ATI RN Leadership Proctored Exam 2026 with NGN
Comprehensive 150-Question Practice Examination with
Detailed Rationales in Italics
SECTION 1: PRIORITIZATION & CLINICAL JUDGMENT
(Questions 1-25)
QUESTION 1 (NGN – Postoperative Hemorrhage)
Scenario: A client is 6 hours postoperative from abdominal surgery. At 1715, the client
was resting comfortably with moderate serosanguineous drainage and pain rated 4/10.
At 2030, the client becomes restless, short of breath, and reports severe abdominal pain
(8/10). The abdominal dressing is saturated with bright red blood.
Question: Which combination of findings most likely indicates hemorrhage requiring
immediate provider notification?
A. Slight pain increase, stable heart rate, unchanged respiratory rate, elevated
temperature, normal O₂ saturation
B. Decreased blood pressure, increased respiratory rate, pain 8/10, large amount of
bright red drainage, decreased oxygen saturation, increased heart rate
C. Moderate serosanguineous drainage, stable vital signs, pain 5/10
D. Unchanged blood pressure, no new drainage, pain resolved
Correct Answer: B
Rationale: Sudden changes including tachycardia, tachypnea, hypotension, severe pain
(8/10), large amounts of bright red blood on dressing, and decreased O₂ saturation
collectively indicate the possibility of hemorrhage. Immediate provider notification and
,intervention are crucial. Options A, C, and D describe stable findings that do not indicate
hemorrhage.
QUESTION 2
A charge nurse is receiving change-of-shift report on a medical-surgical unit. Which
client should the charge nurse assess first?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL
B. A client with aspiration pneumonia who has a respiratory rate of 28/min and oxygen
saturation of 89%
C. A client with a hip fracture in Buck's traction reporting pain of 4 on a 0-10 scale
D. A client with a stage 2 pressure ulcer requiring a dressing change
Correct Answer: B
Rationale: The client with aspiration pneumonia and respiratory rate of 28/min with
oxygen saturation of 89% is showing signs of respiratory compromise and potential
hypoxia. According to the ABCs (Airway, Breathing, Circulation), respiratory issues take
highest priority. This client is unstable and requires immediate assessment and
intervention.
QUESTION 3
A nurse in the emergency department is triaging four clients following a mass casualty
event. Which client should the nurse recommend for treatment first?
A. A client with a closed forearm fracture who is alert and oriented
B. A client with two open chest wounds and left tracheal deviation
C. A client with partial-thickness burns covering 15% of the body
D. A client with a simple laceration that is bleeding slowly
,Correct Answer: B
Rationale: A client with two open chest wounds and tracheal deviation is likely developing
a tension pneumothorax, which is immediately life-threatening. This client requires
emergent (Class I/Red tag) treatment to prevent death. The other clients have injuries that
are either delayed or minor in comparison.
QUESTION 4
A nurse is caring for four clients. Which of the following findings is the highest priority?
A. A client 2 hours post-cardiac catheterization with capillary refill in the great toe of 4
seconds
B. A client with new-onset diabetes who has a blood glucose of 180 mg/dL
C. A client with pneumonia who has a temperature of 38.2°C (100.8°F)
D. A client with a urinary tract infection who is reporting burning with urination
Correct Answer: A
Rationale: Prolonged capillary refill (greater than 3 seconds) in a post-cardiac
catheterization client may indicate circulatory compromise and potential vascular
occlusion at the insertion site. This finding could lead to tissue ischemia and requires
immediate assessment.
QUESTION 5
A nurse enters a client's room and identifies that the client is receiving too much IV fluid
because the IV pump is malfunctioning. Which action should the nurse take first?
A. Notify the provider immediately
B. Turn off the IV pump and stop the infusion
C. Auscultate the client's lungs
, D. Document the incident in the client's chart
Correct Answer: C
Rationale: The nurse should first assess the client for signs of fluid overload (crackles in
lungs, dyspnea, edema, distended neck veins) before intervening. Assessment is always the
first step in the nursing process.
QUESTION 6
A charge nurse is making shift assignments. Which client should be assigned to a float
nurse from a postpartum unit?
A. A client with new-onset atrial fibrillation
B. A client requiring wound care for a stage 3 pressure ulcer
C. A client with a central line receiving TPN
D. A client with stable vital signs awaiting discharge
Correct Answer: D
Rationale: A stable client awaiting discharge is the most appropriate assignment for a
float nurse from another unit. Unstable clients and those requiring specialized skills should
be assigned to nurses with appropriate experience.
QUESTION 7
A nurse is caring for a client who has a new tracheostomy. Which client should the nurse
assess first?
