ATI RN COMPREHENSIVE
PREDICTOR EXIT EXAM 2026
2027 150 HIGHLY
CHALLENGING NCLEX STYLE Q
AND A WITH DETAILED
RATIONALES
Question 1
A nurse is receiving change-of-shift report for four clients. Which
of the following clients should the nurse assess first?
A. A client with a chest tube for a pneumothorax who has 75 mL of
serosanguineous drainage in the collection chamber over the past
hour.
B. A client with acute pancreatitis who reports severe, radiating
epigastric pain and is requesting a PRN analgesic.
C. A client who is 2 days postoperative following a total hip
arthroplasty and has a sudden onset of confusion and petechiae
on the chest.
D. A client with diabetes mellitus whose morning blood glucose is
210 mg/dL and is waiting for their scheduled prandial insulin.
CORRECT ANSWER: C
RATiONAlE: A sudden onset of confusion and petechiae on
the chest in a client who recently underwent major orthopedic
,surgery are classic manifestations of a fat embolism syndrome
(FES), which is a life-threatening medical emergency requiring
immediate intervention. Serosanguineous drainage of 75 mL/hr
from a chest tube is within expected limits (<100 mL/hr). Severe
pain is expected with acute pancreatitis, and while it requires
management, it is not immediately life-threatening compared to
an embolism. A blood glucose of 210 mg/dL is elevated but stable
enough to wait until the scheduled administration window.
Question 2
A nurse in the emergency department is caring for a client who
has a prescription for a continuous intravenous infusion of
nitroprusside for a hypertensive crisis. Which of the following
actions should the nurse take?
A. Protect the intravenous fluid bag and tubing from light using
an opaque cover.
B. Monitor the client’s blood pressure every 4 hours during the
infusion.
C. Prepare protamine sulfate to have at the bedside as an antidote.
D. Administer the medication via a peripheral intravenous line in
the hand.
CORRECT ANSWER: A
RATiONAlE: Nitroprusside is highly sensitive to light and
degrades into cyanide if exposed; therefore, the IV bag and
tubing must be wrapped in an opaque material to protect it.
Blood pressure must be monitored continuously or every 5 to 15
minutes, not every 4 hours, due to the drug's rapid and potent
vasodilatory effects. Protamine sulfate is the antidote for
heparin; the antidote for nitroprusside toxicity (thiocyanate
,toxicity) is sodium thiosulfate. Nitroprusside should ideally be
administered via a central venous catheter due to its vesicant
properties and the need for reliable access.
Question 3
A charge nurse is observing a newly licensed nurse care for a
client who is on airborne precautions for suspected tuberculosis
(TB). Which of the following actions by the newly licensed nurse
requires intervention by the charge nurse?
A. The nurse wears an N95 respirator mask that was fit-tested the
previous year.
B. The nurse dons a clean gown and gloves before entering the
room to perform a dressing change.
C. The nurse requests that the client wear a surgical mask when
being transported to radiology.
D. The nurse leaves the client's room and removes their N95
respirator mask in the hallway outside the room.
CORRECT ANSWER: D
RATiONAlE: For clients on airborne precautions, the nurse
must remove the N95 respirator mask outside the client's room
in the hallway after closing the door to avoid inhaling airborne
pathogens that may still be suspended in the room's air. Annual
fit-testing for N95 masks is appropriate. Gown and gloves are
indicated for standard/contact interactions during a dressing
change. Clients on airborne precautions must wear a surgical
mask when leaving the room for essential transport.
Question 4
, A nurse is reviewing the laboratory results of a client who is
receiving a continuous heparin infusion for a deep vein
thrombosis (DVT). The client’s current activated partial
thromboplastin time (aPTT) is 95 seconds. The institutional
baseline aPTT is 30 seconds. Which of the following actions
should the nurse anticipate taking?
A. Increase the heparin infusion rate by 100 units/hr.
B. Stop the infusion immediately and prepare to administer
protamine sulfate.
C. Decrease or hold the infusion per protocol, as the value is above
the therapeutic range.
D. Maintain the current infusion rate because the value is within
the therapeutic target.
CORRECT ANSWER: C
RATiONAlE: The therapeutic target range for a heparin
infusion is typically 1.5 to 2.5 times the baseline value. With a
baseline of 30 seconds, the target range is 45 to 75 seconds. An
aPTT of 95 seconds indicates over-anticoagulation, putting the
client at a high risk for bleeding. The nurse should anticipate
holding or slowing the infusion per hospital protocol. Protamine
sulfate is reserved for severe, life-threatening hemorrhages, not
just an elevated lab value without active bleeding.
Question 5
A nurse is preparing to administer digoxin 0.25 mg PO daily to an
adult client with heart failure. Which of the following findings
should prompt the nurse to hold the medication and notify the
provider?
