ACTUAL ATI RN COMPREHENSIVE PREDICTOR 2026 LEVEL 3 PROCTORED EXAM QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD
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Core Domains
Management of Care
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
Nursing Process and Clinical Judgment
Next Generation NCLEX (NGN) Case Studies
Introduction
This comprehensive examination assesses the candidate's mastery of nursing concepts required for the
ATI RN Comprehensive Predictor 2026 Level 3 Proctored Exam and NCLEX-RN preparation. It evaluates
knowledge across all major nursing domains including management of care, safety, health promotion,
psychosocial integrity, pharmacology, risk reduction, and physiological adaptation. Questions are
presented in multiple-choice and Next Generation NCLEX (NGN) formats requiring integration of clinical
judgment and decision-making. Emphasis is placed on real-world application, prioritization, and
evidence-based practice. Successful completion demonstrates readiness for professional nursing practice
and first-attempt NCLEX-RN success.
SECTION ONE: QUESTIONS 1–180
Question 1
A nurse is caring for a client who is receiving mechanical ventilation. Which of the following findings
should the nurse report to the provider immediately?
A. Respiratory rate of 18 breaths per minute
B. Peak inspiratory pressure of 35 cm H2O
C. Oxygen saturation of 94%
D. Tidal volume of 500 mL
🟢 B. Peak inspiratory pressure of 35 cm H2O
🔴 RATIONALE: An elevated peak inspiratory pressure (normal 20-30 cm H2O) indicates increased
airway resistance or decreased lung compliance, which may signal pneumothorax, mucus plugging, or
bronchospasm. This requires immediate evaluation as it can lead to barotrauma.
,Question 2
A nurse is prioritizing care for four clients. Which client should the nurse assess first?
A. A client who is 2 days postoperative and reports incisional pain rated 6/10
B. A client with heart failure who has gained 2 kg overnight
C. A client with a new onset of confusion and agitation
D. A client who requires discharge teaching about insulin administration
🟢 C. A client with a new onset of confusion and agitation
🔴 RATIONALE: New onset confusion and agitation may indicate hypoxia, hypoglycemia, medication
reaction, or neurological deterioration. This acute change requires immediate assessment using the
ABCDE approach. Postoperative pain, weight gain in heart failure, and discharge teaching are
important but not immediately life-threatening.
Question 3
A nurse is preparing to administer digoxin to a client with heart failure. The nurse should withhold the
medication and notify the provider if which of the following is noted?
A. Heart rate of 58 beats per minute
B. Potassium level of 4.2 mEq/L
C. Blood pressure of 118/72 mm Hg
D. Digoxin level of 1.2 ng/mL
🟢 A. Heart rate of 58 beats per minute
🔴 RATIONALE: Digoxin should be withheld if the adult heart rate is below 60 beats per minute due to
the risk of bradycardia and heart block. The therapeutic digoxin level is 0.5-2.0 ng/mL, and potassium
should be monitored for hypokalemia, which increases digoxin toxicity risk.
Question 4
A nurse is assessing a client who has been prescribed lithium carbonate. Which of the following
findings indicates lithium toxicity?
A. Serum lithium level of 0.8 mEq/L
B. Fine hand tremors
C. Coarse hand tremors and confusion
D. Increased thirst
,🟢 C. Coarse hand tremors and confusion
🔴 RATIONALE: Coarse hand tremors, confusion, ataxia, and seizures indicate moderate to severe
lithium toxicity (levels above 1.5 mEq/L). Fine hand tremors and increased thirst are expected side
effects within therapeutic range (0.6-1.2 mEq/L).
Question 5
A nurse is caring for a client who has a new prescription for warfarin. Which of the following laboratory
values should the nurse monitor?
A. Platelet count
B. INR
C. aPTT
D. Hemoglobin
🟢 B. INR
🔴 RATIONALE: Warfarin therapy is monitored using the INR (International Normalized Ratio), with a
therapeutic range of 2.0-3.0 for most indications and 2.5-3.5 for mechanical heart valves. aPTT
monitors heparin therapy; platelet count and hemoglobin assess for bleeding complications.
Question 6
A nurse is teaching a client about a new prescription for metformin. Which of the following
instructions should the nurse include?
