ATI RN CONCEPT-BASED ASSESSMENT LEVEL 2
PROCTORED EXAM New Edition
Comprehensive Examination with Verified Answers .
Question 1 (Multiple-Choice)
A nurse is reviewing laboratory results for a client newly diagnosed with colorectal cancer. The
nurse notes the following values:
• CEA (Carcinoembryonic Antigen): 45 ng/mL (Normal: <3.0 ng/mL)
• CA 19-9: 120 U/mL (Normal: <37 U/mL)
• WBC: 3.2 × 10³/µL (Normal: 4.5–11.0 × 10³/µL)
• Platelets: 85,000/µL (Normal: 150,000–400,000/µL)
Which finding requires the most immediate nursing intervention?
A. Elevated CEA level
B. Elevated CA 19-9 level
C. WBC count of 3.2 × 10³/µL
D. Platelet count of 85,000/µL
[CORRECT: D]
Rationale: A platelet count of 85,000/µL indicates thrombocytopenia and places the client at
immediate risk for spontaneous bleeding. While elevated tumor markers (A, B) confirm
diagnosis and guide treatment, they do not pose an acute safety threat. Leukopenia (C)
increases infection risk but does not carry the same immediate life-threatening potential as
severe thrombocytopenia, which can result in intracranial hemorrhage or GI bleeding.
Question 2 (SATA)
A nurse is caring for a client with multiple myeloma who is receiving chemotherapy. The nurse
reviews the following laboratory results:
• Hemoglobin: 7.8 g/dL
• Calcium: 12.4 mg/dL
• Creatinine: 2.8 mg/dL
, • β2-microglobulin: 6.5 mg/L
Which findings indicate complications associated with multiple myeloma? Select all that apply.
□ A. Hemoglobin 7.8 g/dL
□ B. Calcium 12.4 mg/dL
□ C. Creatinine 2.8 mg/dL
□ D. β2-microglobulin 6.5 mg/L
□ E. All of the above
[CORRECT: A, B, C, D]
Rationale: All findings represent classic CRAB criteria and prognostic indicators for multiple
myeloma. A (anemia) results from bone marrow infiltration by plasma cells. B (hypercalcemia
>11 mg/dL) occurs due to osteoclast activation from lytic bone lesions. C (renal impairment)
results from light chain deposition (Bence Jones protein) causing tubular damage. D (elevated
β2-microglobulin >5.5 mg/L) indicates higher tumor burden and is a poor prognostic factor. E is
correct because all individual options are valid.
Question 3 (Calculation-Based)
A client receiving chemotherapy has a hemoglobin of 7.2 g/dL and symptomatic anemia. The
provider orders 2 units of packed red blood cells (PRBCs) to be transfused over 4 hours per unit.
The blood tubing set has a drip factor of 15 gtt/mL. Each unit contains 250 mL.
What is the drip rate in drops per minute (gtt/min) for each unit of PRBCs? Round to the
nearest whole number.
A. 12 gtt/min
B. 16 gtt/min
C. 20 gtt/min
D. 24 gtt/min
[CORRECT: B]
Rationale: Using the formula: (Volume × Drip factor) ÷ Time in minutes. (250 mL × 15 gtt/mL) ÷
240 minutes = 3,750 ÷ 240 = 15.625 gtt/min, rounded to 16 gtt/min. PRBCs must be transfused
within 4 hours per unit to prevent bacterial growth. Options A, C, and D represent
miscalculations of time or drip factor.
Sub-Topic: Nursing Management of Chemotherapy Side Effects (3 Questions)
,Question 4 (Multiple-Choice)
A client receiving high-dose methotrexate for osteosarcoma develops severe mucositis. The
nurse assesses ulcerative lesions on the buccal mucosa and tongue, with the client reporting
pain rated 8/10. Which intervention is the priority?
A. Administer viscous lidocaine before meals and oral care
B. Apply hydrogen peroxide rinses three times daily
C. Instruct the client to use a firm toothbrush to remove plaque
D. Encourage the client to avoid all oral intake until healing occurs
[CORRECT: A]
Rationale: Viscous lidocaine provides topical anesthesia, enabling the client to maintain oral
intake and perform oral care despite painful mucositis. Hydrogen peroxide (B) is cytotoxic to
healing tissue and contraindicated. Firm brushing (C) causes further mucosal trauma; only soft
toothbrushes are used. Avoiding oral intake (D) leads to malnutrition and dehydration,
worsening outcomes.
Question 5 (SATA)
A nurse is caring for a client who received doxorubicin (Adriamycin) 48 hours ago. The client
reports nausea, and the nurse notes a temperature of 101.2°F (38.4°C). Which assessments and
interventions are appropriate? Select all that apply.
