ATI RN CONCEPT-BASED ASSESSMENT LEVEL 2
PROCTORED EXAM (PDF) | 2026 EXAM QUESTIONS AND
ANSWERS + RATIONALES | STUDY GUIDE | 100% CORRECT
1. A nurse is caring for a client who has pneumonia. Which of the following actions is the priority
for the nurse to take?
A) Monitor intake and output
B) Provide teaching about antibiotic therapy
C) Administer the influenza vaccine
D) Observe the client perform incentive spirometry
Correct Answer: D) Observe the client perform incentive spirometry
Rationale: Using the airway, breathing, and circulation (ABC) framework, the priority action is
to ensure adequate oxygenation and airway clearance. Observing the client perform incentive
spirometry directly addresses impaired gas exchange and helps prevent complications like
atelectasis . Teaching, monitoring, and vaccination are important but secondary in the acute
phase.
2. A charge nurse is making assignments on a busy medical-surgical unit. Which client should be
assigned to the most experienced registered nurse?
A) A client with diabetes requiring fingerstick glucose checks
B) A client with pneumonia needing IV antibiotics
C) A client post-cardiac arrest with an unstable arrhythmia
D) A client with a urinary tract infection on oral antibiotics
Correct Answer: C) A client post-cardiac arrest with an unstable arrhythmia
Rationale: The most unstable client with a life-threatening condition requires the most
experienced nurse who can exercise advanced clinical judgment and respond rapidly to changes .
Stable clients with predictable needs can be assigned to less experienced staff.
3. A client who has a do-not-resuscitate (DNR) order experiences respiratory arrest. The family
insists on intubation. What should the nurse do?
A) Honor the family's request and initiate intubation
B) Explain that the DNR order is legally binding and cannot be overridden
C) Call the provider to clarify the DNR order
D) Initiate resuscitation while contacting the ethics committee
Correct Answer: B) Explain that the DNR order is legally binding and cannot be overridden
Rationale: An advance directive, such as a DNR order, is legally binding and reflects the client's
autonomous decision . The nurse must advocate for the client's documented wishes while
providing compassionate support to the family.
,4. A nurse is preparing to administer a medication. The pharmacy sends a tablet that looks different
from the client's usual medication. Which action should the nurse take?
A) Administer the medication as sent
B) Crush the tablet to hide the appearance
C) Call the pharmacy to verify the medication
D) Ask the client if it looks familiar
Correct Answer: C) Call the pharmacy to verify the medication
Rationale: A medication that appears different may be a different drug, strength, or generic
formulation. The nurse's responsibility is to verify the medication with the pharmacy before
administration to prevent a medication error .
5. A nurse is caring for a client who is being discharged against medical advice (AMA). What
action should the nurse take first?
A) Restrain the client to prevent leaving
B) Notify the provider and have the client sign an AMA form
C) Call security to detain the client
D) Discharge the client without documentation
Correct Answer: B) Notify the provider and have the client sign an AMA form
Rationale: Competent adults have the right to leave AMA. The nurse must notify the provider so
the risks of leaving can be discussed, and the client must sign an AMA form to document that
they are leaving against medical advice .
6. A nurse is providing discharge teaching to a client with a new colostomy. Which action by the
nurse ensures effective teaching?
A) Provide written instructions only
B) Have the client demonstrate pouch changes
C) Give a phone number to call with questions
D) Ask, "Do you understand everything?"
Correct Answer: B) Have the client demonstrate pouch changes
Rationale: Return demonstration is the most effective method to evaluate a client's understanding
of a psychomotor skill . A "yes" response to "Do you understand?" does not reliably confirm
comprehension.
7. The nurse is caring for a patient who refuses a blood transfusion due to religious beliefs. Which
response is appropriate?
A) "Your family wants you to have the transfusion."
B) "The doctor will be angry if you refuse."
C) "Tell me more about your concerns regarding the transfusion."
D) "We will give you the transfusion anyway to save your life."
Correct Answer: C) "Tell me more about your concerns regarding the transfusion."
