✅ ATI RN Concept-Based Assessment –
Level 4 (2025_2026)
Questions | Original | Correct Answers | Rationales
1. A client with acute respiratory distress syndrome
(ARDS) is on mechanical ventilation. Which finding
indicates improvement?
A. PaO₂ rising
B. SpO₂ dropping
C. Increasing PEEP requirements
D. Decreased tidal volume
Correct Answer: A. PaO₂ rising
Rationale: Rising PaO₂ indicates improved oxygenation and gas exchange.
2. A nurse is caring for a client with septic shock. Which
intervention is priority?
A. Administer broad-spectrum antibiotics
B. Give oral fluids
C. Apply warm compresses
D. Encourage ambulation
Correct Answer: A. Administer broad-spectrum antibiotics
Rationale: Early antibiotics reduce mortality and treat underlying infection.
3. A client receiving norepinephrine develops cold, pale
fingers. What is the priority action?
,A. Stop infusion and notify provider
B. Apply warm compresses
C. Decrease IV fluid rate
D. Elevate extremities
Correct Answer: A. Stop infusion and notify provider
Rationale: Indicates extravasation or severe vasoconstriction → immediate action required.
4. A client with diabetic ketoacidosis has rapid, deep
respirations. What is this called?
A. Cheyne–Stokes respirations
B. Biot’s respirations
C. Kussmaul respirations
D. Apneustic respirations
Correct Answer: C. Kussmaul respirations
Rationale: Compensatory hyperventilation to correct metabolic acidosis.
5. Which intervention reduces increased intracranial
pressure (ICP) in a client with TBI?
A. Keep head midline, HOB 30°
B. Flex the hips
C. Frequent suctioning
D. Trendelenburg position
Correct Answer: A. Keep head midline, HOB 30°
Rationale: Promotes venous drainage, reduces ICP, and prevents cerebral hypoxia.
6. A client develops stridor after thyroidectomy. What is
the priority action?
A. Prepare for tracheostomy
B. Give oral calcium
,C. Provide ice chips
D. Encourage deep breathing
Correct Answer: A. Prepare for tracheostomy
Rationale: Stridor indicates airway obstruction → airway intervention is urgent.
7. A client with hyperkalemia (K⁺ 6.8 mEq/L) requires
immediate intervention. Which is priority?
A. Administer IV calcium gluconate
B. Restrict dietary potassium
C. Give oral fluids
D. Monitor vital signs
Correct Answer: A. Administer IV calcium gluconate
Rationale: Stabilizes cardiac membranes, preventing arrhythmias.
8. A nurse assesses a client with myasthenia gravis in
crisis. Which assessment is priority?
A. Respiratory status
B. High-calorie meal intake
C. Oral hygiene
D. Limit visitors
Correct Answer: A. Respiratory status
Rationale: MG crisis → risk for respiratory failure → priority is airway and breathing.
9. Which intervention is appropriate for a client in
restraints?
A. Remove restraints every 2 hours
B. Tie to side rails
C. Renew order every 24 hours
D. Document every 8 hours
, Correct Answer: A. Remove restraints every 2 hours
Rationale: Prevents circulation impairment, skin breakdown, and allows assessment.
10. A client receiving mannitol shows serum osmolality
330 mOsm/kg. What should the nurse do?
A. Withhold next dose
B. Increase IV rate
C. Elevate legs
D. Administer hypertonic saline
Correct Answer: A. Withhold next dose
Rationale: Osmolality >320 indicates risk for mannitol toxicity.
11. A client has sudden tracheal deviation and absent
breath sounds on one side. What is the priority?
A. Prepare for needle decompression
B. Apply oxygen
C. Assess vital signs
D. Administer pain medication
Correct Answer: A. Prepare for needle decompression
Rationale: Classic tension pneumothorax → life-threatening emergency.
12. A client reports fruity breath and polyuria. Which
condition is suspected?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Metabolic alkalosis
Correct Answer: B. Diabetic ketoacidosis
Rationale: Ketone accumulation → fruity odor; hallmark of DKA.
