ATI Level 3 Proctored Exam 2026/2027 |
Nursing Level 3 Study Guide | Practice
Questions & Answers | ATI Exam Prep
Question 1 Prioritization / Emergency
Question:
A nurse is working in the emergency department when four clients
arrive simultaneously. Which client should the nurse assess first?
A. A 68-year-old client with COPD who reports increased sputum
production and a low-grade fever
B. A 45-year-old client with a history of hypertension who reports a
sudden, severe headache and neck stiffness
C. A 30-year-old client with a fractured radius who rates pain 7/10
and has a swollen forearm
D. A 55-year-old client with type 2 diabetes who has a blood glucose
of 210 mg/dL and reports polyuria
Correct Answer: B
Detailed Rationale:
The client with a sudden, severe headache and neck stiffness
presents with symptoms suggestive of a subarachnoid hemorrhage
(SAH) or meningeal irritation—both of which are life-threatening
neurologic emergencies requiring immediate assessment and
,intervention. The classic presentation of SAH is a "thunderclap"
headache (sudden, severe) often accompanied by neck stiffness due
to meningeal irritation. Time-sensitive interventions (CT scan,
possible neurosurgical consultation) are critical.
The learner must recognize that sudden-onset, severe neurologic
symptoms take priority over chronic or stable complaints. This is an
emergency situation where delay can result in permanent disability
or death.
Why Each Distractor Is Incorrect:
A: Increased sputum and low-grade fever suggest a COPD
exacerbation or respiratory infection. While this requires
assessment, it is not immediately life-threatening and can be
managed after the emergent client.
C: A fractured radius with swelling and pain is an orthopedic
urgency, not a life-threatening emergency. Neurovascular checks
are important, but this client is stable compared to option B.
D: A glucose of 210 mg/dL with polyuria indicates hyperglycemia
but is not an acute emergency. This client can be assessed after the
emergent client.
Clinical Pearl:
,"Thunderclap" headache + neck stiffness = think subarachnoid
hemorrhage until proven otherwise. This is a "do not pass go"
assessment priority.
Learning Objective:
Apply triage principles to prioritize care for multiple clients based
on acuity and potential for life-threatening deterioration.
Difficulty Level: Moderate
Cognitive Level: Clinical Judgment
Question 2 — Delegation
Question:
A nurse is caring for a team of clients on a medical-surgical unit.
Which task should the nurse delegate to a licensed practical nurse
(LPN)?
A. Administering IV push furosemide (Lasix) to a client with heart
failure
B. Performing a sterile dressing change on a surgical incision
C. Teaching a client about the side effects of warfarin (Coumadin)
D. Initiating a blood transfusion for a client with anemia
Correct Answer: B
, Detailed Rationale:
The nurse must apply the five rights of delegation (right task, right
circumstance, right person, right direction/communication, right
supervision/evaluation). Performing a sterile dressing change on a
surgical incision is within the LPN's scope of practice in most states,
provided the client is stable and the wound is not complex (e.g., no
extensive debridement or unstable vascular status).
The learner must distinguish between tasks that require the
registered nurse's assessment, judgment, or teaching versus those
that are skills-based and can be delegated to licensed personnel.
Why Each Distractor Is Incorrect:
A: IV push administration of high-alert medications like furosemide
typically requires an RN, as it requires assessment of response and
potential for rapid fluid shifts. LPNs may administer IV push
medications in some states, but high-alert drugs often require RN
administration.
C: Teaching is never delegated to an LPN. Client education requires
the assessment and evaluation skills of the RN.
D: Initiating a blood transfusion requires RN assessment,
monitoring for transfusion reactions, and clinical judgment. This is
not delegable to an LPN.
Nursing Level 3 Study Guide | Practice
Questions & Answers | ATI Exam Prep
Question 1 Prioritization / Emergency
Question:
A nurse is working in the emergency department when four clients
arrive simultaneously. Which client should the nurse assess first?
A. A 68-year-old client with COPD who reports increased sputum
production and a low-grade fever
B. A 45-year-old client with a history of hypertension who reports a
sudden, severe headache and neck stiffness
C. A 30-year-old client with a fractured radius who rates pain 7/10
and has a swollen forearm
D. A 55-year-old client with type 2 diabetes who has a blood glucose
of 210 mg/dL and reports polyuria
Correct Answer: B
Detailed Rationale:
The client with a sudden, severe headache and neck stiffness
presents with symptoms suggestive of a subarachnoid hemorrhage
(SAH) or meningeal irritation—both of which are life-threatening
neurologic emergencies requiring immediate assessment and
,intervention. The classic presentation of SAH is a "thunderclap"
headache (sudden, severe) often accompanied by neck stiffness due
to meningeal irritation. Time-sensitive interventions (CT scan,
possible neurosurgical consultation) are critical.
The learner must recognize that sudden-onset, severe neurologic
symptoms take priority over chronic or stable complaints. This is an
emergency situation where delay can result in permanent disability
or death.
Why Each Distractor Is Incorrect:
A: Increased sputum and low-grade fever suggest a COPD
exacerbation or respiratory infection. While this requires
assessment, it is not immediately life-threatening and can be
managed after the emergent client.
C: A fractured radius with swelling and pain is an orthopedic
urgency, not a life-threatening emergency. Neurovascular checks
are important, but this client is stable compared to option B.
D: A glucose of 210 mg/dL with polyuria indicates hyperglycemia
but is not an acute emergency. This client can be assessed after the
emergent client.
Clinical Pearl:
,"Thunderclap" headache + neck stiffness = think subarachnoid
hemorrhage until proven otherwise. This is a "do not pass go"
assessment priority.
Learning Objective:
Apply triage principles to prioritize care for multiple clients based
on acuity and potential for life-threatening deterioration.
Difficulty Level: Moderate
Cognitive Level: Clinical Judgment
Question 2 — Delegation
Question:
A nurse is caring for a team of clients on a medical-surgical unit.
Which task should the nurse delegate to a licensed practical nurse
(LPN)?
A. Administering IV push furosemide (Lasix) to a client with heart
failure
B. Performing a sterile dressing change on a surgical incision
C. Teaching a client about the side effects of warfarin (Coumadin)
D. Initiating a blood transfusion for a client with anemia
Correct Answer: B
, Detailed Rationale:
The nurse must apply the five rights of delegation (right task, right
circumstance, right person, right direction/communication, right
supervision/evaluation). Performing a sterile dressing change on a
surgical incision is within the LPN's scope of practice in most states,
provided the client is stable and the wound is not complex (e.g., no
extensive debridement or unstable vascular status).
The learner must distinguish between tasks that require the
registered nurse's assessment, judgment, or teaching versus those
that are skills-based and can be delegated to licensed personnel.
Why Each Distractor Is Incorrect:
A: IV push administration of high-alert medications like furosemide
typically requires an RN, as it requires assessment of response and
potential for rapid fluid shifts. LPNs may administer IV push
medications in some states, but high-alert drugs often require RN
administration.
C: Teaching is never delegated to an LPN. Client education requires
the assessment and evaluation skills of the RN.
D: Initiating a blood transfusion requires RN assessment,
monitoring for transfusion reactions, and clinical judgment. This is
not delegable to an LPN.
