1
Nursing Fundamentals Study Guide and ATI RN
Comprehensive Predictor 2026: 200 Advanced
Mixed Multiple-Choice Practice Questions with
Correct Answers and Detailed Rationales
Difficulty: Advanced / Hard / Mixed
Audience: Nursing students preparing for RN-level comprehensive examinations
Format: 200 multiple-choice questions
Focus: Fundamentals, clinical judgment, safety, pharmacology principles, adult health,
maternal-newborn, pediatrics, mental health, leadership, infection prevention, and
prioritization.
Study note: These are original practice questions modeled on common RN-level nursing
competencies. They are not official ATI questions.
Questions 1–25: Fundamentals, Safety, and Clinical Judgment
1. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with chronic arthritis reporting pain of 6/10
B. A client with pneumonia whose oxygen saturation is 88% on prescribed oxygen
C. A postoperative client requesting assistance to the bathroom
D. A client awaiting discharge instructions
Answer: B
Rationale: An oxygen saturation of 88% despite prescribed oxygen indicates impaired
oxygenation and takes priority using the ABC framework. The nurse should assess airway and
breathing before addressing stable pain, mobility, or discharge needs.
2. Which action by a newly licensed nurse requires immediate intervention?
A. Elevating the head of the bed for a client receiving enteral feeding
B. Using an alcohol-based hand rub when hands are not visibly soiled
C. Recapping a used needle using two hands
D. Wearing gloves when contacting blood
Answer: C
, 2
Rationale: Used needles should not be manually recapped because this increases needlestick
risk. The needle should be discarded immediately in an approved sharps container.
3. A nurse identifies a client as being at high risk for falls. Which intervention is most
appropriate?
A. Keep all four side rails raised
B. Place the call light within reach
C. Keep the room completely dark at night
D. Encourage the client to ambulate independently
Answer: B
Rationale: Easy access to the call light promotes the client's ability to request assistance. Four
side rails can function as a restraint, while darkness and unsupervised ambulation increase fall
risk.
4. Which assessment finding requires the most immediate intervention?
A. Temperature of 37.4°C (99.3°F)
B. Respiratory rate of 8/min
C. Blood pressure of 138/84 mm Hg
D. Pulse of 88/min
Answer: B
Rationale: A respiratory rate of 8/min indicates significant respiratory depression. Airway and
breathing take priority over the other findings.
5. A nurse is preparing to administer medication. Which action best verifies the correct client?
A. Ask the client to state their room number
B. Compare the medication label with the medication administration record and use two
identifiers
C. Ask another nurse whether the client is correct
D. Identify the client by diagnosis
Answer: B
Rationale: Two approved identifiers, such as name and date of birth, should be used. Room
number and diagnosis are not reliable client identifiers.
6. Which intervention best prevents pressure injury formation in an immobile client?
, 3
A. Massage reddened areas
B. Reposition regularly and manage moisture and pressure
C. Place a donut-shaped cushion beneath the sacrum
D. Keep the head of the bed elevated at 90° continuously
Answer: B
Rationale: Pressure redistribution, repositioning, skin assessment, nutrition, and moisture
management reduce pressure injury risk. Massaging reddened tissue can cause further damage.
7. A client becomes dizzy when standing. Which action should the nurse take first?
A. Encourage the client to walk
B. Assist the client back to a safe sitting or lying position
C. Obtain a meal tray
D. Document the finding and leave
Answer: B
Rationale: The immediate concern is preventing a fall and injury. The nurse should safely
reposition the client before further assessment.
8. Which statement about standard precautions is correct?
A. They apply only to clients with known infections.
B. They apply to all clients regardless of diagnosis.
C. They require an N95 respirator for every interaction.
D. They eliminate the need for hand hygiene.
Answer: B
Rationale: Standard precautions are used for all clients and are based on the possibility of
exposure to blood, body fluids, nonintact skin, and mucous membranes.
9. Which client should the nurse see first after receiving change-of-shift report?
A. Client with a new tracheostomy and noisy respirations
B. Client requesting a sleep medication
C. Client with chronic back pain
D. Client awaiting a routine dressing change
Answer: A
Rationale: Noisy respirations in a client with a new tracheostomy may indicate airway
obstruction. Airway threats require immediate attention.
, 4
10. A nurse hears a fire alarm in a client's room. What is the priority action?
A. Extinguish the fire immediately
B. Remove clients from immediate danger
C. Complete the medication pass
D. Open the windows
Answer: B
Rationale: The first priority in a fire is protecting people in immediate danger. Nurses then
follow the facility's fire-response sequence.
11. Which task is appropriate for the nurse to delegate to assistive personnel?
A. Assess a newly admitted client
B. Teach incentive-spirometer use
C. Obtain routine vital signs on a stable client
D. Evaluate a client's response to medication
Answer: C
Rationale: Routine data collection for a stable client may be delegated. Assessment, teaching,
and evaluation remain nursing responsibilities.
12. A client refuses a prescribed treatment. What should the nurse do first?
A. Tell the client treatment is mandatory
B. Explore the client's reason for refusal
C. Ask the family to force compliance
D. Document noncompliance without discussion
Answer: B
Rationale: The nurse should determine why the client refuses. Understanding concerns may
allow education or problem-solving while respecting autonomy.
