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ATI RN COMPREHENSIVE PREDICTOR EXAM QUESTIONS WITH
DETAILED RATIONALES LATEST EDITION 2026 -2027
NCLEX-RN Review & Next Gen Practice –with Detailed
Rationales
DOMAIN I: MANAGEMENT OF CARE –
PRIORITIZATION & DELEGATION (Questions 1–60)
1. A charge nurse is making client assignments on a medical-surgical unit.
Which client should be assigned to the most experienced RN?
A) A client who is 2 days post-operative following a total hip replacement and
requires pain management
B) A client who is 4 hours post-operative following a thyroidectomy and reports
fullness in the back of the throat
C) A client with a urinary tract infection who requires a urine culture
D) A client with diabetes mellitus who has a blood glucose of 160 mg/dL
Answer: B
A client who is 4 hours post-thyroidectomy and reports fullness in the back of the
throat is at risk for hematoma formation, which can lead to airway obstruction. This
requires immediate assessment and intervention by the most experienced RN. The
other clients are stable and can be assigned to less experienced staff.
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A) A client who is 3 days post-appendectomy with a temperature of 99.2°F
B) A client with chest pain who is experiencing diaphoresis and nausea
C) A client with diabetes mellitus who has a blood glucose of 160 mg/dL
D) A client with a fractured tibia requesting pain medication
Answer: B
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Chest pain with diaphoresis and nausea are classic signs of myocardial infarction,
indicating an immediate life-threatening emergency requiring priority assessment. A
slightly elevated temperature (A) is expected postoperatively. Blood glucose of 160
mg/dL (C) is mildly elevated but not immediately life-threatening. Pain from a fracture
(D) is painful but not immediately life-threatening.
3. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which of
the following tasks should the nurse delegate to a UAP?
A) Assisting a client with feeding
B) Administering oral medications
C) Performing a sterile dressing change
D) Assessing a client's wound
Answer: A
Assisting with feeding is within the scope of UAP. Administering oral medications (B) is
a licensed nursing function. Performing sterile dressing changes (C) requires licensed
nursing judgment. Assessing a client's wound (D) requires nursing assessment and is
not within UAP scope.
4. A nurse is preparing to discharge a client who has a new colostomy. Which of
the following actions should the nurse take?
A) Refer the client to a registered dietitian
B) Evaluate the client's ability to perform ostomy care
C) Provide written instructions only
D) Schedule a follow-up appointment in 1 month
Answer: B
Evaluation of the client's ability to perform ostomy care is the priority before discharge.
The nurse must assess the client's psychomotor skills and understanding to ensure safe
self-care at home. A dietitian referral may be appropriate but is not the priority.
Written instructions alone are insufficient. Follow-up should be scheduled sooner than
1 month.
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5. A charge nurse is assigning rooms for four clients. Which client should be
placed in a private room?
A) Client with pneumonia
B) Client with methicillin-resistant Staphylococcus aureus (MRSA)
C) Client with diabetic foot ulcer
D) Client with chronic obstructive pulmonary disease (COPD)
Answer: B
MRSA requires contact isolation; a private room is essential to prevent transmission to
other clients. Pneumonia may require droplet precautions but MRSA contact is the
priority for single-room assignment.
6. A charge nurse assigns a float RN who usually works in postpartum to a
medical-surgical unit. Which client is most appropriate for the charge nurse to
assign to this RN?
A) Client in diabetic ketoacidosis (DKA)
B) Client who is postoperative day 2 following an appendectomy, stable
C) Client with a chest tube for a pneumothorax
D) Client receiving IV heparin for deep vein thrombosis
Answer: B
A stable, low-acuity postoperative client is safest for a float nurse from a different
specialty. Complex or unstable clients (chest tube, titratable heparin, DKA) require an
RN with current experience in those areas.
7. A nurse is delegating tasks to an assistive personnel (AP). Which task is
appropriate to delegate?
A) Assess a postoperative incision
B) Teach a client how to use a walker
C) Obtain a capillary blood glucose level
D) Evaluate a client's pain level
Answer: C
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APs can perform capillary blood glucose testing. Assessment, teaching, and evaluation
all require nursing judgment and fall outside the AP's scope of practice.
8. A nurse is supervising a newly licensed nurse on a mental health unit. For
which action by the newly licensed nurse should the supervising nurse
intervene?
A) Sets boundaries with a manipulative client
B) Documents client refusals of medication
C) Tells a client he will lose phone privileges if he does not take his medication
D) Uses therapeutic communication techniques
Answer: C
Threatening to remove privileges as a consequence for refusing medication is coercive
and violates client autonomy. This action is unethical and can damage the therapeutic
relationship.
9. A competent adult client refuses a blood transfusion for religious reasons.
Which actions should the nurse take? (Select all that apply)
A) Verify the client understands risks
B) Document the refusal
C) Administer the transfusion if Hgb is critical
D) Notify the provider
E) Ask the family to override the decision
Answer: A, B, D
Competent adults have autonomy. The nurse ensures informed refusal, documents the
refusal, and notifies the provider. Administering the transfusion against the client's
wishes is battery. Asking the family to override the decision is inappropriate.
10. A nurse is caring for four clients. Which client should the nurse assess
FIRST?
