RN Exam Prep · Updated October 2026
ATI Comprehensive Predictor: The Complete RN Study Guide (Format, Scores, 6-Week Plan & Practice Questions)
The ATI RN Comprehensive Predictor is the exam that tells you, and your nursing program, how ready you are for the NCLEX-RN. This guide explains exactly what the test looks like, how to read your score report, what to study first, and how to turn every wrong answer into points. It finishes with 12 practice questions and full rationales so you can test yourself today.
Quick facts
- What it is
- A secure, proctored ATI assessment taken near the end of an RN program to estimate your chance of passing the NCLEX-RN on the first try.
- Length
- 180 questions. In versions ATI has documented, 150 are scored and 30 are unscored pretest items you can't tell apart from the rest.
- Time
- Set by ATI and your school: many programs schedule 3 hours, and some current listings describe a 4-hour session. Confirm the time with your program.
- Content
- The whole RN curriculum, organized by the NCLEX-RN client need categories.
- What you get
- An adjusted score, your predicted probability of passing the NCLEX-RN, category subscores, and a personalized list of topics to review.
What the Comprehensive Predictor is (and isn't)
The Comprehensive Predictor is ATI's capstone assessment for RN students. Most programs give it in the final semester, often as part of a capstone or NCLEX-preparation course. It samples everything you've learned, from fundamentals and pharmacology to maternity, pediatrics, mental health, leadership and adult medical-surgical nursing, and asks you to apply it the way an entry-level nurse would.
Three things make it different from your unit exams:
- It's comprehensive. A question about postpartum hemorrhage can sit next to one about a ventilator alarm and another about delegation. You can't cram one subject and hope for the best.
- It's mapped to the NCLEX-RN. Questions are distributed across the same client need categories the NCLEX uses, so your result is a preview of how your knowledge lines up with the licensure exam.
- It produces a probability, not a pass/fail. ATI converts your score into a predicted chance of passing the NCLEX-RN on your first attempt. Your school decides what score it requires.
What it isn't: a guarantee. A high predicted probability is encouraging, but it reflects how students with similar scores have done in the past. Your preparation between the Predictor and the NCLEX still matters, and a disappointing score is useful information, not a verdict.
Exam format and question types
Expect a long, focused session at a proctored computer. The exact rules come from your school, but the common pattern looks like this:
| Feature | What to expect |
|---|---|
| Number of questions | 180 total (150 scored + 30 unscored pretest items in documented versions). Treat every question as if it counts. |
| Time | Usually around 3 hours; some listings describe up to 4 hours. Check your program's schedule. |
| Question types | Mostly multiple choice, plus select-all-that-apply, ordered response, fill-in-the-blank calculations, and clinical judgment items that resemble the Next Generation NCLEX. |
| Navigation | Rules differ by setting. Practice answering each question carefully the first time rather than relying on going back. |
| Calculator | An on-screen calculator is typically available for dosage questions. |
| Breaks | Often limited or optional; the clock may keep running. Plan water, food and a restroom stop before you start. |
Because the NCLEX-RN now tests clinical judgment heavily (its six steps are recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action and evaluate outcomes), the best preparation for the Predictor is practicing decisions, not just facts.
The content blueprint
ATI builds the Comprehensive Predictor around the NCLEX-RN client need categories. ATI's published technical manual for an earlier version of the exam listed how the 150 scored questions were spread across those categories. The exact numbers can change between versions, but the proportions show you where the points are:
| Client need category | Scored items (of 150) | Share |
|---|---|---|
| Management of Care | 30 | 20% |
| Safety and Infection Control | 18 | 12% |
| Health Promotion and Maintenance | 14 | 9% |
| Psychosocial Integrity | 13 | 9% |
| Basic Care and Comfort | 13 | 9% |
| Pharmacological and Parenteral Therapies | 23 | 15% |
| Reduction of Risk Potential | 18 | 12% |
| Physiological Adaptation | 21 | 14% |
Source: ATI's RN Comprehensive Predictor technical manual (2016 edition). Use it as a guide to proportions, not an exact count for your version.
Management of care (prioritization, delegation, legal and ethical practice, advocacy) plus pharmacology make up about a third of the scored questions. If your schedule is tight, these two areas deserve the biggest share of your hours, followed by physiological adaptation (acute illness and emergencies) and safety and infection control.
