ATI RN COMPREHENSIVE PREDICTOR NGN-STYLE SET 3
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During rapid-response evaluation, a client’s presentation is consistent with deep vein thrombosis. What
is the nurse’s best next action?
A. lung-protective ventilation and treat underlying cause
B. aggressive supportive care with IV fluids, analgesia, and early nutrition as appropriate
C. control blood pressure per protocol and reverse anticoagulation when indicated
D. avoid massaging the leg and begin prescribed anticoagulation
Correct Answer: D. avoid massaging the leg and begin prescribed anticoagulation
Rationale: For deep vein thrombosis, the priority response is to avoid massaging the leg and begin prescribed
anticoagulation.
2. During an acute-care handoff, when caring for a client with appendicitis, which complication deserves
focused surveillance?
A. refractory hypoxemia with bilateral opacities not fully explained by heart failure
B. severe epigastric pain radiating to back with elevated lipase
C. periumbilical pain migrating to right lower quadrant with anorexia
D. sudden neurologic deficit often with headache/vomiting and blood on CT
Correct Answer: C. periumbilical pain migrating to right lower quadrant with anorexia
Rationale: appendicitis is classically associated with periumbilical pain migrating to right lower quadrant with
anorexia.
3. During an interprofessional safety huddle, a nurse receives a handoff for a client whose condition
changed just before shift change. Which action best supports continuity and safety?
A. Read only the medication list
B. Use a structured handoff that includes the recent change, current assessment, pending tests, and required
follow-up
C. Delay communicating the change until rounds
D. Ask the UAP to explain the change
Correct Answer: B. Use a structured handoff that includes the recent change, current assessment, pending tests,
and required follow-up
Rationale: A structured handoff communicates time-sensitive changes, current risks, and required follow-up to
the receiving nurse.
4. At a routine wellness encounter, a parent asks about secondhand smoke and infants. Which teaching is
best?
A. Open a window while smoking in the same room
B. Smoke only in the bathroom with the door closed
C. Use air freshener after smoking indoors
D. Keep the home and car completely smoke-free and avoid smoking around the infant
Correct Answer: D. Keep the home and car completely smoke-free and avoid smoking around the infant
Rationale: Smoke-free indoor environments best protect infants from secondhand smoke exposure.
5. During discharge medication teaching, during medication follow-up, a client taking tiotropium reports
several new symptoms. Which report is most consistent with a known adverse effect of this drug?
A. hypokalemia and volume depletion
B. esophagitis and rare osteonecrosis of jaw
C. uterine tachysystole and fetal compromise
D. dry mouth and urinary retention
Correct Answer: D. dry mouth and urinary retention
Rationale: tiotropium is a long-acting muscarinic antagonist; important adverse effects include dry mouth and
urinary retention. Monitoring and teaching should reflect that risk.
6. On a medical-surgical unit, a client with deep vein thrombosis has the expected presentation of unilateral
leg swelling, warmth, and tenderness. Which worsening development should the nurse anticipate as a
major complication?
A. multiorgan failure
,B. hypocalcemia, shock, or organ failure
C. pulmonary embolism
D. herniation
Correct Answer: C. pulmonary embolism
Rationale: A major complication of deep vein thrombosis is pulmonary embolism.
7. While managing care on a busy unit, a client with limited English proficiency needs consent information.
Which action is best?
A. Ask the client's adolescent child to interpret
B. Use another client who speaks the same language
C. Use a qualified medical interpreter and speak directly to the client
D. Rely on gestures for the consent discussion
Correct Answer: C. Use a qualified medical interpreter and speak directly to the client
Rationale: Qualified interpreters improve accuracy, confidentiality, and informed decision-making; family
members should not be the default for complex consent discussions.
8. During routine supportive care, which nursing action best addresses dry mouth from oxygen therapy?
A. offload pressure immediately, reposition regularly, optimize moisture control and nutrition, and inspect skin
B. use multimodal pain control, position for comfort, and reassess response after intervention
C. orient the client to the room, keep pathways clear, place items consistently, and announce your presence
D. provide frequent oral care and water-based moisturizers while assessing hydration
Correct Answer: D. provide frequent oral care and water-based moisturizers while assessing hydration
Rationale: Oral care and water-based moisturizers improve comfort without adding a combustion hazard.
9. At a chronic-care clinic visit, which therapeutic goal is most consistent with use of oxytocin?
A. edema and heart failure
B. osteoporosis
C. labor induction/augmentation and postpartum hemorrhage prevention
D. symptomatic treatment of Alzheimer disease
Correct Answer: C. labor induction/augmentation and postpartum hemorrhage prevention
Rationale: oxytocin, a uterotonic hormone, is commonly used for labor induction/augmentation and postpartum
hemorrhage prevention.
