ATI Exam Help · Reviewed October 2026
ATI Comprehensive Predictor 2026: What's on It, What Your Score Means, and How to Prepare in 30 Days
Your nursing program is about to hand you a 180-question exam that ends with a single, very loud number: your predicted chance of passing the NCLEX-RN. This Nurse Moose guide takes the mystery out of that exam. You'll see how the test is built, which topics carry the most points, how to decode every line of the score report, a 30-day plan (plus a 10-day emergency version), and 15 practice questions with explanations.
The short version
- 180 questions across the full RN curriculum. In ATI's documented versions, 150 count and 30 are unscored trial items.
- Most of the points come from four areas: management of care, pharmacology, physiological adaptation, and safety/infection control.
- Your report gives an adjusted score, a predicted probability of passing the NCLEX-RN, subscores by category, and a list of topics to review.
- Your school, not ATI, decides the score you need and what happens if you fall short.
- The fastest way to improve is to work out why you miss questions, not just to do more of them.
Where the Predictor fits in nursing school
ATI testing usually follows you through an RN program in two layers. During each course you take Content Mastery Series proctored assessments (Fundamentals, Pharmacology, Adult Medical-Surgical, Maternal Newborn, Nursing Care of Children, Mental Health, Community Health, Leadership). Near graduation, those single-subject tests give way to the RN Comprehensive Predictor, which mixes all of them into one exam.
The timing is deliberate. Your program wants to know, while there's still time to help, whether you're on track for the NCLEX-RN. That's why many schools tie the Predictor to a capstone or NCLEX review course and require remediation if you score below their benchmark.
Content Mastery vs Comprehensive Predictor
| Content Mastery (proctored) | Comprehensive Predictor | |
|---|---|---|
| Scope | One subject per test | The whole RN curriculum at once |
| When | At the end of each course | Usually the final semester |
| Result | Proficiency level (below Level 1 to Level 3) | Predicted probability of passing the NCLEX-RN |
| Main purpose | Shows how well you learned that course | Shows overall readiness for licensure |
Inside the exam: length, timing, item types
Here is what a typical sitting looks like. Your school's testing instructions always take priority.
You won't know which 30 questions are unscored. They look exactly like the others, so give every question your full effort, and don't panic when one seems strangely obscure. It may be a trial item.
Item types you should be ready for:
- Standard multiple choice, still the bulk of the exam
- Multiple response ("select all that apply")
- Ordered response, such as putting steps of a procedure in sequence
- Calculation items where you type the number, with an on-screen calculator
- Hot spot and chart/exhibit items, where you interpret a picture, rhythm strip, or chart
- Clinical judgment items modeled on the Next Generation NCLEX, such as case-based questions, matrix grids, and drop-down "cloze" sentences
The NCLEX-RN measures clinical judgment through six steps: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Practicing that way of thinking prepares you for both exams at once.
Where the points are
The Predictor is organized around the eight NCLEX-RN client need categories. For an older form of the exam, ATI made public exactly how the 150 counted items were split between those categories. Versions change, but the pattern shows you where your study hours earn the most:
Source: ATI RN Comprehensive Predictor technical manual (2016). Your form may differ slightly, so use these as a guide to weighting rather than exact numbers.
Study-time rule of thumb
Split your content review roughly in proportion to these bars, then shift extra time toward whichever categories are weakest on your practice tests. Management of care and pharmacology alone account for about one in every three scored questions.
Your score report, line by line
The report is easier to use once you know what each section is for. The example below uses made-up numbers for illustration only.
You may also see results broken down by other categories, such as nursing process steps or clinical areas. Read them the same way: low areas are where to start.
What to do with your result
There's no universal pass mark. Each program sets its own benchmark, often a minimum predicted probability such as 90% or higher, and the scores that produce each probability vary from one form of the test to another. (As one published data point, the 2016 manual tied a 69.3% adjusted score to a 90% predicted probability, but current forms use their own conversion tables.) Whatever your number, here is how to respond:
| Your situation | What it usually means | Your next move |
|---|---|---|
| Comfortably above your school's benchmark | Your knowledge is broad and your test-taking holds up over a long exam. | Don't stop. Do your remediation anyway, keep doing 50–75 NCLEX-style questions a day, and book your NCLEX while the material is fresh. |
| Just at or just below the benchmark | Mostly ready, with a few categories pulling you down. | Target the two lowest subscores for two to three weeks, use your error log, and sit a complete, timed mock exam before any retake. |
| Well below the benchmark | Gaps in several areas, test-taking habits, or both. | Meet with your faculty advisor, complete every Focused Review topic, and follow the full 30-day plan before retesting. |
Remember what the number is: a statistic built from past test takers, not a forecast written about you personally. Plenty of students raise their scores sharply with focused work.
