ATI Concept Base Level 4

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Sample questions from ATI Concept Base Level 4

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a medical-surgical unit, an RN receives report on four clients. Which client should the RN assess first?

   • A.A 68-year-old client with heart failure who has gained 1 kg in 24 hours and has bilateral ankle edema
   • B.A 7-year-old client admitted with asthma who is speaking in one-word phrases and has diminished breath sounds
   • C.A 45-year-old client 1 day after appendectomy who reports incisional pain of 7 on a 0-to-10 scale
   • D.A 61-year-old client with diabetes whose premeal glucose is 238 mg/dL and who has no symptoms

   Rationale: The child with asthma has signs of severe airflow limitation; diminished breath sounds and inability to speak in sentences can precede respiratory failure. The client with heart failure needs assessment, but the reported edema and weight gain do not indicate the same immediate threat. Pain after surgery and an elevated glucose without symptoms require follow-up but are lower priorities than an airway and breathing emergency. Use airway and breathing status to prioritize care.

2. 2.In a long-term care facility, an RN is planning assignments for the shift. Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Assess a 53-year-old resident who reports new shortness of breath
   • B.Evaluate whether a 68-year-old resident's pain medication relieved incisional pain
   • C.Obtain and record the daily weight of a stable 82-year-old resident with chronic heart failure, then report the result
   • D.Teach a 61-year-old resident how to use a newly prescribed inhaler

   Rationale: Obtaining a routine weight for a stable resident is a predictable task that can be delegated to a competent UAP, with the RN retaining responsibility for interpreting and acting on the result. Assessing new shortness of breath requires nursing judgment. Teaching inhaler use and evaluating medication effectiveness are also RN responsibilities. Delegation transfers a task, not accountability for follow-up.

3. 3.Refer to the client's chart. Which actions should the nurse take now to coordinate care and address the client's changing condition? Select all that apply.

   • A.Establish or maintain large-bore IV access and prepare to administer prescribed fluids
   • B.Quantify blood loss and communicate the trend to the obstetric provider
   • C.Assist the client to ambulate to the bathroom to assess for dizziness
   • D.Activate the facility's emergency response and request immediate assistance
   • E.Massage the uterine fundus firmly while waiting for additional staff

   Rationale: The chart shows increasing blood loss, a boggy fundus, tachycardia, and falling blood pressure, so emergency assistance and rapid communication are needed. Quantifying the loss and preparing IV access support timely treatment of postpartum hemorrhage; fundal massage is appropriate, but it should be performed by the nurse rather than delayed until help arrives, so option 1 as written does not describe the priority coordinated actions in this item. Ambulation is unsafe with active bleeding and hypotension. Escalate deterioration and prevent a fall while preparing for treatment.

4. 4.In a surgical clinic, a 45-year-old client scheduled for an elective procedure says, "I signed the form, but I still do not understand the risks." What should the nurse do?

   • A.Ask the client to identify which risks are unclear and notify the surgeon before the procedure
   • B.Tell the client that signing the form means the procedure can proceed
   • C.Ask a family member to explain the risks so the schedule is not delayed
   • D.Explain the procedural risks in detail and ask the client to sign a second form

   Answer and rationale are in the full material.

5. 5.During a home visit, the parent of a 3-year-old child with a new tracheostomy asks how to prepare for a power outage. Which instructions should the nurse include? Select all that apply.

   • A.Keep the emergency tracheostomy supplies and a manual resuscitation bag accessible
   • B.Call emergency services if the child's airway cannot be maintained
   • C.Know how to use the backup battery and manual ventilation equipment
   • D.Store the backup equipment in a locked cabinet to prevent accidental use
   • E.Include the child's equipment and evacuation plan in the household emergency plan

   Answer and rationale are in the full material.