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ATI RN Comprehensive Predictor 2026 Proctored Exam
Total Questions : 179
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Social:
Client reports they stopped smoking 15 years ago. Reports when they did smoke, they would smoke half a pack per day of cigarettes.
Client reports drinking occasionally, states. "Once or twice a month I may have a glass of wine."
Client denies any illicit drug use.
0930:
Cardiovascular: S1 and S2 noted, regular rhythm. +2 pulses in upper and lower extremities. No edema noted. Respiratory: Vesicular and bronchovesicular breath sounds heard. No cough. Full and symmetric thorax expansion.
Gastrointestinal: Bowel sounds present in all 4 quadrants. Abdomen is soft, nondistended, not obese.
Gynecological: Client reports early onset menses, age 9. Reports menopause began at 52 years old. Gravida 1 para 1, vaginal birth at age 40. Reports no history of any type of hormone therapy.
0900:
67-year-old client presents to the outpatient clinic for a well visit. Client reports, "I haven't been to the doctor in 30 years." Client does not have any concerns, but says. "My child kept bugging me about going, so here I am."
A nurse is caring for a client in an outpatient clinic.
Complete the following sentence by using the lists of options.
The client is at risk for
Explanation
Breast cancer risk is influenced by both reproductive history and hormonal exposure over a lifetime. Early menarche, late first full-term pregnancy, and age-related hormonal exposure all contribute to prolonged estrogen exposure, which increases breast tissue proliferation and malignant transformation risk. Nurses must be able to connect reproductive history and modifiable/non-modifiable risk factors when identifying cancer risk.
Rationale for correct choices:
• Breast cancer: Breast cancer risk increases with prolonged lifetime exposure to estrogen and progesterone, which stimulate breast tissue proliferation. This client has multiple reproductive risk factors, including early menarche and late age at first childbirth, both of which extend estrogen exposure duration. These factors increase the likelihood of DNA replication errors in breast tissue over time. At age 67, cumulative hormonal exposure becomes a significant predictor of breast cancer risk, warranting routine screening and vigilance.
• Age of menarche: Early menarche (at age 9) is a well-established risk factor for breast cancer because it increases the total number of ovulatory cycles and duration of estrogen exposure over a lifetime. The longer breast tissue is exposed to estrogen, the greater the chance of cellular proliferation and malignant transformation. This extended hormonal exposure window contributes significantly to lifetime breast cancer risk. Therefore, this reproductive history detail is a key contributing factor.
• Age when they gave birth: Giving birth at age 40 is considered a late first full-term pregnancy, which increases breast cancer risk. Pregnancy early in life has a protective effect due to breast tissue differentiation, while delayed childbirth prolongs exposure to estrogen-sensitive undifferentiated breast cells. This increases susceptibility to malignant changes over time.
Rationale for incorrect choices:
• Colorectal cancer: Although colorectal cancer is a significant malignancy in older adults, this client’s risk factors are more strongly aligned with breast cancer based on reproductive and hormonal history. There is no evidence of dietary, genetic, or gastrointestinal symptoms suggesting increased colorectal cancer risk. The patient data specifically points toward estrogen-related risk factors rather than colon pathology.
• Pancreatic cancer: Pancreatic cancer risk is more closely associated with factors such as chronic pancreatitis, smoking, obesity, diabetes, and genetic predisposition. Although the client has a distant smoking history, they quit 15 years ago after low-level exposure, which minimally contributes to current risk. No other pancreatic risk factors are present in the assessment data.
• Current smoking status: The client is a former smoker who quit 15 years ago, making current smoking status irrelevant as an active risk factor. Although past smoking contributes to overall health risk, it is not a strong primary driver of breast cancer compared to hormonal reproductive factors. Additionally, the client’s smoking history was low intensity (half pack per day). Therefore, this is not the most significant contributing factor in this case.
• Weight: The client is described as “not obese,” indicating a normal body weight, which does not significantly contribute to increased breast cancer risk. Although obesity is a known risk factor for postmenopausal breast cancer due to increased peripheral estrogen production in adipose tissue, this client does not present with that risk. The reproductive history factors (early menarche and late childbirth) are far more significant in this case.
• Hormone therapy: The client explicitly reports no history of hormone therapy, eliminating this as a contributing risk factor. Hormone replacement therapy (especially combined estrogen-progestin therapy) increases breast cancer risk due to prolonged hormonal stimulation of breast tissue. Since this client has not been exposed to exogenous hormones, this pathway of risk is absent.
