ATI RN Concept-Based Assessment Test
Bank (Levels 1–4)
Comprehensive Practice Examination Core
Focus: Foundational to Advanced Nursing
Concepts, Clinical Judgment, and Evidence-
Based Practice (NCLEX/ATI Style)
Level 1: Foundational Concepts & Core Nursing Skills
Question 1
A nurse is caring for an older adult client who has been on bed rest for one week. Which of
the following findings should the nurse identify as a systemic manifestation of immobility?
A) Increased cardiac output
B) Decreased serum calcium levels
C) Decreased production of insulin
D) Altered patterns of urinary elimination
Correct Answer: D Rationale: Immobility leads to urinary stasis because the lack of physical
movement prevents the normal gravitational flow of urine from the renal pelvis into the
ureters. This urinary stasis predisposes the client to kidney stones and urinary tract
infections. Immobility causes decreased cardiac output, increased serum calcium (due to
bone demineralization), and does not directly decrease insulin production.
Question 2
A nurse is assessing a client who is experiencing fluid volume deficit. Which of the following
clinical findings should the nurse expect? A) Brisk capillary refill under 2 seconds
B) Decreased urine specific gravity
C) Orthostatic hypotension
D) Distended jugular veins
Correct Answer: C Rationale: Fluid volume deficit decreases circulating blood volume,
leading to a drop in blood pressure when changing positions (orthostatic hypotension) and a
compensatory increase in heart rate. Capillary refill is typically prolonged, urine specific
gravity increases as the kidneys attempt to conserve water, and jugular veins flatten out.
Question 3
,A nurse is reviewing the laboratory results of a client who has a serum potassium level of
$3.2\text{ mEq/L}$. Which of the following ECG changes should the nurse expect to
observe? A) Elevated ST segment
B) Tall, tented T waves
C) Flattened T waves and presence of U waves
D) Prolonged PR interval with a widened QRS complex
Correct Answer: C Rationale: A serum potassium level of $3.2\text{ mEq/L}$ indicates
hypokalemia (normal range: $3.5\text{ to }5.0\text{ mEq/L}$). Hypokalemia typically causes
flattened or inverted T waves, ST segment depression, and the development of prominent U
waves. Tall, tented T waves are characteristic of hyperkalemia.
Question 4
A nurse is teaching a newly licensed nurse about the principles of surgical asepsis. Which of
the following statements by the newly licensed nurse indicates an understanding of the
procedure? A) "I can open sterile packages facing away from me first."
B) "A $0.5\text{-inch}$ border around the edge of a sterile field is considered
contaminated."
C) "Sterile objects held below my waist level are considered unsterile."
D) "I can clear fluid splashes on the sterile field by blotting them with a sterile drape."
Correct Answer: C Rationale: In surgical asepsis, any sterile item held below the waist or
above the chest is considered contaminated because it falls outside the operator's line of
direct vision. The first flap of a sterile package should be opened away from the body, a
$1\text{-inch}$ border around the edge is considered contaminated, and any moisture that
penetrates the sterile field contaminates it via capillary action (wicking).
Question 5
A nurse is preparing to administer an intramuscular injection to an adult client who is
emaciated. Which of the following sites is the safest choice for this client? A) Dorsogluteal
B) Ventrogluteal
C) Vastus lateralis
D) Deltoid
Correct Answer: B Rationale: The ventrogluteal site is the safest and preferred site for
intramuscular injections in adults because it contains a thick muscle layer, lacks major nerves
or blood vessels, and has a lower fat content than other sites, even in emaciated clients. The
dorsogluteal site should be avoided due to proximity to the sciatic nerve.
,Question 6
A nurse is caring for a client who is post-operative and reporting pain rated as 7 on a scale of
0 to 10. Which of the following actions should the nurse take first? A) Offer the client a cold
compress.
B) Review the client's medical history for opioid tolerance.
C) Administer the prescribed analgesic medication.
D) Guide the client through deep-breathing exercises.
Correct Answer: C Rationale: Severe pain (rated 7/10) requires prompt pharmacological
intervention using prescribed analgesics to stabilize comfort and avoid the physiological
complications of uncontrolled pain stress responses. Non-pharmacological measures can be
used to complement analgesics but should not replace them for acute, severe pain.
Question 7
A nurse is performing a skin assessment on an immobilized client and notes an area of non-
blanchable erythema over the sacrum with intact skin. How should the nurse document this
finding? A) Stage 1 pressure injury
B) Stage 2 pressure injury
C) Deep tissue pressure injury
D) Unstageable pressure injury
Correct Answer: A Rationale: A Stage 1 pressure injury presents as localized, intact skin with
non-blanchable erythema. Stage 2 involves partial-thickness skin loss with an exposed
dermis, deep tissue injuries present as persistent non-blanchable deep red/purple
discoloration, and unstageable injuries involve full-thickness tissue loss obscured by slough
or eschar.
