ATI RN Comprehensive Predictor Exams 2026 (PDF)
| NGN Nursing Questions | Ati Exit Exam Prep (Latest
Update)
1. A patient with a history of chronic kidney disease (stage 4) is admitted with hyperkalemia (K+
6.8 mEq/L). The electrocardiogram shows peaked T waves. Which of the following interventions
should the nurse implement first?
A. Administer sodium polystyrene sulfonate orally.
B. Administer intravenous calcium gluconate.
C. Initiate hemodialysis immediately.
D. Administer intravenous insulin and dextrose.
Answer: B
Rationale: In hyperkalemia with ECG changes (peaked T waves), calcium gluconate is given first to
stabilize the cardiac membrane and prevent arrhythmias. Insulin and dextrose shift potassium
intracellularly but do not stabilize the heart. Sodium polystyrene sulfonate works slowly. Hemodialysis
removes potassium but takes time to initiate.
2. A patient receiving mechanical ventilation has a sudden drop in oxygen saturation from 95% to
82%. The nurse notes decreased breath sounds on the left side and tracheal deviation to the right.
Which action should the nurse take first?
A. Increase the FiO2 to 100%.
B. Perform needle decompression of the left chest.
C. Obtain a stat portable chest X-ray.
D. Reposition the endotracheal tube.
Answer: B
Rationale: The presentation (sudden desaturation, decreased breath sounds unilaterally, tracheal
deviation away from the affected side) indicates tension pneumothorax. Immediate needle decompression
is life-saving. Increasing FiO2 and obtaining X-ray delay definitive treatment. Repositioning the tube is
not indicated.
3. A patient with diabetic ketoacidosis has a serum glucose of 450 mg/dL, pH 7.1, bicarbonate 12
mEq/L, and positive serum ketones. The nurse initiates an insulin infusion at 0.1 units/kg/hour.
Which of the following laboratory values requires the most immediate nursing intervention?
A. Potassium 3.2 mEq/L
B. Sodium 128 mEq/L
C. Creatinine 1.8 mg/dL
D. Phosphate 1.9 mg/dL
Answer: A
Page 1
,Rationale: In DKA, insulin therapy drives potassium into cells, causing hypokalemia. A potassium level of 3.2 mEq/L is
critically low and can lead to cardiac arrhythmias. The nurse must hold insulin and administer potassium replacement
according to protocol. Hyponatremia is often spurious due to hyperglycemia; creatinine elevation may reflect prerenal
azotemia; hypophosphatemia is common but less immediately dangerous.
4. A nurse is caring for a patient with a pulmonary embolism who is receiving a continuous
heparin infusion. The aPTT is 120 seconds (therapeutic range 60-80 seconds). The patient reports
hemoptysis and has new petechiae on the lower extremities. Which of the following actions should
the nurse take?
A. Decrease the heparin infusion rate by 50%.
B. Stop the heparin infusion and administer protamine sulfate.
C. Continue the heparin infusion and administer vitamin K.
D. Administer fresh frozen plasma and continue heparin.
Answer: B
Rationale: The aPTT is above therapeutic range and the patient shows signs of bleeding (hemoptysis,
petechiae). Heparin should be stopped immediately and reversed with protamine sulfate. Vitamin K
reverses warfarin, not heparin. Fresh frozen plasma is used for coagulopathy but not as first-line for
heparin reversal.
5. A patient with acute pancreatitis has severe epigastric pain radiating to the back, nausea, and
vomiting. The nurse reviews the laboratory results: amylase 1200 U/L, lipase 2500 U/L, WBC
15,000/mm³, and glucose 180 mg/dL. Which of the following nursing interventions is most
appropriate?
