ATI PN Comprehensive Predictor 2026 Exit Exam Study
Guide and Practice Test
Advanced Clinical Reasoning Edition
150 Next
-Generation NCLEX
-Style Questions with
Comprehensive Rationales
EXAM OVERVIEW
The ATI PN Comprehensive Predictor Exit Examination serves as the definitive
benchmark for practical nursing program completion and NCLEX-PN readiness
assessment. This comprehensive 180-question (150 scored + 30 unscored pretest)
proctored examination evaluates practical nursing students across all content domains
utilizing the latest NCLEX-PN test plan framework, incorporating clinical judgment
measurement model (CJMM) principles and Next Generation NCLEX (NGN) item types
including extended multiple response, drag-and-drop, cloze-style, and enhanced
hotspot questions. The examination establishes final proficiency levels ranging from
Level 1 (below passing standard) through Level 3 (exceeds passing standard) and serves
as the final comprehensive evaluation of nursing program outcomes.
Advanced Usage Instructions:
• Complete all questions in timed testing conditions (150 minutes maximum)
• Cover answer key and rationales until completion of each section
• Analyze rationale thoroughly for every item, regardless of accuracy
• Identify patterns in missed content areas for targeted remediation
• Score 80% or higher on all domains before attempting official proctored
examination
Question 1
A practical nurse is caring for a client who has been diagnosed with end-stage renal
disease and is actively receiving hemodialysis three times weekly. The client's advance
directive indicates "do not resuscitate" (DNR) but does not address dialysis continuation
or discontinuation. The client's family requests that dialysis be discontinued due to
,declining quality of life, but the client is currently unable to communicate their wishes.
Which action should the PN take FIRST?
A) Immediately stop dialysis treatments per family request
B) Contact the hospital ethics committee for consultation
C) Document the family's request in the medical record
D) Ask the nephrologist to obtain a surrogate decision-maker designation
Answer: B
Rationale: The priority action is to contact the hospital ethics committee for
consultation. This complex ethical situation involves the intersection of advance
directives, family wishes, client autonomy, and life-sustaining treatment. The ethics
committee provides a structured framework for multidisciplinary deliberation and
ensures all legal and ethical considerations are addressed. Stopping dialysis without
proper legal authorization would constitute abandonment and potentially violate the
client's rights. The surrogate decision-maker designation must be legally established
before treatment decisions can be made. Documentation alone does not address the
immediate clinical and ethical dilemma.
Question 2
,The practical nurse is working on a medical-surgical unit and receives the following shift
assignment from the RN:
• Client A: 68-year-old with COPD exacerbation requiring IV antibiotics and
scheduled nebulizer treatments
• Client B: 72-year-old with hip fracture, 2 days post-operative, requiring PCA
pump management and scheduled pain assessments
• Client C: 55-year-old with newly diagnosed diabetes mellitus requiring
comprehensive discharge teaching about insulin self-administration
• Client D: 80-year-old with pneumonia requiring nasopharyngeal suctioning PRN
and oxygen therapy monitoring
Which client assignments should the PN question and why?
A) Client A because IV antibiotic administration requires RN oversight
B) Client B because PCA pump programming and management are outside LPN scope
of practice
C) Client C because discharge teaching is an RN responsibility
D) Client D because nasopharyngeal suctioning is outside LPN scope
Answer: B
Rationale: The PCA pump represents a complex medication delivery system that
requires RN assessment, programming, and management. While LPNs may reinforce
PCA pump teaching and monitor clients receiving PCA therapy, they cannot
independently manage, program, or titrate PCA pumps. IV antibiotic administration is
within LPN scope when the RN has verified the correct medication and the client is
stable. Discharge teaching can be reinforced by LPNs, though the RN retains ultimate
responsibility. Nasopharyngeal suctioning is well within LPN scope of practice with
appropriate education and competency verification.
, Question 3
A practical nurse is preparing to administer a scheduled dose of furosemide 40 mg IV
push to a client with acute pulmonary edema. The client's most recent vital signs are:
blood pressure 98/62 mm Hg, heart rate 110 bpm, respiratory rate 28/min, oxygen
saturation 89% on 4 L/min nasal cannula. The client reports feeling "dizzy and
lightheaded." Which action should the PN take FIRST?