How to read your score report
Your individual report contains more than one number. Each part answers a different question:
Adjusted individual total score
Your performance, equated so that different versions of the test are comparable. Read it roughly as "percent of questions answered correctly."
Predicted probability of passing
The chance of passing the NCLEX-RN on the first attempt for students with your score, taken from ATI's expectancy table for your test version.
Mean and percentile rank
How you compare with students nationally and in similar programs. A percentile of 70 means you scored at or above 70% of test takers.
Category subscores
Percent correct for each client need category. This is the most useful part for planning: your lowest two or three categories are your study priorities.
Topics to Review
A list built from the questions you missed, each linked to the matching chapter in ATI's review modules.
Focused Review
ATI's personalized remediation that walks you through the content behind each missed question. Many schools require it after the exam.
What score do you need?
There's no single passing score. Two different numbers matter:
- Your school's benchmark. Programs set their own requirements, often tied to a target predicted probability (for example, 90% or higher). Your syllabus or student handbook will say what you need, how many attempts you get, and what remediation is required between attempts.
- ATI's expectancy table. Each version of the Predictor has its own table converting scores to pass probabilities. In ATI's technical manual for an earlier version, for example, an adjusted score of 69.3% corresponded to a 90% predicted probability of passing. Newer versions publish their own cut points, so read the probability printed on your report rather than relying on numbers shared online.
A predicted probability describes groups of students, not you personally. Students with high scores still need steady NCLEX review, and students with lower scores routinely pass the NCLEX after targeted remediation. Use the number to plan, not to panic.
The 6-week study plan
This plan assumes about 2 hours on weekdays and a longer session on weekends. Every week includes mixed questions so you keep practicing across the whole curriculum while you shore up specific areas.
| Week | Focus | Daily routine |
|---|---|---|
| 1 | Baseline and diagnosis. Take a full-length practice assessment under timed conditions. Sort every missed question by client need category and by error type. | 40 mixed questions/day + review all rationales. Start your error log. |
| 2 | Management of care and safety. Prioritization frameworks, delegation (RN vs LPN vs assistive personnel), legal and ethical issues, infection control and isolation, fall and restraint rules. | Content review 45 min + 50 questions in these categories + 25 mixed. |
| 3 | Pharmacology. Drug classes by suffix, high-alert drugs (insulin, anticoagulants, opioids, potassium), antidotes, therapeutic levels, and dosage calculation. | Content review 45 min + 50 pharm questions + 10 calculations + 25 mixed. |
| 4 | Adult medical-surgical and physiological adaptation. Cardiac and EKG basics, respiratory, renal, endocrine (DKA, thyroid), neuro, shock and sepsis. | Content review 45 min + 60 med-surg questions + 25 mixed. |
| 5 | Maternity, pediatrics, mental health and community. Labor and fetal monitoring, postpartum hemorrhage, newborn care, growth and development, pediatric emergencies, therapeutic communication, psychiatric medications. | Content review 45 min + 60 questions across these areas + 25 mixed. |
| 6 | Integration and stamina. Second full-length timed practice test early in the week, then return to the weakest categories it reveals. Taper the day before. | 75–100 mixed questions/day in timed blocks + error-log review. Light review only the day before. |
Short on time? With two weeks, spend the first three days on a baseline test and your two weakest categories, then alternate mixed question blocks (75+ a day) with targeted review of your error log. Don't skip the rationales to do more questions: reviewing why you missed something is where the improvement happens.
High-yield topic checklist
Use this as a self-check. If you can't explain a topic to a classmate in two minutes, add it to your review list.
