NCLEX-STYLE PROFICIENCY REVIEW • QUICK-READ FORMAT
ATI Comprehensive Predictor 2K20
All the information you need for the near exam quick read to guarantee a top score in 15 short pages.
75 Verified Questions with 100% Correct Answers and Comprehensive Rationales • 7 Content Domains • Aligned with 2026/2027 ATI
Testing Content Changes and Practice Standards
SECTION 1 • Safe, Effective Care Environment
Management of Care, Legal/Ethical Issues, Delegation, and Safety/Infection Control
Q1: A nurse is preparing to conduct the first round of assessments on four assigned clients. Which client should the nurse
assess first?
A. A client who is 2 hours post-thoracentesis with a respiratory rate of 10/min and tracheal deviation to the unaffected
side [CORRECT]
B. A client with heart failure who has 2+ pitting edema of the lower extremities and reports weight gain
C. A client who is 1 day postoperative following an appendectomy and reports incisional pain rated 6 on a scale of 0 to 10
D. A client with type 2 diabetes mellitus whose fasting blood glucose is 175 mg/dL before breakfast
Correct Answer: A
Rationale: Using the ABC priority-setting framework, airway and breathing always take precedence over circulation, comfort, and
glucose management. Tracheal deviation with a low respiratory rate following thoracentesis indicates a tension pneumothorax, a
life-threatening complication that requires immediate intervention. The clients with edema, postoperative pain, and moderate
hyperglycemia have important but stable findings that can be addressed after the unstable client is evaluated and treated.
Q2: A charge nurse on a medical-surgical unit is delegating tasks for the shift. Which task is appropriate for the charge nurse to
assign to an assistive personnel (AP)?
A. Teaching a newly diagnosed client how to perform capillary blood glucose monitoring
B. Assessing a client who reports new-onset chest pain rated 8 on a scale of 0 to 10
C. Measuring and recording the urine output of a stable client every 2 hours [CORRECT]
D. Interpreting the cardiac rhythm strips of a client on continuous telemetry
Correct Answer: C
Rationale: Measuring and recording routine intake and output for a physiologically stable client is within the scope of assistive
personnel, who are trained in basic data collection. Teaching, assessing a client with a change in condition, and interpreting cardiac
rhythms require nursing judgment and must be performed by the RN. After delegating, the RN remains accountable for supervision and
must evaluate client outcomes.
Q3: A nurse is managing a team that includes an LPN and an AP. Which client is appropriate for the nurse to assign to the
LPN?
A. A client admitted 1 hour ago with active gastrointestinal bleeding and orthostatic hypotension
B. A stable client who is receiving an IV heparin infusion at a prescribed, non-titrated rate [CORRECT]
C. A client in septic shock who requires titration of a norepinephrine infusion
D. A client who requires initial education about a newly prescribed diabetic exchange diet
Correct Answer: B
Rationale: An LPN can administer prescribed medications, including a heparin infusion at a stable rate, for clients who are
physiologically stable and have predictable outcomes. Clients who are hemodynamically unstable, require vasopressor titration, need
frequent reassessment, or need initial teaching require RN-level judgment and evaluation. Assigning the stable, predictable client to the
LPN maximizes safe and effective use of team members.
1
,ATI Comprehensive Predictor 2K20 - Quick Review | 2026/2027 Edition 75 Questions with Verified Rationales
Q4: A nurse delegates morning ambulation of a postoperative client to an AP. Two hours later, the AP reports that the client
became dizzy during the walk and was assisted back to bed. Which action should the nurse take first?
A. Document the AP report verbatim in the client's medical record
B. Instruct the AP never to ambulate the client again without assistance
C. Notify the charge nurse that the delegated task was unsuccessful
D. Assess the client for orthostatic hypotension and any injury [CORRECT]
Correct Answer: D
Rationale: The delegating RN is accountable for client outcomes and must first assess the client after any reported change in condition
before documenting or coaching staff. Dizziness during ambulation can indicate orthostatic hypotension, internal bleeding, or another
complication that requires nursing evaluation. Re-education of the AP and documentation are completed after the client has been
assessed and made safe.
Q5: A client scheduled for a laparoscopic cholecystectomy asks the nurse, 'What exactly will the surgeon do during my
operation?' Which response by the nurse is accurate?