A. "Take the medication with meals to reduce gastrointestinal upset."
B. "Stop the medication if you experience nausea."
C. "Take the medication at bedtime on an empty stomach."
D. "You can skip doses when your blood sugar is normal."
🟢 A. "Take the medication with meals to reduce gastrointestinal upset."
🔴 RATIONALE: Metformin should be taken with meals to minimize gastrointestinal side effects such
as nausea, diarrhea, and abdominal discomfort. Clients should not stop the medication without
provider approval, and the medication should be continued even when blood glucose is controlled.
Question 7
A nurse is performing a focused assessment on a client who has a chest tube connected to suction.
Which of the following findings requires immediate intervention?
A. Gentle bubbling in the suction control chamber
, B. Continuous bubbling in the water seal chamber
C. Tidaling in the water seal chamber
D. Drainage of 50 mL in the first hour
🟢 B. Continuous bubbling in the water seal chamber
🔴 RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak in the system.
This requires immediate assessment and intervention to identify and correct the leak. Gentle bubbling
in the suction control chamber and tidaling are expected findings.
Question 8
A nurse is caring for a client who is 24 hours postoperative following a total hip arthroplasty. Which of
the following interventions should the nurse include in the plan of care?
A. Place a pillow between the legs when turning
B. Flex the hip to 90 degrees when sitting
C. Avoid using an abduction pillow
D. Encourage crossing the legs when sitting
🟢 A. Place a pillow between the legs when turning
🔴 RATIONALE: Following total hip arthroplasty, the nurse should maintain hip abduction by placing a
pillow between the legs when turning or using an abduction pillow. Clients should avoid hip flexion
greater than 90 degrees, crossing legs, and internal rotation to prevent dislocation.
Question 9
A nurse is assessing a client who is receiving a blood transfusion. Which of the following findings
indicates an acute hemolytic reaction?
A. Temperature elevation of 1°F
B. Urticaria and itching
C. Low back pain and dark urine
D. Mild shortness of breath
🟢 C. Low back pain and dark urine
🔴 RATIONALE: Acute hemolytic transfusion reaction presents with fever, chills, low back pain, dark
urine (hemoglobinuria), and hypotension due to destruction of red blood cells. The nurse should stop
the transfusion immediately and notify the provider.
Question 10
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD
Core Domains
Management of Care
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
Nursing Process and Clinical Judgment
Next Generation NCLEX (NGN) Case Studies
Introduction
This comprehensive examination assesses the candidate's mastery of nursing concepts required for the
ATI RN Comprehensive Predictor 2026 Level 3 Proctored Exam and NCLEX-RN preparation. It evaluates
knowledge across all major nursing domains including management of care, safety, health promotion,
psychosocial integrity, pharmacology, risk reduction, and physiological adaptation. Questions are
presented in multiple-choice and Next Generation NCLEX (NGN) formats requiring integration of clinical
judgment and decision-making. Emphasis is placed on real-world application, prioritization, and
evidence-based practice. Successful completion demonstrates readiness for professional nursing practice
and first-attempt NCLEX-RN success.
SECTION ONE: QUESTIONS 1–180
Question 1
A nurse is caring for a client who is receiving mechanical ventilation. Which of the following findings
should the nurse report to the provider immediately?
A. Respiratory rate of 18 breaths per minute
B. Peak inspiratory pressure of 35 cm H2O
C. Oxygen saturation of 94%
D. Tidal volume of 500 mL
🟢 B. Peak inspiratory pressure of 35 cm H2O
🔴 RATIONALE: An elevated peak inspiratory pressure (normal 20-30 cm H2O) indicates increased
airway resistance or decreased lung compliance, which may signal pneumothorax, mucus plugging, or
bronchospasm. This requires immediate evaluation as it can lead to barotrauma.
,Question 2
A nurse is prioritizing care for four clients. Which client should the nurse assess first?
A. A client who is 2 days postoperative and reports incisional pain rated 6/10
B. A client with heart failure who has gained 2 kg overnight
C. A client with a new onset of confusion and agitation
D. A client who requires discharge teaching about insulin administration
🟢 C. A client with a new onset of confusion and agitation
🔴 RATIONALE: New onset confusion and agitation may indicate hypoxia, hypoglycemia, medication
reaction, or neurological deterioration. This acute change requires immediate assessment using the
ABCDE approach. Postoperative pain, weight gain in heart failure, and discharge teaching are
important but not immediately life-threatening.