, Rationale: The nurse should respect the client's autonomy and explore their concerns using
therapeutic communication . This approach validates the client's beliefs and fosters trust, while
coercion or deception is unethical.
8. A nurse observes a colleague who appears impaired and is preparing to administer medications.
Which action should the nurse take?
A) Ignore the behavior to avoid confrontation
B) Report the suspicion to the nurse manager immediately
C) Confront the colleague privately
D) Take over the colleague's assignment without reporting
Correct Answer: B) Report the suspicion to the nurse manager immediately
Rationale: The nurse has a legal and ethical duty to report suspected impairment to protect
patient safety . The manager will follow facility policy, which may include drug testing and a
fitness-for-duty evaluation.
9. A nurse manager is reviewing staffing ratios. Which patient assignment is unsafe?
A) One RN caring for 4 stable post-op patients
B) One RN caring for 2 ICU patients
C) One RN caring for 8 medical-surgical patients with complex needs
D) One LPN caring for 5 stable patients with an RN supervisor
Correct Answer: C) One RN caring for 8 medical-surgical patients with complex needs
Rationale: High patient acuity with high ratios creates an unsafe assignment . Staffing must
match patient acuity to ensure safe, quality care. The other options reflect more appropriate
assignments.
10. A nurse is preparing to discharge a client with a new diagnosis of heart failure. Which instruction
is most critical to include in the discharge teaching?
A) Weigh yourself daily and report a weight gain of more than 2 pounds in 24 hours
B) Limit your intake of high-fiber foods to prevent bloating
C) Take your diuretic only when you feel short of breath
D) Avoid using the incentive spirometer after surgery
Correct Answer: A) Weigh yourself daily and report a weight gain of more than 2 pounds in 24
hours
Rationale: Daily weight monitoring is essential for early detection of fluid retention, a key
indicator of worsening heart failure . A gain of >2 lbs in 24 hours requires prompt intervention.
Diuretics should be taken as prescribed, not PRN.
11. A client with a history of falls is confused and pulling at IV lines. Which intervention is most
appropriate before considering restraints?
A) Apply wrist restraints to prevent IV removal
B) Place all four side rails up
PROCTORED EXAM (PDF) | 2026 EXAM QUESTIONS AND
ANSWERS + RATIONALES | STUDY GUIDE | 100% CORRECT
1. A nurse is caring for a client who has pneumonia. Which of the following actions is the priority
for the nurse to take?
A) Monitor intake and output
B) Provide teaching about antibiotic therapy
C) Administer the influenza vaccine
D) Observe the client perform incentive spirometry
Correct Answer: D) Observe the client perform incentive spirometry
Rationale: Using the airway, breathing, and circulation (ABC) framework, the priority action is
to ensure adequate oxygenation and airway clearance. Observing the client perform incentive
spirometry directly addresses impaired gas exchange and helps prevent complications like
atelectasis . Teaching, monitoring, and vaccination are important but secondary in the acute
phase.
2. A charge nurse is making assignments on a busy medical-surgical unit. Which client should be
assigned to the most experienced registered nurse?
A) A client with diabetes requiring fingerstick glucose checks
B) A client with pneumonia needing IV antibiotics
C) A client post-cardiac arrest with an unstable arrhythmia
D) A client with a urinary tract infection on oral antibiotics
Correct Answer: C) A client post-cardiac arrest with an unstable arrhythmia
Rationale: The most unstable client with a life-threatening condition requires the most
experienced nurse who can exercise advanced clinical judgment and respond rapidly to changes .
Stable clients with predictable needs can be assigned to less experienced staff.
3. A client who has a do-not-resuscitate (DNR) order experiences respiratory arrest. The family
insists on intubation. What should the nurse do?
A) Honor the family's request and initiate intubation
B) Explain that the DNR order is legally binding and cannot be overridden
C) Call the provider to clarify the DNR order
D) Initiate resuscitation while contacting the ethics committee
Correct Answer: B) Explain that the DNR order is legally binding and cannot be overridden
Rationale: An advance directive, such as a DNR order, is legally binding and reflects the client's
autonomous decision . The nurse must advocate for the client's documented wishes while
providing compassionate support to the family.
