ATI RN Comprehensive Predictor Next Generation
NCLEX NGN Practice Questions Bow Tie and Matrix
Items With Detailed Rationales for Nursing Licensure
Success
Exam Structure Overview
This comprehensive practice exam contains 320 questions designed to mirror
the ATI RN Comprehensive Predictor and Next Generation NCLEX format.
The exam includes traditional multiple choice questions, Bow-tie items,
Matrix/grid items, and extended multiple response questions. Each question is
followed by a detailed rationale explaining the correct answer and why the
distractors are incorrect. The content covers all major nursing content areas
including Medical-Surgical Nursing, Maternity and Newborn Nursing,
Pediatric Nursing, Psychiatric Mental Health Nursing, Pharmacology,
Leadership and Management, Community Health, and Fundamentals of
Nursing. This exam is designed to build clinical judgment and prepare
students for successful licensure.
Section One: Traditional Multiple Choice Questions Questions 1 through 50
Question 1
A nurse is caring for a patient with heart failure who reports sudden onset of
dyspnea and coughing up pink frothy sputum. Which action should the nurse take
first?
A) Place the patient in high Fowler position
B) Administer intravenous furosemide
C) Apply continuous positive airway pressure
D) Check oxygen saturation with pulse oximetry
Answer: A
Explanation: The patient is exhibiting signs of acute pulmonary edema, a life-
threatening complication of heart failure. The priority nursing action is to place the
patient in high Fowler position to reduce venous return to the heart and decrease
pulmonary congestion. This positioning uses gravity to redistribute fluid to
dependent areas and improves ventilation-perfusion matching. Administering
furosemide, applying CPAP, and checking oxygen saturation are all appropriate
,interventions but should occur after positioning the patient to maximize respiratory
effort. The ABC airway breathing circulation framework supports positioning as
the initial step to optimize breathing.
Question 2
A postpartum patient develops a fever of 101.5 degrees Fahrenheit on the third day
after delivery. The patient reports uterine tenderness and foul-smelling lochia.
Which condition should the nurse suspect?
A) Mastitis
B) Endometritis
C) Urinary tract infection
D) Wound infection
Answer: B
Explanation: Endometritis is an infection of the endometrial lining of the uterus
that typically presents on postpartum days 2 through 5 with fever, uterine
tenderness, and foul-smelling lochia. This patient's symptoms are classic for
endometritis, especially the combination of fever, uterine tenderness, and
malodorous discharge. Mastitis presents with breast pain and erythema, urinary
tract infection presents with dysuria and urinary frequency, and wound infection
presents with redness and drainage at a surgical or episiotomy site. Endometritis
requires prompt antibiotic therapy typically with clindamycin and gentamicin.
Question 3
Which laboratory finding is most consistent with a diagnosis of diabetic
ketoacidosis?
A) Serum pH 7.35 and bicarbonate 24 mEq per L
B) Serum pH 7.25 and bicarbonate 16 mEq per L
C) Serum pH 7.45 and bicarbonate 28 mEq per L
D) Serum pH 7.50 and bicarbonate 32 mEq per L
Answer: B
Explanation: Diabetic ketoacidosis is characterized by metabolic acidosis with a
low serum pH below 7.30 and low bicarbonate below 18 mEq per L due to the
accumulation of ketone bodies. Option B shows pH 7.25 and bicarbonate 16 which
are consistent with DKA. Option A represents normal values, option C shows mild
metabolic alkalosis, and option D shows significant metabolic alkalosis. The anion
gap is also elevated in DKA due to unmeasured anions from ketones.
,Question 4
A nurse is preparing to administer digoxin to a patient with atrial fibrillation.
Which assessment finding would indicate the need to hold the medication and
notify the healthcare provider?
A) Apical pulse of 62 beats per minute
B) Serum potassium level of 3.2 mEq per L
C) Serum digoxin level of 1.2 ng per mL
D) Blood pressure of 130 over 80 mmHg
Answer: B
Explanation: Digoxin toxicity is potentiated by hypokalemia because digoxin
competes with potassium for binding sites on the sodium-potassium ATPase pump.
A serum potassium of 3.2 is below the normal range of 3.5 to 5.0 and increases the
risk of digoxin toxicity even at therapeutic levels. The apical pulse of 62 is within
acceptable range for holding digoxin which is typically below 60. The digoxin
level of 1.2 is within therapeutic range of 0.8 to 2.0. The blood pressure is
adequate. Hypokalemia must be corrected before administering digoxin.
Question 5
A patient with chronic obstructive pulmonary disease has an arterial blood gas
showing pH 7.31, PaCO2 58 mmHg, HCO3 28 mEq per L. Which interpretation is
correct?
