ATI RN CONCEPT-BASED ASSESSMENT LEVEL 2
PROCTORED EXAM GRADED A+
COMPLETE PRACTICE QUESTION BANK 2027
Latest 2026 Update | Verified Questions & Detailed Rationales
Exam Preparation Material | Already Graded A+
1. A patient with chronic kidney disease (CKD) has a serum potassium of 6.2 mEq/L
and is experiencing muscle weakness and ECG changes with peaked T waves.
Which intervention should the nurse implement first?
• A) Administer oral sodium polystyrene sulfonate (Kayexalate)
• B) Prepare for hemodialysis
• C) Place the patient on a cardiac monitor and administer IV calcium
gluconate
• D) Restrict all dietary potassium
Rationale: A potassium level of 6.2 mEq/L with ECG changes (peaked T waves) indicates
severe hyperkalemia that can lead to fatal cardiac dysrhythmias. IV calcium gluconate is
the priority intervention because it stabilizes the cardiac membrane and protects the heart
while other treatments work to lower potassium levels. Cardiac monitoring is essential to
detect dysrhythmias immediately.
2. A patient with heart failure is receiving IV furosemide. Which assessment
finding indicates the need to notify the healthcare provider immediately?
• A) Serum potassium of 3.6 mEq/L
• B) Blood pressure of 110/72 mmHg
• C) Tinnitus and hearing loss
, • D) Urine output of 40 mL/hr
Rationale: Tinnitus and hearing loss are signs of ototoxicity, a serious adverse effect of
loop diuretics like furosemide, especially when administered IV rapidly or at high doses.
This requires immediate provider notification and possible dose adjustment or
discontinuation. A potassium of 3.6 is slightly low but not critical, BP of 110/72 is
acceptable, and urine output of 40 mL/hr is adequate.
3. A patient with acute pancreatitis is reporting severe epigastric pain radiating to
the back, accompanied by nausea and vomiting. Which laboratory finding is most
consistent with this diagnosis?
• A) Elevated serum calcium
• B) Elevated serum amylase and lipase
• C) Decreased serum glucose
• D) Elevated serum potassium
Rationale: Acute pancreatitis is characterized by elevated serum amylase and lipase, which
are pancreatic enzymes that leak into the bloodstream when the pancreas is inflamed.
Lipase is more specific to the pancreas. Serum calcium may be decreased (not elevated)
due to fat necrosis, and glucose may be elevated due to impaired insulin production.
4. A patient with COPD is receiving oxygen at 3 L/min via nasal cannula. The nurse
notes the patient is becoming confused and lethargic with a respiratory rate of 8
breaths per minute. Which action should the nurse take first?
• A) Increase the oxygen flow rate to 4 L/min
• B) Administer a bronchodilator nebulizer treatment
• C) Decrease the oxygen flow rate and assess arterial blood gases
• D) Prepare for immediate endotracheal intubation
Rationale: Patients with COPD may have a hypoxic respiratory drive. Excessive oxygen can
suppress this drive, leading to hypoventilation, CO₂ retention, and respiratory acidosis.
Confusion and lethargy with a decreased respiratory rate indicate CO₂ narcosis. The nurse
should decrease the oxygen flow rate and assess ABGs to determine the appropriate
oxygenation level. Increasing oxygen would worsen the condition.
,5. A patient with a chest tube has continuous bubbling in the water seal chamber.
What is the nurse's priority action?
• A) Document this as a normal finding
• B) Increase the suction pressure
• C) Assess the system for an air leak
• D) Clamp the chest tube immediately
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The nurse
should systematically assess the system for leaks (loose connections, cracks, or site issues).
Intermittent bubbling is normal and indicates air being evacuated from the pleural space.
Clamping is not the first action and can cause tension pneumothorax.
6. A patient receiving a blood transfusion develops hives, itching, and shortness of
breath. What is the nurse's priority action?
