➢ Virtual ATI (VATI) PN Comprehensive Predictor
Exam Updated 2026 | 200+ Verified Practice
Questions & Answers | Advanced NCLEX-PN
Review Guide, Comprehensive Predictor Test
Bank, NGN Clinical Judgment, Pharmacology,
Fundamentals, Adult Health, Maternal-Newborn,
Pediatrics, Mental Health, Leadership &
Prioritization, Detailed Rationales for First-Time
Pass Success
Question 1: A client who is 24 hours post-operative following an open
cholecystectomy reports severe pain in the right shoulder. The nurse
understands this pain is most likely a result of which physiological process?
A. Biliary colic radiating from the surgical site.
B. A pulmonary embolism originating in the lower extremities.
C. Gas (carbon dioxide) used for peritoneal insufflation irritating the phrenic nerve.
D. Muscular strain from positioning during the surgical procedure.
CORRECT ANSWER: C. Gas (carbon dioxide) used for peritoneal insufflation
irritating the phrenic nerve.
Rationale: Post-laparoscopic surgery, residual carbon dioxide rises and collects under
the diaphragm. This irritates the phrenic nerve, which has sensory fibers innervating the
shoulder region, causing referred pain (Kehr's sign). This is a common and expected
finding.
Question 2: The PN is reinforcing teaching for a client who is prescribed a
monoamine oxidase inhibitor (MAOI) for depression. Which over-the-counter
cold medication should the client be instructed to avoid due to the risk of a
hypertensive crisis?
A. Guaifenesin.
B. Pseudoephedrine.
C. Dextromethorphan.
D. Diphenhydramine.
CORRECT ANSWER: B. Pseudoephedrine.
Rationale: Pseudoephedrine is a sympathomimetic decongestant. When taken with an
MAOI, it can lead to a massive release of norepinephrine, resulting in a severe
hypertensive crisis. Guaifenesin is an expectorant, dextromethorphan is a cough
suppressant, and diphenhydramine is an antihistamine, all of which are less likely to
cause this specific interaction.
Question 3: A nurse is preparing to administer a dose of digoxin to a client.
Which of the following findings indicates the need to hold the medication and
contact the healthcare provider?
,A. Apical pulse rate of 68 beats per minute.
B. Serum potassium level of 3.2 mEq/L.
C. Serum digoxin level of 1.2 ng/mL.
D. Respiratory rate of 18 breaths per minute.
CORRECT ANSWER: B. Serum potassium level of 3.2 mEq/L.
Rationale: Hypokalemia (serum potassium < 3.5 mEq/L) predisposes the client to
digoxin toxicity, even with normal serum digoxin levels. The nurse should hold the
digoxin, notify the provider, and check the client's potassium levels before
administration. A pulse of 68 is above the typical hold parameter of < 60 BPM for adults.
Question 4: A client with heart failure is prescribed furosemide (Lasix). Which
of the following laboratory values should the nurse monitor most closely?
A. Serum glucose.
B. Serum calcium.
C. Serum potassium.
D. Serum sodium.
CORRECT ANSWER: C. Serum potassium.
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to increased excretion of potassium.
Hypokalemia is a significant side effect and can lead to cardiac arrhythmias.
Question 5: The PN is caring for a client with a new colostomy. Which
statement by the client indicates an accurate understanding of dietary
management?
A. "I need to avoid all fresh fruits and vegetables to prevent blockages."
B. "I should eat large meals at one sitting to help regulate my bowel movements."
C. "Drinking plenty of fluids is important to help prevent constipation."
D. "I will need to be on a strict low-fiber diet for the rest of my life."
CORRECT ANSWER: C. "Drinking plenty of fluids is important to help prevent
constipation."
Rationale: Adequate fluid intake (at least 8-10 glasses per day) is essential to prevent
constipation and maintain stool consistency for colostomy output. High-fiber foods
should be introduced gradually, not avoided entirely, and small frequent meals are often
better tolerated.
Question 6: A nurse is reinforcing discharge teaching to a client following a
myocardial infarction (MI). The client asks if they can resume sexual activity.
The nurse's best response is:
A. "You should wait at least 6 weeks before attempting any sexual activity."
B. "You may resume sexual activity when you can walk one block without experiencing
chest pain or shortness of breath."
,C. "Sexual activity is no longer recommended after a heart attack."
