ATI COMPREHENSIVE
PREDICTOR EXAM 2025/2026
STUDY GUIDE
1. A client with chronic obstructive pulmonary disease
(COPD) has an arterial blood gas showing: pH 7.32, PaCO₂
56 mm Hg, HCO₃⁻ 28 mEq/L. The nurse interprets this as:
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Answer: B. Respiratory acidosis with metabolic
compensation.
Rationale: pH <7.35 indicates acidosis. Elevated PaCO₂ =
respiratory cause. HCO₃⁻ is elevated (partial metabolic
compensation). A is wrong (PaCO₂ high, not low). C and D
wrong because pH and gas values don’t match alkalosis.
2. A nurse prepares to administer 0900 meds. The client
refuses the medication. The best nursing action is to:
A. Tell the client refusal will be documented and not
reoffered
B. Explain benefits again and ask reason for refusal
C. Notify provider immediately to force medication
D. Document refusal and leave the medication tray at
bedside
Answer: B. Explain benefits again and ask reason for
refusal.
, Rationale: Nurse should assess reasons and provide
information — informed refusal. A is premature; C is
inappropriate (forced med without due process). D is
unsafe and not appropriate documentation/care.
3. A client with heart failure has 2+ pitting edema in lower
extremities and weight gain of 4 lb in 48 hrs. The nurse
should first:
A. Elevate the legs and apply TED hose
B. Notify the provider for diuretic adjustment
C. Restrict fluids to 1 L/day immediately
D. Teach low-sodium diet at discharge
Answer: B. Notify the provider for diuretic adjustment.
Rationale: Acute weight gain and edema suggest fluid
retention needing provider assessment and diuretic change.
A provides comfort but not first priority. C and D are
interventions but not immediate actions for acute change.
4. Which finding requires immediate intervention for a
postoperative client?
A. Respiratory rate 14/min, SpO₂ 95% on room air
B. Urine output 25 mL/hr for past 2 hours
C. Pain rated 5/10 one hour after analgesic given
D. Temperature 37.8°C (100°F)
Answer: B. Urine output 25 mL/hr for past 2 hours.
Rationale: UO <30 mL/hr indicates inadequate
perfusion/hypovolemia and needs prompt assessment. A is
normal. C is moderate pain that might require reassessment
of analgesia but not immediate safety issue. D is low-grade
fever; monitor.
5. A client receiving morphine PCA reports sedation and
decreased RR to 8/min. Nurse should:
A. Encourage deep breathing and continue PCA
, B. Stop PCA and administer naloxone per protocol
C. Call respiratory therapy for incentive spirometry
D. Administer oxygen and observe hourly
Answer: B. Stop PCA and administer naloxone per
protocol.
Rationale: RR 8 with sedation indicates opioid overdose —
stop infusion and reverse opioid. A dangerous. C not
appropriate. D supportive but naloxone is priority per
protocol.
6. A nurse teaches a client with newly diagnosed type 1
diabetes about mixing NPH and regular insulin. Which
statement indicates correct understanding?
A. “I draw NPH into the syringe first, then regular insulin.”
B. “I will roll both insulin vials to mix them.”
C. “I will draw regular insulin into the syringe first, then
NPH.”
D. “I should shake both vials vigorously before drawing.”
Answer: C. I will draw regular insulin into the syringe
first, then NPH.
Rationale: Draw clear (regular) before cloudy (NPH) to
avoid contaminating regular with NPH. A is incorrect
order. B correct for NPH only (roll NPH, do not roll
regular). D shaking can denature insulin.
7. A client with acute pancreatitis is NPO and receiving IV
fluids. Which lab change is most important for the nurse to
monitor?
A. Hemoglobin
B. Serum lipase and amylase
C. Serum potassium
D. Platelet count
Answer: C. Serum potassium.
, Rationale: NPO and fluid shifts, plus possible vomiting,
increase risk of hypokalemia, which affects cardiac status.
B is diagnostic but not most critical for immediate
monitoring of electrolyte shifts. A and D less immediately
relevant.
8. Which action best reduces the risk of central line–
associated bloodstream infection (CLABSI)?
A. Using sterile gloves when accessing the line
B. Flushing the line with normal saline before use
C. Applying povidone-iodine to the dressing daily
D. Changing tubing every 48 hours
Answer: A. Using sterile gloves when accessing the line.
Rationale: Aseptic technique when accessing line is key. B
is standard but not primary for CLABSI prevention. C
povidone-iodine may not be appropriate daily;
chlorhexidine is preferred for site care. D tubing change
frequency varies; sterile technique matters more.
9. A client with hyperthyroidism is prescribed propranolol.
The nurse should monitor for:
A. Tachycardia
B. Hypotension and bradycardia
C. Hyperthermia
D. Increased appetite
Answer: B. Hypotension and bradycardia.
Rationale: Propranolol is a beta-blocker — can cause
bradycardia and hypotension. It reduces tachycardia, so A
is opposite. C and D are not typical adverse effects.
