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ATI RN CONCEPT-BASED ASSESSMENT LEVEL 3
PROCTORED ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED |INSTANT
DOWNLOAD!!
1. A client with heart failure has 2+ pitting edema in the lower
extremities. Which intervention should the nurse implement first?
A) Administer a diuretic as prescribed
B) Elevate the head of the bed
C) Encourage ambulation
D) Restrict fluid intake
Rationale: Administering a prescribed diuretic addresses fluid
overload, which is the priority in managing heart failure with edema.
While elevating the head of the bed may help with breathing and fluid
restriction may be part of the plan, pharmacological intervention to
remove excess fluid is the most direct and immediate action to address
the edema.
2. Which lab value indicates effective anticoagulant therapy with
warfarin?
A) INR 1.0
B) INR 2.5
C) PT 10 seconds
D) Platelets 250,000/mm³
Rationale: The therapeutic INR range for most indications (atrial
fibrillation, DVT, pulmonary embolism) is 2–3. An INR of 2.5 falls
within this therapeutic window, indicating effective anticoagulation.
INR 1.0 is subtherapeutic. PT without INR standardization is not
reliable for monitoring warfarin.
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3. A client is prescribed furosemide. Which electrolyte imbalance is
most concerning for a patient on furosemide?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypophosphatemia
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺/K⁺/2Cl⁻
cotransporter in the thick ascending limb of Henle, leading to
increased potassium excretion. Hypokalemia is the most concerning
electrolyte imbalance because it can predispose to cardiac
arrhythmias.
4. A nurse is assessing a client with peripheral arterial disease (PAD).
Which finding is most consistent with this diagnosis?
A) Diminished or absent pulses in the lower extremities
B) Bilateral pitting edema
C) Warm, erythematous skin
D) Distended jugular veins
Rationale: Peripheral arterial disease is characterized by diminished
or absent pulses due to atherosclerotic narrowing of the arteries.
Edema, warmth, and erythema are more consistent with venous
insufficiency or inflammation. Jugular venous distention suggests
right-sided heart failure.
5. A client with chronic obstructive pulmonary disease (COPD) presents
with worsening dyspnea and a productive cough with thick, green
sputum. Which intervention should the nurse prioritize?
A) Administer prescribed bronchodilators
B) Encourage oral fluid intake
C) Position the client in high-Fowler's position
D) Obtain a sputum culture
Rationale: The priority intervention in a COPD exacerbation is to
improve airway patency and gas exchange. Administering prescribed
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bronchodilators (e.g., albuterol, ipratropium) helps relieve
bronchospasm and is the first-line treatment. While fluid intake,
positioning, and sputum culture are important, they are not the initial
priority.
6. A client is admitted with acute respiratory distress syndrome (ARDS).
Which arterial blood gas (ABG) finding is most consistent with this
diagnosis?
A) Hypoxemia refractory to oxygen therapy
B) Respiratory alkalosis
C) Hypercapnia with metabolic alkalosis
D) Normal PaO₂ with elevated PaCO₂
Rationale: ARDS is characterized by severe, refractory hypoxemia
(PaO₂/FiO₂ ratio < 300) due to alveolar-capillary membrane damage
and pulmonary edema. The hypoxemia does not improve significantly
with oxygen administration alone.
7. A client with diabetic ketoacidosis (DKA) has a serum potassium of
5.8 mEq/L. Which intervention should the nurse anticipate?
A) Administer insulin as prescribed
B) Administer potassium supplements
C) Restrict all fluids
D) Administer sodium bicarbonate
Rationale: In DKA, total body potassium is depleted despite an initial
elevated serum potassium due to acidosis shifting potassium out of
cells. Insulin therapy will drive potassium back into cells, lowering
serum levels. Potassium supplements may be needed once levels drop.
Sodium bicarbonate is not routinely recommended.
8. A client is diagnosed with hyperthyroidism (Graves disease). Which
clinical manifestation is most consistent with this diagnosis?
A) Tachycardia and heat intolerance
B) Bradycardia and cold intolerance
C) Weight gain and lethargy
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D) Constipation and dry skin
Rationale: Graves disease causes excess thyroid hormone, leading to
increased metabolic rate, tachycardia, heat intolerance, weight loss,
and diaphoresis. Bradycardia, cold intolerance, weight gain, and
constipation are manifestations of hypothyroidism.
9. A client with chronic kidney disease (CKD) has a serum creatinine of
6.8 mg/dL and potassium of 6.5 mEq/L. Which ECG change should the
nurse anticipate?
A) Peaked T waves
B) Prominent U waves
C) Prolonged QT interval
D) ST-segment depression
Rationale: Hyperkalemia (potassium > 6.5 mEq/L) causes peaked (tall,
tented) T waves on ECG. This is a medical emergency requiring
immediate intervention. Prominent U waves are seen in hypokalemia.
10. A client is receiving peritoneal dialysis. Which finding should the
nurse report to the provider immediately?
A) Cloudy dialysate effluent
B) Mild abdominal discomfort
C) Weight gain of 1 kg
D) Slight erythema at the catheter site
Rationale: Cloudy dialysate effluent is a sign of peritonitis, a serious
complication of peritoneal dialysis. Other signs include abdominal
pain, fever, and nausea. Mild abdominal discomfort and slight
erythema may be expected; weight gain is expected with fluid
retention.
11. A client with a traumatic brain injury (TBI) is at risk for diabetes
insipidus (DI). Which assessment finding is most consistent with DI?
