ATI RN Concept-Based Assessment
Level 2: The Ultimate NGN Practice
Question Bank with Rationales
1. A nurse is planning care for a client who has renal calculi. Which of the
following interventions should the nurse include to promote elimination of the
calculi?
• A) Maintain bedrest until calculi are passed
• B) Withhold thiazide diuretics
• C) Encourage intake of at least 3 L of fluid each day
• D) Begin a 24-hour urine collection
Rationale: C. Increased fluid intake increases urine production, promotes elimination
of calculi, and helps prevent future stone formation. Bedrest (A) is contraindicated as
activity helps stone passage. Diuretics may be used to help manage calcium stone
formation but are not the primary intervention for elimination. While a 24-hour urine
collection may be used for diagnostic purposes, it does not promote elimination of
existing calculi.
2. A nurse is providing postoperative education for a client following a
laparoscopic cholecystectomy for cholelithiasis. Which statement indicates
understanding of the teaching?
• A) "The adhesive bandages on my incision will fall off as the incision
heals"
• B) "I will be able to take a shower in 1 day"
• C) "I will need to follow a liquid diet for the first 3 days after surgery"
• D) "I can begin to resume my normal activity level in 2 weeks"
Rationale: A. The nurse should instruct the client that the small adhesive bandages
will lose their adhesiveness in 7 to 10 days. The client can then remove the bandages
or allow them to fall off. Showering is typically permitted after 24-48 hours with
waterproof dressings. A liquid diet is not typically required for 3 days post-op; a
gradual return to a regular diet is expected. Activity is usually resumed gradually, not
immediately at 2 weeks.
,3. A nurse is teaching a client who has gastroesophageal reflux disease (GERD)
about ways to prevent reflux. Which information should the nurse include?
• A) Drink tomato juice with breakfast
• B) Suck on peppermint when having symptoms
• C) Elevate the head of the bed 10 cm (4 in) using wooden blocks
• D) Plan to finish eating at least 3 hr before bedtime
Rationale: D. The nurse should encourage the client not to eat anything at least 3
hours before bedtime to prevent nocturnal reflux. Tomato juice (A) and peppermint
(B) worsen GERD symptoms by increasing acid or relaxing the LES. While elevating
the head of the bed IS recommended, 10 cm is insufficient—15-20 cm (6-8 inches) is
the standard recommendation.
4. A child with Down syndrome should be evaluated for which condition before
participating in sports?
• A) Hyperflexibility
• B) Cutis marmorata
• C) Atlantoaxial instability
• D) Speckling of the iris (Brushfield spots)
Rationale: C. Children with Down syndrome are at an increased risk for atlantoaxial
instability, a condition where the top two vertebrae in the neck are not properly
aligned. This can pose a significant risk for spinal cord injury during physical
activities, making a pre-participation evaluation essential.
5. A nurse in an emergency department is caring for a client who has heat
stroke. Which action should the nurse take to treat this form of hyperthermia?
• A) Apply ice packs to the client's axillae, neck, groin, and chest
• B) Administer aspirin to the client
• C) Initially offer the client cool, oral fluids
• D) Continue cooling measures until the client's rectal temperature is 37.2°C
(99°F)
,Rationale: A. Treatment for heat stroke involves cooling the client's core body
temperature quickly. The nurse should apply ice to the client's axillae, neck, groin,
and chest (areas of major blood flow) while also spraying the client's body with tepid
water. Antipyretics like aspirin (B) are ineffective because the hypothalamus is not the
cause. Oral fluids (C) are contraindicated if the client has altered mental status
(common in heat stroke). Cooling should stop at 38.3°C (101°F) to prevent
hypothermia (D is incorrect).
6. A nurse is teaching a client who has asthma about medications to treat an
acute asthma attack. Which medication should the nurse include in the
teaching?
• A) Fluticasone
• B) Salmeterol
• C) Albuterol
• D) Montelukast
Rationale: C. Albuterol is a short-acting beta-2 agonist (SABA) that causes rapid
bronchodilation. The client should use albuterol during asthma attacks and before
engaging in activities that are likely to cause an attack. Fluticasone (A) is an inhaled
corticosteroid for long-term control. Salmeterol (B) is a long-acting beta-2 agonist
for maintenance, not rescue. Montelukast (D) is a leukotriene receptor antagonist for
prevention, not acute attacks.
7. A nurse is caring for a client immediately following a cardiac catheterization
via the right femoral artery. Which assessment finding is most concerning?