Management of care and safety
- Prioritization: airway, breathing, circulation; Maslow; acute and unstable before chronic and stable; unexpected findings first
- Delegation: the RN keeps assessment, teaching, evaluation and unstable clients; LPNs take stable clients with predictable outcomes; assistive personnel handle routine care
- Informed consent, advance directives, HIPAA, mandatory reporting, incident reports
- Isolation: standard, contact (including C. diff with soap and water), droplet, airborne (TB, measles, chickenpox); PPE donning and removal order
- Restraints: least restrictive first, time-limited orders, monitoring
- Fall prevention, fire response (RACE/PASS), seizure precautions
Pharmacology
- High-alert drugs: insulin types and mixing, heparin vs warfarin vs DOACs, opioids and sedation monitoring, IV potassium (never IV push)
- Antidotes: naloxone, flumazenil, acetylcysteine, protamine, vitamin K, digoxin immune fab, glucagon
- Drug levels: digoxin, lithium, phenytoin, vancomycin monitoring, INR goals
- Classic adverse effects: ACE inhibitor cough and angioedema, fluoroquinolone tendon rupture, statin muscle pain, clozapine neutropenia, serotonin syndrome vs neuroleptic malignant syndrome, MAOI tyramine reactions
- Dosage calculation: weight-based doses, IV pump rates, drip rates, unit conversions
Physiological adaptation and risk reduction
- Lethal rhythms, ACLS basics, heart failure teaching, acute coronary syndrome care
- ABG interpretation, oxygen delivery, COPD and asthma, chest tubes, ventilator alarms
- Shock types and the sepsis bundle; DKA vs HHS; adrenal crisis; SIADH vs diabetes insipidus
- Increased intracranial pressure, stroke, spinal cord injury and autonomic dysreflexia
- Lab values and critical results; post-operative complications and their timing
Maternal-newborn and pediatrics
- Preeclampsia and magnesium sulfate toxicity; fetal heart rate patterns and interventions
- Postpartum hemorrhage: fundal massage, uterotonics and their contraindications
- Newborn assessment, APGAR, jaundice, hypoglycemia; Rh immune globulin
- Growth and development milestones, immunization principles, pediatric respiratory emergencies (epiglottitis, croup), dehydration
Mental health and community
- Therapeutic vs non-therapeutic communication
- Suicide risk assessment and safety planning; mania, psychosis, anxiety levels
- Alcohol and opioid withdrawal; eating disorders and refeeding syndrome
- Abuse recognition and reporting; crisis intervention; disaster triage
The wrong-answer method that raises scores
Doing thousands of questions doesn't help much if you repeat the same mistakes. What moves scores is figuring out why you missed each question. Keep a simple error log and tag every miss, and every lucky guess, with one of these five reasons:
| Error type | What it looks like | The fix |
|---|---|---|
| Knowledge gap | You didn't know the fact (e.g., the antidote for heparin). | Review the topic, then write one line in your own words. |
| Priority error | You picked something correct but not first. | Re-run the question through ABCs, safety and acute-vs-chronic. |
| Misread | You missed "further teaching," "first," or a key lab value. | Slow down: restate the question in your head before reading options. |
| Assessment vs action | You assessed when the situation called for action, or acted without enough data. | Ask: "Do I already have enough information to act safely?" |
| Changed answer | Your first choice was right and you talked yourself out of it. | Only change an answer when you find a specific reason in the stem. |
After a week, count your tags. If most of your misses are priority errors, more content review won't fix them, but practicing prioritization will. If most are knowledge gaps in one category, you know exactly what to study.
For each missed question, write one sentence you could say to a classmate: "Late decelerations mean the placenta isn't delivering enough oxygen, so stop oxytocin first." A notebook of these sentences becomes your personal, final-week review sheet.
12 practice questions with rationales
These original questions are written in the style of the Comprehensive Predictor and the NCLEX-RN. Answer each one before opening the rationale.
1. After shift report, which client should the nurse see first?
- A client with COPD whose SpO₂ is 89% (baseline 88–90%)
- A post-operative client who is newly restless, with HR 118 and BP 92/58
- A client asking for pain medication for pain rated 6/10
- A client with diabetes whose glucose is 210 mg/dL before lunch
Show answer
B. New restlessness with a rising heart rate and falling blood pressure suggests bleeding or shock: an unstable, unexpected change. The COPD client is at baseline; pain and a moderately high glucose need attention but aren't life-threatening.