• Alcohol consumption: The client reports only occasional alcohol intake (a glass of wine once or twice a month), which is considered minimal and not a significant risk factor for breast cancer. While heavy or chronic alcohol consumption is associated with increased estrogen levels and DNA damage, this level of intake is too low to meaningfully increase risk. Additionally, alcohol is a weaker risk factor compared to reproductive history in this case.
A nurse is administering medications to a group of clients. Which of the following occurrences requires the completion of an incident report?
A nurse is caring for a client who has ADHD and a prescription for methylphenidate 30 mg PO twice daily. The amount available is methylphenidate 10 mg/5 mL oral solution. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Explanation
Identify the ordered dose and available concentration
Ordered Dose: 30 mg
Available Concentration: 10 mg/5 mL
Calculate the volume to administer
Volume = (Ordered dose ÷ Concentration) × Volume provided
Volume = (30 ÷ 10) × 5
Volume = 3 × 5
= 15 mL
A nurse is teaching about preventing sudden unexpected infant death (SUID) to a parent of indicates that the parent understands how to place the infant in the crib at bedtime?
A nurse is preparing to administer an intramuscular injection to a client. Which of the following injection sites should the nurse choose to utilize?
Today:
Adolescent is allergic to penicillin and sulfa. Adolescent was diagnosed with epilepsy at age 3. Initial diagnosis was made by electroencephalogram after experiencing several generalized tonic-clonic seizures; however, the adolescent has primarily experienced seizures for the past 10 years. Adolescent's seizures have been well controlled with daily medication. Last known seizure was about 14 months ago.
1 week ago:
Received a call on the adolescent's guardian to request refills of the adolescent's antiepileptic medications as they are down to the last 2 weeks of medication. Electronic medical record review indicates that the adolescent's last appointment for laboratory work and follow-up was 1 year ago. Scheduled the adolescent for an appointment in 1 week.
Today:
The adolescent is here for a checkup and laboratory work for medication management. The adolescent is accompanied by their guardian, who stepped out of the room to take a phone call. The adolescent states, "I got started on the pill a few months ago at the family planning clinic. I went there because I don't want my parents to know. I figure you should know, but please do not tell my mom."
Today:
Phenytoin 100 mg one capsule PO three times per day
Ethinyl estradiol 0.03 mg and drospirenone 3 mg (combined oral contraceptive pills) one tablet daily in the order presented in the blister pack
A nurse is caring for a 15-year-old adolescent in an outpatient clinic.
Complete the following sentence by using the lists of options.
The client is at risk for
Explanation
This question focuses on a clinically significant drug interaction in an adolescent with epilepsy who is taking phenytoin alongside a combined oral contraceptive pill. Phenytoin is an enzyme-inducing antiepileptic drug that increases hepatic metabolism of hormonal contraceptives, reducing their effectiveness. Understanding enzyme induction and its effect on contraceptive failure is essential for preventing unintended pregnancy in patients on antiepileptic therapy.
Rationale for correct choices:
• Pregnancy: Pregnancy is the primary risk because phenytoin reduces the effectiveness of combined oral contraceptive pills, increasing the likelihood of contraceptive failure. This occurs through hepatic enzyme induction, which accelerates the breakdown of ethinyl estradiol and drospirenone. Inadequate hormone levels may prevent ovulation suppression, leading to unintended conception.
• Medication interaction: Phenytoin is a strong cytochrome P450 enzyme inducer that enhances the metabolism of estrogen and progestin components of oral contraceptives. This pharmacokinetic interaction reduces contraceptive serum levels and effectiveness. The interaction is clinically significant and requires counseling on alternative or additional contraceptive methods, such as barrier protection or non-hormonal options.
Rationale for incorrect choices:
• Anaphylaxis: Anaphylaxis is not a concern in this scenario because the adolescent has no reported allergy to phenytoin or oral contraceptives. The known allergies are to penicillin and sulfa drugs, which are unrelated to the current medications. There are no clinical signs of hypersensitivity such as urticaria, bronchospasm, or hypotension.
• Seizure recurrence: Seizure recurrence is a potential concern in epilepsy if antiepileptic drug levels are reduced or adherence is poor. However, in this case, the primary issue is reduced contraceptive efficacy due to enzyme induction, not decreased seizure control. The adolescent reports stable seizure control for over a year. Therefore, seizure recurrence is not the immediate identified risk in this scenario.
