ATI RN Concept-Based Assessment Level 2 Proctored Exam
2026 - 200 Verified Questions & Answers with Detailed
Rationales | Proctored Exam Preparation - 232 Questions
Section 1: Management of Care (Questions 1-32)
1 A nurse manager is reviewing the staffing plan for a medical-surgical unit. The unit has 24 patients with the
following acuity: 6 patients require total care, 10 patients require moderate assistance, and 8 patients are
self-care. The nurse-to-patient ratio is 1:6 for total care, 1:8 for moderate, and 1:12 for self-care. How many
registered nurses (RNs) are needed for the shift?
A) 3
B) 4
C) 5
D) 6
Answer: C
Rationale: Total care patients: = 1 RN; moderate: = 1.25 !’ 2 RNs; self-care: = 0.67 !’ 1 RN. Total =
1+2+1 = 4, but rounding up for safety and considering break coverage, 5 RNs are needed. Option C accounts for
safe staffing and regulatory compliance.
2 A charge nurse is assigning tasks to the healthcare team. Which task should be delegated to a licensed practical
nurse (LPN)?
A) Administering a blood transfusion to a stable patient
B) Performing the initial assessment of a newly admitted patient with chest pain
C) Reinforcing teaching about wound care to a patient with a new colostomy
D) Evaluating the effectiveness of pain medication for a patient with chronic pain
Answer: C
Rationale: Reinforcing teaching is within LPN scope, provided the RN has initiated the plan. Administering blood
(A) requires RN-level monitoring. Initial assessment (B) and evaluation (D) are RN responsibilities due to
complexity and judgment requirements.
3 A nurse is caring for four patients. Which patient should the nurse assess first?
A) A patient with a history of diabetes who has a blood glucose of 180 mg/dL and is asymptomatic
B) A patient with pneumonia who has a sudden onset of pleuritic chest pain and dyspnea
C) A patient with a urinary tract infection who has a temperature of 38.5°C (101.3°F) and chills
D) A patient with a fractured femur who reports pain of 6 on a 0-10 scale after receiving analgesia
Answer: B
Rationale: Sudden pleuritic chest pain and dyspnea in a patient with pneumonia suggests possible pulmonary
embolism or pneumothorax, which are life-threatening. Option B requires immediate assessment. The other
patients are stable or have expected findings.
4 A nurse is preparing to discharge a patient with a new diagnosis of heart failure. Which instruction is most
critical to include in the discharge teaching?
A) Weigh yourself daily and report a weight gain of more than 2 pounds in 24 hours
B) Limit your intake of high-fiber foods to prevent bloating
C) Take your diuretic only when you feel short of breath
,D) Avoid using the incentive spirometer after surgery
Answer: A
Rationale: Daily weight monitoring is essential for early detection of fluid retention. A gain of >2 lbs in 24 hours
indicates worsening heart failure and requires prompt intervention. Option B is incorrect because fiber is beneficial.
Option C is dangerous because diuretics should be taken as prescribed, not PRN. Option D is irrelevant to heart
failure.
5 A nurse is leading a quality improvement initiative to reduce central line-associated bloodstream infections
(CLABSI). Which intervention should be prioritized?
A) Changing the central line dressing every 7 days
B) Using a chlorhexidine-impregnated sponge at the insertion site
C) Ensuring all providers use a central line insertion checklist
D) Sending daily blood cultures from the central line
Answer: C
Rationale: Using a central line insertion checklist ensures adherence to evidence-based sterile practices, which is the
most effective strategy to prevent CLABSI. Option A is incorrect because dressing changes are typically every
48-72 hours. Option B is an adjunct, not the primary intervention. Option D is not recommended for routine
surveillance.
6 A nurse is coordinating care for a patient with multiple chronic conditions. The patient expresses confusion
about medication schedules. Which action best demonstrates the nurse's role in care coordination?
A) Providing a written medication schedule and reviewing it with the patient
B) Contacting the primary care provider to simplify the medication regimen
C) Referring the patient to a home health aide for medication administration
D) Documenting the confusion in the medical record
Answer: B
Rationale: Simplifying the medication regimen addresses the root cause of confusion and involves interprofessional
collaboration. Option A is helpful but does not address polypharmacy. Option C may be premature. Option D is
passive and does not resolve the issue.