Question 8
A nurse is evaluating a client's understanding of a clear liquid diet. Which of the following
food choices by the client indicates that the teaching was effective? A) Vanilla ice cream
B) Applesauce
C) Chicken broth
D) Orange juice with pulp
Correct Answer: C Rationale: A clear liquid diet consists of fluids that are transparent or
translucent at room temperature, such as chicken broth, gelatin, tea, and black coffee. Ice
cream is a full liquid; applesauce and pulp-containing juices contain solids that disqualify
them from a clear liquid profile.
, Question 9
A nurse is assessing a client's peripheral pulses and notes that the radial pulse is difficult to
palpate and disappears with slight pressure. How should the nurse document the force of
this pulse? A) $0$
B) $+1$
C) $+2$
D) $+3$
Correct Answer: B Rationale: A $+1$ pulse describes a weak, thready pulse that is difficult to
palpate and easily obliterated with light palpation pressure. $0$ indicates an absent pulse,
$+2$ is a normal pulse, and $+3$ represents a bounding pulse.
Question 10
A nurse is caring for a client who has a prescription for airborne precautions. Which of the
following personal protective equipment (PPE) is required to enter the client's room? A)
Surgical mask
B) N95 respirator
C) Face shield
D) Gown and gloves
Correct Answer: B Rationale: Airborne precautions are implemented for pathogens that
remain infectious over long distances when suspended in the air (e.g., tuberculosis, varicella,
rubeola). An N95 or higher-level respirator is required to filter out microscopic airborne
particles. Surgical masks are used for droplet precautions.
Level 2: Core Physiological and Psychosocial Concepts
Question 11
A nurse is assessing a client who has chronic obstructive pulmonary disease (COPD). Which
of the following arterial blood gas (ABG) configurations should the nurse expect for this
client? A) $\text{pH } 7.32, \text{ PaCO}_2\ 55\text{ mmHg}, \text{ HCO}_3^-\ 24\text{
mEq/L}$
B) $\text{pH } 7.36, \text{ PaCO}_2\ 50\text{ mmHg}, \text{ HCO}_3^-\ 30\text{ mEq/L}$
C) $\text{pH } 7.48, \text{ PaCO}_2\ 30\text{ mmHg}, \text{ HCO}_3^-\ 22\text{ mEq/L}$
D) $\text{pH } 7.28, \text{ PaCO}_2\ 38\text{ mmHg}, \text{ HCO}_3^-\ 18\text{ mEq/L}$
Correct Answer: B Rationale: Clients with severe COPD chronically retain carbon dioxide
($\text{PaCO}_2 > 45\text{ mmHg}$). Over time, the kidneys compensate by retaining
Bank (Levels 1–4)
Comprehensive Practice Examination Core
Focus: Foundational to Advanced Nursing
Concepts, Clinical Judgment, and Evidence-
Based Practice (NCLEX/ATI Style)
Level 1: Foundational Concepts & Core Nursing Skills
Question 1
A nurse is caring for an older adult client who has been on bed rest for one week. Which of
the following findings should the nurse identify as a systemic manifestation of immobility?
A) Increased cardiac output
B) Decreased serum calcium levels
C) Decreased production of insulin
D) Altered patterns of urinary elimination
Correct Answer: D Rationale: Immobility leads to urinary stasis because the lack of physical
movement prevents the normal gravitational flow of urine from the renal pelvis into the
ureters. This urinary stasis predisposes the client to kidney stones and urinary tract
infections. Immobility causes decreased cardiac output, increased serum calcium (due to
bone demineralization), and does not directly decrease insulin production.
Question 2
A nurse is assessing a client who is experiencing fluid volume deficit. Which of the following
clinical findings should the nurse expect? A) Brisk capillary refill under 2 seconds
B) Decreased urine specific gravity
C) Orthostatic hypotension
D) Distended jugular veins
Correct Answer: C Rationale: Fluid volume deficit decreases circulating blood volume,
leading to a drop in blood pressure when changing positions (orthostatic hypotension) and a
compensatory increase in heart rate. Capillary refill is typically prolonged, urine specific
gravity increases as the kidneys attempt to conserve water, and jugular veins flatten out.
Question 3
,A nurse is reviewing the laboratory results of a client who has a serum potassium level of
$3.2\text{ mEq/L}$. Which of the following ECG changes should the nurse expect to
observe? A) Elevated ST segment
B) Tall, tented T waves
C) Flattened T waves and presence of U waves
D) Prolonged PR interval with a widened QRS complex
Correct Answer: C Rationale: A serum potassium level of $3.2\text{ mEq/L}$ indicates
hypokalemia (normal range: $3.5\text{ to }5.0\text{ mEq/L}$). Hypokalemia typically causes
flattened or inverted T waves, ST segment depression, and the development of prominent U
waves. Tall, tented T waves are characteristic of hyperkalemia.
Question 4
A nurse is teaching a newly licensed nurse about the principles of surgical asepsis. Which of
the following statements by the newly licensed nurse indicates an understanding of the
procedure? A) "I can open sterile packages facing away from me first."
B) "A $0.5\text{-inch}$ border around the edge of a sterile field is considered
contaminated."
