ATI RN Concept Based Assessment Level 3 Proctored Questions
and Answers with Rationales
Question 1: A nurse is caring for a client in this situation: A client with cancer says body changes have made
intimacy feel impossible. Which action should the nurse take?
A. Explain that phosphodiesterase-5 inhibitors can cause dangerous hypotension when combined with nitrates
B. Provide individualized education about function, fertility, positioning, autonomic risks, and adaptive strategies
C. State clearly that ongoing sexual activity requires freely given and continuing consent and assess safety
D. Explore body-image concerns and desired forms of intimacy rather than assuming intercourse is the only meaningful goal
Answer: D. Explore body-image concerns and desired forms of intimacy rather than assuming intercourse is the only
meaningful goal
Rationale: Sexuality includes body image, affection, identity, intimacy, and sexual activity and can be affected by illness and
treatment. Sexual health care is inclusive, nonjudgmental, consent-centered, and responsive to physical illness, medication effects,
relationships, function, and prevention needs. The other actions may be useful in different circumstances, but they do not best
address the priority cues in this scenario. The nurse should reassess the client after intervention and escalate care if the expected
response does not occur.
Question 2: Which clinical principle best explains the priority concern in this situation: A family reports that a
client has gradually lost the ability to manage finances over several years but remains alert and attentive?
A. Late-day worsening can occur with dementia, and environmental overload, fatigue, pain, and toileting needs can intensify
confusion
B. Gradual persistent loss of complex function is more consistent with dementia than with the acute fluctuating pattern of
delirium
C. Depression can impair concentration and memory and may mimic or worsen cognitive dysfunction
D. Restraints can worsen agitation and do not treat the underlying cause of acute confusion
Answer: B. Gradual persistent loss of complex function is more consistent with dementia than with the acute
fluctuating pattern of delirium
Rationale: Gradual persistent loss of complex function is more consistent with dementia than with the acute fluctuating pattern of
delirium. Cognitive nursing care distinguishes acute reversible changes from progressive impairment and protects function,
communication, and safety. The alternative explanations describe other mechanisms or situations and do not fit the clinical cues as
closely. Correctly linking the cues to the underlying mechanism supports safer nursing decisions and appropriate follow-up. ATI
RN Concept-Based Level 3 Proctored - Original Practice Bank Page 1
Question 3: Which clinical principle best explains the priority concern in this situation: A client started an
antidepressant ten days ago reports new agitation and increased energy but says hopelessness is unchanged?
A. Monoamine oxidase inhibition can prevent tyramine metabolism and trigger excessive catecholamine release
B. Mania can increase energy expenditure and reduce sustained attention to eating, creating nutritional and dehydration risk
C. Early activation can increase the ability to act on suicidal thoughts before mood fully improves
D. Grandiosity and decreased need for sleep can signal mania rather than recovery from bipolar disorder
Answer: C. Early activation can increase the ability to act on suicidal thoughts before mood fully improves
Rationale: Early activation can increase the ability to act on suicidal thoughts before mood fully improves. Mood-disorder care
combines suicide prevention, therapeutic communication, medication safety, physiologic support, and recognition of severe
depression or mania. The alternative explanations describe other mechanisms or situations and do not fit the clinical cues as
closely. Correctly linking the cues to the underlying mechanism supports safer nursing decisions and appropriate follow-up.
,Question 4: A nurse is caring for a client in this situation: A healthy adult asks why sleep is part of wellness
counseling. Which action should the nurse take?
A. Teach sun-protective clothing, broad-spectrum sunscreen, shade use, and evaluation of changing skin lesions
B. Recommend regular physical activity with sustainable nutrition and weight-management goals
C. Explain that adequate sleep supports cognition, metabolic regulation, immune function, and injury prevention
D. Set individualized behavior goals focused on nutrition quality, activity, sleep, and gradual weight change
Answer: C. Explain that adequate sleep supports cognition, metabolic regulation, immune function, and injury
prevention
Rationale: Chronic insufficient sleep is associated with impaired functioning and multiple health risks. Health promotion uses
prevention, screening, risk reduction, behavior change, access, and education to improve outcomes before severe disease develops.