• A) Slow the infusion rate
• B) Administer diphenhydramine (Benadryl)
• C) Stop the transfusion immediately
• D) Continue the infusion and monitor
Rationale: Hives, itching, and shortness of breath indicate a transfusion reaction, which
can progress to anaphylaxis. The priority is to stop the transfusion immediately, maintain
the IV line with normal saline, and notify the provider. Slowing the infusion or continuing
it could worsen the reaction and lead to life-threatening complications.
7. A patient with diabetes has a blood glucose of 45 mg/dL and is unconscious.
Which action should the nurse take?
• A) Administer 15 g of oral glucose
• B) Give 4 oz of orange juice
• C) Administer glucagon 1 mg IM or IV dextrose 50%
• D) Recheck blood glucose in 15 minutes
, Rationale: An unconscious patient cannot safely receive oral glucose due to aspiration risk.
Glucagon IM or IV dextrose is the appropriate treatment for severe hypoglycemia with
altered consciousness. After administration, the patient should be monitored for
improvement and glucose rechecked. Oral glucose is only for conscious patients who can
swallow safely.
8. A patient with a new tracheostomy has thick, tenacious secretions. Which
intervention should the nurse implement first?
• A) Suction the tracheostomy every hour
• B) Instill normal saline before suctioning
• C) Increase humidification and encourage fluid intake
• D) Change the tracheostomy tube
Rationale: The first-line intervention for thick secretions is to increase humidification
(using a tracheostomy collar with humidified oxygen or a heat-moisture exchanger) and
encourage adequate fluid intake to thin secretions. Suctioning is done as needed, not
routinely, and instilling saline is controversial. Changing the tube is not indicated for thick
secretions alone.
9. A patient with asthma is prescribed montelukast (Singulair). The nurse should
teach that this medication:
• A) Is a rescue medication for acute attacks
• B) Is a long-term controller medication that reduces inflammation
• C) Should be taken as needed for wheezing
• D) Works immediately to dilate airways
Rationale: Montelukast is a leukotriene receptor antagonist used as a long-term controller
medication to prevent asthma symptoms by reducing airway inflammation. It is NOT a
rescue medication and does not work acutely. It should be taken daily, even when the
patient feels well, to maintain asthma control.
PROCTORED EXAM GRADED A+
COMPLETE PRACTICE QUESTION BANK 2027
Latest 2026 Update | Verified Questions & Detailed Rationales
Exam Preparation Material | Already Graded A+
1. A patient with chronic kidney disease (CKD) has a serum potassium of 6.2 mEq/L
and is experiencing muscle weakness and ECG changes with peaked T waves.
Which intervention should the nurse implement first?
• A) Administer oral sodium polystyrene sulfonate (Kayexalate)
• B) Prepare for hemodialysis
• C) Place the patient on a cardiac monitor and administer IV calcium
gluconate
• D) Restrict all dietary potassium
Rationale: A potassium level of 6.2 mEq/L with ECG changes (peaked T waves) indicates
severe hyperkalemia that can lead to fatal cardiac dysrhythmias. IV calcium gluconate is
the priority intervention because it stabilizes the cardiac membrane and protects the heart
while other treatments work to lower potassium levels. Cardiac monitoring is essential to
detect dysrhythmias immediately.
2. A patient with heart failure is receiving IV furosemide. Which assessment
finding indicates the need to notify the healthcare provider immediately?
• A) Serum potassium of 3.6 mEq/L
• B) Blood pressure of 110/72 mmHg
• C) Tinnitus and hearing loss
, • D) Urine output of 40 mL/hr
Rationale: Tinnitus and hearing loss are signs of ototoxicity, a serious adverse effect of
loop diuretics like furosemide, especially when administered IV rapidly or at high doses.
This requires immediate provider notification and possible dose adjustment or
discontinuation. A potassium of 3.6 is slightly low but not critical, BP of 110/72 is
acceptable, and urine output of 40 mL/hr is adequate.
3. A patient with acute pancreatitis is reporting severe epigastric pain radiating to
the back, accompanied by nausea and vomiting. Which laboratory finding is most
consistent with this diagnosis?
