1
ATI RN Concept-Based Assessment Level 2 Proctored
Exam (2025/2026) – Actual Exam Questions with
Verified Answers
180-Question Actual Exam: ATI RN Concept-Based Assessment Level 2
1. A nurse is caring for a client who is receiving a continuous heparin infusion for a deep vein
thrombosis (DVT). Which of the following laboratory values should the nurse monitor to evaluate the
therapeutic effect of the heparin?
A) Prothrombin time (PT) / International normalized ratio (INR)
B) Activated partial thromboplastin time (aPTT)
C) Platelet count
D) D-dimer
Answer: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin's primary anticoagulant effect is achieved by potentiating antithrombin III, which
inactivates thrombin and factor Xa. The activated partial thromboplastin time (aPTT) is the most
sensitive and widely used test to monitor the therapeutic range of unfractionated heparin, with a goal
typically 1.5 to 2.5 times the control value. The Prothrombin Time (PT) and International Normalized
Ratio (INR) are used to monitor warfarin therapy (A). While a baseline platelet count is important due to
the risk of heparin-induced thrombocytopenia (HIT), it does not reflect the anticoagulant effect of
heparin (C). D-dimer is a fibrin degradation product used to help rule out thromboembolic disorders, not
to monitor heparin therapy (D).
2. A nurse in an emergency department is caring for a client who has benzodiazepine toxicity due to
an overdose. The client is drowsy and has a respiratory rate of 8/min. Using the nursing process,
which of the following actions is the nurse's priority?
A) Prepare to administer flumazenil.
B) Obtain a complete history of the overdose.
C) Assess and support the client's airway and breathing.
D) Initiate continuous cardiac monitoring.
Answer: C. Assess and support the client's airway and breathing.
Rationale: This question requires the use of the nursing process (ADPIE) and prioritization frameworks
(ABCs). Assessment is the first step. While a complete history (B) and preparing for an antidote (A) are
important, the immediate priority for a client with a compromised respiratory rate of 8/min is to assess
and secure the airway and support breathing. This aligns with the "ABC" (Airway, Breathing, Circulation)
,2
priority-setting framework. The nurse must first ensure the patient is oxygenating before implementing
other interventions. Cardiac monitoring (D) is also important but is secondary to managing the
immediate threat to the airway and breathing.
3. A nurse is assessing a client who has been taking over-the-counter antacids for several weeks to
manage frequent heartburn. The client reports new-onset muscle weakness, lethargy, and
bradycardia. The nurse should suspect which of the following electrolyte imbalances?
A) Hypophosphatemia
B) Hypermagnesemia
C) Hyperkalemia
D) Hypocalcemia
Answer: B. Hypermagnesemia
Rationale: Many over-the-counter antacids and laxatives contain magnesium hydroxide or other
magnesium salts. Chronic, excessive ingestion can lead to hypermagnesemia, especially in clients with
underlying renal insufficiency. Classic manifestations of hypermagnesemia include neuromuscular
depression (muscle weakness, lethargy, diminished deep tendon reflexes), hypotension, and
bradycardia. The other options present with different clinical pictures: hypophosphatemia often
manifests as muscle weakness and bone pain, but it is not a classic complication of antacid use (A).
Hyperkalemia is more often associated with renal failure or medications like ACE inhibitors (C).
Hypocalcemia presents with neuromuscular irritability, such as paresthesia, tetany, and positive
Chvostek's/Trousseau's signs (D).
4. A nurse is planning care for a client who has a new diagnosis of ulcerative colitis. Which of the
following dietary instructions should the nurse include in the plan of care during an acute
exacerbation?
A) Increase intake of high-fiber foods like raw vegetables.
B) Follow a low-residue, low-fiber diet.
C) Drink a glass of red wine daily to reduce stress.
D) Consume a high-fat, ketogenic diet.
Answer: B. Follow a low-residue, low-fiber diet.
