ATI RN Leadership Proctored Exam 2023-2026 with NGN (70
Real Exam Questions and Answers) - Complete Actual Exam
for RN Leadership 2025
SECTION 1: PRIORITIZATION & TRIAGE (Questions 1-20)
Question 1: A nurse in the emergency department is caring for four clients. Which client should the
nurse see first?
• A) A client with chest pain radiating to the jaw and left arm
• B) A client with a laceration on the forearm with moderate bleeding
• C) A client with a sprained ankle requesting pain medication
• D) A client with a fever of 38.3°C (101°F) and cough
Correct Answer: A
Rationale: Chest pain radiating to the jaw and left arm is a classic sign of an acute myocardial infarction,
which is life-threatening and requires immediate intervention. Airway, breathing, and circulation (ABCs)
prioritize this client first.
Question 2: A charge nurse is making client assignments on a medical-surgical unit. Which client should
be assigned to the most experienced nurse?
• A) A client with diabetes requiring insulin administration
• B) A client who is 2 days post-appendectomy
• C) A client with a new tracheostomy requiring frequent suctioning
• D) A client receiving IV antibiotics for a urinary tract infection
Correct Answer: C
Rationale: The client with a new tracheostomy has the highest acuity and requires the most experienced
nurse due to the complexity of care and risk of complications (airway compromise, infection, bleeding).
New or unstable airways always require experienced nursing judgment.
Question 3: A nurse receives change-of-shift report on four clients. Which client should the nurse assess
first?
• A) A client with heart failure who has 2+ pitting edema in the lower extremities
• B) A client with COPD who has an oxygen saturation of 88% on 2 L nasal cannula
, • C) A client with diabetes who has a blood glucose of 180 mg/dL
• D) A client with a fractured hip who reports pain of 6 on a 0-10 scale
Correct Answer: B
Rationale: An oxygen saturation of 88% indicates hypoxemia despite supplemental oxygen, which is a
life-threatening condition requiring immediate assessment and intervention. Airway and breathing
always take priority over circulation, pain, and other findings.
Question 4: A nurse is caring for a client who is 4 hours post-operative following a total hip arthroplasty.
The client reports sudden onset of shortness of breath and chest pain. Which action should the nurse
take first?
• A) Administer oxygen via nasal cannula
• B) Notify the provider immediately
• C) Elevate the head of the bed to 90 degrees
• D) Check the client's oxygen saturation
Correct Answer: C
Rationale: Elevating the head of the bed to a high-Fowler's position (90 degrees) improves ventilation
and is the priority action for a client with sudden shortness of breath. After positioning, the nurse should
assess oxygen saturation and notify the provider.
Question 5: A nurse is assessing a client with suspected pulmonary embolism. Which finding is most
concerning?
• A) Respiratory rate of 24/min
• B) Oxygen saturation of 89% on room air
• C) Heart rate of 110/min
• D) Blood pressure 100/60 mmHg
Correct Answer: B
Rationale: An oxygen saturation of 89% indicates significant hypoxemia requiring immediate
intervention (oxygen administration). While tachycardia and tachypnea are expected findings,
hypoxemia indicates inadequate oxygenation and is the priority.
Question 6: A nurse is caring for four clients. Which of the following findings requires immediate
intervention?
, • A) A client with a blood glucose of 65 mg/dL who is alert and oriented
• B) A client with a potassium level of 3.0 mEq/L
• C) A client with a temperature of 40°C (104°F)
• D) A client with a heart rate of 110/min
Correct Answer: C
Rationale: A temperature of 40°C (104°F) indicates severe hyperthermia, which can lead to neurological
damage and organ failure. This requires immediate intervention. Hypoglycemia (65 mg/dL) in an alert
client can be treated orally.
Question 7: A nurse is caring for a client who had a stroke 2 hours ago. The client's blood pressure is
190/110 mmHg. What is the nurse's priority action?
• A) Administer antihypertensive medication as prescribed
• B) Notify the provider immediately
• C) Recheck the blood pressure in 15 minutes
• D) Place the client in a supine position
Correct Answer: A
Rationale: For acute ischemic stroke, antihypertensive medications are typically administered for BP
>185/110 mmHg to prevent further neurological damage. This is a medical emergency requiring
immediate intervention.
