ATI Comprehensive Predictor 2026 / NCLEX-RN Review
,ATI Comprehensive Predictor 2026 / NCLEX-RN Review
Premium Comprehensive Table of Contents
Section Content Area High-Yield Coverage
Nursing process, clinical judgment, priority setting, Maslow, ABCs,
Foundations of Nursing
I assessment versus intervention, expected versus unexpected
Practice & Clinical Judgment
findings
Standard and transmission-based precautions, PPE, isolation, falls,
Safety, Infection Control &
II restraints, seizures, sterile technique, incident reporting, emergency
Risk Reduction
safety and risk reduction
Hygiene, mobility, positioning, nutrition, elimination, oxygenation,
III Fundamentals of Nursing Care
sleep, comfort, wound care, pressure injuries and perioperative care
Fluid, Electrolyte & Acid–Base IV therapy, dehydration, fluid overload, sodium, potassium, calcium,
IV
Disorders magnesium, ABGs, metabolic and respiratory imbalances
ACS/MI, heart failure, dysrhythmias, hypertension, shock, valvular
V Cardiovascular Nursing
disease, vascular disorders, cardiac medications and monitoring
Asthma, COPD, pneumonia, pulmonary embolism, ARDS,
VI Respiratory Nursing pneumothorax, chest tubes, oxygen delivery and mechanical
ventilation
Neurologic & Sensory Stroke, seizures, increased ICP, meningitis, spinal cord injury,
VII
Disorders Parkinson disease, multiple sclerosis and neurologic emergencies
GI bleeding, peptic ulcer disease, pancreatitis, bowel obstruction,
Gastrointestinal &
VIII inflammatory bowel disease, ostomies, cirrhosis, hepatitis and liver
Hepatobiliary Nursing
failure
AKI, CKD, dialysis, UTIs, pyelonephritis, nephrotic disorders, renal
IX Renal & Urinary Nursing
calculi, urinary retention and catheter care
Endocrine & Metabolic Diabetes, DKA, HHS, thyroid disorders, adrenal disorders, SIADH,
X
Nursing diabetes insipidus and endocrine emergencies
Hematologic, Immune & Anemias, transfusion reactions, neutropenia, thrombocytopenia,
XI
Oncologic Nursing leukemia, chemotherapy precautions and immunologic disorders
,Section Content Area High-Yield Coverage
Musculoskeletal & Fractures, traction, casts, compartment syndrome, joint
XII
Integumentary Nursing replacement, osteoporosis, burns, wounds and skin disorders
Pharmacology & Medication High-alert medications, adverse effects, interactions, antidotes,
XIII
Administration dosage safety, medication reconciliation and patient teaching
Maternal & Antepartum Prenatal assessment, fetal surveillance, pregnancy complications,
XIV
Nursing preeclampsia, gestational diabetes and Rh incompatibility
Stages of labor, fetal heart-rate interpretation, induction, oxytocin
Labor, Delivery & Intrapartum
XV safety, obstetric emergencies, operative birth and intrapartum
Nursing
interventions
Postpartum hemorrhage, infection, breastfeeding, newborn
Postpartum & Newborn
XVI transition, neonatal assessment, jaundice and newborn
Nursing
complications
Growth and development, pediatric assessment, respiratory and GI
XVII Pediatric Nursing disorders, congenital conditions, medications, emergencies and
family-centered care
Therapeutic communication, depression, bipolar disorder,
Mental Health & Psychiatric
XVIII schizophrenia, anxiety, substance use, crisis care and psychiatric
Nursing
medications
RN/LPN/UAP assignments, delegation, supervision, prioritization,
Leadership, Management &
XIX staffing, conflict management, chain of command and quality
Delegation
improvement
Prevention levels, epidemiology, home health, disaster triage,
Community & Public Health
XX communicable diseases, vulnerable populations and community
Nursing
assessment
Shock, sepsis, respiratory failure, ventilator emergencies, cardiac
Emergency, Critical Care &
XXI arrest, dysrhythmias, rapid response, trauma and critical
Rapid Response
deterioration
Informed consent, autonomy, confidentiality, documentation,
Ethical, Legal & Professional
XXII incident reporting, advance directives, restraints, advocacy,
Nursing Practice
professional boundaries and accountability
,Section Content Area High-Yield Coverage
Patient Education, Teach-back, health literacy, interpreters, therapeutic
XXIII Communication & communication, coping, body image, family support, cultural
