RN ATI Comprehensive Predictor 2026
Exit Retake Proctored Exam | All NGN
180 Level 3 Questions and Answers
RN ATI Comprehensive Predictor 2026 Exit Retake Proctored Exam
180 NGN-Style Level 3 Questions with Answers and Rationales
Q1. A nurse is caring for a client who is 24 hours postoperative following abdominal surgery. The
client reports sudden shortness of breath and chest pain. Which of the following actions should the
nurse take first?
A. Administer prescribed analgesic
B. Elevate the head of the bed and apply oxygen
C. Notify the healthcare provider
D. Obtain a stat chest x-ray
Correct Answer: B
Rationale: Sudden shortness of breath and chest pain in a postoperative client suggest pulmonary
embolism, which is a life-threatening emergency. The nurse's immediate priority is to support
oxygenation by elevating the head of the bed to facilitate breathing and administering oxygen. This
addresses the ABCs (Airway, Breathing, Circulation) framework. Notification and imaging are
important but follow the immediate stabilization of the client's respiratory status.
Q2. A nurse is reviewing laboratory results for a client receiving heparin infusion. The aPTT is 95
seconds (therapeutic range 60-80 seconds). Which of the following actions should the nurse take?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 2 units/kg/hr
C. Hold the infusion and notify the healthcare provider
D. Administer vitamin K
Correct Answer: C
Rationale: An aPTT of 95 seconds is supratherapeutic, indicating an increased risk of bleeding. The
nurse should hold the heparin infusion and notify the provider for further orders. Vitamin K is the
antidote for warfarin, not heparin. Continuing or increasing the infusion would worsen the
coagulopathy.
Q3. A client with a history of heart failure is admitted with severe dyspnea and pink frothy sputum.
Which of the following positions should the nurse place the client in?
pg. 1
,A. Supine
B. Trendelenburg
C. High Fowler's
D. Left lateral
Correct Answer: C
Rationale: High Fowler's position (60-90 degrees) reduces venous return to the heart (preload) and
decreases pulmonary congestion by allowing fluid to pool in the dependent extremities. This
position also maximizes chest expansion and improves ventilation. Supine and Trendelenburg
positions would worsen pulmonary edema by increasing venous return.
Q4. A nurse is preparing to administer a blood transfusion. Which of the following solutions should
the nurse use to prime the IV tubing?
A. Lactated Ringer's
B. 5% dextrose in water
C. 0.9% sodium chloride
D. 0.45% sodium chloride
Correct Answer: C
Rationale: Normal saline (0.9% sodium chloride) is the only solution compatible with blood products.
Dextrose solutions cause hemolysis of red blood cells, and Lactated Ringer's contains calcium that
can clot the blood. Hypotonic solutions also cause cell lysis and are not appropriate for blood
administration.
Q5. A nurse is caring for a client who has a new prescription for warfarin. Which of the following
statements by the client indicates a need for further teaching?
A. "I will use an electric razor when shaving."
B. "I will increase my intake of green leafy vegetables."
C. "I will wear a medical alert bracelet."
D. "I will report any unusual bruising or bleeding."
Correct Answer: B
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes warfarin's anticoagulant
effect. Clients should maintain consistent vitamin K intake rather than increasing it. Using an electric
razor, wearing a medical alert bracelet, and reporting bleeding are all appropriate safety measures
for clients on anticoagulant therapy.
Q6. A client with Clostridium difficile infection is placed on contact precautions. Which of the
following actions should the nurse take?
A. Use alcohol-based hand sanitizer after leaving the room
B. Wear an N95 respirator when entering the room
pg. 2
,C. Wash hands with soap and water after leaving the room
D. Place the client in a positive-pressure room
Correct Answer: C
Rationale: C. difficile spores are resistant to alcohol-based hand sanitizers. The nurse must wash
hands with soap and water to physically remove the spores. An N95 respirator is not required for
contact precautions; it is used for airborne precautions. Positive-pressure rooms are used for
immunocompromised clients, not for infection isolation.
Q7. A nurse is assessing a client who is receiving digoxin. Which of the following findings should the
nurse report immediately?
A. Heart rate of 88 beats per minute
B. Blood pressure of 128/76 mm Hg
C. Heart rate of 48 beats per minute
D. Respiratory rate of 18 breaths per minute
Correct Answer: C
Rationale: Bradycardia (heart rate below 60 beats per minute) is a sign of digoxin toxicity. The nurse
should withhold the medication and notify the provider. A heart rate of 88 is within normal limits, as
are the blood pressure and respiratory rate listed.
Q8. A nurse is caring for a client who has been immobile for several days. Which of the following
interventions is most effective in preventing pressure injury formation?
A. Massaging bony prominences every 4 hours
B. Repositioning the client every 2 hours
C. Applying a donut-shaped cushion under the sacrum
D. Using a heat lamp to dry the skin after bathing
Correct Answer: B
Rationale: Repositioning every 2 hours relieves pressure on bony prominences and allows for
reperfusion of compressed tissue. Massaging bony prominences can damage capillaries. Donut-
shaped cushions reduce blood flow and cause tissue ischemia. Heat lamps dry the skin and increase
the risk of burns.
