ATI RN Comprehensive Predictor (NGN-STYLE QUESTIONS & CASE
SCENARIOS) Set 4 Exam
1. In a community clinic, the nurse is reviewing the case of a 34-year-old client. Staff member discussing a
client in a public elevator. Which complication or safety concern is the nurse primarily trying to prevent?
A. privacy and minimum necessary disclosure
B. informed consent responsibilities
C. occupational safety and assignment
D. continuity of care
Correct Answer: A. privacy and minimum necessary disclosure
Rationale: The major safety concern is tied to privacy and minimum necessary disclosure. The cue pattern makes that
risk more immediate than the unrelated complications represented by the distractors.
2. In an urgent care area, a 81-year-old client has the following concern: client taking digoxin has nausea,
weakness, and a slow irregular pulse. Which response by the nurse best promotes immediate client safety?
A. stop the antipsychotic and seek emergency treatment for neuroleptic malignant syndrome
B. stop or slow the infusion as ordered, assess the client, and notify the provider
C. hold the dose and notify the provider while checking pulse, electrolytes, renal function, and digoxin level as ordered
D. stop opioid administration, support airway and breathing, and give reversal therapy as prescribed
Correct Answer: C. hold the dose and notify the provider while checking pulse, electrolytes, renal function, and
digoxin level as ordered
Rationale: The safest response is to hold the dose and notify the provider while checking pulse, electrolytes, renal
function, and digoxin level as ordered. The decision is supported by digoxin safety, which places prevention of
immediate harm ahead of less urgent tasks.
3. During discharge teaching, a 41-year-old client has the following concern: change-of-shift report for a
client with a recent clinical deterioration. Which information is most important to include in handoff to the
next nurse?
A. completion of pending actions and response to interventions, the action taken, and the client's response
B. a complete retelling of the entire hospitalization without prioritization
C. tasks already completed that have no relevance to ongoing safety
D. only the client's room number and diagnosis
Correct Answer: A. completion of pending actions and response to interventions, the action taken, and the client's
response
Rationale: Handoff should emphasize current risk, completion of pending actions and response to interventions, actions
taken, and the client's response so care can continue safely. Irrelevant or unprioritized details can obscure time-sensitive
concerns.
,4. During a postoperative assessment, after the nurse implements the plan for a 62-year-old client with client
receiving rapid-acting insulin becomes diaphoretic and confused, which evaluation finding should be
documented as the best evidence of improvement?
A. eligible clients receive therapy with bleeding risk minimized
B. adrenal crisis is avoided during dose reduction
C. glucose normalizes and symptoms resolve
D. serotonergic toxicity is treated promptly
Correct Answer: C. glucose normalizes and symptoms resolve
Rationale: Glucose normalizes and symptoms resolve is the clearest evidence that the intervention worked. Evaluation
should compare observed results with the expected outcome for insulin safety.
5. In an urgent care area, a 48-year-old client has the following concern: unit identifies an increase in
central-line infections. Which nursing action is the priority?
A. use a structured quality-improvement process to review adherence, identify causes, implement changes, and track
outcomes
B. communicate current status, recent changes, pending tests, and time-sensitive concerns using a structured handoff
C. prioritize clients using the established disaster-triage system to achieve the greatest overall benefit
D. delegate routine bathing and ambulation to assistive personnel after the RN assesses the client
Correct Answer: A. use a structured quality-improvement process to review adherence, identify causes, implement
changes, and track outcomes
Rationale: Use a structured quality-improvement process to review adherence, identify causes, implement changes, and
track outcomes is the priority because the situation is governed by systems thinking and outcome measurement. The other
actions may fit different clients or later phases of care but do not best address this client's immediate need.
6. During a telephone triage call, the nurse is caring for a 68-year-old client. Client receiving a loop diuretic
has muscle cramps and weakness. Which response by the nurse best promotes immediate client safety?
A. review potassium and volume status and report significant abnormalities
B. take it consistently as directed, commonly on an empty stomach, and separate it from interfering supplements such
as iron or calcium
C. report the vision change promptly and assess for medication toxicity
D. stop the infusion and prepare to administer calcium gluconate as prescribed
Correct Answer: A. review potassium and volume status and report significant abnormalities
Rationale: The safest response is to review potassium and volume status and report significant abnormalities. The
decision is supported by diuretic monitoring, which places prevention of immediate harm ahead of less urgent tasks.