• A) The client reports a small amount of tenderness at the insertion site
• B) The client's right pedal pulse is weaker than the left, and the right foot
is cool to the touch
• C) There is a small, quarter-sized amount of serosanguineous drainage on the
pressure dressing
• D) The client's blood pressure is 130/80 mmHg and heart rate is 88/min
Rationale: B. The most significant complication after femoral artery catheterization is
hemorrhage or arterial occlusion. A weak or absent pedal pulse along with a cool
extremity on the affected side is a sign of acute arterial occlusion, which is a vascular
, emergency requiring immediate intervention. Tenderness and a small amount of
drainage are expected findings. The vital signs given are within an acceptable range.
8. A nurse suspects hyperemesis gravidarum in a client at 10 weeks of gestation
who reports severe nausea and vomiting. Which serum laboratory value
confirms this diagnosis?
• A) BUN 10 mg/dL
• B) Hemoglobin 14 g/dL
• C) Urine specific gravity of 1.005
• D) Sodium 130 mEq/L
Rationale: D. Hyperemesis gravidarum involves severe, persistent vomiting leading
to dehydration, electrolyte imbalances, and weight loss. Prolonged vomiting and
dehydration primarily result in electrolyte losses, particularly hyponatremia (sodium
< 135 mEq/L). BUN 10 mg/dL is normal. Hemoglobin 14 g/dL is normal and does not
reflect dehydration directly. Urine specific gravity of 1.005 is very dilute, which
contradicts the finding of dark, concentrated urine; severe dehydration would cause a
high specific gravity (>1.030).
9. A nurse is caring for a client who has pneumonia. Which action is the priority
for the nurse to take?
• A) Monitor intake and output
• B) Provide teaching about antibiotic therapy
• C) Administer the influenza vaccine
• D) Observe the client perform incentive spirometry
Rationale: D. Using the airway, breathing, and circulation (ABC) framework, the
priority action is to ensure adequate oxygenation and airway clearance. Observing
the client perform incentive spirometry directly addresses impaired gas exchange
and helps prevent complications like atelectasis. Teaching, monitoring, and
vaccination are important but secondary in the acute phase.
10. A charge nurse is making assignments on a busy medical-surgical unit.
Which client should be assigned to the most experienced registered nurse?
Level 2: The Ultimate NGN Practice
Question Bank with Rationales
1. A nurse is planning care for a client who has renal calculi. Which of the
following interventions should the nurse include to promote elimination of the
calculi?
• A) Maintain bedrest until calculi are passed
• B) Withhold thiazide diuretics
• C) Encourage intake of at least 3 L of fluid each day
• D) Begin a 24-hour urine collection
Rationale: C. Increased fluid intake increases urine production, promotes elimination
of calculi, and helps prevent future stone formation. Bedrest (A) is contraindicated as
activity helps stone passage. Diuretics may be used to help manage calcium stone
formation but are not the primary intervention for elimination. While a 24-hour urine
collection may be used for diagnostic purposes, it does not promote elimination of
existing calculi.
2. A nurse is providing postoperative education for a client following a
laparoscopic cholecystectomy for cholelithiasis. Which statement indicates
understanding of the teaching?
• A) "The adhesive bandages on my incision will fall off as the incision
heals"
• B) "I will be able to take a shower in 1 day"
• C) "I will need to follow a liquid diet for the first 3 days after surgery"
• D) "I can begin to resume my normal activity level in 2 weeks"
Rationale: A. The nurse should instruct the client that the small adhesive bandages
will lose their adhesiveness in 7 to 10 days. The client can then remove the bandages
or allow them to fall off. Showering is typically permitted after 24-48 hours with
waterproof dressings. A liquid diet is not typically required for 3 days post-op; a
gradual return to a regular diet is expected. Activity is usually resumed gradually, not
immediately at 2 weeks.
,3. A nurse is teaching a client who has gastroesophageal reflux disease (GERD)
about ways to prevent reflux. Which information should the nurse include?
• A) Drink tomato juice with breakfast
• B) Suck on peppermint when having symptoms
• C) Elevate the head of the bed 10 cm (4 in) using wooden blocks
• D) Plan to finish eating at least 3 hr before bedtime
Rationale: D. The nurse should encourage the client not to eat anything at least 3
hours before bedtime to prevent nocturnal reflux. Tomato juice (A) and peppermint
(B) worsen GERD symptoms by increasing acid or relaxing the LES. While elevating
the head of the bed IS recommended, 10 cm is insufficient—15-20 cm (6-8 inches) is
the standard recommendation.