Psychosocial Integrity considerations and discharge education
Dysphagia, tube feeding, aspiration prevention, refeeding
Nutrition, Enteral & Parenteral
XXIV syndrome, TPN, central-line safety, metabolic complications and
Therapy
nutrition monitoring
ATI Priority, Delegation & ABCs, unstable versus stable, acute versus chronic, unexpected
XXV “Who to See First?” findings, RN/LPN/UAP scope, delegation decisions and high-priority
Challenges clinical deterioration
Recognize cues, analyze cues, prioritize hypotheses, generate
Next Generation NCLEX
XXVI solutions, take action, evaluate outcomes and evolving case
Clinical Judgment Cases
scenarios
Extended case studies, SATA, matrix/grid, bow-tie, trend
NGN Case Studies &
XXVII interpretation, ordered response and complex clinical decision-
Alternative Item Formats
making
Mixed-system high-difficulty questions integrating pharmacology,
Comprehensive Predictor Final
XXVIII safety, priority, delegation, emergency recognition and clinical
Review
judgment
Exam Features
• ATI Comprehensive Predictor / NCLEX-RN high-yield focus
• Difficult Clinical Challenge format
• Detailed rationales for every correct answer
• Why the other options are less appropriate
• Clinical Pearl with each challenge
• Exam Strategy for high-yield test-taking guidance
• Mixed traditional and Next Generation NCLEX item formats
• Priority, delegation, safety and medication questions integrated throughout
• Shuffled and balanced A–D answer distribution
• Case-based, trend-based and emergency decision-making questions
• Comprehensive final review designed for advanced predictor preparation
,Foundations of Nursing Practice & Clinical Judgment
Advanced ATI Comprehensive Predictor / NCLEX-RN Review
Clinical Challenge 1
Thirty minutes after receiving IV hydromorphone, a postoperative client becomes difficult to arouse.
Respirations are 7/min and shallow, and oxygen saturation is 84%. Which action should the nurse take first?
A. Obtain an arterial blood gas specimen
B. Notify the healthcare provider and wait for further prescriptions
C. Support ventilation, administer oxygen, and initiate the opioid-reversal protocol
D. Reassess the client's respiratory status in 15 minutes
Correct Answer: C
Rationale: The client has severe opioid-induced respiratory depression, evidenced by markedly decreased
respirations, reduced level of consciousness, and hypoxemia. Airway and breathing are immediate priorities.
The nurse should support ventilation, provide oxygen, stop further opioid delivery, summon assistance, and
administer naloxone according to protocol. Delaying intervention could result in respiratory arrest.
Why the other options are less appropriate:
A. ABG testing may help evaluate respiratory failure but must not delay immediate ventilatory support.
B. Provider notification is appropriate, but the nurse should first initiate emergency measures that are within
nursing scope and protocol.
D. Reassessment without intervention is unsafe because the client is already showing severe respiratory
compromise.
Clinical Pearl: A respiratory rate below 8/min accompanied by decreased consciousness after opioid
administration should be treated as a potential respiratory emergency.
Exam Strategy: When a stem contains an obvious ABC emergency, choose the option that immediately
stabilizes airway, breathing, or circulation.
Clinical Challenge 2
During change-of-shift report, which client should the nurse assess first?
A. A client with chronic kidney disease who reports generalized pruritus
B. A client with pneumonia and a temperature of 38.2°C (100.8°F)
C. A client with diabetes whose premeal glucose is 72 mg/dL
D. A client with COPD who has become restless, confused, and increasingly drowsy
Correct Answer: D
,Rationale: New restlessness, confusion, and drowsiness in a client with COPD can indicate worsening
hypoxemia, carbon dioxide retention, or impending respiratory failure. Acute mental-status changes associated
with respiratory disease require immediate assessment of oxygenation and ventilation.
Why the other options are less appropriate:
A. Pruritus is common with advanced kidney disease and is uncomfortable but not usually immediately life-
threatening.
