ATI PN Comprehensive Predictor 2026 – NGN
Practice Exam B | NGN Clinical Judgment
Case Studies, Verified Answers, &
Comprehensive Rationales
1. A nurse is caring for a client with major depressive
disorder who has recently started sertraline. Which
observation requires immediate intervention?
A. Increased appetite
B. Mild nausea
C. Reports of suicidal thoughts with increased energy
D. Dry mouth
Rationale: Clients starting SSRIs may experience increased
energy before mood improves, which can increase suicide
risk. This creates a window where the client may have enough
motivation to act on suicidal thoughts. This is a priority safety
concern requiring immediate intervention and provider
notification.
2. A client with heart failure is prescribed furosemide.
Which lab value is most concerning?
A. Sodium 138 mEq/L
B. Potassium 3.0 mEq/L
,C. Calcium 9.2 mg/dL
D. Chloride 101 mEq/L
B. Potassium 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes
potassium loss. A potassium level of 3.0 mEq/L indicates
hypokalemia, increasing risk for dysrhythmias and digoxin
toxicity. This is the most dangerous abnormality.
3. A nurse is teaching a client with diabetes about
hypoglycemia. Which statement indicates correct
understanding?
A. “I will skip meals if my sugar is high.”
B. “I should take insulin even if I am not eating.”
C. “I will carry glucose tablets at all times.”
D. “I should exercise when my blood sugar is below 60.”
Rationale: Rapid-acting carbohydrates are essential for
treating hypoglycemia. Carrying glucose tablets ensures
immediate treatment and prevents progression to seizures or
coma.
4. A post-op client suddenly develops chest pain, dyspnea,
and tachycardia. What is the priority action?
A. Obtain a chest X-ray
B. Administer pain medication
C. Apply oxygen and notify the provider immediately
D. Encourage deep breathing exercises
,Rationale: These symptoms suggest pulmonary embolism.
The priority is oxygenation and rapid escalation of care to
prevent respiratory collapse.
5. A nurse is assessing a newborn. Which finding requires
immediate action?
A. Acrocyanosis
B. Heart rate 140 bpm
C. Respiratory rate 50/min
D. Central cyanosis
Rationale: Central cyanosis indicates inadequate oxygenation
and possible congenital heart or respiratory pathology. This is
an emergency finding in a newborn.
6. A client receiving lithium reports diarrhea, tremors, and
confusion. What is the priority action?
A. Give next dose with food
B. Increase fluid intake
C. Hold medication and obtain lithium level
D. Administer anti-diarrheal medication
Rationale: These are signs of lithium toxicity. Immediate
discontinuation and serum level evaluation are required to
prevent seizures and organ damage.
7. A nurse is caring for a client in active labor with variable
decelerations. What is the first action?
, A. Prepare for cesarean section
B. Increase oxytocin infusion
C. Reposition the client laterally
D. Perform a sterile vaginal exam
Rationale: Variable decelerations indicate cord compression.
Repositioning relieves pressure on the umbilical cord and is
the first-line intervention.
8. A client with COPD is receiving oxygen therapy. Which
oxygen delivery method is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 10 L/min
C. Nasal cannula at 1–2 L/min
D. Venturi mask at 60%
Rationale: COPD patients retain CO₂ and require controlled
oxygen delivery. Low-flow nasal cannula prevents suppression
of hypoxic drive.
9. A nurse is caring for a client with suspected stroke. Which
assessment is priority?
A. Blood glucose level
B. Pupillary response
C. Time last known well
D. Reflex testing
Rationale: Time of symptom onset determines eligibility for
thrombolytic therapy. This is critical for treatment decisions.
Practice Exam B | NGN Clinical Judgment
Case Studies, Verified Answers, &
Comprehensive Rationales
1. A nurse is caring for a client with major depressive
disorder who has recently started sertraline. Which
observation requires immediate intervention?
A. Increased appetite
B. Mild nausea
C. Reports of suicidal thoughts with increased energy
D. Dry mouth
Rationale: Clients starting SSRIs may experience increased
energy before mood improves, which can increase suicide
risk. This creates a window where the client may have enough
motivation to act on suicidal thoughts. This is a priority safety
concern requiring immediate intervention and provider
notification.
2. A client with heart failure is prescribed furosemide.
Which lab value is most concerning?
A. Sodium 138 mEq/L
B. Potassium 3.0 mEq/L
,C. Calcium 9.2 mg/dL
D. Chloride 101 mEq/L
B. Potassium 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes
potassium loss. A potassium level of 3.0 mEq/L indicates
hypokalemia, increasing risk for dysrhythmias and digoxin
toxicity. This is the most dangerous abnormality.
3. A nurse is teaching a client with diabetes about
hypoglycemia. Which statement indicates correct
understanding?
A. “I will skip meals if my sugar is high.”
B. “I should take insulin even if I am not eating.”
C. “I will carry glucose tablets at all times.”
D. “I should exercise when my blood sugar is below 60.”
Rationale: Rapid-acting carbohydrates are essential for
treating hypoglycemia. Carrying glucose tablets ensures
immediate treatment and prevents progression to seizures or
coma.
4. A post-op client suddenly develops chest pain, dyspnea,
and tachycardia. What is the priority action?
A. Obtain a chest X-ray
B. Administer pain medication
C. Apply oxygen and notify the provider immediately
D. Encourage deep breathing exercises
,Rationale: These symptoms suggest pulmonary embolism.
The priority is oxygenation and rapid escalation of care to
prevent respiratory collapse.
5. A nurse is assessing a newborn. Which finding requires
immediate action?
A. Acrocyanosis
B. Heart rate 140 bpm
C. Respiratory rate 50/min
D. Central cyanosis
Rationale: Central cyanosis indicates inadequate oxygenation
and possible congenital heart or respiratory pathology. This is
an emergency finding in a newborn.
6. A client receiving lithium reports diarrhea, tremors, and
confusion. What is the priority action?
A. Give next dose with food
B. Increase fluid intake
C. Hold medication and obtain lithium level
D. Administer anti-diarrheal medication
Rationale: These are signs of lithium toxicity. Immediate
discontinuation and serum level evaluation are required to
prevent seizures and organ damage.
7. A nurse is caring for a client in active labor with variable
decelerations. What is the first action?
, A. Prepare for cesarean section
B. Increase oxytocin infusion
C. Reposition the client laterally
D. Perform a sterile vaginal exam
Rationale: Variable decelerations indicate cord compression.
Repositioning relieves pressure on the umbilical cord and is
the first-line intervention.
8. A client with COPD is receiving oxygen therapy. Which
oxygen delivery method is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 10 L/min
C. Nasal cannula at 1–2 L/min
D. Venturi mask at 60%
Rationale: COPD patients retain CO₂ and require controlled
oxygen delivery. Low-flow nasal cannula prevents suppression
of hypoxic drive.
9. A nurse is caring for a client with suspected stroke. Which
assessment is priority?
A. Blood glucose level
B. Pupillary response
C. Time last known well
D. Reflex testing
Rationale: Time of symptom onset determines eligibility for
thrombolytic therapy. This is critical for treatment decisions.