Q9. A nurse is providing oral care to an unconscious client. Which of the following actions is the
priority to prevent aspiration?
A. Use a toothbrush with toothpaste
B. Position the client in a side-lying position
C. Apply mineral oil to the lips
D. Keep the head of the bed flat
Correct Answer: B
pg. 3
, Rationale: An unconscious client lacks a gag reflex and is at high risk for aspiration. Side-lying
positioning allows oral secretions and fluids to drain out of the mouth by gravity rather than pooling
in the pharynx. Keeping the head flat increases aspiration risk. Mineral oil should be avoided due to
the risk of lipoid pneumonia if aspirated.
Q10. A client with tuberculosis is placed in airborne precautions. Which of the following actions
should the nurse take?
A. Wear a surgical mask when entering the room
B. Wear an N95 respirator when entering the room
C. Keep the door to the client's room open
D. Place the client in a positive-pressure room
Correct Answer: B
Rationale: Tuberculosis is transmitted via airborne particles, requiring an N95 or higher-level
respirator for protection. Surgical masks are not adequate for airborne precautions. The door to the
negative-pressure room must remain closed to maintain the air pressure differential.
Q11. A nurse is administering insulin to a client. Which of the following actions should the nurse take
to ensure safety?
A. Verify the dose with another nurse
B. Administer the insulin intramuscularly
C. Use a tuberculin syringe to measure the dose
D. Shake the vial vigorously before drawing up
Correct Answer: A
Rationale: Insulin is a high-alert medication that requires an independent double-check with another
nurse to prevent serious dosing errors. Insulin is administered subcutaneously, not intramuscularly.
Insulin syringes are calibrated in units, not milliliters. Insulin vials should be gently rolled, not shaken,
to mix suspensions.
Q12. A nurse is caring for a client who has a serum potassium level of 6.2 mEq/L. Which of the
following actions should the nurse take first?
A. Document the finding
B. Notify the healthcare provider immediately
C. Prepare to administer potassium-wasting diuretics
D. Encourage increased oral fluid intake
Correct Answer: B
Rationale: A potassium level of 6.2 mEq/L is critically elevated and places the client at risk for life-
threatening cardiac dysrhythmias. The nurse must notify the provider immediately for further
orders, which may include calcium gluconate, insulin with glucose, or sodium polystyrene sulfonate.
Documentation follows notification.
pg. 4
Exit Retake Proctored Exam | All NGN
180 Level 3 Questions and Answers
RN ATI Comprehensive Predictor 2026 Exit Retake Proctored Exam
180 NGN-Style Level 3 Questions with Answers and Rationales
Q1. A nurse is caring for a client who is 24 hours postoperative following abdominal surgery. The
client reports sudden shortness of breath and chest pain. Which of the following actions should the
nurse take first?
A. Administer prescribed analgesic
B. Elevate the head of the bed and apply oxygen
C. Notify the healthcare provider
D. Obtain a stat chest x-ray
Correct Answer: B
Rationale: Sudden shortness of breath and chest pain in a postoperative client suggest pulmonary
embolism, which is a life-threatening emergency. The nurse's immediate priority is to support
oxygenation by elevating the head of the bed to facilitate breathing and administering oxygen. This
addresses the ABCs (Airway, Breathing, Circulation) framework. Notification and imaging are
important but follow the immediate stabilization of the client's respiratory status.
Q2. A nurse is reviewing laboratory results for a client receiving heparin infusion. The aPTT is 95
seconds (therapeutic range 60-80 seconds). Which of the following actions should the nurse take?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 2 units/kg/hr
C. Hold the infusion and notify the healthcare provider
D. Administer vitamin K
Correct Answer: C
Rationale: An aPTT of 95 seconds is supratherapeutic, indicating an increased risk of bleeding. The
nurse should hold the heparin infusion and notify the provider for further orders. Vitamin K is the
antidote for warfarin, not heparin. Continuing or increasing the infusion would worsen the
coagulopathy.
Q3. A client with a history of heart failure is admitted with severe dyspnea and pink frothy sputum.
Which of the following positions should the nurse place the client in?
pg. 1
,A. Supine
B. Trendelenburg
C. High Fowler's
D. Left lateral
Correct Answer: C
Rationale: High Fowler's position (60-90 degrees) reduces venous return to the heart (preload) and
decreases pulmonary congestion by allowing fluid to pool in the dependent extremities. This
position also maximizes chest expansion and improves ventilation. Supine and Trendelenburg
positions would worsen pulmonary edema by increasing venous return.
Q4. A nurse is preparing to administer a blood transfusion. Which of the following solutions should
the nurse use to prime the IV tubing?
A. Lactated Ringer's
B. 5% dextrose in water
C. 0.9% sodium chloride
D. 0.45% sodium chloride
Correct Answer: C
Rationale: Normal saline (0.9% sodium chloride) is the only solution compatible with blood products.