A. Initiate total parenteral nutrition immediately.
B. Place the patient in a supine position to promote comfort.
C. Administer morphine sulfate for pain as prescribed.
D. Insert a nasogastric tube and connect to low intermittent suction.
Answer: C
Rationale: Pain management is a priority in acute pancreatitis. Morphine is the preferred opioid as it
does not cause spasm of the sphincter of Oddi (unlike meperidine). TPN is not initiated immediately; the
patient is NPO initially. Supine position often worsens pain; side-lying with knees flexed is better. NG
tube is used for persistent vomiting or ileus, not routine.
6. A patient with a history of bipolar disorder is admitted in a manic episode. The patient is
agitated, pacing, and speaking rapidly. Which of the following interventions should the nurse
implement first?
A. Administer lithium carbonate as prescribed.
B. Place the patient in a quiet, low-stimulation environment.
C. Initiate one-to-one observation and apply soft restraints.
D. Encourage the patient to attend group therapy to redirect energy.
Answer: B
Rationale: The priority is to decrease environmental stimulation to prevent escalation of mania. Lithium
is a long-term mood stabilizer, not for acute agitation. Restraints are a last resort. Group therapy may
overstimulate the patient. A quiet environment is the least restrictive and most appropriate initial
Page 2
,intervention.
7. A patient with a new diagnosis of HIV is started on antiretroviral therapy (ART) with
tenofovir/emtricitabine and dolutegravir. Which of the following statements by the patient
indicates a need for further teaching?
A. I will take my medications at the same time every day to maintain consistent drug levels.
B. I should expect to have a negative viral load within 2-4 weeks of starting therapy.
C. I will use condoms consistently even though I am on ART to prevent transmission.
D. I need to have regular blood tests to monitor kidney function and liver enzymes.
Answer: B
Rationale: It typically takes 6 months or more for viral load to become undetectable, not 2-4 weeks. The
other statements are correct: adherence is crucial, condoms are recommended to prevent transmission,
and monitoring for renal and hepatic toxicity is necessary with tenofovir and dolutegravir.
8. A nurse is assessing a patient who has just undergone a liver biopsy. Which of the following
findings requires immediate intervention?
A. Pain at the biopsy site rated 4 on a 0-10 scale.
B. Heart rate 98 bpm, blood pressure 110/70 mm Hg.
C. Serous drainage on the pressure dressing.
D. Respiratory rate 22 breaths per minute with shallow breathing.
Answer: D
Rationale: After liver biopsy, a complication is pneumothorax or hemothorax. Tachypnea with shallow
breathing may indicate respiratory compromise. Pain is expected and can be managed. Vital signs are
stable. Serous drainage is not alarming. The nurse should assess breath sounds and oxygen saturation.
9. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse notes
the patient has a serum potassium of 5.5 mEq/L. Which of the following actions should the nurse
take?
A. Administer the spironolactone as prescribed.
B. Hold the spironolactone and notify the prescriber.
C. Administer furosemide 40 mg IV push immediately.
D. Encourage the patient to eat potassium-rich foods.
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. With hyperkalemia (K+ >5.0 mEq/L), it
should be held to avoid worsening hyperkalemia. The prescriber may adjust the dose or switch to a loop
diuretic. Furosemide may be used but is not given without order. Potassium-rich foods would exacerbate
hyperkalemia.
10. A patient with a traumatic brain injury has an intracranial pressure (ICP) monitor in place.
The ICP reading is 22 mm Hg, and the mean arterial pressure (MAP) is 70 mm Hg. Which of the
following interventions should the nurse implement first?
A. Administer mannitol 0.5 g/kg IV as prescribed.
Page 3
, B. Increase the head of the bed to 30 degrees.
C. Administer propofol infusion for sedation.
D. Notify the neurosurgeon of the ICP and MAP values.
Answer: B
Rationale: Cerebral perfusion pressure (CPP) = MAP - ICP. Here CPP = 70 - 22 = 48 mm Hg (goal >60
mm Hg). Increasing the head of the bed to 30 degrees promotes venous drainage and can lower ICP
quickly without medication. Mannitol and propofol are later interventions. The surgeon should be
notified after initial nursing action.
