ATI Comprehensive Predictor Exam 2025: Complete
Solution with 100% Verified Answers (A+ Graded)
Introduction
This guide provides 80 high-difficulty NCLEX-style questions for the ATI Comprehensive Pre-
dictor Exam 2025, integrating core subjects: Medical-Surgical, Maternal Health, Mental Health,
Pediatrics, Pharmacology, Leadership, and Community Health. Each question includes four an-
swer options, the correct answer, and a detailed rationale based on evidence-based practice. A
final answer key is provided for quick reference. The format is optimized for professional PDF
output.
Questions
Question 1: A client with acute myocardial infarction develops cardiogenic shock. Which finding is
most concerning?
A. Blood pressure 88/50 mmHg
B. Heart rate 120 bpm
C. Respiratory rate 24 breaths/min
D. Oxygen saturation 92%
Correct Answer: A. Blood pressure 88/50 mmHg
Rationale: Cardiogenic shock is characterized by severe hypotension (BP <90/60 mmHg),
indicating inadequate tissue perfusion. While tachycardia (B), tachypnea (C), and low
oxygen saturation (D) are concerning, hypotension is the most critical indicator requiring
immediate intervention.
Question 2: A nurse is caring for a client with a pulmonary embolism. Which intervention is the
priority?
A. Administer oxygen
B. Initiate IV fluids
C. Prepare for chest X-ray
D. Administer pain medication
Correct Answer: A. Administer oxygen
Rationale: Pulmonary embolism impairs oxygenation due to blocked pulmonary arteries.
Administering oxygen is the priority to address hypoxemia. IV fluids (B), imaging (C),
and pain medication (D) are secondary.
Question 3: A client with diabetic ketoacidosis has a pH of 7.20. What is the nurse’s priority action?
A. Administer sodium bicarbonate
1
, B. Initiate insulin infusion
C. Increase IV fluid rate
D. Monitor blood glucose
Correct Answer: B. Initiate insulin infusion
Rationale: Insulin infusion corrects hyperglycemia and halts ketone production in DKA,
addressing the underlying acidosis. Bicarbonate (A) is rarely used, fluids (C) are support-
ive, and monitoring glucose (D) is ongoing but not the priority.
Question 4: A client post-thyroidectomy reports muscle twitching. Which lab value should the nurse
assess first?
A. Serum potassium
B. Serum calcium
C. Serum sodium
D. Serum magnesium
Correct Answer: B. Serum calcium
Rationale: Muscle twitching post-thyroidectomy suggests hypocalcemia due to parathy-
roid gland damage. Calcium levels should be checked first. Other electrolytes (A, C, D)
are less likely causes.
Question 5: A nurse is caring for a client with acute pancreatitis. Which dietary order is most appro-
priate?
A. Clear liquid diet
B. High-protein diet
C. Low-fat diet
D. NPO
Correct Answer: D. NPO
Rationale: NPO status rests the pancreas in acute pancreatitis, reducing enzyme secre-
tion. Liquids (A), high-protein (B), and low-fat diets (C) may stimulate pancreatic activ-
ity.
Question 6: A client with chronic kidney disease develops hyperkalemia. Which ECG change is most
concerning?
A. Flat T waves
B. Peaked T waves
C. Prolonged PR interval
D. Narrow QRS complex
Correct Answer: B. Peaked T waves
Rationale: Peaked T waves indicate hyperkalemia, which can lead to life-threatening
arrhythmias. Flat T waves (A) suggest hypokalemia, while PR prolongation (C) and QRS
changes (D) are less specific.
Question 7: A nurse is assessing a client with heart failure. Which finding indicates worsening con-
dition?
A. Weight gain of 2 kg in 24 hours
B. Heart rate 80 bpm
C. Blood pressure 120/80 mmHg
D. Clear lung sounds
Correct Answer: A. Weight gain of 2 kg in 24 hours
Rationale: Rapid weight gain (2 kg in 24 hours) indicates fluid retention, a sign of wors-
ening heart failure. Normal heart rate (B), blood pressure (C), and clear lungs (D) do not
2
, suggest decompensation.
Question 8: A client with a spinal cord injury at T4 is at risk for which complication?
