ATI RN Comprehensive Predictor (NGN-STYLE QUESTIONS & CASE
SCENARIOS) Set 5 Exam
1. During morning rounds, a 48-year-old client has the following concern: competent adult refuses a
recommended blood transfusion after receiving information. Which information is most important to include
in handoff to the next nurse?
A. nonurgent social details that do not affect current care
B. ongoing status and whether the client wishes to reconsider, the action taken, and the client's response
C. tasks already completed that have no relevance to ongoing safety
D. a complete retelling of the entire hospitalization without prioritization
Correct Answer: B. ongoing status and whether the client wishes to reconsider, the action taken, and the client's
response
Rationale: Handoff should emphasize current risk, ongoing status and whether the client wishes to reconsider, actions
taken, and the client's response so care can continue safely. Irrelevant or unprioritized details can obscure time-sensitive
concerns.
2. At change of shift, a 68-year-old client has the following concern: client newly taking an ACE inhibitor
reports lip swelling. Which response by the nurse best promotes immediate client safety?
A. avoid high-tyramine foods and review all medications and supplements for interactions
B. assess for bleeding and review INR and interacting medications or diet changes
C. hold lithium and obtain urgent evaluation, including serum level and fluid-electrolyte status
D. stop the medication and seek urgent evaluation for angioedema
Correct Answer: D. stop the medication and seek urgent evaluation for angioedema
Rationale: The safest response is to stop the medication and seek urgent evaluation for angioedema. The decision is
supported by ACE inhibitor safety, which places prevention of immediate harm ahead of less urgent tasks.
3. At change of shift, a 34-year-old client has the following concern: nurse discovers that a medication entry
from two hours earlier was omitted. Which nursing action is the priority?
A. follow facility radiation-safety policy and avoid assignments that exceed permitted exposure
B. enter a late documentation entry according to policy with the actual current time and accurate facts
C. withhold the unsafe action and use the chain of command to resolve the concern
D. stop the conversation and move any necessary discussion to a private location
Correct Answer: B. enter a late documentation entry according to policy with the actual current time and accurate
facts
Rationale: Enter a late documentation entry according to policy with the actual current time and accurate facts is the
priority because the situation is governed by legal documentation. The other actions may fit different clients or later
phases of care but do not best address this client's immediate need.
,4. In the emergency department, a 34-year-old client has the following concern: client prescribed an MAOI
asks about diet. Which response by the nurse best promotes immediate client safety?
A. stop heparin and notify the provider for evaluation of heparin-induced thrombocytopenia
B. stop the antipsychotic and seek emergency treatment for neuroleptic malignant syndrome
C. assess for bleeding and review INR and interacting medications or diet changes
D. avoid high-tyramine foods and review all medications and supplements for interactions
Correct Answer: D. avoid high-tyramine foods and review all medications and supplements for interactions
Rationale: The safest response is to avoid high-tyramine foods and review all medications and supplements for
interactions. The decision is supported by MAOI interactions, which places prevention of immediate harm ahead of less
urgent tasks.
5. Avery is a 74-year-old client and is being assessed by the nurse. Stable client requiring a sterile dressing
change and scheduled oral medications. Which nursing action is the priority?
A. assign the sterile dressing change and routine oral medications to the LPN/VN when permitted by jurisdiction and
policy
B. assess and intervene for the client with stridor first
C. enter a late documentation entry according to policy with the actual current time and accurate facts
D. begin interdisciplinary discharge planning early and assess equipment, caregiver, and follow-up needs
Correct Answer: A. assign the sterile dressing change and routine oral medications to the LPN/VN when permitted by
jurisdiction and policy
Rationale: Assign the sterile dressing change and routine oral medications to the lpn/vn when permitted by jurisdiction
and policy is the priority because the situation is governed by scope and predictability. The other actions may fit different
clients or later phases of care but do not best address this client's immediate need.
6. The nurse reviews the situation of a 81-year-old client: client receiving an aminoglycoside reports tinnitus.
Which teaching point is most important for the nurse to reinforce?
