1
2026 ATI COMPREHENSIVE PREDICTOR PROCTORED
EXAM | 150 NGN PRACTICE QUESTIONS WITH DETAILED
RATIONALES | RN & PN COMPREHENSIVE REVIEW
QUESTION 1: PRIORITIZATION - ABCDE FRAMEWORK
• Question: A nurse receives shift report on four patients. One patient has a new
tracheostomy with thick secretions and audible stridor. Another patient has a
postoperative fever of 38.5°C with tachycardia. A third patient is requesting pain
medication for a 6/10 headache. The fourth patient has a blood pressure of 148/92
mmHg. Which patient should the nurse assess FIRST based on the ABCDE prioritization
framework?
• Options:
A. The patient with postoperative fever and tachycardia
B. The patient with a new tracheostomy, thick secretions, and audible stridor
C. The patient requesting pain medication for a 6/10 headache
D. The patient with a blood pressure of 148/92 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Airway is the first priority in the ABCDE
framework. Stridor is a high-pitched sound indicating partial airway obstruction,
which can progress to complete airway obstruction. Patients with new
tracheostomies are at high risk for mucus plugging. This patient requires
immediate suctioning and airway assessment.
o Distractor Pitfalls: A (Fever) is urgent but not immediately life-threatening. C
(Pain) is a comfort issue, not a priority over airway. D (Hypertension) is important
but does not threaten the airway or breathing immediately.
QUESTION 2: DELEGATION - UAP SCOPE OF PRACTICE
• Question: A registered nurse (RN) is working on a medical-surgical unit with a licensed
practical nurse (LPN) and an unlicensed assistive personnel (UAP). The RN is delegating
tasks to team members. Which task is appropriate for the RN to delegate to the UAP?
, 2
• Options:
A. Changing a sterile wound dressing
B. Administering oral medications to a stable patient
C. Assessing a patient's lung sounds
D. Measuring and recording the patient's intake and output
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: UAPs can measure and record intake and output,
take vital signs, assist with activities of daily living, and report abnormalities to
the RN. This is within their scope of practice. Intake and output measurement
does not require nursing judgment or assessment.
o Distractor Pitfalls: A (Sterile dressing) requires sterile technique and should be
performed by RN or LPN. B (Oral medications) is not within UAP scope. C
(Assessment) is an RN or LPN task, not UAP.
QUESTION 3: DELEGATION - LPN SCOPE OF PRACTICE
• Question: An RN is delegating tasks to the LPN on the medical-surgical unit. The LPN
has experience with medication administration and patient monitoring. Which task can
the RN appropriately delegate to the LPN?
• Options:
A. Perform an initial admission assessment on a new patient
B. Develop a plan of care for a patient with a new diagnosis
C. Administer a routine oral antibiotic to a stable patient
D. Administer IV push morphine to a patient in severe pain
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: LPNs can administer oral medications, including
antibiotics, to stable patients with predictable outcomes. This is within the LPN
scope of practice in most states. The RN remains responsible for overall patient
care and assessment.
o Distractor Pitfalls: A (Initial assessment) is an RN responsibility. B (Plan of
care) is an RN responsibility requiring comprehensive assessment. D (IV push
morphine) is typically not within LPN scope in acute care settings.
, 3
QUESTION 4: PRIORITIZATION - URGENT VS. STABLE
• Question: A nurse is caring for four patients after receiving shift report. One patient has
chest pain radiating to the left arm with diaphoresis. Another patient has a surgical wound
infection with a temperature of 38.2°C. A third patient is requesting a PRN analgesic for
postoperative pain. The fourth patient has a blood pressure of 150/95 mmHg. Which
patient requires the most immediate assessment?
• Options:
A. The patient with chest pain radiating to the left arm with diaphoresis
B. The patient with a surgical wound infection and temperature of 38.2°C
C. The patient requesting a PRN analgesic for postoperative pain
D. The patient with a blood pressure of 150/95 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Chest pain radiating to the left arm with diaphoresis
is concerning for acute myocardial infarction (STEMI/NSTEMI). This is an
emergent situation requiring immediate assessment, ECG, and possible
intervention. Time is muscle in acute coronary syndrome.
o Distractor Pitfalls: B (Wound infection) is urgent but not immediately life-
threatening. C (Pain management) is important but lower priority. D
(Hypertension) is stable and not immediately dangerous at this level.
