ATI RN Concept-Based Assessment Proctored Exam –
Level 2 Medical-Surgical Nursing: Chronic Illness,
Clinical Judgment, and Complex Care Complete Level
2 Question Bank
Q1. A nurse is caring for a client who has heart failure and reports sudden weight gain of 2
kilograms in 24 hours. Which action should the nurse take first in response to this finding?
A. Notify the provider immediately.
B. Restrict all oral fluids for the next 8 hours.
C. Administer furosemide 40 mg intravenously.
D. Auscultate the client's lung sounds for crackles or wheezes.
Rationale: Rapid weight gain indicates fluid retention. Lung auscultation assesses for
pulmonary edema, which is a life-threatening complication of worsening heart failure
requiring immediate intervention. Assessment always precedes notification or medication
administration.
Q2. A nurse is teaching a client who has a new diagnosis of type 2 diabetes mellitus about
foot care. Which statement by the client indicates a need for further teaching about proper
foot hygiene?
A. "I will check the inside of my shoes before putting them on each day."
B. "I will trim my toenails straight across and file the edges smooth."
C. "I will wear cotton socks and change them daily or more often if they become damp."
D. "I will soak my feet in warm water for 30 minutes every day to keep them clean and
soft."
Rationale: Prolonged soaking macerates skin and increases infection risk. Clients with
diabetes should wash feet daily with mild soap and dry thoroughly, especially between the
toes, but soaking for extended periods is harmful.
Q3. A nurse is assessing a client who has chronic obstructive pulmonary disease and is
receiving oxygen at 2 liters per minute via nasal cannula. Which finding indicates the client
is experiencing oxygen toxicity?
,A. The client's oxygen saturation level is 94 percent on the current flow rate.
B. The client reports feeling more energetic and less short of breath.
C. The client's respiratory rate has decreased from 24 to 16 breaths per minute.
D. The client reports substernal chest pain and has a nonproductive cough.
Rationale: Oxygen toxicity causes substernal discomfort, coughing, and dyspnea. It occurs
most often with high concentrations of oxygen delivered for prolonged periods. These
symptoms require immediate evaluation.
Q4. A nurse is caring for a client who has a new diagnosis of deep vein thrombosis in the
left calf. Which finding should the nurse report to the provider immediately?
A. The client's left calf measures 2 centimeters larger than the right calf.
B. The client reports mild tenderness when the left calf is palpated.
C. The client's left foot is slightly warmer than the right foot.
D. The client reports sudden onset of chest pain and difficulty breathing.
Rationale: Sudden chest pain and dyspnea in a client with DVT suggest pulmonary
embolism, a life-threatening complication requiring immediate intervention. The other
findings are expected with DVT.
Q5. A nurse is providing discharge teaching to a client who has a new prescription for
warfarin after a mechanical heart valve replacement. Which statement by the client
indicates correct understanding of this medication?
A. "I will take ibuprofen for headaches instead of acetaminophen."
B. "I will eat a large spinach salad every day to keep my blood healthy."
C. "I will report any bruising or bleeding to my provider right away."
D. "I will stop taking warfarin for three days before having my teeth cleaned."
Rationale: Warfarin increases bleeding risk. Any unusual bruising or bleeding must be
reported. Ibuprofen increases bleeding risk further. Consistent vitamin K intake is important,
not large variations.
Q6. A nurse is assessing a client who has hyperthyroidism due to Graves' disease. Which
finding should the nurse expect to observe in this client?
A. Cold intolerance and dry, brittle hair.
B. Weight gain of 5 kilograms in the past month.
C. Bradycardia with a heart rate of 52 beats per minute.
D. Exophthalmos with lid lag and heat intolerance.
Rationale: Graves' disease causes hyperthyroidism, leading to exophthalmos (protruding
, eyes), lid lag, heat intolerance, weight loss, tachycardia, and fine hair. Cold intolerance and
weight gain are seen in hypothyroidism.
Q7. A nurse is caring for a client who is receiving a continuous heparin infusion for a
pulmonary embolism. Which laboratory value should the nurse monitor to evaluate the
effectiveness of this therapy?
A. Prothrombin time and INR.
B. Activated partial thromboplastin time.
C. Complete blood count with platelet count.
D. Serum sodium and potassium levels.
Rationale: Heparin therapy is monitored using aPTT, which should be 1.5 to 2.5 times the
normal value. PT/INR monitors warfarin. CBC monitors for bleeding but does not evaluate
therapeutic effect.
Q8. A nurse is teaching a client who has a new prescription for metformin for type 2
diabetes mellitus. Which adverse effect should the nurse instruct the client to report to the
provider immediately?
A. Nausea and mild diarrhea after meals.
B. Weight loss of 1 kilogram per week.
C. Metallic taste in the mouth.
D. Muscle pain and unusual tiredness.
Rationale: Muscle pain and fatigue may indicate lactic acidosis, a rare but serious adverse
effect of metformin. Gastrointestinal effects are common initially but often resolve. Lactic
acidosis requires immediate medical attention.
Q9. A nurse is assessing a client who has chronic kidney disease stage 4. Which laboratory
finding should the nurse report to the provider immediately?
A. Hemoglobin of 11 g/dL.
B. Blood urea nitrogen of 48 mg/dL.
C. Creatinine of 3.2 mg/dL.
D. Serum potassium of 6.2 mEq/L.
Rationale: A potassium level of 6.2 mEq/L is critically high and can cause life-threatening
cardiac dysrhythmias. Hyperkalemia requires immediate intervention. The other findings are
abnormal but expected in stage 4 CKD.
Q10. A nurse is providing teaching to a client who has a new colostomy for colon cancer.
