ATI RN Concept Based Assessment Level 3 Online Practice
Form A Questions and Answers with Rationales
Question 1: The nurse is assessing a client receiving antineoplastic therapy with a platelet count of 18,000/mm3.
Which finding is most consistent with chemotherapy-induced thrombocytopenia?
A. petechiae, mucosal bleeding, and easy bruising
B. oral ulceration, erythema, and pain that interfere with nutrition
C. hyperkalemia, hyperphosphatemia, hypocalcemia, and rising uric acid
D. facial and upper-extremity edema with distended neck and chest veins
Answer: A. petechiae, mucosal bleeding, and easy bruising
Rationale: petechiae, mucosal bleeding, and easy bruising is the finding that best fits this clinical pattern. A very low platelet count
increases the risk for spontaneous and procedure-related bleeding. The other findings can occur in other conditions, but they do not
match the defining cues for chemotherapy-induced thrombocytopenia as closely. The nurse should compare the finding with the
client's baseline and continue focused assessment for changes that would alter urgency or management.
Question 2: Which treatment is most consistent with evidence-based management of a client receiving
antineoplastic therapy with a platelet count of 18,000/mm3?
A. compression therapy and specialized exercise when prescribed
B. platelet transfusion when clinically indicated
C. tumor-directed radiation, chemotherapy, or endovascular stenting as prescribed
D. urate-lowering therapy such as allopurinol or rasburicase as prescribed
Answer: B. platelet transfusion when clinically indicated
Rationale: platelet transfusion when clinically indicated is the therapy most closely aligned with the primary problem described. A
very low platelet count increases the risk for spontaneous and procedure-related bleeding. Treatment still requires review of
contraindications, current clinical status, and the provider's specific prescription. The nurse should monitor for therapeutic response
and adverse effects and escalate care if the expected improvement does not occur.
Question 3: A client is being treated for chemotherapy-induced thrombocytopenia. Which potential complication
should the nurse monitor for?
A. spontaneous intracranial or gastrointestinal hemorrhage
B. cellulitis and progressive tissue fibrosis
C. dehydration, malnutrition, and secondary oral infection
D. airway compromise and reduced cerebral venous drainage
Answer: A. spontaneous intracranial or gastrointestinal hemorrhage
Rationale: spontaneous intracranial or gastrointestinal hemorrhage is a clinically important complication associated with this problem.
A very low platelet count increases the risk for spontaneous and procedure-related bleeding. Recognizing early warning signs
allows the nurse to escalate care before preventable deterioration occurs. The other complications may be relevant in different
disorders, but they are less directly connected to the cues in this scenario.
,Question 4: The nurse is evaluating a client after axillary lymph-node dissection who has arm heaviness and
swelling. Which data are most important to trend? Page 1 ATI RN Concept-Based Assessment Level 3 - Online
Practice Form A
A. platelet count, hemoglobin, and evidence of bleeding
B. potassium, calcium, phosphorus, uric acid, creatinine, and urine output
C. hemoglobin, hematocrit, heart rate, oxygenation, and symptoms
D. arm circumference, skin integrity, and signs of infection
Answer: D. arm circumference, skin integrity, and signs of infection
Rationale: arm circumference, skin integrity, and signs of infection provides the most useful data for evaluating progression, response
to treatment, and emerging complications. Disrupted lymphatic drainage can cause chronic protein-rich edema and increase
infection risk. Monitoring should be targeted to the mechanism of illness rather than performed as an unfocused collection of tests.
The nurse should trend results over time and relate changes to the client's symptoms and overall clinical status.
Question 5: Which statement should the nurse include when teaching a client with a high-burden hematologic
malignancy shortly after starting chemotherapy?
A. use a soft toothbrush, bland rinses, and avoid alcohol-containing mouthwash and irritating foods
B. avoid lying flat and report worsening dyspnea, stridor, or confusion immediately
C. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
D. balance activity with rest and change positions slowly if dizziness occurs
Answer: C. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
Rationale: report muscle weakness, palpitations, decreased urine output, or new confusion promptly is the most appropriate teaching
point because it directly reduces risk and supports safe self-management. Rapid tumor-cell breakdown releases intracellular
contents and can cause metabolic emergencies and renal injury. The alternative instructions either apply to different conditions or
could delay recognition of an important complication. The nurse should confirm understanding with teach-back and adapt
instructions to the client's health literacy and resources.