A. Explain each step of the surgical procedure before the client signs the consent form
B. Tell the client that the surgeon will answer all questions after the procedure is completed
C. Contact the surgeon, because the provider who performs the procedure is responsible for explaining it [CORRECT]
D. Provide the client with a hospital brochure that describes the surgical unit
Correct Answer: C
Rationale: The provider performing the procedure is legally responsible for explaining the risks, benefits, alternatives, and expected
outcomes when obtaining informed consent. The nurse's role is to witness the signature, verify that the client demonstrates
understanding, and notify the provider when questions arise. Answering procedure-specific questions beyond nursing knowledge
constitutes practicing outside the nurse's legal scope of practice.
Q6: An alert, competent adult client has a signed advance directive refusing blood transfusions. The client is brought to surgery
after a motor-vehicle crash, and the family demands that the surgical team administer blood. Which action should the nurse
take?
A. Prepare the blood products, because the family represents the client in an emergency
B. Ask the hospital ethics committee to approve an urgent transfusion
C. Request a court order so the surgical team can override the directive
D. Support the client's documented wishes and communicate them to the surgical team [CORRECT]
Correct Answer: D
Rationale: A competent adult client's advance directive is legally binding, and the nurse acts as an advocate by upholding the
documented wishes and ensuring the surgical team is informed. Family preference does not override the autonomous decision of a
competent adult. Ethics consultation and court orders apply only when the directive's validity is unclear or documentation is absent, not
when clear refusal exists.
Q7: Which action by a nurse constitutes a violation of client confidentiality under HIPAA regulations?
A. Reporting a newly diagnosed case of tuberculosis to the public health department
B. Reviewing the electronic health record of a client who is not assigned to the nurse's care [CORRECT]
C. Giving shift report to the oncoming nurse inside a private conference room
D. Using two client identifiers before administering prescribed medications
Correct Answer: B
Rationale: Accessing a client's record without a treatment-related need violates HIPAA even when no information is disclosed to
others. Mandatory public health reporting, private handoff communication, and proper client identification are required activities that
protect privacy and promote safety. Nurses should access only the records of clients assigned to their care for the purpose of providing
treatment.
Q8: A nurse admits a 5-year-old child who has burns of several different ages. The caregiver delayed seeking treatment and
gives inconsistent explanations about how the injuries occurred. Which action should the nurse take?
A. Confront the caregiver with the suspected abuse before any report is made
B. Hold a discharge planning conference with social services before reporting
C. Document the suspicions in the medical record and take no further action
D. Report the findings to child protective services as mandated by law [CORRECT]
Correct Answer: D
Rationale: Nurses are mandated reporters who must report suspected abuse based on objective findings such as injuries of various
ages, an inconsistent history, and a delay in seeking care. The investigation belongs to child protective services, not the nurse, and direct
confrontation can endanger the child. Thorough documentation supports the report but never replaces the legal duty to report.
2
, ATI Comprehensive Predictor 2K20 - Quick Review | 2026/2027 Edition 75 Questions with Verified Rationales
Q9: A confused client repeatedly pulls out an IV line and an indwelling urinary catheter. After alternative measures fail, the
provider prescribes soft wrist restraints. Which action should the nurse take when applying the restraints?
A. Tie the restraint straps with a quick-release knot in a location the client cannot reach [CORRECT]
B. Secure the restraint ties to the side rails to prevent the client from turning
C. Apply the restraints and plan to check circulation at the end of the shift
D. Apply the restraints first and obtain the provider prescription afterward
Correct Answer: A
Rationale: Restraints must be secured with a quick-release knot that the client cannot reach, never tied to side rails, and circulation and
skin integrity must be checked at least every 2 hours with regular release per facility protocol. A provider prescription is required
before or immediately after emergency application, and documentation of the behavior leading to restraints is mandatory. These
measures reflect the least-restrictive-intervention standard.
Q10: A nurse has completed care of a client on contact precautions and is preparing to leave the room. In which order should
the nurse remove the personal protective equipment?
A. Gown, gloves, mask, goggles
B. Goggles, gloves, gown, mask
C. Gloves, goggles, gown, mask [CORRECT]
D. Mask, gown, goggles, gloves
Correct Answer: C
Rationale: The most contaminated items are removed first: gloves, followed by eye protection or goggles, then the gown, and the mask
or respirator last, removed after leaving the room. This sequence prevents contamination of the nurse's skin, clothing, and mucous
membranes. Hand hygiene is performed immediately after all personal protective equipment has been removed.