10. In the emergency department, which intervention best addresses the acute priorities of a client with
appendicitis?
A. lung-protective ventilation and treat underlying cause
B. keep NPO and prepare for surgical evaluation
C. aggressive supportive care with IV fluids, analgesia, and early nutrition as appropriate
D. control blood pressure per protocol and reverse anticoagulation when indicated
Correct Answer: B. keep NPO and prepare for surgical evaluation
Rationale: For appendicitis, the priority response is to keep NPO and prepare for surgical evaluation.
11. While preparing care for a high-risk client, a client using a PCA pump becomes very difficult to arouse
with respirations of 7/min. Which action is the priority?
A. Encourage the family to press the PCA button less often
B. Offer an oral opioid for breakthrough pain
C. Allow the client to sleep and reassess in 4 hours
D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Correct Answer: D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Rationale: Marked sedation with bradypnea indicates opioid toxicity and requires immediate airway/ventilation
support and reversal as indicated.
12. An older hospitalized client becomes acutely disoriented overnight and alternates between agitation and
sleepiness. Which condition is most likely? Abrupt, overnight Onset Fluctuating Course Impaired
Attention
A. Major depressive disorder
B. Stable dementia progression
C. Delirium
D. Generalized anxiety disorder
Correct Answer: C. Delirium
, Rationale: Acute onset with fluctuating attention and consciousness is characteristic of delirium.
13. At a community health appointment, a 68-year-old man smoked for 25 years but quit 5 years ago.
Which screening should the nurse discuss?
A. Routine carotid ultrasound for all adults
B. One-time abdominal aortic aneurysm ultrasound because he is 65 to 75 and has ever smoked
C. Annual echocardiography
D. No vascular screening is indicated by smoking history
Correct Answer: B. One-time abdominal aortic aneurysm ultrasound because he is 65 to 75 and has ever smoked
Rationale: Men ages 65 to 75 who have ever smoked are recommended to receive one-time ultrasound screening
for abdominal aortic aneurysm.
14. A client is 6 hours after craniotomy. The nurse notes a new unilateral dilated pupil and decreasing
responsiveness. What should the nurse do? 6 hours Post-op time Unilateral dilated pupil; decreasing
responsiveness New findings
A. Allow the client to sleep and reassess in 4 hours
B. Give oral fluids
C. Notify the neurosurgical team immediately and initiate emergency neurologic measures per protocol
D. Lower the head of bed flat without an indication
Correct Answer: C. Notify the neurosurgical team immediately and initiate emergency neurologic measures per
protocol
Rationale: A new fixed/dilated pupil with declining consciousness may signal expanding intracranial bleeding or
herniation and requires immediate action.
15. While planning comfort-focused bedside care, which client statement demonstrates correct teaching
about dry mouth from oxygen therapy?
A. use a consistent sleep schedule and limit late caffeine when feasible
B. avoid petroleum products near oxygen equipment
C. take small bites and sips using the recommended swallowing strategy and remain upright after meals as
directed
D. take small frequent sips and foods as tolerated and report persistent vomiting
Correct Answer: B. avoid petroleum products near oxygen equipment
Rationale: Oral care and water-based moisturizers improve comfort without adding a combustion hazard.
16. During an interprofessional safety huddle, a client lacks capacity and has no advance directive or
available surrogate. A major nonemergent treatment decision is needed. What should the nurse do?
A. Ask the roommate to consent
B. Make the decision independently without consultation
C. Use the facility's legal/ethics process to identify an authorized decision-maker and protect the client's best
interests
D. Delay all basic care indefinitely
Correct Answer: C. Use the facility's legal/ethics process to identify an authorized decision-maker and protect
the client's best interests
Rationale: When no surrogate is available, organizations use legal and ethics processes to establish appropriate
decision-making authority.
17. At an ambulatory medication review, which client condition most commonly explains a prescription for
amoxicillin?
A. susceptible bacterial infections
B. edema and heart failure
C. osteoporosis
D. labor induction/augmentation and postpartum hemorrhage prevention
Correct Answer: A. susceptible bacterial infections
Rationale: amoxicillin, a aminopenicillin antibiotic, is commonly used for susceptible bacterial infections.
18. During a focused safety round, a client with dysphagia is receiving oral medications. Which action is
safest before crushing tablets?
