ATI RN Comprehensive Predictor 2026 –
Version 3 Practice Exam | NGN-Style
Questions & Rationales
1. A nurse is caring for a client with acute heart failure.
Which assessment finding requires immediate intervention?
A. Bilateral crackles in lower lobes
B. +2 pitting edema in ankles
C. Heart rate 88 bpm
D. Urine output 40 mL/hr
Correct Answer: A. Bilateral crackles in lower lobes
Rationale: Crackles indicate fluid accumulation in the lungs,
suggesting worsening pulmonary edema and potential
respiratory compromise, which is a priority over peripheral
edema or stable vitals.
2. A client is prescribed warfarin. Which laboratory value
indicates a therapeutic effect?
A. aPTT 45 seconds
B. INR 2.5
C. Platelets 150,000/mm³
D. PT 9 seconds
Correct Answer: B. INR 2.5
,Rationale: Warfarin therapy is monitored using INR, with a
therapeutic range typically between 2.0–3.0 for most
indications.
3. A nurse is assessing a client with diabetic ketoacidosis
(DKA). Which finding is expected?
A. Bradypnea
B. Kussmaul respirations
C. Hypoglycemia
D. Metabolic alkalosis
Correct Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations are deep and rapid
breathing patterns that indicate metabolic acidosis
compensation in DKA.
4. Which action should the nurse take first for a client
experiencing anaphylaxis?
A. Administer diphenhydramine
B. Apply oxygen via nasal cannula
C. Administer epinephrine IM
D. Obtain vital signs
Correct Answer: C. Administer epinephrine IM
Rationale: Epinephrine is the first-line treatment for
anaphylaxis because it reverses airway constriction and
hypotension rapidly.
,5. A postoperative client reports sudden chest pain and
dyspnea. What is the nurse’s priority action?
A. Encourage coughing and deep breathing
B. Administer pain medication
C. Assess oxygen saturation
D. Notify provider
Correct Answer: C. Assess oxygen saturation
Rationale: Sudden chest pain and dyspnea may indicate
pulmonary embolism; oxygenation status must be assessed
immediately.
6. A nurse is teaching a client about metformin. Which
instruction is appropriate?
A. Take with alcohol to enhance absorption
B. Monitor for hypoglycemia daily
C. Hold medication before contrast dye procedures
D. Take on an empty stomach only
Correct Answer: C. Hold medication before contrast dye
procedures
Rationale: Metformin should be withheld before and after
contrast dye due to risk of lactic acidosis.
7. Which electrolyte imbalance is most associated with
tetany and positive Chvostek sign?
, A. Hyperkalemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyponatremia
Correct Answer: B. Hypocalcemia
Rationale: Low calcium levels increase neuromuscular
excitability leading to tetany and positive Chvostek sign.
8. A client receiving heparin therapy reports bleeding gums.
What is the nurse’s priority action?
A. Administer vitamin K
B. Stop the infusion
C. Assess aPTT level
D. Apply ice packs
Correct Answer: C. Assess aPTT level
Rationale: aPTT determines therapeutic or excessive
anticoagulation; assessment comes before intervention
changes unless life-threatening bleeding occurs.
9. Which finding indicates right-sided heart failure?
A. Pulmonary edema
B. Jugular vein distention
C. Pink frothy sputum
D. Crackles in lungs
Correct Answer: B. Jugular vein distention
Version 3 Practice Exam | NGN-Style
Questions & Rationales
1. A nurse is caring for a client with acute heart failure.
Which assessment finding requires immediate intervention?
A. Bilateral crackles in lower lobes
B. +2 pitting edema in ankles
C. Heart rate 88 bpm
D. Urine output 40 mL/hr
Correct Answer: A. Bilateral crackles in lower lobes
Rationale: Crackles indicate fluid accumulation in the lungs,
suggesting worsening pulmonary edema and potential
respiratory compromise, which is a priority over peripheral
edema or stable vitals.
2. A client is prescribed warfarin. Which laboratory value
indicates a therapeutic effect?
A. aPTT 45 seconds
B. INR 2.5
C. Platelets 150,000/mm³
D. PT 9 seconds
Correct Answer: B. INR 2.5
,Rationale: Warfarin therapy is monitored using INR, with a
therapeutic range typically between 2.0–3.0 for most
indications.
3. A nurse is assessing a client with diabetic ketoacidosis
(DKA). Which finding is expected?
A. Bradypnea
B. Kussmaul respirations
C. Hypoglycemia
D. Metabolic alkalosis
Correct Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations are deep and rapid
breathing patterns that indicate metabolic acidosis
compensation in DKA.
4. Which action should the nurse take first for a client
experiencing anaphylaxis?
A. Administer diphenhydramine
B. Apply oxygen via nasal cannula
C. Administer epinephrine IM
D. Obtain vital signs
Correct Answer: C. Administer epinephrine IM
Rationale: Epinephrine is the first-line treatment for
anaphylaxis because it reverses airway constriction and
hypotension rapidly.
,5. A postoperative client reports sudden chest pain and
dyspnea. What is the nurse’s priority action?
A. Encourage coughing and deep breathing
B. Administer pain medication
C. Assess oxygen saturation
D. Notify provider
Correct Answer: C. Assess oxygen saturation
Rationale: Sudden chest pain and dyspnea may indicate
pulmonary embolism; oxygenation status must be assessed
immediately.
6. A nurse is teaching a client about metformin. Which
instruction is appropriate?
A. Take with alcohol to enhance absorption
B. Monitor for hypoglycemia daily
C. Hold medication before contrast dye procedures
D. Take on an empty stomach only
Correct Answer: C. Hold medication before contrast dye
procedures
Rationale: Metformin should be withheld before and after
contrast dye due to risk of lactic acidosis.
7. Which electrolyte imbalance is most associated with
tetany and positive Chvostek sign?
, A. Hyperkalemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyponatremia
Correct Answer: B. Hypocalcemia
Rationale: Low calcium levels increase neuromuscular
excitability leading to tetany and positive Chvostek sign.
8. A client receiving heparin therapy reports bleeding gums.
What is the nurse’s priority action?
A. Administer vitamin K
B. Stop the infusion
C. Assess aPTT level
D. Apply ice packs
Correct Answer: C. Assess aPTT level
Rationale: aPTT determines therapeutic or excessive
anticoagulation; assessment comes before intervention
changes unless life-threatening bleeding occurs.
9. Which finding indicates right-sided heart failure?
A. Pulmonary edema
B. Jugular vein distention
C. Pink frothy sputum
D. Crackles in lungs
Correct Answer: B. Jugular vein distention