,7. In a rehabilitation setting, the nurse is caring for a 74-year-old client. Disaster triage with limited
resources and multiple victims. Which nursing action is the priority?
A. begin interdisciplinary discharge planning early and assess equipment, caregiver, and follow-up needs
B. assess and intervene for the client with stridor first
C. prioritize clients using the established disaster-triage system to achieve the greatest overall benefit
D. delegate routine bathing and ambulation to assistive personnel after the RN assesses the client
Correct Answer: C. prioritize clients using the established disaster-triage system to achieve the greatest overall benefit
Rationale: Prioritize clients using the established disaster-triage system to achieve the greatest overall benefit is the
priority because the situation is governed by disaster ethics and triage. The other actions may fit different clients or later
phases of care but do not best address this client's immediate need.
8. The nurse reviews the situation of a 48-year-old client: client recently started an SSRI develops agitation,
diaphoresis, diarrhea, and hyperreflexia after adding another serotonergic drug. Which response by the
nurse best promotes immediate client safety?
A. hold serotonergic agents and seek urgent evaluation for serotonin toxicity
B. hold the dose and notify the provider while checking pulse, electrolytes, renal function, and digoxin level as ordered
C. stop the medication and seek urgent evaluation for angioedema
D. stop the infusion and prepare to administer calcium gluconate as prescribed
Correct Answer: A. hold serotonergic agents and seek urgent evaluation for serotonin toxicity
Rationale: The safest response is to hold serotonergic agents and seek urgent evaluation for serotonin toxicity. The
decision is supported by serotonin syndrome, which places prevention of immediate harm ahead of less urgent tasks.
9. During a home-health visit, a 24-year-old client has the following concern: multiple clients requiring
attention, including one with new inspiratory stridor. Which nursing action is the priority?
A. follow facility radiation-safety policy and avoid assignments that exceed permitted exposure
B. assess and intervene for the client with stridor first
C. withhold the unsafe action and use the chain of command to resolve the concern
D. assign the sterile dressing change and routine oral medications to the LPN/VN when permitted by jurisdiction and
policy
Correct Answer: B. assess and intervene for the client with stridor first
Rationale: Assess and intervene for the client with stridor first is the priority because the situation is governed by ABCs
and acute change. The other actions may fit different clients or later phases of care but do not best address this client's
immediate need.
, 10. During a telephone triage call, the nurse is reviewing the case of a 2-year-old child. Child has fever,
drooling, tripod positioning, and muffled voice. Which complication or safety concern is the nurse primarily
trying to prevent?
A. status asthmaticus
B. pediatric dehydration
C. epiglottitis
D. pediatric upper-airway illness
Correct Answer: C. epiglottitis
Rationale: The major safety concern is tied to epiglottitis. The cue pattern makes that risk more immediate than the
unrelated complications represented by the distractors.
11. During an interdisciplinary care conference, the nurse is evaluating a 81-year-old client for a change in
condition. Which finding is most consistent with the clinical problem described as privacy and minimum
necessary disclosure?
A. competent adult refuses a recommended blood transfusion after receiving information
B. stable postoperative client needing bathing and ambulation
C. staff member discussing a client in a public elevator
D. client scheduled for an invasive procedure who says the risks are not understood
Correct Answer: C. staff member discussing a client in a public elevator
Rationale: Staff member discussing a client in a public elevator is a high-value cue for privacy and minimum necessary
disclosure. The alternative findings are associated with different clinical problems and would lead the nurse down a
different reasoning pathway.
12. At change of shift, a 34-year-old client has the following concern: client develops flushing and
hypotension during a rapid vancomycin infusion. Which nursing action is the priority?
A. stop the infusion and prepare to administer calcium gluconate as prescribed
B. verify eligibility, bleeding risk, timing, imaging results, and blood pressure criteria before administration
C. take it consistently as directed, commonly on an empty stomach, and separate it from interfering supplements such
as iron or calcium
D. stop or slow the infusion as ordered, assess the client, and notify the provider
Correct Answer: D. stop or slow the infusion as ordered, assess the client, and notify the provider
Rationale: Stop or slow the infusion as ordered, assess the client, and notify the provider is the priority because the
situation is governed by vancomycin infusion safety. The other actions may fit different clients or later phases of care but
do not best address this client's immediate need.
