ATI NCLEX-RN 2026 EXAM PRACTICE | 180
NGN-STYLE QUESTIONS & ANSWERS WITH
RATIONALES | COMPREHENSIVE TEST BANK |
LATEST 2026/2027 UPDATE | ASSURED PASS
Core Domains
1. Management of Care – Delegation, Prioritization, Assignment, and Resource
Management
2. Safety and Infection Control – Injury Prevention, Accident Prevention,
Standard/Transmission-Based Precautions
3. Health Promotion and Maintenance – Developmental Stages, Health Screening,
Ante/Intra/Postpartum Care
4. Psychosocial Integrity – Coping Mechanisms, Grief, Therapeutic Communication,
Crisis Intervention
5. Basic Care and Comfort – Mobility, Hygiene, Nutrition, Pain Management,
Rest/Sleep
6. Pharmacology – Medication Administration, Side Effects, Contraindications,
Calculations
7. Reduction of Risk Potential – Diagnostic Tests, Vital Signs, Therapeutic
Procedures, Laboratory Values
8. Physiological Adaptation – Pathophysiology, Fluid/Electrolyte Balance, Immune
Response, Medical Emergencies
9. Clinical Judgment – NGN Case Studies, Prioritization, Clinical Decision-Making
Introduction
This comprehensive practice examination is designed to simulate the ATI NCLEX-
RN 2026 exam experience with 180 Next Generation NCLEX (NGN)-style questions
and detailed rationales. The assessment covers all eight client needs categories as
,outlined by the NCSBN, with an emphasis on clinical judgment and the NGN item
types (bow-tie, drag-and-drop, multiple response, and case studies). You will
encounter questions that test your ability to recognize cues, analyze cues, prioritize
hypotheses, generate solutions, take action, and evaluate outcomes. The structure
is designed to challenge your critical thinking and clinical decision-making skills in
preparation for both the ATI Comprehensive Predictor and the NCLEX-RN. Mastery
of these topics is essential for any nursing student seeking to pass the NCLEX-RN
on their first attempt. According to ATI research, students who achieve Level 2 or
higher on ATI Comprehensive Predictor assessments reach nearly a 98%
probability of passing the NCLEX-RN.
SECTION ONE: QUESTIONS 1 – 100
1. A charge nurse is making assignments on a medical-surgical unit. Which
client should be assigned to the most experienced nurse?
A. A client with pneumonia who requires IV antibiotics every 6 hours
B. A client who is 2 days post-operative after a cholecystectomy and is ambulating
independently
C. A client with acute pancreatitis who is experiencing severe pain and unstable
vital signs
D. A client with diabetes mellitus who requires insulin administration before meals
C. A client with acute pancreatitis who is experiencing severe pain and
unstable vital signs
RATIONALE: The client with acute pancreatitis and unstable vital signs is the
most unstable and requires the highest level of nursing expertise. The most
experienced nurse should be assigned to the client with the greatest acuity and
potential for rapid deterioration.
2. A nurse is caring for a client who has a new diagnosis of terminal cancer and
is crying. Which of the following responses by the nurse is therapeutic?
,A. "You should be grateful you have time to say goodbye to your family."
B. "I understand how you feel. My grandmother died of cancer last year."
C. "It's okay to cry. I am here to listen if you want to talk."
D. "You need to stay strong for your family during this difficult time."
C. "It's okay to cry. I am here to listen if you want to talk."
RATIONALE: This response acknowledges the client's feelings, provides
permission to express emotions, and offers support without judgment or advice. It
demonstrates therapeutic communication by validating the client's emotional state.
3. A nurse is preparing to administer 0.9% sodium chloride 1,000 mL IV to
infuse over 8 hours. The drop factor of the IV tubing is 15 gtt/mL. The nurse
should set the manual IV infusion to deliver how many gtt/min?
A. 15 gtt/min
B. 21 gtt/min
C. 31 gtt/min
D. 42 gtt/min
C. 31 gtt/min
RATIONALE: The correct calculation is: (1,000 mL ÷ 480 minutes) × 15 gtt/mL =
31.25 gtt/min, rounded to 31 gtt/min. The infusion time of 8 hours equals 480
minutes.
4. A client with heart failure is prescribed furosemide 40 mg IV push. Which of
the following laboratory values should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
, B. Serum potassium
RATIONALE: Furosemide is a loop diuretic that causes potassium excretion,
leading to hypokalemia. Hypokalemia can precipitate life-threatening cardiac
dysrhythmias, making serum potassium the priority laboratory value to monitor.
5. A nurse is providing discharge teaching to a client who has a new prescription
for warfarin. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I will take ibuprofen for headaches instead of acetaminophen."
B. "I will increase my intake of green leafy vegetables."
C. "I will notify my dentist that I am taking this medication."
D. "I will check my blood glucose level daily."
C. "I will notify my dentist that I am taking this medication."
RATIONALE: Warfarin is an anticoagulant that increases bleeding risk. Clients
should notify all healthcare providers, including dentists, of their warfarin use to
prevent excessive bleeding during procedures.
NGN CASE STUDY 1
A nurse in the emergency department is caring for a 72-year-old client who
presents with sudden onset of severe headache, nausea, vomiting, and
confusion. The client's blood pressure is 220/120 mm Hg. The client's family
reports that the client has a history of hypertension but has not been taking
prescribed medications regularly.
