ATI RN Concept-Based Assessment Level 2
Proctored Exam 2026 – Verified Questions and
Answers with Detailed Explanations (Exam
Preparation Material)
1. A client with diabetic ketoacidosis has deep, rapid
respirations (Kussmaul’s). Which acid-base imbalance is
most likely?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Respiratory alkalosis
Answer: C
Rationale: DKA causes excess ketones (acids), leading to
metabolic acidosis. Kussmaul’s respirations are a
compensatory mechanism to blow off CO₂ .
2. A client taking furosemide reports weakness and
confusion. ABG: pH 7.48, PaCO₂ 48, HCO₃ 32. Which
1
,imbalance is present?
A) Uncompensated respiratory alkalosis
B) Fully compensated metabolic alkalosis
C) Partially compensated metabolic alkalosis
D) Uncompensated metabolic acidosis
Answer: B
Rationale: High pH (alkalosis), high HCO₃ (metabolic
cause), and elevated PaCO₂ (respiratory compensation)
with pH near normal indicates full compensation.
3. A client with salicylate overdose has ABG: pH 7.32,
PaCO₂ 28, HCO₃ 16. What is the interpretation?
A) Metabolic alkalosis with compensation
B) Respiratory acidosis with compensation
C) Metabolic acidosis with respiratory compensation
D) Mixed metabolic and respiratory acidosis
Answer: C
Rationale: Low pH (acidosis), low HCO₃ (metabolic
2
,acidosis), low PaCO₂ (respiratory compensation via
hyperventilation).
4. Which client is at highest risk for respiratory acidosis?
A) Client on a ventilator with rate 22
B) Client with an opioid overdose
C) Client with panic attack
D) Client with diabetic ketoacidosis
Answer: B
Rationale: Opioids depress respiratory drive →
hypoventilation → CO₂ retention → respiratory
acidosis.
5. A client’s ABG shows pH 7.28, PaCO₂ 55, HCO₃ 24.
Which intervention is priority?
A) Administer sodium bicarbonate
B) Encourage deep breathing and coughing
C) Prepare for intubation and mechanical ventilation
D) Administer IV fluids
3
, Answer: C
Rationale: Uncompensated respiratory acidosis with
severe hypoventilation requires ventilatory support.
Concept: Perfusion
6. A client with chest pain and diaphoresis has BP 90/60,
HR 120, RR 28. Which priority action?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG
C) Start a large-bore IV and give fluids
D) Give morphine for pain
Answer: C
Rationale: Hypotension with tachycardia suggests
cardiogenic shock. Fluids (cautiously) and IV access are
priority before nitrates (which lower BP further).
7. A client post-MI has jugular vein distention, crackles,
and S3 heart sound. What complication is likely?
A) Cardiac tamponade
4
Proctored Exam 2026 – Verified Questions and
Answers with Detailed Explanations (Exam
Preparation Material)
1. A client with diabetic ketoacidosis has deep, rapid
respirations (Kussmaul’s). Which acid-base imbalance is
most likely?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Respiratory alkalosis
Answer: C
Rationale: DKA causes excess ketones (acids), leading to
metabolic acidosis. Kussmaul’s respirations are a
compensatory mechanism to blow off CO₂ .
2. A client taking furosemide reports weakness and
confusion. ABG: pH 7.48, PaCO₂ 48, HCO₃ 32. Which
1
,imbalance is present?
A) Uncompensated respiratory alkalosis
B) Fully compensated metabolic alkalosis
C) Partially compensated metabolic alkalosis
D) Uncompensated metabolic acidosis
Answer: B
Rationale: High pH (alkalosis), high HCO₃ (metabolic
cause), and elevated PaCO₂ (respiratory compensation)
with pH near normal indicates full compensation.
3. A client with salicylate overdose has ABG: pH 7.32,
PaCO₂ 28, HCO₃ 16. What is the interpretation?
A) Metabolic alkalosis with compensation
B) Respiratory acidosis with compensation
C) Metabolic acidosis with respiratory compensation
D) Mixed metabolic and respiratory acidosis
Answer: C
Rationale: Low pH (acidosis), low HCO₃ (metabolic
2
,acidosis), low PaCO₂ (respiratory compensation via
hyperventilation).
4. Which client is at highest risk for respiratory acidosis?
A) Client on a ventilator with rate 22
B) Client with an opioid overdose
C) Client with panic attack
D) Client with diabetic ketoacidosis
Answer: B
Rationale: Opioids depress respiratory drive →
hypoventilation → CO₂ retention → respiratory
acidosis.
5. A client’s ABG shows pH 7.28, PaCO₂ 55, HCO₃ 24.
Which intervention is priority?
A) Administer sodium bicarbonate
B) Encourage deep breathing and coughing
C) Prepare for intubation and mechanical ventilation
D) Administer IV fluids
3
, Answer: C
Rationale: Uncompensated respiratory acidosis with
severe hypoventilation requires ventilatory support.
Concept: Perfusion
6. A client with chest pain and diaphoresis has BP 90/60,
HR 120, RR 28. Which priority action?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG
C) Start a large-bore IV and give fluids
D) Give morphine for pain
Answer: C
Rationale: Hypotension with tachycardia suggests
cardiogenic shock. Fluids (cautiously) and IV access are
priority before nitrates (which lower BP further).
7. A client post-MI has jugular vein distention, crackles,
and S3 heart sound. What complication is likely?
A) Cardiac tamponade
4
