ATI RN Comprehensive Predictor
2026: High-Yield NCLEX-Style Practice
Questions with Evidence-Based
Rationales for Nursing Students
Management of Care & Prioritization
1. A charge nurse is assigning client care on a medical-surgical unit.
Which client should be assigned to the most experienced RN?
A. A client with type 2 diabetes requiring insulin administration
B. A client who had a total hip replacement 3 days ago
C. A client with an NG tube, chest tube, and epidural PCA
D. A client with a urinary tract infection on oral antibiotics
Answer: C
Rationale: The client with multiple invasive devices (NG tube, chest tube,
epidural PCA) has complex care needs requiring the most experienced RN.
Stable clients with predictable needs can be delegated to less experienced
staff. Match client acuity with staff competency.
2. A nurse is caring for four clients. Which client should the nurse
assess first?
A. Client reporting pain of 4/10 post-operative day 2
B. Client with new onset confusion and oxygen saturation of 89%
,C. Client requesting assistance with the bedpan
D. Client with a scheduled antibiotic due in 30 minutes
Answer: B
Rationale: New onset confusion with low oxygen saturation indicates
potential hypoxia or acute neurological change. This is a priority using the
ABC (Airway, Breathing, Circulation) framework and safety principles.
3. A nurse is delegating tasks to assistive personnel (AP). Which task is
appropriate to delegate?
A. Performing a sterile wound dressing change
B. Assessing a client's bowel sounds
C. Obtaining a client's daily weight
D. Teaching a client about a new medication
Answer: C
Rationale: Obtaining daily weight is a standard task within the AP scope of
practice. Assessment and teaching require RN-level clinical judgment.
Medication administration requires licensed personnel.
4. A client scheduled for surgery asks the nurse to explain the
procedure again. What is the nurse's best response?
A. "I will call the provider to come speak with you."
B. "Let me explain the procedure to you in detail."
C. "You should have asked this question yesterday."
D. "Have the client sign another consent form."
Answer: A
Rationale: Informed consent is the provider's responsibility. The nurse can
clarify information but should NOT provide detailed procedural
,explanations. If the client has questions, the provider must be contacted to
ensure informed consent is valid.
5. A nurse manager is discussing disaster triage with staff. In a mass
casualty event, which client should receive a red tag?
A. Client with a minor ankle sprain walking independently
B. Client with agonal breathing and no palpable pulse
C. Client with a sucking chest wound and respiratory distress
D. Client with a closed head injury and fixed dilated pupils
Answer: C
Rationale: RED TAG = emergent/immediate - threat to life but survivable.
A sucking chest wound requires immediate intervention. Black tag =
expectant (agonal breathing/no pulse). Green = minor injuries. Yellow =
delayed care.
6. A nurse is caring for an older adult client with kidney failure who
states, "I have decided to stop my hemodialysis treatments." Which
action by the nurse demonstrates client advocacy?
A. Notifying the client's family of the decision
B. Asking the provider to explain the consequences again
C. Supporting the client's decision regarding treatment
D. Documenting that the client is non-compliant
Answer: C
Rationale: Supporting the client's autonomous decision regarding
treatment demonstrates client advocacy. The nurse should respect the
client's right to make healthcare decisions.
, 7. A nurse is preparing to administer a blood transfusion. Which action
should the nurse take first?
A. Start the transfusion at 125 mL/hour
B. Verify the client's identity using two identifiers
C. Obtain vital signs and baseline assessment
D. Check the blood product expiration date
Answer: B
Rationale: Verifying client identity using two identifiers is the first and most
critical safety step before any blood product administration. This prevents
transfusion errors and ensures the correct blood is given to the correct
client.
Safe & Effective Care Environment
8. A nurse is caring for a client who has a new tracheostomy and is
experiencing respiratory distress. What is the priority nursing action?
A. Suction the tracheostomy
B. Check for tube obstruction
C. Call the provider immediately
D. Increase oxygen flow rate
Answer: B
Rationale: Checking for obstruction (such as mucus plugging) addresses
the immediate cause of distress per airway management priorities.
Suctioning or oxygen may follow if needed.
9. A client's IV infusion site is painful with a red line extending up the
vein. What is the priority nursing action?
