ATI RN Comprehensive Predictor Exit
Exam 2023/2026 with NGN All 180
Questions With Answers
Question 1:
A nurse is caring for four clients. Which client should the nurse
assess first?
A. A client with heart failure who gained 1 kg (2.2 lb) since yesterday.
B. A client with a new tracheostomy who has coarse crackles in the upper
lung fields.
C. A client 2 hours post-appendectomy requesting pain medication.
D. A client with diabetes whose morning blood glucose is 180 mg/dL.
Rationale: The correct answer is B. This client has a new tracheostomy.
Coarse crackles may indicate secretions that the client cannot effectively
clear due to an impaired cough reflex from the new tracheostomy. This
poses an immediate risk for airway obstruction and requires prompt
suctioning and assessment to maintain a patent airway. While the other
clients need attention (A requires monitoring for worsening failure, C
needs comfort, D needs possible insulin adjustment), an actual or
potential airway issue is always the top priority.
,Question 2:
The charge nurse is making assignments for the day. Which client is most
appropriate to assign to a licensed practical nurse (LPN)?
A. A client newly admitted with diabetic ketoacidosis (DKA) on an insulin
drip.
B. A client with pneumonia who is on oxygen and needs frequent vital
signs.
C. A client who is 1-day post-operative total knee arthroplasty needing
discharge teaching.
D. A client with a chest tube to water-seal drainage who reports sudden
shortness of breath.
Rationale: The correct answer is B. An LPN, under RN supervision, can
competently monitor stable clients, administer certain medications
(excluding IV push in many states), and perform routine care like vital
signs. The clients in A, C, and D are unstable (A: requires complex titration
and monitoring), need comprehensive education (C: an RN
responsibility), or have a potential acute complication (D: could indicate a
pneumothorax), all of which require the assessment and critical thinking
skills of an RN.
Question 3:
A nurse is administering furosemide 40 mg IV to a client with pulmonary
edema. Which finding requires immediate intervention by the nurse?
A. The client's blood pressure decreases from 138/86 to 110/72 mmHg.
B. The client reports ringing in the ears (tinnitus).
C. The client's potassium level is 3.2 mEq/L.
D. The client voids 400 mL within one hour of administration.
Rationale: The correct answer is B. Tinnitus and hearing loss are signs
of ototoxicity, a serious adverse effect of loop diuretics like furosemide,
especially with rapid IV administration. This must be reported
immediately, and the infusion may need to be slowed or stopped. Option
A is an expected mild hypotensive effect. Option C (hypokalemia) is a
,common and expected side effect that needs to be corrected but is not an
immediate life threat. Option D is the desired therapeutic effect.
Question 4:
A client with a terminal illness tells the nurse, "I have a bottle of pills
hidden, and I plan to use them when the pain gets too bad." What is the
nurse's best initial action?
A. Respect the client's confidentiality and document the statement in the
chart.
B. Search the client's belongings for the hidden medication.
C. Sit with the client and explore the meaning of this statement.
D. Inform the provider and the client's family immediately.
Rationale: The correct answer is C. The nurse's first action should be
therapeutic communication to assess the client's intent, level of distress,
and specific plans. This is a cry for help and an opportunity to discuss
fears, pain management options, and goals of care. Jumping to action (B,
D) violates trust and autonomy without first understanding. Simply
documenting (A) ignores the nurse's duty to promote safety and provide
psychosocial support.
Question 5:
A nurse is assessing a newborn 12 hours after a vaginal delivery. The
nurse observes the infant's skin to have a generalized yellow hue. The
infant's vital signs are stable, and he is breastfeeding well. What is the
nurse's priority action?
A. Document the findings as physiologic jaundice.
B. Place the infant under phototherapy lights.
, C. Check the infant's serum bilirubin level.
D. Supplement breastfeeding with formula.
Rationale: The correct answer is C. Jaundice appearing within the first 24
hours of life is pathologic until proven otherwise and requires
investigation. The priority is to obtain a serum bilirubin level to determine
the severity and guide treatment. While physiologic jaundice is common,
it typically appears after 24 hours. The nurse should not assume it's
physiologic (A) or initiate treatment like phototherapy (B) without data.
Supplementation (D) may be a later intervention if levels are high, but
assessment comes first.
Question 6:
A client with severe depression is admitted to the inpatient unit. During
the morning assessment, the client is lying in bed, facing the wall, and
speaks in monosyllables. Which statement by the nurse is most
therapeutic?
A. "You need to get out of bed and join the group session to feel better."
B. "I'm going to sit here with you for 15 minutes. I am here if you'd like to
talk or just have some quiet company."
C. "Why are you so sad today? You have so many things to be thankful
for."
D. "I'll come back later when you feel more like talking."
Rationale: The correct answer is B. This statement
demonstrates therapeutic use of self, presence, and offering self. It
accepts the client in their current state without making demands, gives a
specific time frame (which is less threatening), and provides an open,
non-judgmental invitation for connection. Option A is demanding and
minimizes the client's feelings. Option C is nontherapeutic ("why"
questions can feel accusatory) and uses false reassurance. Option D
abandons the client.