The other actions may be useful in different circumstances, but they do not best address the priority cues in this scenario. The nurse
should reassess the client after intervention and escalate care if the expected response does not occur.
Question 5: After the priority intervention is implemented for this situation - A client with chronic pain withdraws
from friends and stops all enjoyable activities - which finding best indicates the desired response?
A. The client identifies a safe next step and at least one source of support
B. The client uses the strategy consistently and reports improved ability to regulate anxiety
C. The client reports lower anxiety and demonstrates slower breathing before surgery
D. The client resumes selected activities and reports improved function even if pain is not fully eliminated
Answer: D. The client resumes selected activities and reports improved function even if pain is not fully eliminated
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Social withdrawal and loss of
reinforcing activities can worsen both distress and perceived pain burden. Stress and coping care identifies stressors, physiologic
effects, coping patterns, supports, crisis risk, and strategies that improve adaptation and function. The nurse should continue
trending the relevant clinical findings because deterioration or failure to improve requires reassessment and escalation. ATI RN
Concept-Based Level 3 Proctored - Original Practice Bank Page 2
Question 6: A nurse is caring for a client in this situation: A client receiving a blood transfusion develops fever,
chills, flank pain, and hypotension. Which action should the nurse take?
A. Recognize impaired oxygen-carrying capacity and evaluate the need for treatment of anemia
B. Stop the transfusion immediately and follow the transfusion-reaction protocol
C. Treat the findings as inadequate cardiac output and escalate care for cardiogenic shock
D. Prepare to start prescribed vasopressor therapy while continuing source control and perfusion monitoring
Answer: B. Stop the transfusion immediately and follow the transfusion-reaction protocol
Rationale: An acute hemolytic reaction can cause intravascular hemolysis, shock, and kidney injury and requires immediate cessation
of donor blood. Perfusion depends on effective circulation, adequate blood volume and oxygen-carrying capacity, vascular
patency, and timely treatment of shock or ischemia. The other actions may be useful in different circumstances, but they do not
best address the priority cues in this scenario. The nurse should reassess the client after intervention and escalate care if the
expected response does not occur.
,Question 7: After the priority intervention is implemented for this situation - An older adult recently retired and
says life no longer has a useful purpose - which finding best indicates the desired response?
A. The toddler participates in care with fewer power struggles
B. The child identifies areas of competence and remains engaged in school and peer activities
C. The client identifies meaningful activities and receives further evaluation if depressive symptoms are present
D. The client identifies relationship choices that preserve important supports and personal goals
Answer: C. The client identifies meaningful activities and receives further evaluation if depressive symptoms are
present
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Later-life adaptation involves
integrating life experiences while maintaining purpose and connection. Developmental care interprets health needs in the context of
age-related physical, cognitive, psychosocial, and functional change. The nurse should continue trending the relevant clinical
findings because deterioration or failure to improve requires reassessment and escalation.
Question 8: After the priority intervention is implemented for this situation - A client taking high-dose
nonsteroidal anti-inflammatory drugs develops black stools and dizziness - which finding best indicates the desired
response?
A. Antimicrobial and resuscitation therapy begin promptly with stabilization of perfusion
B. The inflammatory marker falls as the underlying inflammatory process improves
C. The client is evaluated for bleeding and remains hemodynamically stable with safer pain management
D. Blood pressure and lactate improve as perfusion and the underlying cause are treated
Answer: C. The client is evaluated for bleeding and remains hemodynamically stable with safer pain management
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Cyclooxygenase inhibition can
reduce gastric mucosal protection and increase bleeding risk. Inflammation is a protective response to injury or infection that can
become harmful when excessive, persistent, or systemic. The nurse should continue trending the relevant clinical findings because
deterioration or failure to improve requires reassessment and escalation. ATI RN Concept-Based Level 3 Proctored - Original
Practice Bank Page 3
Question 9: A nurse is caring for a client in this situation: A client with terminal illness says, I am afraid of being
alone when I die. Which action should the nurse take?