Rationale: During an acute exacerbation of ulcerative colitis, the colon is inflamed and irritated. A low-
residue, low-fiber diet is recommended to reduce the frequency and volume of stools, thereby
minimizing mechanical irritation to the inflamed bowel and decreasing abdominal cramping. Foods like
raw vegetables, nuts, and seeds are high in fiber and should be avoided during a flare-up (A). Alcohol,
caffeine, and spicy foods can also exacerbate symptoms and should be limited or avoided (C). A high-fat
diet can be difficult to digest and may worsen diarrhea (D).
5. A nurse is caring for a client who has a chest tube in place following a thoracotomy. The nurse notes
continuous bubbling in the water seal chamber of the chest drainage system. Which of the following
,3
actions should the nurse take first?
A) Clamp the chest tube near the insertion site.
B) Notify the healthcare provider.
C) Assess the chest tube tubing and connections for an air leak.
D) Increase the wall suction to -40 cm H2O.
Answer: C. Assess the chest tube tubing and connections for an air leak.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak somewhere in the
system, which can prevent the lung from fully re-expanding. The nurse's first action should be to
systematically assess for the source of the leak. This includes checking all connections from the chest
tube to the drainage unit to ensure they are tight and intact. The nurse should also assess the insertion
site dressing for an air leak. A chest tube should never be clamped except momentarily to assess for the
leak location or during a specific procedure, and only with a provider's order, due to the risk of tension
pneumothorax (A). Notifying the provider (B) and adjusting wall suction (D) are not the initial actions;
the nurse must first assess the equipment.
6. A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the
following statements by the client indicates an understanding of the teaching?
A) "I can use a salt substitute that contains potassium."
B) "It's okay to stop this medication once my blood pressure is normal."
C) "I should report the development of a dry, persistent cough to my provider."
D) "I will take this medication with a glass of milk to prevent stomach upset."
Answer: C. "I should report the development of a dry, persistent cough to my provider."
Rationale: Lisinopril is an ACE inhibitor. A common and bothersome side effect is a dry, hacking cough,
which is caused by the accumulation of bradykinin. The client should be taught to report this, as the
provider may switch them to an ARB (Angiotensin II Receptor Blocker), which does not have this effect.
Clients taking ACE inhibitors should avoid salt substitutes containing potassium chloride due to the risk
of hyperkalemia (A). Antihypertensive medications are typically lifelong; they should not be stopped
abruptly even if blood pressure normalizes (B). There is no need to take lisinopril with milk (D).
7. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central
venous catheter. The new bag of TPN has not arrived from the pharmacy, and the current infusion is
about to finish. Which of the following actions should the nurse take?
A) Discontinue the infusion and flush the line with normal saline.
B) Clamp the catheter and wait for the new TPN bag.
C) Infuse 0.9% sodium chloride at the same rate.
D) Infuse 10% dextrose in water at the same rate.
Answer: D. Infuse 10% dextrose in water at the same rate.
Rationale: Abrupt discontinuation of TPN can cause a rapid drop in blood glucose levels, leading to
rebound hypoglycemia. The pancreas has been secreting high levels of insulin in response to the high
, 4
glucose concentration in the TPN. To prevent this, a solution of 10% dextrose in water (D10W) should be
infused at the same rate as the TPN until the new bag is available. Infusing 0.9% sodium chloride will not
provide the necessary glucose (C). Simply stopping the infusion or clamping the catheter without a
dextrose source is dangerous and can lead to a hypoglycemic crisis (A, B).
8. A nurse is assessing a client who has a new diagnosis of myasthenia gravis. The nurse should expect
the client to report which of the following manifestations?