Exam 2023/2026 with NGN All 180
Questions With Answers
Question 1:
A nurse is caring for four clients. Which client should the nurse
assess first?
A. A client with heart failure who gained 1 kg (2.2 lb) since yesterday.
B. A client with a new tracheostomy who has coarse crackles in the upper
lung fields.
C. A client 2 hours post-appendectomy requesting pain medication.
D. A client with diabetes whose morning blood glucose is 180 mg/dL.
Rationale: The correct answer is B. This client has a new tracheostomy.
Coarse crackles may indicate secretions that the client cannot effectively
clear due to an impaired cough reflex from the new tracheostomy. This
poses an immediate risk for airway obstruction and requires prompt
suctioning and assessment to maintain a patent airway. While the other
clients need attention (A requires monitoring for worsening failure, C
needs comfort, D needs possible insulin adjustment), an actual or
potential airway issue is always the top priority.
,Question 2:
The charge nurse is making assignments for the day. Which client is most
appropriate to assign to a licensed practical nurse (LPN)?
A. A client newly admitted with diabetic ketoacidosis (DKA) on an insulin
drip.
B. A client with pneumonia who is on oxygen and needs frequent vital
signs.
C. A client who is 1-day post-operative total knee arthroplasty needing
discharge teaching.
D. A client with a chest tube to water-seal drainage who reports sudden
shortness of breath.
Rationale: The correct answer is B. An LPN, under RN supervision, can
competently monitor stable clients, administer certain medications
(excluding IV push in many states), and perform routine care like vital
signs. The clients in A, C, and D are unstable (A: requires complex titration
and monitoring), need comprehensive education (C: an RN
responsibility), or have a potential acute complication (D: could indicate a
pneumothorax), all of which require the assessment and critical thinking
skills of an RN.
Question 3:
A nurse is administering furosemide 40 mg IV to a client with pulmonary
edema. Which finding requires immediate intervention by the nurse?
A. The client's blood pressure decreases from 138/86 to 110/72 mmHg.
B. The client reports ringing in the ears (tinnitus).
C. The client's potassium level is 3.2 mEq/L.
D. The client voids 400 mL within one hour of administration.
Rationale: The correct answer is B. Tinnitus and hearing loss are signs
of ototoxicity, a serious adverse effect of loop diuretics like furosemide,
especially with rapid IV administration. This must be reported
immediately, and the infusion may need to be slowed or stopped. Option
A is an expected mild hypotensive effect. Option C (hypokalemia) is a
,common and expected side effect that needs to be corrected but is not an
immediate life threat. Option D is the desired therapeutic effect.
Question 4:
A client with a terminal illness tells the nurse, "I have a bottle of pills
hidden, and I plan to use them when the pain gets too bad." What is the
nurse's best initial action?
A. Respect the client's confidentiality and document the statement in the
chart.
B. Search the client's belongings for the hidden medication.
C. Sit with the client and explore the meaning of this statement.
D. Inform the provider and the client's family immediately.
Rationale: The correct answer is C. The nurse's first action should be
therapeutic communication to assess the client's intent, level of distress,
and specific plans. This is a cry for help and an opportunity to discuss
fears, pain management options, and goals of care. Jumping to action (B,
D) violates trust and autonomy without first understanding. Simply
documenting (A) ignores the nurse's duty to promote safety and provide
psychosocial support.
Question 5:
A nurse is assessing a newborn 12 hours after a vaginal delivery. The
nurse observes the infant's skin to have a generalized yellow hue. The
infant's vital signs are stable, and he is breastfeeding well. What is the
nurse's priority action?
A. Document the findings as physiologic jaundice.
B. Place the infant under phototherapy lights.
, C. Check the infant's serum bilirubin level.
D. Supplement breastfeeding with formula.
Rationale: The correct answer is C. Jaundice appearing within the first 24
hours of life is pathologic until proven otherwise and requires
investigation. The priority is to obtain a serum bilirubin level to determine
the severity and guide treatment. While physiologic jaundice is common,
it typically appears after 24 hours. The nurse should not assume it's
physiologic (A) or initiate treatment like phototherapy (B) without data.
Supplementation (D) may be a later intervention if levels are high, but
assessment comes first.
Question 6:
A client with severe depression is admitted to the inpatient unit. During
the morning assessment, the client is lying in bed, facing the wall, and
speaks in monosyllables. Which statement by the nurse is most
therapeutic?
A. "You need to get out of bed and join the group session to feel better."
B. "I'm going to sit here with you for 15 minutes. I am here if you'd like to
talk or just have some quiet company."
C. "Why are you so sad today? You have so many things to be thankful
for."
D. "I'll come back later when you feel more like talking."
Rationale: The correct answer is B. This statement
demonstrates therapeutic use of self, presence, and offering self. It
accepts the client in their current state without making demands, gives a
specific time frame (which is less threatening), and provides an open,
non-judgmental invitation for connection. Option A is demanding and
minimizes the client's feelings. Option C is nontherapeutic ("why"
questions can feel accusatory) and uses false reassurance. Option D
abandons the client.