11. A patient with severe sepsis is being managed in the intensive care unit. The nurse notes a mean
arterial pressure (MAP) of 58 mmHg despite fluid resuscitation of 30 mL/kg crystalloids. Which
hemodynamic parameter would best guide the next step in management?
A. Central venous pressure (CVP) of 4 mmHg
B. Cardiac index (CI) of 2.2 L/min/m²
C. Systemic vascular resistance (SVR) of 600 dyn-s/cm
D. Pulmonary artery occlusion pressure (PAOP) of 8 mmHg
Answer: C
Rationale: In septic shock, after adequate fluid resuscitation, persistent hypotension (MAP <65 mmHg)
typically indicates vasodilation. A low SVR suggests the need for vasopressors (e.g., norepinephrine).
CVP and PAOP assess volume status but are less specific for vasodilation. Cardiac index may be low but
does not directly guide vasopressor initiation.
12. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) on
pressure-controlled ventilation. The plateau pressure is 32 cm HO, and the PaO/FiO ratio is 150.
Which intervention should be prioritized to reduce ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 15 cm HO
B. Decrease tidal volume to 4 mL/kg predicted body weight
C. Switch to volume-controlled ventilation with a rate of 20 breaths/min
D. Administer a neuromuscular blocking agent
Answer: B
Rationale: In ARDS, lung-protective ventilation with low tidal volumes (4-6 mL/kg PBW) is essential to
minimize barotrauma and volutrauma. Plateau pressure should be kept <30 cm HO; the current 32 cm
HO indicates overdistension. Increasing PEEP may improve oxygenation but does not directly reduce
overdistension. NMBA may be considered for refractory hypoxemia but is not the first step to reduce
injury.
13. A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed
sacubitril/valsartan. Which laboratory value requires close monitoring due to the mechanism of
action of this combination?
A. Serum potassium
B. Serum sodium
C. Serum creatinine
D. Serum magnesium
Page 4
| NGN Nursing Questions | Ati Exit Exam Prep (Latest
Update)
1. A patient with a history of chronic kidney disease (stage 4) is admitted with hyperkalemia (K+
6.8 mEq/L). The electrocardiogram shows peaked T waves. Which of the following interventions
should the nurse implement first?
A. Administer sodium polystyrene sulfonate orally.
B. Administer intravenous calcium gluconate.
C. Initiate hemodialysis immediately.
D. Administer intravenous insulin and dextrose.
Answer: B
Rationale: In hyperkalemia with ECG changes (peaked T waves), calcium gluconate is given first to
stabilize the cardiac membrane and prevent arrhythmias. Insulin and dextrose shift potassium
intracellularly but do not stabilize the heart. Sodium polystyrene sulfonate works slowly. Hemodialysis
removes potassium but takes time to initiate.
2. A patient receiving mechanical ventilation has a sudden drop in oxygen saturation from 95% to
82%. The nurse notes decreased breath sounds on the left side and tracheal deviation to the right.
Which action should the nurse take first?
A. Increase the FiO2 to 100%.
B. Perform needle decompression of the left chest.
C. Obtain a stat portable chest X-ray.
D. Reposition the endotracheal tube.
Answer: B
Rationale: The presentation (sudden desaturation, decreased breath sounds unilaterally, tracheal
deviation away from the affected side) indicates tension pneumothorax. Immediate needle decompression
is life-saving. Increasing FiO2 and obtaining X-ray delay definitive treatment. Repositioning the tube is
not indicated.
3. A patient with diabetic ketoacidosis has a serum glucose of 450 mg/dL, pH 7.1, bicarbonate 12
mEq/L, and positive serum ketones. The nurse initiates an insulin infusion at 0.1 units/kg/hour.
Which of the following laboratory values requires the most immediate nursing intervention?