Q11: A nurse receives report on four clients and plans the first round of care. For which client should the nurse put on a gown
and gloves before entering the room?
A. A client admitted with pertussis
B. A client with Clostridioides difficile infection and frequent loose stools [CORRECT]
C. A client with suspected active pulmonary tuberculosis
D. A client with meningococcal meningitis
Correct Answer: B
Rationale: C. difficile requires contact precautions, including a gown and gloves, because the organism spreads by direct contact with
contaminated skin and surfaces and is not reliably killed by alcohol-based hand rub, so soap and water handwashing is required.
Pertussis and meningococcal meningitis require droplet precautions with a mask within 3 to 6 feet, and suspected tuberculosis requires
airborne precautions with a fit-tested N95 respirator.
Q12: A client with suspected active pulmonary tuberculosis requires transport to the radiology department for a CT scan.
Which action should the nurse take to protect others during transport?
A. Place a surgical mask on the nurse and transport through the service elevator
B. Schedule the transport during visiting hours to reduce hallway staff exposure
C. Have the client wear an N95 respirator for the duration of transport
D. Place a surgical mask on the client and follow the shortest route to radiology [CORRECT]
Correct Answer: D
Rationale: A client with suspected or confirmed tuberculosis wears a surgical mask during transport because it contains droplet nuclei
at the source; the N95 respirator protects the wearer and does not serve as a client barrier. Masking the client and using the shortest
route limits exposure of other clients, visitors, and staff. Staff and visitors entering the client's room require a fit-tested N95 respirator.
Q13: A nurse discovers flames coming from a wastebasket in a client's room. Which action should the nurse take first?
A. Rescue and remove the client from the room [CORRECT]
B. Activate the nearest fire alarm pull station
C. Extinguish the fire with a portable fire extinguisher
D. Close the doors and windows on the unit to confine the fire
Correct Answer: A
Rationale: The RACE sequence prioritizes Rescue of any client in immediate danger first, then Activate the alarm, then Confine the
fire by closing doors and windows, and finally Extinguish the fire only if it is small and the nurse remains safe. Client safety always
takes precedence over property protection and fire suppression.
3
ATI Comprehensive Predictor 2K20
All the information you need for the near exam quick read to guarantee a top score in 15 short pages.
75 Verified Questions with 100% Correct Answers and Comprehensive Rationales • 7 Content Domains • Aligned with 2026/2027 ATI
Testing Content Changes and Practice Standards
SECTION 1 • Safe, Effective Care Environment
Management of Care, Legal/Ethical Issues, Delegation, and Safety/Infection Control
Q1: A nurse is preparing to conduct the first round of assessments on four assigned clients. Which client should the nurse
assess first?
A. A client who is 2 hours post-thoracentesis with a respiratory rate of 10/min and tracheal deviation to the unaffected
side [CORRECT]
B. A client with heart failure who has 2+ pitting edema of the lower extremities and reports weight gain
C. A client who is 1 day postoperative following an appendectomy and reports incisional pain rated 6 on a scale of 0 to 10
D. A client with type 2 diabetes mellitus whose fasting blood glucose is 175 mg/dL before breakfast
Correct Answer: A
Rationale: Using the ABC priority-setting framework, airway and breathing always take precedence over circulation, comfort, and
glucose management. Tracheal deviation with a low respiratory rate following thoracentesis indicates a tension pneumothorax, a
life-threatening complication that requires immediate intervention. The clients with edema, postoperative pain, and moderate
hyperglycemia have important but stable findings that can be addressed after the unstable client is evaluated and treated.
Q2: A charge nurse on a medical-surgical unit is delegating tasks for the shift. Which task is appropriate for the charge nurse to
assign to an assistive personnel (AP)?
A. Teaching a newly diagnosed client how to perform capillary blood glucose monitoring
B. Assessing a client who reports new-onset chest pain rated 8 on a scale of 0 to 10
C. Measuring and recording the urine output of a stable client every 2 hours [CORRECT]
D. Interpreting the cardiac rhythm strips of a client on continuous telemetry
Correct Answer: C
Rationale: Measuring and recording routine intake and output for a physiologically stable client is within the scope of assistive
personnel, who are trained in basic data collection. Teaching, assessing a client with a change in condition, and interpreting cardiac
rhythms require nursing judgment and must be performed by the RN. After delegating, the RN remains accountable for supervision and
must evaluate client outcomes.
