ATI RN Concepts Level 3 | Comprehensive Nursing
Concepts Examination | 2026/2027 Edition |
Comprehensive Practice Set ATI Nursing Education
| Verified Q&A | NCLEX-RN® Readiness | NGN-
Aligned
Introduction
This comprehensive ATI RN Concepts Level 3 Exam practice set covers
Medical-Surgical Nursing, Maternal-Newborn & Pediatric Nursing, Mental
Health & Psychosocial Nursing, Leadership, Management & Community
Health, and Fundamentals, Pharmacology & NGN Clinical Judgment. The
questions emphasize clinical judgment, prioritization, pharmacology,
delegation, and evidence-based nursing interventions aligned with the Next
Generation NCLEX (NGN) standards. All items are expert-verified with correct
answers and detailed rationales, designed for accurate evaluation and pass-
level readiness in accordance with the 2026/2027 ATI RN Comprehensive
curriculum.
Domain 1: Medical-Surgical Nursing
1. A nurse is caring for a client with a myocardial infarction. Which
finding should the nurse identify as the earliest indicator of left-sided
heart failure?
• A. Bilateral crackles
• B. Persistent cough
• C. Weight gain of 2 kg
• D. Orthopnea
Answer: B
Rationale: A persistent cough is an early indicator of left-sided heart failure
caused by pulmonary congestion. Crackles, weight gain, and orthopnea are
,later manifestations. Why Wrong: A, C, and D are later signs of worsening
failure rather than the earliest indicator. Reference: ATI RN Medical-Surgical
Nursing, 2026 Edition.
2. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen therapy. Which oxygen delivery method is most
appropriate for this client?
• A. 100% non-rebreather mask at 12 L/min
• B. Nasal cannula at 2 L/min
• C. Simple face mask at 8 L/min
• D. Venturi mask at 24%
Answer: B
Rationale: Clients with COPD rely on a hypoxic drive; low-flow oxygen (1-2
L/min via nasal cannula) maintains oxygenation without suppressing the
respiratory drive. Why Wrong: A and C deliver high oxygen concentrations
that may suppress the hypoxic drive; D may be used but is more complex than
needed for stability. Reference: ATI RN Medical-Surgical Nursing, 2026
Edition.
3. A nurse is assessing a client with suspected appendicitis. Which
assessment finding confirms McBurney's point tenderness?
• A. Right upper quadrant
• B. Left lower quadrant
• C. Right lower quadrant, one-third of the distance from the anterior
superior iliac spine to the umbilicus
• D. Left upper quadrant
Answer: C
Rationale: McBurney's point is located in the right lower quadrant, one-third
of the distance from the right anterior superior iliac spine to the umbilicus,
and is the classic tenderness site for appendicitis. Why Wrong: A, B, and D are
,incorrect anatomical locations for McBurney's point. Reference: ATI RN
Medical-Surgical Nursing, 2026 Edition.
4. A client with diabetes mellitus has a blood glucose of 48 mg/dL and is
conscious. Which action should the nurse take first?
• A. Administer glucagon IM
• B. Provide 15 g of fast-acting carbohydrate
• C. Administer 50% dextrose IV
• D. Recheck glucose in 15 minutes
Answer: B
Rationale: For a conscious client with hypoglycemia, the first action is to
provide 15 g of fast-acting oral carbohydrate (e.g., 4 oz juice) per ADA
guidelines. Why Wrong: A is for unconscious clients; C is for IV access
situations; D is the follow-up action after treatment. Reference: ATI RN
Medical-Surgical Nursing, 2026 Edition.
5. A client is receiving heparin therapy for deep vein thrombosis. The
nurse notes the aPTT is 90 seconds (control 30 seconds). Which action is
appropriate?
• A. Increase heparin rate
• B. Continue current dose
• C. Notify provider to decrease dose
• D. Stop infusion permanently
Answer: C
Rationale: The therapeutic aPTT for heparin is 1.5-2 times control (45-60
seconds). At 90 seconds (3 times control), the dose should be decreased per
protocol to prevent bleeding. Why Wrong: A would worsen anticoagulation; B
continues an excessive dose; D is unnecessary without active bleeding.
Reference: ATI RN Medical-Surgical Nursing, 2026 Edition.
, 6. A nurse is caring for a client with a chest tube. Which finding indicates
the chest drainage system is functioning properly?
• A. Continuous bubbling in the water seal chamber
• B. Intermittent bubbling in the suction control chamber
• C. No bubbling in any chamber
• D. Continuous bubbling in the suction control chamber only
Answer: B
Rationale: Intermittent bubbling in the suction control chamber indicates
proper suction operation. Continuous bubbling in the water seal chamber
suggests an air leak requiring investigation. Why Wrong: A indicates an air
leak; C suggests system malfunction; D alone is insufficient for proper function
confirmation. Reference: ATI RN Medical-Surgical Nursing, 2026 Edition.
7. A client with chronic kidney disease has a potassium level of 6.8
mEq/L. Which ECG finding should the nurse expect?
• A. Flat T waves
• B. Peaked T waves
• C. Prolonged PR interval
• D. Widened QRS
Answer: B
Rationale: Hyperkalemia causes peaked T waves as the earliest ECG change,
followed by prolonged PR, widened QRS, and eventually cardiac arrest if
untreated. Why Wrong: A occurs in hypokalemia; C and D are later
manifestations of severe hyperkalemia. Reference: ATI RN Medical-Surgical
Nursing, 2026 Edition.
8. A nurse is preparing to administer digoxin. The client's apical pulse is
52 bpm. Which action should the nurse take?