B. A moderate fever in pneumonia requires monitoring but is less urgent than signs of respiratory
deterioration.
C. A glucose of 72 mg/dL is low-normal and does not represent the same immediate threat in an asymptomatic
client.
Clinical Pearl: Restlessness may be an early sign of hypoxemia; increasing somnolence may indicate worsening
hypercapnia.
Exam Strategy: ATI often signals deterioration through new mental-status changes, especially in
respiratory clients.
Clinical Challenge 3
The RN is assigning care to an experienced unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
A. Evaluate whether an analgesic relieved postoperative pain
B. Obtain routine vital signs for a stable client
C. Teach a newly diagnosed client how to use a glucometer
D. Complete an admission fall-risk assessment
Correct Answer: B
Rationale: Routine vital-sign measurement for a stable client is a predictable task that trained UAP can
perform. The RN remains responsible for interpreting the findings and responding to abnormalities.
Assessment, teaching, and evaluation require nursing judgment.
Why the other options are less appropriate:
A. Evaluation of a medication's effectiveness requires RN judgment.
C. Initial teaching is an RN responsibility.
D. Admission assessment requires professional nursing assessment and cannot be delegated to UAP.
Clinical Pearl: Delegation transfers performance of a task, not nursing accountability.
Exam Strategy: Think routine + stable + predictable = UAP.
Clinical Challenge 4
,A postoperative client suddenly develops dyspnea, tachypnea, and an oxygen saturation of 82%. Which
intervention has priority?
A. Review the operative report for potential complications
B. Obtain a complete medication history
C. Notify the client's family
D. Raise the head of the bed and immediately support oxygenation
Correct Answer: D
Rationale: Severe hypoxemia represents an immediate breathing problem. Upright positioning improves lung
expansion, and oxygen therapy helps correct the immediate deficit while the nurse continues rapid assessment
and initiates escalation of care.
Why the other options are less appropriate:
A. Reviewing records may help identify the cause but does not correct hypoxemia.
B. Medication history is secondary during an acute respiratory emergency.
C. Family notification is not a priority while the client is unstable.
Clinical Pearl: In acute deterioration, stabilize the physiology first and investigate the cause concurrently or
afterward.
Exam Strategy: Choose intervention before investigation when the client is already unstable.
Clinical Challenge 5
While preparing a medication, the nurse notices that the prescribed dose is several times greater than the
usual therapeutic dose. What should the nurse do?
A. Withhold the medication and clarify the prescription
B. Administer half the prescribed dose
C. Give the medication and closely monitor the client
D. Ask another nurse to administer the medication
Correct Answer: A
Rationale: Nurses are accountable for safe medication administration and must question prescriptions that
appear unsafe. The nurse should hold the medication until the dose is verified with the appropriate provider or
pharmacist.
Why the other options are less appropriate:
B. Independently changing the dose constitutes unauthorized alteration of a prescription.
C. Administering a potentially toxic dose exposes the client to preventable harm.
D. Asking another nurse to give the medication does not resolve the safety concern.
Clinical Pearl: “The provider ordered it” does not remove the nurse's responsibility to identify unsafe
prescriptions.
, Exam Strategy: For questionable prescriptions, select hold and clarify.
Clinical Challenge 6
Following teaching about heart-failure self-management, which statement provides the strongest evidence
that the client understood the instructions?
A. “Everything you explained makes sense.”
B. “I will weigh myself every morning under similar conditions and report a rapid increase.”
C. “My spouse remembers all the instructions.”
D. “I'll review the handout again when I get home.”
Correct Answer: B
Rationale: The client accurately describes a specific self-management behavior, demonstrating understanding
through teach-back. Daily weights are important for identifying early fluid retention in heart failure.
Why the other options are less appropriate:
A. Stating understanding does not demonstrate actual comprehension.
C. The client's own ability to manage care should be assessed rather than relying solely on family.
D. Reading written materials later does not establish current understanding.
Clinical Pearl: Teach-back is one of the strongest methods for verifying effective client education.
Exam Strategy: Choose the answer that demonstrates observable client understanding, not a vague
statement of comprehension.
Clinical Challenge 7
Which finding requires the most immediate nursing response?
