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ATI RN Comprehensive Predictor Exit
Exam 2026 Level 3 – 180 NGN
Questions & Answers with Rationales
Prepare for the 2026 ATI RN Comprehensive Predictor
Exit Exam with 180 NGN-style questions covering
management of care, pharmacology, medical-surgical,
maternal-newborn, pediatrics, and mental health.
Includes detailed rationales for prioritization, delegation,
and clinical judgment. Updated for the latest NCLEX-RN
test plan. Ideal for final semester review and
remediation. Forms A, B, and C included.
1. A nurse is assessing a client who has fluid volume deficit. Which of the
following findings should the nurse expect?
A. Bounding pulse
B. Distended neck veins
C. Decreased urine output
D. Crackles in the lungs
Rationale: Decreased urine output is a hallmark sign of fluid volume deficit as the
kidneys attempt to conserve water. Bounding pulse, distended neck veins, and crackles
are manifestations of fluid volume excess.
2. A nurse is caring for a client who is receiving heparin therapy. Which of the
following laboratory values should the nurse monitor to evaluate the
effectiveness of the therapy?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
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D. Platelet count
Rationale: aPTT is used to monitor the effectiveness of heparin therapy. PT and INR are
used to monitor warfarin therapy. Platelet count is monitored for heparin-induced
thrombocytopenia.
3. A nurse is preparing to administer digoxin to a client who has heart failure.
Which of the following findings should the nurse report to the provider before
administering the medication?
A. Heart rate of 68/min
B. Blood pressure of 110/70 mm Hg
C. Heart rate of 52/min
D. Potassium level of 4.0 mEq/L
Rationale: Digoxin should be withheld if the heart rate is below 60/min in adults, as it
can further slow the heart rate and lead to toxicity. A heart rate of 52/min is
bradycardic and should be reported.
4. A nurse is teaching a client who has a new prescription for warfarin. Which of
the following instructions should the nurse include?
A. Increase intake of leafy green vegetables.
B. Avoid using a razor blade to shave.
C. Take aspirin for headaches.
D. Expect dark urine as a therapeutic effect.
Rationale: Warfarin increases bleeding risk. Clients should use an electric razor to
prevent cuts. Leafy greens contain vitamin K, which antagonizes warfarin. Aspirin
increases bleeding risk. Dark urine is a sign of bleeding, not a therapeutic effect.
5. A nurse is assessing a client who has a new onset of atrial fibrillation. Which
of the following findings is the priority for the nurse to report?
A. Irregular heart rate
B. Client report of palpitations and dizziness
C. Blood pressure of 128/76 mm Hg
D. Respiratory rate of 18/min
Rationale: Dizziness and palpitations in atrial fibrillation can indicate decreased
cardiac output and hemodynamic instability. While an irregular heart rate is expected,
symptoms of decreased perfusion are the priority to report.
6. A nurse is caring for a client who is postoperative following a thyroidectomy.
Which of the following findings indicates the client is experiencing a
complication?
A. Hoarse voice
B. Laryngeal stridor
C. Serum calcium level of 9.0 mg/dL
D. Drainage of 20 mL serosanguineous fluid
Rationale: Laryngeal stridor is a sign of respiratory obstruction due to laryngeal edema
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or nerve damage, a life-threatening complication after thyroidectomy. Hoarseness can
be expected due to surgical trauma. A calcium level of 9.0 is within normal limits.
7. A nurse is administering insulin lispro to a client who has type 1 diabetes
mellitus. The nurse should instruct the client that the onset of action for this
insulin is which of the following?
A. 15 minutes
B. 30 minutes
C. 1 hour
D. 2 hours
Rationale: Insulin lispro is a rapid-acting insulin with an onset of 15 minutes. The client
should eat a meal within 15 minutes of administration to prevent hypoglycemia.
8. A nurse is assessing a client who has a suspected peptic ulcer. Which of the
following findings should the nurse expect?
A. Pain that worsens with eating
B. Pain that is relieved by eating
C. Pain that radiates to the right shoulder
D. Pain that is sharp and constant
Rationale: Duodenal ulcers, a type of peptic ulcer, typically cause pain that is relieved
by eating. Gastric ulcers cause pain that worsens with eating. Right shoulder pain is
associated with gallbladder disease.
9. A nurse is caring for a client who is in the acute phase of a burn injury. Which
of the following findings is the priority for the nurse to address?
A. Pain level of 8 on a 0-10 scale
B. Urine output of 20 mL/hr
C. Heart rate of 110/min
D. Body temperature of 37.8°C (100°F)
Rationale: A urine output of less than 30 mL/hr indicates inadequate fluid resuscitation
and renal perfusion in a burn client. This is a priority because it can lead to acute
kidney injury. Pain, tachycardia, and low-grade fever are expected in the acute phase.
10. A nurse is teaching a client who has asthma about using a peak flow meter.
Which of the following instructions should the nurse include?