Question 6: A client is being treated for anemia related to marrow suppression. Which potential complication
should the nurse monitor for?
A. airway compromise and reduced cerebral venous drainage
B. myocardial ischemia or tissue hypoxia when severe
C. dehydration, malnutrition, and secondary oral infection
D. spontaneous intracranial or gastrointestinal hemorrhage
Answer: B. myocardial ischemia or tissue hypoxia when severe
Rationale: myocardial ischemia or tissue hypoxia when severe is a clinically important complication associated with this problem.
Reduced red-cell mass decreases oxygen-carrying capacity and can impair tissue oxygen delivery. Recognizing early warning signs
allows the nurse to escalate care before preventable deterioration occurs. The other complications may be relevant in different
disorders, but they are less directly connected to the cues in this scenario.
,Question 7: Which client teaching best supports safe self-management for a client receiving cytotoxic
chemotherapy whose absolute neutrophil count is 420/mm3?
A. avoid crowds, sick contacts, raw or undercooked foods, and rectal procedures while neutropenic
B. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
C. report new weakness, numbness, saddle anesthesia, or urinary retention without delay
D. use a soft toothbrush and electric razor and report black stools or prolonged bleeding Page 2 ATI RN Concept-Based
Assessment Level 3 - Online Practice Form A
Answer: A. avoid crowds, sick contacts, raw or undercooked foods, and rectal procedures while neutropenic
Rationale: avoid crowds, sick contacts, raw or undercooked foods, and rectal procedures while neutropenic is the most appropriate
teaching point because it directly reduces risk and supports safe self-management. Severe neutropenia markedly reduces the client's
ability to contain bacterial and fungal infection. The alternative instructions either apply to different conditions or could delay
recognition of an important complication. The nurse should confirm understanding with teach-back and adapt instructions to the
client's health literacy and resources.
Question 8: A client presents as a client receiving cytotoxic chemotherapy whose absolute neutrophil count is
420/mm3. What should the nurse do first?
A. cluster care, assess for symptomatic hypoxia, and notify the provider about severe anemia
B. begin aggressive prescribed IV hydration and continuous cardiac monitoring
C. elevate the head of the bed and urgently notify the provider
D. initiate neutropenic precautions and notify the provider about fever
Answer: D. initiate neutropenic precautions and notify the provider about fever
Rationale: initiate neutropenic precautions and notify the provider about fever is the priority because it addresses the most immediate
safety or physiologic need in this situation. Severe neutropenia markedly reduces the client's ability to contain bacterial and fungal
infection. The alternative actions may have a role later or in different clinical circumstances, but they do not take precedence over
the problem described. After the initial intervention, the nurse should reassess the client's response and communicate any
deterioration promptly.
Question 9: The nurse is providing discharge teaching for a client after axillary lymph-node dissection who has
arm heaviness and swelling. Which instruction is most appropriate?
A. report new weakness, numbness, saddle anesthesia, or urinary retention without delay
B. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
C. avoid constrictive clothing and skin injury and follow prescribed compression and exercise guidance
D. balance activity with rest and change positions slowly if dizziness occurs
Answer: C. avoid constrictive clothing and skin injury and follow prescribed compression and exercise guidance
Rationale: avoid constrictive clothing and skin injury and follow prescribed compression and exercise guidance is the most
appropriate teaching point because it directly reduces risk and supports safe self-management. Disrupted lymphatic drainage can
cause chronic protein-rich edema and increase infection risk. The alternative instructions either apply to different conditions or
could delay recognition of an important complication. The nurse should confirm understanding with teach-back and adapt
instructions to the client's health literacy and resources.
, Question 10: Which prescribed therapy best addresses the primary problem in a client with a high-burden
hematologic malignancy shortly after starting chemotherapy?
