WEST COAST UNIVERSITY — COLLEGE OF NURSING
ATI COMPREHENSIVE PREDICTOR EXIT EXAMINATION
Course: NURS 490 / NCLEX Readiness | Term: Fall 2026 | Exam Standard: 170 Questions (100% Scale)
Student Name: ___________________________ | Student ID: ______________ | Score: _____ / 100%
EXAMINATION INSTRUCTIONS: This official practice paper is derived from West Coast University ATI
Comprehensive Predictor core question banks. Each question features 4 multiple-choice options (A, B, C, D).
Correct answers are indicated with a green checkmark (✔) and accompanied by clinical rationales in yellow
panels. All questions are presented continuously without subsection breaks.
Question 1. A client develops cor pulmonale (right-sided heart failure) secondary to chronic
pulmonary disease. Which of the following clinical manifestations should the nurse expect to observe
during assessment?
[A] Increasing respiratory difficulty with exertion
[B] Twitching of extremities and hyperreflexia
[C] Productive cough with thick, yellow mucus
[D] Peripheral edema and anorexia
✔ Correct Answer: Option [D] — Peripheral edema and anorexia
CLINICAL RATIONALE: Cor pulmonale causes right ventricular failure, leading to systemic venous congestion.
Expected findings include peripheral edema, jugular venous distention, hepatomegaly, and anorexia due to GI
tract congestion.
Question 2. The charge nurse on a medical-surgical floor is making shift assignments. The team
includes two RNs, one LPN, and one Assistive Personnel (AP). Which assignment is most appropriate for
the AP?
[A] Assisting a client with Alzheimer's disease who requires feeding assistance
[B] Evaluating a client with osteoporosis complaining of dysuria
[C] Caring for a client with end-stage cancer exhibiting Cheyne-Stokes respirations
[D] Providing tube feedings to a client diagnosed with scleroderma
✔ Correct Answer: Option [A] — Assisting a client with Alzheimer's disease who requires feeding
assistance
CLINICAL RATIONALE: AP scope of practice includes assisting stable clients with ADLs such as feeding,
bathing, and hygiene. Feeding a client with cognitive impairment (without swallowing precautions) is within AP
competency.
CONFIDENTIAL & PROPRIETARY — FALL 2026 EXAMINATION PAPER Page 1 of 17
,WEST COAST UNIVERSITY | COLLEGE OF NURSING ATI COMPREHENSIVE PREDICTOR FALL 2026
Question 3. A 23-year-old male is admitted to the neurosurgical unit with a subdural hematoma and
cerebral edema following a motorcycle crash. Which initial symptom indicates rising intracranial
pressure (ICP)?
[A] Decreased level of consciousness
[B] Unequal and fixed dilated pupils
[C] Decerebrate posturing to painful stimuli
[D] Onset of generalized tonic-clonic seizures
✔ Correct Answer: Option [A] — Decreased level of consciousness
CLINICAL RATIONALE: A change in level of consciousness (restlessness, irritability, or lethargy) is the earliest
and most sensitive indicator of increasing ICP. Pupil changes and posturing represent late signs.
Question 4. A nurse in an outpatient prenatal clinic evaluates a 23-year-old client at 32 weeks
gestation. Which assessment finding indicates a potential pregnancy complication requiring provider
notification?
[A] Sensation of pressure against the diaphragm during fetal movement
[B] Increased volume of thin, whitish vaginal discharge
[C] Urine dipstick positive for glucose and acetone
[D] Presence of 1+ pedal edema in both feet late in the afternoon
✔ Correct Answer: Option [C] — Urine dipstick positive for glucose and acetone
CLINICAL RATIONALE: Ketonuria (acetone) and glucosuria during pregnancy indicate altered carbohydrate
metabolism, potential gestational diabetes, or severe ketoacidosis, requiring immediate investigation.
Question 5. A client is returned to the surgical unit following a subtotal thyroidectomy. When
verifying emergency equipment at the patient's bedside, which item is nonessential?
[A] Emergency tracheostomy tray
[B] Functioning suction machine and tubing
[C] Calcium gluconate IV injection setup
[D] Potassium chloride IV solution
✔ Correct Answer: Option [D] — Potassium chloride IV solution
CLINICAL RATIONALE: Post-thyroidectomy emergency setup requires tracheostomy equipment and suction
(for airway edema/stridor) and IV calcium gluconate (for acute hypocalcemia from parathyroid injury). IV KCl is
not routine bedside emergency gear.