D. "You can resume sexual activity as soon as you feel emotionally ready."
CORRECT ANSWER: B. "You may resume sexual activity when you can walk
one block without experiencing chest pain or shortness of breath."
Rationale: The metabolic demand of sexual activity is roughly equivalent to walking
one to two blocks on a flat surface. Therefore, if a client can perform this activity
without symptoms (chest pain, SOB, or palpitations), it is generally considered safe to
gradually resume sexual activity.
Question 7: A client with diabetes mellitus is receiving insulin glargine
(Lantus) once daily. The nurse understands this insulin is unique because it:
A. Has a rapid onset of action and should be given with meals.
B. Has a peak effect within 2-4 hours.
C. Provides a steady basal level of insulin without a pronounced peak.
D. Is the only insulin that can be given intravenously.
CORRECT ANSWER: C. Provides a steady basal level of insulin without a
pronounced peak.
Rationale: Insulin glargine is a long-acting insulin analog designed to provide a
relatively constant, peakless level of basal insulin for 24 hours. It is not given
intravenously, and its onset is slow.
Question 8: The nurse is assessing a client who is 2 days post-operative
following a total hip arthroplasty. Which of the following findings would be of
greatest concern and warrant immediate intervention?
A. Pain of 4 on a scale of 0-10 at the surgical site.
B. Localized warmth and erythema around the incision.
C. Sudden onset of chest pain and shortness of breath.
D. Mild edema of the lower extremity on the operative side.
CORRECT ANSWER: C. Sudden onset of chest pain and shortness of breath.
Rationale: These symptoms are classic signs of a pulmonary embolism (PE), a life-
threatening complication following orthopedic surgery due to deep vein thrombosis.
This requires immediate medical intervention. While warmth and erythema could
indicate infection, they are not as immediately life-threatening as PE.
Question 9: A client is prescribed warfarin (Coumadin) for atrial fibrillation.
Which dietary education is a priority for the nurse to reinforce?
A. Increase intake of green leafy vegetables.
B. Avoid consuming grapefruit juice.
C. Maintain a consistent intake of vitamin K-rich foods.
D. Limit all protein intake to prevent bleeding.
CORRECT ANSWER: C. Maintain a consistent intake of vitamin K-rich foods.
, Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors.
Fluctuations in dietary vitamin K intake (found in green leafy vegetables) can alter the
International Normalized Ratio (INR) and therapeutic effect. The priority is to educate
the client to maintain a consistent daily intake of vitamin K.
Question 10: The PN is preparing to administer a tuberculin skin test (TST).
Which action is correct regarding the administration of this test?
A. Administer the injection subcutaneously in the forearm.
B. Administer 0.1 mL of purified protein derivative (PPD) intradermally.
C. Massage the site vigorously after injection to distribute the antigen.
D. Use a 1-inch 25-gauge needle to ensure deep injection.
CORRECT ANSWER: B. Administer 0.1 mL of purified protein derivative (PPD)
intradermally.
Rationale: The TST is administered intradermally (between the dermis and epidermis)
on the volar (inner) surface of the forearm using a tuberculin syringe and a small (e.g.,
27-gauge) needle. A small wheal should appear. It is not massaged.
Question 11: A client is receiving a blood transfusion. Fifteen minutes after the
start of the infusion, the client reports low back pain and chills. What is the
nurse's priority action?
A. Slow the infusion rate to prevent fluid overload.
B. Stop the transfusion immediately and disconnect the tubing.
C. Administer diphenhydramine (Benadryl) as an antihistamine.
D. Stop the transfusion and keep the intravenous line open with normal saline.
CORRECT ANSWER: D. Stop the transfusion and keep the intravenous line
open with normal saline.
Rationale: These symptoms indicate a potential hemolytic transfusion reaction. The
nurse's priority is to stop the transfusion immediately, maintain IV access with normal
saline through new tubing, and notify the provider and blood bank. The blood product
and tubing should be returned to the lab.
Question 12: The PN is reinforcing teaching with a client who has intermittent
claudication. Which statement by the client indicates a need for further
education?
A. "I will exercise by walking until the pain is severe, then rest until it subsides."
B. "I should elevate my legs above my heart to improve circulation."
C. "I need to stop smoking to help reduce my symptoms."
D. "I should inspect my feet daily for any injuries."
CORRECT ANSWER: B. "I should elevate my legs above my heart to improve
circulation."
