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ATI RN Comprehensive Predictor 2026 Exit Exam:
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180 Next Generation NCLEX Practice Questions with
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Detailed Rationales for Nursing Students # # # #
ATI RN COMPREHENSIVE PREDICTOR – FULL 180-QUESTION SIMULATED EXAM
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EXAM INSTRUCTIONS #
• Total Questions: 180 # #
• Time Allowed: 180 minutes # # #
• Format: Multiple choice, NGN case studies, bow-tie, matrix, drag-and-drop
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• Passing Standard: 70% or higher for NCLEX readiness prediction
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SECTION 1: MANAGEMENT OF CARE (Questions 1-36)
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Question 1 #
A charge nurse is making client assignments on a medical-surgical unit. Which
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client should be assigned to the most experienced RN?
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A) A client with diabetes mellitus requiring insulin administration
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B) A client with pneumonia requiring q4h vital signs
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C) A client with chest tubes and a new onset of respiratory distress
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D) A client with a urinary tract infection requiring IV antibiotics
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Answer: C #
Rationale: The client with chest tubes and respiratory distress is unstable and
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requires complex assessment and intervention. This client should be assigned to
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the most experienced RN. Stable clients with routine care (A, B, D) can be
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assigned to LPNs or less experienced RNs under supervision.
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Question 2 #
A nurse is caring for a client who refuses a blood transfusion due to religious
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beliefs. The client's family requests that the transfusion be given anyway. What is
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the nurse's priority action?
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A) Administer the transfusion as the family requests
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B) Notify the healthcare provider of the client's refusal
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C) Contact the ethics committee for a consultation
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D) Ask the client to reconsider the family's wishes
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Answer: B #
Rationale: The nurse must respect the client's autonomy and right to refuse
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treatment. The healthcare provider should be notified so alternative treatments
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can be considered. The client's decision must be honored regardless of family
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wishes.
Question 3 #
A nurse manager is reviewing informed consent with staff. Which statement by a
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staff member indicates understanding?
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A) "The nurse is responsible for explaining the procedure to the client."
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B) "A witness signature confirms the client gave voluntary consent."
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C) "Informed consent is only required for surgical procedures."
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D) "A family member can sign consent for any adult client."
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Answer: B #
Rationale: The witness signature confirms the client signed voluntarily and
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appeared competent. The provider (not nurse) is responsible for explaining the
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procedure (A). Consent is required for invasive procedures, not just surgery (C).
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Family can only sign if the client is incapacitated and a durable power of attorney
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is in place (D).
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Question 4 #
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A nurse is delegating tasks to an assistive personnel (AP). Which task is
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appropriate for the AP to perform? # # # # #
A) Ambulate a client who is 2 hours post-cardiac catheterization
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B) Measure the intake and output for a client with heart failure
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C) Assess the pain level of a client reporting abdominal discomfort
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D) Change the dressing on a client's surgical wound
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Answer: B #
Rationale: Measuring intake and output is a standard task within the AP's scope
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of practice. Ambulating a post-catheterization client (A) requires assessment of
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the insertion site. Pain assessment (C) and wound care (D) require nursing
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judgment and are outside AP scope.
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Question 5 #
A nurse is providing discharge teaching to a client who speaks a different
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language than the nurse. An interpreter is not immediately available. What is the
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appropriate action? #
A) Use the client's family member as an interpreter
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B) Provide written instructions in the client's language
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C) Delay discharge until an interpreter is available
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D) Use a translation app on a hospital device
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Answer: C #
Rationale: Delaying discharge until a qualified medical interpreter is available
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ensures accurate communication and safe discharge. Family members (A) may
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not provide accurate medical interpretation. Written instructions (B) may not be
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understood if the client is illiterate. Translation apps (D) may not be HIPAA-
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compliant or accurate. # #
Question 6 #
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A nurse is caring for a client who has a living will. The client's condition has
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deteriorated, and the family wants aggressive treatment. What should the nurse
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do?
