2026 UPDATED QUESTIONS DOWNLOAD
ATI RN Comprehensive Predictor 2026-2027 | 550-Question Practice Set: Med-Surg,
Pharmacology, Pediatrics, OB, Mental Health, & Lead Management with Detailed
Rationales
Achieve a 90% or higher predictability score on your nursing exit exam with this
meticulously updated 550-question practice set for the 2026-2027 cycle. Each
question is designed to test high-level clinical judgment, focusing on the most "must-
know" topics like electrolyte imbalances, acid-base disorders, and emergency
interventions. Every answer includes a detailed italicized rationale to bridge the gap
between knowing a fact and applying it to complex patient scenarios.
A nurse is caring for a client who is 12 hours postoperative following a total
thyroidectomy. Which of the following is the priority assessment?
A. Serum calcium level
B. Laryngeal stridor
C. Hoarseness of the voice
D. Pain at the incision site
Rationale: Stidor indicates an upper airway obstruction caused by edema or tetany
(from hypocalcemia), which is a life-threatening emergency. While calcium and
hoarseness are important, airway is the priority according to ABCs.
A nurse is reviewing the laboratory results of a client who has liver cirrhosis and is
receiving lactulose. Which of the following findings indicates the medication is
effective?
A. Increased serum albumin
B. Decreased prothrombin time
C. Decreased serum ammonia
D. Increased serum potassium
Rationale: Lactulose is administered to promote the excretion of ammonia through
the stool in clients with hepatic encephalopathy. A decrease in ammonia levels
indicates therapeutic effect.
A nurse is preparing to administer an IV bolus of phenytoin to a client. Which of the
following solutions is the only compatible fluid for this medication?
,2026 UPDATED QUESTIONS DOWNLOAD
A. 5% Dextrose in water (D5W)
B. Lactated Ringer's
C. 0.9% Sodium Chloride (NS)
D. 0.45% Sodium Chloride (1/2 NS)
Rationale: Phenytoin precipitates immediately when mixed with dextrose-containing
solutions. Only 0.9% sodium chloride should be used to flush the line before and
after administration.
A nurse is caring for a client who has a prescription for lithium carbonate. Which of
the following dietary instructions should the nurse provide?
A. "Limit your fluid intake to 1.5 liters per day."
B. "Maintain a consistent intake of sodium."
C. "Avoid high-protein foods."
D. "Increase your intake of green leafy vegetables."
Rationale: Lithium is a salt. If sodium intake is restricted or lost (via
sweating/diuretics), the kidneys will reabsorb lithium instead of sodium, leading to
toxicity.
A nurse is assessing a client who is at 36 weeks of gestation and reports painless,
bright red vaginal bleeding. Which of the following conditions should the nurse
suspect?
A. Abruptio placentae
B. Placenta previa
C. Preeclampsia
D. Ectopic pregnancy
Rationale: Painless, bright red bleeding is the hallmark sign of placenta previa.
Abruptio placentae usually involves painful, dark red bleeding and a board-like
abdomen.
A nurse is teaching a client who has a new prescription for alendronate. Which of the
following instructions should the nurse include?
A. "Take the medication with your morning coffee."
B. "Lie down for 30 minutes after taking the dose."
,2026 UPDATED QUESTIONS DOWNLOAD
C. "Take the medication with a full glass of water on an empty stomach."
D. "Crush the tablet if you have trouble swallowing."
Rationale: Alendronate can cause severe esophageal erosion. It must be taken with
8 oz of plain water 30 minutes before food, and the client must remain upright.
A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2
52, HCO3 26. Which of the following is the correct interpretation?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 indicates that the
lungs are retaining CO2, identifying the cause as respiratory.
A nurse is caring for a client who is experiencing an acute manic episode of bipolar
disorder. Which of the following nursing interventions is the priority?
A. Encourage the client to join a group therapy session.
B. Provide high-calorie finger foods.
C. Dim the lights in the client's room.
D. Ask the client to explain their feelings.
Rationale: Clients in a manic state are often too hyperactive to sit for meals. Finger
foods ensure they maintain adequate nutrition and hydration while moving.
A nurse is assessing a client with a chest tube and notes continuous bubbling in the
water seal chamber. Which of the following should the nurse do?
A. Document this as a normal finding.
B. Check the system for an air leak.
C. Increase the suction level.
D. Clamp the tube for 15 minutes.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak.
Intermittent bubbling is normal in a client with a pneumothorax during expiration
or coughing.
, 2026 UPDATED QUESTIONS DOWNLOAD
A nurse is preparing to administer digoxin to a client. Which of the following findings
should lead the nurse to withhold the medication?
A. Blood pressure 140/90 mm Hg
B. Apical pulse 52/min
C. Respiratory rate 20/min
D. Potassium 4.8 mEq/L
Rationale: Digoxin should be withheld if the apical pulse is less than 60/min in an
adult, as it decreases the heart rate (negative chronotropic effect).
A nurse is caring for a client who has a prescription for warfarin. Which of the
following laboratory values should the nurse monitor?
A. aPTT
B. PT/INR
C. Platelet count
D. Hemoglobin
Rationale: INR (International Normalized Ratio) and PT (Prothrombin Time) are used
to monitor warfarin. aPTT is used for heparin.
A nurse is caring for a client who has an active pulmonary tuberculosis (TB)
infection. Which of the following personal protective equipment (PPE) is
required?
A. Surgical mask
B. N95 respirator
C. Gown and gloves only
D. Face shield
Rationale: TB is an airborne disease. Healthcare workers must wear a fit-tested N95
respirator to filter out the small airborne particles.
A nurse is assessing a client with hyperkalemia. Which of the following EKG
changes should the nurse expect?
