RN ATI Concept-Based Assessment
Examination
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Comprehensive Nursing Concept Integration
Competency Assessment
2026/2027
60 Multiple-Choice Questions
Pre-Licensure Nursing Programs
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, TABLE OF CONTENTS
1. Exam Instructions ........................................ 3
2. Section I: Clinical Judgment & Nursing Process (Q1–Q8) ........................................ 4
3. Section II: Safety & Infection Control (Q9–Q15) ........................................ 7
4. Section III: Basic Care & Comfort (Q16–Q22) ........................................ 10
5. Section IV: Psychosocial Integrity & Therapeutic Communication (Q23–Q28)
........................................ 13
6. Section V: Health Promotion & Maintenance (Q29–Q34) ........................................ 15
7. Section VI: Pharmacological & Parenteral Therapies (Q35–Q42) ........................................ 17
8. Section VII: Physiological Adaptation & Acute Care Management (Q43–Q50)
........................................ 20
9. Section VIII: Reduction of Risk Potential & Diagnostic Reasoning (Q51–Q55)
........................................ 23
10. Section IX: Management of Care & Professional Practice (Q56–Q60) ........................................ 25
11. Answer Key ........................................ 27
EXAM INSTRUCTIONS
Exam Structure: This assessment consists of 60 multiple-choice questions (MCQ) distributed
across nine clinical concept domains. Each question has four answer options (A–D) unless otherwise
marked as Select-All-That-Apply (SATA).
Timing: The total allowed time for this examination is 90 minutes. Pace yourself accordingly —
approximately 1.5 minutes per question is recommended.
Passing Score: A passing score of 75–80% (45–48 correct answers out of 60) is required to
demonstrate competency. Scores below 75% indicate the need for remediation in identified content
areas.
NCLEX-RN Readiness Benchmarks: Score 90–100% (54–60): High probability of NCLEX-RN
success. Score 80–89% (48–53): Moderate probability; focused review recommended. Score 75–79%
(45–47): Low–moderate probability; comprehensive remediation needed. Score below 75% (<45):
Significant remediation required across multiple domains.
Item Types Included: Standard MCQ (single best answer), Select-All-That-Apply (SATA)
questions, Prioritization scenarios (ABC/Maslow frameworks), Clinical judgment vignettes (NGN-
style), Calculation-based items (dosage, IV rates, ABG interpretation)
Test-Taking Strategies: Read each question stem carefully before reviewing options. Identify key
words (e.g., 'most important,' 'first,' 'best,' 'priority'). Use the process of elimination for difficult
questions. For prioritization questions, apply ABC, Maslow's hierarchy, and the Nursing Process. For
SATA questions, evaluate each option independently as true or false.
, Section I: Clinical Judgment & Nursing Process
(Q1–Q8)
This section assesses the nurse's ability to apply the NCSBN Clinical Judgment Measurement Model
(CJMM), including recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions,
taking action, and evaluating outcomes. Questions integrate the nursing process (ADPIE) and
require clinical reasoning across diverse care scenarios.
───────────────────────────────────────────────────────────────
───────
Q1. A nurse is assessing a client who was admitted with heart failure. Which of the
following findings should the nurse identify as the most critical cue requiring
immediate intervention?
A. Bilateral crackles in the lung bases
B. 2+ pitting edema of the lower extremities
C. Pink, frothy sputum
D. Jugular vein distension
Correct Answer: C. Pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of acute pulmonary edema, a life-threatening
complication of heart failure that indicates severe fluid accumulation in the alveoli. This finding
represents a medical emergency requiring immediate intervention such as oxygen administration,
diuretics, and possibly positive pressure ventilation. While bilateral crackles (A), pitting edema (B),
and jugular vein distension (D) are all signs of heart failure exacerbation, pink frothy sputum
indicates the most acute and dangerous presentation requiring the most urgent response.
Q2. A client presents to the emergency department with a blood pressure of 80/50
mmHg, heart rate of 120/min, and cool, clammy skin. Using the ABC prioritization
framework, which nursing action should be implemented first?
A. Obtain a 12-lead electrocardiogram
B. Initiate intravenous fluid resuscitation
C. Administer prescribed vasopressor medication
D. Assess oxygen saturation and apply supplemental oxygen
Correct Answer: D. Assess oxygen saturation and apply supplemental oxygen
Rationale: Following the ABC (Airway, Breathing, Circulation) framework, the nurse must first
ensure adequate oxygenation before addressing circulation. The client's presentation (hypotension,
tachycardia, diaphoresis) suggests shock, and tissue perfusion depends on adequate oxygen
delivery. Assessing oxygen saturation and applying supplemental oxygen addresses the Breathing
component first. IV fluids (B) address Circulation but should follow oxygenation. An ECG (A) is
diagnostic and not the first priority. Vasopressors (C) are typically initiated after fluid resuscitation
when perfusion remains inadequate.
Q3. A nurse is caring for a postoperative client who has a patient-controlled analgesia
(PCA) pump. The client's respiratory rate is 8/min and SpO2 is 88%. Which of the
following actions should the nurse take first?