A) Follow the family's wishes to avoid conflict
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B) Initiate aggressive treatment as requested
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C) Review the living will with the family and honor the client's wishes
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D) Contact risk management for legal guidance
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Answer: C #
Rationale: The living will documents the client's wishes and must be honored. The
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nurse should review it with the family and advocate for the client's autonomy.
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The provider may need to clarify the document, but the client's wishes take
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precedence over family preferences. # # #
Question 7 #
A charge nurse is observing a new graduate nurse perform a sterile dressing
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change. Which action requires intervention?
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A) Opening the sterile kit away from the body
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B) Adding sterile supplies by dropping them onto the sterile field
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C) Reaching over the sterile field to obtain additional supplies
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D) Holding the sterile drape at the corners to place it
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Answer: C #
Rationale: Reaching over the sterile field contaminates the field. The nurse should
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walk around to the side to add supplies. Opening away from the body (A),
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dropping supplies onto the field (B), and holding drapes at corners (D) are correct
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sterile technique. #
Question 8 #
A nurse is preparing to transfer a client from the ICU to a medical-surgical unit.
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Which information must be included in the handoff report? (Select all that apply)
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1
ATI RN Comprehensive Predictor 2026 Exit Exam:
# # # # # #
180 Next Generation NCLEX Practice Questions with
# # # # # #
Detailed Rationales for Nursing Students # # # #
ATI RN COMPREHENSIVE PREDICTOR – FULL 180-QUESTION SIMULATED EXAM
# # # # # # # #
EXAM INSTRUCTIONS #
• Total Questions: 180 # #
• Time Allowed: 180 minutes # # #
• Format: Multiple choice, NGN case studies, bow-tie, matrix, drag-and-drop
# # # # # # # #
• Passing Standard: 70% or higher for NCLEX readiness prediction
# # # # # # # #
SECTION 1: MANAGEMENT OF CARE (Questions 1-36)
# # # # # #
Question 1 #
A charge nurse is making client assignments on a medical-surgical unit. Which
# # # # # # # # # # #
client should be assigned to the most experienced RN?
# # # # # # # #
A) A client with diabetes mellitus requiring insulin administration
# # # # # # # #
B) A client with pneumonia requiring q4h vital signs
# # # # # # # #
C) A client with chest tubes and a new onset of respiratory distress
# # # # # # # # # # # #
D) A client with a urinary tract infection requiring IV antibiotics
# # # # # # # # # #
Answer: C #
Rationale: The client with chest tubes and respiratory distress is unstable and
# # # # # # # # # # #
requires complex assessment and intervention. This client should be assigned to
# # # # # # # # # #
the most experienced RN. Stable clients with routine care (A, B, D) can be
# # # # # # # # # # # # #
assigned to LPNs or less experienced RNs under supervision.
# # # # # # # #
,#
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Question 2 #
A nurse is caring for a client who refuses a blood transfusion due to religious
# # # # # # # # # # # # # #
beliefs. The client's family requests that the transfusion be given anyway. What is
# # # # # # # # # # # #
the nurse's priority action?
# # #
A) Administer the transfusion as the family requests
# # # # # # #
B) Notify the healthcare provider of the client's refusal
# # # # # # # #
C) Contact the ethics committee for a consultation
# # # # # # #
D) Ask the client to reconsider the family's wishes
# # # # # # # #
Answer: B #
Rationale: The nurse must respect the client's autonomy and right to refuse
# # # # # # # # # # #
treatment. The healthcare provider should be notified so alternative treatments
# # # # # # # # #
can be considered. The client's decision must be honored regardless of family
# # # # # # # # # # #
wishes.
Question 3 #
A nurse manager is reviewing informed consent with staff. Which statement by a
# # # # # # # # # # # #
staff member indicates understanding?
# # #
A) "The nurse is responsible for explaining the procedure to the client."
# # # # # # # # # # #
B) "A witness signature confirms the client gave voluntary consent."
# # # # # # # # #
C) "Informed consent is only required for surgical procedures."
# # # # # # # #
D) "A family member can sign consent for any adult client."
