ATI PN Comprehensive Predictor 2026 –
Version 1 Practice Exam | NGN Clinical
Judgment Case Studies, Verified Answers,
& Comprehensive Rationales
Question 1
A nurse is caring for a client with heart failure who reports
increasing dyspnea. Which finding requires immediate
intervention?
A. Weight gain of 0.9 kg (2 lb) in 24 hr
B. Bilateral ankle edema +1
C. Oxygen saturation 86% on room air
D. Fatigue with ambulation
Rationale: An oxygen saturation of 86% indicates significant
hypoxemia and impaired gas exchange. This finding poses an
immediate threat to oxygen delivery to tissues and requires
prompt intervention. Mild edema, fatigue, and modest weight
gain are expected manifestations of worsening heart failure
but are not as immediately life-threatening as hypoxemia.
Question 2
,A nurse is reinforcing teaching with a client prescribed
warfarin. Which statement by the client indicates
understanding?
A. "I will take aspirin if I develop a headache."
B. "I should stop the medication if bruising occurs."
C. "I should maintain a consistent intake of foods containing
vitamin K."
D. "I can double the dose if I miss a dose."
Rationale: Clients taking warfarin should maintain a
consistent intake of vitamin K-containing foods to avoid
fluctuations in anticoagulation levels. Aspirin increases
bleeding risk, unexplained bruising should be reported rather
than independently stopping the medication, and missed
doses should not be doubled.
Question 3
A nurse is caring for a client 24 hr after a thyroidectomy.
Which finding should be reported immediately?
A. Hoarseness
B. Pain rated 4 on a 0–10 scale
C. Tingling around the mouth
D. Mild neck edema
Rationale: Perioral tingling is an early manifestation of
hypocalcemia resulting from accidental removal or injury to
the parathyroid glands during surgery. Untreated
hypocalcemia can progress to tetany, seizures, and
,laryngospasm. Mild hoarseness and discomfort are expected
postoperative findings.
Question 4
A nurse is collecting data from a client who has bacterial
meningitis. Which manifestation is expected?
A. Bradycardia
B. Nuchal rigidity
C. Hyperactivity
D. Hypothermia
Rationale: Nuchal rigidity is a classic sign of meningeal
irritation associated with meningitis. Fever, headache,
photophobia, and altered mental status are also common
findings. Bradycardia and hypothermia are not typical early
manifestations.
Question 5
A nurse is caring for a client receiving furosemide. Which
laboratory value requires immediate reporting?
A. Sodium 138 mEq/L
B. Chloride 102 mEq/L
C. Potassium 2.9 mEq/L
D. Magnesium 2.0 mg/dL
Rationale: Furosemide can cause potassium depletion. A
potassium level of 2.9 mEq/L places the client at risk for
, potentially life-threatening cardiac dysrhythmias and muscle
weakness. This finding requires prompt intervention.
Question 6
A nurse is caring for a client who has a chest tube connected
to a water-seal drainage system. Continuous bubbling is
observed in the water-seal chamber. What should the nurse
suspect?
A. Normal functioning
B. Obstruction in tubing
C. Lung re-expansion
D. Air leak in the system
Rationale: Continuous bubbling in the water-seal chamber
suggests an air leak somewhere within the drainage system.
The nurse should assess tubing connections and the insertion
site. Intermittent bubbling may be expected with a
pneumothorax.
Question 7
A nurse is caring for a client experiencing hypoglycemia.
Which manifestation is expected?
A. Bradycardia
B. Warm dry skin
C. Diaphoresis
D. Kussmaul respirations
Version 1 Practice Exam | NGN Clinical
Judgment Case Studies, Verified Answers,
& Comprehensive Rationales
Question 1
A nurse is caring for a client with heart failure who reports
increasing dyspnea. Which finding requires immediate
intervention?
A. Weight gain of 0.9 kg (2 lb) in 24 hr
B. Bilateral ankle edema +1
C. Oxygen saturation 86% on room air
D. Fatigue with ambulation
Rationale: An oxygen saturation of 86% indicates significant
hypoxemia and impaired gas exchange. This finding poses an
immediate threat to oxygen delivery to tissues and requires
prompt intervention. Mild edema, fatigue, and modest weight
gain are expected manifestations of worsening heart failure
but are not as immediately life-threatening as hypoxemia.
Question 2
,A nurse is reinforcing teaching with a client prescribed
warfarin. Which statement by the client indicates
understanding?
A. "I will take aspirin if I develop a headache."
B. "I should stop the medication if bruising occurs."
C. "I should maintain a consistent intake of foods containing
vitamin K."
D. "I can double the dose if I miss a dose."
Rationale: Clients taking warfarin should maintain a
consistent intake of vitamin K-containing foods to avoid
fluctuations in anticoagulation levels. Aspirin increases
bleeding risk, unexplained bruising should be reported rather
than independently stopping the medication, and missed
doses should not be doubled.
Question 3
A nurse is caring for a client 24 hr after a thyroidectomy.
Which finding should be reported immediately?
A. Hoarseness
B. Pain rated 4 on a 0–10 scale
C. Tingling around the mouth
D. Mild neck edema
Rationale: Perioral tingling is an early manifestation of
hypocalcemia resulting from accidental removal or injury to
the parathyroid glands during surgery. Untreated
hypocalcemia can progress to tetany, seizures, and
,laryngospasm. Mild hoarseness and discomfort are expected
postoperative findings.
Question 4
A nurse is collecting data from a client who has bacterial
meningitis. Which manifestation is expected?
A. Bradycardia
B. Nuchal rigidity
C. Hyperactivity
D. Hypothermia
Rationale: Nuchal rigidity is a classic sign of meningeal
irritation associated with meningitis. Fever, headache,
photophobia, and altered mental status are also common
findings. Bradycardia and hypothermia are not typical early
manifestations.
Question 5
A nurse is caring for a client receiving furosemide. Which
laboratory value requires immediate reporting?
A. Sodium 138 mEq/L
B. Chloride 102 mEq/L
C. Potassium 2.9 mEq/L
D. Magnesium 2.0 mg/dL
Rationale: Furosemide can cause potassium depletion. A
potassium level of 2.9 mEq/L places the client at risk for
, potentially life-threatening cardiac dysrhythmias and muscle
weakness. This finding requires prompt intervention.
Question 6
A nurse is caring for a client who has a chest tube connected
to a water-seal drainage system. Continuous bubbling is
observed in the water-seal chamber. What should the nurse
suspect?
A. Normal functioning
B. Obstruction in tubing
C. Lung re-expansion
D. Air leak in the system
Rationale: Continuous bubbling in the water-seal chamber
suggests an air leak somewhere within the drainage system.
The nurse should assess tubing connections and the insertion
site. Intermittent bubbling may be expected with a
pneumothorax.
Question 7
A nurse is caring for a client experiencing hypoglycemia.
Which manifestation is expected?
A. Bradycardia
B. Warm dry skin
C. Diaphoresis
D. Kussmaul respirations
