ATI RN CONCEPT-BASED ASSESSMENT LEVEL 2
LATEST UPDATED 2026-2027 ACTUAL FINAL EXAM
WITH COMPLETE DETAILED 100 QUESTIONS AND
ANSWERS WITH RATIONALES PLUS ANSWER KEY
A+ GRADE GUARANTEED SUCCESS!!!
1. A nurse is caring for a patient with a STEMI who received tPA and suddenly
develops a severe headache, vomiting, and a blood pressure of 200/110 mmHg.
What is the nurse's immediate action?
A. Administer an antiemetic.
B. Lower the head of the bed.
C. Give acetaminophen.
D. Notify the provider and prepare for an emergency CT scan.
Rationale: A severe headache and hypertension following tPA administration
are classic signs of intracranial hemorrhage, a life-threatening complication.
Rapid imaging and neurosurgical consultation are critical. Administering an
antiemetic or acetaminophen delays definitive treatment.
2. A patient with sepsis has a lactate of 5.2 mmol/L and a blood pressure of 82/48
mmHg after receiving 30 mL/kg of crystalloid fluid. What is the next priority
action?
A. Start a dopamine infusion.
B. Obtain a CT scan of the abdomen.
C. Administer broad-spectrum antibiotics.
D. Begin norepinephrine to maintain a MAP of at least 65 mmHg.
,Rationale: Fluid-refractory septic shock requires vasopressor support. According
to the Surviving Sepsis Campaign Guidelines, norepinephrine is the first-line
vasopressor to maintain mean arterial pressure (MAP) ≥ 65 mmHg. Antibiotics
should have been given earlier.
3. A nurse is assessing a patient post-craniotomy who has a sudden decrease in
level of consciousness and a blown pupil. What is the nurse's first action?
A. Obtain a stat CT scan order.
B. Administer mannitol as prescribed.
C. Notify the patient's family.
D. Raise the head of the bed to 30 degrees and hyperventilate the patient.
Rationale: A sudden decrease in LOC and a blown pupil indicate herniation from
increased ICP. Immediate interventions include elevating the head of the bed
(HOB) to 30 degrees to promote venous drainage and hyperventilating to reduce
PaCO₂, causing cerebral vasoconstriction. These actions buy time while
preparing for mannitol or hypertonic saline.
4. A charge nurse is making assignments on a busy medical-surgical unit. Which
patient should be assigned to the most experienced RN?
A. A patient with diabetes requiring fingerstick glucose checks.
B. A patient with pneumonia needing IV antibiotics.
C. A patient post-cardiac arrest with an unstable arrhythmia.
D. A patient with a urinary tract infection on oral antibiotics.
Rationale: The most unstable patient (post-cardiac arrest with arrhythmia)
requires the most experienced nurse. Stable patients can be assigned to less
experienced staff.
5. A nurse is caring for a patient with a skull fracture who has clear fluid draining
from the nose. What is the priority nursing action?
A. Insert a nasogastric tube.
B. Pack the nares with gauze.
C. Administer prophylactic antibiotics.
D. Test the fluid for glucose and avoid inserting an NG tube.
Rationale: Clear nasal drainage after a skull fracture suggests a cerebrospinal
, fluid (CSF) leak. The fluid should be tested for glucose (CSF contains glucose;
mucus does not). Nasogastric tubes are contraindicated because they can pass
through the fracture site and cause meningitis.
6. A nurse is supervising a licensed practical nurse (LPN) on a medical-surgical unit.
Which task is appropriate to assign to the LPN?
A. Performing the initial admission assessment of a patient with pneumonia.
B. Administering IV push morphine to a postoperative patient.
C. Inserting an indwelling urinary catheter.
D. Teaching a patient about insulin self-administration.
Rationale: LPNs can insert urinary catheters, administer certain medications (but
not IV push in many states), and perform stable patient care. Initial assessment
and patient teaching are the RN's responsibility.
7. A patient with COPD reports increased shortness of breath. What is the nurse's
priority action?
A. Increase IV fluids.
B. Encourage pursed-lip breathing.
C. Apply 4 L/min of oxygen via nasal cannula.
D. Administer a cough suppressant.
Rationale: Pursed-lip breathing improves CO₂ elimination and reduces dyspnea
by creating back pressure in the airways. This technique is a first-line non-
pharmacologic intervention for COPD.
8. A patient with heart failure has gained 2 kg (4.4 lbs) in 24 hours and has 2+
pitting edema. What is the priority nursing action?
A. Encourage bed rest.
B. Start IV furosemide without an order.
C. Obtain a 12-lead ECG.
D. Assess oxygen saturation and lung sounds.
Rationale: Increased shortness of breath and edema indicate worsening heart
failure. The priority is to assess oxygenation and lung sounds first to determine
the severity of fluid overload before notifying the provider.