A) Administer the furosemide as scheduled
B) Hold the furosemide and notify the provider
C) Decrease the IV push rate to 2 minutes
D) Administer the furosemide with a 50 mL normal saline flush
Answer: B
Rationale: The client is experiencing hypotension with signs of hypovolemia (dizziness,
tachycardia, low blood pressure). Furosemide, a potent loop diuretic, will further reduce
preload and exacerbate hypotension, potentially leading to hypovolemic shock. The PN
must hold the medication and notify the provider immediately. Although the client has
pulmonary edema, the blood pressure indicates that aggressive diuresis would be
Guide and Practice Test
Advanced Clinical Reasoning Edition
150 Next
-Generation NCLEX
-Style Questions with
Comprehensive Rationales
EXAM OVERVIEW
The ATI PN Comprehensive Predictor Exit Examination serves as the definitive
benchmark for practical nursing program completion and NCLEX-PN readiness
assessment. This comprehensive 180-question (150 scored + 30 unscored pretest)
proctored examination evaluates practical nursing students across all content domains
utilizing the latest NCLEX-PN test plan framework, incorporating clinical judgment
measurement model (CJMM) principles and Next Generation NCLEX (NGN) item types
including extended multiple response, drag-and-drop, cloze-style, and enhanced
hotspot questions. The examination establishes final proficiency levels ranging from
Level 1 (below passing standard) through Level 3 (exceeds passing standard) and serves
as the final comprehensive evaluation of nursing program outcomes.
Advanced Usage Instructions:
• Complete all questions in timed testing conditions (150 minutes maximum)
• Cover answer key and rationales until completion of each section
• Analyze rationale thoroughly for every item, regardless of accuracy
• Identify patterns in missed content areas for targeted remediation
• Score 80% or higher on all domains before attempting official proctored
examination
Question 1
A practical nurse is caring for a client who has been diagnosed with end-stage renal
disease and is actively receiving hemodialysis three times weekly. The client's advance
directive indicates "do not resuscitate" (DNR) but does not address dialysis continuation
or discontinuation. The client's family requests that dialysis be discontinued due to
,declining quality of life, but the client is currently unable to communicate their wishes.
Which action should the PN take FIRST?
A) Immediately stop dialysis treatments per family request
B) Contact the hospital ethics committee for consultation
C) Document the family's request in the medical record
D) Ask the nephrologist to obtain a surrogate decision-maker designation
Answer: B
Rationale: The priority action is to contact the hospital ethics committee for
consultation. This complex ethical situation involves the intersection of advance
directives, family wishes, client autonomy, and life-sustaining treatment. The ethics
committee provides a structured framework for multidisciplinary deliberation and
ensures all legal and ethical considerations are addressed. Stopping dialysis without
proper legal authorization would constitute abandonment and potentially violate the
client's rights. The surrogate decision-maker designation must be legally established
before treatment decisions can be made. Documentation alone does not address the
immediate clinical and ethical dilemma.
Question 2
,The practical nurse is working on a medical-surgical unit and receives the following shift
assignment from the RN:
• Client A: 68-year-old with COPD exacerbation requiring IV antibiotics and
scheduled nebulizer treatments
• Client B: 72-year-old with hip fracture, 2 days post-operative, requiring PCA
pump management and scheduled pain assessments
• Client C: 55-year-old with newly diagnosed diabetes mellitus requiring
comprehensive discharge teaching about insulin self-administration
• Client D: 80-year-old with pneumonia requiring nasopharyngeal suctioning PRN
and oxygen therapy monitoring
Which client assignments should the PN question and why?
A) Client A because IV antibiotic administration requires RN oversight
B) Client B because PCA pump programming and management are outside LPN scope
of practice
C) Client C because discharge teaching is an RN responsibility
D) Client D because nasopharyngeal suctioning is outside LPN scope
Answer: B
Rationale: The PCA pump represents a complex medication delivery system that
requires RN assessment, programming, and management. While LPNs may reinforce
PCA pump teaching and monitor clients receiving PCA therapy, they cannot
independently manage, program, or titrate PCA pumps. IV antibiotic administration is
within LPN scope when the RN has verified the correct medication and the client is
stable. Discharge teaching can be reinforced by LPNs, though the RN retains ultimate
responsibility. Nasopharyngeal suctioning is well within LPN scope of practice with
appropriate education and competency verification.
, Question 3
A practical nurse is preparing to administer a scheduled dose of furosemide 40 mg IV
push to a client with acute pulmonary edema. The client's most recent vital signs are:
blood pressure 98/62 mm Hg, heart rate 110 bpm, respiratory rate 28/min, oxygen
saturation 89% on 4 L/min nasal cannula. The client reports feeling "dizzy and
lightheaded." Which action should the PN take FIRST?
A) Administer the furosemide as scheduled
B) Hold the furosemide and notify the provider
C) Decrease the IV push rate to 2 minutes
D) Administer the furosemide with a 50 mL normal saline flush
Answer: B
Rationale: The client is experiencing hypotension with signs of hypovolemia (dizziness,
tachycardia, low blood pressure). Furosemide, a potent loop diuretic, will further reduce
preload and exacerbate hypotension, potentially leading to hypovolemic shock. The PN
must hold the medication and notify the provider immediately. Although the client has
pulmonary edema, the blood pressure indicates that aggressive diuresis would be