7 A nurse discovers that a colleague has been diverting opioids from the medication supply. What is the nurse's
priority action?
A) Confront the colleague privately
B) Report the suspicion to the nurse manager
C) Ignore the behavior unless there is direct evidence
D) Submit an anonymous report to the state board of nursing
Answer: B
Rationale: Reporting to the nurse manager is the first step to ensure patient safety and initiate investigation.
Confrontation (A) may escalate the situation. Ignoring (C) is unethical. Anonymous reporting (D) is appropriate but
after internal reporting.
8 A patient with a do-not-resuscitate (DNR) order experiences respiratory arrest. The family insists on intubation.
What should the nurse do?
A) Honor the family's request and intubate
B) Explain that the DNR order is legally binding and cannot be overridden
C) Call the provider to clarify the DNR order
D) Initiate resuscitation while contacting the ethics committee
,Answer: C
Rationale: The nurse should clarify the DNR order with the provider, as the family's request may indicate a change
in the patient's wishes. Option B is correct but may be premature without reassessment. Option A violates the
DNR. Option D is inappropriate if DNR is valid.
9 A nurse is evaluating the effectiveness of a fall prevention program. Which outcome measure indicates success?
A) Decreased number of fall-related injuries
B) Increased use of bed alarms
C) Higher patient satisfaction scores
D) Reduced length of stay for fall risk patients
Answer: A
Rationale: The primary goal of fall prevention is to reduce injuries from falls. Option B is a process measure, not an
outcome. Option C is not directly related. Option D may be confounded by other factors.
10 A nurse is managing a conflict between two staff members about a patient care approach. Which strategy
should the nurse use first?
A) Mediate a discussion between the staff members to identify common goals
B) Assign the patient to a different nurse
C) Escalate the issue to the unit director
D) Document the conflict in each staff member's personnel file
Answer: A
Rationale: Mediation fosters collaboration and resolution at the lowest level. Option B avoids the issue. Option C
may be necessary if mediation fails. Option D is punitive and not a first step.
11 A charge nurse is evaluating the assignments for the upcoming shift. Which assignment demonstrates the most
appropriate delegation based on the 'Rights of Delegation'?
A) Assigning a licensed practical nurse (LPN) to perform the initial assessment of a newly admitted patient with
complex needs.
B) Assigning a registered nurse (RN) to administer a blood transfusion to a stable patient.
C) Assigning an unlicensed assistive personnel (UAP) to reinforce teaching about wound care to a patient.
D) Assigning an LPN to administer IV push medications to a patient with a central line.
Answer: B
Rationale: The RN is the appropriate caregiver for administering blood transfusions, which require assessment and
monitoring. Option A violates delegation as initial assessments should be done by RNs. Option C is inappropriate
because patient teaching requires a licensed nurse. Option D is beyond LPN scope in many states.
12 A nurse is caring for a client who is scheduled for a colonoscopy. The client asks, 'Why do I need to stop taking
my blood thinner?' Which response by the nurse demonstrates an understanding of informed consent and the
nurse's role?
A) Your doctor will explain the risks and benefits of stopping the medication before the procedure.
B) The blood thinner increases your risk of bleeding during the procedure, so it must be stopped.
C) I cannot answer that question; you need to ask the physician.
D) Stopping the blood thinner is necessary to prevent complications, and I will document your question.
Answer: B
Rationale: The nurse can provide factual information about the procedure and medications. Option A is incorrect
because the nurse can explain the rationale. Option C is dismissive and not helpful. Option D is incomplete and
does not directly answer the client's question.
, 13 A nurse manager is reviewing incident reports. Which situation requires the most immediate follow-up and
potential root cause analysis?
A) A patient's IV site infiltrated, requiring removal and restart of the line.
B) A nurse administered an incorrect dose of insulin, and the patient experienced hypoglycemia.
C) A patient fell out of bed but was not injured.
D) A visitor complained about the noise level on the unit.
Answer: B
Rationale: Medication errors that cause patient harm require immediate investigation to prevent recurrence. Option
A is a common occurrence that may not require extensive analysis. Option C, though important, did not result in
injury. Option D is a complaint, not an incident.
14 A nurse is preparing to discharge a client with a new diagnosis of heart failure. Which instruction should the
nurse prioritize to ensure continuity of care?