A. compression therapy and specialized exercise when prescribed
B. urate-lowering therapy such as allopurinol or rasburicase as prescribed
C. platelet transfusion when clinically indicated
D. topical oral analgesic measures and systemic pain control as prescribed
Answer: B. urate-lowering therapy such as allopurinol or rasburicase as prescribed
Rationale: urate-lowering therapy such as allopurinol or rasburicase as prescribed is the therapy most closely aligned with the primary
problem described. Rapid tumor-cell breakdown releases intracellular contents and can cause metabolic Page 3 ATI RN
Concept-Based Assessment Level 3 - Online Practice Form A emergencies and renal injury. Treatment still requires review of
contraindications, current clinical status, and the provider's specific prescription. The nurse should monitor for therapeutic response
and adverse effects and escalate care if the expected improvement does not occur.
Question 11: Which complication is a significant concern for a client receiving head and neck radiation who has
painful oral erythema?
A. dehydration, malnutrition, and secondary oral infection
B. cellulitis and progressive tissue fibrosis
C. airway compromise and reduced cerebral venous drainage
D. spontaneous intracranial or gastrointestinal hemorrhage
Answer: A. dehydration, malnutrition, and secondary oral infection
Rationale: dehydration, malnutrition, and secondary oral infection is a clinically important complication associated with this problem.
Radiation can injure rapidly dividing mucosal cells, producing painful inflammation and impaired intake. Recognizing early
warning signs allows the nurse to escalate care before preventable deterioration occurs. The other complications may be relevant in
different disorders, but they are less directly connected to the cues in this scenario.
Question 12: Which assessment or monitoring plan is most appropriate for a client with metastatic cancer who
reports new severe back pain and leg weakness?
A. oral mucosa, weight, intake, and signs of infection
B. hemoglobin, hematocrit, heart rate, oxygenation, and symptoms
C. motor strength, sensation, reflexes, and bladder function
D. respiratory status, neurologic status, and degree of upper-body edema
Answer: C. motor strength, sensation, reflexes, and bladder function
Rationale: motor strength, sensation, reflexes, and bladder function provides the most useful data for evaluating progression, response
to treatment, and emerging complications. Spinal cord compression is an oncologic emergency in which rapid treatment can
preserve neurologic function. Monitoring should be targeted to the mechanism of illness rather than performed as an unfocused
collection of tests. The nurse should trend results over time and relate changes to the client's symptoms and overall clinical status.
Form A Questions and Answers with Rationales
Question 1: The nurse is assessing a client receiving antineoplastic therapy with a platelet count of 18,000/mm3.
Which finding is most consistent with chemotherapy-induced thrombocytopenia?
A. petechiae, mucosal bleeding, and easy bruising
B. oral ulceration, erythema, and pain that interfere with nutrition
C. hyperkalemia, hyperphosphatemia, hypocalcemia, and rising uric acid
D. facial and upper-extremity edema with distended neck and chest veins
Answer: A. petechiae, mucosal bleeding, and easy bruising
Rationale: petechiae, mucosal bleeding, and easy bruising is the finding that best fits this clinical pattern. A very low platelet count
increases the risk for spontaneous and procedure-related bleeding. The other findings can occur in other conditions, but they do not
match the defining cues for chemotherapy-induced thrombocytopenia as closely. The nurse should compare the finding with the
client's baseline and continue focused assessment for changes that would alter urgency or management.
Question 2: Which treatment is most consistent with evidence-based management of a client receiving
antineoplastic therapy with a platelet count of 18,000/mm3?
A. compression therapy and specialized exercise when prescribed
B. platelet transfusion when clinically indicated
C. tumor-directed radiation, chemotherapy, or endovascular stenting as prescribed
D. urate-lowering therapy such as allopurinol or rasburicase as prescribed
Answer: B. platelet transfusion when clinically indicated
Rationale: platelet transfusion when clinically indicated is the therapy most closely aligned with the primary problem described. A
very low platelet count increases the risk for spontaneous and procedure-related bleeding. Treatment still requires review of
contraindications, current clinical status, and the provider's specific prescription. The nurse should monitor for therapeutic response
and adverse effects and escalate care if the expected improvement does not occur.
Question 3: A client is being treated for chemotherapy-induced thrombocytopenia. Which potential complication
should the nurse monitor for?
A. spontaneous intracranial or gastrointestinal hemorrhage
B. cellulitis and progressive tissue fibrosis
C. dehydration, malnutrition, and secondary oral infection
D. airway compromise and reduced cerebral venous drainage
Answer: A. spontaneous intracranial or gastrointestinal hemorrhage
Rationale: spontaneous intracranial or gastrointestinal hemorrhage is a clinically important complication associated with this problem.