10. A 2-day postoperative client has serosanguineous
drainage on the dressing and is afebrile. The dressing is
intact. The nurse should:
A. Reinforce the dressing and continue to monitor
PREDICTOR EXAM 2025/2026
STUDY GUIDE
1. A client with chronic obstructive pulmonary disease
(COPD) has an arterial blood gas showing: pH 7.32, PaCO₂
56 mm Hg, HCO₃⁻ 28 mEq/L. The nurse interprets this as:
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Answer: B. Respiratory acidosis with metabolic
compensation.
Rationale: pH <7.35 indicates acidosis. Elevated PaCO₂ =
respiratory cause. HCO₃⁻ is elevated (partial metabolic
compensation). A is wrong (PaCO₂ high, not low). C and D
wrong because pH and gas values don’t match alkalosis.
2. A nurse prepares to administer 0900 meds. The client
refuses the medication. The best nursing action is to:
A. Tell the client refusal will be documented and not
reoffered
B. Explain benefits again and ask reason for refusal
C. Notify provider immediately to force medication
D. Document refusal and leave the medication tray at
bedside
Answer: B. Explain benefits again and ask reason for
refusal.
, Rationale: Nurse should assess reasons and provide
information — informed refusal. A is premature; C is
inappropriate (forced med without due process). D is
unsafe and not appropriate documentation/care.
3. A client with heart failure has 2+ pitting edema in lower
extremities and weight gain of 4 lb in 48 hrs. The nurse
should first:
A. Elevate the legs and apply TED hose
B. Notify the provider for diuretic adjustment
C. Restrict fluids to 1 L/day immediately
D. Teach low-sodium diet at discharge
Answer: B. Notify the provider for diuretic adjustment.
Rationale: Acute weight gain and edema suggest fluid
retention needing provider assessment and diuretic change.
A provides comfort but not first priority. C and D are
interventions but not immediate actions for acute change.
4. Which finding requires immediate intervention for a
postoperative client?
A. Respiratory rate 14/min, SpO₂ 95% on room air
B. Urine output 25 mL/hr for past 2 hours
C. Pain rated 5/10 one hour after analgesic given
D. Temperature 37.8°C (100°F)
Answer: B. Urine output 25 mL/hr for past 2 hours.
Rationale: UO <30 mL/hr indicates inadequate
perfusion/hypovolemia and needs prompt assessment. A is
normal. C is moderate pain that might require reassessment
of analgesia but not immediate safety issue. D is low-grade
fever; monitor.
5. A client receiving morphine PCA reports sedation and
decreased RR to 8/min. Nurse should:
A. Encourage deep breathing and continue PCA
, B. Stop PCA and administer naloxone per protocol
C. Call respiratory therapy for incentive spirometry
D. Administer oxygen and observe hourly
Answer: B. Stop PCA and administer naloxone per
protocol.
Rationale: RR 8 with sedation indicates opioid overdose —
stop infusion and reverse opioid. A dangerous. C not
appropriate. D supportive but naloxone is priority per
protocol.
6. A nurse teaches a client with newly diagnosed type 1
diabetes about mixing NPH and regular insulin. Which
statement indicates correct understanding?
A. “I draw NPH into the syringe first, then regular insulin.”
B. “I will roll both insulin vials to mix them.”
C. “I will draw regular insulin into the syringe first, then
NPH.”
D. “I should shake both vials vigorously before drawing.”
Answer: C. I will draw regular insulin into the syringe
first, then NPH.
Rationale: Draw clear (regular) before cloudy (NPH) to
avoid contaminating regular with NPH. A is incorrect
order. B correct for NPH only (roll NPH, do not roll
regular). D shaking can denature insulin.
7. A client with acute pancreatitis is NPO and receiving IV
fluids. Which lab change is most important for the nurse to
monitor?
A. Hemoglobin
B. Serum lipase and amylase
C. Serum potassium
D. Platelet count
Answer: C. Serum potassium.
, Rationale: NPO and fluid shifts, plus possible vomiting,
increase risk of hypokalemia, which affects cardiac status.
B is diagnostic but not most critical for immediate
monitoring of electrolyte shifts. A and D less immediately
relevant.
8. Which action best reduces the risk of central line–
associated bloodstream infection (CLABSI)?
A. Using sterile gloves when accessing the line
B. Flushing the line with normal saline before use
C. Applying povidone-iodine to the dressing daily
D. Changing tubing every 48 hours
Answer: A. Using sterile gloves when accessing the line.
Rationale: Aseptic technique when accessing line is key. B
is standard but not primary for CLABSI prevention. C
povidone-iodine may not be appropriate daily;
chlorhexidine is preferred for site care. D tubing change
frequency varies; sterile technique matters more.
9. A client with hyperthyroidism is prescribed propranolol.
The nurse should monitor for:
A. Tachycardia
B. Hypotension and bradycardia
C. Hyperthermia
D. Increased appetite
Answer: B. Hypotension and bradycardia.
Rationale: Propranolol is a beta-blocker — can cause
bradycardia and hypotension. It reduces tachycardia, so A
is opposite. C and D are not typical adverse effects.
10. A 2-day postoperative client has serosanguineous
drainage on the dressing and is afebrile. The dressing is
intact. The nurse should:
A. Reinforce the dressing and continue to monitor