A) Progressive muscle weakness that worsens with activity and improves with rest
B) Ascending flaccid paralysis that begins in the lower extremities
C) A resting tremor that disappears with intentional movement
D) Severe muscle rigidity and "lead-pipe" resistance to movement
Answer: A. Progressive muscle weakness that worsens with activity and improves with rest
Rationale: Myasthenia gravis is a chronic autoimmune disorder characterized by fluctuating weakness of
voluntary muscle groups. The classic symptom is fatigable weakness, meaning that muscle strength is
best in the morning or after a period of rest and deteriorates with repeated use. Ascending flaccid
paralysis is a hallmark of Guillain-Barré syndrome (B). A resting tremor that disappears with movement
is characteristic of Parkinson's disease (C). Muscle rigidity and "lead-pipe" resistance are associated with
Parkinson's disease as well (D).
9. A nurse is monitoring a client who is receiving a blood transfusion. Fifteen minutes after the start of
the transfusion, the client reports chills, low back pain, and a feeling of anxiety. The nurse assesses a
fever, tachycardia, and hypotension. Which of the following actions should the nurse take first?
A) Slow the transfusion rate and reassess the client in 15 minutes.
B) Administer acetaminophen as prescribed for the fever.
C) Stop the transfusion immediately.
D) Notify the blood bank of a possible transfusion reaction.
Answer: C. Stop the transfusion immediately.
Rationale: The client is exhibiting classic signs of an acute hemolytic transfusion reaction (fever, chills,
low back pain, hypotension, tachycardia), which is a life-threatening emergency. The first and most
critical action is to immediately stop the transfusion to prevent the infusion of any more incompatible
blood. After stopping the transfusion, the nurse should maintain IV access with a new tubing and normal
saline, notify the provider and blood bank, and manage the client's symptoms. Slowing the rate is an
inappropriate and dangerous action (A). Administering acetaminophen and notifying the blood bank are
important but are not the first actions (B, D).
10. A nurse is providing discharge teaching to a client who has a new colostomy. Which of the
following statements by the client indicates a need for further teaching?
A) "I will avoid foods that cause gas, like cabbage and onions."
B) "I should change my pouching system when it is about one-third full."
ATI RN Concept-Based Assessment Level 2 Proctored
Exam (2025/2026) – Actual Exam Questions with
Verified Answers
180-Question Actual Exam: ATI RN Concept-Based Assessment Level 2
1. A nurse is caring for a client who is receiving a continuous heparin infusion for a deep vein
thrombosis (DVT). Which of the following laboratory values should the nurse monitor to evaluate the
therapeutic effect of the heparin?
A) Prothrombin time (PT) / International normalized ratio (INR)
B) Activated partial thromboplastin time (aPTT)
C) Platelet count
D) D-dimer
Answer: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin's primary anticoagulant effect is achieved by potentiating antithrombin III, which
inactivates thrombin and factor Xa. The activated partial thromboplastin time (aPTT) is the most
sensitive and widely used test to monitor the therapeutic range of unfractionated heparin, with a goal
typically 1.5 to 2.5 times the control value. The Prothrombin Time (PT) and International Normalized
Ratio (INR) are used to monitor warfarin therapy (A). While a baseline platelet count is important due to
the risk of heparin-induced thrombocytopenia (HIT), it does not reflect the anticoagulant effect of
heparin (C). D-dimer is a fibrin degradation product used to help rule out thromboembolic disorders, not
to monitor heparin therapy (D).
2. A nurse in an emergency department is caring for a client who has benzodiazepine toxicity due to
an overdose. The client is drowsy and has a respiratory rate of 8/min. Using the nursing process,
which of the following actions is the nurse's priority?
A) Prepare to administer flumazenil.
B) Obtain a complete history of the overdose.
C) Assess and support the client's airway and breathing.
D) Initiate continuous cardiac monitoring.
Answer: C. Assess and support the client's airway and breathing.
