ATI RN Comprehensive Predictor 2026: 100 Practice
Questions and Answers with Rationales | NGN
NCLEX Review
Part 1: Questions 1–25 — Fundamentals and
medical-surgical nursing
Questions 1–10: Prioritization and patient safety
1. Which client should the nurse assess first?
A. A client with chronic arthritis reporting pain of 6/10 B. A client with pneumonia who has new
confusion and an oxygen saturation of 84% C. A client awaiting discharge instructions D. A
client with constipation for three days
Answer: B. Rationale: New confusion and severe hypoxemia suggest impaired oxygenation and
possible respiratory deterioration. Airway and breathing threats take priority.
2. A nurse is caring for a client who has suspected pulmonary embolism. Which finding requires
immediate intervention?
A. Mild anxiety B. Sudden dyspnea and chest pain C. Decreased appetite D. Fatigue after
walking
Answer: B. Rationale: Sudden dyspnea and chest pain may indicate pulmonary embolism, which
can rapidly compromise circulation and oxygenation. Initiate emergency assessment and
escalation.
3. Which task can the RN delegate to unlicensed assistive personnel (UAP) for a stable client?
A. Assessing a new pressure injury B. Teaching insulin administration C. Obtaining routine vital
signs D. Evaluating pain medication effectiveness
Answer: C. Rationale: UAP can perform routine, predictable tasks for stable clients. Assessment,
teaching, and evaluation require nursing judgment.
4. A client receiving an opioid has a respiratory rate of 7/min and is difficult to awaken. What
should the nurse do first?
,A. Document the expected adverse effect B. Support ventilation, stimulate the client, and
activate emergency assistance C. Offer oral fluids D. Reassess in 30 minutes
Answer: B. Rationale: Severe respiratory depression is life-threatening. Support airway and
breathing, summon help, and administer naloxone according to emergency protocols.
5. Which intervention is appropriate for a client with suspected Clostridioides difficile infection?
A. Use alcohol hand sanitizer alone B. Use contact precautions and wash hands with soap and
water C. Place the client in a positive-pressure room D. Discontinue gloves when handling
contaminated equipment
Answer: B. Rationale: Contact precautions, appropriate environmental sporicidal cleaning, and
soap-and-water handwashing are important because C. difficile forms spores.
6. A client develops chills, fever, and flank pain during a blood transfusion. What is the priority
action?
A. Slow the transfusion B. Stop the transfusion immediately C. Administer an antipyretic and
continue D. Flush the blood tubing with dextrose
Answer: B. Rationale: These findings may indicate an acute transfusion reaction. Stop the blood,
maintain IV access with compatible normal saline using new tubing, assess the client, and notify
the appropriate clinicians and blood bank.
7. Which client requires airborne precautions?
A. A client with pulmonary tuberculosis B. A client with a urinary tract infection C. A client
with localized cellulitis D. A client with uncomplicated influenza receiving routine droplet
precautions
Answer: A. Rationale: Suspected or confirmed infectious pulmonary tuberculosis requires
airborne precautions, including a suitable negative-pressure room and a fit-tested respirator.
8. A nurse discovers a medication error. What is the priority?
A. Complete an incident report before assessing the client B. Assess the client and intervene to
prevent harm C. Wait for symptoms before notifying anyone D. Alter the medication
administration record to conceal the error
Answer: B. Rationale: The client's safety comes first. Assess, provide indicated treatment, notify
the appropriate clinician, and follow reporting procedures with accurate documentation.
9. Which finding is most consistent with hypoglycemia?
, A. Fruity breath and deep respirations B. Sweating, tremors, and confusion C. Warm, dry skin
and excessive thirst D. Gradual weight gain and bradycardia
Answer: B. Rationale: Hypoglycemia commonly causes adrenergic symptoms such as sweating
and tremors, followed by neuroglycopenic symptoms such as confusion.
10. A client with a suspected stroke arrives at the emergency department. Which information is
especially important to obtain immediately?
A. Favorite foods B. Exact time the client was last known to be at baseline C. Date of the last
dental appointment D. Usual bedtime
Answer: B. Rationale: The last-known-well time helps determine eligibility for time-sensitive
stroke interventions. Activate the stroke protocol and rapidly assess the client.
Questions 11–25: Adult medical-surgical nursing
11. Which finding in a client with heart failure requires prompt escalation?
A. Stable ankle edema B. Sudden severe dyspnea with pink, frothy sputum C. Mild fatigue after
activity D. Chronic nocturia
Answer: B. Rationale: This presentation suggests acute pulmonary edema. Support oxygenation
and ventilation as indicated and activate emergency management.
12. Which laboratory result is most concerning for a client with chronic kidney disease?
A. Potassium 6.4 mEq/L B. Sodium 139 mEq/L C. Calcium 9.2 mg/dL D. Hemoglobin 13 g/dL
Answer: A. Rationale: Severe hyperkalemia can cause fatal cardiac dysrhythmias and requires
urgent evaluation and treatment.
13. A client with diabetes is awake, able to swallow, and has a blood glucose of 54 mg/dL. What
should the nurse do first?
A. Give approximately 15 g of fast-acting carbohydrate B. Administer the scheduled rapid-acting
insulin C. Encourage the client to exercise D. Restrict oral intake
Answer: A. Rationale: Treat conscious clients who can swallow using fast-acting carbohydrate,
then recheck glucose in about 15 minutes and repeat treatment if still low.