6. Which of the following is the priority nursing action?
A. Administer an antihypertensive medication
B. Assess the client's neurological status using a stroke scale
NGN-STYLE QUESTIONS & ANSWERS WITH
RATIONALES | COMPREHENSIVE TEST BANK |
LATEST 2026/2027 UPDATE | ASSURED PASS
Core Domains
1. Management of Care – Delegation, Prioritization, Assignment, and Resource
Management
2. Safety and Infection Control – Injury Prevention, Accident Prevention,
Standard/Transmission-Based Precautions
3. Health Promotion and Maintenance – Developmental Stages, Health Screening,
Ante/Intra/Postpartum Care
4. Psychosocial Integrity – Coping Mechanisms, Grief, Therapeutic Communication,
Crisis Intervention
5. Basic Care and Comfort – Mobility, Hygiene, Nutrition, Pain Management,
Rest/Sleep
6. Pharmacology – Medication Administration, Side Effects, Contraindications,
Calculations
7. Reduction of Risk Potential – Diagnostic Tests, Vital Signs, Therapeutic
Procedures, Laboratory Values
8. Physiological Adaptation – Pathophysiology, Fluid/Electrolyte Balance, Immune
Response, Medical Emergencies
9. Clinical Judgment – NGN Case Studies, Prioritization, Clinical Decision-Making
Introduction
This comprehensive practice examination is designed to simulate the ATI NCLEX-
RN 2026 exam experience with 180 Next Generation NCLEX (NGN)-style questions
and detailed rationales. The assessment covers all eight client needs categories as
,outlined by the NCSBN, with an emphasis on clinical judgment and the NGN item
types (bow-tie, drag-and-drop, multiple response, and case studies). You will
encounter questions that test your ability to recognize cues, analyze cues, prioritize
hypotheses, generate solutions, take action, and evaluate outcomes. The structure
is designed to challenge your critical thinking and clinical decision-making skills in
preparation for both the ATI Comprehensive Predictor and the NCLEX-RN. Mastery
of these topics is essential for any nursing student seeking to pass the NCLEX-RN
on their first attempt. According to ATI research, students who achieve Level 2 or
higher on ATI Comprehensive Predictor assessments reach nearly a 98%
probability of passing the NCLEX-RN.
SECTION ONE: QUESTIONS 1 – 100
1. A charge nurse is making assignments on a medical-surgical unit. Which
client should be assigned to the most experienced nurse?
A. A client with pneumonia who requires IV antibiotics every 6 hours
B. A client who is 2 days post-operative after a cholecystectomy and is ambulating
independently
C. A client with acute pancreatitis who is experiencing severe pain and unstable
vital signs
D. A client with diabetes mellitus who requires insulin administration before meals
C. A client with acute pancreatitis who is experiencing severe pain and
unstable vital signs
RATIONALE: The client with acute pancreatitis and unstable vital signs is the
most unstable and requires the highest level of nursing expertise. The most
experienced nurse should be assigned to the client with the greatest acuity and
potential for rapid deterioration.
2. A nurse is caring for a client who has a new diagnosis of terminal cancer and
is crying. Which of the following responses by the nurse is therapeutic?
,A. "You should be grateful you have time to say goodbye to your family."
B. "I understand how you feel. My grandmother died of cancer last year."
C. "It's okay to cry. I am here to listen if you want to talk."
D. "You need to stay strong for your family during this difficult time."
C. "It's okay to cry. I am here to listen if you want to talk."
RATIONALE: This response acknowledges the client's feelings, provides
permission to express emotions, and offers support without judgment or advice. It
demonstrates therapeutic communication by validating the client's emotional state.
3. A nurse is preparing to administer 0.9% sodium chloride 1,000 mL IV to
infuse over 8 hours. The drop factor of the IV tubing is 15 gtt/mL. The nurse
should set the manual IV infusion to deliver how many gtt/min?
A. 15 gtt/min
B. 21 gtt/min
C. 31 gtt/min
D. 42 gtt/min
C. 31 gtt/min
RATIONALE: The correct calculation is: (1,000 mL ÷ 480 minutes) × 15 gtt/mL =
31.25 gtt/min, rounded to 31 gtt/min. The infusion time of 8 hours equals 480
minutes.
4. A client with heart failure is prescribed furosemide 40 mg IV push. Which of
the following laboratory values should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
, B. Serum potassium
RATIONALE: Furosemide is a loop diuretic that causes potassium excretion,
leading to hypokalemia. Hypokalemia can precipitate life-threatening cardiac
dysrhythmias, making serum potassium the priority laboratory value to monitor.
5. A nurse is providing discharge teaching to a client who has a new prescription
for warfarin. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I will take ibuprofen for headaches instead of acetaminophen."
B. "I will increase my intake of green leafy vegetables."
C. "I will notify my dentist that I am taking this medication."
D. "I will check my blood glucose level daily."
C. "I will notify my dentist that I am taking this medication."
RATIONALE: Warfarin is an anticoagulant that increases bleeding risk. Clients
should notify all healthcare providers, including dentists, of their warfarin use to
prevent excessive bleeding during procedures.
NGN CASE STUDY 1
A nurse in the emergency department is caring for a 72-year-old client who
presents with sudden onset of severe headache, nausea, vomiting, and
confusion. The client's blood pressure is 220/120 mm Hg. The client's family
reports that the client has a history of hypertension but has not been taking
prescribed medications regularly.
6. Which of the following is the priority nursing action?
A. Administer an antihypertensive medication
B. Assess the client's neurological status using a stroke scale