QUESTION 5: DELEGATION - ASSESSMENT TASKS
• Question: An RN is assigning patient care tasks to team members on a busy medical-
surgical unit. The unit has RNs, LPNs, and UAPs available. Which task should the RN
perform personally rather than delegating to an LPN or UAP?
• Options:
A. Taking a patient's vital signs
B. Administering a subcutaneous insulin injection
C. Assisting a patient with ambulation using a gait belt
D. Assessing a patient with new-onset confusion
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
, 4
o Pathophysiology Summary: New-onset confusion is a change in neurological
status requiring comprehensive RN assessment. This could indicate stroke,
infection, metabolic disturbance, or other serious conditions. Assessment and
clinical judgment are RN responsibilities that cannot be delegated.
o Distractor Pitfalls: A (Vital signs) can be delegated to UAP. B (Insulin injection)
can be delegated to LPN. C (Ambulation) can be delegated to UAP with proper
instruction.
QUESTION 6: MANAGEMENT OF CARE - PATIENT ASSIGNMENT
• Question: The charge nurse is making patient assignments for the shift on a unit with
RNs, LPNs, and UAPs available. Which patient should the charge nurse assign to the
most experienced RN based on acuity?
• Options:
A. A patient who is 2 days post-appendectomy with stable vital signs
B. A patient requiring discharge teaching on insulin administration
C. A patient with a urinary tract infection receiving oral antibiotics
D. A patient who is 24 hours post-cardiac arrest receiving multiple vasopressors
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: The patient who is 24 hours post-cardiac arrest on
multiple vasopressors is the most unstable and requires the most experienced RN.
This patient requires complex critical care nursing judgment, medication titration,
and hemodynamic monitoring.
o Distractor Pitfalls: A (Appendectomy) is stable and can be assigned to an RN or
LPN with less experience. B (Discharge teaching) can be done by an RN with less
experience. C (UTI) is stable and can be assigned to an LPN.
QUESTION 7: PRIORITIZATION - MASS CASUALTY TRIAGE
• Question: A mass casualty event occurs, and the triage nurse is using the START triage
system to prioritize patients. Which patient should be tagged as "IMMEDIATE" (RED)
and prioritized for treatment?
• Options:
A. A patient who is walking and talking with minor injuries
2026 ATI COMPREHENSIVE PREDICTOR PROCTORED
EXAM | 150 NGN PRACTICE QUESTIONS WITH DETAILED
RATIONALES | RN & PN COMPREHENSIVE REVIEW
QUESTION 1: PRIORITIZATION - ABCDE FRAMEWORK
• Question: A nurse receives shift report on four patients. One patient has a new
tracheostomy with thick secretions and audible stridor. Another patient has a
postoperative fever of 38.5°C with tachycardia. A third patient is requesting pain
medication for a 6/10 headache. The fourth patient has a blood pressure of 148/92
mmHg. Which patient should the nurse assess FIRST based on the ABCDE prioritization
framework?
• Options:
A. The patient with postoperative fever and tachycardia
B. The patient with a new tracheostomy, thick secretions, and audible stridor
C. The patient requesting pain medication for a 6/10 headache
D. The patient with a blood pressure of 148/92 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Airway is the first priority in the ABCDE
framework. Stridor is a high-pitched sound indicating partial airway obstruction,
which can progress to complete airway obstruction. Patients with new
tracheostomies are at high risk for mucus plugging. This patient requires
immediate suctioning and airway assessment.
o Distractor Pitfalls: A (Fever) is urgent but not immediately life-threatening. C
(Pain) is a comfort issue, not a priority over airway. D (Hypertension) is important
but does not threaten the airway or breathing immediately.
QUESTION 2: DELEGATION - UAP SCOPE OF PRACTICE
• Question: A registered nurse (RN) is working on a medical-surgical unit with a licensed
practical nurse (LPN) and an unlicensed assistive personnel (UAP). The RN is delegating
tasks to team members. Which task is appropriate for the RN to delegate to the UAP?
, 2
• Options:
A. Changing a sterile wound dressing
B. Administering oral medications to a stable patient
C. Assessing a patient's lung sounds
D. Measuring and recording the patient's intake and output
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: UAPs can measure and record intake and output,
take vital signs, assist with activities of daily living, and report abnormalities to
the RN. This is within their scope of practice. Intake and output measurement
does not require nursing judgment or assessment.
o Distractor Pitfalls: A (Sterile dressing) requires sterile technique and should be
performed by RN or LPN. B (Oral medications) is not within UAP scope. C
(Assessment) is an RN or LPN task, not UAP.