A. Potassium 3.4 mEq/L in a client receiving furosemide
B. Hemoglobin 10.2 g/dL in a client with chronic anemia
C. Sudden facial droop, unilateral arm weakness, and difficulty speaking
D. Blood pressure 154/88 mm Hg in a client with chronic hypertension
Correct Answer: C
Rationale: Sudden focal neurologic deficits strongly suggest an acute stroke. Immediate neurologic assessment
and activation of a stroke pathway are necessary because treatment options can be highly time-sensitive.
Why the other options are less appropriate:
A. Mild hypokalemia requires follow-up but is not as immediately time-critical.
B. Chronic mild anemia is generally less urgent in a stable client.
D. Moderate hypertension without acute symptoms is not the highest priority.
Clinical Pearl: Establishing the client's last-known-well time is essential when stroke is suspected.
, Exam Strategy: New neurologic deficit + sudden onset = emergency.
Clinical Challenge 8
Which nursing documentation entry is most appropriate?
A. “Client had a terrible night.”
B. “Client appears septic.”
C. “Client was uncooperative with treatment.”
D. “Temperature 38.6°C; HR 112/min; 2-cm erythematous area with purulent drainage at incision; provider
notified.”
Correct Answer: D
Rationale: Effective nursing documentation is objective, measurable, specific, and factual. This entry describes
observable findings and an action taken without judgmental or speculative language.
Why the other options are less appropriate:
A. “Terrible” is subjective and vague.
B. Nurses should document assessment findings rather than unsupported diagnostic conclusions.
C. “Uncooperative” is judgmental and does not describe the client's specific behavior.
Clinical Pearl: Chart what you see, hear, measure, do, and communicate.
Exam Strategy: Prefer documentation containing objective data + nursing action.
Clinical Challenge 9
A competent adult refuses a prescribed blood transfusion after being informed of the potential
consequences. What should the nurse do?
A. Respect the refusal, notify the provider, and document the decision
B. Ask the family to override the client's decision
C. Administer the transfusion because it may save the client's life
D. Request security assistance to prevent the client from leaving
Correct Answer: A
Rationale: Competent adults have the legal and ethical right to refuse treatment. The nurse should ensure the
refusal is informed, respect the decision, notify the appropriate provider, and document the discussion and
outcome.
Why the other options are less appropriate:
B. Family members cannot override a competent adult's informed decision.
C. Administering treatment without consent may constitute battery.
D. Security involvement is not indicated simply because a competent client refuses treatment.
, Clinical Pearl: Informed refusal is an expression of client autonomy.
Exam Strategy: When a competent adult makes an informed decision, autonomy generally takes priority.
Clinical Challenge 10
Which hospitalized client has the greatest fall risk?
A. A 34-year-old receiving IV antibiotics
B. An 82-year-old with acute confusion, urinary urgency, orthostatic hypotension, and recent sedative use
C. A 47-year-old with a forearm cast
D. A 58-year-old who wears corrective lenses
Correct Answer: B
Rationale: This client has several major fall-risk factors occurring simultaneously: advanced age, confusion,
urgency, postural hypotension, and sedative exposure. Combined risk factors significantly increase fall
likelihood.
Why the other options are less appropriate:
A. IV therapy alone does not create the same level of risk.
C. An arm cast may limit function but does not create as many fall risks.
D. Corrective lenses alone represent a relatively minor risk compared with the combination in option B.
Clinical Pearl: Fall risk is usually multifactorial.
Exam Strategy: When comparing risk, consider both the number and severity of risk factors.
Clinical Challenge 11
Minutes after an IV antibiotic is started, the client develops generalized urticaria, facial swelling, wheezing,
and hypotension. What should the nurse do first?
A. Obtain a detailed medication-allergy history
B. Document the adverse reaction
C. Stop the infusion and initiate emergency treatment for anaphylaxis
D. Slow the infusion rate
Correct Answer: C
Rationale: The client is demonstrating classic signs of anaphylaxis, including airway involvement and circulatory
compromise. The offending medication should be stopped immediately, emergency assistance activated, and
treatment initiated according to protocol.