The 30-day plan
Plan on about 2–3 focused hours a day, five or six days a week. Every day ends with a block of mixed questions, so you keep switching between subjects the way the real exam does.
Days 1–3
Find your starting point
Take a full-length timed practice assessment. Score it by client need category and tag each miss by why you missed it (see question strategy). Pick your three weakest categories.
Days 4–10
Safety, priority & delegation
Management of care and safety come first because they show up in every subject. Cover ABCs, Maslow, acute vs chronic, scope of practice for RN, LPN/LVN and assistive personnel, isolation types, restraints, consent, and reporting. Daily: 40 questions in these categories + 30 mixed.
Days 11–17
Pharmacology & physiological adaptation
High-alert medications, antidotes, drug levels, and calculations, paired with emergencies: shock, sepsis, DKA, dysrhythmias, respiratory failure, increased ICP. Daily: 40 questions + 10 calculations + 30 mixed.
Days 18–24
Specialty areas
Maternal-newborn, pediatrics, mental health, and health promotion. Concentrate on the warning signs in each population, such as preeclampsia, postpartum hemorrhage, pediatric airway emergencies, suicide risk, and withdrawal. Daily: 40 questions + 30 mixed.
Days 25–30
Put it together
Second full-length timed practice test on day 25. Spend days 26–28 on whatever it shows is weak, day 29 on your error log and rationale notes, and day 30 resting.
The 10-day emergency plan
If your test date is close, focus on the highest-yield work and drop everything else:
- Day 1: Timed 75–100 question mixed practice set. Rank your categories from weakest to strongest.
- Days 2–3: Prioritization, delegation, and safety (they're worth the most points).
- Days 4–5: High-alert medications, antidotes, lab values, and calculations.
- Days 6–7: Your two weakest categories from day 1.
- Day 8: A second long timed set to build stamina, then review every rationale.
- Day 9: Error log and "must-know" table below. Only light, mixed questions.
- Day 10: Rest, prepare your login and ID, and go to bed on time.
Must-know facts by system
These facts come up again and again on ATI and NCLEX-style exams. If any line surprises you, that topic goes on your list.
| Area | Must-know fact |
|---|---|
| Endocrine | Hypoglycemia: give 15 g of fast-acting carbohydrate if the client can swallow, recheck glucose in 15 minutes, and repeat if still low. If the client can't swallow safely, give IV dextrose or glucagon. |
| Endocrine | DKA: check potassium before starting insulin, because insulin moves potassium into the cells and can cause dangerous hypokalemia. |
| Cardiac | Hyperkalemia causes peaked T waves. IV calcium gluconate protects the heart first; insulin with glucose shifts potassium into the cells. |
| Respiratory | Chest tube: gentle tidaling in the water seal is expected. Constant bubbling in the water seal suggests an air leak. If the tube comes out of the chest, cover the site with a sterile dressing taped on three sides. |
| Neuro | Cushing's triad (rising systolic BP with a widening pulse pressure, bradycardia, irregular breathing) is a late sign of increased intracranial pressure. Raise the head of the bed to about 30° and keep the head midline. |
| Hematology | Suspected transfusion reaction: stop the transfusion, keep the IV access open with normal saline through new tubing, stay with the client, and notify the provider and blood bank. |
| Pharmacology | Warfarin is monitored by INR (a common target is 2–3) and reversed with vitamin K. Heparin is reversed with protamine sulfate. |
| Pharmacology | Lithium has a narrow therapeutic range (about 0.6–1.2 mEq/L). Dehydration and low sodium raise lithium levels, so clients need steady fluid and salt intake. |
| Maternal | A boggy uterus after birth: massage the fundus first. Methylergonovine is avoided in clients with hypertension. |
| Pediatrics | During a "tet spell" (hypercyanotic episode), place the child in a knee-chest position to improve blood flow to the lungs. |
| Mental health | Alcohol withdrawal can start within 6–24 hours of the last drink; delirium tremens typically appears around 48–72 hours. Give thiamine and monitor with a withdrawal scale. |
| Infection control | Tuberculosis needs airborne precautions: a negative-pressure room and a fit-tested N95 respirator (or higher). |
| Safety | Restraints: use the least restrictive option, tie them to the bed frame (never the side rail) with a quick-release knot, and monitor the client often. |
How to attack each question type
"Which client first?"