14. Which finding suggests diabetic ketoacidosis (DKA)?
A. Hypoglycemia and shallow breathing B. Hyperglycemia, dehydration, and deep, rapid
respirations C. Bradycardia and hypothermia alone D. Peripheral edema and weight gain
Questions and Answers with Rationales | NGN
NCLEX Review
Part 1: Questions 1–25 — Fundamentals and
medical-surgical nursing
Questions 1–10: Prioritization and patient safety
1. Which client should the nurse assess first?
A. A client with chronic arthritis reporting pain of 6/10 B. A client with pneumonia who has new
confusion and an oxygen saturation of 84% C. A client awaiting discharge instructions D. A
client with constipation for three days
Answer: B. Rationale: New confusion and severe hypoxemia suggest impaired oxygenation and
possible respiratory deterioration. Airway and breathing threats take priority.
2. A nurse is caring for a client who has suspected pulmonary embolism. Which finding requires
immediate intervention?
A. Mild anxiety B. Sudden dyspnea and chest pain C. Decreased appetite D. Fatigue after
walking
Answer: B. Rationale: Sudden dyspnea and chest pain may indicate pulmonary embolism, which
can rapidly compromise circulation and oxygenation. Initiate emergency assessment and
escalation.
3. Which task can the RN delegate to unlicensed assistive personnel (UAP) for a stable client?
A. Assessing a new pressure injury B. Teaching insulin administration C. Obtaining routine vital
signs D. Evaluating pain medication effectiveness
Answer: C. Rationale: UAP can perform routine, predictable tasks for stable clients. Assessment,
teaching, and evaluation require nursing judgment.
4. A client receiving an opioid has a respiratory rate of 7/min and is difficult to awaken. What
should the nurse do first?
,A. Document the expected adverse effect B. Support ventilation, stimulate the client, and
activate emergency assistance C. Offer oral fluids D. Reassess in 30 minutes
Answer: B. Rationale: Severe respiratory depression is life-threatening. Support airway and
breathing, summon help, and administer naloxone according to emergency protocols.
5. Which intervention is appropriate for a client with suspected Clostridioides difficile infection?
A. Use alcohol hand sanitizer alone B. Use contact precautions and wash hands with soap and
water C. Place the client in a positive-pressure room D. Discontinue gloves when handling
contaminated equipment
Answer: B. Rationale: Contact precautions, appropriate environmental sporicidal cleaning, and
soap-and-water handwashing are important because C. difficile forms spores.
6. A client develops chills, fever, and flank pain during a blood transfusion. What is the priority
action?
A. Slow the transfusion B. Stop the transfusion immediately C. Administer an antipyretic and
continue D. Flush the blood tubing with dextrose
Answer: B. Rationale: These findings may indicate an acute transfusion reaction. Stop the blood,
maintain IV access with compatible normal saline using new tubing, assess the client, and notify
the appropriate clinicians and blood bank.
7. Which client requires airborne precautions?
A. A client with pulmonary tuberculosis B. A client with a urinary tract infection C. A client
with localized cellulitis D. A client with uncomplicated influenza receiving routine droplet
precautions
Answer: A. Rationale: Suspected or confirmed infectious pulmonary tuberculosis requires
airborne precautions, including a suitable negative-pressure room and a fit-tested respirator.
8. A nurse discovers a medication error. What is the priority?
A. Complete an incident report before assessing the client B. Assess the client and intervene to
prevent harm C. Wait for symptoms before notifying anyone D. Alter the medication
administration record to conceal the error
Answer: B. Rationale: The client's safety comes first. Assess, provide indicated treatment, notify
the appropriate clinician, and follow reporting procedures with accurate documentation.
9. Which finding is most consistent with hypoglycemia?
, A. Fruity breath and deep respirations B. Sweating, tremors, and confusion C. Warm, dry skin
and excessive thirst D. Gradual weight gain and bradycardia
Answer: B. Rationale: Hypoglycemia commonly causes adrenergic symptoms such as sweating
and tremors, followed by neuroglycopenic symptoms such as confusion.
10. A client with a suspected stroke arrives at the emergency department. Which information is
especially important to obtain immediately?
A. Favorite foods B. Exact time the client was last known to be at baseline C. Date of the last
dental appointment D. Usual bedtime
Answer: B. Rationale: The last-known-well time helps determine eligibility for time-sensitive
stroke interventions. Activate the stroke protocol and rapidly assess the client.
Questions 11–25: Adult medical-surgical nursing
11. Which finding in a client with heart failure requires prompt escalation?
A. Stable ankle edema B. Sudden severe dyspnea with pink, frothy sputum C. Mild fatigue after
activity D. Chronic nocturia
Answer: B. Rationale: This presentation suggests acute pulmonary edema. Support oxygenation
and ventilation as indicated and activate emergency management.
12. Which laboratory result is most concerning for a client with chronic kidney disease?
A. Potassium 6.4 mEq/L B. Sodium 139 mEq/L C. Calcium 9.2 mg/dL D. Hemoglobin 13 g/dL
Answer: A. Rationale: Severe hyperkalemia can cause fatal cardiac dysrhythmias and requires
urgent evaluation and treatment.
13. A client with diabetes is awake, able to swallow, and has a blood glucose of 54 mg/dL. What
should the nurse do first?
A. Give approximately 15 g of fast-acting carbohydrate B. Administer the scheduled rapid-acting
insulin C. Encourage the client to exercise D. Restrict oral intake
Answer: A. Rationale: Treat conscious clients who can swallow using fast-acting carbohydrate,
then recheck glucose in about 15 minutes and repeat treatment if still low.
14. Which finding suggests diabetic ketoacidosis (DKA)?
A. Hypoglycemia and shallow breathing B. Hyperglycemia, dehydration, and deep, rapid
respirations C. Bradycardia and hypothermia alone D. Peripheral edema and weight gain
