ATI RN Concept-Based Assessment Level 3 Practice A Version 2 (Latest 2023/ 2024) Questions and Verified Answers with Rationales| 100% Correct| Grade A
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ATI RN Concept-Based Assessment Level 3 Practice A Version 2 (Latest 2023/ 2024) Questions and Verified Answers with Rationales| 100% Correct| Grade A
ATI RN Concept-Based Assessment Level 3
Practice A Version 2 (Latest 2023/ 2024)
Questions and Verified Answers with
Rationales| 100% Correct| Grade A
Q: A nurse in an emergency department is assessing a client who was in a motor-vehicle crash.
The client has a blood alcohol concentration of 0.18% and states, "I would never drink and
drive." The nurse should identify that the client is demonstrating use of which of the following
defense mechanisms?
Answer:
Denial
Rationale: Denial occurs when a client refuses to acknowledge the reality of a situation.
Q: A nurse is caring for a newly-admitted client who is at 37 weeks of gestation and is
experiencing moderate placental abruption. Which of the following actions should the nurse
take?
Answer:
Insert a large-bore IV catheter
Rationale: The nurse should insert a 16- to 18-gauge IV catheter into the client's brachial artery
because fluid volume and blood replacement might be necessary to correct defects in
coagulation.
Q: A nurse is planning care for a client who has benign chondroma of the tibia. Which of the
following interventions should the nurse plan to include?
Answer:
Palpate for changes in the muscle of the affected extremity
Rationale: The nurse should palpate the muscle of the affected extremity to monitor for changes
such as muscle spasm, atrophy, or swelling. These manifestations indicate enlargement of the
tumor.
Q: A nurse is caring for a client who is experiencing hypovolemic shock due to postpartum
hemorrhage. After notifying the provider, which of the following actions should the nurse take
next?
Answer:
Message the client's fundus
Rationale: The greatest risk to the client is hemorrhage. Therefore, the next action the nurse
should take is to massage the client's fundus to expel clots and promote contractions.
Q: An intensive care nurse is providing education about organ and tissue donation to the parent
of an adolescent who has died following a motor-vehicle crash. Which of the following
responses by the parent indicates an understanding of the teaching?
Answer:
"No one will notice the organs were donated if we have an open casket the funeral."
Rationale: The nurse should reassure the parent that organ transplantation does not change the
appearance of the body. Therefore, if the family wishes to have an open casket at the funeral,
there will be no noticeable disfigurement to the adolescent.
Q: A nurse in an emergency department is creating a plan of care for a client who reports a
recent sexual assault. Which of the following interventions should the nurse plan to include?
Answer:
Explain to the client the reason each procedure is conducted
Rationale: The nurse should explain the reason each assessment procedure is conducted and
why because a client who reports a recent sexual assault is extremely vulnerable in the
immediate postcrisis period. Explaining the purpose for each procedure will decrease the client's
anxiety and fear and increase feelings of trust.
Q: A community health nurse is assessing an older adult client. Which of the following
situations should the nurse identify as a possible indication of undue influence?
Answer:
The client's niece moves into her home to provide care
Rationale: The nurse should identify that this client is at risk for undue influence. Undue
influence can occur when an older adult moves into someone's home, or when someone moves
into her home, under the pretense of providing better care for the client. This allows the abuser to
have access and control to the client at all times, and makes it easier for the abuser to influence
the client's decisions about medical care, property, and finances.
Q: A nurse is preparing to administer immunizations to a 2-month-old infant at a well-child
visit. Which of the following immunizations should the nurse plan to administer?
Answer:
Haemophilus influenzae type b (Hib)
Rationale: The nurse should plan to administer the Hib immunization. This vaccine is
administered in a series of three to four doses starting at 2 months of age.
Q: A nurse is discussing palliative care with the family of a client who is terminally ill. Which
of the following information should the nurse include?
Answer:
Palliative care includes a variety of therapies
Rationale: Along with medical treatments, palliative care includes a holistic approach using a
variety of therapies to improve the client's level of comfort. Therapies such as yoga, meditation,
and pet therapy enhance the client's quality of life.
Q: A nurse is creating a plan of care for a newborn who has a myelomeningocele. Which of the
following interventions should the nurse include?
Answer:
Place the newborn in a prone-kneeling position
Rationale: The nurse should place the newborn in a prone-kneeling position to protect the
protruding meningeal sac from injury.
Q: A nurse is caring for a client who has major depressive disorder. Which of the following
client responses should the nurse identify as an overt statement indicating the potential for
suicide?
Answer:
"I just can't go on living like this any longer."
Rationale: The nurse should recognize this as a direct or overt statement indicating that the
client wishes to end her life.
Q: A nurse is caring for a client who is in active labor. The nurse notices an abnormal pattern
on the fetal heart monitor. Which of the following actions should the nurse take for late
decelerations?
Answer:
Administer oxygen by nonrebreather facemask at 10 L/min
Rationale: The nurse should administer oxygen by nonrebreather facemask at 10 L/min. Late
decelerations are primarily caused by impaired oxygenation to the placenta.
Q: A nurse is assessing a client who is in early stages of Alzheimer's disease. Which of the
following findings should the nurse expect?
Answer:
The client misplaces familiar objects
Rationale: The nurse should expect the client to display forgetfulness and forget the location of
familiar objects in the earlier stages of Alzheimer's disease.
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