SCENARIOS) Set 4 Exam
1. In a community clinic, the nurse is reviewing the case of a 34-year-old client. Staff member discussing a
client in a public elevator. Which complication or safety concern is the nurse primarily trying to prevent?
A. privacy and minimum necessary disclosure
B. informed consent responsibilities
C. occupational safety and assignment
D. continuity of care
Correct Answer: A. privacy and minimum necessary disclosure
Rationale: The major safety concern is tied to privacy and minimum necessary disclosure. The cue pattern makes that
risk more immediate than the unrelated complications represented by the distractors.
2. In an urgent care area, a 81-year-old client has the following concern: client taking digoxin has nausea,
weakness, and a slow irregular pulse. Which response by the nurse best promotes immediate client safety?
A. stop the antipsychotic and seek emergency treatment for neuroleptic malignant syndrome
B. stop or slow the infusion as ordered, assess the client, and notify the provider
C. hold the dose and notify the provider while checking pulse, electrolytes, renal function, and digoxin level as ordered
D. stop opioid administration, support airway and breathing, and give reversal therapy as prescribed
Correct Answer: C. hold the dose and notify the provider while checking pulse, electrolytes, renal function, and
digoxin level as ordered
Rationale: The safest response is to hold the dose and notify the provider while checking pulse, electrolytes, renal
function, and digoxin level as ordered. The decision is supported by digoxin safety, which places prevention of
immediate harm ahead of less urgent tasks.
3. During discharge teaching, a 41-year-old client has the following concern: change-of-shift report for a
client with a recent clinical deterioration. Which information is most important to include in handoff to the
next nurse?
A. completion of pending actions and response to interventions, the action taken, and the client's response
B. a complete retelling of the entire hospitalization without prioritization
C. tasks already completed that have no relevance to ongoing safety
D. only the client's room number and diagnosis
Correct Answer: A. completion of pending actions and response to interventions, the action taken, and the client's
response
Rationale: Handoff should emphasize current risk, completion of pending actions and response to interventions, actions
taken, and the client's response so care can continue safely. Irrelevant or unprioritized details can obscure time-sensitive
concerns.
,4. During a postoperative assessment, after the nurse implements the plan for a 62-year-old client with client
receiving rapid-acting insulin becomes diaphoretic and confused, which evaluation finding should be
documented as the best evidence of improvement?
A. eligible clients receive therapy with bleeding risk minimized
B. adrenal crisis is avoided during dose reduction
C. glucose normalizes and symptoms resolve
D. serotonergic toxicity is treated promptly
Correct Answer: C. glucose normalizes and symptoms resolve
Rationale: Glucose normalizes and symptoms resolve is the clearest evidence that the intervention worked. Evaluation
should compare observed results with the expected outcome for insulin safety.
5. In an urgent care area, a 48-year-old client has the following concern: unit identifies an increase in
central-line infections. Which nursing action is the priority?
A. use a structured quality-improvement process to review adherence, identify causes, implement changes, and track
outcomes
B. communicate current status, recent changes, pending tests, and time-sensitive concerns using a structured handoff
C. prioritize clients using the established disaster-triage system to achieve the greatest overall benefit
D. delegate routine bathing and ambulation to assistive personnel after the RN assesses the client
Correct Answer: A. use a structured quality-improvement process to review adherence, identify causes, implement
changes, and track outcomes
Rationale: Use a structured quality-improvement process to review adherence, identify causes, implement changes, and
track outcomes is the priority because the situation is governed by systems thinking and outcome measurement. The other
actions may fit different clients or later phases of care but do not best address this client's immediate need.
6. During a telephone triage call, the nurse is caring for a 68-year-old client. Client receiving a loop diuretic
has muscle cramps and weakness. Which response by the nurse best promotes immediate client safety?
A. review potassium and volume status and report significant abnormalities
B. take it consistently as directed, commonly on an empty stomach, and separate it from interfering supplements such
as iron or calcium
C. report the vision change promptly and assess for medication toxicity
D. stop the infusion and prepare to administer calcium gluconate as prescribed
Correct Answer: A. review potassium and volume status and report significant abnormalities
Rationale: The safest response is to review potassium and volume status and report significant abnormalities. The
decision is supported by diuretic monitoring, which places prevention of immediate harm ahead of less urgent tasks.
