ATI RN Concept-Based Assessment Level 2 Proctored Exam
2026 – 200 Verified Questions & Answers with Detailed
Rationales | Proctored Exam Preparation
Table of Contents
Domain Questions
1. Advanced Clinical Judgment & Priority Setting 1–40
2. Pharmacology 41–80
3. Physiological Adaptation 81–120
4. Psychosocial Integrity 121–150
5. Safety & Infection Control 151–175
6. Health Promotion & Maintenance 176–200
Domain 1: Advanced Clinical Judgment & Priority Setting (1–40)
1. A patient with a STEMI receives tPA and suddenly develops a severe
headache and vomiting. BP 200/110 mmHg. What is the nurse's immediate
action?
A. Administer antiemetic
B. Notify provider and prepare for emergency CT scan
C. Lower head of bed
D. Give acetaminophen
Answer: B – Severe headache, vomiting, hypertension after thrombolytics suggest
intracranial hemorrhage. Stop tPA, notify provider, prepare for CT scan.
2. A nurse receives report on four patients. Which patient should be assessed
first?
A. Post-op day 2, incisional pain 5/10
B. Diabetes with blood glucose 180 mg/dL
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,C. COPD with SpO2 88% on 2 L/min oxygen
D. Heart failure with 1+ pitting edema
Answer: C – SpO2 <90% indicates hypoxemia, which is life-threatening (ABC
priority).
3. A patient is admitted with chest pain. Which laboratory result requires the
most immediate action?
A. Troponin I 0.04 ng/mL
B. Potassium 5.9 mEq/L
C. Hemoglobin 11.2 g/dL
D. WBC 12,000/mm³
Answer: B – Severe hyperkalemia (K >5.5) can cause cardiac arrest.
4. A patient with a tracheostomy develops respiratory distress. The inner
cannula is obstructed. Priority action?
A. Suction through tracheostomy
B. Remove and replace inner cannula
C. Call rapid response
D. Bag-valve mask over tracheostomy
Answer: B – Removing the obstructed inner cannula immediately restores airway
patency.
5. A patient with an NG tube to low intermittent suction reports nausea and
abdominal distension. First action?
A. Irrigate NG tube with 30 mL water
B. Check tube placement and suction function
C. Reposition patient on left side
D. Notify provider for antiemetic
Answer: B – Verify tube placement and suction first; malfunction or malposition is
likely.
6. A patient with a seizure disorder is found unresponsive with tonic-clonic
activity. Immediate action?
A. Restrain limbs
B. Place padded tongue blade in mouth
C. Turn patient to side and protect head
D. Administer IV lorazepam
2|Page
,Answer: C – Prevent aspiration and injury during seizure. Lorazepam if seizure >5
minutes.
7. A patient receiving a blood transfusion reports chills and low back pain 15
minutes after initiation. First action?
A. Stop the transfusion
B. Slow the infusion rate
C. Administer acetaminophen
D. Obtain a urine sample
Answer: A – Stop transfusion immediately; suspect acute hemolytic reaction.
8. A patient with a head injury has ICP 22 mm Hg. Which finding should be
reported immediately?
A. PaCO2 35 mm Hg
B. Systolic BP 110 mm Hg
C. Pupil asymmetry and sluggish response
D. Temperature 37.5°C
Answer: C – Pupil asymmetry indicates brain herniation, a neurological
emergency.
9. A patient’s chest tube drainage system is disconnected from the patient. First
action?
A. Clamp the chest tube near insertion site
B. Place end of chest tube in sterile water
C. Apply occlusive dressing over insertion site
D. Reconnect to drainage system
Answer: B – Submerging the tube in sterile water creates a water seal and
prevents air entry.
10. A patient with DKA is receiving IV insulin. Serum potassium is 4.8 mEq/L.
Most appropriate action?
A. Continue insulin infusion as ordered
B. Hold insulin and notify provider
C. Administer potassium chloride IV push
D. Change to subcutaneous insulin
Answer: A – Potassium 4.8 is normal; insulin should continue; potassium
replacement will be added if level drops.
3|Page
, 11. A patient with acute pancreatitis reports severe epigastric pain radiating to
the back. Which position is best for pain relief?
A. Supine with legs flat
B. Prone
C. Side-lying with knees flexed (fetal)
D. High-Fowler’s with legs dangling
Answer: C – Fetal position reduces tension on the pancreas.
12. A patient with a recent stroke has difficulty swallowing. The nurse
auscultates wet breath sounds after a sip of water. First action?
A. Suction the oropharynx
B. Place patient NPO and notify speech therapy
C. Elevate HOB to 90 degrees
D. Offer thickened liquids
Answer: B – Wet breath sounds indicate aspiration; patient should be NPO and
undergo swallow evaluation.
13. A patient with a spinal cord injury at T6 develops sudden hypertension,
bradycardia, and pounding headache. First action?
A. Administer hydralazine IV
B. Place patient in sitting position
C. Check for distended bladder or fecal impaction
D. Notify provider
Answer: C – Autonomic dysreflexia; remove noxious stimulus (e.g., empty
bladder) first.
14. A patient with a pulmonary embolism on heparin drip has aPTT 110 seconds
(control 30). First action?
A. Continue infusion at same rate
B. Decrease infusion rate by 2 units/kg/hour
C. Stop infusion and prepare protamine sulfate
D. Notify provider of critical value
Answer: C – aPTT >100 indicates high bleeding risk; stop heparin, prepare
protamine.
15. A patient with peanut allergy has stridor and difficulty breathing. First
medication?