Look for the client who is unstable or whose condition has changed unexpectedly. Airway beats breathing, breathing beats circulation, and an expected finding for a diagnosis is rarely the answer.
Delegation
Ask what the task needs. Anything needing RN judgment, such as initial assessment, client teaching, evaluating outcomes, or caring for someone unstable, stays with the RN. Stable, predictable care can go to the LPN/LVN, and routine tasks to assistive personnel.
Select all that apply
Treat each option as a true/false question for this client. Don't guess based on how many options you've already picked.
"Needs further teaching"
You're looking for the incorrect statement. Say "this is wrong" in your head before you choose.
Case studies
Read the whole scenario first. Note what's abnormal (recognize cues), what's causing it (analyze), what's most dangerous (prioritize), and then what you'd do and how you'd know it worked.
Calculations
Write the units at every step, convert first (lb → kg, g → mg), and ask whether the answer makes sense. A 10 kg child doesn't get 50 mL of an IV push.
Tag every miss
Label each wrong answer as one of these: didn't know it, wrong priority, misread the question, assessed when I should have acted (or acted too soon), or changed a correct answer. After 100 questions, the most common tag tells you what to fix. If it's a knowledge gap, read. If it's anything else, practice questions slowly and study the rationales.
15 practice questions
Each question below was written for Nurse Moose to mirror the way ATI and NCLEX items are phrased. Pick your answer before you tap to reveal it.
1. Four clients have just been assigned to the nurse. Who should the nurse assess first?
- A client 6 hours after thyroidectomy who reports a "tight" feeling in the throat and has a hoarse voice
- A client with type 2 diabetes whose morning glucose is 168 mg/dL
- A client with a hip fracture rating pain 7/10, due for medication in 30 minutes
- A client with pneumonia who has a temperature of 38.3 °C (101 °F)
Reveal answer
A. Throat tightness and a changing voice after thyroidectomy can signal swelling or bleeding that threatens the airway. Airway comes first; the other findings need attention but aren't immediately life-threatening.
2. A client is shaky, sweaty, and alert, with a capillary glucose of 58 mg/dL. Which action comes first?
- Give 4 oz (120 mL) of fruit juice
- Give glucagon IM
- Recheck the glucose in 15 minutes
- Notify the provider
Reveal answer
A. An alert client who can swallow should get about 15 g of fast-acting carbohydrate, such as 4 oz of juice, then a glucose recheck in 15 minutes. Glucagon is for clients who can't swallow safely.
3. A client in DKA has a potassium level of 3.0 mEq/L. The insulin infusion has not started yet. What should the nurse anticipate?
- Starting the insulin infusion immediately at the ordered rate
- Replacing potassium before starting insulin
- Giving sodium bicarbonate
- Restricting IV fluids
Reveal answer
B. Insulin drives potassium into cells. Starting it while potassium is already low can cause life-threatening dysrhythmias, so potassium is replaced first.
4. Ten minutes into a unit of packed red blood cells, a client develops chills, back pain, and a temperature rise of 1.5 °C. Which action comes first?
- Slow the transfusion and recheck vital signs in 15 minutes
- Stop the transfusion
- Give acetaminophen as ordered
- Call the blood bank
Reveal answer
B. These are signs of a transfusion reaction. Stop the blood immediately, keep the line open with normal saline using new tubing, then notify the provider and blood bank.
5. The nurse finds continuous bubbling in the water-seal chamber of a client's chest drainage system. What does this indicate?