Q3: A nurse is managing a team that includes an LPN and an AP. Which client is appropriate for the nurse to assign to the
LPN?
A. A client admitted 1 hour ago with active gastrointestinal bleeding and orthostatic hypotension
B. A stable client who is receiving an IV heparin infusion at a prescribed, non-titrated rate [CORRECT]
C. A client in septic shock who requires titration of a norepinephrine infusion
D. A client who requires initial education about a newly prescribed diabetic exchange diet
Correct Answer: B
Rationale: An LPN can administer prescribed medications, including a heparin infusion at a stable rate, for clients who are
physiologically stable and have predictable outcomes. Clients who are hemodynamically unstable, require vasopressor titration, need
frequent reassessment, or need initial teaching require RN-level judgment and evaluation. Assigning the stable, predictable client to the
LPN maximizes safe and effective use of team members.
1
,ATI Comprehensive Predictor 2K20 - Quick Review | 2026/2027 Edition 75 Questions with Verified Rationales
Q4: A nurse delegates morning ambulation of a postoperative client to an AP. Two hours later, the AP reports that the client
became dizzy during the walk and was assisted back to bed. Which action should the nurse take first?
A. Document the AP report verbatim in the client's medical record
B. Instruct the AP never to ambulate the client again without assistance
C. Notify the charge nurse that the delegated task was unsuccessful
D. Assess the client for orthostatic hypotension and any injury [CORRECT]
Correct Answer: D
Rationale: The delegating RN is accountable for client outcomes and must first assess the client after any reported change in condition
before documenting or coaching staff. Dizziness during ambulation can indicate orthostatic hypotension, internal bleeding, or another
complication that requires nursing evaluation. Re-education of the AP and documentation are completed after the client has been
assessed and made safe.
Q5: A client scheduled for a laparoscopic cholecystectomy asks the nurse, 'What exactly will the surgeon do during my
operation?' Which response by the nurse is accurate?
A. Explain each step of the surgical procedure before the client signs the consent form
B. Tell the client that the surgeon will answer all questions after the procedure is completed
C. Contact the surgeon, because the provider who performs the procedure is responsible for explaining it [CORRECT]
D. Provide the client with a hospital brochure that describes the surgical unit
Correct Answer: C
Rationale: The provider performing the procedure is legally responsible for explaining the risks, benefits, alternatives, and expected
outcomes when obtaining informed consent. The nurse's role is to witness the signature, verify that the client demonstrates
understanding, and notify the provider when questions arise. Answering procedure-specific questions beyond nursing knowledge
constitutes practicing outside the nurse's legal scope of practice.
Q6: An alert, competent adult client has a signed advance directive refusing blood transfusions. The client is brought to surgery
after a motor-vehicle crash, and the family demands that the surgical team administer blood. Which action should the nurse
take?
A. Prepare the blood products, because the family represents the client in an emergency
B. Ask the hospital ethics committee to approve an urgent transfusion
C. Request a court order so the surgical team can override the directive
D. Support the client's documented wishes and communicate them to the surgical team [CORRECT]
Correct Answer: D
Rationale: A competent adult client's advance directive is legally binding, and the nurse acts as an advocate by upholding the
documented wishes and ensuring the surgical team is informed. Family preference does not override the autonomous decision of a
competent adult. Ethics consultation and court orders apply only when the directive's validity is unclear or documentation is absent, not
when clear refusal exists.
Q7: Which action by a nurse constitutes a violation of client confidentiality under HIPAA regulations?
A. Reporting a newly diagnosed case of tuberculosis to the public health department
B. Reviewing the electronic health record of a client who is not assigned to the nurse's care [CORRECT]
C. Giving shift report to the oncoming nurse inside a private conference room
D. Using two client identifiers before administering prescribed medications
Correct Answer: B
Rationale: Accessing a client's record without a treatment-related need violates HIPAA even when no information is disclosed to
others. Mandatory public health reporting, private handoff communication, and proper client identification are required activities that
protect privacy and promote safety. Nurses should access only the records of clients assigned to their care for the purpose of providing
treatment.
Q8: A nurse admits a 5-year-old child who has burns of several different ages. The caregiver delayed seeking treatment and
gives inconsistent explanations about how the injuries occurred. Which action should the nurse take?