Rationale: This question requires the use of the nursing process (ADPIE) and prioritization frameworks
(ABCs). Assessment is the first step. While a complete history (B) and preparing for an antidote (A) are
important, the immediate priority for a client with a compromised respiratory rate of 8/min is to assess
and secure the airway and support breathing. This aligns with the "ABC" (Airway, Breathing, Circulation)
,2
priority-setting framework. The nurse must first ensure the patient is oxygenating before implementing
other interventions. Cardiac monitoring (D) is also important but is secondary to managing the
immediate threat to the airway and breathing.
3. A nurse is assessing a client who has been taking over-the-counter antacids for several weeks to
manage frequent heartburn. The client reports new-onset muscle weakness, lethargy, and
bradycardia. The nurse should suspect which of the following electrolyte imbalances?
A) Hypophosphatemia
B) Hypermagnesemia
C) Hyperkalemia
D) Hypocalcemia
Answer: B. Hypermagnesemia
Rationale: Many over-the-counter antacids and laxatives contain magnesium hydroxide or other
magnesium salts. Chronic, excessive ingestion can lead to hypermagnesemia, especially in clients with
underlying renal insufficiency. Classic manifestations of hypermagnesemia include neuromuscular
depression (muscle weakness, lethargy, diminished deep tendon reflexes), hypotension, and
bradycardia. The other options present with different clinical pictures: hypophosphatemia often
manifests as muscle weakness and bone pain, but it is not a classic complication of antacid use (A).
Hyperkalemia is more often associated with renal failure or medications like ACE inhibitors (C).
Hypocalcemia presents with neuromuscular irritability, such as paresthesia, tetany, and positive
Chvostek's/Trousseau's signs (D).
4. A nurse is planning care for a client who has a new diagnosis of ulcerative colitis. Which of the
following dietary instructions should the nurse include in the plan of care during an acute
exacerbation?
A) Increase intake of high-fiber foods like raw vegetables.
B) Follow a low-residue, low-fiber diet.
C) Drink a glass of red wine daily to reduce stress.
D) Consume a high-fat, ketogenic diet.
Answer: B. Follow a low-residue, low-fiber diet.
Rationale: During an acute exacerbation of ulcerative colitis, the colon is inflamed and irritated. A low-
residue, low-fiber diet is recommended to reduce the frequency and volume of stools, thereby
minimizing mechanical irritation to the inflamed bowel and decreasing abdominal cramping. Foods like
raw vegetables, nuts, and seeds are high in fiber and should be avoided during a flare-up (A). Alcohol,
caffeine, and spicy foods can also exacerbate symptoms and should be limited or avoided (C). A high-fat
diet can be difficult to digest and may worsen diarrhea (D).
5. A nurse is caring for a client who has a chest tube in place following a thoracotomy. The nurse notes
continuous bubbling in the water seal chamber of the chest drainage system. Which of the following
,3
actions should the nurse take first?
A) Clamp the chest tube near the insertion site.
B) Notify the healthcare provider.
C) Assess the chest tube tubing and connections for an air leak.
D) Increase the wall suction to -40 cm H2O.
Answer: C. Assess the chest tube tubing and connections for an air leak.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak somewhere in the
system, which can prevent the lung from fully re-expanding. The nurse's first action should be to
systematically assess for the source of the leak. This includes checking all connections from the chest
tube to the drainage unit to ensure they are tight and intact. The nurse should also assess the insertion
site dressing for an air leak. A chest tube should never be clamped except momentarily to assess for the
leak location or during a specific procedure, and only with a provider's order, due to the risk of tension
pneumothorax (A). Notifying the provider (B) and adjusting wall suction (D) are not the initial actions;
the nurse must first assess the equipment.
6. A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the
following statements by the client indicates an understanding of the teaching?
A) "I can use a salt substitute that contains potassium."
B) "It's okay to stop this medication once my blood pressure is normal."
C) "I should report the development of a dry, persistent cough to my provider."
D) "I will take this medication with a glass of milk to prevent stomach upset."
Answer: C. "I should report the development of a dry, persistent cough to my provider."