Level 4 (2025_2026)
Questions | Original | Correct Answers | Rationales
1. A client with acute respiratory distress syndrome
(ARDS) is on mechanical ventilation. Which finding
indicates improvement?
A. PaO₂ rising
B. SpO₂ dropping
C. Increasing PEEP requirements
D. Decreased tidal volume
Correct Answer: A. PaO₂ rising
Rationale: Rising PaO₂ indicates improved oxygenation and gas exchange.
2. A nurse is caring for a client with septic shock. Which
intervention is priority?
A. Administer broad-spectrum antibiotics
B. Give oral fluids
C. Apply warm compresses
D. Encourage ambulation
Correct Answer: A. Administer broad-spectrum antibiotics
Rationale: Early antibiotics reduce mortality and treat underlying infection.
3. A client receiving norepinephrine develops cold, pale
fingers. What is the priority action?
,A. Stop infusion and notify provider
B. Apply warm compresses
C. Decrease IV fluid rate
D. Elevate extremities
Correct Answer: A. Stop infusion and notify provider
Rationale: Indicates extravasation or severe vasoconstriction → immediate action required.
4. A client with diabetic ketoacidosis has rapid, deep
respirations. What is this called?
A. Cheyne–Stokes respirations
B. Biot’s respirations
C. Kussmaul respirations
D. Apneustic respirations
Correct Answer: C. Kussmaul respirations
Rationale: Compensatory hyperventilation to correct metabolic acidosis.
5. Which intervention reduces increased intracranial
pressure (ICP) in a client with TBI?
A. Keep head midline, HOB 30°
B. Flex the hips
C. Frequent suctioning
D. Trendelenburg position
Correct Answer: A. Keep head midline, HOB 30°
Rationale: Promotes venous drainage, reduces ICP, and prevents cerebral hypoxia.
6. A client develops stridor after thyroidectomy. What is
the priority action?
A. Prepare for tracheostomy
B. Give oral calcium
,C. Provide ice chips
D. Encourage deep breathing
Correct Answer: A. Prepare for tracheostomy
Rationale: Stridor indicates airway obstruction → airway intervention is urgent.
7. A client with hyperkalemia (K⁺ 6.8 mEq/L) requires
immediate intervention. Which is priority?
A. Administer IV calcium gluconate
B. Restrict dietary potassium
C. Give oral fluids
D. Monitor vital signs
Correct Answer: A. Administer IV calcium gluconate
Rationale: Stabilizes cardiac membranes, preventing arrhythmias.
8. A nurse assesses a client with myasthenia gravis in
crisis. Which assessment is priority?
A. Respiratory status
B. High-calorie meal intake
C. Oral hygiene
D. Limit visitors
Correct Answer: A. Respiratory status
Rationale: MG crisis → risk for respiratory failure → priority is airway and breathing.
9. Which intervention is appropriate for a client in
restraints?
A. Remove restraints every 2 hours
B. Tie to side rails
C. Renew order every 24 hours
D. Document every 8 hours
, Correct Answer: A. Remove restraints every 2 hours
Rationale: Prevents circulation impairment, skin breakdown, and allows assessment.
10. A client receiving mannitol shows serum osmolality
330 mOsm/kg. What should the nurse do?
A. Withhold next dose
B. Increase IV rate
C. Elevate legs
D. Administer hypertonic saline
Correct Answer: A. Withhold next dose
Rationale: Osmolality >320 indicates risk for mannitol toxicity.
11. A client has sudden tracheal deviation and absent
breath sounds on one side. What is the priority?
A. Prepare for needle decompression
B. Apply oxygen
C. Assess vital signs
D. Administer pain medication
Correct Answer: A. Prepare for needle decompression
Rationale: Classic tension pneumothorax → life-threatening emergency.
12. A client reports fruity breath and polyuria. Which
condition is suspected?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Metabolic alkalosis
Correct Answer: B. Diabetic ketoacidosis
Rationale: Ketone accumulation → fruity odor; hallmark of DKA.