A. Confront the caregiver with the suspected abuse before any report is made
B. Hold a discharge planning conference with social services before reporting
C. Document the suspicions in the medical record and take no further action
D. Report the findings to child protective services as mandated by law [CORRECT]
Correct Answer: D
Rationale: Nurses are mandated reporters who must report suspected abuse based on objective findings such as injuries of various
ages, an inconsistent history, and a delay in seeking care. The investigation belongs to child protective services, not the nurse, and direct
confrontation can endanger the child. Thorough documentation supports the report but never replaces the legal duty to report.
2
, ATI Comprehensive Predictor 2K20 - Quick Review | 2026/2027 Edition 75 Questions with Verified Rationales
Q9: A confused client repeatedly pulls out an IV line and an indwelling urinary catheter. After alternative measures fail, the
provider prescribes soft wrist restraints. Which action should the nurse take when applying the restraints?
A. Tie the restraint straps with a quick-release knot in a location the client cannot reach [CORRECT]
B. Secure the restraint ties to the side rails to prevent the client from turning
C. Apply the restraints and plan to check circulation at the end of the shift
D. Apply the restraints first and obtain the provider prescription afterward
Correct Answer: A
Rationale: Restraints must be secured with a quick-release knot that the client cannot reach, never tied to side rails, and circulation and
skin integrity must be checked at least every 2 hours with regular release per facility protocol. A provider prescription is required
before or immediately after emergency application, and documentation of the behavior leading to restraints is mandatory. These
measures reflect the least-restrictive-intervention standard.
Q10: A nurse has completed care of a client on contact precautions and is preparing to leave the room. In which order should
the nurse remove the personal protective equipment?
A. Gown, gloves, mask, goggles
B. Goggles, gloves, gown, mask
C. Gloves, goggles, gown, mask [CORRECT]
D. Mask, gown, goggles, gloves
Correct Answer: C
Rationale: The most contaminated items are removed first: gloves, followed by eye protection or goggles, then the gown, and the mask
or respirator last, removed after leaving the room. This sequence prevents contamination of the nurse's skin, clothing, and mucous
membranes. Hand hygiene is performed immediately after all personal protective equipment has been removed.
Q11: A nurse receives report on four clients and plans the first round of care. For which client should the nurse put on a gown
and gloves before entering the room?
A. A client admitted with pertussis
B. A client with Clostridioides difficile infection and frequent loose stools [CORRECT]
C. A client with suspected active pulmonary tuberculosis
D. A client with meningococcal meningitis
Correct Answer: B
Rationale: C. difficile requires contact precautions, including a gown and gloves, because the organism spreads by direct contact with
contaminated skin and surfaces and is not reliably killed by alcohol-based hand rub, so soap and water handwashing is required.
Pertussis and meningococcal meningitis require droplet precautions with a mask within 3 to 6 feet, and suspected tuberculosis requires
airborne precautions with a fit-tested N95 respirator.
Q12: A client with suspected active pulmonary tuberculosis requires transport to the radiology department for a CT scan.
Which action should the nurse take to protect others during transport?
A. Place a surgical mask on the nurse and transport through the service elevator
B. Schedule the transport during visiting hours to reduce hallway staff exposure
C. Have the client wear an N95 respirator for the duration of transport
D. Place a surgical mask on the client and follow the shortest route to radiology [CORRECT]
Correct Answer: D
Rationale: A client with suspected or confirmed tuberculosis wears a surgical mask during transport because it contains droplet nuclei
at the source; the N95 respirator protects the wearer and does not serve as a client barrier. Masking the client and using the shortest
route limits exposure of other clients, visitors, and staff. Staff and visitors entering the client's room require a fit-tested N95 respirator.
Q13: A nurse discovers flames coming from a wastebasket in a client's room. Which action should the nurse take first?
A. Rescue and remove the client from the room [CORRECT]
B. Activate the nearest fire alarm pull station
C. Extinguish the fire with a portable fire extinguisher
D. Close the doors and windows on the unit to confine the fire
Correct Answer: A
Rationale: The RACE sequence prioritizes Rescue of any client in immediate danger first, then Activate the alarm, then Confine the
fire by closing doors and windows, and finally Extinguish the fire only if it is small and the nurse remains safe. Client safety always
takes precedence over property protection and fire suppression.
3