Rationale: Lisinopril is an ACE inhibitor. A common and bothersome side effect is a dry, hacking cough,
which is caused by the accumulation of bradykinin. The client should be taught to report this, as the
provider may switch them to an ARB (Angiotensin II Receptor Blocker), which does not have this effect.
Clients taking ACE inhibitors should avoid salt substitutes containing potassium chloride due to the risk
of hyperkalemia (A). Antihypertensive medications are typically lifelong; they should not be stopped
abruptly even if blood pressure normalizes (B). There is no need to take lisinopril with milk (D).
7. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central
venous catheter. The new bag of TPN has not arrived from the pharmacy, and the current infusion is
about to finish. Which of the following actions should the nurse take?
A) Discontinue the infusion and flush the line with normal saline.
B) Clamp the catheter and wait for the new TPN bag.
C) Infuse 0.9% sodium chloride at the same rate.
D) Infuse 10% dextrose in water at the same rate.
Answer: D. Infuse 10% dextrose in water at the same rate.
Rationale: Abrupt discontinuation of TPN can cause a rapid drop in blood glucose levels, leading to
rebound hypoglycemia. The pancreas has been secreting high levels of insulin in response to the high
, 4
glucose concentration in the TPN. To prevent this, a solution of 10% dextrose in water (D10W) should be
infused at the same rate as the TPN until the new bag is available. Infusing 0.9% sodium chloride will not
provide the necessary glucose (C). Simply stopping the infusion or clamping the catheter without a
dextrose source is dangerous and can lead to a hypoglycemic crisis (A, B).
8. A nurse is assessing a client who has a new diagnosis of myasthenia gravis. The nurse should expect
the client to report which of the following manifestations?
A) Progressive muscle weakness that worsens with activity and improves with rest
B) Ascending flaccid paralysis that begins in the lower extremities
C) A resting tremor that disappears with intentional movement
D) Severe muscle rigidity and "lead-pipe" resistance to movement
Answer: A. Progressive muscle weakness that worsens with activity and improves with rest
Rationale: Myasthenia gravis is a chronic autoimmune disorder characterized by fluctuating weakness of
voluntary muscle groups. The classic symptom is fatigable weakness, meaning that muscle strength is
best in the morning or after a period of rest and deteriorates with repeated use. Ascending flaccid
paralysis is a hallmark of Guillain-Barré syndrome (B). A resting tremor that disappears with movement
is characteristic of Parkinson's disease (C). Muscle rigidity and "lead-pipe" resistance are associated with
Parkinson's disease as well (D).
9. A nurse is monitoring a client who is receiving a blood transfusion. Fifteen minutes after the start of
the transfusion, the client reports chills, low back pain, and a feeling of anxiety. The nurse assesses a
fever, tachycardia, and hypotension. Which of the following actions should the nurse take first?
A) Slow the transfusion rate and reassess the client in 15 minutes.
B) Administer acetaminophen as prescribed for the fever.
C) Stop the transfusion immediately.
D) Notify the blood bank of a possible transfusion reaction.
Answer: C. Stop the transfusion immediately.
Rationale: The client is exhibiting classic signs of an acute hemolytic transfusion reaction (fever, chills,
low back pain, hypotension, tachycardia), which is a life-threatening emergency. The first and most
critical action is to immediately stop the transfusion to prevent the infusion of any more incompatible
blood. After stopping the transfusion, the nurse should maintain IV access with a new tubing and normal
saline, notify the provider and blood bank, and manage the client's symptoms. Slowing the rate is an
inappropriate and dangerous action (A). Administering acetaminophen and notifying the blood bank are
important but are not the first actions (B, D).
10. A nurse is providing discharge teaching to a client who has a new colostomy. Which of the
following statements by the client indicates a need for further teaching?
A) "I will avoid foods that cause gas, like cabbage and onions."
B) "I should change my pouching system when it is about one-third full."