ATI RN COMPREHENSIVE PREDICTOR EXAM QUESTIONS WITH
DETAILED RATIONALES LATEST EDITION 2026 -2027
NCLEX-RN Review & Next Gen Practice –with Detailed
Rationales
DOMAIN I: MANAGEMENT OF CARE –
PRIORITIZATION & DELEGATION (Questions 1–60)
1. A charge nurse is making client assignments on a medical-surgical unit.
Which client should be assigned to the most experienced RN?
A) A client who is 2 days post-operative following a total hip replacement and
requires pain management
B) A client who is 4 hours post-operative following a thyroidectomy and reports
fullness in the back of the throat
C) A client with a urinary tract infection who requires a urine culture
D) A client with diabetes mellitus who has a blood glucose of 160 mg/dL
Answer: B
A client who is 4 hours post-thyroidectomy and reports fullness in the back of the
throat is at risk for hematoma formation, which can lead to airway obstruction. This
requires immediate assessment and intervention by the most experienced RN. The
other clients are stable and can be assigned to less experienced staff.
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A) A client who is 3 days post-appendectomy with a temperature of 99.2°F
B) A client with chest pain who is experiencing diaphoresis and nausea
C) A client with diabetes mellitus who has a blood glucose of 160 mg/dL
D) A client with a fractured tibia requesting pain medication
Answer: B
, Page 2 of 111
Chest pain with diaphoresis and nausea are classic signs of myocardial infarction,
indicating an immediate life-threatening emergency requiring priority assessment. A
slightly elevated temperature (A) is expected postoperatively. Blood glucose of 160
mg/dL (C) is mildly elevated but not immediately life-threatening. Pain from a fracture
(D) is painful but not immediately life-threatening.
3. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which of
the following tasks should the nurse delegate to a UAP?
A) Assisting a client with feeding
B) Administering oral medications
C) Performing a sterile dressing change
D) Assessing a client's wound
Answer: A
Assisting with feeding is within the scope of UAP. Administering oral medications (B) is
a licensed nursing function. Performing sterile dressing changes (C) requires licensed
nursing judgment. Assessing a client's wound (D) requires nursing assessment and is
not within UAP scope.
4. A nurse is preparing to discharge a client who has a new colostomy. Which of
the following actions should the nurse take?
A) Refer the client to a registered dietitian
B) Evaluate the client's ability to perform ostomy care
C) Provide written instructions only
D) Schedule a follow-up appointment in 1 month
Answer: B
Evaluation of the client's ability to perform ostomy care is the priority before discharge.
The nurse must assess the client's psychomotor skills and understanding to ensure safe
self-care at home. A dietitian referral may be appropriate but is not the priority.
Written instructions alone are insufficient. Follow-up should be scheduled sooner than
1 month.
, Page 3 of 111
5. A charge nurse is assigning rooms for four clients. Which client should be
placed in a private room?
A) Client with pneumonia
B) Client with methicillin-resistant Staphylococcus aureus (MRSA)
C) Client with diabetic foot ulcer
D) Client with chronic obstructive pulmonary disease (COPD)
Answer: B
MRSA requires contact isolation; a private room is essential to prevent transmission to
other clients. Pneumonia may require droplet precautions but MRSA contact is the
priority for single-room assignment.
6. A charge nurse assigns a float RN who usually works in postpartum to a
medical-surgical unit. Which client is most appropriate for the charge nurse to
assign to this RN?
A) Client in diabetic ketoacidosis (DKA)
B) Client who is postoperative day 2 following an appendectomy, stable
C) Client with a chest tube for a pneumothorax
D) Client receiving IV heparin for deep vein thrombosis
Answer: B
A stable, low-acuity postoperative client is safest for a float nurse from a different
specialty. Complex or unstable clients (chest tube, titratable heparin, DKA) require an
RN with current experience in those areas.
7. A nurse is delegating tasks to an assistive personnel (AP). Which task is
appropriate to delegate?
A) Assess a postoperative incision
B) Teach a client how to use a walker
C) Obtain a capillary blood glucose level
D) Evaluate a client's pain level
Answer: C
, Page 4 of 111
APs can perform capillary blood glucose testing. Assessment, teaching, and evaluation
all require nursing judgment and fall outside the AP's scope of practice.
8. A nurse is supervising a newly licensed nurse on a mental health unit. For
which action by the newly licensed nurse should the supervising nurse
intervene?
A) Sets boundaries with a manipulative client
B) Documents client refusals of medication
C) Tells a client he will lose phone privileges if he does not take his medication
D) Uses therapeutic communication techniques
Answer: C
Threatening to remove privileges as a consequence for refusing medication is coercive
and violates client autonomy. This action is unethical and can damage the therapeutic
relationship.
9. A competent adult client refuses a blood transfusion for religious reasons.
Which actions should the nurse take? (Select all that apply)
A) Verify the client understands risks
B) Document the refusal
C) Administer the transfusion if Hgb is critical
D) Notify the provider
E) Ask the family to override the decision
Answer: A, B, D
Competent adults have autonomy. The nurse ensures informed refusal, documents the
refusal, and notifies the provider. Administering the transfusion against the client's
wishes is battery. Asking the family to override the decision is inappropriate.
10. A nurse is caring for four clients. Which client should the nurse assess
FIRST?