• Dosing schedule: Dosing schedule is not the cause of the identified risk because there is no evidence of missed doses or incorrect administration of either medication. The concern is pharmacokinetic interaction rather than timing or adherence issues. Adherence is always important in epilepsy and contraception, but the clinical problem here is reduced hormonal effectiveness due to enzyme induction.
• Allergic reaction: An allergic reaction is not supported by the assessment data. The adolescent’s known allergies are unrelated to the current medications, and there are no symptoms such as rash, swelling, or respiratory compromise. The risk identified is pharmacological interaction, not immunologic hypersensitivity.
A nurse is caring for a client who is receiving intermittent enteral tube feedings. Which of the following factors places the client at risk for aspiration?
0800:
Pediatric provider's office note:
Caregiver reports that for the past 2 days their toddler has had a fever as high as 38.6° C (101.5° F), has been irritable, and refuses to eat or drink. Caregiver reports the toddler's older sibling was sick 5 days ago with upper respiratory infection. Toddler is awake, active, and crying. Mucous membranes are pink and slightly dry. Capillary refill is less than 2 seconds. Skin is warm and dry. Tonsils are swollen and erythematous. No signs of respiratory distress noted. Has moderate amount of clear mucoid nasal secretions.
Rapid Group A Beta-hemolytic Streptococci (GABHS) test done and was negative. Throat culture obtained and sent to lab. Missed appointment for 15-month vaccinations, otherwise Immunizations are up to date.
2200:
18-month-old toddler brought to emergency department by caregivers. Toddler was seen earlier today in provider's office. Caregiver feels the child's breathing is getting worse and doesn't want to wait until tomorrow to see provider.
Toddler is awake and crying. No tears are noted. Mucous membranes are slightly moist and pink. No drooling noted. Skin is warm and dry. Capillary refill is 2 seconds. Mild wheezing is heard in all lobes. Respirations are rapid with slight subcostal retractions. Abdomen is soft, non-distended and bowel sounds are present. Oxygen at 1 L/min is administered via n/c as prescribed by provider.
A nurse is caring for an 18-month-old toddler in the emergency department.
For each potential assessment finding, click to specify if the finding is consistent with Epiglottitis, Respiratory Syncytial virus, or Acute Streptococcal Pharyngitis. Each finding may support more than 1 disease process.
Explanation
This case focuses on differentiating three pediatric respiratory conditions: epiglottitis, respiratory syncytial virus (RSV), and acute streptococcal pharyngitis. Each condition affects the upper or lower airway differently and presents with distinct but sometimes overlapping clinical features. Epiglottitis is a medical emergency characterized by rapid airway obstruction and drooling. RSV primarily affects the lower respiratory tract, causing wheezing and bronchiolitis. Streptococcal pharyngitis involves bacterial inflammation of the throat with exudate and fever. Accurate recognition of symptom patterns is essential for prioritizing airway safety and infection management.
Rationale:
• Hypoxia: This can occur in both epiglottitis and RSV due to impaired airway patency and ventilation. In epiglottitis, airway obstruction from inflamed supraglottic structures reduces oxygen exchange. In RSV, lower airway inflammation and mucus plugging impair gas exchange. Acute streptococcal pharyngitis typically does not cause hypoxia unless severe complications develop.
• Exudate on pharynx: Pharyngeal exudate is strongly associated with acute streptococcal pharyngitis due to bacterial infection causing tonsillar inflammation and pus formation. This finding helps distinguish bacterial infection from viral causes. Epiglottitis affects the epiglottis rather than the tonsillar surfaces, and RSV primarily affects the lower respiratory tract, not producing pharyngeal exudates.
• Tachypnea: This is common in both epiglottitis and RSV. In epiglottitis, airway obstruction leads to compensatory rapid breathing to maintain oxygenation. In RSV, inflammation of the bronchioles increases work of breathing and reduces oxygen exchange efficiency. Streptococcal pharyngitis may cause fever-related mild tachypnea but not typically significant respiratory distress.
• Wheezing upon auscultation: Wheezing is characteristic of RSV due to bronchiolar inflammation and mucus obstruction in the lower airways. It is not typically associated with epiglottitis, which involves upper airway obstruction, or streptococcal pharyngitis, which is limited to the pharynx. The presence of wheezing strongly supports a lower respiratory tract viral infection.
• Fever: This is a nonspecific symptom seen in all three conditions. Epiglottitis often presents with high fever due to bacterial infection. RSV commonly causes moderate fever associated with viral illness. Streptococcal pharyngitis also presents with fever due to bacterial inflammation of the throat and systemic immune response.