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2026 – 200 Verified Questions & Answers with Detailed
Rationales | Proctored Exam Preparation
Table of Contents
Domain Questions
1. Advanced Clinical Judgment & Priority Setting 1–40
2. Pharmacology 41–80
3. Physiological Adaptation 81–120
4. Psychosocial Integrity 121–150
5. Safety & Infection Control 151–175
6. Health Promotion & Maintenance 176–200
Domain 1: Advanced Clinical Judgment & Priority Setting (1–40)
1. A patient with a STEMI receives tPA and suddenly develops a severe
headache and vomiting. BP 200/110 mmHg. What is the nurse's immediate
action?
A. Administer antiemetic
B. Notify provider and prepare for emergency CT scan
C. Lower head of bed
D. Give acetaminophen
Answer: B – Severe headache, vomiting, hypertension after thrombolytics suggest
intracranial hemorrhage. Stop tPA, notify provider, prepare for CT scan.
2. A nurse receives report on four patients. Which patient should be assessed
first?
A. Post-op day 2, incisional pain 5/10
B. Diabetes with blood glucose 180 mg/dL
1|Page
,C. COPD with SpO2 88% on 2 L/min oxygen
D. Heart failure with 1+ pitting edema
Answer: C – SpO2 <90% indicates hypoxemia, which is life-threatening (ABC
priority).
3. A patient is admitted with chest pain. Which laboratory result requires the
most immediate action?
A. Troponin I 0.04 ng/mL
B. Potassium 5.9 mEq/L
C. Hemoglobin 11.2 g/dL
D. WBC 12,000/mm³
Answer: B – Severe hyperkalemia (K >5.5) can cause cardiac arrest.
4. A patient with a tracheostomy develops respiratory distress. The inner
cannula is obstructed. Priority action?
A. Suction through tracheostomy
B. Remove and replace inner cannula
C. Call rapid response
D. Bag-valve mask over tracheostomy
Answer: B – Removing the obstructed inner cannula immediately restores airway
patency.
5. A patient with an NG tube to low intermittent suction reports nausea and
abdominal distension. First action?
A. Irrigate NG tube with 30 mL water
B. Check tube placement and suction function
C. Reposition patient on left side
D. Notify provider for antiemetic
Answer: B – Verify tube placement and suction first; malfunction or malposition is
likely.
6. A patient with a seizure disorder is found unresponsive with tonic-clonic
activity. Immediate action?
A. Restrain limbs
B. Place padded tongue blade in mouth
C. Turn patient to side and protect head
D. Administer IV lorazepam
2|Page
,Answer: C – Prevent aspiration and injury during seizure. Lorazepam if seizure >5
minutes.
7. A patient receiving a blood transfusion reports chills and low back pain 15
minutes after initiation. First action?
A. Stop the transfusion
B. Slow the infusion rate
C. Administer acetaminophen
D. Obtain a urine sample
Answer: A – Stop transfusion immediately; suspect acute hemolytic reaction.
8. A patient with a head injury has ICP 22 mm Hg. Which finding should be
reported immediately?
A. PaCO2 35 mm Hg
B. Systolic BP 110 mm Hg
C. Pupil asymmetry and sluggish response
D. Temperature 37.5°C
Answer: C – Pupil asymmetry indicates brain herniation, a neurological
emergency.
9. A patient’s chest tube drainage system is disconnected from the patient. First
action?
A. Clamp the chest tube near insertion site
B. Place end of chest tube in sterile water
C. Apply occlusive dressing over insertion site
D. Reconnect to drainage system
Answer: B – Submerging the tube in sterile water creates a water seal and
prevents air entry.
10. A patient with DKA is receiving IV insulin. Serum potassium is 4.8 mEq/L.
Most appropriate action?
A. Continue insulin infusion as ordered
B. Hold insulin and notify provider
C. Administer potassium chloride IV push
D. Change to subcutaneous insulin
Answer: A – Potassium 4.8 is normal; insulin should continue; potassium
replacement will be added if level drops.
3|Page
, 11. A patient with acute pancreatitis reports severe epigastric pain radiating to
the back. Which position is best for pain relief?
A. Supine with legs flat
B. Prone
C. Side-lying with knees flexed (fetal)
D. High-Fowler’s with legs dangling
Answer: C – Fetal position reduces tension on the pancreas.
12. A patient with a recent stroke has difficulty swallowing. The nurse
auscultates wet breath sounds after a sip of water. First action?
A. Suction the oropharynx
B. Place patient NPO and notify speech therapy
C. Elevate HOB to 90 degrees
D. Offer thickened liquids
Answer: B – Wet breath sounds indicate aspiration; patient should be NPO and
undergo swallow evaluation.
13. A patient with a spinal cord injury at T6 develops sudden hypertension,
bradycardia, and pounding headache. First action?
A. Administer hydralazine IV
B. Place patient in sitting position
C. Check for distended bladder or fecal impaction
D. Notify provider
Answer: C – Autonomic dysreflexia; remove noxious stimulus (e.g., empty
bladder) first.
14. A patient with a pulmonary embolism on heparin drip has aPTT 110 seconds
(control 30). First action?
A. Continue infusion at same rate
B. Decrease infusion rate by 2 units/kg/hour
C. Stop infusion and prepare protamine sulfate
D. Notify provider of critical value
Answer: C – aPTT >100 indicates high bleeding risk; stop heparin, prepare
protamine.
15. A patient with peanut allergy has stridor and difficulty breathing. First
medication?
4|Page