,4. A nurse is preparing to administer a medication. The pharmacy sends a tablet that looks different
from the client's usual medication. Which action should the nurse take?
A) Administer the medication as sent
B) Crush the tablet to hide the appearance
C) Call the pharmacy to verify the medication
D) Ask the client if it looks familiar
Correct Answer: C) Call the pharmacy to verify the medication
Rationale: A medication that appears different may be a different drug, strength, or generic
formulation. The nurse's responsibility is to verify the medication with the pharmacy before
administration to prevent a medication error .
5. A nurse is caring for a client who is being discharged against medical advice (AMA). What
action should the nurse take first?
A) Restrain the client to prevent leaving
B) Notify the provider and have the client sign an AMA form
C) Call security to detain the client
D) Discharge the client without documentation
Correct Answer: B) Notify the provider and have the client sign an AMA form
Rationale: Competent adults have the right to leave AMA. The nurse must notify the provider so
the risks of leaving can be discussed, and the client must sign an AMA form to document that
they are leaving against medical advice .
6. A nurse is providing discharge teaching to a client with a new colostomy. Which action by the
nurse ensures effective teaching?
A) Provide written instructions only
B) Have the client demonstrate pouch changes
C) Give a phone number to call with questions
D) Ask, "Do you understand everything?"
Correct Answer: B) Have the client demonstrate pouch changes
Rationale: Return demonstration is the most effective method to evaluate a client's understanding
of a psychomotor skill . A "yes" response to "Do you understand?" does not reliably confirm
comprehension.
7. The nurse is caring for a patient who refuses a blood transfusion due to religious beliefs. Which
response is appropriate?
A) "Your family wants you to have the transfusion."
B) "The doctor will be angry if you refuse."
C) "Tell me more about your concerns regarding the transfusion."
D) "We will give you the transfusion anyway to save your life."
Correct Answer: C) "Tell me more about your concerns regarding the transfusion."
, Rationale: The nurse should respect the client's autonomy and explore their concerns using
therapeutic communication . This approach validates the client's beliefs and fosters trust, while
coercion or deception is unethical.
8. A nurse observes a colleague who appears impaired and is preparing to administer medications.
Which action should the nurse take?
A) Ignore the behavior to avoid confrontation
B) Report the suspicion to the nurse manager immediately
C) Confront the colleague privately
D) Take over the colleague's assignment without reporting
Correct Answer: B) Report the suspicion to the nurse manager immediately
Rationale: The nurse has a legal and ethical duty to report suspected impairment to protect
patient safety . The manager will follow facility policy, which may include drug testing and a
fitness-for-duty evaluation.
9. A nurse manager is reviewing staffing ratios. Which patient assignment is unsafe?
A) One RN caring for 4 stable post-op patients
B) One RN caring for 2 ICU patients
C) One RN caring for 8 medical-surgical patients with complex needs
D) One LPN caring for 5 stable patients with an RN supervisor
Correct Answer: C) One RN caring for 8 medical-surgical patients with complex needs
Rationale: High patient acuity with high ratios creates an unsafe assignment . Staffing must
match patient acuity to ensure safe, quality care. The other options reflect more appropriate
assignments.
10. A nurse is preparing to discharge a client with a new diagnosis of heart failure. Which instruction
is most critical to include in the discharge teaching?
A) Weigh yourself daily and report a weight gain of more than 2 pounds in 24 hours
B) Limit your intake of high-fiber foods to prevent bloating
C) Take your diuretic only when you feel short of breath
D) Avoid using the incentive spirometer after surgery
Correct Answer: A) Weigh yourself daily and report a weight gain of more than 2 pounds in 24
hours
Rationale: Daily weight monitoring is essential for early detection of fluid retention, a key
indicator of worsening heart failure . A gain of >2 lbs in 24 hours requires prompt intervention.
Diuretics should be taken as prescribed, not PRN.
11. A client with a history of falls is confused and pulling at IV lines. Which intervention is most
appropriate before considering restraints?
A) Apply wrist restraints to prevent IV removal
B) Place all four side rails up