A. Use the meter immediately after using a bronchodilator.
B. Stand or sit upright to use the meter.
C. Inhale quickly and deeply through the meter.
D. Record the highest of three attempts.
Rationale: The client should stand or sit upright to allow for maximum lung expansion.
The meter should be used before using a bronchodilator. The client should exhale
forcefully, not inhale, through the meter. The highest of three attempts is recorded, but
the instruction to stand upright is a key technique.
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11. A nurse is caring for a client who has a chest tube following a thoracotomy.
Which of the following actions should the nurse take?
A. Clamp the chest tube when the client ambulates.
B. Keep the drainage system below the level of the client's chest.
C. Strip or milk the chest tube every 4 hours.
D. Expect continuous bubbling in the water seal chamber.
Rationale: Keeping the drainage system below chest level prevents fluid from flowing
back into the pleural space. Clamping is only done for specific reasons. Stripping is no
longer recommended. Continuous bubbling in the water seal chamber indicates an air
leak.
12. A nurse is assessing a client who has increased intracranial pressure (ICP).
Which of the following findings is an early sign of increased ICP?
A. Decerebrate posturing
B. Decreased level of consciousness
C. Fixed and dilated pupils
D. Cushing's triad
Rationale: A decreased level of consciousness is often the earliest and most sensitive
indicator of increased ICP. Decerebrate posturing, fixed pupils, and Cushing's triad are
late signs.
13. A nurse is providing discharge teaching to a client who has a new
prescription for metoprolol. Which of the following instructions should the
nurse include?
A. "Stop taking the medication if your heart rate is below 60."
B. "Do not stop taking this medication abruptly."
C. "Take this medication with a high-protein meal."
D. "Expect to experience insomnia."
Rationale: Abrupt discontinuation of metoprolol, a beta-blocker, can cause rebound
hypertension, tachycardia, and angina. The client should not stop the medication
without consulting the provider.
14. A nurse is caring for a client who is receiving a blood transfusion. Which of
the following findings indicates an acute hemolytic reaction?
A. Urticaria and itching
B. Fever and chills
C. Low back pain and dark urine
D. Crackles in the lungs
Rationale: Acute hemolytic reaction manifests with fever, chills, low back pain, and
dark urine (hemoglobinuria). Urticaria is an allergic reaction. Crackles indicate fluid
overload.
15. A nurse is teaching a client who has a new prescription for levothyroxine.
Which of the following instructions should the nurse include?
ATI RN Comprehensive Predictor Exit
Exam 2026 Level 3 – 180 NGN
Questions & Answers with Rationales
Prepare for the 2026 ATI RN Comprehensive Predictor
Exit Exam with 180 NGN-style questions covering
management of care, pharmacology, medical-surgical,
maternal-newborn, pediatrics, and mental health.
Includes detailed rationales for prioritization, delegation,
and clinical judgment. Updated for the latest NCLEX-RN
test plan. Ideal for final semester review and
remediation. Forms A, B, and C included.
1. A nurse is assessing a client who has fluid volume deficit. Which of the
following findings should the nurse expect?
A. Bounding pulse
B. Distended neck veins
C. Decreased urine output
D. Crackles in the lungs
Rationale: Decreased urine output is a hallmark sign of fluid volume deficit as the
kidneys attempt to conserve water. Bounding pulse, distended neck veins, and crackles
are manifestations of fluid volume excess.
2. A nurse is caring for a client who is receiving heparin therapy. Which of the
following laboratory values should the nurse monitor to evaluate the
effectiveness of the therapy?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
,2|Page
D. Platelet count
Rationale: aPTT is used to monitor the effectiveness of heparin therapy. PT and INR are
used to monitor warfarin therapy. Platelet count is monitored for heparin-induced
thrombocytopenia.
3. A nurse is preparing to administer digoxin to a client who has heart failure.
Which of the following findings should the nurse report to the provider before
administering the medication?
A. Heart rate of 68/min
B. Blood pressure of 110/70 mm Hg
C. Heart rate of 52/min
D. Potassium level of 4.0 mEq/L
Rationale: Digoxin should be withheld if the heart rate is below 60/min in adults, as it
can further slow the heart rate and lead to toxicity. A heart rate of 52/min is
bradycardic and should be reported.
4. A nurse is teaching a client who has a new prescription for warfarin. Which of
the following instructions should the nurse include?
A. Increase intake of leafy green vegetables.
B. Avoid using a razor blade to shave.
C. Take aspirin for headaches.
D. Expect dark urine as a therapeutic effect.
Rationale: Warfarin increases bleeding risk. Clients should use an electric razor to
prevent cuts. Leafy greens contain vitamin K, which antagonizes warfarin. Aspirin
increases bleeding risk. Dark urine is a sign of bleeding, not a therapeutic effect.
5. A nurse is assessing a client who has a new onset of atrial fibrillation. Which
of the following findings is the priority for the nurse to report?