Why the other options are less appropriate:
A. Allergy history can be reviewed after immediate stabilization.
,ATI Comprehensive Predictor 2026 / NCLEX-RN Review
Premium Comprehensive Table of Contents
Section Content Area High-Yield Coverage
Nursing process, clinical judgment, priority setting, Maslow, ABCs,
Foundations of Nursing
I assessment versus intervention, expected versus unexpected
Practice & Clinical Judgment
findings
Standard and transmission-based precautions, PPE, isolation, falls,
Safety, Infection Control &
II restraints, seizures, sterile technique, incident reporting, emergency
Risk Reduction
safety and risk reduction
Hygiene, mobility, positioning, nutrition, elimination, oxygenation,
III Fundamentals of Nursing Care
sleep, comfort, wound care, pressure injuries and perioperative care
Fluid, Electrolyte & Acid–Base IV therapy, dehydration, fluid overload, sodium, potassium, calcium,
IV
Disorders magnesium, ABGs, metabolic and respiratory imbalances
ACS/MI, heart failure, dysrhythmias, hypertension, shock, valvular
V Cardiovascular Nursing
disease, vascular disorders, cardiac medications and monitoring
Asthma, COPD, pneumonia, pulmonary embolism, ARDS,
VI Respiratory Nursing pneumothorax, chest tubes, oxygen delivery and mechanical
ventilation
Neurologic & Sensory Stroke, seizures, increased ICP, meningitis, spinal cord injury,
VII
Disorders Parkinson disease, multiple sclerosis and neurologic emergencies
GI bleeding, peptic ulcer disease, pancreatitis, bowel obstruction,
Gastrointestinal &
VIII inflammatory bowel disease, ostomies, cirrhosis, hepatitis and liver
Hepatobiliary Nursing
failure
AKI, CKD, dialysis, UTIs, pyelonephritis, nephrotic disorders, renal
IX Renal & Urinary Nursing
calculi, urinary retention and catheter care
Endocrine & Metabolic Diabetes, DKA, HHS, thyroid disorders, adrenal disorders, SIADH,
X
Nursing diabetes insipidus and endocrine emergencies
Hematologic, Immune & Anemias, transfusion reactions, neutropenia, thrombocytopenia,
XI
Oncologic Nursing leukemia, chemotherapy precautions and immunologic disorders
,Section Content Area High-Yield Coverage
Musculoskeletal & Fractures, traction, casts, compartment syndrome, joint
XII
Integumentary Nursing replacement, osteoporosis, burns, wounds and skin disorders
Pharmacology & Medication High-alert medications, adverse effects, interactions, antidotes,
XIII
Administration dosage safety, medication reconciliation and patient teaching
Maternal & Antepartum Prenatal assessment, fetal surveillance, pregnancy complications,
XIV
Nursing preeclampsia, gestational diabetes and Rh incompatibility
Stages of labor, fetal heart-rate interpretation, induction, oxytocin
Labor, Delivery & Intrapartum
XV safety, obstetric emergencies, operative birth and intrapartum
Nursing
interventions
Postpartum hemorrhage, infection, breastfeeding, newborn
Postpartum & Newborn
XVI transition, neonatal assessment, jaundice and newborn
Nursing
complications
Growth and development, pediatric assessment, respiratory and GI
XVII Pediatric Nursing disorders, congenital conditions, medications, emergencies and
family-centered care
Therapeutic communication, depression, bipolar disorder,
Mental Health & Psychiatric
XVIII schizophrenia, anxiety, substance use, crisis care and psychiatric
Nursing
medications
RN/LPN/UAP assignments, delegation, supervision, prioritization,
Leadership, Management &
XIX staffing, conflict management, chain of command and quality
Delegation
improvement
Prevention levels, epidemiology, home health, disaster triage,
Community & Public Health
XX communicable diseases, vulnerable populations and community
Nursing
assessment
Shock, sepsis, respiratory failure, ventilator emergencies, cardiac
Emergency, Critical Care &
XXI arrest, dysrhythmias, rapid response, trauma and critical
Rapid Response
deterioration
Informed consent, autonomy, confidentiality, documentation,
Ethical, Legal & Professional
XXII incident reporting, advance directives, restraints, advocacy,
Nursing Practice
professional boundaries and accountability
,Section Content Area High-Yield Coverage
Patient Education, Teach-back, health literacy, interpreters, therapeutic
XXIII Communication & communication, coping, body image, family support, cultural