A. A client with a tracheostomy whose secretions are thick and requires frequent
suctioning
B. A client with a tracheostomy who has audible stridor and oxygen saturation of 90%
C. A client with a tracheostomy who is requesting pain medication
Comprehensive 150-Question Practice Examination with
Detailed Rationales in Italics
SECTION 1: PRIORITIZATION & CLINICAL JUDGMENT
(Questions 1-25)
QUESTION 1 (NGN – Postoperative Hemorrhage)
Scenario: A client is 6 hours postoperative from abdominal surgery. At 1715, the client
was resting comfortably with moderate serosanguineous drainage and pain rated 4/10.
At 2030, the client becomes restless, short of breath, and reports severe abdominal pain
(8/10). The abdominal dressing is saturated with bright red blood.
Question: Which combination of findings most likely indicates hemorrhage requiring
immediate provider notification?
A. Slight pain increase, stable heart rate, unchanged respiratory rate, elevated
temperature, normal O₂ saturation
B. Decreased blood pressure, increased respiratory rate, pain 8/10, large amount of
bright red drainage, decreased oxygen saturation, increased heart rate
C. Moderate serosanguineous drainage, stable vital signs, pain 5/10
D. Unchanged blood pressure, no new drainage, pain resolved
Correct Answer: B
Rationale: Sudden changes including tachycardia, tachypnea, hypotension, severe pain
(8/10), large amounts of bright red blood on dressing, and decreased O₂ saturation
collectively indicate the possibility of hemorrhage. Immediate provider notification and
,intervention are crucial. Options A, C, and D describe stable findings that do not indicate
hemorrhage.
QUESTION 2
A charge nurse is receiving change-of-shift report on a medical-surgical unit. Which
client should the charge nurse assess first?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL
B. A client with aspiration pneumonia who has a respiratory rate of 28/min and oxygen
saturation of 89%
C. A client with a hip fracture in Buck's traction reporting pain of 4 on a 0-10 scale
D. A client with a stage 2 pressure ulcer requiring a dressing change
Correct Answer: B
Rationale: The client with aspiration pneumonia and respiratory rate of 28/min with
oxygen saturation of 89% is showing signs of respiratory compromise and potential
hypoxia. According to the ABCs (Airway, Breathing, Circulation), respiratory issues take
highest priority. This client is unstable and requires immediate assessment and
intervention.
QUESTION 3
A nurse in the emergency department is triaging four clients following a mass casualty
event. Which client should the nurse recommend for treatment first?
A. A client with a closed forearm fracture who is alert and oriented
B. A client with two open chest wounds and left tracheal deviation
C. A client with partial-thickness burns covering 15% of the body
D. A client with a simple laceration that is bleeding slowly
,Correct Answer: B
Rationale: A client with two open chest wounds and tracheal deviation is likely developing
a tension pneumothorax, which is immediately life-threatening. This client requires
emergent (Class I/Red tag) treatment to prevent death. The other clients have injuries that
are either delayed or minor in comparison.
QUESTION 4
A nurse is caring for four clients. Which of the following findings is the highest priority?
A. A client 2 hours post-cardiac catheterization with capillary refill in the great toe of 4
seconds
B. A client with new-onset diabetes who has a blood glucose of 180 mg/dL
C. A client with pneumonia who has a temperature of 38.2°C (100.8°F)
D. A client with a urinary tract infection who is reporting burning with urination
Correct Answer: A
Rationale: Prolonged capillary refill (greater than 3 seconds) in a post-cardiac
catheterization client may indicate circulatory compromise and potential vascular
occlusion at the insertion site. This finding could lead to tissue ischemia and requires
immediate assessment.
QUESTION 5
A nurse enters a client's room and identifies that the client is receiving too much IV fluid
because the IV pump is malfunctioning. Which action should the nurse take first?
A. Notify the provider immediately
B. Turn off the IV pump and stop the infusion
C. Auscultate the client's lungs
, D. Document the incident in the client's chart
Correct Answer: C
Rationale: The nurse should first assess the client for signs of fluid overload (crackles in
lungs, dyspnea, edema, distended neck veins) before intervening. Assessment is always the
first step in the nursing process.
QUESTION 6
A charge nurse is making shift assignments. Which client should be assigned to a float
nurse from a postpartum unit?
A. A client with new-onset atrial fibrillation
B. A client requiring wound care for a stage 3 pressure ulcer
C. A client with a central line receiving TPN
D. A client with stable vital signs awaiting discharge
Correct Answer: D
Rationale: A stable client awaiting discharge is the most appropriate assignment for a
float nurse from another unit. Unstable clients and those requiring specialized skills should
be assigned to nurses with appropriate experience.
QUESTION 7
A nurse is caring for a client who has a new tracheostomy. Which client should the nurse
assess first?
A. A client with a tracheostomy whose secretions are thick and requires frequent
suctioning
B. A client with a tracheostomy who has audible stridor and oxygen saturation of 90%
C. A client with a tracheostomy who is requesting pain medication