A. Irregular heart rate
B. Client report of palpitations and dizziness
C. Blood pressure of 128/76 mm Hg
D. Respiratory rate of 18/min
Rationale: Dizziness and palpitations in atrial fibrillation can indicate decreased
cardiac output and hemodynamic instability. While an irregular heart rate is expected,
symptoms of decreased perfusion are the priority to report.
6. A nurse is caring for a client who is postoperative following a thyroidectomy.
Which of the following findings indicates the client is experiencing a
complication?
A. Hoarse voice
B. Laryngeal stridor
C. Serum calcium level of 9.0 mg/dL
D. Drainage of 20 mL serosanguineous fluid
Rationale: Laryngeal stridor is a sign of respiratory obstruction due to laryngeal edema
,3|Page
or nerve damage, a life-threatening complication after thyroidectomy. Hoarseness can
be expected due to surgical trauma. A calcium level of 9.0 is within normal limits.
7. A nurse is administering insulin lispro to a client who has type 1 diabetes
mellitus. The nurse should instruct the client that the onset of action for this
insulin is which of the following?
A. 15 minutes
B. 30 minutes
C. 1 hour
D. 2 hours
Rationale: Insulin lispro is a rapid-acting insulin with an onset of 15 minutes. The client
should eat a meal within 15 minutes of administration to prevent hypoglycemia.
8. A nurse is assessing a client who has a suspected peptic ulcer. Which of the
following findings should the nurse expect?
A. Pain that worsens with eating
B. Pain that is relieved by eating
C. Pain that radiates to the right shoulder
D. Pain that is sharp and constant
Rationale: Duodenal ulcers, a type of peptic ulcer, typically cause pain that is relieved
by eating. Gastric ulcers cause pain that worsens with eating. Right shoulder pain is
associated with gallbladder disease.
9. A nurse is caring for a client who is in the acute phase of a burn injury. Which
of the following findings is the priority for the nurse to address?
A. Pain level of 8 on a 0-10 scale
B. Urine output of 20 mL/hr
C. Heart rate of 110/min
D. Body temperature of 37.8°C (100°F)
Rationale: A urine output of less than 30 mL/hr indicates inadequate fluid resuscitation
and renal perfusion in a burn client. This is a priority because it can lead to acute
kidney injury. Pain, tachycardia, and low-grade fever are expected in the acute phase.
10. A nurse is teaching a client who has asthma about using a peak flow meter.
Which of the following instructions should the nurse include?
A. Use the meter immediately after using a bronchodilator.
B. Stand or sit upright to use the meter.
C. Inhale quickly and deeply through the meter.
D. Record the highest of three attempts.
Rationale: The client should stand or sit upright to allow for maximum lung expansion.
The meter should be used before using a bronchodilator. The client should exhale
forcefully, not inhale, through the meter. The highest of three attempts is recorded, but
the instruction to stand upright is a key technique.
, 4|Page
11. A nurse is caring for a client who has a chest tube following a thoracotomy.
Which of the following actions should the nurse take?
A. Clamp the chest tube when the client ambulates.
B. Keep the drainage system below the level of the client's chest.
C. Strip or milk the chest tube every 4 hours.
D. Expect continuous bubbling in the water seal chamber.
Rationale: Keeping the drainage system below chest level prevents fluid from flowing
back into the pleural space. Clamping is only done for specific reasons. Stripping is no
longer recommended. Continuous bubbling in the water seal chamber indicates an air
leak.
12. A nurse is assessing a client who has increased intracranial pressure (ICP).
Which of the following findings is an early sign of increased ICP?
A. Decerebrate posturing
B. Decreased level of consciousness
C. Fixed and dilated pupils
D. Cushing's triad
Rationale: A decreased level of consciousness is often the earliest and most sensitive
indicator of increased ICP. Decerebrate posturing, fixed pupils, and Cushing's triad are
late signs.
13. A nurse is providing discharge teaching to a client who has a new
prescription for metoprolol. Which of the following instructions should the
nurse include?
A. "Stop taking the medication if your heart rate is below 60."
B. "Do not stop taking this medication abruptly."
C. "Take this medication with a high-protein meal."
D. "Expect to experience insomnia."
Rationale: Abrupt discontinuation of metoprolol, a beta-blocker, can cause rebound
hypertension, tachycardia, and angina. The client should not stop the medication
without consulting the provider.
14. A nurse is caring for a client who is receiving a blood transfusion. Which of
the following findings indicates an acute hemolytic reaction?
A. Urticaria and itching
B. Fever and chills
C. Low back pain and dark urine
D. Crackles in the lungs
Rationale: Acute hemolytic reaction manifests with fever, chills, low back pain, and
dark urine (hemoglobinuria). Urticaria is an allergic reaction. Crackles indicate fluid
overload.
15. A nurse is teaching a client who has a new prescription for levothyroxine.
Which of the following instructions should the nurse include?