A. Potassium 3.2 mEq/L
B. Sodium 128 mEq/L
C. Creatinine 1.8 mg/dL
D. Phosphate 1.9 mg/dL
Answer: A
Page 1
,Rationale: In DKA, insulin therapy drives potassium into cells, causing hypokalemia. A potassium level of 3.2 mEq/L is
critically low and can lead to cardiac arrhythmias. The nurse must hold insulin and administer potassium replacement
according to protocol. Hyponatremia is often spurious due to hyperglycemia; creatinine elevation may reflect prerenal
azotemia; hypophosphatemia is common but less immediately dangerous.
4. A nurse is caring for a patient with a pulmonary embolism who is receiving a continuous
heparin infusion. The aPTT is 120 seconds (therapeutic range 60-80 seconds). The patient reports
hemoptysis and has new petechiae on the lower extremities. Which of the following actions should
the nurse take?
A. Decrease the heparin infusion rate by 50%.
B. Stop the heparin infusion and administer protamine sulfate.
C. Continue the heparin infusion and administer vitamin K.
D. Administer fresh frozen plasma and continue heparin.
Answer: B
Rationale: The aPTT is above therapeutic range and the patient shows signs of bleeding (hemoptysis,
petechiae). Heparin should be stopped immediately and reversed with protamine sulfate. Vitamin K
reverses warfarin, not heparin. Fresh frozen plasma is used for coagulopathy but not as first-line for
heparin reversal.
5. A patient with acute pancreatitis has severe epigastric pain radiating to the back, nausea, and
vomiting. The nurse reviews the laboratory results: amylase 1200 U/L, lipase 2500 U/L, WBC
15,000/mm³, and glucose 180 mg/dL. Which of the following nursing interventions is most
appropriate?
A. Initiate total parenteral nutrition immediately.
B. Place the patient in a supine position to promote comfort.
C. Administer morphine sulfate for pain as prescribed.
D. Insert a nasogastric tube and connect to low intermittent suction.
Answer: C
Rationale: Pain management is a priority in acute pancreatitis. Morphine is the preferred opioid as it
does not cause spasm of the sphincter of Oddi (unlike meperidine). TPN is not initiated immediately; the
patient is NPO initially. Supine position often worsens pain; side-lying with knees flexed is better. NG
tube is used for persistent vomiting or ileus, not routine.
6. A patient with a history of bipolar disorder is admitted in a manic episode. The patient is
agitated, pacing, and speaking rapidly. Which of the following interventions should the nurse
implement first?
A. Administer lithium carbonate as prescribed.
B. Place the patient in a quiet, low-stimulation environment.
C. Initiate one-to-one observation and apply soft restraints.
D. Encourage the patient to attend group therapy to redirect energy.
Answer: B
Rationale: The priority is to decrease environmental stimulation to prevent escalation of mania. Lithium
is a long-term mood stabilizer, not for acute agitation. Restraints are a last resort. Group therapy may
overstimulate the patient. A quiet environment is the least restrictive and most appropriate initial
Page 2
,intervention.
7. A patient with a new diagnosis of HIV is started on antiretroviral therapy (ART) with
tenofovir/emtricitabine and dolutegravir. Which of the following statements by the patient
indicates a need for further teaching?
A. I will take my medications at the same time every day to maintain consistent drug levels.
B. I should expect to have a negative viral load within 2-4 weeks of starting therapy.
C. I will use condoms consistently even though I am on ART to prevent transmission.
D. I need to have regular blood tests to monitor kidney function and liver enzymes.
Answer: B
Rationale: It typically takes 6 months or more for viral load to become undetectable, not 2-4 weeks. The
other statements are correct: adherence is crucial, condoms are recommended to prevent transmission,
and monitoring for renal and hepatic toxicity is necessary with tenofovir and dolutegravir.
8. A nurse is assessing a patient who has just undergone a liver biopsy. Which of the following
findings requires immediate intervention?
