ATI RN Concept-Based Assessment
Proctored Level 2 –Exam
Next-Generation NCLEX (NGN) Questions with Answers
Page 1
,Question 1. A nurse is caring for a client with heart failure who is being
discharged home. Which statement by the client indicates a need for
further teaching?
A. "I will weigh myself every morning before breakfast."
B. "I will call my provider if I gain 3 lb in one day."
C. "I will add extra salt to my food to improve the taste."
D. "I will rest between activities if I become short of breath."
Answer: C. "I will add extra salt to my food to improve the taste."
Rationale: Clients with heart failure must restrict sodium intake because
excess sodium causes fluid retention, increasing cardiac workload and
worsening heart failure. Daily weights, reporting rapid weight gain (2-3 lb in a
day or 5 lb in a week), and pacing activities are all appropriate
self-management strategies.
Question 2. A client with chronic obstructive pulmonary disease (COPD)
is being taught pursed-lip breathing. What is the primary purpose of this
technique?
A. To increase the respiratory rate
B. To prevent airway collapse and trap air in the alveoli
C. To decrease the amount of oxygen needed
D. To strengthen the diaphragm muscle
Answer: B. To prevent airway collapse and trap air in the alveoli
Rationale: Pursed-lip breathing creates back-pressure in the airways that
keeps them open longer during exhalation, preventing air trapping and
alveolar collapse. This allows more complete exhalation of trapped CO2 and
reduces the work of breathing in clients with COPD.
Question 3. A nurse finds a client with type 1 diabetes mellitus
diaphoretic, shaky, and confused. Fingerstick glucose is 52 mg/dL. The
client is alert enough to swallow safely. What should the nurse do first?
A. Administer 15 g of a fast-acting carbohydrate such as 4 oz of juice
B. Administer regular insulin per sliding scale
Page 2
, C. Call the provider for an order for IV dextrose
D. Recheck the glucose level in 30 minutes before intervening
Answer: A. Administer 15 g of a fast-acting carbohydrate such as 4 oz of
juice
Rationale: For a conscious client who can swallow safely, the priority is to
treat hypoglycemia immediately with 15 g of a fast-acting carbohydrate, then
recheck glucose in 15 minutes (rule of 15). Insulin would worsen
hypoglycemia, and waiting to recheck without treating delays needed care.
Question 4. A nurse is planning care for a postoperative client to prevent
deep vein thrombosis (DVT). Which intervention is most effective?
A. Keeping the client on strict bed rest for 48 hours
B. Applying sequential compression devices and encouraging early
ambulation
C. Massaging the calves twice daily
D. Placing a pillow under the knees to elevate the legs
Answer: B. Applying sequential compression devices and encouraging
early ambulation
Rationale: Sequential compression devices promote venous return, and early
ambulation prevents venous stasis, the primary risk factor for DVT. Bed rest
increases DVT risk, calf massage can dislodge a clot if one is present, and
pillows under the knees impede venous return.
Question 5. A client with cirrhosis and ascites is prescribed a
low-sodium diet. Which food choice by the client requires further
teaching?
A. Fresh grilled chicken breast
B. Canned tomato soup
C. Steamed broccoli
D. Fresh apple slices
Answer: B. Canned tomato soup
Rationale: Canned soups are typically very high in sodium due to
preservatives and added salt, which would worsen fluid retention and ascites
in a client with cirrhosis. Fresh, unprocessed foods such as chicken, broccoli,
and apples are naturally low in sodium.
Page 3
, Question 6. A nurse is reviewing laboratory results for a client with acute
kidney injury. Which finding requires the most immediate action?
A. Serum creatinine of 2.1 mg/dL
B. Serum potassium of 6.8 mEq/L
C. BUN of 32 mg/dL
D. Serum sodium of 138 mEq/L
Answer: B. Serum potassium of 6.8 mEq/L
Rationale: A potassium of 6.8 mEq/L is severely elevated (normal 3.5-5.0
mEq/L) and can cause life-threatening cardiac dysrhythmias, including
cardiac arrest. This finding takes priority over the elevated creatinine and
BUN, which reflect kidney function but are not immediately life-threatening,
and the sodium is within normal limits.
Question 7. A client is admitted following an ischemic stroke with
right-sided weakness and dysphagia. Which nursing action is the
priority before the client's first meal?
A. Position the client supine to reduce aspiration risk
B. Have the client sit upright at 90 degrees and perform a bedside swallow
evaluation
C. Offer thin liquids first to assess swallowing
D. Feed the client quickly to prevent fatigue
Answer: B. Have the client sit upright at 90 degrees and perform a
bedside swallow evaluation
Rationale: Clients with dysphagia after stroke are at high risk for aspiration.
The nurse must position the client upright at 90 degrees and ensure a
swallow evaluation has been completed before offering any oral intake.
Supine positioning and thin liquids both increase aspiration risk.
Question 8. A client reports crushing substernal chest pain radiating to
the left arm. After calling for help, what is the nurse's next priority
action?