A very low platelet count increases the risk for spontaneous and procedure-related bleeding. Recognizing early warning signs
allows the nurse to escalate care before preventable deterioration occurs. The other complications may be relevant in different
disorders, but they are less directly connected to the cues in this scenario.
,Question 4: The nurse is evaluating a client after axillary lymph-node dissection who has arm heaviness and
swelling. Which data are most important to trend? Page 1 ATI RN Concept-Based Assessment Level 3 - Online
Practice Form A
A. platelet count, hemoglobin, and evidence of bleeding
B. potassium, calcium, phosphorus, uric acid, creatinine, and urine output
C. hemoglobin, hematocrit, heart rate, oxygenation, and symptoms
D. arm circumference, skin integrity, and signs of infection
Answer: D. arm circumference, skin integrity, and signs of infection
Rationale: arm circumference, skin integrity, and signs of infection provides the most useful data for evaluating progression, response
to treatment, and emerging complications. Disrupted lymphatic drainage can cause chronic protein-rich edema and increase
infection risk. Monitoring should be targeted to the mechanism of illness rather than performed as an unfocused collection of tests.
The nurse should trend results over time and relate changes to the client's symptoms and overall clinical status.
Question 5: Which statement should the nurse include when teaching a client with a high-burden hematologic
malignancy shortly after starting chemotherapy?
A. use a soft toothbrush, bland rinses, and avoid alcohol-containing mouthwash and irritating foods
B. avoid lying flat and report worsening dyspnea, stridor, or confusion immediately
C. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
D. balance activity with rest and change positions slowly if dizziness occurs
Answer: C. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
Rationale: report muscle weakness, palpitations, decreased urine output, or new confusion promptly is the most appropriate teaching
point because it directly reduces risk and supports safe self-management. Rapid tumor-cell breakdown releases intracellular
contents and can cause metabolic emergencies and renal injury. The alternative instructions either apply to different conditions or
could delay recognition of an important complication. The nurse should confirm understanding with teach-back and adapt
instructions to the client's health literacy and resources.
Question 6: A client is being treated for anemia related to marrow suppression. Which potential complication
should the nurse monitor for?
A. airway compromise and reduced cerebral venous drainage
B. myocardial ischemia or tissue hypoxia when severe
C. dehydration, malnutrition, and secondary oral infection
D. spontaneous intracranial or gastrointestinal hemorrhage
Answer: B. myocardial ischemia or tissue hypoxia when severe
Rationale: myocardial ischemia or tissue hypoxia when severe is a clinically important complication associated with this problem.
Reduced red-cell mass decreases oxygen-carrying capacity and can impair tissue oxygen delivery. Recognizing early warning signs
allows the nurse to escalate care before preventable deterioration occurs. The other complications may be relevant in different
disorders, but they are less directly connected to the cues in this scenario.
,Question 7: Which client teaching best supports safe self-management for a client receiving cytotoxic
chemotherapy whose absolute neutrophil count is 420/mm3?
A. avoid crowds, sick contacts, raw or undercooked foods, and rectal procedures while neutropenic
B. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
C. report new weakness, numbness, saddle anesthesia, or urinary retention without delay
D. use a soft toothbrush and electric razor and report black stools or prolonged bleeding Page 2 ATI RN Concept-Based
Assessment Level 3 - Online Practice Form A
Answer: A. avoid crowds, sick contacts, raw or undercooked foods, and rectal procedures while neutropenic
Rationale: avoid crowds, sick contacts, raw or undercooked foods, and rectal procedures while neutropenic is the most appropriate
teaching point because it directly reduces risk and supports safe self-management. Severe neutropenia markedly reduces the client's
ability to contain bacterial and fungal infection. The alternative instructions either apply to different conditions or could delay
recognition of an important complication. The nurse should confirm understanding with teach-back and adapt instructions to the
client's health literacy and resources.
Question 8: A client presents as a client receiving cytotoxic chemotherapy whose absolute neutrophil count is
420/mm3. What should the nurse do first?