A. Pain at the biopsy site rated 4 on a 0-10 scale.
B. Heart rate 98 bpm, blood pressure 110/70 mm Hg.
C. Serous drainage on the pressure dressing.
D. Respiratory rate 22 breaths per minute with shallow breathing.
Answer: D
Rationale: After liver biopsy, a complication is pneumothorax or hemothorax. Tachypnea with shallow
breathing may indicate respiratory compromise. Pain is expected and can be managed. Vital signs are
stable. Serous drainage is not alarming. The nurse should assess breath sounds and oxygen saturation.
9. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse notes
the patient has a serum potassium of 5.5 mEq/L. Which of the following actions should the nurse
take?
A. Administer the spironolactone as prescribed.
B. Hold the spironolactone and notify the prescriber.
C. Administer furosemide 40 mg IV push immediately.
D. Encourage the patient to eat potassium-rich foods.
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. With hyperkalemia (K+ >5.0 mEq/L), it
should be held to avoid worsening hyperkalemia. The prescriber may adjust the dose or switch to a loop
diuretic. Furosemide may be used but is not given without order. Potassium-rich foods would exacerbate
hyperkalemia.
10. A patient with a traumatic brain injury has an intracranial pressure (ICP) monitor in place.
The ICP reading is 22 mm Hg, and the mean arterial pressure (MAP) is 70 mm Hg. Which of the
following interventions should the nurse implement first?
A. Administer mannitol 0.5 g/kg IV as prescribed.
Page 3
, B. Increase the head of the bed to 30 degrees.
C. Administer propofol infusion for sedation.
D. Notify the neurosurgeon of the ICP and MAP values.
Answer: B
Rationale: Cerebral perfusion pressure (CPP) = MAP - ICP. Here CPP = 70 - 22 = 48 mm Hg (goal >60
mm Hg). Increasing the head of the bed to 30 degrees promotes venous drainage and can lower ICP
quickly without medication. Mannitol and propofol are later interventions. The surgeon should be
notified after initial nursing action.
11. A patient with severe sepsis is being managed in the intensive care unit. The nurse notes a mean
arterial pressure (MAP) of 58 mmHg despite fluid resuscitation of 30 mL/kg crystalloids. Which
hemodynamic parameter would best guide the next step in management?
A. Central venous pressure (CVP) of 4 mmHg
B. Cardiac index (CI) of 2.2 L/min/m²
C. Systemic vascular resistance (SVR) of 600 dyn-s/cm
D. Pulmonary artery occlusion pressure (PAOP) of 8 mmHg
Answer: C
Rationale: In septic shock, after adequate fluid resuscitation, persistent hypotension (MAP <65 mmHg)
typically indicates vasodilation. A low SVR suggests the need for vasopressors (e.g., norepinephrine).
CVP and PAOP assess volume status but are less specific for vasodilation. Cardiac index may be low but
does not directly guide vasopressor initiation.
12. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) on
pressure-controlled ventilation. The plateau pressure is 32 cm HO, and the PaO/FiO ratio is 150.
Which intervention should be prioritized to reduce ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 15 cm HO
B. Decrease tidal volume to 4 mL/kg predicted body weight
C. Switch to volume-controlled ventilation with a rate of 20 breaths/min
D. Administer a neuromuscular blocking agent
Answer: B
Rationale: In ARDS, lung-protective ventilation with low tidal volumes (4-6 mL/kg PBW) is essential to
minimize barotrauma and volutrauma. Plateau pressure should be kept <30 cm HO; the current 32 cm
HO indicates overdistension. Increasing PEEP may improve oxygenation but does not directly reduce
overdistension. NMBA may be considered for refractory hypoxemia but is not the first step to reduce
injury.
13. A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed
sacubitril/valsartan. Which laboratory value requires close monitoring due to the mechanism of
action of this combination?
A. Serum potassium
B. Serum sodium
C. Serum creatinine
D. Serum magnesium
Page 4