Exam Updated 2026 | 200+ Verified Practice
Questions & Answers | Advanced NCLEX-PN
Review Guide, Comprehensive Predictor Test
Bank, NGN Clinical Judgment, Pharmacology,
Fundamentals, Adult Health, Maternal-Newborn,
Pediatrics, Mental Health, Leadership &
Prioritization, Detailed Rationales for First-Time
Pass Success
Question 1: A client who is 24 hours post-operative following an open
cholecystectomy reports severe pain in the right shoulder. The nurse
understands this pain is most likely a result of which physiological process?
A. Biliary colic radiating from the surgical site.
B. A pulmonary embolism originating in the lower extremities.
C. Gas (carbon dioxide) used for peritoneal insufflation irritating the phrenic nerve.
D. Muscular strain from positioning during the surgical procedure.
CORRECT ANSWER: C. Gas (carbon dioxide) used for peritoneal insufflation
irritating the phrenic nerve.
Rationale: Post-laparoscopic surgery, residual carbon dioxide rises and collects under
the diaphragm. This irritates the phrenic nerve, which has sensory fibers innervating the
shoulder region, causing referred pain (Kehr's sign). This is a common and expected
finding.
Question 2: The PN is reinforcing teaching for a client who is prescribed a
monoamine oxidase inhibitor (MAOI) for depression. Which over-the-counter
cold medication should the client be instructed to avoid due to the risk of a
hypertensive crisis?
A. Guaifenesin.
B. Pseudoephedrine.
C. Dextromethorphan.
D. Diphenhydramine.
CORRECT ANSWER: B. Pseudoephedrine.
Rationale: Pseudoephedrine is a sympathomimetic decongestant. When taken with an
MAOI, it can lead to a massive release of norepinephrine, resulting in a severe
hypertensive crisis. Guaifenesin is an expectorant, dextromethorphan is a cough
suppressant, and diphenhydramine is an antihistamine, all of which are less likely to
cause this specific interaction.
Question 3: A nurse is preparing to administer a dose of digoxin to a client.
Which of the following findings indicates the need to hold the medication and
contact the healthcare provider?
,A. Apical pulse rate of 68 beats per minute.
B. Serum potassium level of 3.2 mEq/L.
C. Serum digoxin level of 1.2 ng/mL.
D. Respiratory rate of 18 breaths per minute.
CORRECT ANSWER: B. Serum potassium level of 3.2 mEq/L.
Rationale: Hypokalemia (serum potassium < 3.5 mEq/L) predisposes the client to
digoxin toxicity, even with normal serum digoxin levels. The nurse should hold the
digoxin, notify the provider, and check the client's potassium levels before
administration. A pulse of 68 is above the typical hold parameter of < 60 BPM for adults.
Question 4: A client with heart failure is prescribed furosemide (Lasix). Which
of the following laboratory values should the nurse monitor most closely?
A. Serum glucose.
B. Serum calcium.
C. Serum potassium.
D. Serum sodium.
CORRECT ANSWER: C. Serum potassium.
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to increased excretion of potassium.
Hypokalemia is a significant side effect and can lead to cardiac arrhythmias.
Question 5: The PN is caring for a client with a new colostomy. Which
statement by the client indicates an accurate understanding of dietary
management?
A. "I need to avoid all fresh fruits and vegetables to prevent blockages."
B. "I should eat large meals at one sitting to help regulate my bowel movements."
C. "Drinking plenty of fluids is important to help prevent constipation."
D. "I will need to be on a strict low-fiber diet for the rest of my life."
CORRECT ANSWER: C. "Drinking plenty of fluids is important to help prevent
constipation."
Rationale: Adequate fluid intake (at least 8-10 glasses per day) is essential to prevent
constipation and maintain stool consistency for colostomy output. High-fiber foods
should be introduced gradually, not avoided entirely, and small frequent meals are often
better tolerated.
Question 6: A nurse is reinforcing discharge teaching to a client following a
myocardial infarction (MI). The client asks if they can resume sexual activity.
The nurse's best response is:
A. "You should wait at least 6 weeks before attempting any sexual activity."
B. "You may resume sexual activity when you can walk one block without experiencing
chest pain or shortness of breath."
,C. "Sexual activity is no longer recommended after a heart attack."
