ATI PN Comprehensive Predictor 2026 –
Version 3 Practice Exam | NGN Clinical
Judgment Case Studies, Verified Answers,
& Comprehensive Rationales
1. A nurse is caring for a client who has chronic heart failure.
Which assessment finding requires immediate intervention?
A. Weight gain of 1 lb (0.45 kg) in 24 hr
B. Bilateral ankle edema +1
C. New onset crackles throughout both lung fields
D. Fatigue after ambulation
Rationale: New onset diffuse crackles indicate worsening
pulmonary edema and impaired oxygenation. Airway and
breathing take priority over fluid retention findings such as
mild edema or minimal weight gain.
2. A nurse is preparing to administer digoxin to a client.
Which finding should cause the nurse to withhold the
medication and notify the provider?
A. Potassium level 4.2 mEq/L
B. Apical pulse 88/min
C. Blood pressure 138/84 mm Hg
D. Apical pulse 54/min
,Rationale: Digoxin can further decrease heart rate. An apical
pulse below 60/min in adults is generally a contraindication
for administration until the provider is notified.
3. A nurse is caring for a client who is 12 hr postoperative
following abdominal surgery. Which finding should the
nurse report immediately?
A. Temperature 37.6°C (99.7°F)
B. Pain rating 5 on a 0–10 scale
C. Urine output 20 mL/hr for 2 consecutive hours
D. Diminished bowel sounds
Rationale: Urine output below 30 mL/hr suggests inadequate
renal perfusion, hypovolemia, or shock and requires prompt
intervention.
4. A nurse is caring for a client receiving a blood transfusion.
Which finding indicates an acute hemolytic reaction?
A. Mild fever
B. Flushing
C. Low back pain and chills
D. Headache
Rationale: Acute hemolytic reactions commonly present with
chills, fever, low back pain, tachycardia, and hypotension. The
transfusion should be stopped immediately.
,5. A nurse is teaching a client who has newly diagnosed type
1 diabetes mellitus. Which statement indicates
understanding?
A. "I should rotate insulin injection sites within the same
anatomical region."
B. "I can skip meals if I take my insulin."
C. "I should massage the injection site after administration."
D. "I can reuse insulin needles indefinitely."
Rationale: Rotating sites within the same anatomical region
promotes consistent insulin absorption while preventing
lipodystrophy. Meals should not be skipped after insulin
administration.
6. A nurse is caring for a client experiencing hypoglycemia.
Which finding should the nurse expect?
A. Bradycardia
B. Dry skin
C. Diaphoresis and tremors
D. Fruity breath odor
Rationale: Adrenergic symptoms of hypoglycemia include
sweating, tremors, tachycardia, hunger, and anxiety. Fruity
breath is associated with diabetic ketoacidosis.
7. A nurse is assessing a client who has increased
intracranial pressure. Which finding is expected?
, A. Tachycardia
B. Bradycardia with widened pulse pressure
C. Hypotension
D. Hyperactive bowel sounds
Rationale: Cushing's triad consists of bradycardia, widened
pulse pressure, and irregular respirations and indicates
increased intracranial pressure.
8. A nurse is caring for a client who has a chest tube
connected to suction. Which finding requires intervention?
A. Gentle tidaling in water-seal chamber
B. Drainage of 50 mL serosanguineous fluid
C. Continuous bubbling in water-seal chamber
D. Occlusive dressing intact
Rationale: Continuous bubbling suggests an air leak in the
system that can compromise lung re-expansion.
9. A nurse is caring for a client who has Addison's disease.
Which laboratory finding should the nurse expect?
A. Hypernatremia
B. Hypokalemia
C. Hyperglycemia
D. Hyponatremia
Rationale: Addison's disease causes decreased aldosterone
and cortisol, leading to sodium loss, hyperkalemia, and
hypoglycemia.
Version 3 Practice Exam | NGN Clinical
Judgment Case Studies, Verified Answers,
& Comprehensive Rationales
1. A nurse is caring for a client who has chronic heart failure.
Which assessment finding requires immediate intervention?
A. Weight gain of 1 lb (0.45 kg) in 24 hr
B. Bilateral ankle edema +1
C. New onset crackles throughout both lung fields
D. Fatigue after ambulation
Rationale: New onset diffuse crackles indicate worsening
pulmonary edema and impaired oxygenation. Airway and
breathing take priority over fluid retention findings such as
mild edema or minimal weight gain.
2. A nurse is preparing to administer digoxin to a client.
Which finding should cause the nurse to withhold the
medication and notify the provider?
A. Potassium level 4.2 mEq/L
B. Apical pulse 88/min
C. Blood pressure 138/84 mm Hg
D. Apical pulse 54/min
,Rationale: Digoxin can further decrease heart rate. An apical
pulse below 60/min in adults is generally a contraindication
for administration until the provider is notified.
3. A nurse is caring for a client who is 12 hr postoperative
following abdominal surgery. Which finding should the
nurse report immediately?
A. Temperature 37.6°C (99.7°F)
B. Pain rating 5 on a 0–10 scale
C. Urine output 20 mL/hr for 2 consecutive hours
D. Diminished bowel sounds
Rationale: Urine output below 30 mL/hr suggests inadequate
renal perfusion, hypovolemia, or shock and requires prompt
intervention.
4. A nurse is caring for a client receiving a blood transfusion.
Which finding indicates an acute hemolytic reaction?
A. Mild fever
B. Flushing
C. Low back pain and chills
D. Headache
Rationale: Acute hemolytic reactions commonly present with
chills, fever, low back pain, tachycardia, and hypotension. The
transfusion should be stopped immediately.
,5. A nurse is teaching a client who has newly diagnosed type
1 diabetes mellitus. Which statement indicates
understanding?
A. "I should rotate insulin injection sites within the same
anatomical region."
B. "I can skip meals if I take my insulin."
C. "I should massage the injection site after administration."
D. "I can reuse insulin needles indefinitely."
Rationale: Rotating sites within the same anatomical region
promotes consistent insulin absorption while preventing
lipodystrophy. Meals should not be skipped after insulin
administration.
6. A nurse is caring for a client experiencing hypoglycemia.
Which finding should the nurse expect?
A. Bradycardia
B. Dry skin
C. Diaphoresis and tremors
D. Fruity breath odor
Rationale: Adrenergic symptoms of hypoglycemia include
sweating, tremors, tachycardia, hunger, and anxiety. Fruity
breath is associated with diabetic ketoacidosis.
7. A nurse is assessing a client who has increased
intracranial pressure. Which finding is expected?
, A. Tachycardia
B. Bradycardia with widened pulse pressure
C. Hypotension
D. Hyperactive bowel sounds
Rationale: Cushing's triad consists of bradycardia, widened
pulse pressure, and irregular respirations and indicates
increased intracranial pressure.
8. A nurse is caring for a client who has a chest tube
connected to suction. Which finding requires intervention?
A. Gentle tidaling in water-seal chamber
B. Drainage of 50 mL serosanguineous fluid
C. Continuous bubbling in water-seal chamber
D. Occlusive dressing intact
Rationale: Continuous bubbling suggests an air leak in the
system that can compromise lung re-expansion.
9. A nurse is caring for a client who has Addison's disease.
Which laboratory finding should the nurse expect?
A. Hypernatremia
B. Hypokalemia
C. Hyperglycemia
D. Hyponatremia
Rationale: Addison's disease causes decreased aldosterone
and cortisol, leading to sodium loss, hyperkalemia, and
hypoglycemia.