Dextrose solutions cause hemolysis of red blood cells, and Lactated Ringer's contains calcium that
can clot the blood. Hypotonic solutions also cause cell lysis and are not appropriate for blood
administration.
Q5. A nurse is caring for a client who has a new prescription for warfarin. Which of the following
statements by the client indicates a need for further teaching?
A. "I will use an electric razor when shaving."
B. "I will increase my intake of green leafy vegetables."
C. "I will wear a medical alert bracelet."
D. "I will report any unusual bruising or bleeding."
Correct Answer: B
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes warfarin's anticoagulant
effect. Clients should maintain consistent vitamin K intake rather than increasing it. Using an electric
razor, wearing a medical alert bracelet, and reporting bleeding are all appropriate safety measures
for clients on anticoagulant therapy.
Q6. A client with Clostridium difficile infection is placed on contact precautions. Which of the
following actions should the nurse take?
A. Use alcohol-based hand sanitizer after leaving the room
B. Wear an N95 respirator when entering the room
pg. 2
,C. Wash hands with soap and water after leaving the room
D. Place the client in a positive-pressure room
Correct Answer: C
Rationale: C. difficile spores are resistant to alcohol-based hand sanitizers. The nurse must wash
hands with soap and water to physically remove the spores. An N95 respirator is not required for
contact precautions; it is used for airborne precautions. Positive-pressure rooms are used for
immunocompromised clients, not for infection isolation.
Q7. A nurse is assessing a client who is receiving digoxin. Which of the following findings should the
nurse report immediately?
A. Heart rate of 88 beats per minute
B. Blood pressure of 128/76 mm Hg
C. Heart rate of 48 beats per minute
D. Respiratory rate of 18 breaths per minute
Correct Answer: C
Rationale: Bradycardia (heart rate below 60 beats per minute) is a sign of digoxin toxicity. The nurse
should withhold the medication and notify the provider. A heart rate of 88 is within normal limits, as
are the blood pressure and respiratory rate listed.
Q8. A nurse is caring for a client who has been immobile for several days. Which of the following
interventions is most effective in preventing pressure injury formation?
A. Massaging bony prominences every 4 hours
B. Repositioning the client every 2 hours
C. Applying a donut-shaped cushion under the sacrum
D. Using a heat lamp to dry the skin after bathing
Correct Answer: B
Rationale: Repositioning every 2 hours relieves pressure on bony prominences and allows for
reperfusion of compressed tissue. Massaging bony prominences can damage capillaries. Donut-
shaped cushions reduce blood flow and cause tissue ischemia. Heat lamps dry the skin and increase
the risk of burns.
Q9. A nurse is providing oral care to an unconscious client. Which of the following actions is the
priority to prevent aspiration?
A. Use a toothbrush with toothpaste
B. Position the client in a side-lying position
C. Apply mineral oil to the lips
D. Keep the head of the bed flat
Correct Answer: B
pg. 3
, Rationale: An unconscious client lacks a gag reflex and is at high risk for aspiration. Side-lying
positioning allows oral secretions and fluids to drain out of the mouth by gravity rather than pooling
in the pharynx. Keeping the head flat increases aspiration risk. Mineral oil should be avoided due to
the risk of lipoid pneumonia if aspirated.
Q10. A client with tuberculosis is placed in airborne precautions. Which of the following actions
should the nurse take?
A. Wear a surgical mask when entering the room
B. Wear an N95 respirator when entering the room
C. Keep the door to the client's room open
D. Place the client in a positive-pressure room
Correct Answer: B
Rationale: Tuberculosis is transmitted via airborne particles, requiring an N95 or higher-level
respirator for protection. Surgical masks are not adequate for airborne precautions. The door to the
negative-pressure room must remain closed to maintain the air pressure differential.
Q11. A nurse is administering insulin to a client. Which of the following actions should the nurse take
to ensure safety?
A. Verify the dose with another nurse
B. Administer the insulin intramuscularly
C. Use a tuberculin syringe to measure the dose
D. Shake the vial vigorously before drawing up
Correct Answer: A
Rationale: Insulin is a high-alert medication that requires an independent double-check with another
nurse to prevent serious dosing errors. Insulin is administered subcutaneously, not intramuscularly.
Insulin syringes are calibrated in units, not milliliters. Insulin vials should be gently rolled, not shaken,
to mix suspensions.
Q12. A nurse is caring for a client who has a serum potassium level of 6.2 mEq/L. Which of the
following actions should the nurse take first?
A. Document the finding
B. Notify the healthcare provider immediately
C. Prepare to administer potassium-wasting diuretics
D. Encourage increased oral fluid intake
Correct Answer: B
Rationale: A potassium level of 6.2 mEq/L is critically elevated and places the client at risk for life-
threatening cardiac dysrhythmias. The nurse must notify the provider immediately for further
orders, which may include calcium gluconate, insulin with glucose, or sodium polystyrene sulfonate.
Documentation follows notification.
pg. 4
