everything will be fine."
D. "The nurse told me other clients have recovered."
Answer: B
,Rationale: Open-ended questions encourage clients to express concerns and promote therapeutic
communication.
Why the other options are incorrect:
• A: Minimizes feelings.
• C: Provides false reassurance.
• D: Compares the client with others.
Clinical Pearl: Therapeutic communication focuses on the client's feelings and perspective.
ATI Success Tip: Open-ended questions are frequently tested on ATI exams.
10. A nurse identifies water spilled on the floor outside a client's room. Which action should the nurse take
first?
A. Notify housekeeping.
B. Place a warning sign and ensure the spill is cleaned immediately.
C. Document the environmental hazard.
D. Wait until routine cleaning is scheduled.
Answer: B
Rationale: Immediate removal or isolation of environmental hazards helps prevent falls and injuries.
Why the other options are incorrect:
• A: Housekeeping may be notified, but the hazard must be addressed immediately.
• C: Documentation alone does not eliminate the risk.
• D: Delaying increases the risk of injury.
Clinical Pearl: Environmental safety is one of the most effective strategies for preventing inpatient falls.
ATI Success Tip: On ATI exams, always eliminate immediate safety hazards before performing nonurgent
tasks.
11. A charge nurse is assigning tasks for the shift. Which client should the nurse assign to a newly licensed RN?
A. A client 2 hours after a thyroidectomy who reports difficulty swallowing.
B. A client receiving the first dose of IV vancomycin.
C. A client admitted with diabetic ketoacidosis requiring an insulin infusion.
D. A client recovering from pneumonia who is scheduled for routine discharge later that morning.
Answer: D
, Rationale: A stable client preparing for discharge is an appropriate assignment for a newly licensed RN. Clients
with unstable conditions, high-risk medications, or potential postoperative complications require the expertise
of an experienced nurse.
Why the other options are incorrect:
• A: Difficulty swallowing after thyroidectomy may indicate airway compromise.
• B: First-dose IV antibiotics require close monitoring for adverse reactions.
• C: Diabetic ketoacidosis requires frequent assessment and complex management.
Clinical Pearl: Stable clients with predictable outcomes are appropriate assignments for newly licensed
nurses.
ATI Success Tip: Assign the most stable clients to less experienced staff.
12. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client receiving a blood transfusion who reports chills and lower back pain.
B. A client requesting assistance to walk after breakfast.
C. A client awaiting routine dressing changes.
D. A client whose pain level is 5 out of 10 one hour after receiving acetaminophen.
Answer: A
Rationale: Chills and lower back pain during a blood transfusion may indicate an acute hemolytic transfusion
reaction, which requires immediate intervention.
Why the other options are incorrect:
• B: Ambulation can safely be delayed.
• C: Dressing changes are not the highest priority.
• D: Mild persistent pain is less urgent than a possible transfusion reaction.
Clinical Pearl: Stop the transfusion immediately if a transfusion reaction is suspected.
ATI Success Tip: Unexpected complications always take priority over routine care.
13. Which task is appropriate for the nurse to delegate to an experienced unlicensed assistive personnel
(UAP)?
A. Reinforcing discharge instructions for a client with heart failure.
B. Collecting a clean-catch urine specimen from a stable client.
C. Assessing a client's pain after receiving morphine.
D. Evaluating the effectiveness of a new antihypertensive medication.
,Table of Contents
ATI RN Comprehensive Predictor 2026 Proctored Exam
Comprehensive Mixed Review with NGN Clinical Judgment Case Studies
Question
Section Content
Numbers
1 Nursing Leadership, Management & Delegation 1–20
2 Fundamentals of Nursing & Patient Safety 21–40
3 Pharmacology & Medication Administration 41–60
4 Adult Medical-Surgical Nursing I 61–80
5 Adult Medical-Surgical Nursing II 81–100
6 Renal & Urinary Disorders 101–120
7 Gastrointestinal Disorders 121–130
8 Maternity & Newborn Nursing 131–140
9 Pediatric Nursing 141–150
10 Mental Health Nursing 151–160
11 Leadership, Delegation & Prioritization 161–170
NGN Clinical Judgment Case Study 1 – Acute ST-Elevation Myocardial Infarction
12 171–176
(STEMI)
13 NGN Clinical Judgment Case Study 2 – Septic Shock 177–182
14 NGN Clinical Judgment Case Study 3 – Acute Ischemic Stroke 183–188
NGN Clinical Judgment Case Study 4 – Septic Shock Secondary to Perforated
15 189–194
Diverticulitis
16 NGN Clinical Judgment Case Study 5 – Diabetic Ketoacidosis (DKA) 195–200
17 Mixed Comprehensive Predictor Review – Part I 201–210
18 Mixed Comprehensive Predictor Review – Part II 211–220
, Question
Section Content
Numbers
19 Mixed Comprehensive Predictor Review – Part III 221–230
20 Mixed Comprehensive Predictor Review – Part IV 231–240
21 Mixed Comprehensive Predictor Review – Part V 241–250
Exam Features
250 Premium ATI RN Comprehensive Predictor Questions
Next Generation NCLEX (NGN) Clinical Judgment Case Studies
Prioritization & Delegation
Select-All-That-Apply (SATA) Questions
Clinical Judgment (Recognize Cues → Analyze Cues → Prioritize Hypotheses → Generate Solutions →
Take Action → Evaluate Outcomes)
Detailed Rationales
Why the Other Options Are Incorrect
Clinical Pearl
ATI Success Tip
Randomized & Unpredictable Answer Distribution (A–D)
High-Level NCLEX/ATI Critical Thinking Questions
Comprehensive Coverage of All Major ATI RN Predictor Blueprint Topics
Question 1
1. During morning assessment, a nurse finds that an older adult client who was alert one hour ago is now
confused, restless, and attempting to climb out of bed. Which nursing action has the highest priority?