Question 8: A nurse is caring for a client receiving a blood transfusion. The client reports low back pain
and chills. What is the priority action?
• A) Slow the transfusion rate
• B) Stop the transfusion immediately
• C) Notify the provider
• D) Administer acetaminophen
Correct Answer: B
Rationale: Low back pain and chills are signs of an acute hemolytic transfusion reaction, which is life-
threatening. The transfusion must be stopped immediately to prevent further antigen-antibody
reaction.
, Question 9: A charge nurse is making assignments for a shift. Which client should be assigned to a float
nurse from the pediatrics unit?
• A) A client with a new diagnosis of diabetes requiring initial teaching
• B) A client with a stable COPD receiving routine medications
• C) A client with a new tracheostomy requiring frequent suctioning
• D) A client with an acute myocardial infarction requiring cardiac monitoring
Correct Answer: B
Rationale: The float nurse should be assigned the most stable client. A client with stable COPD receiving
routine medications has predictable needs and is appropriate for a nurse unfamiliar with the unit.
Question 10: A nurse is caring for a client with a chest tube following a thoracotomy. Which finding
requires immediate intervention?
• A) Continuous bubbling in the water-seal chamber
• B) Tidaling in the water-seal chamber with respirations
• C) Gentle bubbling in the suction control chamber
• D) Serosanguineous drainage of 50 mL in 8 hours
Correct Answer: A
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which can
lead to pneumothorax. This requires immediate assessment and intervention. Tidaling and gentle
suction bubbling are expected findings.
Question 11: A nurse is caring for a client with diabetic ketoacidosis (DKA). Which finding indicates the
client is responding to treatment?
• A) Blood glucose decreased from 600 mg/dL to 300 mg/dL
• B) Serum potassium level of 2.9 mEq/L
• C) Anion gap increased from 12 to 20
• D) pH decreased from 7.30 to 7.25
Correct Answer: A
Rationale: Decreasing blood glucose indicates that insulin therapy is effective. Improving DKA is
indicated by decreasing blood glucose, normalizing anion gap, and improving pH. Hypokalemia requires
monitoring but is not a sign of improvement.
Real Exam Questions and Answers) - Complete Actual Exam
for RN Leadership 2025
SECTION 1: PRIORITIZATION & TRIAGE (Questions 1-20)
Question 1: A nurse in the emergency department is caring for four clients. Which client should the
nurse see first?
• A) A client with chest pain radiating to the jaw and left arm
• B) A client with a laceration on the forearm with moderate bleeding
• C) A client with a sprained ankle requesting pain medication
• D) A client with a fever of 38.3°C (101°F) and cough
Correct Answer: A
Rationale: Chest pain radiating to the jaw and left arm is a classic sign of an acute myocardial infarction,
which is life-threatening and requires immediate intervention. Airway, breathing, and circulation (ABCs)
prioritize this client first.
Question 2: A charge nurse is making client assignments on a medical-surgical unit. Which client should
be assigned to the most experienced nurse?
• A) A client with diabetes requiring insulin administration
• B) A client who is 2 days post-appendectomy
• C) A client with a new tracheostomy requiring frequent suctioning
• D) A client receiving IV antibiotics for a urinary tract infection
Correct Answer: C
Rationale: The client with a new tracheostomy has the highest acuity and requires the most experienced
nurse due to the complexity of care and risk of complications (airway compromise, infection, bleeding).
New or unstable airways always require experienced nursing judgment.
Question 3: A nurse receives change-of-shift report on four clients. Which client should the nurse assess
first?
• A) A client with heart failure who has 2+ pitting edema in the lower extremities
• B) A client with COPD who has an oxygen saturation of 88% on 2 L nasal cannula
, • C) A client with diabetes who has a blood glucose of 180 mg/dL
• D) A client with a fractured hip who reports pain of 6 on a 0-10 scale
Correct Answer: B
Rationale: An oxygen saturation of 88% indicates hypoxemia despite supplemental oxygen, which is a
life-threatening condition requiring immediate assessment and intervention. Airway and breathing
always take priority over circulation, pain, and other findings.
Question 4: A nurse is caring for a client who is 4 hours post-operative following a total hip arthroplasty.