4. A child with Down syndrome should be evaluated for which condition before
participating in sports?
• A) Hyperflexibility
• B) Cutis marmorata
• C) Atlantoaxial instability
• D) Speckling of the iris (Brushfield spots)
Rationale: C. Children with Down syndrome are at an increased risk for atlantoaxial
instability, a condition where the top two vertebrae in the neck are not properly
aligned. This can pose a significant risk for spinal cord injury during physical
activities, making a pre-participation evaluation essential.
5. A nurse in an emergency department is caring for a client who has heat
stroke. Which action should the nurse take to treat this form of hyperthermia?
• A) Apply ice packs to the client's axillae, neck, groin, and chest
• B) Administer aspirin to the client
• C) Initially offer the client cool, oral fluids
• D) Continue cooling measures until the client's rectal temperature is 37.2°C
(99°F)
,Rationale: A. Treatment for heat stroke involves cooling the client's core body
temperature quickly. The nurse should apply ice to the client's axillae, neck, groin,
and chest (areas of major blood flow) while also spraying the client's body with tepid
water. Antipyretics like aspirin (B) are ineffective because the hypothalamus is not the
cause. Oral fluids (C) are contraindicated if the client has altered mental status
(common in heat stroke). Cooling should stop at 38.3°C (101°F) to prevent
hypothermia (D is incorrect).
6. A nurse is teaching a client who has asthma about medications to treat an
acute asthma attack. Which medication should the nurse include in the
teaching?
• A) Fluticasone
• B) Salmeterol
• C) Albuterol
• D) Montelukast
Rationale: C. Albuterol is a short-acting beta-2 agonist (SABA) that causes rapid
bronchodilation. The client should use albuterol during asthma attacks and before
engaging in activities that are likely to cause an attack. Fluticasone (A) is an inhaled
corticosteroid for long-term control. Salmeterol (B) is a long-acting beta-2 agonist
for maintenance, not rescue. Montelukast (D) is a leukotriene receptor antagonist for
prevention, not acute attacks.
7. A nurse is caring for a client immediately following a cardiac catheterization
via the right femoral artery. Which assessment finding is most concerning?
• A) The client reports a small amount of tenderness at the insertion site
• B) The client's right pedal pulse is weaker than the left, and the right foot
is cool to the touch
• C) There is a small, quarter-sized amount of serosanguineous drainage on the
pressure dressing
• D) The client's blood pressure is 130/80 mmHg and heart rate is 88/min
Rationale: B. The most significant complication after femoral artery catheterization is
hemorrhage or arterial occlusion. A weak or absent pedal pulse along with a cool
extremity on the affected side is a sign of acute arterial occlusion, which is a vascular
, emergency requiring immediate intervention. Tenderness and a small amount of
drainage are expected findings. The vital signs given are within an acceptable range.
8. A nurse suspects hyperemesis gravidarum in a client at 10 weeks of gestation
who reports severe nausea and vomiting. Which serum laboratory value
confirms this diagnosis?
• A) BUN 10 mg/dL
• B) Hemoglobin 14 g/dL
• C) Urine specific gravity of 1.005
• D) Sodium 130 mEq/L
Rationale: D. Hyperemesis gravidarum involves severe, persistent vomiting leading
to dehydration, electrolyte imbalances, and weight loss. Prolonged vomiting and
dehydration primarily result in electrolyte losses, particularly hyponatremia (sodium
< 135 mEq/L). BUN 10 mg/dL is normal. Hemoglobin 14 g/dL is normal and does not
reflect dehydration directly. Urine specific gravity of 1.005 is very dilute, which
contradicts the finding of dark, concentrated urine; severe dehydration would cause a
high specific gravity (>1.030).
9. A nurse is caring for a client who has pneumonia. Which action is the priority
for the nurse to take?
• A) Monitor intake and output
• B) Provide teaching about antibiotic therapy
• C) Administer the influenza vaccine
• D) Observe the client perform incentive spirometry
Rationale: D. Using the airway, breathing, and circulation (ABC) framework, the
priority action is to ensure adequate oxygenation and airway clearance. Observing
the client perform incentive spirometry directly addresses impaired gas exchange
and helps prevent complications like atelectasis. Teaching, monitoring, and
vaccination are important but secondary in the acute phase.
10. A charge nurse is making assignments on a busy medical-surgical unit.
Which client should be assigned to the most experienced registered nurse?
