ATI CMS Fundamentals Exam
250+ Questions & Answers with Rationales
Graded A+ | 2026/2027
Comprehensive Review Examination aligned with the 2026-2027 NCLEX-RN Test Plan
255 Questions with Verified Answers and Detailed Clinical Rationales
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Format: 4-Option Multiple Choice (A-D) | Single Correct Answer
NCLEX-Style Priority Setting and Clinical Judgment Questions Included
Medication Calculations with Embedded Clinical Scenarios
Table of Contents
Section 1: Management of Care (Questions 1-40)
Section 2: Safety and Infection Control (Questions 41-75)
Section 3: Health Promotion and Maintenance (Questions 76-105)
Section 4: Psychosocial Integrity (Questions 106-135)
Section 5: Basic Care and Comfort (Questions 136-175)
Section 6: Pharmacological and Parenteral Therapies (Questions 176-210)
Section 7: Reduction of Risk Potential (Questions 211-235)
Section 8: Physiological Adaptation (Questions 236-255)
1
,Section 1: Management of Care (Client Rights, Advocacy, Delegation, & Legal/Ethical
Issues)
Questions 1-40
Q1: A nurse on a medical-surgical unit is delegating tasks to a licensed practical nurse (LPN) and an unlicensed
assistive personnel (UAP). Which of the following tasks should the nurse delegate to the UAP?
A. Administering an oral analgesic to a client with postoperative pain
B. Obtaining a clean-catch urine specimen from a client with a suspected UTI [CORRECT]
C. Evaluating the effectiveness of a new antihypertensive medication
D. Teaching a client with heart failure about sodium restriction
Correct Answer: B
Rationale: Obtaining a clean-catch urine specimen is a standardized, unchanging procedure that falls within the UAP scope of
practice. Administering medications and evaluating effectiveness are RN responsibilities. Teaching requires clinical judgment and
RN-level education competency. The RN retains accountability for all delegated tasks per the state Nurse Practice Act and ATI
delegation framework.
Q2: A client diagnosed with metastatic cancer tells the nurse, 'I do not want any more chemotherapy. I just want to be
comfortable.' Which of the following is the nurse's priority action?
A. Inform the client that stopping chemotherapy will lead to death within weeks
B. Document the client's refusal and notify the health care provider [CORRECT]
C. Encourage the client to discuss the decision with family members first
D. Ask the client to sign a against-medical-advice (AMA) form
Correct Answer: B
Rationale: The client has the legal and ethical right to refuse treatment, including life-prolonging therapies. The nurse's priority is
to document the refusal and notify the provider so the care plan can be adjusted. Informing the client of impending death is not
supportive and may constitute coercion. While involving family is beneficial, it is not the priority over respecting the client's
autonomous decision. An AMA form is inappropriate because the client is exercising an informed right to refuse, not leaving
against advice.
Q3: A preoperative client signed the informed consent form for a cholecystectomy. The client then says to the nurse,
'My surgeon said this was a simple procedure with no risks, but I read online that I could have a bile duct injury.'
Which of the following responses should the nurse make?
A. 'The surgeon would not have recommended the surgery if the risks were significant.'
B. 'I will have your surgeon come back and discuss the procedure and its risks with you again.' [CORRECT]
C. 'The consent form you signed already lists all the potential risks of the surgery.'
D. 'Online information is often inaccurate, so you should not worry about what you read.'
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives. If the client
expresses new concerns or indicates inadequate understanding, the nurse must arrange for the surgeon to return and clarify. The
nurse cannot provide the explanation because the surgeon who will perform the procedure is responsible for obtaining informed
consent. Dismissing the client's concerns or telling them not to worry violates the ethical principle of veracity and the client's right
to full disclosure.
2
,Q4: A nurse is caring for an older adult client who is admitted with dehydration and malnutrition. The client's
daughter, who is the designated health care proxy, insists that the client should not receive IV fluids because 'she
would not want to be kept alive artificially.' The client is alert, oriented, and capable of making decisions. Which of
the following actions should the nurse take?