A. cluster care, assess for symptomatic hypoxia, and notify the provider about severe anemia
B. begin aggressive prescribed IV hydration and continuous cardiac monitoring
C. elevate the head of the bed and urgently notify the provider
D. initiate neutropenic precautions and notify the provider about fever
Answer: D. initiate neutropenic precautions and notify the provider about fever
Rationale: initiate neutropenic precautions and notify the provider about fever is the priority because it addresses the most immediate
safety or physiologic need in this situation. Severe neutropenia markedly reduces the client's ability to contain bacterial and fungal
infection. The alternative actions may have a role later or in different clinical circumstances, but they do not take precedence over
the problem described. After the initial intervention, the nurse should reassess the client's response and communicate any
deterioration promptly.
Question 9: The nurse is providing discharge teaching for a client after axillary lymph-node dissection who has
arm heaviness and swelling. Which instruction is most appropriate?
A. report new weakness, numbness, saddle anesthesia, or urinary retention without delay
B. report muscle weakness, palpitations, decreased urine output, or new confusion promptly
C. avoid constrictive clothing and skin injury and follow prescribed compression and exercise guidance
D. balance activity with rest and change positions slowly if dizziness occurs
Answer: C. avoid constrictive clothing and skin injury and follow prescribed compression and exercise guidance
Rationale: avoid constrictive clothing and skin injury and follow prescribed compression and exercise guidance is the most
appropriate teaching point because it directly reduces risk and supports safe self-management. Disrupted lymphatic drainage can
cause chronic protein-rich edema and increase infection risk. The alternative instructions either apply to different conditions or
could delay recognition of an important complication. The nurse should confirm understanding with teach-back and adapt
instructions to the client's health literacy and resources.
, Question 10: Which prescribed therapy best addresses the primary problem in a client with a high-burden
hematologic malignancy shortly after starting chemotherapy?
A. compression therapy and specialized exercise when prescribed
B. urate-lowering therapy such as allopurinol or rasburicase as prescribed
C. platelet transfusion when clinically indicated
D. topical oral analgesic measures and systemic pain control as prescribed
Answer: B. urate-lowering therapy such as allopurinol or rasburicase as prescribed
Rationale: urate-lowering therapy such as allopurinol or rasburicase as prescribed is the therapy most closely aligned with the primary
problem described. Rapid tumor-cell breakdown releases intracellular contents and can cause metabolic Page 3 ATI RN
Concept-Based Assessment Level 3 - Online Practice Form A emergencies and renal injury. Treatment still requires review of
contraindications, current clinical status, and the provider's specific prescription. The nurse should monitor for therapeutic response
and adverse effects and escalate care if the expected improvement does not occur.
Question 11: Which complication is a significant concern for a client receiving head and neck radiation who has
painful oral erythema?
A. dehydration, malnutrition, and secondary oral infection
B. cellulitis and progressive tissue fibrosis
C. airway compromise and reduced cerebral venous drainage
D. spontaneous intracranial or gastrointestinal hemorrhage
Answer: A. dehydration, malnutrition, and secondary oral infection
Rationale: dehydration, malnutrition, and secondary oral infection is a clinically important complication associated with this problem.
Radiation can injure rapidly dividing mucosal cells, producing painful inflammation and impaired intake. Recognizing early
warning signs allows the nurse to escalate care before preventable deterioration occurs. The other complications may be relevant in
different disorders, but they are less directly connected to the cues in this scenario.
Question 12: Which assessment or monitoring plan is most appropriate for a client with metastatic cancer who
reports new severe back pain and leg weakness?
A. oral mucosa, weight, intake, and signs of infection
B. hemoglobin, hematocrit, heart rate, oxygenation, and symptoms
C. motor strength, sensation, reflexes, and bladder function
D. respiratory status, neurologic status, and degree of upper-body edema
Answer: C. motor strength, sensation, reflexes, and bladder function
Rationale: motor strength, sensation, reflexes, and bladder function provides the most useful data for evaluating progression, response
to treatment, and emerging complications. Spinal cord compression is an oncologic emergency in which rapid treatment can
preserve neurologic function. Monitoring should be targeted to the mechanism of illness rather than performed as an unfocused
collection of tests. The nurse should trend results over time and relate changes to the client's symptoms and overall clinical status.