Psychosocial Integrity considerations and discharge education
Dysphagia, tube feeding, aspiration prevention, refeeding
Nutrition, Enteral & Parenteral
XXIV syndrome, TPN, central-line safety, metabolic complications and
Therapy
nutrition monitoring
ATI Priority, Delegation & ABCs, unstable versus stable, acute versus chronic, unexpected
XXV “Who to See First?” findings, RN/LPN/UAP scope, delegation decisions and high-priority
Challenges clinical deterioration
Recognize cues, analyze cues, prioritize hypotheses, generate
Next Generation NCLEX
XXVI solutions, take action, evaluate outcomes and evolving case
Clinical Judgment Cases
scenarios
Extended case studies, SATA, matrix/grid, bow-tie, trend
NGN Case Studies &
XXVII interpretation, ordered response and complex clinical decision-
Alternative Item Formats
making
Mixed-system high-difficulty questions integrating pharmacology,
Comprehensive Predictor Final
XXVIII safety, priority, delegation, emergency recognition and clinical
Review
judgment
Exam Features
• ATI Comprehensive Predictor / NCLEX-RN high-yield focus
• Difficult Clinical Challenge format
• Detailed rationales for every correct answer
• Why the other options are less appropriate
• Clinical Pearl with each challenge
• Exam Strategy for high-yield test-taking guidance
• Mixed traditional and Next Generation NCLEX item formats
• Priority, delegation, safety and medication questions integrated throughout
• Shuffled and balanced A–D answer distribution
• Case-based, trend-based and emergency decision-making questions
• Comprehensive final review designed for advanced predictor preparation
,Foundations of Nursing Practice & Clinical Judgment
Advanced ATI Comprehensive Predictor / NCLEX-RN Review
Clinical Challenge 1
Thirty minutes after receiving IV hydromorphone, a postoperative client becomes difficult to arouse.
Respirations are 7/min and shallow, and oxygen saturation is 84%. Which action should the nurse take first?
A. Obtain an arterial blood gas specimen
B. Notify the healthcare provider and wait for further prescriptions
C. Support ventilation, administer oxygen, and initiate the opioid-reversal protocol
D. Reassess the client's respiratory status in 15 minutes
Correct Answer: C
Rationale: The client has severe opioid-induced respiratory depression, evidenced by markedly decreased
respirations, reduced level of consciousness, and hypoxemia. Airway and breathing are immediate priorities.
The nurse should support ventilation, provide oxygen, stop further opioid delivery, summon assistance, and
administer naloxone according to protocol. Delaying intervention could result in respiratory arrest.
Why the other options are less appropriate:
A. ABG testing may help evaluate respiratory failure but must not delay immediate ventilatory support.
B. Provider notification is appropriate, but the nurse should first initiate emergency measures that are within
nursing scope and protocol.
D. Reassessment without intervention is unsafe because the client is already showing severe respiratory
compromise.
Clinical Pearl: A respiratory rate below 8/min accompanied by decreased consciousness after opioid
administration should be treated as a potential respiratory emergency.
Exam Strategy: When a stem contains an obvious ABC emergency, choose the option that immediately
stabilizes airway, breathing, or circulation.
Clinical Challenge 2
During change-of-shift report, which client should the nurse assess first?
A. A client with chronic kidney disease who reports generalized pruritus
B. A client with pneumonia and a temperature of 38.2°C (100.8°F)
C. A client with diabetes whose premeal glucose is 72 mg/dL
D. A client with COPD who has become restless, confused, and increasingly drowsy
Correct Answer: D
,Rationale: New restlessness, confusion, and drowsiness in a client with COPD can indicate worsening
hypoxemia, carbon dioxide retention, or impending respiratory failure. Acute mental-status changes associated
with respiratory disease require immediate assessment of oxygenation and ventilation.
Why the other options are less appropriate:
A. Pruritus is common with advanced kidney disease and is uncomfortable but not usually immediately life-
threatening.