A) Uncompensated respiratory acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Uncompensated metabolic acidosis
Answer: B
Explanation: The pH is low at 7.31 indicating acidosis. The PaCO2 is elevated at
58 indicating a respiratory cause. The bicarbonate is elevated at 28 indicating the
kidneys are attempting to compensate by retaining bicarbonate. However, the pH
remains below 7.35 so compensation is partial rather than complete. Full
compensation would return the pH to normal range. This is a classic partially
compensated respiratory acidosis pattern seen in COPD exacerbations.
Question 6
Which medication is the antidote for heparin overdose?
A) Vitamin K
B) Protamine sulfate
, C) Naloxone
D) Flumazenil
Answer: B
Explanation: Protamine sulfate is the specific antidote for heparin overdose. It is a
positively charged protein that binds to negatively charged heparin molecules,
forming an inactive complex that is removed by the reticuloendothelial system.
Vitamin K is the antidote for warfarin, naloxone reverses opioid overdose, and
flumazenil reverses benzodiazepine overdose. Protamine sulfate is administered
slowly intravenously to reverse heparin-induced bleeding.
Question 7
A nurse is assessing a newborn who is 24 hours old. Which finding requires
immediate intervention?
A) Heart rate of 140 beats per minute
B) Respiratory rate of 45 breaths per minute
C) Axillary temperature of 97.8 degrees Fahrenheit
D) Grunting respirations with nasal flaring
Answer: D
Explanation: Grunting respirations with nasal flaring are signs of respiratory
distress in a newborn and require immediate intervention. Grunting is an
expiratory maneuver that generates positive end-expiratory pressure to keep
alveoli open, indicating the newborn is working hard to breathe. Normal heart rate
for a newborn is 110 to 160, respiratory rate is 30 to 60, and temperature should be
maintained at 97.7 to 99.5. The other options are within normal limits. This
newborn may have transient tachypnea, respiratory distress syndrome, or infection
requiring evaluation.
Question 8
A patient with major depressive disorder is prescribed phenelzine. Which dietary
instruction is most important for the nurse to provide?
A) Avoid foods containing tyramine
B) Increase intake of high-fiber foods
C) Limit caffeine consumption
D) Avoid grapefruit juice
Answer: A
NCLEX NGN Practice Questions Bow Tie and Matrix
Items With Detailed Rationales for Nursing Licensure
Success
Exam Structure Overview
This comprehensive practice exam contains 320 questions designed to mirror
the ATI RN Comprehensive Predictor and Next Generation NCLEX format.
The exam includes traditional multiple choice questions, Bow-tie items,
Matrix/grid items, and extended multiple response questions. Each question is
followed by a detailed rationale explaining the correct answer and why the
distractors are incorrect. The content covers all major nursing content areas
including Medical-Surgical Nursing, Maternity and Newborn Nursing,
Pediatric Nursing, Psychiatric Mental Health Nursing, Pharmacology,
Leadership and Management, Community Health, and Fundamentals of
Nursing. This exam is designed to build clinical judgment and prepare
students for successful licensure.
Section One: Traditional Multiple Choice Questions Questions 1 through 50
Question 1
A nurse is caring for a patient with heart failure who reports sudden onset of
dyspnea and coughing up pink frothy sputum. Which action should the nurse take
first?
A) Place the patient in high Fowler position
B) Administer intravenous furosemide
C) Apply continuous positive airway pressure
D) Check oxygen saturation with pulse oximetry
Answer: A
Explanation: The patient is exhibiting signs of acute pulmonary edema, a life-
threatening complication of heart failure. The priority nursing action is to place the
patient in high Fowler position to reduce venous return to the heart and decrease
pulmonary congestion. This positioning uses gravity to redistribute fluid to
dependent areas and improves ventilation-perfusion matching. Administering
furosemide, applying CPAP, and checking oxygen saturation are all appropriate
,interventions but should occur after positioning the patient to maximize respiratory
effort. The ABC airway breathing circulation framework supports positioning as
the initial step to optimize breathing.
Question 2
A postpartum patient develops a fever of 101.5 degrees Fahrenheit on the third day
after delivery. The patient reports uterine tenderness and foul-smelling lochia.
Which condition should the nurse suspect?