A. Check whether each medication may be crushed and obtain an alternative form for extended-release or
enteric-coated products
B. Crush all tablets together regardless of formulation
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During rapid-response evaluation, a client’s presentation is consistent with deep vein thrombosis. What
is the nurse’s best next action?
A. lung-protective ventilation and treat underlying cause
B. aggressive supportive care with IV fluids, analgesia, and early nutrition as appropriate
C. control blood pressure per protocol and reverse anticoagulation when indicated
D. avoid massaging the leg and begin prescribed anticoagulation
Correct Answer: D. avoid massaging the leg and begin prescribed anticoagulation
Rationale: For deep vein thrombosis, the priority response is to avoid massaging the leg and begin prescribed
anticoagulation.
2. During an acute-care handoff, when caring for a client with appendicitis, which complication deserves
focused surveillance?
A. refractory hypoxemia with bilateral opacities not fully explained by heart failure
B. severe epigastric pain radiating to back with elevated lipase
C. periumbilical pain migrating to right lower quadrant with anorexia
D. sudden neurologic deficit often with headache/vomiting and blood on CT
Correct Answer: C. periumbilical pain migrating to right lower quadrant with anorexia
Rationale: appendicitis is classically associated with periumbilical pain migrating to right lower quadrant with
anorexia.
3. During an interprofessional safety huddle, a nurse receives a handoff for a client whose condition
changed just before shift change. Which action best supports continuity and safety?
A. Read only the medication list
B. Use a structured handoff that includes the recent change, current assessment, pending tests, and required
follow-up
C. Delay communicating the change until rounds
D. Ask the UAP to explain the change
Correct Answer: B. Use a structured handoff that includes the recent change, current assessment, pending tests,
and required follow-up
Rationale: A structured handoff communicates time-sensitive changes, current risks, and required follow-up to
the receiving nurse.
4. At a routine wellness encounter, a parent asks about secondhand smoke and infants. Which teaching is
best?
A. Open a window while smoking in the same room
B. Smoke only in the bathroom with the door closed
C. Use air freshener after smoking indoors
D. Keep the home and car completely smoke-free and avoid smoking around the infant
Correct Answer: D. Keep the home and car completely smoke-free and avoid smoking around the infant
Rationale: Smoke-free indoor environments best protect infants from secondhand smoke exposure.
5. During discharge medication teaching, during medication follow-up, a client taking tiotropium reports
several new symptoms. Which report is most consistent with a known adverse effect of this drug?
A. hypokalemia and volume depletion
B. esophagitis and rare osteonecrosis of jaw
C. uterine tachysystole and fetal compromise
D. dry mouth and urinary retention
Correct Answer: D. dry mouth and urinary retention
Rationale: tiotropium is a long-acting muscarinic antagonist; important adverse effects include dry mouth and
urinary retention. Monitoring and teaching should reflect that risk.
6. On a medical-surgical unit, a client with deep vein thrombosis has the expected presentation of unilateral
leg swelling, warmth, and tenderness. Which worsening development should the nurse anticipate as a
major complication?
A. multiorgan failure
,B. hypocalcemia, shock, or organ failure
C. pulmonary embolism
D. herniation
Correct Answer: C. pulmonary embolism
Rationale: A major complication of deep vein thrombosis is pulmonary embolism.
7. While managing care on a busy unit, a client with limited English proficiency needs consent information.
Which action is best?
A. Ask the client's adolescent child to interpret
B. Use another client who speaks the same language
C. Use a qualified medical interpreter and speak directly to the client
D. Rely on gestures for the consent discussion
Correct Answer: C. Use a qualified medical interpreter and speak directly to the client
Rationale: Qualified interpreters improve accuracy, confidentiality, and informed decision-making; family
members should not be the default for complex consent discussions.
8. During routine supportive care, which nursing action best addresses dry mouth from oxygen therapy?
A. offload pressure immediately, reposition regularly, optimize moisture control and nutrition, and inspect skin
B. use multimodal pain control, position for comfort, and reassess response after intervention
C. orient the client to the room, keep pathways clear, place items consistently, and announce your presence
D. provide frequent oral care and water-based moisturizers while assessing hydration
Correct Answer: D. provide frequent oral care and water-based moisturizers while assessing hydration
Rationale: Oral care and water-based moisturizers improve comfort without adding a combustion hazard.
9. At a chronic-care clinic visit, which therapeutic goal is most consistent with use of oxytocin?
A. edema and heart failure
B. osteoporosis
C. labor induction/augmentation and postpartum hemorrhage prevention
D. symptomatic treatment of Alzheimer disease
Correct Answer: C. labor induction/augmentation and postpartum hemorrhage prevention
Rationale: oxytocin, a uterotonic hormone, is commonly used for labor induction/augmentation and postpartum
hemorrhage prevention.