LATEST UPDATED 2026-2027 ACTUAL FINAL EXAM
WITH COMPLETE DETAILED 100 QUESTIONS AND
ANSWERS WITH RATIONALES PLUS ANSWER KEY
A+ GRADE GUARANTEED SUCCESS!!!
1. A nurse is caring for a patient with a STEMI who received tPA and suddenly
develops a severe headache, vomiting, and a blood pressure of 200/110 mmHg.
What is the nurse's immediate action?
A. Administer an antiemetic.
B. Lower the head of the bed.
C. Give acetaminophen.
D. Notify the provider and prepare for an emergency CT scan.
Rationale: A severe headache and hypertension following tPA administration
are classic signs of intracranial hemorrhage, a life-threatening complication.
Rapid imaging and neurosurgical consultation are critical. Administering an
antiemetic or acetaminophen delays definitive treatment.
2. A patient with sepsis has a lactate of 5.2 mmol/L and a blood pressure of 82/48
mmHg after receiving 30 mL/kg of crystalloid fluid. What is the next priority
action?
A. Start a dopamine infusion.
B. Obtain a CT scan of the abdomen.
C. Administer broad-spectrum antibiotics.
D. Begin norepinephrine to maintain a MAP of at least 65 mmHg.
,Rationale: Fluid-refractory septic shock requires vasopressor support. According
to the Surviving Sepsis Campaign Guidelines, norepinephrine is the first-line
vasopressor to maintain mean arterial pressure (MAP) ≥ 65 mmHg. Antibiotics
should have been given earlier.
3. A nurse is assessing a patient post-craniotomy who has a sudden decrease in
level of consciousness and a blown pupil. What is the nurse's first action?
A. Obtain a stat CT scan order.
B. Administer mannitol as prescribed.
C. Notify the patient's family.
D. Raise the head of the bed to 30 degrees and hyperventilate the patient.
Rationale: A sudden decrease in LOC and a blown pupil indicate herniation from
increased ICP. Immediate interventions include elevating the head of the bed
(HOB) to 30 degrees to promote venous drainage and hyperventilating to reduce
PaCO₂, causing cerebral vasoconstriction. These actions buy time while
preparing for mannitol or hypertonic saline.
4. A charge nurse is making assignments on a busy medical-surgical unit. Which
patient should be assigned to the most experienced RN?
A. A patient with diabetes requiring fingerstick glucose checks.
B. A patient with pneumonia needing IV antibiotics.
C. A patient post-cardiac arrest with an unstable arrhythmia.
D. A patient with a urinary tract infection on oral antibiotics.
Rationale: The most unstable patient (post-cardiac arrest with arrhythmia)
requires the most experienced nurse. Stable patients can be assigned to less
experienced staff.
5. A nurse is caring for a patient with a skull fracture who has clear fluid draining
from the nose. What is the priority nursing action?
A. Insert a nasogastric tube.
B. Pack the nares with gauze.
C. Administer prophylactic antibiotics.
D. Test the fluid for glucose and avoid inserting an NG tube.
Rationale: Clear nasal drainage after a skull fracture suggests a cerebrospinal
, fluid (CSF) leak. The fluid should be tested for glucose (CSF contains glucose;
mucus does not). Nasogastric tubes are contraindicated because they can pass
through the fracture site and cause meningitis.
6. A nurse is supervising a licensed practical nurse (LPN) on a medical-surgical unit.
Which task is appropriate to assign to the LPN?
A. Performing the initial admission assessment of a patient with pneumonia.
B. Administering IV push morphine to a postoperative patient.
C. Inserting an indwelling urinary catheter.
D. Teaching a patient about insulin self-administration.
Rationale: LPNs can insert urinary catheters, administer certain medications (but
not IV push in many states), and perform stable patient care. Initial assessment
and patient teaching are the RN's responsibility.
7. A patient with COPD reports increased shortness of breath. What is the nurse's
priority action?
A. Increase IV fluids.
B. Encourage pursed-lip breathing.
C. Apply 4 L/min of oxygen via nasal cannula.
D. Administer a cough suppressant.
Rationale: Pursed-lip breathing improves CO₂ elimination and reduces dyspnea
by creating back pressure in the airways. This technique is a first-line non-
pharmacologic intervention for COPD.
8. A patient with heart failure has gained 2 kg (4.4 lbs) in 24 hours and has 2+
pitting edema. What is the priority nursing action?
A. Encourage bed rest.
B. Start IV furosemide without an order.
C. Obtain a 12-lead ECG.
D. Assess oxygen saturation and lung sounds.
Rationale: Increased shortness of breath and edema indicate worsening heart
failure. The priority is to assess oxygenation and lung sounds first to determine
the severity of fluid overload before notifying the provider.