A) Mastitis
B) Endometritis
C) Urinary tract infection
D) Wound infection
Answer: B
Explanation: Endometritis is an infection of the endometrial lining of the uterus
that typically presents on postpartum days 2 through 5 with fever, uterine
tenderness, and foul-smelling lochia. This patient's symptoms are classic for
endometritis, especially the combination of fever, uterine tenderness, and
malodorous discharge. Mastitis presents with breast pain and erythema, urinary
tract infection presents with dysuria and urinary frequency, and wound infection
presents with redness and drainage at a surgical or episiotomy site. Endometritis
requires prompt antibiotic therapy typically with clindamycin and gentamicin.
Question 3
Which laboratory finding is most consistent with a diagnosis of diabetic
ketoacidosis?
A) Serum pH 7.35 and bicarbonate 24 mEq per L
B) Serum pH 7.25 and bicarbonate 16 mEq per L
C) Serum pH 7.45 and bicarbonate 28 mEq per L
D) Serum pH 7.50 and bicarbonate 32 mEq per L
Answer: B
Explanation: Diabetic ketoacidosis is characterized by metabolic acidosis with a
low serum pH below 7.30 and low bicarbonate below 18 mEq per L due to the
accumulation of ketone bodies. Option B shows pH 7.25 and bicarbonate 16 which
are consistent with DKA. Option A represents normal values, option C shows mild
metabolic alkalosis, and option D shows significant metabolic alkalosis. The anion
gap is also elevated in DKA due to unmeasured anions from ketones.
,Question 4
A nurse is preparing to administer digoxin to a patient with atrial fibrillation.
Which assessment finding would indicate the need to hold the medication and
notify the healthcare provider?
A) Apical pulse of 62 beats per minute
B) Serum potassium level of 3.2 mEq per L
C) Serum digoxin level of 1.2 ng per mL
D) Blood pressure of 130 over 80 mmHg
Answer: B
Explanation: Digoxin toxicity is potentiated by hypokalemia because digoxin
competes with potassium for binding sites on the sodium-potassium ATPase pump.
A serum potassium of 3.2 is below the normal range of 3.5 to 5.0 and increases the
risk of digoxin toxicity even at therapeutic levels. The apical pulse of 62 is within
acceptable range for holding digoxin which is typically below 60. The digoxin
level of 1.2 is within therapeutic range of 0.8 to 2.0. The blood pressure is
adequate. Hypokalemia must be corrected before administering digoxin.
Question 5
A patient with chronic obstructive pulmonary disease has an arterial blood gas
showing pH 7.31, PaCO2 58 mmHg, HCO3 28 mEq per L. Which interpretation is
correct?
A) Uncompensated respiratory acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Uncompensated metabolic acidosis
Answer: B
Explanation: The pH is low at 7.31 indicating acidosis. The PaCO2 is elevated at
58 indicating a respiratory cause. The bicarbonate is elevated at 28 indicating the
kidneys are attempting to compensate by retaining bicarbonate. However, the pH
remains below 7.35 so compensation is partial rather than complete. Full
compensation would return the pH to normal range. This is a classic partially
compensated respiratory acidosis pattern seen in COPD exacerbations.
Question 6
Which medication is the antidote for heparin overdose?
A) Vitamin K
B) Protamine sulfate
, C) Naloxone
D) Flumazenil
Answer: B
Explanation: Protamine sulfate is the specific antidote for heparin overdose. It is a
positively charged protein that binds to negatively charged heparin molecules,
forming an inactive complex that is removed by the reticuloendothelial system.
Vitamin K is the antidote for warfarin, naloxone reverses opioid overdose, and
flumazenil reverses benzodiazepine overdose. Protamine sulfate is administered
slowly intravenously to reverse heparin-induced bleeding.
Question 7
A nurse is assessing a newborn who is 24 hours old. Which finding requires
immediate intervention?
A) Heart rate of 140 beats per minute
B) Respiratory rate of 45 breaths per minute
C) Axillary temperature of 97.8 degrees Fahrenheit
D) Grunting respirations with nasal flaring
Answer: D
Explanation: Grunting respirations with nasal flaring are signs of respiratory
distress in a newborn and require immediate intervention. Grunting is an
expiratory maneuver that generates positive end-expiratory pressure to keep
alveoli open, indicating the newborn is working hard to breathe. Normal heart rate
for a newborn is 110 to 160, respiratory rate is 30 to 60, and temperature should be
maintained at 97.7 to 99.5. The other options are within normal limits. This
newborn may have transient tachypnea, respiratory distress syndrome, or infection
requiring evaluation.
Question 8
A patient with major depressive disorder is prescribed phenelzine. Which dietary
instruction is most important for the nurse to provide?
A) Avoid foods containing tyramine
B) Increase intake of high-fiber foods
C) Limit caffeine consumption
D) Avoid grapefruit juice
Answer: A