A) Provide a list of low-sodium foods and dietary restrictions.
B) Schedule a follow-up appointment with the primary care provider within one week.
C) Teach the client to weigh themselves daily and report a gain of 2 pounds in 24 hours.
D) Ensure the client understands the medication regimen, including diuretics and ACE inhibitors.
Answer: B
Rationale: Scheduling a follow-up appointment is critical for continuity of care and early detection of complications.
While all options are important, the follow-up appointment ensures ongoing management and coordination.
Without it, other instructions may not be effectively monitored.
15 A nurse is evaluating the effectiveness of a quality improvement initiative aimed at reducing
catheter-associated urinary tract infections (CAUTIs). Which outcome indicates the initiative was successful?
A) The unit's CAUTI rate decreased from 5.2 to 3.8 per 1,000 catheter days.
B) Staff compliance with daily catheter necessity assessments increased from 70% to 90%.
C) The average duration of catheterization decreased from 4 days to 2.5 days.
D) Patient satisfaction scores regarding urinary management improved by 10%.
Answer: A
Rationale: The primary goal of a CAUTI reduction initiative is to lower infection rates. Option A directly measures
that outcome. Options B and C are process measures that may contribute to the outcome but do not confirm
success. Option D is a subjective measure not directly related to infection rates.
16 A nurse is caring for a client who has a living will that refuses life-sustaining treatment. The client's family
insists on aggressive care. Which action should the nurse take?
A) Follow the family's wishes to avoid conflict and potential legal issues.
B) Contact the ethics committee to mediate the situation.
C) Explain that the living will is legally binding and must be respected.
D) Ask the provider to write a do-not-resuscitate order.
Answer: B
Rationale: When there is a conflict between the client's advance directive and family wishes, the ethics committee
can provide guidance and mediation. Option A disregards the client's autonomy. Option C may be true but does not
address the conflict. Option D is premature without resolving the ethical dilemma.
17 A nurse is triaging patients in the emergency department. Which patient should be prioritized for immediate
care?
A) A patient with a history of diabetes reporting a blood glucose level of 180 mg/dL and mild confusion.
2026 - 200 Verified Questions & Answers with Detailed
Rationales | Proctored Exam Preparation - 232 Questions
Section 1: Management of Care (Questions 1-32)
1 A nurse manager is reviewing the staffing plan for a medical-surgical unit. The unit has 24 patients with the
following acuity: 6 patients require total care, 10 patients require moderate assistance, and 8 patients are
self-care. The nurse-to-patient ratio is 1:6 for total care, 1:8 for moderate, and 1:12 for self-care. How many
registered nurses (RNs) are needed for the shift?
A) 3
B) 4
C) 5
D) 6
Answer: C
Rationale: Total care patients: = 1 RN; moderate: = 1.25 !’ 2 RNs; self-care: = 0.67 !’ 1 RN. Total =
1+2+1 = 4, but rounding up for safety and considering break coverage, 5 RNs are needed. Option C accounts for
safe staffing and regulatory compliance.
2 A charge nurse is assigning tasks to the healthcare team. Which task should be delegated to a licensed practical
nurse (LPN)?
A) Administering a blood transfusion to a stable patient
B) Performing the initial assessment of a newly admitted patient with chest pain
C) Reinforcing teaching about wound care to a patient with a new colostomy
D) Evaluating the effectiveness of pain medication for a patient with chronic pain
Answer: C
Rationale: Reinforcing teaching is within LPN scope, provided the RN has initiated the plan. Administering blood
(A) requires RN-level monitoring. Initial assessment (B) and evaluation (D) are RN responsibilities due to
complexity and judgment requirements.
3 A nurse is caring for four patients. Which patient should the nurse assess first?
A) A patient with a history of diabetes who has a blood glucose of 180 mg/dL and is asymptomatic
B) A patient with pneumonia who has a sudden onset of pleuritic chest pain and dyspnea
C) A patient with a urinary tract infection who has a temperature of 38.5°C (101.3°F) and chills
D) A patient with a fractured femur who reports pain of 6 on a 0-10 scale after receiving analgesia
Answer: B
Rationale: Sudden pleuritic chest pain and dyspnea in a patient with pneumonia suggests possible pulmonary
embolism or pneumothorax, which are life-threatening. Option B requires immediate assessment. The other
patients are stable or have expected findings.