A. Apply soft wrist restraints immediately.
B. Assess airway, breathing, circulation, and obtain a blood glucose level.
C. Notify the healthcare provider before performing an assessment.
D. Ask the unlicensed assistive personnel (UAP) to remain with the client.
Answer: B
,Rationale: An acute change in mental status may indicate hypoxia, hypoglycemia, stroke, infection, or another
life-threatening condition. The nurse should first assess the client using the ABC approach and identify
reversible causes before implementing other interventions.
Why the other options are incorrect:
• A: Restraints are a last resort after less restrictive interventions fail.
• C: Assessment precedes provider notification.
• D: Observation is helpful but does not replace immediate assessment.
Clinical Pearl: Acute confusion is never considered a normal finding in older adults.
ATI Success Tip: Unexpected neurological changes always require immediate assessment before
intervention.
2. A nurse prepares to administer a scheduled dose of digoxin. Which assessment finding requires the nurse to
withhold the medication?
A. Apical pulse of 54 beats/min
B. Blood pressure of 132/76 mm Hg
C. Respiratory rate of 18 breaths/min
D. Temperature of 37°C (98.6°F)
Answer: A
Rationale: Digoxin slows cardiac conduction. An apical pulse below 60 beats/min in an adult should be
reported before administration.
Why the other options are incorrect:
• B: Blood pressure is within an acceptable range.
• C: Respiratory rate is normal.
• D: Temperature is normal.
Clinical Pearl: Always count the apical pulse for one full minute before administering digoxin.
ATI Success Tip: Digoxin + HR <60 = Hold the medication and notify the provider.
3. Which client should the nurse assess first after receiving change-of-shift report?
A. A client requesting pain medication for chronic arthritis.
B. A client with an oxygen saturation that decreased from 96% to 88%.
C. A client awaiting discharge instructions.
D. A client requesting assistance with bathing.
,Answer: B
Rationale: A sudden decline in oxygen saturation indicates impaired oxygenation and requires immediate
assessment.
Why the other options are incorrect:
• A: Chronic pain is important but not immediately life-threatening.
• C: Discharge teaching can safely wait.
• D: Hygiene needs are lower priority.
Clinical Pearl: Respiratory deterioration often occurs before cardiovascular collapse.
ATI Success Tip: Prioritize airway and breathing concerns first.
4. A nurse prepares to delegate ambulation of a stable postoperative client to an experienced UAP. Which
nursing responsibility cannot be delegated?
A. Assisting the client to the bathroom.
B. Obtaining routine vital signs.
C. Performing the initial assessment before ambulation.
D. Documenting intake and output.
Answer: C
Rationale: Assessment requires nursing judgment and cannot be delegated.
Why the other options are incorrect:
• A: Appropriate delegation.
• B: Routine vital signs may be delegated.
• D: Intake and output measurement may be delegated.
Clinical Pearl: Nurses delegate tasks—not assessment, teaching, or evaluation.
ATI Success Tip: Assessment, teaching, evaluation, and clinical judgment always remain the nurse's
responsibility.
5. A postoperative client suddenly reports shortness of breath and chest pain. Which nursing action is the
priority?
A. Encourage coughing and deep breathing.
B. Assess oxygen saturation and respiratory status immediately.
C. Administer the prescribed analgesic.
D. Notify the client's family.
,Answer: B
Rationale: These symptoms may indicate pulmonary embolism or another life-threatening complication
requiring immediate assessment.
Why the other options are incorrect:
• A: Appropriate only after assessment.
• C: Pain medication does not address the underlying emergency.
• D: Family notification is not the priority.
Clinical Pearl: Sudden dyspnea after surgery should always raise suspicion for pulmonary embolism.
ATI Success Tip: ABCs always guide prioritization.
6. Which finding requires immediate intervention in a client receiving IV morphine?
A. Pain decreased from 8/10 to 3/10.
B. Respiratory rate of 7 breaths/min.
C. Heart rate of 82 beats/min.
D. Blood pressure of 126/78 mm Hg.
Answer: B
Rationale: Respiratory depression is the most serious adverse effect of opioid therapy and requires immediate
intervention.
Why the other options are incorrect:
• A: Indicates effective pain relief.
• C: Heart rate is normal.
• D: Blood pressure is stable.