□ A. Obtain blood cultures from two separate sites before administering antibiotics
□ B. Administer ondansetron 8 mg IV for chemotherapy-induced nausea
□ C. Assess for signs of cardiotoxicity, including irregular heart rate
□ D. Apply ice packs to the IV site to prevent extravasation injury
□ E. Monitor for signs of tumor lysis syndrome, including hyperuricemia
[CORRECT: A, B, C, E]
Rationale: Fever in a neutropenic client receiving chemotherapy is a medical emergency
requiring blood cultures before antibiotics (A). Ondansetron (B) is appropriate for CINV.
Doxorubicin is cardiotoxic (C), requiring cardiac monitoring. Tumor lysis syndrome (E) is a risk
with rapidly proliferating tumors. Ice packs (D) are inappropriate; doxorubicin extravasation
requires warm compresses to increase blood flow and antidote administration (dexrazoxane).
, Question 6 (Multiple-Choice)
A client with chemotherapy-induced neutropenia has a WBC count of 1.8 × 10³/µL and an
absolute neutrophil count (ANC) of 450/µL. Which nursing action is the priority?
A. Place the client in a positive-pressure room with HEPA filtration
B. Restrict all visitors to immediate family members only
C. Implement protective isolation and strict hand hygiene protocols
D. Administer filgrastim (Neupogen) to stimulate neutrophil production
[CORRECT: C]
Rationale: An ANC <500/µL indicates severe neutropenia. Protective isolation (reverse isolation)
with strict hand hygiene is the priority nursing intervention to prevent infection. Positive-
pressure rooms (A) are reserved for bone marrow transplant recipients, not standard
chemotherapy patients. Visitor restriction (B) is less critical than proper hand hygiene. Filgrastim
(D) is a provider order, not an independent nursing action, and does not address immediate
infection prevention.
Sub-Topic: Principles of Radiation Therapy and Skin Care (2 Questions)
Question 7 (Multiple-Choice)
A client receiving external beam radiation therapy to the neck for laryngeal cancer develops
moist desquamation in the treatment field. Which instruction should the nurse provide?
A. "Apply a heating pad to the area for 20 minutes to promote circulation."
B. "Use a mild soap and pat the area dry; avoid perfumed lotions."
C. "Cover the area with an occlusive hydrocolloid dressing."
D. "Expose the area to direct sunlight for 10 minutes daily to promote healing."
[CORRECT: B]
Rationale: Moist desquamation requires gentle cleansing with mild soap, patting dry, and
avoiding irritating substances. Heat (A) worsens tissue damage. Occlusive dressings (C) are
contraindicated over infected or weeping radiation dermatitis without provider order. Sun
exposure (D) causes further radiation recall reaction and skin damage.
Question 8 (SATA)
PROCTORED EXAM New Edition
Comprehensive Examination with Verified Answers .
Question 1 (Multiple-Choice)
A nurse is reviewing laboratory results for a client newly diagnosed with colorectal cancer. The
nurse notes the following values:
• CEA (Carcinoembryonic Antigen): 45 ng/mL (Normal: <3.0 ng/mL)
• CA 19-9: 120 U/mL (Normal: <37 U/mL)
• WBC: 3.2 × 10³/µL (Normal: 4.5–11.0 × 10³/µL)
• Platelets: 85,000/µL (Normal: 150,000–400,000/µL)
Which finding requires the most immediate nursing intervention?
A. Elevated CEA level
B. Elevated CA 19-9 level
C. WBC count of 3.2 × 10³/µL
D. Platelet count of 85,000/µL
[CORRECT: D]
Rationale: A platelet count of 85,000/µL indicates thrombocytopenia and places the client at
immediate risk for spontaneous bleeding. While elevated tumor markers (A, B) confirm
diagnosis and guide treatment, they do not pose an acute safety threat. Leukopenia (C)
increases infection risk but does not carry the same immediate life-threatening potential as
severe thrombocytopenia, which can result in intracranial hemorrhage or GI bleeding.
Question 2 (SATA)
A nurse is caring for a client with multiple myeloma who is receiving chemotherapy. The nurse
reviews the following laboratory results:
• Hemoglobin: 7.8 g/dL
• Calcium: 12.4 mg/dL
• Creatinine: 2.8 mg/dL
, • β2-microglobulin: 6.5 mg/L
Which findings indicate complications associated with multiple myeloma? Select all that apply.
□ A. Hemoglobin 7.8 g/dL
□ B. Calcium 12.4 mg/dL
□ C. Creatinine 2.8 mg/dL
□ D. β2-microglobulin 6.5 mg/L
□ E. All of the above
[CORRECT: A, B, C, D]
Rationale: All findings represent classic CRAB criteria and prognostic indicators for multiple
myeloma. A (anemia) results from bone marrow infiltration by plasma cells. B (hypercalcemia
>11 mg/dL) occurs due to osteoclast activation from lytic bone lesions. C (renal impairment)
results from light chain deposition (Bence Jones protein) causing tubular damage. D (elevated
β2-microglobulin >5.5 mg/L) indicates higher tumor burden and is a poor prognostic factor. E is
correct because all individual options are valid.