,7. In a rehabilitation setting, the nurse is caring for a 74-year-old client. Disaster triage with limited
resources and multiple victims. Which nursing action is the priority?
A. begin interdisciplinary discharge planning early and assess equipment, caregiver, and follow-up needs
B. assess and intervene for the client with stridor first
C. prioritize clients using the established disaster-triage system to achieve the greatest overall benefit
D. delegate routine bathing and ambulation to assistive personnel after the RN assesses the client
Correct Answer: C. prioritize clients using the established disaster-triage system to achieve the greatest overall benefit
Rationale: Prioritize clients using the established disaster-triage system to achieve the greatest overall benefit is the
priority because the situation is governed by disaster ethics and triage. The other actions may fit different clients or later
phases of care but do not best address this client's immediate need.
8. The nurse reviews the situation of a 48-year-old client: client recently started an SSRI develops agitation,
diaphoresis, diarrhea, and hyperreflexia after adding another serotonergic drug. Which response by the
nurse best promotes immediate client safety?
A. hold serotonergic agents and seek urgent evaluation for serotonin toxicity
B. hold the dose and notify the provider while checking pulse, electrolytes, renal function, and digoxin level as ordered
C. stop the medication and seek urgent evaluation for angioedema
D. stop the infusion and prepare to administer calcium gluconate as prescribed
Correct Answer: A. hold serotonergic agents and seek urgent evaluation for serotonin toxicity
Rationale: The safest response is to hold serotonergic agents and seek urgent evaluation for serotonin toxicity. The
decision is supported by serotonin syndrome, which places prevention of immediate harm ahead of less urgent tasks.
9. During a home-health visit, a 24-year-old client has the following concern: multiple clients requiring
attention, including one with new inspiratory stridor. Which nursing action is the priority?
A. follow facility radiation-safety policy and avoid assignments that exceed permitted exposure
B. assess and intervene for the client with stridor first
C. withhold the unsafe action and use the chain of command to resolve the concern
D. assign the sterile dressing change and routine oral medications to the LPN/VN when permitted by jurisdiction and
policy
Correct Answer: B. assess and intervene for the client with stridor first
Rationale: Assess and intervene for the client with stridor first is the priority because the situation is governed by ABCs
and acute change. The other actions may fit different clients or later phases of care but do not best address this client's
immediate need.
, 10. During a telephone triage call, the nurse is reviewing the case of a 2-year-old child. Child has fever,
drooling, tripod positioning, and muffled voice. Which complication or safety concern is the nurse primarily
trying to prevent?
A. status asthmaticus
B. pediatric dehydration
C. epiglottitis
D. pediatric upper-airway illness
Correct Answer: C. epiglottitis
Rationale: The major safety concern is tied to epiglottitis. The cue pattern makes that risk more immediate than the
unrelated complications represented by the distractors.
11. During an interdisciplinary care conference, the nurse is evaluating a 81-year-old client for a change in
condition. Which finding is most consistent with the clinical problem described as privacy and minimum
necessary disclosure?
A. competent adult refuses a recommended blood transfusion after receiving information
B. stable postoperative client needing bathing and ambulation
C. staff member discussing a client in a public elevator
D. client scheduled for an invasive procedure who says the risks are not understood
Correct Answer: C. staff member discussing a client in a public elevator
Rationale: Staff member discussing a client in a public elevator is a high-value cue for privacy and minimum necessary
disclosure. The alternative findings are associated with different clinical problems and would lead the nurse down a
different reasoning pathway.
12. At change of shift, a 34-year-old client has the following concern: client develops flushing and
hypotension during a rapid vancomycin infusion. Which nursing action is the priority?
A. stop the infusion and prepare to administer calcium gluconate as prescribed
B. verify eligibility, bleeding risk, timing, imaging results, and blood pressure criteria before administration
C. take it consistently as directed, commonly on an empty stomach, and separate it from interfering supplements such
as iron or calcium
D. stop or slow the infusion as ordered, assess the client, and notify the provider
Correct Answer: D. stop or slow the infusion as ordered, assess the client, and notify the provider
Rationale: Stop or slow the infusion as ordered, assess the client, and notify the provider is the priority because the
situation is governed by vancomycin infusion safety. The other actions may fit different clients or later phases of care but
do not best address this client's immediate need.