A. Potassium level of 4.8 mEq/L
PREDICTOR EXIT EXAM 2026
2027 150 HIGHLY
CHALLENGING NCLEX STYLE Q
AND A WITH DETAILED
RATIONALES
Question 1
A nurse is receiving change-of-shift report for four clients. Which
of the following clients should the nurse assess first?
A. A client with a chest tube for a pneumothorax who has 75 mL of
serosanguineous drainage in the collection chamber over the past
hour.
B. A client with acute pancreatitis who reports severe, radiating
epigastric pain and is requesting a PRN analgesic.
C. A client who is 2 days postoperative following a total hip
arthroplasty and has a sudden onset of confusion and petechiae
on the chest.
D. A client with diabetes mellitus whose morning blood glucose is
210 mg/dL and is waiting for their scheduled prandial insulin.
CORRECT ANSWER: C
RATiONAlE: A sudden onset of confusion and petechiae on
the chest in a client who recently underwent major orthopedic
,surgery are classic manifestations of a fat embolism syndrome
(FES), which is a life-threatening medical emergency requiring
immediate intervention. Serosanguineous drainage of 75 mL/hr
from a chest tube is within expected limits (<100 mL/hr). Severe
pain is expected with acute pancreatitis, and while it requires
management, it is not immediately life-threatening compared to
an embolism. A blood glucose of 210 mg/dL is elevated but stable
enough to wait until the scheduled administration window.
Question 2
A nurse in the emergency department is caring for a client who
has a prescription for a continuous intravenous infusion of
nitroprusside for a hypertensive crisis. Which of the following
actions should the nurse take?
A. Protect the intravenous fluid bag and tubing from light using
an opaque cover.
B. Monitor the client’s blood pressure every 4 hours during the
infusion.
C. Prepare protamine sulfate to have at the bedside as an antidote.
D. Administer the medication via a peripheral intravenous line in
the hand.
CORRECT ANSWER: A
RATiONAlE: Nitroprusside is highly sensitive to light and
degrades into cyanide if exposed; therefore, the IV bag and
tubing must be wrapped in an opaque material to protect it.
Blood pressure must be monitored continuously or every 5 to 15
minutes, not every 4 hours, due to the drug's rapid and potent
vasodilatory effects. Protamine sulfate is the antidote for
heparin; the antidote for nitroprusside toxicity (thiocyanate
,toxicity) is sodium thiosulfate. Nitroprusside should ideally be
administered via a central venous catheter due to its vesicant
properties and the need for reliable access.
Question 3
A charge nurse is observing a newly licensed nurse care for a
client who is on airborne precautions for suspected tuberculosis
(TB). Which of the following actions by the newly licensed nurse
requires intervention by the charge nurse?
A. The nurse wears an N95 respirator mask that was fit-tested the
previous year.
B. The nurse dons a clean gown and gloves before entering the
room to perform a dressing change.
C. The nurse requests that the client wear a surgical mask when
being transported to radiology.
D. The nurse leaves the client's room and removes their N95
respirator mask in the hallway outside the room.
CORRECT ANSWER: D
RATiONAlE: For clients on airborne precautions, the nurse
must remove the N95 respirator mask outside the client's room
in the hallway after closing the door to avoid inhaling airborne
pathogens that may still be suspended in the room's air. Annual
fit-testing for N95 masks is appropriate. Gown and gloves are
indicated for standard/contact interactions during a dressing
change. Clients on airborne precautions must wear a surgical
mask when leaving the room for essential transport.
Question 4
, A nurse is reviewing the laboratory results of a client who is
receiving a continuous heparin infusion for a deep vein
thrombosis (DVT). The client’s current activated partial
thromboplastin time (aPTT) is 95 seconds. The institutional
baseline aPTT is 30 seconds. Which of the following actions
should the nurse anticipate taking?
A. Increase the heparin infusion rate by 100 units/hr.
B. Stop the infusion immediately and prepare to administer
protamine sulfate.
C. Decrease or hold the infusion per protocol, as the value is above
the therapeutic range.
D. Maintain the current infusion rate because the value is within
the therapeutic target.
CORRECT ANSWER: C
RATiONAlE: The therapeutic target range for a heparin
infusion is typically 1.5 to 2.5 times the baseline value. With a
baseline of 30 seconds, the target range is 45 to 75 seconds. An
aPTT of 95 seconds indicates over-anticoagulation, putting the
client at a high risk for bleeding. The nurse should anticipate
holding or slowing the infusion per hospital protocol. Protamine
sulfate is reserved for severe, life-threatening hemorrhages, not
just an elevated lab value without active bleeding.
Question 5
A nurse is preparing to administer digoxin 0.25 mg PO daily to an
adult client with heart failure. Which of the following findings
should prompt the nurse to hold the medication and notify the
provider?
A. Potassium level of 4.8 mEq/L