A. Follow the daughter's instructions because she is the legal health care proxy
B. Ask the client directly about her wishes regarding IV fluid therapy [CORRECT]
C. Request a social work consult to mediate the family conflict
D. Administer IV fluids because the daughter cannot refuse treatment for a competent client
Correct Answer: B
Rationale: When a client is alert, oriented, and capable of making decisions, the client's own informed consent or refusal takes
priority over the proxy's wishes. A health care proxy only makes decisions when the client lacks decision-making capacity. The
nurse should ask the client directly about her preferences. Administering treatment against the client's unknown wishes would also
be inappropriate until the client's own preferences are clarified.
Q5: A nurse is preparing to administer a scheduled medication to a client. The nurse notices that the medication has
been discontinued by the provider but the pharmacy has not yet updated the medication drawer. Which of the
following actions should the nurse take first?
A. Administer the medication since it was previously scheduled and the pharmacy has not updated the system
B. Contact the pharmacy to request the medication be removed from the client's drawer
C. Verify the discontinuation order in the client's medical record before taking further action [CORRECT]
D. Document the error and notify the nurse manager about the pharmacy communication failure
Correct Answer: C
Rationale: The nurse must first verify the discontinuation order in the medical record to confirm it is legitimate and current. The
five rights of medication administration include the right medication, and a discontinued order means the medication should not be
given. Once verified, the nurse should not administer the medication, should notify the pharmacy, and document appropriately.
Administering a discontinued medication constitutes a medication error regardless of the pharmacy's update status.
Q6: A charge nurse is making client assignments for the shift. The team includes an RN, an LPN, and a UAP. Which
of the following clients is most appropriate to assign to the LPN?
A. A client who is 2 hours postoperative following a thyroidectomy and needs assessment of airway patency
B. A client with heart failure who has new-onset dyspnea and needs a comprehensive respiratory assessment
C. A client who is 1 day post-appendectomy with stable vital signs and needs wound care and ambulation assistance
[CORRECT]
D. A client admitted with diabetic ketoacidosis who requires continuous insulin infusion monitoring
Correct Answer: C
Rationale: The LPN scope of practice includes caring for stable clients with predictable outcomes. A client 1 day
post-appendectomy with stable vital signs who needs wound care and ambulation is appropriate for LPN assignment. Postoperative
thyroidectomy requires RN-level airway assessment due to risk of hemorrhage and tracheal compression. New-onset dyspnea in
heart failure and DKA with continuous insulin infusion require RN-level assessment, clinical judgment, and monitoring for
complications.
Q7: A nurse is giving a telephone report to a home health nurse about a client who is being discharged. The nurse
verifies that she is speaking to the correct home health nurse by asking for the nurse's name and agency. Which of the
following additional actions is required before providing the report?
A. Obtain a written authorization from the client before sharing any information [CORRECT]
B. Request the home health nurse's license number and verify it with the state board
3
, C. Provide the report since the home health nurse has a legitimate need to know for continuity of care
D. Ask the client's family member to confirm the home health agency before proceeding
Correct Answer: A
Rationale: HIPAA permits sharing protected health information (PHI) for treatment, payment, and healthcare operations without
specific written authorization. The home health nurse has a legitimate need to know for the purpose of continuity of care, which
falls under the treatment exception. Verifying the nurse's identity and agency is sufficient. A separate written authorization is not
required when disclosure is for treatment purposes. Asking for a license number or family confirmation adds unnecessary barriers
to care coordination.
Q8: A client with end-stage chronic obstructive pulmonary disease (COPD) has a do-not-resuscitate (DNR) order in
place. The client develops acute respiratory distress and the family insists that the nurse 'do everything possible.'
Which of the following is the nurse's best response?
A. Initiate resuscitation measures because the family is requesting them
B. Explain that the DNR order is legally binding and resuscitation will not be performed
C. Contact the charge nurse and the provider to review the DNR order with the family [CORRECT]
D. Ask the family to leave the room while the nurse provides comfort measures only
Correct Answer: C
Rationale: When family requests conflict with an existing DNR order, the nurse should involve the charge nurse and provider to
facilitate a discussion with the family about the client's previously expressed wishes. The DNR order was established by the client
(or surrogate) and remains in effect unless formally revoked. The nurse cannot unilaterally override a valid DNR, but should not
simply dismiss the family's concerns. Initiating resuscitation against a valid DNR order would violate the client's autonomous
decision and could constitute battery.