10. In the emergency department, which intervention best addresses the acute priorities of a client with
appendicitis?
A. lung-protective ventilation and treat underlying cause
B. keep NPO and prepare for surgical evaluation
C. aggressive supportive care with IV fluids, analgesia, and early nutrition as appropriate
D. control blood pressure per protocol and reverse anticoagulation when indicated
Correct Answer: B. keep NPO and prepare for surgical evaluation
Rationale: For appendicitis, the priority response is to keep NPO and prepare for surgical evaluation.
11. While preparing care for a high-risk client, a client using a PCA pump becomes very difficult to arouse
with respirations of 7/min. Which action is the priority?
A. Encourage the family to press the PCA button less often
B. Offer an oral opioid for breakthrough pain
C. Allow the client to sleep and reassess in 4 hours
D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Correct Answer: D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Rationale: Marked sedation with bradypnea indicates opioid toxicity and requires immediate airway/ventilation
support and reversal as indicated.
12. An older hospitalized client becomes acutely disoriented overnight and alternates between agitation and
sleepiness. Which condition is most likely? Abrupt, overnight Onset Fluctuating Course Impaired
Attention
A. Major depressive disorder
B. Stable dementia progression
C. Delirium
D. Generalized anxiety disorder
Correct Answer: C. Delirium
, Rationale: Acute onset with fluctuating attention and consciousness is characteristic of delirium.
13. At a community health appointment, a 68-year-old man smoked for 25 years but quit 5 years ago.
Which screening should the nurse discuss?
A. Routine carotid ultrasound for all adults
B. One-time abdominal aortic aneurysm ultrasound because he is 65 to 75 and has ever smoked
C. Annual echocardiography
D. No vascular screening is indicated by smoking history
Correct Answer: B. One-time abdominal aortic aneurysm ultrasound because he is 65 to 75 and has ever smoked
Rationale: Men ages 65 to 75 who have ever smoked are recommended to receive one-time ultrasound screening
for abdominal aortic aneurysm.
14. A client is 6 hours after craniotomy. The nurse notes a new unilateral dilated pupil and decreasing
responsiveness. What should the nurse do? 6 hours Post-op time Unilateral dilated pupil; decreasing
responsiveness New findings
A. Allow the client to sleep and reassess in 4 hours
B. Give oral fluids
C. Notify the neurosurgical team immediately and initiate emergency neurologic measures per protocol
D. Lower the head of bed flat without an indication
Correct Answer: C. Notify the neurosurgical team immediately and initiate emergency neurologic measures per
protocol
Rationale: A new fixed/dilated pupil with declining consciousness may signal expanding intracranial bleeding or
herniation and requires immediate action.
15. While planning comfort-focused bedside care, which client statement demonstrates correct teaching
about dry mouth from oxygen therapy?
A. use a consistent sleep schedule and limit late caffeine when feasible
B. avoid petroleum products near oxygen equipment
C. take small bites and sips using the recommended swallowing strategy and remain upright after meals as
directed
D. take small frequent sips and foods as tolerated and report persistent vomiting
Correct Answer: B. avoid petroleum products near oxygen equipment
Rationale: Oral care and water-based moisturizers improve comfort without adding a combustion hazard.
16. During an interprofessional safety huddle, a client lacks capacity and has no advance directive or
available surrogate. A major nonemergent treatment decision is needed. What should the nurse do?
A. Ask the roommate to consent
B. Make the decision independently without consultation
C. Use the facility's legal/ethics process to identify an authorized decision-maker and protect the client's best
interests
D. Delay all basic care indefinitely
Correct Answer: C. Use the facility's legal/ethics process to identify an authorized decision-maker and protect
the client's best interests
Rationale: When no surrogate is available, organizations use legal and ethics processes to establish appropriate
decision-making authority.
17. At an ambulatory medication review, which client condition most commonly explains a prescription for
amoxicillin?
A. susceptible bacterial infections
B. edema and heart failure
C. osteoporosis
D. labor induction/augmentation and postpartum hemorrhage prevention
Correct Answer: A. susceptible bacterial infections
Rationale: amoxicillin, a aminopenicillin antibiotic, is commonly used for susceptible bacterial infections.
18. During a focused safety round, a client with dysphagia is receiving oral medications. Which action is
safest before crushing tablets?
A. Check whether each medication may be crushed and obtain an alternative form for extended-release or
enteric-coated products
B. Crush all tablets together regardless of formulation