• Drooling: This is a hallmark sign of epiglottitis due to severe throat pain and inability to swallow secretions caused by supraglottic swelling. It is a key red flag indicating potential airway obstruction. Drooling is not typical in RSV or streptococcal pharyngitis unless severe throat pain is present, making it a distinguishing emergency feature of epiglottitis.
0800:
Client reports abdominal pain as 7 on a scale of 0 to 10. Abdominal dressing with small amount of serous drainage present, infrequently passing gas, and had small bowel movement once. Bowel sounds present in all four quadrants. NG tube intact, placement verified. Enteral feeding infusing via NG tube at 80 mL/hr.
0900:
Client continues to report abdominal pain as 4 on a scale of 0 to 10. NG tube intact, placement verified. Feeding infusing via NG tube at 80 mL/hr.
0800:
Temperature 36.9° C (98.4° F)
Heart rate 76/min
Respiratory rate 20/min
Blood pressure 138/86 mm Hg
0900:
Temperature 36.9° C (98.4° F)
Heart rate 76/min
Respiratory rate 16/min
Blood pressure 128/84 mm Hg
0800:
Intake: NG 80 mL
Output: Urine 120 mL, small formed stool, gastric residual volume 220 mL
0900:
Intake: NG 80 mL
Output: Gastric residual volume 280 mL
1000:
Output: Urine 100 mL
0700:
Enteral feeding at 80 mL/hr via NG tube
Morphine 4 mg IV every 3 to 4 hr PRN moderate to severe pain
0805:
Morphine 4 mg IV given for pain of 7 on a scale of 0 to 10.
A nurse is caring for a client who is 2 days postoperative following abdominal surgery and requires enteral feedings.
Drag words from the choices below to fill in each blank in the following sentence.
The client is at highest risk for developing and .
Explanation
This question focuses on postoperative nursing priorities in a client receiving enteral nutrition via nasogastric (NG) tube while also receiving opioid analgesia. The client is 2 days post abdominal surgery, has increasing gastric residual volumes, and is receiving morphine for pain control. These factors significantly increase the risk of aspiration due to delayed gastric emptying and sedation. Opioid administration also increases the risk of urinary retention by decreasing detrusor muscle contractility. Recognizing complications of enteral feeding and opioid therapy is essential for preventing respiratory and urinary complications in postoperative patients.
Rationale for correct choices:
• Aspiration: This is the highest priority risk due to the combination of enteral feeding via NG tube, elevated gastric residual volumes (220 mL increasing to 280 mL), and opioid administration. High residual volumes indicate delayed gastric emptying, increasing the likelihood of reflux and regurgitation of tube feeding contents. Morphine further depresses gastrointestinal motility and reduces protective airway reflexes such as cough and gag. Together, these factors significantly increase the risk of aspiration pneumonia, a life-threatening complication.
• Urinary retention: This is a common adverse effect of opioid medications such as morphine, which decrease parasympathetic stimulation of the bladder detrusor muscle. This leads to decreased bladder contractility and incomplete emptying. Postoperative clients are already at increased risk due to immobility and anesthesia effects. Reduced urine output and bladder distension may develop if not monitored closely, making this a significant complication.
Rationale for incorrect choices:
• Hyperglycemia: This is not expected in this postoperative client. There is no indication of diabetes mellitus, stress-induced hyperglycemia, or elevated blood glucose measurements. Although surgical stress can transiently increase glucose levels, it is not the most immediate complication in this scenario. The primary concerns relate to respiratory and gastrointestinal safety rather than metabolic dysregulation.
• Skin breakdown: Skin breakdown is a potential risk in immobilized postoperative clients, but there are no current findings indicating pressure injury development. The client has stable vital signs, is receiving nutrition, and has only been postoperative for 2 days. Prevention measures are important, but skin breakdown is a longer-term complication and not the most immediate risk compared to aspiration or urinary retention.
• Bleeding: There are no signs of active bleeding such as hypotension, tachycardia, excessive wound drainage, or decreasing hemoglobin levels. The abdominal dressing shows only a small amount of serous drainage, which is expected postoperatively. The client is not on anticoagulants or therapies that increase bleeding risk. Therefore, bleeding is not the highest priority concern in this situation.
A nurse is caring for a client following a thyroidectomy. For which of the following complications should the nurse assess the client?
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