The client reports sudden onset of shortness of breath and chest pain. Which action should the nurse
take first?
• A) Administer oxygen via nasal cannula
• B) Notify the provider immediately
• C) Elevate the head of the bed to 90 degrees
• D) Check the client's oxygen saturation
Correct Answer: C
Rationale: Elevating the head of the bed to a high-Fowler's position (90 degrees) improves ventilation
and is the priority action for a client with sudden shortness of breath. After positioning, the nurse should
assess oxygen saturation and notify the provider.
Question 5: A nurse is assessing a client with suspected pulmonary embolism. Which finding is most
concerning?
• A) Respiratory rate of 24/min
• B) Oxygen saturation of 89% on room air
• C) Heart rate of 110/min
• D) Blood pressure 100/60 mmHg
Correct Answer: B
Rationale: An oxygen saturation of 89% indicates significant hypoxemia requiring immediate
intervention (oxygen administration). While tachycardia and tachypnea are expected findings,
hypoxemia indicates inadequate oxygenation and is the priority.
Question 6: A nurse is caring for four clients. Which of the following findings requires immediate
intervention?
, • A) A client with a blood glucose of 65 mg/dL who is alert and oriented
• B) A client with a potassium level of 3.0 mEq/L
• C) A client with a temperature of 40°C (104°F)
• D) A client with a heart rate of 110/min
Correct Answer: C
Rationale: A temperature of 40°C (104°F) indicates severe hyperthermia, which can lead to neurological
damage and organ failure. This requires immediate intervention. Hypoglycemia (65 mg/dL) in an alert
client can be treated orally.
Question 7: A nurse is caring for a client who had a stroke 2 hours ago. The client's blood pressure is
190/110 mmHg. What is the nurse's priority action?
• A) Administer antihypertensive medication as prescribed
• B) Notify the provider immediately
• C) Recheck the blood pressure in 15 minutes
• D) Place the client in a supine position
Correct Answer: A
Rationale: For acute ischemic stroke, antihypertensive medications are typically administered for BP
>185/110 mmHg to prevent further neurological damage. This is a medical emergency requiring
immediate intervention.
Question 8: A nurse is caring for a client receiving a blood transfusion. The client reports low back pain
and chills. What is the priority action?
• A) Slow the transfusion rate
• B) Stop the transfusion immediately
• C) Notify the provider
• D) Administer acetaminophen
Correct Answer: B
Rationale: Low back pain and chills are signs of an acute hemolytic transfusion reaction, which is life-
threatening. The transfusion must be stopped immediately to prevent further antigen-antibody
reaction.
, Question 9: A charge nurse is making assignments for a shift. Which client should be assigned to a float
nurse from the pediatrics unit?
• A) A client with a new diagnosis of diabetes requiring initial teaching
• B) A client with a stable COPD receiving routine medications
• C) A client with a new tracheostomy requiring frequent suctioning
• D) A client with an acute myocardial infarction requiring cardiac monitoring
Correct Answer: B
Rationale: The float nurse should be assigned the most stable client. A client with stable COPD receiving
routine medications has predictable needs and is appropriate for a nurse unfamiliar with the unit.
Question 10: A nurse is caring for a client with a chest tube following a thoracotomy. Which finding
requires immediate intervention?
• A) Continuous bubbling in the water-seal chamber
• B) Tidaling in the water-seal chamber with respirations
• C) Gentle bubbling in the suction control chamber
• D) Serosanguineous drainage of 50 mL in 8 hours
Correct Answer: A
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which can
lead to pneumothorax. This requires immediate assessment and intervention. Tidaling and gentle
suction bubbling are expected findings.
Question 11: A nurse is caring for a client with diabetic ketoacidosis (DKA). Which finding indicates the
client is responding to treatment?
• A) Blood glucose decreased from 600 mg/dL to 300 mg/dL
• B) Serum potassium level of 2.9 mEq/L
• C) Anion gap increased from 12 to 20
• D) pH decreased from 7.30 to 7.25
Correct Answer: A
Rationale: Decreasing blood glucose indicates that insulin therapy is effective. Improving DKA is
indicated by decreasing blood glucose, normalizing anion gap, and improving pH. Hypokalemia requires
monitoring but is not a sign of improvement.
