NGN ATI PN COMPREHENSIVE PREDICTOR EXAM 2026/2027
Test Bank | A+ Graded | 200 Questions
Aligned with NCLEX-PN Test Plan & NCSBN Clinical Judgment Measurement
Model
CASE STUDY 1: Mr. Henderson - Post-Operative Care in LTC
Setting: Long-Term Care Facility
Background: 82-year-old male, day 3 post-hip pinning for a fracture. History of mild
dementia. Orders: Vital signs q4h, OOB to chair with assist BID, Docusate 100mg PO
BID, Enoxaparin 40mg subQ daily, Acetaminophen 650mg q6h PRN pain.
Exhibit: CNA Report: "Mr. H. refused his afternoon dose of docusate. He ate only 25% of
lunch. He's been complaining of right calf pain since this morning. I didn't take his vitals
at 1400 because he was sleeping."
Q1 (Recognize Cues - Multiple Response): Which findings from the CNA report require
immediate follow-up by the PN? Select all that apply.
A. Refused docusate
B. Complaining of new right calf pain [CORRECT]
C. Ate only 25% of lunch
D. 1400 vital signs were not taken [CORRECT]
E. History of mild dementia
Correct Answer: B, D
,Rationale: [NCJMM: RECOGNIZE CUES] The PN must identify urgent vs. non-urgent
data. New calf pain (B) in a post-op patient on anticoagulation is a red flag for deep vein
thrombosis (DVT), a potential emergency requiring immediate assessment and
reporting to the supervising RN. Missing ordered vital signs (D) is a deviation from the
care plan that must be addressed to monitor for post-op complications like infection or
bleeding. Why others are wrong: (A) Refusing a stool softener is not an immediate
safety threat; monitor for constipation. (C) Poor intake should be monitored and
reported but is not an acute emergency. (E) This is baseline information, not a new
change requiring intervention.
Q2 (Prioritize Hypotheses - Cloze): Based on the cue of new calf pain, what is the PN's
priority hypothesis?
The PN should suspect: __________
A. Expected post-operative pain
B. Possible deep vein thrombosis (DVT) [CORRECT]
C. Medication side effect
D. Muscle strain from therapy
Correct Answer: B
Rationale: [NCJMM: PRIORITIZE HYPOTHESES] In the context of recent orthopedic
surgery, immobility, and anticoagulant prophylaxis, new unilateral calf pain raises the
highest priority concern for DVT, a life-threatening complication that can lead to
pulmonary embolism. While muscle strain is possible, the PN must prioritize the most
dangerous possibility first and report immediately for diagnostic evaluation (duplex
ultrasound).
,Q3 (Take Action - Extended Drag & Drop): The PN enters the room to assess Mr.
Henderson. Prioritize the nurse's actions from first to last.
Available Actions:
● Perform hand hygiene and introduce yourself
● Assess the right calf for warmth, redness, swelling, and tenderness; measure calf
circumference
● Take the patient's vital signs (BP, HR, RR, Temp, SpO2)
● Notify the supervising RN of the findings immediately
Correct Order:
1. Perform hand hygiene and introduce yourself [CORRECT]
2. Assess the right calf for warmth, redness, swelling, and tenderness; measure calf
circumference [CORRECT]
3. Take the patient's vital signs (BP, HR, RR, Temp, SpO2) [CORRECT]
4. Notify the supervising RN of the findings immediately [CORRECT]
Rationale: [NCJMM: TAKE ACTION] Safety & Scope Sequence: Standard infection
control first (1). Then, perform the focused assessment related to the primary concern
(calf assessment for DVT signs: Homans' sign is NOT recommended due to risk of
embolism) (2). Next, obtain objective vital signs to provide complete data (tachycardia
or dyspnea would indicate PE risk) (3). Finally, report the findings to the RN (4), as
initiating a medical diagnosis (DVT) and subsequent orders (e.g., ultrasound, heparin
protocol) are outside the PN's independent scope.
Q4 (Generate Solutions - Multiple Choice): The RN confirms the suspicion of possible
DVT and instructs the PN to administer the scheduled enoxaparin. Which action is
essential for the PN?
A. Hold the enoxaparin and await new orders
, B. Administer the enoxaparin as ordered in the abdomen, avoiding any bruises or scars
[CORRECT]
C. Massage the injection site vigorously after administration
D. Apply heat to the right calf after the injection
Correct Answer: B
Rationale: [NCJMM: GENERATE SOLUTIONS] Enoxaparin is a treatment for and
prevention of DVT. The PN should administer it as prescribed. Correct technique
includes using abdominal subcutaneous tissue (2 inches from umbilicus), rotating sites,
and not massaging the site (which can cause bruising). Why others are wrong: (A)
Incorrect; enoxaparin is indicated for DVT treatment/prophylaxis. (C) Increases risk of
hematoma and bruising. (D) Heat is contraindicated in suspected DVT as it could
increase circulation and potential dislodgement of the clot.