A. Autonomic dysreflexia
B. Hypoglycemia
C. Seizures
D. Hypoventilation
Correct Answer: A. Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a risk in spinal cord injuries above T6 due to unop-
posed sympathetic responses. Hypoglycemia (B), seizures (C), and hypoventilation (D)
are less specific to T4 injuries.
Question 9: A nurse is caring for a client with a chest tube. What indicates a potential air leak?
A. Continuous bubbling in the water seal chamber
B. Tidaling in the water seal chamber
C. Suction chamber bubbling
D. Dry water seal chamber
Correct Answer: A. Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
pleural space or tubing. Tidaling (B) is normal, suction bubbling (C) is expected, and a
dry chamber (D) suggests occlusion.
Question 10: A client with COPD has a PaCO2 of 60 mmHg. What is the nurse’s priority action?
A. Increase oxygen to 4 L/min
B. Position in high Fowler’s
C. Administer bronchodilator
D. Encourage pursed-lip breathing
Correct Answer: C. Administer bronchodilator
Rationale: Elevated PaCO2 in COPD indicates poor ventilation; bronchodilators im-
prove airflow and gas exchange. Increasing oxygen (A) may worsen hypercapnia, posi-
tioning (B) and breathing techniques (D) are supportive but secondary.
Question 11: A nurse is caring for a client with a new colostomy. Which teaching is most important?
A. Increase dietary fiber
B. Change the pouch every 24 hours
C. Monitor stoma color
D. Avoid physical activity
Correct Answer: C. Monitor stoma color
Rationale: A pink or red stoma indicates good perfusion; a pale or dark stoma suggests
complications. Fiber (A) is adjusted gradually, pouch changes (B) occur every 3–7 days,
and activity (D) is encouraged.
Question 12: A client with sepsis is prescribed norepinephrine. What is the primary goal of this med-
ication?
A. Increase heart rate
B. Maintain blood pressure
C. Reduce fever
D. Improve oxygenation
Correct Answer: B. Maintain blood pressure
Rationale: Norepinephrine, a vasopressor, is used in sepsis to maintain blood pressure
3
Solution with 100% Verified Answers (A+ Graded)
Introduction
This guide provides 80 high-difficulty NCLEX-style questions for the ATI Comprehensive Pre-
dictor Exam 2025, integrating core subjects: Medical-Surgical, Maternal Health, Mental Health,
Pediatrics, Pharmacology, Leadership, and Community Health. Each question includes four an-
swer options, the correct answer, and a detailed rationale based on evidence-based practice. A
final answer key is provided for quick reference. The format is optimized for professional PDF
output.
Questions
Question 1: A client with acute myocardial infarction develops cardiogenic shock. Which finding is
most concerning?
A. Blood pressure 88/50 mmHg
B. Heart rate 120 bpm
C. Respiratory rate 24 breaths/min
D. Oxygen saturation 92%
Correct Answer: A. Blood pressure 88/50 mmHg
Rationale: Cardiogenic shock is characterized by severe hypotension (BP <90/60 mmHg),
indicating inadequate tissue perfusion. While tachycardia (B), tachypnea (C), and low
oxygen saturation (D) are concerning, hypotension is the most critical indicator requiring
immediate intervention.
Question 2: A nurse is caring for a client with a pulmonary embolism. Which intervention is the
priority?
A. Administer oxygen
B. Initiate IV fluids
C. Prepare for chest X-ray
D. Administer pain medication
Correct Answer: A. Administer oxygen
Rationale: Pulmonary embolism impairs oxygenation due to blocked pulmonary arteries.
Administering oxygen is the priority to address hypoxemia. IV fluids (B), imaging (C),
and pain medication (D) are secondary.
Question 3: A client with diabetic ketoacidosis has a pH of 7.20. What is the nurse’s priority action?
A. Administer sodium bicarbonate
1
, B. Initiate insulin infusion
C. Increase IV fluid rate
D. Monitor blood glucose
Correct Answer: B. Initiate insulin infusion
Rationale: Insulin infusion corrects hyperglycemia and halts ketone production in DKA,
addressing the underlying acidosis. Bicarbonate (A) is rarely used, fluids (C) are support-
ive, and monitoring glucose (D) is ongoing but not the priority.