A. Obtain a 12-lead ECG and administer sublingual nitroglycerin per
protocol
B. Ambulate the client to the bathroom
C. Administer an oral analgesic
Page 4
Proctored Level 2 –Exam
Next-Generation NCLEX (NGN) Questions with Answers
Page 1
,Question 1. A nurse is caring for a client with heart failure who is being
discharged home. Which statement by the client indicates a need for
further teaching?
A. "I will weigh myself every morning before breakfast."
B. "I will call my provider if I gain 3 lb in one day."
C. "I will add extra salt to my food to improve the taste."
D. "I will rest between activities if I become short of breath."
Answer: C. "I will add extra salt to my food to improve the taste."
Rationale: Clients with heart failure must restrict sodium intake because
excess sodium causes fluid retention, increasing cardiac workload and
worsening heart failure. Daily weights, reporting rapid weight gain (2-3 lb in a
day or 5 lb in a week), and pacing activities are all appropriate
self-management strategies.
Question 2. A client with chronic obstructive pulmonary disease (COPD)
is being taught pursed-lip breathing. What is the primary purpose of this
technique?
A. To increase the respiratory rate
B. To prevent airway collapse and trap air in the alveoli
C. To decrease the amount of oxygen needed
D. To strengthen the diaphragm muscle
Answer: B. To prevent airway collapse and trap air in the alveoli
Rationale: Pursed-lip breathing creates back-pressure in the airways that
keeps them open longer during exhalation, preventing air trapping and
alveolar collapse. This allows more complete exhalation of trapped CO2 and
reduces the work of breathing in clients with COPD.
Question 3. A nurse finds a client with type 1 diabetes mellitus
diaphoretic, shaky, and confused. Fingerstick glucose is 52 mg/dL. The
client is alert enough to swallow safely. What should the nurse do first?
A. Administer 15 g of a fast-acting carbohydrate such as 4 oz of juice
B. Administer regular insulin per sliding scale
Page 2
, C. Call the provider for an order for IV dextrose
D. Recheck the glucose level in 30 minutes before intervening
Answer: A. Administer 15 g of a fast-acting carbohydrate such as 4 oz of
juice
Rationale: For a conscious client who can swallow safely, the priority is to
treat hypoglycemia immediately with 15 g of a fast-acting carbohydrate, then
recheck glucose in 15 minutes (rule of 15). Insulin would worsen
hypoglycemia, and waiting to recheck without treating delays needed care.
Question 4. A nurse is planning care for a postoperative client to prevent
deep vein thrombosis (DVT). Which intervention is most effective?
A. Keeping the client on strict bed rest for 48 hours
B. Applying sequential compression devices and encouraging early
ambulation
C. Massaging the calves twice daily
D. Placing a pillow under the knees to elevate the legs
Answer: B. Applying sequential compression devices and encouraging
early ambulation
Rationale: Sequential compression devices promote venous return, and early
ambulation prevents venous stasis, the primary risk factor for DVT. Bed rest
increases DVT risk, calf massage can dislodge a clot if one is present, and
pillows under the knees impede venous return.
Question 5. A client with cirrhosis and ascites is prescribed a
low-sodium diet. Which food choice by the client requires further
teaching?
A. Fresh grilled chicken breast
B. Canned tomato soup
C. Steamed broccoli
D. Fresh apple slices
Answer: B. Canned tomato soup
Rationale: Canned soups are typically very high in sodium due to
preservatives and added salt, which would worsen fluid retention and ascites
in a client with cirrhosis. Fresh, unprocessed foods such as chicken, broccoli,
and apples are naturally low in sodium.
Page 3
, Question 6. A nurse is reviewing laboratory results for a client with acute
kidney injury. Which finding requires the most immediate action?
A. Serum creatinine of 2.1 mg/dL
B. Serum potassium of 6.8 mEq/L
C. BUN of 32 mg/dL
D. Serum sodium of 138 mEq/L
Answer: B. Serum potassium of 6.8 mEq/L
Rationale: A potassium of 6.8 mEq/L is severely elevated (normal 3.5-5.0
mEq/L) and can cause life-threatening cardiac dysrhythmias, including
cardiac arrest. This finding takes priority over the elevated creatinine and
BUN, which reflect kidney function but are not immediately life-threatening,
and the sodium is within normal limits.
Question 7. A client is admitted following an ischemic stroke with
right-sided weakness and dysphagia. Which nursing action is the
priority before the client's first meal?
A. Position the client supine to reduce aspiration risk
B. Have the client sit upright at 90 degrees and perform a bedside swallow
evaluation
C. Offer thin liquids first to assess swallowing
D. Feed the client quickly to prevent fatigue
Answer: B. Have the client sit upright at 90 degrees and perform a
bedside swallow evaluation
Rationale: Clients with dysphagia after stroke are at high risk for aspiration.
The nurse must position the client upright at 90 degrees and ensure a
swallow evaluation has been completed before offering any oral intake.
Supine positioning and thin liquids both increase aspiration risk.
Question 8. A client reports crushing substernal chest pain radiating to
the left arm. After calling for help, what is the nurse's next priority
action?
A. Obtain a 12-lead ECG and administer sublingual nitroglycerin per
protocol
B. Ambulate the client to the bathroom
C. Administer an oral analgesic
Page 4