A. Explore the family concern while maintaining the client right to truthful information and informed decision-making
B. Administer prescribed opioids and position for comfort while assessing distress
C. Support the referral because palliative care can be provided alongside treatments intended to prolong life
D. Acknowledge the fear and help arrange presence from chosen family, staff, or spiritual supports
Answer: D. Acknowledge the fear and help arrange presence from chosen family, staff, or spiritual supports
Rationale: Therapeutic end-of-life care addresses emotional and existential concerns rather than offering false reassurance.
End-of-life care prioritizes comfort, informed goals, dignity, symptom relief, family support, and respect for client autonomy. The
other actions may be useful in different circumstances, but they do not best address the priority cues in this scenario. The nurse
should reassess the client after intervention and escalate care if the expected response does not occur.
, Question 10: Which clinical principle best explains the priority concern in this situation: A client with metastatic
cancer reports new persistent focal back pain and leg weakness?
A. Metastatic tumor growth in the vertebral column can compress neural tissue and cause irreversible neurologic injury if
treatment is delayed
B. Metastasis occurs when malignant cells detach, invade surrounding structures, enter circulation, and establish growth at
another site
C. A growing tumor requires vascular support, and malignant cells can promote formation of new vessels to sustain growth
D. Severe neutropenia with fever can represent a life-threatening infection that requires rapid evaluation and antimicrobial
treatment
Answer: A. Metastatic tumor growth in the vertebral column can compress neural tissue and cause irreversible
neurologic injury if treatment is delayed
Rationale: Metastatic tumor growth in the vertebral column can compress neural tissue and cause irreversible neurologic injury if
treatment is delayed. Cellular regulation questions integrate cell growth, replication, differentiation, tissue injury, and treatment
effects on both malignant and normal cells. The alternative explanations describe other mechanisms or situations and do not fit the
clinical cues as closely. Correctly linking the cues to the underlying mechanism supports safer nursing decisions and appropriate
follow-up.
Question 11: After the priority intervention is implemented for this situation - A client with head trauma becomes
increasingly drowsy and develops a unilateral dilated pupil - which finding best indicates the desired response?
A. Airway and cerebral perfusion are supported while urgent neurosurgical evaluation proceeds
B. Blood pressure falls after the triggering stimulus is removed and symptoms resolve
C. Cerebrospinal fluid drainage returns to the prescribed range with stable neurologic findings
D. Neurologic symptoms return toward baseline after body temperature normalizes
Answer: A. Airway and cerebral perfusion are supported while urgent neurosurgical evaluation proceeds
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Declining consciousness with
pupillary asymmetry can signal dangerous intracranial mass effect. Neural regulation care prioritizes rapid recognition of changes
that threaten cerebral perfusion, airway function, spinal cord integrity, and neurologic recovery. The nurse should continue
trending the relevant clinical findings because deterioration or failure to improve requires reassessment and escalation. ATI RN
Concept-Based Level 3 Proctored - Original Practice Bank Page 4
Question 12: A nurse is caring for a client in this situation: A laboring client has recurrent late fetal heart-rate
decelerations. Which action should the nurse take?
A. Continue effective milk removal and obtain treatment for suspected mastitis
B. Treat the findings as severe preeclampsia and initiate urgent maternal-fetal evaluation and prescribed therapy
C. Massage the fundus and initiate the postpartum hemorrhage protocol
D. Reposition the client, improve maternal oxygen delivery and perfusion, stop uterotonic stimulation if present, and escalate
care
Answer: D. Reposition the client, improve maternal oxygen delivery and perfusion, stop uterotonic stimulation if
present, and escalate care
Rationale: Late decelerations suggest uteroplacental insufficiency and reduced fetal oxygen reserve. Reproductive nursing integrates
maternal-fetal safety, pregnancy complications, labor, postpartum care, fertility, and reproductive health across the lifespan. The
other actions may be useful in different circumstances, but they do not best address the priority cues in this scenario. The nurse
should reassess the client after intervention and escalate care if the expected response does not occur.
and Answers with Rationales
Question 1: A nurse is caring for a client in this situation: A client with cancer says body changes have made
intimacy feel impossible. Which action should the nurse take?
