ATI RN Concept-Based Assessment Level 3 Actual Exam
2026 |100 NCLEX-Style Questions with Answers in Bold &
Detailed Rationales | PDF
1. A nurse is caring for four patients. Which patient should the nurse assess first?
A. Postoperative patient with pain rated 6/10
B. Client with heart failure reporting weight gain
C. Client with COPD who is restless and has a new onset of confusion
D. Client awaiting discharge teaching
Answer: C
Explanation: New confusion in a COPD patient suggests hypoxia and requires immediate
assessment using ABC priorities.
2. Which finding best indicates effective treatment for a patient in diabetic
ketoacidosis (DKA)?
A. Decreased urine output
B. Serum glucose below 250 mg/dL
C. Increased ketones in urine
D. Respiratory rate of 30/min
Answer: B
Explanation: Resolution of DKA is marked by lowering glucose below 250 mg/dL with
correction of acidosis and ketones.
3. A nurse is delegating tasks to a UAP. Which task is appropriate?
A. Assessing pain after medication
B. Teaching incentive spirometer use
, C. Obtaining vital signs on a stable patient
D. Evaluating oxygen saturation trends
Answer: C
Explanation: UAPs may perform routine, non-assessment tasks on stable patients.
4. A patient receiving heparin therapy has a platelet count of 90,000/mm³. What is the
priority action?
A. Administer vitamin K
B. Continue medication
C. Notify the provider immediately
D. Recheck labs in 24 hours
Answer: C
Explanation: Thrombocytopenia suggests possible HIT, requiring immediate
discontinuation and provider notification.
5. A patient develops stridor and facial swelling after IV antibiotic administration. What
should the nurse do first?
A. Stop the infusion
B. Administer antihistamine
C. Maintain airway and call rapid response
D. Document the reaction
Answer: C
Explanation: Stridor and facial swelling indicate anaphylaxis—airway management is the
priority.
6. Which assessment finding indicates increased intracranial pressure?
A. Bradycardia
B. Widening pulse pressure
C. Tachypnea
D. Hypotension
, Answer: B
Explanation: Widened pulse pressure is part of Cushing’s triad associated with increased
ICP.
7. A nurse is caring for a patient with sepsis. Which order should be implemented first?
A. Administer antipyretic
B. Draw blood cultures
C. Initiate IV fluid bolus
D. Insert urinary catheter
Answer: C
Explanation: Early aggressive fluid resuscitation is critical to prevent septic shock.
8. Which client is at highest risk for aspiration?
A. Client with hypertension
B. Client with decreased level of consciousness
C. Client with diarrhea
D. Client with urinary retention
Answer: B
Explanation: Decreased LOC compromises airway protection and increases aspiration risk.
9. Which medication requires monitoring for ototoxicity?
A. Acetaminophen
B. Ceftriaxone
C. Furosemide
D. Metoprolol
Answer: C
Explanation: Loop diuretics can cause ototoxicity, especially at high doses.
10. A patient with chest pain has ST elevation on ECG. What is the nurse’s priority?
A. Obtain consent
2026 |100 NCLEX-Style Questions with Answers in Bold &
Detailed Rationales | PDF
1. A nurse is caring for four patients. Which patient should the nurse assess first?
A. Postoperative patient with pain rated 6/10
B. Client with heart failure reporting weight gain
C. Client with COPD who is restless and has a new onset of confusion
D. Client awaiting discharge teaching
Answer: C
Explanation: New confusion in a COPD patient suggests hypoxia and requires immediate
assessment using ABC priorities.
2. Which finding best indicates effective treatment for a patient in diabetic
ketoacidosis (DKA)?
A. Decreased urine output
B. Serum glucose below 250 mg/dL
C. Increased ketones in urine
D. Respiratory rate of 30/min
Answer: B
Explanation: Resolution of DKA is marked by lowering glucose below 250 mg/dL with
correction of acidosis and ketones.
3. A nurse is delegating tasks to a UAP. Which task is appropriate?
A. Assessing pain after medication
B. Teaching incentive spirometer use
, C. Obtaining vital signs on a stable patient
D. Evaluating oxygen saturation trends
Answer: C
Explanation: UAPs may perform routine, non-assessment tasks on stable patients.
4. A patient receiving heparin therapy has a platelet count of 90,000/mm³. What is the
priority action?
A. Administer vitamin K
B. Continue medication
C. Notify the provider immediately
D. Recheck labs in 24 hours
Answer: C
Explanation: Thrombocytopenia suggests possible HIT, requiring immediate
discontinuation and provider notification.
5. A patient develops stridor and facial swelling after IV antibiotic administration. What
should the nurse do first?
A. Stop the infusion
B. Administer antihistamine
C. Maintain airway and call rapid response
D. Document the reaction
Answer: C
Explanation: Stridor and facial swelling indicate anaphylaxis—airway management is the
priority.
6. Which assessment finding indicates increased intracranial pressure?
A. Bradycardia
B. Widening pulse pressure
C. Tachypnea
D. Hypotension
, Answer: B
Explanation: Widened pulse pressure is part of Cushing’s triad associated with increased
ICP.
7. A nurse is caring for a patient with sepsis. Which order should be implemented first?
A. Administer antipyretic
B. Draw blood cultures
C. Initiate IV fluid bolus
D. Insert urinary catheter
Answer: C
Explanation: Early aggressive fluid resuscitation is critical to prevent septic shock.
8. Which client is at highest risk for aspiration?
A. Client with hypertension
B. Client with decreased level of consciousness
C. Client with diarrhea
D. Client with urinary retention
Answer: B
Explanation: Decreased LOC compromises airway protection and increases aspiration risk.
9. Which medication requires monitoring for ototoxicity?
A. Acetaminophen
B. Ceftriaxone
C. Furosemide
D. Metoprolol
Answer: C
Explanation: Loop diuretics can cause ototoxicity, especially at high doses.
10. A patient with chest pain has ST elevation on ECG. What is the nurse’s priority?
A. Obtain consent