Q9: A nurse is caring for a 4-year-old child who is brought to the emergency department with multiple bruises in
various stages of healing on the back and buttocks. The parent states the child 'falls a lot.' Which of the following
actions should the nurse take?
A. Confront the parent about the suspected abuse and demand an explanation
B. Document the findings and report the suspected abuse to the appropriate state agency [CORRECT]
C. Wait for the provider to assess the child before making any report
D. Ask the child privately who caused the bruises to confirm abuse before reporting
Correct Answer: B
Rationale: Nurses are mandatory reporters of suspected child abuse. The nurse must report suspected abuse to the appropriate
state agency (such as Child Protective Services) based on clinical findings. The location of bruises (back and buttocks) and varying
stages of healing are consistent with non-accidental trauma. The nurse does not need to prove abuse before reporting, only have
reasonable suspicion. Confronting the parent may escalate the situation. Waiting for the provider or trying to confirm abuse
through the child delays the legally required report.
Q10: A nurse receives change-of-shift report on four clients. Which of the following clients should the nurse assess
first?
A. A client with type 2 diabetes who has a blood glucose of 180 mg/dL and is awaiting breakfast
B. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L and is scheduled for dialysis
C. A client with pneumonia who has a temperature of 38.9 degrees C (102 degrees F) and a productive cough
D. A client with heart failure who reports new-onset dyspnea at rest and has gained 2 kg in 2 days [CORRECT]
Correct Answer: D
Rationale: New-onset dyspnea at rest and rapid weight gain (2 kg in 2 days) indicate acute fluid overload and possible
decompensated heart failure, which is a life-threatening condition requiring immediate assessment and intervention using the ABC
(airway, breathing, circulation) framework. The other clients have findings that, while requiring intervention, are not immediately
4
250+ Questions & Answers with Rationales
Graded A+ | 2026/2027
Comprehensive Review Examination aligned with the 2026-2027 NCLEX-RN Test Plan
255 Questions with Verified Answers and Detailed Clinical Rationales
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Format: 4-Option Multiple Choice (A-D) | Single Correct Answer
NCLEX-Style Priority Setting and Clinical Judgment Questions Included
Medication Calculations with Embedded Clinical Scenarios
Table of Contents
Section 1: Management of Care (Questions 1-40)
Section 2: Safety and Infection Control (Questions 41-75)
Section 3: Health Promotion and Maintenance (Questions 76-105)
Section 4: Psychosocial Integrity (Questions 106-135)
Section 5: Basic Care and Comfort (Questions 136-175)
Section 6: Pharmacological and Parenteral Therapies (Questions 176-210)
Section 7: Reduction of Risk Potential (Questions 211-235)
Section 8: Physiological Adaptation (Questions 236-255)
1
,Section 1: Management of Care (Client Rights, Advocacy, Delegation, & Legal/Ethical
Issues)
Questions 1-40
Q1: A nurse on a medical-surgical unit is delegating tasks to a licensed practical nurse (LPN) and an unlicensed
assistive personnel (UAP). Which of the following tasks should the nurse delegate to the UAP?
A. Administering an oral analgesic to a client with postoperative pain
B. Obtaining a clean-catch urine specimen from a client with a suspected UTI [CORRECT]
C. Evaluating the effectiveness of a new antihypertensive medication
D. Teaching a client with heart failure about sodium restriction
Correct Answer: B
Rationale: Obtaining a clean-catch urine specimen is a standardized, unchanging procedure that falls within the UAP scope of
practice. Administering medications and evaluating effectiveness are RN responsibilities. Teaching requires clinical judgment and
RN-level education competency. The RN retains accountability for all delegated tasks per the state Nurse Practice Act and ATI
delegation framework.
Q2: A client diagnosed with metastatic cancer tells the nurse, 'I do not want any more chemotherapy. I just want to be
comfortable.' Which of the following is the nurse's priority action?