A. Explain that phosphodiesterase-5 inhibitors can cause dangerous hypotension when combined with nitrates
B. Provide individualized education about function, fertility, positioning, autonomic risks, and adaptive strategies
C. State clearly that ongoing sexual activity requires freely given and continuing consent and assess safety
D. Explore body-image concerns and desired forms of intimacy rather than assuming intercourse is the only meaningful goal
Answer: D. Explore body-image concerns and desired forms of intimacy rather than assuming intercourse is the only
meaningful goal
Rationale: Sexuality includes body image, affection, identity, intimacy, and sexual activity and can be affected by illness and
treatment. Sexual health care is inclusive, nonjudgmental, consent-centered, and responsive to physical illness, medication effects,
relationships, function, and prevention needs. The other actions may be useful in different circumstances, but they do not best
address the priority cues in this scenario. The nurse should reassess the client after intervention and escalate care if the expected
response does not occur.
Question 2: Which clinical principle best explains the priority concern in this situation: A family reports that a
client has gradually lost the ability to manage finances over several years but remains alert and attentive?
A. Late-day worsening can occur with dementia, and environmental overload, fatigue, pain, and toileting needs can intensify
confusion
B. Gradual persistent loss of complex function is more consistent with dementia than with the acute fluctuating pattern of
delirium
C. Depression can impair concentration and memory and may mimic or worsen cognitive dysfunction
D. Restraints can worsen agitation and do not treat the underlying cause of acute confusion
Answer: B. Gradual persistent loss of complex function is more consistent with dementia than with the acute
fluctuating pattern of delirium
Rationale: Gradual persistent loss of complex function is more consistent with dementia than with the acute fluctuating pattern of
delirium. Cognitive nursing care distinguishes acute reversible changes from progressive impairment and protects function,
communication, and safety. The alternative explanations describe other mechanisms or situations and do not fit the clinical cues as
closely. Correctly linking the cues to the underlying mechanism supports safer nursing decisions and appropriate follow-up. ATI
RN Concept-Based Level 3 Proctored - Original Practice Bank Page 1
Question 3: Which clinical principle best explains the priority concern in this situation: A client started an
antidepressant ten days ago reports new agitation and increased energy but says hopelessness is unchanged?
A. Monoamine oxidase inhibition can prevent tyramine metabolism and trigger excessive catecholamine release
B. Mania can increase energy expenditure and reduce sustained attention to eating, creating nutritional and dehydration risk
C. Early activation can increase the ability to act on suicidal thoughts before mood fully improves
D. Grandiosity and decreased need for sleep can signal mania rather than recovery from bipolar disorder
Answer: C. Early activation can increase the ability to act on suicidal thoughts before mood fully improves
Rationale: Early activation can increase the ability to act on suicidal thoughts before mood fully improves. Mood-disorder care
combines suicide prevention, therapeutic communication, medication safety, physiologic support, and recognition of severe
depression or mania. The alternative explanations describe other mechanisms or situations and do not fit the clinical cues as
closely. Correctly linking the cues to the underlying mechanism supports safer nursing decisions and appropriate follow-up.
,Question 4: A nurse is caring for a client in this situation: A healthy adult asks why sleep is part of wellness
counseling. Which action should the nurse take?
A. Teach sun-protective clothing, broad-spectrum sunscreen, shade use, and evaluation of changing skin lesions
B. Recommend regular physical activity with sustainable nutrition and weight-management goals
C. Explain that adequate sleep supports cognition, metabolic regulation, immune function, and injury prevention
D. Set individualized behavior goals focused on nutrition quality, activity, sleep, and gradual weight change
Answer: C. Explain that adequate sleep supports cognition, metabolic regulation, immune function, and injury
prevention
Rationale: Chronic insufficient sleep is associated with impaired functioning and multiple health risks. Health promotion uses
prevention, screening, risk reduction, behavior change, access, and education to improve outcomes before severe disease develops.