2. Which task can the RN delegate to assistive personnel?
- Assessing a newly admitted client
- Teaching a client to self-inject insulin
- Taking vital signs on a stable client on post-op day 2
- Giving an IV push medication
Show answer
C. Routine tasks for stable clients can be delegated. Assessment, teaching and IV medications require RN judgment.
3. After caring for a client with Clostridioides difficile, how should the nurse clean their hands?
- Alcohol-based hand rub for 20 seconds
- Soap and water
- Alcohol rub, then new gloves
- Chlorhexidine wipes
Show answer
B. Alcohol doesn't kill C. diff spores; washing with soap and water physically removes them.
4. Which order should the nurse question?
- Potassium chloride 10 mEq in 100 mL IV over 1 hour by infusion pump
- Potassium chloride 40 mEq IV push
- Potassium chloride 20 mEq orally with food
- Serum potassium level in the morning
Show answer
B. IV potassium is never given by IV push; it can cause fatal dysrhythmias. It must be diluted and infused on a pump.
5. Which finding in a client taking digoxin needs the nurse's immediate follow-up?
- Apical pulse 68/min
- Serum potassium 3.1 mEq/L
- Digoxin level 0.8 ng/mL
- BNP lower than yesterday
Show answer
B. Low potassium increases the risk of digoxin toxicity. The pulse and drug level are acceptable, and a falling BNP means heart failure is improving.
6. A client receiving IV magnesium sulfate for preeclampsia has absent patellar reflexes and a respiratory rate of 10/min. What should the nurse do first?
- Increase the infusion rate
- Stop the infusion
- Recheck reflexes in 1 hour
- Give oxygen and continue the infusion
Show answer
B. Lost reflexes and a respiratory rate below 12 signal magnesium toxicity. Stop the infusion, notify the provider, and prepare calcium gluconate, the antidote.
7. A 4-year-old has a sudden high fever, is drooling, sits leaning forward, and has a muffled voice. Which action should the nurse avoid?
- Keeping the child on the parent's lap
- Inspecting the throat with a tongue blade
- Keeping emergency airway equipment at the bedside
- Keeping the child calm
Show answer
B. These are signs of epiglottitis. Examining the throat can trigger complete airway obstruction.
8. A client with depression says, "Nobody would even notice if I was gone." What is the nurse's best response?
- "Of course people would notice. You have a lovely family."
- "Are you thinking about killing yourself?"
- "Why would you say something like that?"
- "Let's talk about something more cheerful."
Show answer
B. Asking directly about suicide is how risk is assessed, and it doesn't put the idea in someone's head. The other options offer false reassurance, ask "why", or change the subject.
9. A client with a T4 spinal cord injury suddenly has a pounding headache, BP 210/110 and flushing above the injury. What is the nurse's first action?
- Lay the client flat
- Sit the client upright
- Give acetaminophen
- Apply a cold compress
Show answer
B. This is autonomic dysreflexia. Sitting up lowers blood pressure; then loosen clothing and look for the trigger, most often a full bladder.
10. A client with a COPD exacerbation has SpO₂ 84% on room air. Which action is best?
- Withhold oxygen to protect the hypoxic drive
- Apply a Venturi mask and titrate to SpO₂ 88–92%
- Apply a non-rebreather at 15 L/min to reach 100%
- Wait for the ABG before giving oxygen
Show answer
B. Never withhold oxygen from a hypoxic client. For clients who retain carbon dioxide, give controlled oxygen to a target of 88–92% and watch for drowsiness.
11. The nurse teaches a client with heart failure. Which statements show understanding? Select all that apply.
- "I'll weigh myself every morning after I urinate and before breakfast."
- "I'll call if I gain 3 pounds in one day."
- "I can use salt substitutes freely because I take spironolactone."
- "Ibuprofen is fine for my knee pain."
- "I'll report needing more pillows to breathe at night."
Show answer
A, B, E. Daily weights, reporting a gain of 2–3 lb in a day (or 5 lb in a week) and new breathlessness when lying down are correct. Salt substitutes contain potassium, which is dangerous with spironolactone, and NSAIDs cause fluid retention.
12. A heparin infusion of 25,000 units in 500 mL is running. The order is 1,200 units/hour. At what rate (mL/h) should the pump be set?
Show answer
24 mL/h. Concentration = 25,000 ÷ 500 = 50 units/mL. Rate = 1,200 ÷ 50 = 24 mL/h.
How did you do? Tag each miss in your error log. If you missed questions 1, 2 or 9, spend extra time on prioritization; if you missed 4, 5 or 12, start with pharmacology and calculations.