13. Which finding is most consistent with orthostatic hypotension?
A. Blood pressure increases when standing
B. Blood pressure decreases with position change and the client becomes dizzy
C. Pulse decreases after exercise
D. Temperature increases after meals
Answer: B
Nursing Fundamentals Study Guide and ATI RN
Comprehensive Predictor 2026: 200 Advanced
Mixed Multiple-Choice Practice Questions with
Correct Answers and Detailed Rationales
Difficulty: Advanced / Hard / Mixed
Audience: Nursing students preparing for RN-level comprehensive examinations
Format: 200 multiple-choice questions
Focus: Fundamentals, clinical judgment, safety, pharmacology principles, adult health,
maternal-newborn, pediatrics, mental health, leadership, infection prevention, and
prioritization.
Study note: These are original practice questions modeled on common RN-level nursing
competencies. They are not official ATI questions.
Questions 1–25: Fundamentals, Safety, and Clinical Judgment
1. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with chronic arthritis reporting pain of 6/10
B. A client with pneumonia whose oxygen saturation is 88% on prescribed oxygen
C. A postoperative client requesting assistance to the bathroom
D. A client awaiting discharge instructions
Answer: B
Rationale: An oxygen saturation of 88% despite prescribed oxygen indicates impaired
oxygenation and takes priority using the ABC framework. The nurse should assess airway and
breathing before addressing stable pain, mobility, or discharge needs.
2. Which action by a newly licensed nurse requires immediate intervention?
A. Elevating the head of the bed for a client receiving enteral feeding
B. Using an alcohol-based hand rub when hands are not visibly soiled
C. Recapping a used needle using two hands
D. Wearing gloves when contacting blood
Answer: C
, 2
Rationale: Used needles should not be manually recapped because this increases needlestick
risk. The needle should be discarded immediately in an approved sharps container.
3. A nurse identifies a client as being at high risk for falls. Which intervention is most
appropriate?
A. Keep all four side rails raised
B. Place the call light within reach
C. Keep the room completely dark at night
D. Encourage the client to ambulate independently
Answer: B
Rationale: Easy access to the call light promotes the client's ability to request assistance. Four
side rails can function as a restraint, while darkness and unsupervised ambulation increase fall
risk.
4. Which assessment finding requires the most immediate intervention?
A. Temperature of 37.4°C (99.3°F)
B. Respiratory rate of 8/min
C. Blood pressure of 138/84 mm Hg
D. Pulse of 88/min
Answer: B
Rationale: A respiratory rate of 8/min indicates significant respiratory depression. Airway and
breathing take priority over the other findings.
5. A nurse is preparing to administer medication. Which action best verifies the correct client?
A. Ask the client to state their room number
B. Compare the medication label with the medication administration record and use two
identifiers
C. Ask another nurse whether the client is correct
D. Identify the client by diagnosis
Answer: B
Rationale: Two approved identifiers, such as name and date of birth, should be used. Room
number and diagnosis are not reliable client identifiers.
6. Which intervention best prevents pressure injury formation in an immobile client?
, 3
A. Massage reddened areas
B. Reposition regularly and manage moisture and pressure
C. Place a donut-shaped cushion beneath the sacrum
D. Keep the head of the bed elevated at 90° continuously
Answer: B
Rationale: Pressure redistribution, repositioning, skin assessment, nutrition, and moisture
management reduce pressure injury risk. Massaging reddened tissue can cause further damage.
7. A client becomes dizzy when standing. Which action should the nurse take first?
A. Encourage the client to walk
B. Assist the client back to a safe sitting or lying position
C. Obtain a meal tray
D. Document the finding and leave
Answer: B
Rationale: The immediate concern is preventing a fall and injury. The nurse should safely
reposition the client before further assessment.
8. Which statement about standard precautions is correct?
A. They apply only to clients with known infections.
B. They apply to all clients regardless of diagnosis.
C. They require an N95 respirator for every interaction.
D. They eliminate the need for hand hygiene.
Answer: B
Rationale: Standard precautions are used for all clients and are based on the possibility of
exposure to blood, body fluids, nonintact skin, and mucous membranes.
9. Which client should the nurse see first after receiving change-of-shift report?
A. Client with a new tracheostomy and noisy respirations
B. Client requesting a sleep medication
C. Client with chronic back pain
D. Client awaiting a routine dressing change
Answer: A
Rationale: Noisy respirations in a client with a new tracheostomy may indicate airway
obstruction. Airway threats require immediate attention.
, 4
10. A nurse hears a fire alarm in a client's room. What is the priority action?
A. Extinguish the fire immediately
B. Remove clients from immediate danger
C. Complete the medication pass
D. Open the windows
Answer: B
Rationale: The first priority in a fire is protecting people in immediate danger. Nurses then
follow the facility's fire-response sequence.
11. Which task is appropriate for the nurse to delegate to assistive personnel?
A. Assess a newly admitted client
B. Teach incentive-spirometer use
C. Obtain routine vital signs on a stable client
D. Evaluate a client's response to medication
Answer: C
Rationale: Routine data collection for a stable client may be delegated. Assessment, teaching,
and evaluation remain nursing responsibilities.
12. A client refuses a prescribed treatment. What should the nurse do first?
A. Tell the client treatment is mandatory
B. Explore the client's reason for refusal
C. Ask the family to force compliance
D. Document noncompliance without discussion
Answer: B
Rationale: The nurse should determine why the client refuses. Understanding concerns may
allow education or problem-solving while respecting autonomy.
13. Which finding is most consistent with orthostatic hypotension?
A. Blood pressure increases when standing
B. Blood pressure decreases with position change and the client becomes dizzy
C. Pulse decreases after exercise
D. Temperature increases after meals
Answer: B