# # # # # # # # # #
Answer: B #
Rationale: The witness signature confirms the client signed voluntarily and
# # # # # # # # #
appeared competent. The provider (not nurse) is responsible for explaining the
# # # # # # # # # #
procedure (A). Consent is required for invasive procedures, not just surgery (C).
# # # # # # # # # # #
Family can only sign if the client is incapacitated and a durable power of attorney
# # # # # # # # # # # # # #
is in place (D).
# # #
Question 4 #
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3
A nurse is delegating tasks to an assistive personnel (AP). Which task is
# # # # # # # # # # # #
appropriate for the AP to perform? # # # # #
A) Ambulate a client who is 2 hours post-cardiac catheterization
# # # # # # # # #
B) Measure the intake and output for a client with heart failure
# # # # # # # # # # #
C) Assess the pain level of a client reporting abdominal discomfort
# # # # # # # # # #
D) Change the dressing on a client's surgical wound
# # # # # # # #
Answer: B #
Rationale: Measuring intake and output is a standard task within the AP's scope
# # # # # # # # # # # #
of practice. Ambulating a post-catheterization client (A) requires assessment of
# # # # # # # # #
the insertion site. Pain assessment (C) and wound care (D) require nursing
# # # # # # # # # # #
judgment and are outside AP scope.
# # # # #
Question 5 #
A nurse is providing discharge teaching to a client who speaks a different
# # # # # # # # # # # #
language than the nurse. An interpreter is not immediately available. What is the
# # # # # # # # # # # #
appropriate action? #
A) Use the client's family member as an interpreter
# # # # # # # #
B) Provide written instructions in the client's language
# # # # # # #
C) Delay discharge until an interpreter is available
# # # # # # #
D) Use a translation app on a hospital device
# # # # # # # #
Answer: C #
Rationale: Delaying discharge until a qualified medical interpreter is available
# # # # # # # # #
ensures accurate communication and safe discharge. Family members (A) may
# # # # # # # # #
not provide accurate medical interpretation. Written instructions (B) may not be
# # # # # # # # # #
understood if the client is illiterate. Translation apps (D) may not be HIPAA-
# # # # # # # # # # # #
compliant or accurate. # #
Question 6 #
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4
A nurse is caring for a client who has a living will. The client's condition has
# # # # # # # # # # # # # # #
deteriorated, and the family wants aggressive treatment. What should the nurse
# # # # # # # # # #
do?
A) Follow the family's wishes to avoid conflict
# # # # # # #
B) Initiate aggressive treatment as requested
# # # # #
C) Review the living will with the family and honor the client's wishes
# # # # # # # # # # # #
D) Contact risk management for legal guidance
# # # # # #
Answer: C #
Rationale: The living will documents the client's wishes and must be honored. The
# # # # # # # # # # # #
nurse should review it with the family and advocate for the client's autonomy.
# # # # # # # # # # # #
The provider may need to clarify the document, but the client's wishes take
# # # # # # # # # # # #
precedence over family preferences. # # #
Question 7 #
A charge nurse is observing a new graduate nurse perform a sterile dressing
# # # # # # # # # # # #
change. Which action requires intervention?
# # # #
A) Opening the sterile kit away from the body
# # # # # # # #
B) Adding sterile supplies by dropping them onto the sterile field
# # # # # # # # # #
C) Reaching over the sterile field to obtain additional supplies
# # # # # # # # #
D) Holding the sterile drape at the corners to place it
# # # # # # # # # #
Answer: C #
Rationale: Reaching over the sterile field contaminates the field. The nurse should
# # # # # # # # # # #
walk around to the side to add supplies. Opening away from the body (A),
# # # # # # # # # # # # #
dropping supplies onto the field (B), and holding drapes at corners (D) are correct
# # # # # # # # # # # # #
sterile technique. #
Question 8 #
A nurse is preparing to transfer a client from the ICU to a medical-surgical unit.
# # # # # # # # # # # # # #
Which information must be included in the handoff report? (Select all that apply)
# # # # # # # # # # # #