2026: High-Yield NCLEX-Style Practice
Questions with Evidence-Based
Rationales for Nursing Students
Management of Care & Prioritization
1. A charge nurse is assigning client care on a medical-surgical unit.
Which client should be assigned to the most experienced RN?
A. A client with type 2 diabetes requiring insulin administration
B. A client who had a total hip replacement 3 days ago
C. A client with an NG tube, chest tube, and epidural PCA
D. A client with a urinary tract infection on oral antibiotics
Answer: C
Rationale: The client with multiple invasive devices (NG tube, chest tube,
epidural PCA) has complex care needs requiring the most experienced RN.
Stable clients with predictable needs can be delegated to less experienced
staff. Match client acuity with staff competency.
2. A nurse is caring for four clients. Which client should the nurse
assess first?
A. Client reporting pain of 4/10 post-operative day 2
B. Client with new onset confusion and oxygen saturation of 89%
,C. Client requesting assistance with the bedpan
D. Client with a scheduled antibiotic due in 30 minutes
Answer: B
Rationale: New onset confusion with low oxygen saturation indicates
potential hypoxia or acute neurological change. This is a priority using the
ABC (Airway, Breathing, Circulation) framework and safety principles.
3. A nurse is delegating tasks to assistive personnel (AP). Which task is
appropriate to delegate?
A. Performing a sterile wound dressing change
B. Assessing a client's bowel sounds
C. Obtaining a client's daily weight
D. Teaching a client about a new medication
Answer: C
Rationale: Obtaining daily weight is a standard task within the AP scope of
practice. Assessment and teaching require RN-level clinical judgment.
Medication administration requires licensed personnel.
4. A client scheduled for surgery asks the nurse to explain the
procedure again. What is the nurse's best response?
A. "I will call the provider to come speak with you."
B. "Let me explain the procedure to you in detail."
C. "You should have asked this question yesterday."
D. "Have the client sign another consent form."
Answer: A
Rationale: Informed consent is the provider's responsibility. The nurse can
clarify information but should NOT provide detailed procedural
,explanations. If the client has questions, the provider must be contacted to
ensure informed consent is valid.
5. A nurse manager is discussing disaster triage with staff. In a mass
casualty event, which client should receive a red tag?
A. Client with a minor ankle sprain walking independently
B. Client with agonal breathing and no palpable pulse
C. Client with a sucking chest wound and respiratory distress
D. Client with a closed head injury and fixed dilated pupils
Answer: C
Rationale: RED TAG = emergent/immediate - threat to life but survivable.
A sucking chest wound requires immediate intervention. Black tag =
expectant (agonal breathing/no pulse). Green = minor injuries. Yellow =
delayed care.
6. A nurse is caring for an older adult client with kidney failure who
states, "I have decided to stop my hemodialysis treatments." Which
action by the nurse demonstrates client advocacy?
A. Notifying the client's family of the decision
B. Asking the provider to explain the consequences again
C. Supporting the client's decision regarding treatment
D. Documenting that the client is non-compliant
Answer: C
Rationale: Supporting the client's autonomous decision regarding
treatment demonstrates client advocacy. The nurse should respect the
client's right to make healthcare decisions.
, 7. A nurse is preparing to administer a blood transfusion. Which action
should the nurse take first?
A. Start the transfusion at 125 mL/hour
B. Verify the client's identity using two identifiers
C. Obtain vital signs and baseline assessment
D. Check the blood product expiration date
Answer: B
Rationale: Verifying client identity using two identifiers is the first and most
critical safety step before any blood product administration. This prevents
transfusion errors and ensures the correct blood is given to the correct
client.
Safe & Effective Care Environment
8. A nurse is caring for a client who has a new tracheostomy and is
experiencing respiratory distress. What is the priority nursing action?
A. Suction the tracheostomy
B. Check for tube obstruction
C. Call the provider immediately
D. Increase oxygen flow rate
Answer: B
Rationale: Checking for obstruction (such as mucus plugging) addresses
the immediate cause of distress per airway management priorities.
Suctioning or oxygen may follow if needed.
9. A client's IV infusion site is painful with a red line extending up the
vein. What is the priority nursing action?