The other actions may be useful in different circumstances, but they do not best address the priority cues in this scenario. The nurse
should reassess the client after intervention and escalate care if the expected response does not occur.
Question 5: After the priority intervention is implemented for this situation - A client with chronic pain withdraws
from friends and stops all enjoyable activities - which finding best indicates the desired response?
A. The client identifies a safe next step and at least one source of support
B. The client uses the strategy consistently and reports improved ability to regulate anxiety
C. The client reports lower anxiety and demonstrates slower breathing before surgery
D. The client resumes selected activities and reports improved function even if pain is not fully eliminated
Answer: D. The client resumes selected activities and reports improved function even if pain is not fully eliminated
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Social withdrawal and loss of
reinforcing activities can worsen both distress and perceived pain burden. Stress and coping care identifies stressors, physiologic
effects, coping patterns, supports, crisis risk, and strategies that improve adaptation and function. The nurse should continue
trending the relevant clinical findings because deterioration or failure to improve requires reassessment and escalation. ATI RN
Concept-Based Level 3 Proctored - Original Practice Bank Page 2
Question 6: A nurse is caring for a client in this situation: A client receiving a blood transfusion develops fever,
chills, flank pain, and hypotension. Which action should the nurse take?
A. Recognize impaired oxygen-carrying capacity and evaluate the need for treatment of anemia
B. Stop the transfusion immediately and follow the transfusion-reaction protocol
C. Treat the findings as inadequate cardiac output and escalate care for cardiogenic shock
D. Prepare to start prescribed vasopressor therapy while continuing source control and perfusion monitoring
Answer: B. Stop the transfusion immediately and follow the transfusion-reaction protocol
Rationale: An acute hemolytic reaction can cause intravascular hemolysis, shock, and kidney injury and requires immediate cessation
of donor blood. Perfusion depends on effective circulation, adequate blood volume and oxygen-carrying capacity, vascular
patency, and timely treatment of shock or ischemia. The other actions may be useful in different circumstances, but they do not
best address the priority cues in this scenario. The nurse should reassess the client after intervention and escalate care if the
expected response does not occur.
,Question 7: After the priority intervention is implemented for this situation - An older adult recently retired and
says life no longer has a useful purpose - which finding best indicates the desired response?
A. The toddler participates in care with fewer power struggles
B. The child identifies areas of competence and remains engaged in school and peer activities
C. The client identifies meaningful activities and receives further evaluation if depressive symptoms are present
D. The client identifies relationship choices that preserve important supports and personal goals
Answer: C. The client identifies meaningful activities and receives further evaluation if depressive symptoms are
present
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Later-life adaptation involves
integrating life experiences while maintaining purpose and connection. Developmental care interprets health needs in the context of
age-related physical, cognitive, psychosocial, and functional change. The nurse should continue trending the relevant clinical
findings because deterioration or failure to improve requires reassessment and escalation.
Question 8: After the priority intervention is implemented for this situation - A client taking high-dose
nonsteroidal anti-inflammatory drugs develops black stools and dizziness - which finding best indicates the desired
response?
A. Antimicrobial and resuscitation therapy begin promptly with stabilization of perfusion
B. The inflammatory marker falls as the underlying inflammatory process improves
C. The client is evaluated for bleeding and remains hemodynamically stable with safer pain management
D. Blood pressure and lactate improve as perfusion and the underlying cause are treated
Answer: C. The client is evaluated for bleeding and remains hemodynamically stable with safer pain management
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Cyclooxygenase inhibition can
reduce gastric mucosal protection and increase bleeding risk. Inflammation is a protective response to injury or infection that can
become harmful when excessive, persistent, or systemic. The nurse should continue trending the relevant clinical findings because
deterioration or failure to improve requires reassessment and escalation. ATI RN Concept-Based Level 3 Proctored - Original
Practice Bank Page 3
Question 9: A nurse is caring for a client in this situation: A client with terminal illness says, I am afraid of being
alone when I die. Which action should the nurse take?