4 A nurse is preparing to discharge a patient with a new diagnosis of heart failure. Which instruction is most
critical to include in the discharge teaching?
A) Weigh yourself daily and report a weight gain of more than 2 pounds in 24 hours
B) Limit your intake of high-fiber foods to prevent bloating
C) Take your diuretic only when you feel short of breath
,D) Avoid using the incentive spirometer after surgery
Answer: A
Rationale: Daily weight monitoring is essential for early detection of fluid retention. A gain of >2 lbs in 24 hours
indicates worsening heart failure and requires prompt intervention. Option B is incorrect because fiber is beneficial.
Option C is dangerous because diuretics should be taken as prescribed, not PRN. Option D is irrelevant to heart
failure.
5 A nurse is leading a quality improvement initiative to reduce central line-associated bloodstream infections
(CLABSI). Which intervention should be prioritized?
A) Changing the central line dressing every 7 days
B) Using a chlorhexidine-impregnated sponge at the insertion site
C) Ensuring all providers use a central line insertion checklist
D) Sending daily blood cultures from the central line
Answer: C
Rationale: Using a central line insertion checklist ensures adherence to evidence-based sterile practices, which is the
most effective strategy to prevent CLABSI. Option A is incorrect because dressing changes are typically every
48-72 hours. Option B is an adjunct, not the primary intervention. Option D is not recommended for routine
surveillance.
6 A nurse is coordinating care for a patient with multiple chronic conditions. The patient expresses confusion
about medication schedules. Which action best demonstrates the nurse's role in care coordination?
A) Providing a written medication schedule and reviewing it with the patient
B) Contacting the primary care provider to simplify the medication regimen
C) Referring the patient to a home health aide for medication administration
D) Documenting the confusion in the medical record
Answer: B
Rationale: Simplifying the medication regimen addresses the root cause of confusion and involves interprofessional
collaboration. Option A is helpful but does not address polypharmacy. Option C may be premature. Option D is
passive and does not resolve the issue.
7 A nurse discovers that a colleague has been diverting opioids from the medication supply. What is the nurse's
priority action?
A) Confront the colleague privately
B) Report the suspicion to the nurse manager
C) Ignore the behavior unless there is direct evidence
D) Submit an anonymous report to the state board of nursing
Answer: B
Rationale: Reporting to the nurse manager is the first step to ensure patient safety and initiate investigation.
Confrontation (A) may escalate the situation. Ignoring (C) is unethical. Anonymous reporting (D) is appropriate but
after internal reporting.
8 A patient with a do-not-resuscitate (DNR) order experiences respiratory arrest. The family insists on intubation.
What should the nurse do?
A) Honor the family's request and intubate
B) Explain that the DNR order is legally binding and cannot be overridden
C) Call the provider to clarify the DNR order
D) Initiate resuscitation while contacting the ethics committee
,Answer: C
Rationale: The nurse should clarify the DNR order with the provider, as the family's request may indicate a change
in the patient's wishes. Option B is correct but may be premature without reassessment. Option A violates the
DNR. Option D is inappropriate if DNR is valid.
9 A nurse is evaluating the effectiveness of a fall prevention program. Which outcome measure indicates success?
A) Decreased number of fall-related injuries
B) Increased use of bed alarms
C) Higher patient satisfaction scores
D) Reduced length of stay for fall risk patients
Answer: A
Rationale: The primary goal of fall prevention is to reduce injuries from falls. Option B is a process measure, not an
outcome. Option C is not directly related. Option D may be confounded by other factors.
10 A nurse is managing a conflict between two staff members about a patient care approach. Which strategy
should the nurse use first?
A) Mediate a discussion between the staff members to identify common goals
B) Assign the patient to a different nurse
C) Escalate the issue to the unit director
D) Document the conflict in each staff member's personnel file
Answer: A
Rationale: Mediation fosters collaboration and resolution at the lowest level. Option B avoids the issue. Option C
may be necessary if mediation fails. Option D is punitive and not a first step.
11 A charge nurse is evaluating the assignments for the upcoming shift. Which assignment demonstrates the most
appropriate delegation based on the 'Rights of Delegation'?