Q5 (Take Action - Cloze): When preparing the enoxaparin prefilled syringe, the PN must
remember: __________
A. To expel the air bubble from the syringe before injection
B. To NOT expel the air bubble from the syringe before injection [CORRECT]
C. To shake the syringe vigorously to mix the medication
D. To aspirate for blood before injecting
Correct Answer: B
Rationale: [NCJMM: TAKE ACTION] Medication Safety: For prefilled low molecular
weight heparin syringes (enoxaparin), the air bubble should NOT be expelled. It is
Test Bank | A+ Graded | 200 Questions
Aligned with NCLEX-PN Test Plan & NCSBN Clinical Judgment Measurement
Model
CASE STUDY 1: Mr. Henderson - Post-Operative Care in LTC
Setting: Long-Term Care Facility
Background: 82-year-old male, day 3 post-hip pinning for a fracture. History of mild
dementia. Orders: Vital signs q4h, OOB to chair with assist BID, Docusate 100mg PO
BID, Enoxaparin 40mg subQ daily, Acetaminophen 650mg q6h PRN pain.
Exhibit: CNA Report: "Mr. H. refused his afternoon dose of docusate. He ate only 25% of
lunch. He's been complaining of right calf pain since this morning. I didn't take his vitals
at 1400 because he was sleeping."
Q1 (Recognize Cues - Multiple Response): Which findings from the CNA report require
immediate follow-up by the PN? Select all that apply.
A. Refused docusate
B. Complaining of new right calf pain [CORRECT]
C. Ate only 25% of lunch
D. 1400 vital signs were not taken [CORRECT]
E. History of mild dementia
Correct Answer: B, D
,Rationale: [NCJMM: RECOGNIZE CUES] The PN must identify urgent vs. non-urgent
data. New calf pain (B) in a post-op patient on anticoagulation is a red flag for deep vein
thrombosis (DVT), a potential emergency requiring immediate assessment and
reporting to the supervising RN. Missing ordered vital signs (D) is a deviation from the
care plan that must be addressed to monitor for post-op complications like infection or
bleeding. Why others are wrong: (A) Refusing a stool softener is not an immediate
safety threat; monitor for constipation. (C) Poor intake should be monitored and
reported but is not an acute emergency. (E) This is baseline information, not a new
change requiring intervention.
Q2 (Prioritize Hypotheses - Cloze): Based on the cue of new calf pain, what is the PN's
priority hypothesis?
The PN should suspect: __________
A. Expected post-operative pain
B. Possible deep vein thrombosis (DVT) [CORRECT]
C. Medication side effect
D. Muscle strain from therapy
Correct Answer: B
Rationale: [NCJMM: PRIORITIZE HYPOTHESES] In the context of recent orthopedic
surgery, immobility, and anticoagulant prophylaxis, new unilateral calf pain raises the
highest priority concern for DVT, a life-threatening complication that can lead to
pulmonary embolism. While muscle strain is possible, the PN must prioritize the most
dangerous possibility first and report immediately for diagnostic evaluation (duplex
ultrasound).
,Q3 (Take Action - Extended Drag & Drop): The PN enters the room to assess Mr.
Henderson. Prioritize the nurse's actions from first to last.
Available Actions:
● Perform hand hygiene and introduce yourself
● Assess the right calf for warmth, redness, swelling, and tenderness; measure calf
circumference
● Take the patient's vital signs (BP, HR, RR, Temp, SpO2)
● Notify the supervising RN of the findings immediately
Correct Order:
1. Perform hand hygiene and introduce yourself [CORRECT]
2. Assess the right calf for warmth, redness, swelling, and tenderness; measure calf
circumference [CORRECT]
3. Take the patient's vital signs (BP, HR, RR, Temp, SpO2) [CORRECT]
4. Notify the supervising RN of the findings immediately [CORRECT]
Rationale: [NCJMM: TAKE ACTION] Safety & Scope Sequence: Standard infection
control first (1). Then, perform the focused assessment related to the primary concern
(calf assessment for DVT signs: Homans' sign is NOT recommended due to risk of
embolism) (2). Next, obtain objective vital signs to provide complete data (tachycardia
or dyspnea would indicate PE risk) (3). Finally, report the findings to the RN (4), as
initiating a medical diagnosis (DVT) and subsequent orders (e.g., ultrasound, heparin
protocol) are outside the PN's independent scope.
Q4 (Generate Solutions - Multiple Choice): The RN confirms the suspicion of possible
DVT and instructs the PN to administer the scheduled enoxaparin. Which action is
essential for the PN?
A. Hold the enoxaparin and await new orders
, B. Administer the enoxaparin as ordered in the abdomen, avoiding any bruises or scars
[CORRECT]
C. Massage the injection site vigorously after administration
D. Apply heat to the right calf after the injection
Correct Answer: B
Rationale: [NCJMM: GENERATE SOLUTIONS] Enoxaparin is a treatment for and
prevention of DVT. The PN should administer it as prescribed. Correct technique
includes using abdominal subcutaneous tissue (2 inches from umbilicus), rotating sites,
and not massaging the site (which can cause bruising). Why others are wrong: (A)
Incorrect; enoxaparin is indicated for DVT treatment/prophylaxis. (C) Increases risk of
hematoma and bruising. (D) Heat is contraindicated in suspected DVT as it could
increase circulation and potential dislodgement of the clot.
Q5 (Take Action - Cloze): When preparing the enoxaparin prefilled syringe, the PN must
remember: __________
A. To expel the air bubble from the syringe before injection
B. To NOT expel the air bubble from the syringe before injection [CORRECT]
C. To shake the syringe vigorously to mix the medication
D. To aspirate for blood before injecting
Correct Answer: B
Rationale: [NCJMM: TAKE ACTION] Medication Safety: For prefilled low molecular
weight heparin syringes (enoxaparin), the air bubble should NOT be expelled. It is