C) "Sterile objects held below my waist level are considered unsterile."
D) "I can clear fluid splashes on the sterile field by blotting them with a sterile drape."
Correct Answer: C Rationale: In surgical asepsis, any sterile item held below the waist or
above the chest is considered contaminated because it falls outside the operator's line of
direct vision. The first flap of a sterile package should be opened away from the body, a
$1\text{-inch}$ border around the edge is considered contaminated, and any moisture that
penetrates the sterile field contaminates it via capillary action (wicking).
Question 5
A nurse is preparing to administer an intramuscular injection to an adult client who is
emaciated. Which of the following sites is the safest choice for this client? A) Dorsogluteal
B) Ventrogluteal
C) Vastus lateralis
D) Deltoid
Correct Answer: B Rationale: The ventrogluteal site is the safest and preferred site for
intramuscular injections in adults because it contains a thick muscle layer, lacks major nerves
or blood vessels, and has a lower fat content than other sites, even in emaciated clients. The
dorsogluteal site should be avoided due to proximity to the sciatic nerve.
,Question 6
A nurse is caring for a client who is post-operative and reporting pain rated as 7 on a scale of
0 to 10. Which of the following actions should the nurse take first? A) Offer the client a cold
compress.
B) Review the client's medical history for opioid tolerance.
C) Administer the prescribed analgesic medication.
D) Guide the client through deep-breathing exercises.
Correct Answer: C Rationale: Severe pain (rated 7/10) requires prompt pharmacological
intervention using prescribed analgesics to stabilize comfort and avoid the physiological
complications of uncontrolled pain stress responses. Non-pharmacological measures can be
used to complement analgesics but should not replace them for acute, severe pain.
Question 7
A nurse is performing a skin assessment on an immobilized client and notes an area of non-
blanchable erythema over the sacrum with intact skin. How should the nurse document this
finding? A) Stage 1 pressure injury
B) Stage 2 pressure injury
C) Deep tissue pressure injury
D) Unstageable pressure injury
Correct Answer: A Rationale: A Stage 1 pressure injury presents as localized, intact skin with
non-blanchable erythema. Stage 2 involves partial-thickness skin loss with an exposed
dermis, deep tissue injuries present as persistent non-blanchable deep red/purple
discoloration, and unstageable injuries involve full-thickness tissue loss obscured by slough
or eschar.
Question 8
A nurse is evaluating a client's understanding of a clear liquid diet. Which of the following
food choices by the client indicates that the teaching was effective? A) Vanilla ice cream
B) Applesauce
C) Chicken broth
D) Orange juice with pulp
Correct Answer: C Rationale: A clear liquid diet consists of fluids that are transparent or
translucent at room temperature, such as chicken broth, gelatin, tea, and black coffee. Ice
cream is a full liquid; applesauce and pulp-containing juices contain solids that disqualify
them from a clear liquid profile.
, Question 9
A nurse is assessing a client's peripheral pulses and notes that the radial pulse is difficult to
palpate and disappears with slight pressure. How should the nurse document the force of
this pulse? A) $0$
B) $+1$
C) $+2$
D) $+3$
Correct Answer: B Rationale: A $+1$ pulse describes a weak, thready pulse that is difficult to
palpate and easily obliterated with light palpation pressure. $0$ indicates an absent pulse,
$+2$ is a normal pulse, and $+3$ represents a bounding pulse.
Question 10
A nurse is caring for a client who has a prescription for airborne precautions. Which of the
following personal protective equipment (PPE) is required to enter the client's room? A)
Surgical mask
B) N95 respirator
C) Face shield
D) Gown and gloves
Correct Answer: B Rationale: Airborne precautions are implemented for pathogens that
remain infectious over long distances when suspended in the air (e.g., tuberculosis, varicella,
rubeola). An N95 or higher-level respirator is required to filter out microscopic airborne
particles. Surgical masks are used for droplet precautions.
Level 2: Core Physiological and Psychosocial Concepts
Question 11
A nurse is assessing a client who has chronic obstructive pulmonary disease (COPD). Which
of the following arterial blood gas (ABG) configurations should the nurse expect for this
client? A) $\text{pH } 7.32, \text{ PaCO}_2\ 55\text{ mmHg}, \text{ HCO}_3^-\ 24\text{
mEq/L}$
B) $\text{pH } 7.36, \text{ PaCO}_2\ 50\text{ mmHg}, \text{ HCO}_3^-\ 30\text{ mEq/L}$
C) $\text{pH } 7.48, \text{ PaCO}_2\ 30\text{ mmHg}, \text{ HCO}_3^-\ 22\text{ mEq/L}$
D) $\text{pH } 7.28, \text{ PaCO}_2\ 38\text{ mmHg}, \text{ HCO}_3^-\ 18\text{ mEq/L}$
Correct Answer: B Rationale: Clients with severe COPD chronically retain carbon dioxide
($\text{PaCO}_2 > 45\text{ mmHg}$). Over time, the kidneys compensate by retaining