CONFIDENTIAL & PROPRIETARY — FALL 2026 EXAMINATION PAPER Page 2 of 17
, WEST COAST UNIVERSITY | COLLEGE OF NURSING ATI COMPREHENSIVE PREDICTOR FALL 2026
Question 6. A 59-year-old client with bipolar disorder receiving haloperidol 2 mg PO TID reports to the
nurse, 'Milk is draining from my breasts.' Which response by the nurse is therapeutic and accurate?
[A] 'Let us participate in a distraction activity in the dayroom.'
[B] 'You are experiencing a visual hallucination due to your elevated mood.'
[C] 'You are experiencing galactorrhea, a known adverse effect of Haldol.'
[D] 'I will immediately contact your provider to discontinue all psychiatric drugs.'
✔ Correct Answer: Option [C] — 'You are experiencing galactorrhea, a known adverse effect of
Haldol.'
CLINICAL RATIONALE: Haloperidol blocks dopamine receptors, leading to hyperprolactinemia, which
manifests as galactorrhea and gynecomastia. Providing factual education reassures the client.
Question 7. A 69-year-old client is undergoing a second exchange of intermittent peritoneal dialysis
(IPD). Which assessment finding mandates immediate nursing intervention?
[A] Slight blood-tinged fluid around the catheter exit site
[B] Abdominal discomfort during the initial dialysate inflow phase
[C] Cloudy dialysate outflow fluid
[D] Client report of mild constipation
✔ Correct Answer: Option [C] — Cloudy dialysate outflow fluid
CLINICAL RATIONALE: Cloudy dialysate drainage is the primary sign of peritonitis, a major complication of
peritoneal dialysis. Effluent samples must be sent for culture and sensitivity immediately.
Question 8. A charge nurse provides education regarding infection control measures for a client
diagnosed with Clostridium difficile. Which instruction must be included?
[A] Require visitors to wear a gown and gloves while in the client's room
[B] Clean environmental surfaces daily using a standard phenol solution
[C] Assign the client to a negative-airflow isolation room
[D] Decontaminate hands using alcohol-based hand rub upon exiting
✔ Correct Answer: Option [A] — Require visitors to wear a gown and gloves while in the client's
room
CLINICAL RATIONALE: C. difficile requires Contact Precautions (gown and gloves). Hand hygiene must be
performed with soap and water because alcohol rubs do not destroy C. diff bacterial endospores.
CONFIDENTIAL & PROPRIETARY — FALL 2026 EXAMINATION PAPER Page 3 of 17
ATI COMPREHENSIVE PREDICTOR EXIT EXAMINATION
Course: NURS 490 / NCLEX Readiness | Term: Fall 2026 | Exam Standard: 170 Questions (100% Scale)
Student Name: ___________________________ | Student ID: ______________ | Score: _____ / 100%
EXAMINATION INSTRUCTIONS: This official practice paper is derived from West Coast University ATI
Comprehensive Predictor core question banks. Each question features 4 multiple-choice options (A, B, C, D).
Correct answers are indicated with a green checkmark (✔) and accompanied by clinical rationales in yellow
panels. All questions are presented continuously without subsection breaks.
Question 1. A client develops cor pulmonale (right-sided heart failure) secondary to chronic
pulmonary disease. Which of the following clinical manifestations should the nurse expect to observe
during assessment?
[A] Increasing respiratory difficulty with exertion
[B] Twitching of extremities and hyperreflexia
[C] Productive cough with thick, yellow mucus
[D] Peripheral edema and anorexia
✔ Correct Answer: Option [D] — Peripheral edema and anorexia
CLINICAL RATIONALE: Cor pulmonale causes right ventricular failure, leading to systemic venous congestion.
Expected findings include peripheral edema, jugular venous distention, hepatomegaly, and anorexia due to GI
tract congestion.
Question 2. The charge nurse on a medical-surgical floor is making shift assignments. The team
includes two RNs, one LPN, and one Assistive Personnel (AP). Which assignment is most appropriate for
the AP?
[A] Assisting a client with Alzheimer's disease who requires feeding assistance
[B] Evaluating a client with osteoporosis complaining of dysuria
[C] Caring for a client with end-stage cancer exhibiting Cheyne-Stokes respirations
[D] Providing tube feedings to a client diagnosed with scleroderma
✔ Correct Answer: Option [A] — Assisting a client with Alzheimer's disease who requires feeding
assistance
CLINICAL RATIONALE: AP scope of practice includes assisting stable clients with ADLs such as feeding,
bathing, and hygiene. Feeding a client with cognitive impairment (without swallowing precautions) is within AP
competency.