A) Polyuria and polydipsia
B) Oliguria and hypertension
C) Weight gain and edema
ATI RN CONCEPT-BASED ASSESSMENT LEVEL 3
PROCTORED ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED |INSTANT
DOWNLOAD!!
1. A client with heart failure has 2+ pitting edema in the lower
extremities. Which intervention should the nurse implement first?
A) Administer a diuretic as prescribed
B) Elevate the head of the bed
C) Encourage ambulation
D) Restrict fluid intake
Rationale: Administering a prescribed diuretic addresses fluid
overload, which is the priority in managing heart failure with edema.
While elevating the head of the bed may help with breathing and fluid
restriction may be part of the plan, pharmacological intervention to
remove excess fluid is the most direct and immediate action to address
the edema.
2. Which lab value indicates effective anticoagulant therapy with
warfarin?
A) INR 1.0
B) INR 2.5
C) PT 10 seconds
D) Platelets 250,000/mm³
Rationale: The therapeutic INR range for most indications (atrial
fibrillation, DVT, pulmonary embolism) is 2–3. An INR of 2.5 falls
within this therapeutic window, indicating effective anticoagulation.
INR 1.0 is subtherapeutic. PT without INR standardization is not
reliable for monitoring warfarin.
,2|Page
3. A client is prescribed furosemide. Which electrolyte imbalance is
most concerning for a patient on furosemide?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypophosphatemia
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺/K⁺/2Cl⁻
cotransporter in the thick ascending limb of Henle, leading to
increased potassium excretion. Hypokalemia is the most concerning
electrolyte imbalance because it can predispose to cardiac
arrhythmias.
4. A nurse is assessing a client with peripheral arterial disease (PAD).
Which finding is most consistent with this diagnosis?
A) Diminished or absent pulses in the lower extremities
B) Bilateral pitting edema
C) Warm, erythematous skin
D) Distended jugular veins
Rationale: Peripheral arterial disease is characterized by diminished
or absent pulses due to atherosclerotic narrowing of the arteries.
Edema, warmth, and erythema are more consistent with venous
insufficiency or inflammation. Jugular venous distention suggests
right-sided heart failure.
5. A client with chronic obstructive pulmonary disease (COPD) presents
with worsening dyspnea and a productive cough with thick, green
sputum. Which intervention should the nurse prioritize?
A) Administer prescribed bronchodilators
B) Encourage oral fluid intake
C) Position the client in high-Fowler's position
D) Obtain a sputum culture
Rationale: The priority intervention in a COPD exacerbation is to
improve airway patency and gas exchange. Administering prescribed
,3|Page
bronchodilators (e.g., albuterol, ipratropium) helps relieve
bronchospasm and is the first-line treatment. While fluid intake,
positioning, and sputum culture are important, they are not the initial
priority.
6. A client is admitted with acute respiratory distress syndrome (ARDS).
Which arterial blood gas (ABG) finding is most consistent with this
diagnosis?
A) Hypoxemia refractory to oxygen therapy
B) Respiratory alkalosis
C) Hypercapnia with metabolic alkalosis
D) Normal PaO₂ with elevated PaCO₂
Rationale: ARDS is characterized by severe, refractory hypoxemia
(PaO₂/FiO₂ ratio < 300) due to alveolar-capillary membrane damage
and pulmonary edema. The hypoxemia does not improve significantly
with oxygen administration alone.
7. A client with diabetic ketoacidosis (DKA) has a serum potassium of
5.8 mEq/L. Which intervention should the nurse anticipate?
A) Administer insulin as prescribed
B) Administer potassium supplements
C) Restrict all fluids
D) Administer sodium bicarbonate
Rationale: In DKA, total body potassium is depleted despite an initial
elevated serum potassium due to acidosis shifting potassium out of
cells. Insulin therapy will drive potassium back into cells, lowering
serum levels. Potassium supplements may be needed once levels drop.
Sodium bicarbonate is not routinely recommended.
8. A client is diagnosed with hyperthyroidism (Graves disease). Which
clinical manifestation is most consistent with this diagnosis?
A) Tachycardia and heat intolerance
B) Bradycardia and cold intolerance
C) Weight gain and lethargy
, 4|Page
D) Constipation and dry skin
Rationale: Graves disease causes excess thyroid hormone, leading to
increased metabolic rate, tachycardia, heat intolerance, weight loss,
and diaphoresis. Bradycardia, cold intolerance, weight gain, and
constipation are manifestations of hypothyroidism.
9. A client with chronic kidney disease (CKD) has a serum creatinine of
6.8 mg/dL and potassium of 6.5 mEq/L. Which ECG change should the
nurse anticipate?
A) Peaked T waves
B) Prominent U waves
C) Prolonged QT interval
D) ST-segment depression
Rationale: Hyperkalemia (potassium > 6.5 mEq/L) causes peaked (tall,
tented) T waves on ECG. This is a medical emergency requiring
immediate intervention. Prominent U waves are seen in hypokalemia.
10. A client is receiving peritoneal dialysis. Which finding should the
nurse report to the provider immediately?
A) Cloudy dialysate effluent
B) Mild abdominal discomfort
C) Weight gain of 1 kg
D) Slight erythema at the catheter site
Rationale: Cloudy dialysate effluent is a sign of peritonitis, a serious
complication of peritoneal dialysis. Other signs include abdominal
pain, fever, and nausea. Mild abdominal discomfort and slight
erythema may be expected; weight gain is expected with fluid
retention.
11. A client with a traumatic brain injury (TBI) is at risk for diabetes
insipidus (DI). Which assessment finding is most consistent with DI?
A) Polyuria and polydipsia
B) Oliguria and hypertension
C) Weight gain and edema