Question 4: A client post-thyroidectomy reports muscle twitching. Which lab value should the nurse
assess first?
A. Serum potassium
B. Serum calcium
C. Serum sodium
D. Serum magnesium
Correct Answer: B. Serum calcium
Rationale: Muscle twitching post-thyroidectomy suggests hypocalcemia due to parathy-
roid gland damage. Calcium levels should be checked first. Other electrolytes (A, C, D)
are less likely causes.
Question 5: A nurse is caring for a client with acute pancreatitis. Which dietary order is most appro-
priate?
A. Clear liquid diet
B. High-protein diet
C. Low-fat diet
D. NPO
Correct Answer: D. NPO
Rationale: NPO status rests the pancreas in acute pancreatitis, reducing enzyme secre-
tion. Liquids (A), high-protein (B), and low-fat diets (C) may stimulate pancreatic activ-
ity.
Question 6: A client with chronic kidney disease develops hyperkalemia. Which ECG change is most
concerning?
A. Flat T waves
B. Peaked T waves
C. Prolonged PR interval
D. Narrow QRS complex
Correct Answer: B. Peaked T waves
Rationale: Peaked T waves indicate hyperkalemia, which can lead to life-threatening
arrhythmias. Flat T waves (A) suggest hypokalemia, while PR prolongation (C) and QRS
changes (D) are less specific.
Question 7: A nurse is assessing a client with heart failure. Which finding indicates worsening con-
dition?
A. Weight gain of 2 kg in 24 hours
B. Heart rate 80 bpm
C. Blood pressure 120/80 mmHg
D. Clear lung sounds
Correct Answer: A. Weight gain of 2 kg in 24 hours
Rationale: Rapid weight gain (2 kg in 24 hours) indicates fluid retention, a sign of wors-
ening heart failure. Normal heart rate (B), blood pressure (C), and clear lungs (D) do not
2
, suggest decompensation.
Question 8: A client with a spinal cord injury at T4 is at risk for which complication?
A. Autonomic dysreflexia
B. Hypoglycemia
C. Seizures
D. Hypoventilation
Correct Answer: A. Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a risk in spinal cord injuries above T6 due to unop-
posed sympathetic responses. Hypoglycemia (B), seizures (C), and hypoventilation (D)
are less specific to T4 injuries.
Question 9: A nurse is caring for a client with a chest tube. What indicates a potential air leak?
A. Continuous bubbling in the water seal chamber
B. Tidaling in the water seal chamber
C. Suction chamber bubbling
D. Dry water seal chamber
Correct Answer: A. Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
pleural space or tubing. Tidaling (B) is normal, suction bubbling (C) is expected, and a
dry chamber (D) suggests occlusion.
Question 10: A client with COPD has a PaCO2 of 60 mmHg. What is the nurse’s priority action?
A. Increase oxygen to 4 L/min
B. Position in high Fowler’s
C. Administer bronchodilator
D. Encourage pursed-lip breathing
Correct Answer: C. Administer bronchodilator
Rationale: Elevated PaCO2 in COPD indicates poor ventilation; bronchodilators im-
prove airflow and gas exchange. Increasing oxygen (A) may worsen hypercapnia, posi-
tioning (B) and breathing techniques (D) are supportive but secondary.
Question 11: A nurse is caring for a client with a new colostomy. Which teaching is most important?
A. Increase dietary fiber
B. Change the pouch every 24 hours
C. Monitor stoma color
D. Avoid physical activity
Correct Answer: C. Monitor stoma color
Rationale: A pink or red stoma indicates good perfusion; a pale or dark stoma suggests
complications. Fiber (A) is adjusted gradually, pouch changes (B) occur every 3–7 days,
and activity (D) is encouraged.
Question 12: A client with sepsis is prescribed norepinephrine. What is the primary goal of this med-
ication?
A. Increase heart rate
B. Maintain blood pressure
C. Reduce fever
D. Improve oxygenation
Correct Answer: B. Maintain blood pressure
Rationale: Norepinephrine, a vasopressor, is used in sepsis to maintain blood pressure
3