A. loop diuretics can cause electrolyte loss and volume depletion
B. dehydration and sodium changes can raise lithium concentration and toxicity risk
C. rapid IV potassium administration can cause fatal dysrhythmia
D. aminoglycosides can cause ototoxicity and nephrotoxicity
Correct Answer: D. aminoglycosides can cause ototoxicity and nephrotoxicity
Rationale: The key teaching is that aminoglycosides can cause ototoxicity and nephrotoxicity. This instruction targets
the preventable risk central to aminoglycoside safety and supports safe self-management.
,7. During morning rounds, the nurse is caring for a 48-year-old client. Client with a valid advance directive
that conflicts with a family request. Which assessment data should the nurse monitor most closely to evaluate
safety and response to care?
A. completion of pending actions and response to interventions
B. client understanding and voluntariness of the decision
C. wound appearance, pain, and response to medication
D. documentation and consistency of the plan with the directive
Correct Answer: D. documentation and consistency of the plan with the directive
Rationale: The most relevant monitoring is documentation and consistency of the plan with the directive because it
directly tracks the risks and expected response associated with autonomy and self-determination. Monitoring unrelated
systems would not provide the same early warning value.
8. During a postoperative assessment, the nurse is evaluating a 48-year-old client for a change in condition.
Which finding is most consistent with the clinical problem described as thyroid replacement?
A. client starting levothyroxine asks when to take it
B. client taking isoniazid, rifampin, pyrazinamide, and ethambutol reports vision changes
C. client receiving magnesium sulfate for severe preeclampsia develops absent reflexes and slow respirations
D. client taking digoxin has nausea, weakness, and a slow irregular pulse
Correct Answer: A. client starting levothyroxine asks when to take it
Rationale: Client starting levothyroxine asks when to take it is a high-value cue for thyroid replacement. The alternative
findings are associated with different clinical problems and would lead the nurse down a different reasoning pathway.
9. The nurse reviews the situation of a 81-year-old client: nurse believes a prescription places a client at
serious risk and the prescriber dismisses the concern. Which teaching point is most important for the nurse
to reinforce?
A. the RN should retain tasks requiring initial assessment, teaching, and unstable-client judgment
B. airway compromise takes priority over non-life-threatening needs
C. the safety report supports quality improvement and is not charted as part of the medical record
D. nurses must advocate when a safety concern remains unresolved
Correct Answer: D. nurses must advocate when a safety concern remains unresolved
Rationale: The key teaching is that nurses must advocate when a safety concern remains unresolved. This instruction
targets the preventable risk central to advocacy and escalation and supports safe self-management.
, 10. During morning rounds, a 48-year-old client has the following concern: client with COPD has increasing
dyspnea and sputum production. Which information is most important to include in handoff to the next
nurse?
A. tasks already completed that have no relevance to ongoing safety
B. work of breathing, oxygenation, mental status, and response to therapy, the action taken, and the client's response
C. nonurgent social details that do not affect current care
D. only the client's room number and diagnosis
Correct Answer: B. work of breathing, oxygenation, mental status, and response to therapy, the action taken, and the
client's response
Rationale: Handoff should emphasize current risk, work of breathing, oxygenation, mental status, and response to
therapy, actions taken, and the client's response so care can continue safely. Irrelevant or unprioritized details can obscure
time-sensitive concerns.
11. During discharge teaching, a 48-year-old client has the following concern: competent adult refuses a
recommended blood transfusion after receiving information. Which principle best explains the nurse's
clinical decision-making in this situation?
A. disaster ethics and triage
B. continuity of care
C. scope and predictability
D. autonomy and informed refusal
Correct Answer: D. autonomy and informed refusal
Rationale: The central principle is autonomy and informed refusal. It links the client cues to the safest nursing response
and helps distinguish the best option from alternatives that may be reasonable in other contexts.
12. In an urgent care area, the nurse is caring for a 55-year-old client. Provider prescribes iv potassium for
severe hypokalemia. Which assessment data should the nurse monitor most closely to evaluate safety and
response to care?
A. cardiac rhythm, potassium, renal function, and infusion site
B. respiratory rate, reflexes, urine output, and magnesium level
C. potassium, magnesium, renal function, blood pressure, and weight
D. visual acuity/color discrimination, liver tests, adherence, and neuropathy symptoms
Correct Answer: A. cardiac rhythm, potassium, renal function, and infusion site
Rationale: The most relevant monitoring is cardiac rhythm, potassium, renal function, and infusion site because it
directly tracks the risks and expected response associated with electrolyte replacement. Monitoring unrelated systems
would not provide the same early warning value.