A) Assigning a licensed practical nurse (LPN) to perform the initial assessment of a newly admitted patient with
complex needs.
B) Assigning a registered nurse (RN) to administer a blood transfusion to a stable patient.
C) Assigning an unlicensed assistive personnel (UAP) to reinforce teaching about wound care to a patient.
D) Assigning an LPN to administer IV push medications to a patient with a central line.
Answer: B
Rationale: The RN is the appropriate caregiver for administering blood transfusions, which require assessment and
monitoring. Option A violates delegation as initial assessments should be done by RNs. Option C is inappropriate
because patient teaching requires a licensed nurse. Option D is beyond LPN scope in many states.
12 A nurse is caring for a client who is scheduled for a colonoscopy. The client asks, 'Why do I need to stop taking
my blood thinner?' Which response by the nurse demonstrates an understanding of informed consent and the
nurse's role?
A) Your doctor will explain the risks and benefits of stopping the medication before the procedure.
B) The blood thinner increases your risk of bleeding during the procedure, so it must be stopped.
C) I cannot answer that question; you need to ask the physician.
D) Stopping the blood thinner is necessary to prevent complications, and I will document your question.
Answer: B
Rationale: The nurse can provide factual information about the procedure and medications. Option A is incorrect
because the nurse can explain the rationale. Option C is dismissive and not helpful. Option D is incomplete and
does not directly answer the client's question.
, 13 A nurse manager is reviewing incident reports. Which situation requires the most immediate follow-up and
potential root cause analysis?
A) A patient's IV site infiltrated, requiring removal and restart of the line.
B) A nurse administered an incorrect dose of insulin, and the patient experienced hypoglycemia.
C) A patient fell out of bed but was not injured.
D) A visitor complained about the noise level on the unit.
Answer: B
Rationale: Medication errors that cause patient harm require immediate investigation to prevent recurrence. Option
A is a common occurrence that may not require extensive analysis. Option C, though important, did not result in
injury. Option D is a complaint, not an incident.
14 A nurse is preparing to discharge a client with a new diagnosis of heart failure. Which instruction should the
nurse prioritize to ensure continuity of care?
A) Provide a list of low-sodium foods and dietary restrictions.
B) Schedule a follow-up appointment with the primary care provider within one week.
C) Teach the client to weigh themselves daily and report a gain of 2 pounds in 24 hours.
D) Ensure the client understands the medication regimen, including diuretics and ACE inhibitors.
Answer: B
Rationale: Scheduling a follow-up appointment is critical for continuity of care and early detection of complications.
While all options are important, the follow-up appointment ensures ongoing management and coordination.
Without it, other instructions may not be effectively monitored.
15 A nurse is evaluating the effectiveness of a quality improvement initiative aimed at reducing
catheter-associated urinary tract infections (CAUTIs). Which outcome indicates the initiative was successful?
A) The unit's CAUTI rate decreased from 5.2 to 3.8 per 1,000 catheter days.
B) Staff compliance with daily catheter necessity assessments increased from 70% to 90%.
C) The average duration of catheterization decreased from 4 days to 2.5 days.
D) Patient satisfaction scores regarding urinary management improved by 10%.
Answer: A
Rationale: The primary goal of a CAUTI reduction initiative is to lower infection rates. Option A directly measures
that outcome. Options B and C are process measures that may contribute to the outcome but do not confirm
success. Option D is a subjective measure not directly related to infection rates.
16 A nurse is caring for a client who has a living will that refuses life-sustaining treatment. The client's family
insists on aggressive care. Which action should the nurse take?
A) Follow the family's wishes to avoid conflict and potential legal issues.
B) Contact the ethics committee to mediate the situation.
C) Explain that the living will is legally binding and must be respected.
D) Ask the provider to write a do-not-resuscitate order.
Answer: B
Rationale: When there is a conflict between the client's advance directive and family wishes, the ethics committee
can provide guidance and mediation. Option A disregards the client's autonomy. Option C may be true but does not
address the conflict. Option D is premature without resolving the ethical dilemma.
17 A nurse is triaging patients in the emergency department. Which patient should be prioritized for immediate
care?
A) A patient with a history of diabetes reporting a blood glucose level of 180 mg/dL and mild confusion.