- The system is working as expected
- A possible air leak
- The lung has fully re-expanded
- The suction is set too low
Reveal answer
B. Gentle rise and fall (tidaling) is expected in the water seal; constant bubbling suggests an air leak in the system or at the insertion site. Bubbling in the suction-control chamber of a wet system is a different, expected finding.
6. A client's ECG shows tall, peaked T waves and the potassium level is 6.8 mEq/L. Which medication does the nurse expect to give first to protect the heart?
- Calcium gluconate IV
- Sodium polystyrene sulfonate orally
- Furosemide IV
- Potassium chloride IV
Reveal answer
A. IV calcium stabilizes the heart muscle within minutes but doesn't lower the potassium level. Drugs that shift or remove potassium follow.
7. A client with a head injury has BP 178/62 (previously 132/80), HR 52, and irregular respirations. How should the nurse interpret these findings?
- Expected response to pain
- Signs of rising intracranial pressure
- Hypovolemic shock
- A side effect of the IV fluids
Reveal answer
B. Rising systolic pressure with a widening pulse pressure, a slowing heart rate, and irregular breathing (Cushing's triad) is a late sign of increased ICP. Notify the provider immediately.
8. A client taking warfarin has an INR of 6.2 and new bruising on the arms. Which medication should the nurse have available?
- Protamine sulfate
- Vitamin K (phytonadione)
- Naloxone
- Aminocaproic acid
Reveal answer
B. Vitamin K reverses warfarin. Protamine reverses heparin, and naloxone reverses opioids.
9. A client taking lithium reports vomiting and diarrhea for two days, a coarse hand tremor, and unsteady walking. What is the priority action?
- Tell the client to take the next dose with food
- Hold the lithium and obtain a serum lithium level
- Encourage a low-sodium diet
- Reassure the client that a tremor is a common side effect
Reveal answer
B. Fluid loss raises lithium levels. A coarse tremor and unsteady gait suggest toxicity, so hold the drug and check a level. A fine tremor is common; a coarse one is a warning sign.
10. One hour after a vaginal birth, the fundus is boggy, two fingerbreadths above the umbilicus, and the client has heavy lochia. Which action comes first?
- Massage the fundus
- Insert a urinary catheter
- Increase the IV fluid rate
- Give methylergonovine
Reveal answer
A. Fundal massage is the first action for uterine atony. Then help the client empty the bladder if it's full, and give uterotonics as ordered. Methylergonovine is avoided if the client has hypertension.
11. A toddler with tetralogy of Fallot suddenly becomes deeply cyanotic and irritable while crying. Where should the nurse position the child?
- Flat on the back
- In a knee-chest position
- In Trendelenburg
- Prone with the head turned
Reveal answer
B. The knee-chest position increases systemic vascular resistance, which sends more blood through the lungs. Older children often squat for the same reason.
12. A client admitted 30 hours ago after a fall has tremors, sweating, a heart rate of 112, and is anxious. The client's history includes daily heavy drinking. Which order should the nurse expect to give priority?
- A benzodiazepine per the withdrawal protocol
- An antipsychotic as needed for agitation
- A high-carbohydrate snack
- A referral to a support group
Reveal answer
A. These are signs of alcohol withdrawal. Benzodiazepines, dosed with a withdrawal scale, prevent progression to seizures and delirium tremens. Thiamine is also given. A referral matters later, not now.
13. Which actions are correct when caring for a client with suspected pulmonary tuberculosis? Select all that apply.
- Place the client in a negative-pressure room
- Wear a fit-tested N95 respirator when entering
- Wear a surgical mask when entering
- Have the client wear a surgical mask during transport
- Keep the door open for observation
Reveal answer
A, B, D. TB spreads through the air, so it requires an airborne infection isolation room and an N95 or higher respirator for staff. The client wears a surgical mask outside the room. The door must stay closed.
14. A child who weighs 22 lb is prescribed ceftriaxone 50 mg/kg IV once daily. The vial is reconstituted to 100 mg/mL. How many mL should the nurse give?
Reveal answer
5 mL. 22 lb ÷ 2.2 = 10 kg. 10 kg × 50 mg/kg = 500 mg. 500 mg ÷ 100 mg/mL = 5 mL.