SCENARIOS) Set 5 Exam
1. During morning rounds, a 48-year-old client has the following concern: competent adult refuses a
recommended blood transfusion after receiving information. Which information is most important to include
in handoff to the next nurse?
A. nonurgent social details that do not affect current care
B. ongoing status and whether the client wishes to reconsider, the action taken, and the client's response
C. tasks already completed that have no relevance to ongoing safety
D. a complete retelling of the entire hospitalization without prioritization
Correct Answer: B. ongoing status and whether the client wishes to reconsider, the action taken, and the client's
response
Rationale: Handoff should emphasize current risk, ongoing status and whether the client wishes to reconsider, actions
taken, and the client's response so care can continue safely. Irrelevant or unprioritized details can obscure time-sensitive
concerns.
2. At change of shift, a 68-year-old client has the following concern: client newly taking an ACE inhibitor
reports lip swelling. Which response by the nurse best promotes immediate client safety?
A. avoid high-tyramine foods and review all medications and supplements for interactions
B. assess for bleeding and review INR and interacting medications or diet changes
C. hold lithium and obtain urgent evaluation, including serum level and fluid-electrolyte status
D. stop the medication and seek urgent evaluation for angioedema
Correct Answer: D. stop the medication and seek urgent evaluation for angioedema
Rationale: The safest response is to stop the medication and seek urgent evaluation for angioedema. The decision is
supported by ACE inhibitor safety, which places prevention of immediate harm ahead of less urgent tasks.
3. At change of shift, a 34-year-old client has the following concern: nurse discovers that a medication entry
from two hours earlier was omitted. Which nursing action is the priority?
A. follow facility radiation-safety policy and avoid assignments that exceed permitted exposure
B. enter a late documentation entry according to policy with the actual current time and accurate facts
C. withhold the unsafe action and use the chain of command to resolve the concern
D. stop the conversation and move any necessary discussion to a private location
Correct Answer: B. enter a late documentation entry according to policy with the actual current time and accurate
facts
Rationale: Enter a late documentation entry according to policy with the actual current time and accurate facts is the
priority because the situation is governed by legal documentation. The other actions may fit different clients or later
phases of care but do not best address this client's immediate need.
,4. In the emergency department, a 34-year-old client has the following concern: client prescribed an MAOI
asks about diet. Which response by the nurse best promotes immediate client safety?
A. stop heparin and notify the provider for evaluation of heparin-induced thrombocytopenia
B. stop the antipsychotic and seek emergency treatment for neuroleptic malignant syndrome
C. assess for bleeding and review INR and interacting medications or diet changes
D. avoid high-tyramine foods and review all medications and supplements for interactions
Correct Answer: D. avoid high-tyramine foods and review all medications and supplements for interactions
Rationale: The safest response is to avoid high-tyramine foods and review all medications and supplements for
interactions. The decision is supported by MAOI interactions, which places prevention of immediate harm ahead of less
urgent tasks.
5. Avery is a 74-year-old client and is being assessed by the nurse. Stable client requiring a sterile dressing
change and scheduled oral medications. Which nursing action is the priority?
A. assign the sterile dressing change and routine oral medications to the LPN/VN when permitted by jurisdiction and
policy
B. assess and intervene for the client with stridor first
C. enter a late documentation entry according to policy with the actual current time and accurate facts
D. begin interdisciplinary discharge planning early and assess equipment, caregiver, and follow-up needs
Correct Answer: A. assign the sterile dressing change and routine oral medications to the LPN/VN when permitted by
jurisdiction and policy
Rationale: Assign the sterile dressing change and routine oral medications to the lpn/vn when permitted by jurisdiction
and policy is the priority because the situation is governed by scope and predictability. The other actions may fit different
clients or later phases of care but do not best address this client's immediate need.
6. The nurse reviews the situation of a 81-year-old client: client receiving an aminoglycoside reports tinnitus.
Which teaching point is most important for the nurse to reinforce?
A. loop diuretics can cause electrolyte loss and volume depletion
B. dehydration and sodium changes can raise lithium concentration and toxicity risk
C. rapid IV potassium administration can cause fatal dysrhythmia
D. aminoglycosides can cause ototoxicity and nephrotoxicity
Correct Answer: D. aminoglycosides can cause ototoxicity and nephrotoxicity
Rationale: The key teaching is that aminoglycosides can cause ototoxicity and nephrotoxicity. This instruction targets
the preventable risk central to aminoglycoside safety and supports safe self-management.