A. Explore the family concern while maintaining the client right to truthful information and informed decision-making
B. Administer prescribed opioids and position for comfort while assessing distress
C. Support the referral because palliative care can be provided alongside treatments intended to prolong life
D. Acknowledge the fear and help arrange presence from chosen family, staff, or spiritual supports
Answer: D. Acknowledge the fear and help arrange presence from chosen family, staff, or spiritual supports
Rationale: Therapeutic end-of-life care addresses emotional and existential concerns rather than offering false reassurance.
End-of-life care prioritizes comfort, informed goals, dignity, symptom relief, family support, and respect for client autonomy. The
other actions may be useful in different circumstances, but they do not best address the priority cues in this scenario. The nurse
should reassess the client after intervention and escalate care if the expected response does not occur.
, Question 10: Which clinical principle best explains the priority concern in this situation: A client with metastatic
cancer reports new persistent focal back pain and leg weakness?
A. Metastatic tumor growth in the vertebral column can compress neural tissue and cause irreversible neurologic injury if
treatment is delayed
B. Metastasis occurs when malignant cells detach, invade surrounding structures, enter circulation, and establish growth at
another site
C. A growing tumor requires vascular support, and malignant cells can promote formation of new vessels to sustain growth
D. Severe neutropenia with fever can represent a life-threatening infection that requires rapid evaluation and antimicrobial
treatment
Answer: A. Metastatic tumor growth in the vertebral column can compress neural tissue and cause irreversible
neurologic injury if treatment is delayed
Rationale: Metastatic tumor growth in the vertebral column can compress neural tissue and cause irreversible neurologic injury if
treatment is delayed. Cellular regulation questions integrate cell growth, replication, differentiation, tissue injury, and treatment
effects on both malignant and normal cells. The alternative explanations describe other mechanisms or situations and do not fit the
clinical cues as closely. Correctly linking the cues to the underlying mechanism supports safer nursing decisions and appropriate
follow-up.
Question 11: After the priority intervention is implemented for this situation - A client with head trauma becomes
increasingly drowsy and develops a unilateral dilated pupil - which finding best indicates the desired response?
A. Airway and cerebral perfusion are supported while urgent neurosurgical evaluation proceeds
B. Blood pressure falls after the triggering stimulus is removed and symptoms resolve
C. Cerebrospinal fluid drainage returns to the prescribed range with stable neurologic findings
D. Neurologic symptoms return toward baseline after body temperature normalizes
Answer: A. Airway and cerebral perfusion are supported while urgent neurosurgical evaluation proceeds
Rationale: The expected finding reflects improvement after the priority intervention is implemented. Declining consciousness with
pupillary asymmetry can signal dangerous intracranial mass effect. Neural regulation care prioritizes rapid recognition of changes
that threaten cerebral perfusion, airway function, spinal cord integrity, and neurologic recovery. The nurse should continue
trending the relevant clinical findings because deterioration or failure to improve requires reassessment and escalation. ATI RN
Concept-Based Level 3 Proctored - Original Practice Bank Page 4
Question 12: A nurse is caring for a client in this situation: A laboring client has recurrent late fetal heart-rate
decelerations. Which action should the nurse take?
A. Continue effective milk removal and obtain treatment for suspected mastitis
B. Treat the findings as severe preeclampsia and initiate urgent maternal-fetal evaluation and prescribed therapy
C. Massage the fundus and initiate the postpartum hemorrhage protocol
D. Reposition the client, improve maternal oxygen delivery and perfusion, stop uterotonic stimulation if present, and escalate
care
Answer: D. Reposition the client, improve maternal oxygen delivery and perfusion, stop uterotonic stimulation if
present, and escalate care
Rationale: Late decelerations suggest uteroplacental insufficiency and reduced fetal oxygen reserve. Reproductive nursing integrates
maternal-fetal safety, pregnancy complications, labor, postpartum care, fertility, and reproductive health across the lifespan. The
other actions may be useful in different circumstances, but they do not best address the priority cues in this scenario. The nurse
should reassess the client after intervention and escalate care if the expected response does not occur.