Which statement by the client indicates correct understanding of stoma care?
Level 2 Medical-Surgical Nursing: Chronic Illness,
Clinical Judgment, and Complex Care Complete Level
2 Question Bank
Q1. A nurse is caring for a client who has heart failure and reports sudden weight gain of 2
kilograms in 24 hours. Which action should the nurse take first in response to this finding?
A. Notify the provider immediately.
B. Restrict all oral fluids for the next 8 hours.
C. Administer furosemide 40 mg intravenously.
D. Auscultate the client's lung sounds for crackles or wheezes.
Rationale: Rapid weight gain indicates fluid retention. Lung auscultation assesses for
pulmonary edema, which is a life-threatening complication of worsening heart failure
requiring immediate intervention. Assessment always precedes notification or medication
administration.
Q2. A nurse is teaching a client who has a new diagnosis of type 2 diabetes mellitus about
foot care. Which statement by the client indicates a need for further teaching about proper
foot hygiene?
A. "I will check the inside of my shoes before putting them on each day."
B. "I will trim my toenails straight across and file the edges smooth."
C. "I will wear cotton socks and change them daily or more often if they become damp."
D. "I will soak my feet in warm water for 30 minutes every day to keep them clean and
soft."
Rationale: Prolonged soaking macerates skin and increases infection risk. Clients with
diabetes should wash feet daily with mild soap and dry thoroughly, especially between the
toes, but soaking for extended periods is harmful.
Q3. A nurse is assessing a client who has chronic obstructive pulmonary disease and is
receiving oxygen at 2 liters per minute via nasal cannula. Which finding indicates the client
is experiencing oxygen toxicity?
,A. The client's oxygen saturation level is 94 percent on the current flow rate.
B. The client reports feeling more energetic and less short of breath.
C. The client's respiratory rate has decreased from 24 to 16 breaths per minute.
D. The client reports substernal chest pain and has a nonproductive cough.
Rationale: Oxygen toxicity causes substernal discomfort, coughing, and dyspnea. It occurs
most often with high concentrations of oxygen delivered for prolonged periods. These
symptoms require immediate evaluation.
Q4. A nurse is caring for a client who has a new diagnosis of deep vein thrombosis in the
left calf. Which finding should the nurse report to the provider immediately?
A. The client's left calf measures 2 centimeters larger than the right calf.
B. The client reports mild tenderness when the left calf is palpated.
C. The client's left foot is slightly warmer than the right foot.
D. The client reports sudden onset of chest pain and difficulty breathing.
Rationale: Sudden chest pain and dyspnea in a client with DVT suggest pulmonary
embolism, a life-threatening complication requiring immediate intervention. The other
findings are expected with DVT.
Q5. A nurse is providing discharge teaching to a client who has a new prescription for
warfarin after a mechanical heart valve replacement. Which statement by the client
indicates correct understanding of this medication?
A. "I will take ibuprofen for headaches instead of acetaminophen."
B. "I will eat a large spinach salad every day to keep my blood healthy."
C. "I will report any bruising or bleeding to my provider right away."
D. "I will stop taking warfarin for three days before having my teeth cleaned."
Rationale: Warfarin increases bleeding risk. Any unusual bruising or bleeding must be
reported. Ibuprofen increases bleeding risk further. Consistent vitamin K intake is important,
not large variations.
Q6. A nurse is assessing a client who has hyperthyroidism due to Graves' disease. Which
finding should the nurse expect to observe in this client?
A. Cold intolerance and dry, brittle hair.
B. Weight gain of 5 kilograms in the past month.
C. Bradycardia with a heart rate of 52 beats per minute.
D. Exophthalmos with lid lag and heat intolerance.
Rationale: Graves' disease causes hyperthyroidism, leading to exophthalmos (protruding
, eyes), lid lag, heat intolerance, weight loss, tachycardia, and fine hair. Cold intolerance and
weight gain are seen in hypothyroidism.
Q7. A nurse is caring for a client who is receiving a continuous heparin infusion for a
pulmonary embolism. Which laboratory value should the nurse monitor to evaluate the
effectiveness of this therapy?
A. Prothrombin time and INR.
B. Activated partial thromboplastin time.
C. Complete blood count with platelet count.
D. Serum sodium and potassium levels.
Rationale: Heparin therapy is monitored using aPTT, which should be 1.5 to 2.5 times the
normal value. PT/INR monitors warfarin. CBC monitors for bleeding but does not evaluate
therapeutic effect.
Q8. A nurse is teaching a client who has a new prescription for metformin for type 2
diabetes mellitus. Which adverse effect should the nurse instruct the client to report to the
provider immediately?
A. Nausea and mild diarrhea after meals.
B. Weight loss of 1 kilogram per week.
C. Metallic taste in the mouth.
D. Muscle pain and unusual tiredness.
Rationale: Muscle pain and fatigue may indicate lactic acidosis, a rare but serious adverse
effect of metformin. Gastrointestinal effects are common initially but often resolve. Lactic
acidosis requires immediate medical attention.
Q9. A nurse is assessing a client who has chronic kidney disease stage 4. Which laboratory
finding should the nurse report to the provider immediately?
A. Hemoglobin of 11 g/dL.
B. Blood urea nitrogen of 48 mg/dL.
C. Creatinine of 3.2 mg/dL.
D. Serum potassium of 6.2 mEq/L.
Rationale: A potassium level of 6.2 mEq/L is critically high and can cause life-threatening
cardiac dysrhythmias. Hyperkalemia requires immediate intervention. The other findings are
abnormal but expected in stage 4 CKD.
Q10. A nurse is providing teaching to a client who has a new colostomy for colon cancer.
Which statement by the client indicates correct understanding of stoma care?