15. A client is prescribed 1,000 mL of IV fluid over 8 hours using tubing with a drop factor of 15 gtt/mL. At how many drops per minute should the nurse set the infusion? (Round to the nearest whole number.)
Reveal answer
31 gtt/min. 1,000 mL ÷ 480 min = 2.083 mL/min. 2.083 × 15 = 31.25, which rounds to 31 gtt/min.
Score yourself. Missed 1, 4, 7 or 10? Practice prioritization. Missed 3, 6, 8 or 9? Focus on pharmacology. Missed 14 or 15? Do 10 calculation problems a day until they're automatic.
Remediation and retakes
If your score falls below your program's benchmark, you'll usually complete required remediation before a retake. Most programs give a retake window, and the details (how many attempts, how long you wait, what counts as remediation) are in your syllabus.
- Start your Focused Review early. ATI builds it from the questions you missed, so it's the most personal study material you'll get.
- Fill in active learning templates in your own words. Copying the textbook doesn't build recall; summarizing does.
- Use your subscores. Spend most of your remediation time in your two or three lowest categories.
- Retest your stamina. Sit a full-length mock exam in one go, on the clock, before you retest.
- Avoid "recalled question" banks. Recalled items are often wrong, don't teach reasoning, and passing around real test items can violate ATI's rules and get you in trouble with your program's honor code.
FAQ
How many questions does the ATI Comprehensive Predictor have?
You'll answer 180 items. According to ATI's published documentation, 150 of them count toward your score, while the other 30 are trial questions that don't, and you can't tell which ones those are.
How much time do you get?
A 3-hour window is common, though some programs give extra time. Your school's testing instructions give your exact time limit.
What score do you need to pass the ATI Comprehensive Predictor?
There's no universal passing score. Each nursing program sets its own benchmark, commonly stated as a target NCLEX-RN pass probability, with 90% a popular cutoff. The percent-correct score that earns that probability for that probability depends on your test version.
How accurate is the predicted probability?
It's based on how earlier students with similar scores did on the NCLEX-RN, so it's a useful estimate for groups of students, not a guarantee for any one person. Your preparation after the Predictor still makes a difference.
What's the difference between the Comprehensive Predictor and Content Mastery exams?
Content Mastery Series exams test one subject at the end of a course and report a proficiency level. The Comprehensive Predictor covers the whole curriculum near graduation and reports a predicted probability of passing the NCLEX-RN.
Is the Comprehensive Predictor like the NCLEX?
The content and categories line up closely, but the format differs. The Predictor is a fixed 180-question test. The NCLEX-RN uses computerized adaptive testing, stopping anywhere from 85 to 150 questions, with a 5-hour time limit.
How long should I study for the Comprehensive Predictor?
About 4 to 6 weeks of steady daily study works well for most students. If you only have about 10 days, focus on prioritization, safety, pharmacology, and your weakest categories.
Can I retake the Predictor if I don't meet the benchmark?
Usually, yes. Schools typically permit a second attempt once you finish their remediation requirements. Your program decides how many tries you get and how long you wait between them.
Which subjects does the Comprehensive Predictor cover?
Everything in the RN curriculum: fundamentals, pharmacology, adult medical-surgical, maternal-newborn, pediatrics, mental health, community health, and leadership. Questions are grouped by the eight NCLEX-RN client need categories.
Does the Comprehensive Predictor have NGN-style questions?
Expect clinical judgment items modeled on the Next Generation NCLEX, such as case-based sets and newer item formats, alongside traditional multiple-choice and select-all-that-apply questions. Check ATI's practice resources from your school to see the formats in your version.
References
- Assessment Technologies Institute. Technical Manual for the RN Comprehensive Predictor (2016). atitesting.com
- National Council of State Boards of Nursing. NCLEX-RN test plan and NCLEX candidate information. nclex.com
- Centers for Disease Control and Prevention. Infection control guidance for tuberculosis in health care settings. cdc.gov
ATI, Comprehensive Predictor, and Content Mastery Series are trademarks of Assessment Technologies Institute, LLC. NCLEX is a registered trademark of NCSBN. Nurse Moose is an independent study site with no connection to, or endorsement from, ATI or NCSBN. This guide is a study aid. Follow your program's and ATI's current instructions, and confirm clinical details with current references.