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ATI RN Comprehensive Predictor
2026/2027 – Complete 220-Question
Practice Examination
Advanced/Hard Difficulty Level with Detailed Rationales for RN Students, Graduate Nurses, and
NCLEX-RN Candidates Preparing for the ATI Comprehensive Predictor Exit Exam and Next Generation
NCLEX (NGN) Clinical Judgment Assessments
SECTION 1: MANAGEMENT OF CARE – DELEGATION, PRIORITIZATION, AND
LEADERSHIP (Questions 1–40)
1. A charge nurse is assigning clients on a medical-surgical unit. Which client
should be assigned to an LPN?
A) A client with new-onset chest pain and ST elevation on telemetry
B) A client with diabetes mellitus who requires insulin administration
C) A client with acute respiratory distress requiring frequent suctioning
D) A client post-cardiac catheterization with a femoral artery sheath
Correct Answer: B
Rationale: LPNs can administer medications, including insulin, to stable clients.
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The client with chest pain (A) requires RN assessment, the client with respiratory
distress (C) requires RN-level airway management, and the post-catheterization
client (D) requires RN assessment for bleeding and complications.
2. A nurse is caring for a client who is 2 hours post-operative following a total
hip arthroplasty. Which of the following findings should the nurse report to the
provider immediately?
A) Heart rate of 88/min
B) Blood pressure of 142/88 mmHg
C) Oxygen saturation of 89% on room air
D) Pain rating of 6 on a 0-10 scale
Correct Answer: C
Rationale: An oxygen saturation of 89% indicates hypoxemia and requires
immediate intervention. This could indicate pulmonary embolism, atelectasis, or
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other post-operative complications. The other vital signs are within acceptable
ranges for a post-operative client.
3. A nurse is caring for a group of clients. Which of the following clients should
the nurse see first?
A) A client with pneumonia who has a new onset of confusion
B) A client with chronic obstructive pulmonary disease who has an oxygen
saturation of 91%
C) A client with heart failure who has 1+ pitting edema in the lower extremities
D) A client with diabetes mellitus who has a blood glucose of 180 mg/dL
Correct Answer: A
Rationale: New-onset confusion in a client with pneumonia indicates possible
sepsis, hypoxia, or worsening infection requiring immediate assessment. The
other clients have stable or expected findings.
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4. A nurse is preparing to delegate tasks to an assistive personnel (AP). Which of
the following tasks is appropriate to delegate?
A) Ambulating a client who is 1 day post-operative following a hip fracture
B) Administering a tap water enema to a client with constipation
C) Performing a sterile wound dressing change
D) Assessing a client's pain level
Correct Answer: A
Rationale: Ambulating a stable post-operative client is within the scope of
practice for AP. Enemas (B) require nursing judgment, sterile procedures (C)
require sterile technique training, and pain assessment (D) requires RN-level
assessment skills.
ATI RN Comprehensive Predictor
2026/2027 – Complete 220-Question
Practice Examination
Advanced/Hard Difficulty Level with Detailed Rationales for RN Students, Graduate Nurses, and
NCLEX-RN Candidates Preparing for the ATI Comprehensive Predictor Exit Exam and Next Generation
NCLEX (NGN) Clinical Judgment Assessments
SECTION 1: MANAGEMENT OF CARE – DELEGATION, PRIORITIZATION, AND
LEADERSHIP (Questions 1–40)
1. A charge nurse is assigning clients on a medical-surgical unit. Which client
should be assigned to an LPN?
A) A client with new-onset chest pain and ST elevation on telemetry
B) A client with diabetes mellitus who requires insulin administration
C) A client with acute respiratory distress requiring frequent suctioning
D) A client post-cardiac catheterization with a femoral artery sheath
Correct Answer: B
Rationale: LPNs can administer medications, including insulin, to stable clients.
, 2
The client with chest pain (A) requires RN assessment, the client with respiratory
distress (C) requires RN-level airway management, and the post-catheterization
client (D) requires RN assessment for bleeding and complications.
2. A nurse is caring for a client who is 2 hours post-operative following a total
hip arthroplasty. Which of the following findings should the nurse report to the
provider immediately?
A) Heart rate of 88/min
B) Blood pressure of 142/88 mmHg
C) Oxygen saturation of 89% on room air
D) Pain rating of 6 on a 0-10 scale
Correct Answer: C
Rationale: An oxygen saturation of 89% indicates hypoxemia and requires
immediate intervention. This could indicate pulmonary embolism, atelectasis, or
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other post-operative complications. The other vital signs are within acceptable
ranges for a post-operative client.
3. A nurse is caring for a group of clients. Which of the following clients should
the nurse see first?
A) A client with pneumonia who has a new onset of confusion
B) A client with chronic obstructive pulmonary disease who has an oxygen
saturation of 91%
C) A client with heart failure who has 1+ pitting edema in the lower extremities
D) A client with diabetes mellitus who has a blood glucose of 180 mg/dL
Correct Answer: A
Rationale: New-onset confusion in a client with pneumonia indicates possible
sepsis, hypoxia, or worsening infection requiring immediate assessment. The
other clients have stable or expected findings.
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4. A nurse is preparing to delegate tasks to an assistive personnel (AP). Which of
the following tasks is appropriate to delegate?
A) Ambulating a client who is 1 day post-operative following a hip fracture
B) Administering a tap water enema to a client with constipation
C) Performing a sterile wound dressing change
D) Assessing a client's pain level
Correct Answer: A
Rationale: Ambulating a stable post-operative client is within the scope of
practice for AP. Enemas (B) require nursing judgment, sterile procedures (C)
require sterile technique training, and pain assessment (D) requires RN-level
assessment skills.