A. Administer naloxone per protocol
B. Discontinue the PCA pump
C. Apply a non-rebreather mask at 10-15 L/min
D. Assess the client's level of consciousness
Correct Answer: B. Discontinue the PCA pump
Rationale: The first action is to remove the source of the problem — the PCA pump delivering
opioid medication causing respiratory depression. Stopping the opioid infusion halts further drug
Examination
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━
Comprehensive Nursing Concept Integration
Competency Assessment
2026/2027
60 Multiple-Choice Questions
Pre-Licensure Nursing Programs
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━
, TABLE OF CONTENTS
1. Exam Instructions ........................................ 3
2. Section I: Clinical Judgment & Nursing Process (Q1–Q8) ........................................ 4
3. Section II: Safety & Infection Control (Q9–Q15) ........................................ 7
4. Section III: Basic Care & Comfort (Q16–Q22) ........................................ 10
5. Section IV: Psychosocial Integrity & Therapeutic Communication (Q23–Q28)
........................................ 13
6. Section V: Health Promotion & Maintenance (Q29–Q34) ........................................ 15
7. Section VI: Pharmacological & Parenteral Therapies (Q35–Q42) ........................................ 17
8. Section VII: Physiological Adaptation & Acute Care Management (Q43–Q50)
........................................ 20
9. Section VIII: Reduction of Risk Potential & Diagnostic Reasoning (Q51–Q55)
........................................ 23
10. Section IX: Management of Care & Professional Practice (Q56–Q60) ........................................ 25
11. Answer Key ........................................ 27
EXAM INSTRUCTIONS
Exam Structure: This assessment consists of 60 multiple-choice questions (MCQ) distributed
across nine clinical concept domains. Each question has four answer options (A–D) unless otherwise
marked as Select-All-That-Apply (SATA).
Timing: The total allowed time for this examination is 90 minutes. Pace yourself accordingly —
approximately 1.5 minutes per question is recommended.
Passing Score: A passing score of 75–80% (45–48 correct answers out of 60) is required to
demonstrate competency. Scores below 75% indicate the need for remediation in identified content
areas.
NCLEX-RN Readiness Benchmarks: Score 90–100% (54–60): High probability of NCLEX-RN
success. Score 80–89% (48–53): Moderate probability; focused review recommended. Score 75–79%
(45–47): Low–moderate probability; comprehensive remediation needed. Score below 75% (<45):
Significant remediation required across multiple domains.
Item Types Included: Standard MCQ (single best answer), Select-All-That-Apply (SATA)
questions, Prioritization scenarios (ABC/Maslow frameworks), Clinical judgment vignettes (NGN-
style), Calculation-based items (dosage, IV rates, ABG interpretation)
Test-Taking Strategies: Read each question stem carefully before reviewing options. Identify key
words (e.g., 'most important,' 'first,' 'best,' 'priority'). Use the process of elimination for difficult
questions. For prioritization questions, apply ABC, Maslow's hierarchy, and the Nursing Process. For
SATA questions, evaluate each option independently as true or false.
, Section I: Clinical Judgment & Nursing Process
(Q1–Q8)
This section assesses the nurse's ability to apply the NCSBN Clinical Judgment Measurement Model
(CJMM), including recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions,
taking action, and evaluating outcomes. Questions integrate the nursing process (ADPIE) and
require clinical reasoning across diverse care scenarios.
───────────────────────────────────────────────────────────────
───────
Q1. A nurse is assessing a client who was admitted with heart failure. Which of the
following findings should the nurse identify as the most critical cue requiring
immediate intervention?
A. Bilateral crackles in the lung bases
B. 2+ pitting edema of the lower extremities
C. Pink, frothy sputum
D. Jugular vein distension
Correct Answer: C. Pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of acute pulmonary edema, a life-threatening
complication of heart failure that indicates severe fluid accumulation in the alveoli. This finding
represents a medical emergency requiring immediate intervention such as oxygen administration,
diuretics, and possibly positive pressure ventilation. While bilateral crackles (A), pitting edema (B),
and jugular vein distension (D) are all signs of heart failure exacerbation, pink frothy sputum
indicates the most acute and dangerous presentation requiring the most urgent response.
Q2. A client presents to the emergency department with a blood pressure of 80/50
mmHg, heart rate of 120/min, and cool, clammy skin. Using the ABC prioritization
framework, which nursing action should be implemented first?
A. Obtain a 12-lead electrocardiogram
B. Initiate intravenous fluid resuscitation
C. Administer prescribed vasopressor medication
D. Assess oxygen saturation and apply supplemental oxygen
Correct Answer: D. Assess oxygen saturation and apply supplemental oxygen
Rationale: Following the ABC (Airway, Breathing, Circulation) framework, the nurse must first
ensure adequate oxygenation before addressing circulation. The client's presentation (hypotension,
tachycardia, diaphoresis) suggests shock, and tissue perfusion depends on adequate oxygen
delivery. Assessing oxygen saturation and applying supplemental oxygen addresses the Breathing
component first. IV fluids (B) address Circulation but should follow oxygenation. An ECG (A) is
diagnostic and not the first priority. Vasopressors (C) are typically initiated after fluid resuscitation
when perfusion remains inadequate.
Q3. A nurse is caring for a postoperative client who has a patient-controlled analgesia
(PCA) pump. The client's respiratory rate is 8/min and SpO2 is 88%. Which of the
following actions should the nurse take first?
A. Administer naloxone per protocol
B. Discontinue the PCA pump
C. Apply a non-rebreather mask at 10-15 L/min
D. Assess the client's level of consciousness
Correct Answer: B. Discontinue the PCA pump
Rationale: The first action is to remove the source of the problem — the PCA pump delivering
opioid medication causing respiratory depression. Stopping the opioid infusion halts further drug