B. A moderate fever in pneumonia requires monitoring but is less urgent than signs of respiratory
deterioration.
C. A glucose of 72 mg/dL is low-normal and does not represent the same immediate threat in an asymptomatic
client.
Clinical Pearl: Restlessness may be an early sign of hypoxemia; increasing somnolence may indicate worsening
hypercapnia.
Exam Strategy: ATI often signals deterioration through new mental-status changes, especially in
respiratory clients.
Clinical Challenge 3
The RN is assigning care to an experienced unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
A. Evaluate whether an analgesic relieved postoperative pain
B. Obtain routine vital signs for a stable client
C. Teach a newly diagnosed client how to use a glucometer
D. Complete an admission fall-risk assessment
Correct Answer: B
Rationale: Routine vital-sign measurement for a stable client is a predictable task that trained UAP can
perform. The RN remains responsible for interpreting the findings and responding to abnormalities.
Assessment, teaching, and evaluation require nursing judgment.
Why the other options are less appropriate:
A. Evaluation of a medication's effectiveness requires RN judgment.
C. Initial teaching is an RN responsibility.
D. Admission assessment requires professional nursing assessment and cannot be delegated to UAP.
Clinical Pearl: Delegation transfers performance of a task, not nursing accountability.
Exam Strategy: Think routine + stable + predictable = UAP.
Clinical Challenge 4
,A postoperative client suddenly develops dyspnea, tachypnea, and an oxygen saturation of 82%. Which
intervention has priority?
A. Review the operative report for potential complications
B. Obtain a complete medication history
C. Notify the client's family
D. Raise the head of the bed and immediately support oxygenation
Correct Answer: D
Rationale: Severe hypoxemia represents an immediate breathing problem. Upright positioning improves lung
expansion, and oxygen therapy helps correct the immediate deficit while the nurse continues rapid assessment
and initiates escalation of care.
Why the other options are less appropriate:
A. Reviewing records may help identify the cause but does not correct hypoxemia.
B. Medication history is secondary during an acute respiratory emergency.
C. Family notification is not a priority while the client is unstable.
Clinical Pearl: In acute deterioration, stabilize the physiology first and investigate the cause concurrently or
afterward.
Exam Strategy: Choose intervention before investigation when the client is already unstable.
Clinical Challenge 5
While preparing a medication, the nurse notices that the prescribed dose is several times greater than the
usual therapeutic dose. What should the nurse do?
A. Withhold the medication and clarify the prescription
B. Administer half the prescribed dose
C. Give the medication and closely monitor the client
D. Ask another nurse to administer the medication
Correct Answer: A
Rationale: Nurses are accountable for safe medication administration and must question prescriptions that
appear unsafe. The nurse should hold the medication until the dose is verified with the appropriate provider or
pharmacist.
Why the other options are less appropriate:
B. Independently changing the dose constitutes unauthorized alteration of a prescription.
C. Administering a potentially toxic dose exposes the client to preventable harm.
D. Asking another nurse to give the medication does not resolve the safety concern.
Clinical Pearl: “The provider ordered it” does not remove the nurse's responsibility to identify unsafe
prescriptions.
, Exam Strategy: For questionable prescriptions, select hold and clarify.
Clinical Challenge 6
Following teaching about heart-failure self-management, which statement provides the strongest evidence
that the client understood the instructions?
A. “Everything you explained makes sense.”
B. “I will weigh myself every morning under similar conditions and report a rapid increase.”
C. “My spouse remembers all the instructions.”
D. “I'll review the handout again when I get home.”
Correct Answer: B
Rationale: The client accurately describes a specific self-management behavior, demonstrating understanding
through teach-back. Daily weights are important for identifying early fluid retention in heart failure.
Why the other options are less appropriate:
A. Stating understanding does not demonstrate actual comprehension.
C. The client's own ability to manage care should be assessed rather than relying solely on family.
D. Reading written materials later does not establish current understanding.
Clinical Pearl: Teach-back is one of the strongest methods for verifying effective client education.
Exam Strategy: Choose the answer that demonstrates observable client understanding, not a vague
statement of comprehension.
Clinical Challenge 7
Which finding requires the most immediate nursing response?