• A) Elevated serum calcium
• B) Elevated serum amylase and lipase
• C) Decreased serum glucose
• D) Elevated serum potassium
Rationale: Acute pancreatitis is characterized by elevated serum amylase and lipase, which
are pancreatic enzymes that leak into the bloodstream when the pancreas is inflamed.
Lipase is more specific to the pancreas. Serum calcium may be decreased (not elevated)
due to fat necrosis, and glucose may be elevated due to impaired insulin production.
4. A patient with COPD is receiving oxygen at 3 L/min via nasal cannula. The nurse
notes the patient is becoming confused and lethargic with a respiratory rate of 8
breaths per minute. Which action should the nurse take first?
• A) Increase the oxygen flow rate to 4 L/min
• B) Administer a bronchodilator nebulizer treatment
• C) Decrease the oxygen flow rate and assess arterial blood gases
• D) Prepare for immediate endotracheal intubation
Rationale: Patients with COPD may have a hypoxic respiratory drive. Excessive oxygen can
suppress this drive, leading to hypoventilation, CO₂ retention, and respiratory acidosis.
Confusion and lethargy with a decreased respiratory rate indicate CO₂ narcosis. The nurse
should decrease the oxygen flow rate and assess ABGs to determine the appropriate
oxygenation level. Increasing oxygen would worsen the condition.
,5. A patient with a chest tube has continuous bubbling in the water seal chamber.
What is the nurse's priority action?
• A) Document this as a normal finding
• B) Increase the suction pressure
• C) Assess the system for an air leak
• D) Clamp the chest tube immediately
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The nurse
should systematically assess the system for leaks (loose connections, cracks, or site issues).
Intermittent bubbling is normal and indicates air being evacuated from the pleural space.
Clamping is not the first action and can cause tension pneumothorax.
6. A patient receiving a blood transfusion develops hives, itching, and shortness of
breath. What is the nurse's priority action?
• A) Slow the infusion rate
• B) Administer diphenhydramine (Benadryl)
• C) Stop the transfusion immediately
• D) Continue the infusion and monitor
Rationale: Hives, itching, and shortness of breath indicate a transfusion reaction, which
can progress to anaphylaxis. The priority is to stop the transfusion immediately, maintain
the IV line with normal saline, and notify the provider. Slowing the infusion or continuing
it could worsen the reaction and lead to life-threatening complications.
7. A patient with diabetes has a blood glucose of 45 mg/dL and is unconscious.
Which action should the nurse take?
• A) Administer 15 g of oral glucose
• B) Give 4 oz of orange juice
• C) Administer glucagon 1 mg IM or IV dextrose 50%
• D) Recheck blood glucose in 15 minutes
, Rationale: An unconscious patient cannot safely receive oral glucose due to aspiration risk.
Glucagon IM or IV dextrose is the appropriate treatment for severe hypoglycemia with
altered consciousness. After administration, the patient should be monitored for
improvement and glucose rechecked. Oral glucose is only for conscious patients who can
swallow safely.
8. A patient with a new tracheostomy has thick, tenacious secretions. Which
intervention should the nurse implement first?
• A) Suction the tracheostomy every hour
• B) Instill normal saline before suctioning
• C) Increase humidification and encourage fluid intake
• D) Change the tracheostomy tube
Rationale: The first-line intervention for thick secretions is to increase humidification
(using a tracheostomy collar with humidified oxygen or a heat-moisture exchanger) and
encourage adequate fluid intake to thin secretions. Suctioning is done as needed, not
routinely, and instilling saline is controversial. Changing the tube is not indicated for thick
secretions alone.
9. A patient with asthma is prescribed montelukast (Singulair). The nurse should
teach that this medication:
• A) Is a rescue medication for acute attacks
• B) Is a long-term controller medication that reduces inflammation
• C) Should be taken as needed for wheezing
• D) Works immediately to dilate airways
Rationale: Montelukast is a leukotriene receptor antagonist used as a long-term controller
medication to prevent asthma symptoms by reducing airway inflammation. It is NOT a
rescue medication and does not work acutely. It should be taken daily, even when the
patient feels well, to maintain asthma control.