D. "You can resume sexual activity as soon as you feel emotionally ready."
CORRECT ANSWER: B. "You may resume sexual activity when you can walk
one block without experiencing chest pain or shortness of breath."
Rationale: The metabolic demand of sexual activity is roughly equivalent to walking
one to two blocks on a flat surface. Therefore, if a client can perform this activity
without symptoms (chest pain, SOB, or palpitations), it is generally considered safe to
gradually resume sexual activity.
Question 7: A client with diabetes mellitus is receiving insulin glargine
(Lantus) once daily. The nurse understands this insulin is unique because it:
A. Has a rapid onset of action and should be given with meals.
B. Has a peak effect within 2-4 hours.
C. Provides a steady basal level of insulin without a pronounced peak.
D. Is the only insulin that can be given intravenously.
CORRECT ANSWER: C. Provides a steady basal level of insulin without a
pronounced peak.
Rationale: Insulin glargine is a long-acting insulin analog designed to provide a
relatively constant, peakless level of basal insulin for 24 hours. It is not given
intravenously, and its onset is slow.
Question 8: The nurse is assessing a client who is 2 days post-operative
following a total hip arthroplasty. Which of the following findings would be of
greatest concern and warrant immediate intervention?
A. Pain of 4 on a scale of 0-10 at the surgical site.
B. Localized warmth and erythema around the incision.
C. Sudden onset of chest pain and shortness of breath.
D. Mild edema of the lower extremity on the operative side.
CORRECT ANSWER: C. Sudden onset of chest pain and shortness of breath.
Rationale: These symptoms are classic signs of a pulmonary embolism (PE), a life-
threatening complication following orthopedic surgery due to deep vein thrombosis.
This requires immediate medical intervention. While warmth and erythema could
indicate infection, they are not as immediately life-threatening as PE.
Question 9: A client is prescribed warfarin (Coumadin) for atrial fibrillation.
Which dietary education is a priority for the nurse to reinforce?
A. Increase intake of green leafy vegetables.
B. Avoid consuming grapefruit juice.
C. Maintain a consistent intake of vitamin K-rich foods.
D. Limit all protein intake to prevent bleeding.
CORRECT ANSWER: C. Maintain a consistent intake of vitamin K-rich foods.
, Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors.
Fluctuations in dietary vitamin K intake (found in green leafy vegetables) can alter the
International Normalized Ratio (INR) and therapeutic effect. The priority is to educate
the client to maintain a consistent daily intake of vitamin K.
Question 10: The PN is preparing to administer a tuberculin skin test (TST).
Which action is correct regarding the administration of this test?
A. Administer the injection subcutaneously in the forearm.
B. Administer 0.1 mL of purified protein derivative (PPD) intradermally.
C. Massage the site vigorously after injection to distribute the antigen.
D. Use a 1-inch 25-gauge needle to ensure deep injection.
CORRECT ANSWER: B. Administer 0.1 mL of purified protein derivative (PPD)
intradermally.
Rationale: The TST is administered intradermally (between the dermis and epidermis)
on the volar (inner) surface of the forearm using a tuberculin syringe and a small (e.g.,
27-gauge) needle. A small wheal should appear. It is not massaged.
Question 11: A client is receiving a blood transfusion. Fifteen minutes after the
start of the infusion, the client reports low back pain and chills. What is the
nurse's priority action?
A. Slow the infusion rate to prevent fluid overload.
B. Stop the transfusion immediately and disconnect the tubing.
C. Administer diphenhydramine (Benadryl) as an antihistamine.
D. Stop the transfusion and keep the intravenous line open with normal saline.
CORRECT ANSWER: D. Stop the transfusion and keep the intravenous line
open with normal saline.
Rationale: These symptoms indicate a potential hemolytic transfusion reaction. The
nurse's priority is to stop the transfusion immediately, maintain IV access with normal
saline through new tubing, and notify the provider and blood bank. The blood product
and tubing should be returned to the lab.
Question 12: The PN is reinforcing teaching with a client who has intermittent
claudication. Which statement by the client indicates a need for further
education?
A. "I will exercise by walking until the pain is severe, then rest until it subsides."
B. "I should elevate my legs above my heart to improve circulation."
C. "I need to stop smoking to help reduce my symptoms."
D. "I should inspect my feet daily for any injuries."
CORRECT ANSWER: B. "I should elevate my legs above my heart to improve
circulation."