QUESTION 3: DELEGATION - LPN SCOPE OF PRACTICE
• Question: An RN is delegating tasks to the LPN on the medical-surgical unit. The LPN
has experience with medication administration and patient monitoring. Which task can
the RN appropriately delegate to the LPN?
• Options:
A. Perform an initial admission assessment on a new patient
B. Develop a plan of care for a patient with a new diagnosis
C. Administer a routine oral antibiotic to a stable patient
D. Administer IV push morphine to a patient in severe pain
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: LPNs can administer oral medications, including
antibiotics, to stable patients with predictable outcomes. This is within the LPN
scope of practice in most states. The RN remains responsible for overall patient
care and assessment.
o Distractor Pitfalls: A (Initial assessment) is an RN responsibility. B (Plan of
care) is an RN responsibility requiring comprehensive assessment. D (IV push
morphine) is typically not within LPN scope in acute care settings.
, 3
QUESTION 4: PRIORITIZATION - URGENT VS. STABLE
• Question: A nurse is caring for four patients after receiving shift report. One patient has
chest pain radiating to the left arm with diaphoresis. Another patient has a surgical wound
infection with a temperature of 38.2°C. A third patient is requesting a PRN analgesic for
postoperative pain. The fourth patient has a blood pressure of 150/95 mmHg. Which
patient requires the most immediate assessment?
• Options:
A. The patient with chest pain radiating to the left arm with diaphoresis
B. The patient with a surgical wound infection and temperature of 38.2°C
C. The patient requesting a PRN analgesic for postoperative pain
D. The patient with a blood pressure of 150/95 mmHg
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Chest pain radiating to the left arm with diaphoresis
is concerning for acute myocardial infarction (STEMI/NSTEMI). This is an
emergent situation requiring immediate assessment, ECG, and possible
intervention. Time is muscle in acute coronary syndrome.
o Distractor Pitfalls: B (Wound infection) is urgent but not immediately life-
threatening. C (Pain management) is important but lower priority. D
(Hypertension) is stable and not immediately dangerous at this level.
QUESTION 5: DELEGATION - ASSESSMENT TASKS
• Question: An RN is assigning patient care tasks to team members on a busy medical-
surgical unit. The unit has RNs, LPNs, and UAPs available. Which task should the RN
perform personally rather than delegating to an LPN or UAP?
• Options:
A. Taking a patient's vital signs
B. Administering a subcutaneous insulin injection
C. Assisting a patient with ambulation using a gait belt
D. Assessing a patient with new-onset confusion
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
, 4
o Pathophysiology Summary: New-onset confusion is a change in neurological
status requiring comprehensive RN assessment. This could indicate stroke,
infection, metabolic disturbance, or other serious conditions. Assessment and
clinical judgment are RN responsibilities that cannot be delegated.
o Distractor Pitfalls: A (Vital signs) can be delegated to UAP. B (Insulin injection)
can be delegated to LPN. C (Ambulation) can be delegated to UAP with proper
instruction.
QUESTION 6: MANAGEMENT OF CARE - PATIENT ASSIGNMENT
• Question: The charge nurse is making patient assignments for the shift on a unit with
RNs, LPNs, and UAPs available. Which patient should the charge nurse assign to the
most experienced RN based on acuity?
• Options:
A. A patient who is 2 days post-appendectomy with stable vital signs
B. A patient requiring discharge teaching on insulin administration
C. A patient with a urinary tract infection receiving oral antibiotics
D. A patient who is 24 hours post-cardiac arrest receiving multiple vasopressors
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: The patient who is 24 hours post-cardiac arrest on
multiple vasopressors is the most unstable and requires the most experienced RN.
This patient requires complex critical care nursing judgment, medication titration,
and hemodynamic monitoring.
o Distractor Pitfalls: A (Appendectomy) is stable and can be assigned to an RN or
LPN with less experience. B (Discharge teaching) can be done by an RN with less
experience. C (UTI) is stable and can be assigned to an LPN.
QUESTION 7: PRIORITIZATION - MASS CASUALTY TRIAGE
• Question: A mass casualty event occurs, and the triage nurse is using the START triage
system to prioritize patients. Which patient should be tagged as "IMMEDIATE" (RED)
and prioritized for treatment?
• Options:
A. A patient who is walking and talking with minor injuries