Test-day strategy
Before you start
Sleep, eat a real breakfast, and arrive early with the ID and login details your school requires. Use the restroom right before the session.
Pace yourself
About 1 minute per question leaves time for harder items. If a question is taking much longer, make your best choice and move on.
Read like a nurse
Identify the client, the problem and what's being asked: first, best, priority, or "needs further teaching" (which means find the wrong statement).
Use frameworks
ABCs, Maslow, safety, and acute over chronic settle most priority questions. Assess before acting unless the stem already tells you what's happening.
Select-all-that-apply
Judge each option on its own as true or false for this client. Don't look for a pattern in how many to pick.
Protect your focus
Expect a few questions on topics you barely remember. They may be unscored pretest items. Don't let one hard question shake the next ten.
If your score is lower than you hoped
A lower score is common and fixable. Most programs build in a remediation step and a retake window. Make the most of it:
- Start your Focused Review promptly. Work through every topic linked to a missed question, not just the ones that look familiar.
- Rank your subscores. Pick the two or three lowest client need categories as your main targets.
- Complete your school's remediation tasks thoroughly, such as active learning templates or a required number of review hours. Treat them as study, not paperwork.
- Use your error log. If most misses were priority or misreading errors, practice questions with careful rationale review will help more than re-reading notes.
- Retake under real conditions. Do at least one full timed practice test before the retake to rebuild stamina.
Mistakes to avoid
- Starting in the final week. Content this broad needs several weeks of spaced review.
- Studying only your favorite subjects. The blueprint rewards balance, and weak areas show up on the report.
- Skipping rationales to do more questions. The rationale is where you learn.
- Memorizing "answer banks". Exam items change, and recalled questions shared online are often wrong. Sharing or using exam content also breaks ATI's terms and most schools' honor codes. Learn the concepts instead.
- Studying only passively. Reading and highlighting feel productive; answering questions and explaining your reasoning actually build skill.
- Ignoring stamina. Practice at least two long, timed sessions before test day.
Frequently asked questions
How many questions are on the ATI Comprehensive Predictor?
The RN Comprehensive Predictor has 180 questions. In the versions ATI has documented, 150 are scored and 30 are unscored pretest items that look identical to the others.
How long is the exam?
Timing is set by ATI and your school. Many programs schedule 3 hours, and some current descriptions list up to 4 hours. Check your program's testing instructions.
What is a good score on the Comprehensive Predictor?
A good score is one that meets your school's benchmark, which is usually expressed as a minimum predicted probability of passing the NCLEX-RN (often 90% or higher). The exact cut points depend on your test version, so use the probability printed on your report.
Does a high predicted probability guarantee I'll pass the NCLEX?
No. It reflects how students with similar scores have done in the past. Keep reviewing steadily between the Predictor and your NCLEX date.
Is the Comprehensive Predictor harder than the NCLEX?
They're different experiences. The Predictor is a fixed-length test of 180 questions, while the NCLEX-RN is computerized adaptive: it adjusts difficulty to your answers and ends anywhere between 85 and 150 questions. Many students find the Predictor's length the hardest part.
Can I retake the Comprehensive Predictor?
Most programs allow at least one retake after required remediation, often a few weeks later. The number of attempts and the waiting period are set by your school.
What's the best way to study in the last week?
Do mixed, timed question blocks, review your error log and personal rationale notes, and sleep well. Avoid learning large new topics in the final two days.
Are "leaked" ATI test banks worth using?
No. They're often inaccurate, they don't teach the reasoning the exam measures, and using or sharing exam content can violate ATI's terms and your school's academic integrity policy. Practice questions with rationales prepare you far better.
Sources
- Assessment Technologies Institute. Technical Manual for the RN Comprehensive Predictor (2016 edition): item counts, content blueprint and score reporting. atitesting.com
- National Council of State Boards of Nursing. NCLEX-RN test plan and Next Generation NCLEX information. ncsbn.org
- California State University, East Bay Testing Office. RN Comprehensive Predictor Assessment information. csueastbay.edu
ATI and the Comprehensive Predictor are trademarks of Assessment Technologies Institute, LLC. NursingPlex is not affiliated with or endorsed by ATI or NCSBN. Exam details can change; always follow your school's and ATI's current instructions.