,7. During morning rounds, the nurse is caring for a 48-year-old client. Client with a valid advance directive
that conflicts with a family request. Which assessment data should the nurse monitor most closely to evaluate
safety and response to care?
A. completion of pending actions and response to interventions
B. client understanding and voluntariness of the decision
C. wound appearance, pain, and response to medication
D. documentation and consistency of the plan with the directive
Correct Answer: D. documentation and consistency of the plan with the directive
Rationale: The most relevant monitoring is documentation and consistency of the plan with the directive because it
directly tracks the risks and expected response associated with autonomy and self-determination. Monitoring unrelated
systems would not provide the same early warning value.
8. During a postoperative assessment, the nurse is evaluating a 48-year-old client for a change in condition.
Which finding is most consistent with the clinical problem described as thyroid replacement?
A. client starting levothyroxine asks when to take it
B. client taking isoniazid, rifampin, pyrazinamide, and ethambutol reports vision changes
C. client receiving magnesium sulfate for severe preeclampsia develops absent reflexes and slow respirations
D. client taking digoxin has nausea, weakness, and a slow irregular pulse
Correct Answer: A. client starting levothyroxine asks when to take it
Rationale: Client starting levothyroxine asks when to take it is a high-value cue for thyroid replacement. The alternative
findings are associated with different clinical problems and would lead the nurse down a different reasoning pathway.
9. The nurse reviews the situation of a 81-year-old client: nurse believes a prescription places a client at
serious risk and the prescriber dismisses the concern. Which teaching point is most important for the nurse
to reinforce?
A. the RN should retain tasks requiring initial assessment, teaching, and unstable-client judgment
B. airway compromise takes priority over non-life-threatening needs
C. the safety report supports quality improvement and is not charted as part of the medical record
D. nurses must advocate when a safety concern remains unresolved
Correct Answer: D. nurses must advocate when a safety concern remains unresolved
Rationale: The key teaching is that nurses must advocate when a safety concern remains unresolved. This instruction
targets the preventable risk central to advocacy and escalation and supports safe self-management.
, 10. During morning rounds, a 48-year-old client has the following concern: client with COPD has increasing
dyspnea and sputum production. Which information is most important to include in handoff to the next
nurse?
A. tasks already completed that have no relevance to ongoing safety
B. work of breathing, oxygenation, mental status, and response to therapy, the action taken, and the client's response
C. nonurgent social details that do not affect current care
D. only the client's room number and diagnosis
Correct Answer: B. work of breathing, oxygenation, mental status, and response to therapy, the action taken, and the
client's response
Rationale: Handoff should emphasize current risk, work of breathing, oxygenation, mental status, and response to
therapy, actions taken, and the client's response so care can continue safely. Irrelevant or unprioritized details can obscure
time-sensitive concerns.
11. During discharge teaching, a 48-year-old client has the following concern: competent adult refuses a
recommended blood transfusion after receiving information. Which principle best explains the nurse's
clinical decision-making in this situation?
A. disaster ethics and triage
B. continuity of care
C. scope and predictability
D. autonomy and informed refusal
Correct Answer: D. autonomy and informed refusal
Rationale: The central principle is autonomy and informed refusal. It links the client cues to the safest nursing response
and helps distinguish the best option from alternatives that may be reasonable in other contexts.
12. In an urgent care area, the nurse is caring for a 55-year-old client. Provider prescribes iv potassium for
severe hypokalemia. Which assessment data should the nurse monitor most closely to evaluate safety and
response to care?
A. cardiac rhythm, potassium, renal function, and infusion site
B. respiratory rate, reflexes, urine output, and magnesium level
C. potassium, magnesium, renal function, blood pressure, and weight
D. visual acuity/color discrimination, liver tests, adherence, and neuropathy symptoms
Correct Answer: A. cardiac rhythm, potassium, renal function, and infusion site
Rationale: The most relevant monitoring is cardiac rhythm, potassium, renal function, and infusion site because it
directly tracks the risks and expected response associated with electrolyte replacement. Monitoring unrelated systems
would not provide the same early warning value.