Question 3 (Calculation-Based)
A client receiving chemotherapy has a hemoglobin of 7.2 g/dL and symptomatic anemia. The
provider orders 2 units of packed red blood cells (PRBCs) to be transfused over 4 hours per unit.
The blood tubing set has a drip factor of 15 gtt/mL. Each unit contains 250 mL.
What is the drip rate in drops per minute (gtt/min) for each unit of PRBCs? Round to the
nearest whole number.
A. 12 gtt/min
B. 16 gtt/min
C. 20 gtt/min
D. 24 gtt/min
[CORRECT: B]
Rationale: Using the formula: (Volume × Drip factor) ÷ Time in minutes. (250 mL × 15 gtt/mL) ÷
240 minutes = 3,750 ÷ 240 = 15.625 gtt/min, rounded to 16 gtt/min. PRBCs must be transfused
within 4 hours per unit to prevent bacterial growth. Options A, C, and D represent
miscalculations of time or drip factor.
Sub-Topic: Nursing Management of Chemotherapy Side Effects (3 Questions)
,Question 4 (Multiple-Choice)
A client receiving high-dose methotrexate for osteosarcoma develops severe mucositis. The
nurse assesses ulcerative lesions on the buccal mucosa and tongue, with the client reporting
pain rated 8/10. Which intervention is the priority?
A. Administer viscous lidocaine before meals and oral care
B. Apply hydrogen peroxide rinses three times daily
C. Instruct the client to use a firm toothbrush to remove plaque
D. Encourage the client to avoid all oral intake until healing occurs
[CORRECT: A]
Rationale: Viscous lidocaine provides topical anesthesia, enabling the client to maintain oral
intake and perform oral care despite painful mucositis. Hydrogen peroxide (B) is cytotoxic to
healing tissue and contraindicated. Firm brushing (C) causes further mucosal trauma; only soft
toothbrushes are used. Avoiding oral intake (D) leads to malnutrition and dehydration,
worsening outcomes.
Question 5 (SATA)
A nurse is caring for a client who received doxorubicin (Adriamycin) 48 hours ago. The client
reports nausea, and the nurse notes a temperature of 101.2°F (38.4°C). Which assessments and
interventions are appropriate? Select all that apply.
□ A. Obtain blood cultures from two separate sites before administering antibiotics
□ B. Administer ondansetron 8 mg IV for chemotherapy-induced nausea
□ C. Assess for signs of cardiotoxicity, including irregular heart rate
□ D. Apply ice packs to the IV site to prevent extravasation injury
□ E. Monitor for signs of tumor lysis syndrome, including hyperuricemia
[CORRECT: A, B, C, E]
Rationale: Fever in a neutropenic client receiving chemotherapy is a medical emergency
requiring blood cultures before antibiotics (A). Ondansetron (B) is appropriate for CINV.
Doxorubicin is cardiotoxic (C), requiring cardiac monitoring. Tumor lysis syndrome (E) is a risk
with rapidly proliferating tumors. Ice packs (D) are inappropriate; doxorubicin extravasation
requires warm compresses to increase blood flow and antidote administration (dexrazoxane).
, Question 6 (Multiple-Choice)
A client with chemotherapy-induced neutropenia has a WBC count of 1.8 × 10³/µL and an
absolute neutrophil count (ANC) of 450/µL. Which nursing action is the priority?
A. Place the client in a positive-pressure room with HEPA filtration
B. Restrict all visitors to immediate family members only
C. Implement protective isolation and strict hand hygiene protocols
D. Administer filgrastim (Neupogen) to stimulate neutrophil production
[CORRECT: C]
Rationale: An ANC <500/µL indicates severe neutropenia. Protective isolation (reverse isolation)
with strict hand hygiene is the priority nursing intervention to prevent infection. Positive-
pressure rooms (A) are reserved for bone marrow transplant recipients, not standard
chemotherapy patients. Visitor restriction (B) is less critical than proper hand hygiene. Filgrastim
(D) is a provider order, not an independent nursing action, and does not address immediate
infection prevention.
Sub-Topic: Principles of Radiation Therapy and Skin Care (2 Questions)
Question 7 (Multiple-Choice)
A client receiving external beam radiation therapy to the neck for laryngeal cancer develops
moist desquamation in the treatment field. Which instruction should the nurse provide?
A. "Apply a heating pad to the area for 20 minutes to promote circulation."
B. "Use a mild soap and pat the area dry; avoid perfumed lotions."
C. "Cover the area with an occlusive hydrocolloid dressing."
D. "Expose the area to direct sunlight for 10 minutes daily to promote healing."
[CORRECT: B]
Rationale: Moist desquamation requires gentle cleansing with mild soap, patting dry, and
avoiding irritating substances. Heat (A) worsens tissue damage. Occlusive dressings (C) are
contraindicated over infected or weeping radiation dermatitis without provider order. Sun
exposure (D) causes further radiation recall reaction and skin damage.
Question 8 (SATA)