Question 3
A nurse is preparing to administer digoxin to a client with heart failure. The nurse should withhold the
medication and notify the provider if which of the following is noted?
A. Heart rate of 58 beats per minute
B. Potassium level of 4.2 mEq/L
C. Blood pressure of 118/72 mm Hg
D. Digoxin level of 1.2 ng/mL
🟢 A. Heart rate of 58 beats per minute
🔴 RATIONALE: Digoxin should be withheld if the adult heart rate is below 60 beats per minute due to
the risk of bradycardia and heart block. The therapeutic digoxin level is 0.5-2.0 ng/mL, and potassium
should be monitored for hypokalemia, which increases digoxin toxicity risk.
Question 4
A nurse is assessing a client who has been prescribed lithium carbonate. Which of the following
findings indicates lithium toxicity?
A. Serum lithium level of 0.8 mEq/L
B. Fine hand tremors
C. Coarse hand tremors and confusion
D. Increased thirst
,🟢 C. Coarse hand tremors and confusion
🔴 RATIONALE: Coarse hand tremors, confusion, ataxia, and seizures indicate moderate to severe
lithium toxicity (levels above 1.5 mEq/L). Fine hand tremors and increased thirst are expected side
effects within therapeutic range (0.6-1.2 mEq/L).
Question 5
A nurse is caring for a client who has a new prescription for warfarin. Which of the following laboratory
values should the nurse monitor?
A. Platelet count
B. INR
C. aPTT
D. Hemoglobin
🟢 B. INR
🔴 RATIONALE: Warfarin therapy is monitored using the INR (International Normalized Ratio), with a
therapeutic range of 2.0-3.0 for most indications and 2.5-3.5 for mechanical heart valves. aPTT
monitors heparin therapy; platelet count and hemoglobin assess for bleeding complications.
Question 6
A nurse is teaching a client about a new prescription for metformin. Which of the following
instructions should the nurse include?
A. "Take the medication with meals to reduce gastrointestinal upset."
B. "Stop the medication if you experience nausea."
C. "Take the medication at bedtime on an empty stomach."
D. "You can skip doses when your blood sugar is normal."
🟢 A. "Take the medication with meals to reduce gastrointestinal upset."
🔴 RATIONALE: Metformin should be taken with meals to minimize gastrointestinal side effects such
as nausea, diarrhea, and abdominal discomfort. Clients should not stop the medication without
provider approval, and the medication should be continued even when blood glucose is controlled.
Question 7
A nurse is performing a focused assessment on a client who has a chest tube connected to suction.
Which of the following findings requires immediate intervention?
A. Gentle bubbling in the suction control chamber
, B. Continuous bubbling in the water seal chamber
C. Tidaling in the water seal chamber
D. Drainage of 50 mL in the first hour
🟢 B. Continuous bubbling in the water seal chamber
🔴 RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak in the system.
This requires immediate assessment and intervention to identify and correct the leak. Gentle bubbling
in the suction control chamber and tidaling are expected findings.
Question 8
A nurse is caring for a client who is 24 hours postoperative following a total hip arthroplasty. Which of
the following interventions should the nurse include in the plan of care?
A. Place a pillow between the legs when turning
B. Flex the hip to 90 degrees when sitting
C. Avoid using an abduction pillow
D. Encourage crossing the legs when sitting
🟢 A. Place a pillow between the legs when turning
🔴 RATIONALE: Following total hip arthroplasty, the nurse should maintain hip abduction by placing a
pillow between the legs when turning or using an abduction pillow. Clients should avoid hip flexion
greater than 90 degrees, crossing legs, and internal rotation to prevent dislocation.
Question 9
A nurse is assessing a client who is receiving a blood transfusion. Which of the following findings
indicates an acute hemolytic reaction?
A. Temperature elevation of 1°F
B. Urticaria and itching
C. Low back pain and dark urine
D. Mild shortness of breath
🟢 C. Low back pain and dark urine
🔴 RATIONALE: Acute hemolytic transfusion reaction presents with fever, chills, low back pain, dark
urine (hemoglobinuria), and hypotension due to destruction of red blood cells. The nurse should stop
the transfusion immediately and notify the provider.
Question 10