Clinical Pearl: Respiratory status is the most important assessment after opioid administration.
ATI Success Tip: RR less than 8/min is an emergency.
7. A client refuses a scheduled blood transfusion after receiving education about the risks and benefits. What
should the nurse do?
A. Begin the transfusion because it is prescribed.
B. Respect the client's decision and notify the healthcare provider.
C. Ask a family member to provide consent.
D. Delay the discussion until the provider arrives.
,Answer: B
Rationale: Competent adults have the legal right to refuse treatment after receiving adequate information.
Why the other options are incorrect:
• A: Violates client autonomy.
• C: Family cannot override a competent client's decision.
• D: The refusal should be communicated promptly.
Clinical Pearl: Respect for autonomy is a fundamental ethical principle.
ATI Success Tip: Clients may refuse any treatment if they have decision-making capacity.
8. A nurse notices that a prescribed medication dose is significantly higher than the usual therapeutic dose.
What should the nurse do first?
A. Administer half of the prescribed dose.
B. Hold the medication and verify the prescription.
C. Ask another nurse to administer the medication.
D. Administer the medication because the provider prescribed it.
Answer: B
Rationale: Nurses are responsible for questioning medication orders that appear unsafe before administration.
Why the other options are incorrect:
• A: Nurses should not independently change prescribed doses.
• C: Delegation does not resolve the safety concern.
• D: Unsafe medication orders require clarification.
Clinical Pearl: Every nurse is accountable for safe medication administration.
ATI Success Tip: When in doubt, stop and clarify the prescription.
9. Which client statement demonstrates an understanding of therapeutic communication?
A. "The nurse told me not to worry."
B. "The nurse asked me to explain what concerns me most."
C. "The nurse said everything will be fine."
D. "The nurse told me other clients have recovered."
Answer: B
,Rationale: Open-ended questions encourage clients to express concerns and promote therapeutic
communication.
Why the other options are incorrect:
• A: Minimizes feelings.
• C: Provides false reassurance.
• D: Compares the client with others.
Clinical Pearl: Therapeutic communication focuses on the client's feelings and perspective.
ATI Success Tip: Open-ended questions are frequently tested on ATI exams.
10. A nurse identifies water spilled on the floor outside a client's room. Which action should the nurse take
first?
A. Notify housekeeping.
B. Place a warning sign and ensure the spill is cleaned immediately.
C. Document the environmental hazard.
D. Wait until routine cleaning is scheduled.
Answer: B
Rationale: Immediate removal or isolation of environmental hazards helps prevent falls and injuries.
Why the other options are incorrect:
• A: Housekeeping may be notified, but the hazard must be addressed immediately.
• C: Documentation alone does not eliminate the risk.
• D: Delaying increases the risk of injury.
Clinical Pearl: Environmental safety is one of the most effective strategies for preventing inpatient falls.
ATI Success Tip: On ATI exams, always eliminate immediate safety hazards before performing nonurgent
tasks.
11. A charge nurse is assigning tasks for the shift. Which client should the nurse assign to a newly licensed RN?
A. A client 2 hours after a thyroidectomy who reports difficulty swallowing.
B. A client receiving the first dose of IV vancomycin.
C. A client admitted with diabetic ketoacidosis requiring an insulin infusion.
D. A client recovering from pneumonia who is scheduled for routine discharge later that morning.
Answer: D
, Rationale: A stable client preparing for discharge is an appropriate assignment for a newly licensed RN. Clients
with unstable conditions, high-risk medications, or potential postoperative complications require the expertise
of an experienced nurse.
Why the other options are incorrect:
• A: Difficulty swallowing after thyroidectomy may indicate airway compromise.
• B: First-dose IV antibiotics require close monitoring for adverse reactions.
• C: Diabetic ketoacidosis requires frequent assessment and complex management.
Clinical Pearl: Stable clients with predictable outcomes are appropriate assignments for newly licensed
nurses.
ATI Success Tip: Assign the most stable clients to less experienced staff.
12. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client receiving a blood transfusion who reports chills and lower back pain.
B. A client requesting assistance to walk after breakfast.
C. A client awaiting routine dressing changes.
D. A client whose pain level is 5 out of 10 one hour after receiving acetaminophen.
Answer: A
Rationale: Chills and lower back pain during a blood transfusion may indicate an acute hemolytic transfusion
reaction, which requires immediate intervention.
Why the other options are incorrect:
• B: Ambulation can safely be delayed.
• C: Dressing changes are not the highest priority.
• D: Mild persistent pain is less urgent than a possible transfusion reaction.
Clinical Pearl: Stop the transfusion immediately if a transfusion reaction is suspected.
ATI Success Tip: Unexpected complications always take priority over routine care.
13. Which task is appropriate for the nurse to delegate to an experienced unlicensed assistive personnel
(UAP)?
A. Reinforcing discharge instructions for a client with heart failure.
B. Collecting a clean-catch urine specimen from a stable client.
C. Assessing a client's pain after receiving morphine.
D. Evaluating the effectiveness of a new antihypertensive medication.