Concepts Examination | 2026/2027 Edition |
Comprehensive Practice Set ATI Nursing Education
| Verified Q&A | NCLEX-RN® Readiness | NGN-
Aligned
Introduction
This comprehensive ATI RN Concepts Level 3 Exam practice set covers
Medical-Surgical Nursing, Maternal-Newborn & Pediatric Nursing, Mental
Health & Psychosocial Nursing, Leadership, Management & Community
Health, and Fundamentals, Pharmacology & NGN Clinical Judgment. The
questions emphasize clinical judgment, prioritization, pharmacology,
delegation, and evidence-based nursing interventions aligned with the Next
Generation NCLEX (NGN) standards. All items are expert-verified with correct
answers and detailed rationales, designed for accurate evaluation and pass-
level readiness in accordance with the 2026/2027 ATI RN Comprehensive
curriculum.
Domain 1: Medical-Surgical Nursing
1. A nurse is caring for a client with a myocardial infarction. Which
finding should the nurse identify as the earliest indicator of left-sided
heart failure?
• A. Bilateral crackles
• B. Persistent cough
• C. Weight gain of 2 kg
• D. Orthopnea
Answer: B
Rationale: A persistent cough is an early indicator of left-sided heart failure
caused by pulmonary congestion. Crackles, weight gain, and orthopnea are
,later manifestations. Why Wrong: A, C, and D are later signs of worsening
failure rather than the earliest indicator. Reference: ATI RN Medical-Surgical
Nursing, 2026 Edition.
2. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen therapy. Which oxygen delivery method is most
appropriate for this client?
• A. 100% non-rebreather mask at 12 L/min
• B. Nasal cannula at 2 L/min
• C. Simple face mask at 8 L/min
• D. Venturi mask at 24%
Answer: B
Rationale: Clients with COPD rely on a hypoxic drive; low-flow oxygen (1-2
L/min via nasal cannula) maintains oxygenation without suppressing the
respiratory drive. Why Wrong: A and C deliver high oxygen concentrations
that may suppress the hypoxic drive; D may be used but is more complex than
needed for stability. Reference: ATI RN Medical-Surgical Nursing, 2026
Edition.
3. A nurse is assessing a client with suspected appendicitis. Which
assessment finding confirms McBurney's point tenderness?
• A. Right upper quadrant
• B. Left lower quadrant
• C. Right lower quadrant, one-third of the distance from the anterior
superior iliac spine to the umbilicus
• D. Left upper quadrant
Answer: C
Rationale: McBurney's point is located in the right lower quadrant, one-third
of the distance from the right anterior superior iliac spine to the umbilicus,
and is the classic tenderness site for appendicitis. Why Wrong: A, B, and D are
,incorrect anatomical locations for McBurney's point. Reference: ATI RN
Medical-Surgical Nursing, 2026 Edition.
4. A client with diabetes mellitus has a blood glucose of 48 mg/dL and is
conscious. Which action should the nurse take first?
• A. Administer glucagon IM
• B. Provide 15 g of fast-acting carbohydrate
• C. Administer 50% dextrose IV
• D. Recheck glucose in 15 minutes
Answer: B
Rationale: For a conscious client with hypoglycemia, the first action is to
provide 15 g of fast-acting oral carbohydrate (e.g., 4 oz juice) per ADA
guidelines. Why Wrong: A is for unconscious clients; C is for IV access
situations; D is the follow-up action after treatment. Reference: ATI RN
Medical-Surgical Nursing, 2026 Edition.
5. A client is receiving heparin therapy for deep vein thrombosis. The
nurse notes the aPTT is 90 seconds (control 30 seconds). Which action is
appropriate?
• A. Increase heparin rate
• B. Continue current dose
• C. Notify provider to decrease dose
• D. Stop infusion permanently
Answer: C
Rationale: The therapeutic aPTT for heparin is 1.5-2 times control (45-60
seconds). At 90 seconds (3 times control), the dose should be decreased per
protocol to prevent bleeding. Why Wrong: A would worsen anticoagulation; B
continues an excessive dose; D is unnecessary without active bleeding.
Reference: ATI RN Medical-Surgical Nursing, 2026 Edition.
, 6. A nurse is caring for a client with a chest tube. Which finding indicates
the chest drainage system is functioning properly?
• A. Continuous bubbling in the water seal chamber
• B. Intermittent bubbling in the suction control chamber
• C. No bubbling in any chamber
• D. Continuous bubbling in the suction control chamber only
Answer: B
Rationale: Intermittent bubbling in the suction control chamber indicates
proper suction operation. Continuous bubbling in the water seal chamber
suggests an air leak requiring investigation. Why Wrong: A indicates an air
leak; C suggests system malfunction; D alone is insufficient for proper function
confirmation. Reference: ATI RN Medical-Surgical Nursing, 2026 Edition.
7. A client with chronic kidney disease has a potassium level of 6.8
mEq/L. Which ECG finding should the nurse expect?
• A. Flat T waves
• B. Peaked T waves
• C. Prolonged PR interval
• D. Widened QRS
Answer: B
Rationale: Hyperkalemia causes peaked T waves as the earliest ECG change,
followed by prolonged PR, widened QRS, and eventually cardiac arrest if
untreated. Why Wrong: A occurs in hypokalemia; C and D are later
manifestations of severe hyperkalemia. Reference: ATI RN Medical-Surgical
Nursing, 2026 Edition.
8. A nurse is preparing to administer digoxin. The client's apical pulse is
52 bpm. Which action should the nurse take?