A. ST-segment depression
B. Peaked T waves
ATI RN Comprehensive Predictor 2026-2027 | 550-Question Practice Set: Med-Surg,
Pharmacology, Pediatrics, OB, Mental Health, & Lead Management with Detailed
Rationales
Achieve a 90% or higher predictability score on your nursing exit exam with this
meticulously updated 550-question practice set for the 2026-2027 cycle. Each
question is designed to test high-level clinical judgment, focusing on the most "must-
know" topics like electrolyte imbalances, acid-base disorders, and emergency
interventions. Every answer includes a detailed italicized rationale to bridge the gap
between knowing a fact and applying it to complex patient scenarios.
A nurse is caring for a client who is 12 hours postoperative following a total
thyroidectomy. Which of the following is the priority assessment?
A. Serum calcium level
B. Laryngeal stridor
C. Hoarseness of the voice
D. Pain at the incision site
Rationale: Stidor indicates an upper airway obstruction caused by edema or tetany
(from hypocalcemia), which is a life-threatening emergency. While calcium and
hoarseness are important, airway is the priority according to ABCs.
A nurse is reviewing the laboratory results of a client who has liver cirrhosis and is
receiving lactulose. Which of the following findings indicates the medication is
effective?
A. Increased serum albumin
B. Decreased prothrombin time
C. Decreased serum ammonia
D. Increased serum potassium
Rationale: Lactulose is administered to promote the excretion of ammonia through
the stool in clients with hepatic encephalopathy. A decrease in ammonia levels
indicates therapeutic effect.
A nurse is preparing to administer an IV bolus of phenytoin to a client. Which of the
following solutions is the only compatible fluid for this medication?
,2026 UPDATED QUESTIONS DOWNLOAD
A. 5% Dextrose in water (D5W)
B. Lactated Ringer's
C. 0.9% Sodium Chloride (NS)
D. 0.45% Sodium Chloride (1/2 NS)
Rationale: Phenytoin precipitates immediately when mixed with dextrose-containing
solutions. Only 0.9% sodium chloride should be used to flush the line before and
after administration.
A nurse is caring for a client who has a prescription for lithium carbonate. Which of
the following dietary instructions should the nurse provide?
A. "Limit your fluid intake to 1.5 liters per day."
B. "Maintain a consistent intake of sodium."
C. "Avoid high-protein foods."
D. "Increase your intake of green leafy vegetables."
Rationale: Lithium is a salt. If sodium intake is restricted or lost (via
sweating/diuretics), the kidneys will reabsorb lithium instead of sodium, leading to
toxicity.
A nurse is assessing a client who is at 36 weeks of gestation and reports painless,
bright red vaginal bleeding. Which of the following conditions should the nurse
suspect?
A. Abruptio placentae
B. Placenta previa
C. Preeclampsia
D. Ectopic pregnancy
Rationale: Painless, bright red bleeding is the hallmark sign of placenta previa.
Abruptio placentae usually involves painful, dark red bleeding and a board-like
abdomen.
A nurse is teaching a client who has a new prescription for alendronate. Which of the
following instructions should the nurse include?
A. "Take the medication with your morning coffee."
B. "Lie down for 30 minutes after taking the dose."
,2026 UPDATED QUESTIONS DOWNLOAD
C. "Take the medication with a full glass of water on an empty stomach."
D. "Crush the tablet if you have trouble swallowing."
Rationale: Alendronate can cause severe esophageal erosion. It must be taken with
8 oz of plain water 30 minutes before food, and the client must remain upright.
A nurse is reviewing the arterial blood gas (ABG) results for a client: pH 7.30, PaCO2
52, HCO3 26. Which of the following is the correct interpretation?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 indicates that the
lungs are retaining CO2, identifying the cause as respiratory.
A nurse is caring for a client who is experiencing an acute manic episode of bipolar
disorder. Which of the following nursing interventions is the priority?
A. Encourage the client to join a group therapy session.
B. Provide high-calorie finger foods.
C. Dim the lights in the client's room.
D. Ask the client to explain their feelings.
Rationale: Clients in a manic state are often too hyperactive to sit for meals. Finger
foods ensure they maintain adequate nutrition and hydration while moving.
A nurse is assessing a client with a chest tube and notes continuous bubbling in the
water seal chamber. Which of the following should the nurse do?
A. Document this as a normal finding.
B. Check the system for an air leak.
C. Increase the suction level.
D. Clamp the tube for 15 minutes.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak.
Intermittent bubbling is normal in a client with a pneumothorax during expiration
or coughing.
, 2026 UPDATED QUESTIONS DOWNLOAD
A nurse is preparing to administer digoxin to a client. Which of the following findings
should lead the nurse to withhold the medication?
A. Blood pressure 140/90 mm Hg
B. Apical pulse 52/min
C. Respiratory rate 20/min
D. Potassium 4.8 mEq/L
Rationale: Digoxin should be withheld if the apical pulse is less than 60/min in an
adult, as it decreases the heart rate (negative chronotropic effect).
A nurse is caring for a client who has a prescription for warfarin. Which of the
following laboratory values should the nurse monitor?
A. aPTT
B. PT/INR
C. Platelet count
D. Hemoglobin
Rationale: INR (International Normalized Ratio) and PT (Prothrombin Time) are used
to monitor warfarin. aPTT is used for heparin.
A nurse is caring for a client who has an active pulmonary tuberculosis (TB)
infection. Which of the following personal protective equipment (PPE) is
required?
A. Surgical mask
B. N95 respirator
C. Gown and gloves only
D. Face shield
Rationale: TB is an airborne disease. Healthcare workers must wear a fit-tested N95
respirator to filter out the small airborne particles.
A nurse is assessing a client with hyperkalemia. Which of the following EKG
changes should the nurse expect?
A. ST-segment depression
B. Peaked T waves