CONFIDENTIAL & PROPRIETARY — FALL 2026 EXAMINATION PAPER Page 1 of 17
,WEST COAST UNIVERSITY | COLLEGE OF NURSING ATI COMPREHENSIVE PREDICTOR FALL 2026
Question 3. A 23-year-old male is admitted to the neurosurgical unit with a subdural hematoma and
cerebral edema following a motorcycle crash. Which initial symptom indicates rising intracranial
pressure (ICP)?
[A] Decreased level of consciousness
[B] Unequal and fixed dilated pupils
[C] Decerebrate posturing to painful stimuli
[D] Onset of generalized tonic-clonic seizures
✔ Correct Answer: Option [A] — Decreased level of consciousness
CLINICAL RATIONALE: A change in level of consciousness (restlessness, irritability, or lethargy) is the earliest
and most sensitive indicator of increasing ICP. Pupil changes and posturing represent late signs.
Question 4. A nurse in an outpatient prenatal clinic evaluates a 23-year-old client at 32 weeks
gestation. Which assessment finding indicates a potential pregnancy complication requiring provider
notification?
[A] Sensation of pressure against the diaphragm during fetal movement
[B] Increased volume of thin, whitish vaginal discharge
[C] Urine dipstick positive for glucose and acetone
[D] Presence of 1+ pedal edema in both feet late in the afternoon
✔ Correct Answer: Option [C] — Urine dipstick positive for glucose and acetone
CLINICAL RATIONALE: Ketonuria (acetone) and glucosuria during pregnancy indicate altered carbohydrate
metabolism, potential gestational diabetes, or severe ketoacidosis, requiring immediate investigation.
Question 5. A client is returned to the surgical unit following a subtotal thyroidectomy. When
verifying emergency equipment at the patient's bedside, which item is nonessential?
[A] Emergency tracheostomy tray
[B] Functioning suction machine and tubing
[C] Calcium gluconate IV injection setup
[D] Potassium chloride IV solution
✔ Correct Answer: Option [D] — Potassium chloride IV solution
CLINICAL RATIONALE: Post-thyroidectomy emergency setup requires tracheostomy equipment and suction
(for airway edema/stridor) and IV calcium gluconate (for acute hypocalcemia from parathyroid injury). IV KCl is
not routine bedside emergency gear.
CONFIDENTIAL & PROPRIETARY — FALL 2026 EXAMINATION PAPER Page 2 of 17
, WEST COAST UNIVERSITY | COLLEGE OF NURSING ATI COMPREHENSIVE PREDICTOR FALL 2026
Question 6. A 59-year-old client with bipolar disorder receiving haloperidol 2 mg PO TID reports to the
nurse, 'Milk is draining from my breasts.' Which response by the nurse is therapeutic and accurate?
[A] 'Let us participate in a distraction activity in the dayroom.'
[B] 'You are experiencing a visual hallucination due to your elevated mood.'
[C] 'You are experiencing galactorrhea, a known adverse effect of Haldol.'
[D] 'I will immediately contact your provider to discontinue all psychiatric drugs.'
✔ Correct Answer: Option [C] — 'You are experiencing galactorrhea, a known adverse effect of
Haldol.'
CLINICAL RATIONALE: Haloperidol blocks dopamine receptors, leading to hyperprolactinemia, which
manifests as galactorrhea and gynecomastia. Providing factual education reassures the client.
Question 7. A 69-year-old client is undergoing a second exchange of intermittent peritoneal dialysis
(IPD). Which assessment finding mandates immediate nursing intervention?
[A] Slight blood-tinged fluid around the catheter exit site
[B] Abdominal discomfort during the initial dialysate inflow phase
[C] Cloudy dialysate outflow fluid
[D] Client report of mild constipation
✔ Correct Answer: Option [C] — Cloudy dialysate outflow fluid
CLINICAL RATIONALE: Cloudy dialysate drainage is the primary sign of peritonitis, a major complication of
peritoneal dialysis. Effluent samples must be sent for culture and sensitivity immediately.
Question 8. A charge nurse provides education regarding infection control measures for a client
diagnosed with Clostridium difficile. Which instruction must be included?
[A] Require visitors to wear a gown and gloves while in the client's room
[B] Clean environmental surfaces daily using a standard phenol solution
[C] Assign the client to a negative-airflow isolation room
[D] Decontaminate hands using alcohol-based hand rub upon exiting
✔ Correct Answer: Option [A] — Require visitors to wear a gown and gloves while in the client's
room
CLINICAL RATIONALE: C. difficile requires Contact Precautions (gown and gloves). Hand hygiene must be
performed with soap and water because alcohol rubs do not destroy C. diff bacterial endospores.
CONFIDENTIAL & PROPRIETARY — FALL 2026 EXAMINATION PAPER Page 3 of 17