A. Potassium 3.4 mEq/L in a client receiving furosemide
B. Hemoglobin 10.2 g/dL in a client with chronic anemia
C. Sudden facial droop, unilateral arm weakness, and difficulty speaking
D. Blood pressure 154/88 mm Hg in a client with chronic hypertension
Correct Answer: C
Rationale: Sudden focal neurologic deficits strongly suggest an acute stroke. Immediate neurologic assessment
and activation of a stroke pathway are necessary because treatment options can be highly time-sensitive.
Why the other options are less appropriate:
A. Mild hypokalemia requires follow-up but is not as immediately time-critical.
B. Chronic mild anemia is generally less urgent in a stable client.
D. Moderate hypertension without acute symptoms is not the highest priority.
Clinical Pearl: Establishing the client's last-known-well time is essential when stroke is suspected.
, Exam Strategy: New neurologic deficit + sudden onset = emergency.
Clinical Challenge 8
Which nursing documentation entry is most appropriate?
A. “Client had a terrible night.”
B. “Client appears septic.”
C. “Client was uncooperative with treatment.”
D. “Temperature 38.6°C; HR 112/min; 2-cm erythematous area with purulent drainage at incision; provider
notified.”
Correct Answer: D
Rationale: Effective nursing documentation is objective, measurable, specific, and factual. This entry describes
observable findings and an action taken without judgmental or speculative language.
Why the other options are less appropriate:
A. “Terrible” is subjective and vague.
B. Nurses should document assessment findings rather than unsupported diagnostic conclusions.
C. “Uncooperative” is judgmental and does not describe the client's specific behavior.
Clinical Pearl: Chart what you see, hear, measure, do, and communicate.
Exam Strategy: Prefer documentation containing objective data + nursing action.
Clinical Challenge 9
A competent adult refuses a prescribed blood transfusion after being informed of the potential
consequences. What should the nurse do?
A. Respect the refusal, notify the provider, and document the decision
B. Ask the family to override the client's decision
C. Administer the transfusion because it may save the client's life
D. Request security assistance to prevent the client from leaving
Correct Answer: A
Rationale: Competent adults have the legal and ethical right to refuse treatment. The nurse should ensure the
refusal is informed, respect the decision, notify the appropriate provider, and document the discussion and
outcome.
Why the other options are less appropriate:
B. Family members cannot override a competent adult's informed decision.
C. Administering treatment without consent may constitute battery.
D. Security involvement is not indicated simply because a competent client refuses treatment.
, Clinical Pearl: Informed refusal is an expression of client autonomy.
Exam Strategy: When a competent adult makes an informed decision, autonomy generally takes priority.
Clinical Challenge 10
Which hospitalized client has the greatest fall risk?
A. A 34-year-old receiving IV antibiotics
B. An 82-year-old with acute confusion, urinary urgency, orthostatic hypotension, and recent sedative use
C. A 47-year-old with a forearm cast
D. A 58-year-old who wears corrective lenses
Correct Answer: B
Rationale: This client has several major fall-risk factors occurring simultaneously: advanced age, confusion,
urgency, postural hypotension, and sedative exposure. Combined risk factors significantly increase fall
likelihood.
Why the other options are less appropriate:
A. IV therapy alone does not create the same level of risk.
C. An arm cast may limit function but does not create as many fall risks.
D. Corrective lenses alone represent a relatively minor risk compared with the combination in option B.
Clinical Pearl: Fall risk is usually multifactorial.
Exam Strategy: When comparing risk, consider both the number and severity of risk factors.
Clinical Challenge 11
Minutes after an IV antibiotic is started, the client develops generalized urticaria, facial swelling, wheezing,
and hypotension. What should the nurse do first?
A. Obtain a detailed medication-allergy history
B. Document the adverse reaction
C. Stop the infusion and initiate emergency treatment for anaphylaxis
D. Slow the infusion rate
Correct Answer: C
Rationale: The client is demonstrating classic signs of anaphylaxis, including airway involvement and circulatory
compromise. The offending medication should be stopped immediately, emergency assistance activated, and
treatment initiated according to protocol.
Why the other options are less appropriate:
A. Allergy history can be reviewed after immediate stabilization.
