ATI PN Comprehensive Predictor 2026
Next Generation NCLEX (NGN) Style Practice Exam & Clinical Judgment Review
TARGET EXAM FOCUS FRAMEWORK ITEM STANDARDS PASSING STANDARD
ATI PN Exit 2026 NCJMM Level 3 NGN Clinical Models Predicted Probability ≥
92%
SECTION 1: NGN UNFOLDING CLINICAL CASE STUDY
CLIENT EMR: Ward 4B — Bed 12 | Age: 68 | Gender: Female Admit Diagnosis: Acute Exacerbation of Heart Failure
Nurses' Notes (0800): Client reports severe shortness of breath, inability to lie flat in bed, and bilateral lower extremity
swelling (+3 pitting edema). Client appears anxious, diaphoretic, and is using accessory muscles to breathe. Fine
crackles heard bilaterally in lower lung fields. SpO2 is 87% on room air. History of hypertension, type 2 diabetes, and
chronic kidney disease.
Vital Signs: BP 168/94 mmHg, HR 112 bpm (irregular), RR 28/min, Temp 37.1°C (98.8°F).
Question 1 (Step 1: Recognize Cues) MULTIPLE RESPONSE
The Practical Nurse (PN) reviews the client's EMR upon taking shift report. Which of the following assessment
findings require immediate nursing action? (Select All That Apply)
A. SpO2 87% on room air
B. Respiratory rate 28/min with accessory muscle use
C. Bilateral fine crackles on auscultation
D. Body temperature of 37.1°C (98.8°F)
E. Heart rate 112 bpm irregular
F. History of hypertension
Correct Answer: A, B, C, E
Rationale: An SpO2 of 87%, tachypnea (RR 28) with accessory muscle strain, fine pulmonary crackles (indicating fluid in
alveoli), and tachycardia with irregularity reflect acute respiratory distress and fluid volume overload. Temperature and remote
history of hypertension are non-acute baseline findings in this acute scenario.
Question 2 (Step 2: Analyze Cues) MATRIX / GRID
For each clinical finding, indicate whether the finding indicates Left-Sided Heart Failure or Right-Sided Heart Failure.
Clinical Assessment Finding Left-Sided HF Right-Sided HF
Bilateral pulmonary crackles and dyspnea ✔
+3 Pitting edema in lower extremities ✔
Jugular Venous Distension (JVD) ✔
Orthopnea and paroxysmal nocturnal dyspnea ✔
ATI PN Comprehensive Predictor 2026 — NGN Practice Guide Page 1 of 4
Next Generation NCLEX (NGN) Style Practice Exam & Clinical Judgment Review
TARGET EXAM FOCUS FRAMEWORK ITEM STANDARDS PASSING STANDARD
ATI PN Exit 2026 NCJMM Level 3 NGN Clinical Models Predicted Probability ≥
92%
SECTION 1: NGN UNFOLDING CLINICAL CASE STUDY
CLIENT EMR: Ward 4B — Bed 12 | Age: 68 | Gender: Female Admit Diagnosis: Acute Exacerbation of Heart Failure
Nurses' Notes (0800): Client reports severe shortness of breath, inability to lie flat in bed, and bilateral lower extremity
swelling (+3 pitting edema). Client appears anxious, diaphoretic, and is using accessory muscles to breathe. Fine
crackles heard bilaterally in lower lung fields. SpO2 is 87% on room air. History of hypertension, type 2 diabetes, and
chronic kidney disease.
Vital Signs: BP 168/94 mmHg, HR 112 bpm (irregular), RR 28/min, Temp 37.1°C (98.8°F).
Question 1 (Step 1: Recognize Cues) MULTIPLE RESPONSE
The Practical Nurse (PN) reviews the client's EMR upon taking shift report. Which of the following assessment
findings require immediate nursing action? (Select All That Apply)
A. SpO2 87% on room air
B. Respiratory rate 28/min with accessory muscle use
C. Bilateral fine crackles on auscultation
D. Body temperature of 37.1°C (98.8°F)
E. Heart rate 112 bpm irregular
F. History of hypertension
Correct Answer: A, B, C, E
Rationale: An SpO2 of 87%, tachypnea (RR 28) with accessory muscle strain, fine pulmonary crackles (indicating fluid in
alveoli), and tachycardia with irregularity reflect acute respiratory distress and fluid volume overload. Temperature and remote
history of hypertension are non-acute baseline findings in this acute scenario.
Question 2 (Step 2: Analyze Cues) MATRIX / GRID
For each clinical finding, indicate whether the finding indicates Left-Sided Heart Failure or Right-Sided Heart Failure.
Clinical Assessment Finding Left-Sided HF Right-Sided HF
Bilateral pulmonary crackles and dyspnea ✔
+3 Pitting edema in lower extremities ✔
Jugular Venous Distension (JVD) ✔
Orthopnea and paroxysmal nocturnal dyspnea ✔
ATI PN Comprehensive Predictor 2026 — NGN Practice Guide Page 1 of 4