A. Inform the client that stopping chemotherapy will lead to death within weeks
B. Document the client's refusal and notify the health care provider [CORRECT]
C. Encourage the client to discuss the decision with family members first
D. Ask the client to sign a against-medical-advice (AMA) form
Correct Answer: B
Rationale: The client has the legal and ethical right to refuse treatment, including life-prolonging therapies. The nurse's priority is
to document the refusal and notify the provider so the care plan can be adjusted. Informing the client of impending death is not
supportive and may constitute coercion. While involving family is beneficial, it is not the priority over respecting the client's
autonomous decision. An AMA form is inappropriate because the client is exercising an informed right to refuse, not leaving
against advice.
Q3: A preoperative client signed the informed consent form for a cholecystectomy. The client then says to the nurse,
'My surgeon said this was a simple procedure with no risks, but I read online that I could have a bile duct injury.'
Which of the following responses should the nurse make?
A. 'The surgeon would not have recommended the surgery if the risks were significant.'
B. 'I will have your surgeon come back and discuss the procedure and its risks with you again.' [CORRECT]
C. 'The consent form you signed already lists all the potential risks of the surgery.'
D. 'Online information is often inaccurate, so you should not worry about what you read.'
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives. If the client
expresses new concerns or indicates inadequate understanding, the nurse must arrange for the surgeon to return and clarify. The
nurse cannot provide the explanation because the surgeon who will perform the procedure is responsible for obtaining informed
consent. Dismissing the client's concerns or telling them not to worry violates the ethical principle of veracity and the client's right
to full disclosure.
2
,Q4: A nurse is caring for an older adult client who is admitted with dehydration and malnutrition. The client's
daughter, who is the designated health care proxy, insists that the client should not receive IV fluids because 'she
would not want to be kept alive artificially.' The client is alert, oriented, and capable of making decisions. Which of
the following actions should the nurse take?
A. Follow the daughter's instructions because she is the legal health care proxy
B. Ask the client directly about her wishes regarding IV fluid therapy [CORRECT]
C. Request a social work consult to mediate the family conflict
D. Administer IV fluids because the daughter cannot refuse treatment for a competent client
Correct Answer: B
Rationale: When a client is alert, oriented, and capable of making decisions, the client's own informed consent or refusal takes
priority over the proxy's wishes. A health care proxy only makes decisions when the client lacks decision-making capacity. The
nurse should ask the client directly about her preferences. Administering treatment against the client's unknown wishes would also
be inappropriate until the client's own preferences are clarified.
Q5: A nurse is preparing to administer a scheduled medication to a client. The nurse notices that the medication has
been discontinued by the provider but the pharmacy has not yet updated the medication drawer. Which of the
following actions should the nurse take first?
A. Administer the medication since it was previously scheduled and the pharmacy has not updated the system
B. Contact the pharmacy to request the medication be removed from the client's drawer
C. Verify the discontinuation order in the client's medical record before taking further action [CORRECT]
D. Document the error and notify the nurse manager about the pharmacy communication failure
Correct Answer: C
Rationale: The nurse must first verify the discontinuation order in the medical record to confirm it is legitimate and current. The
five rights of medication administration include the right medication, and a discontinued order means the medication should not be
given. Once verified, the nurse should not administer the medication, should notify the pharmacy, and document appropriately.
Administering a discontinued medication constitutes a medication error regardless of the pharmacy's update status.
Q6: A charge nurse is making client assignments for the shift. The team includes an RN, an LPN, and a UAP. Which
of the following clients is most appropriate to assign to the LPN?
A. A client who is 2 hours postoperative following a thyroidectomy and needs assessment of airway patency
B. A client with heart failure who has new-onset dyspnea and needs a comprehensive respiratory assessment
C. A client who is 1 day post-appendectomy with stable vital signs and needs wound care and ambulation assistance
[CORRECT]
D. A client admitted with diabetic ketoacidosis who requires continuous insulin infusion monitoring
Correct Answer: C
Rationale: The LPN scope of practice includes caring for stable clients with predictable outcomes. A client 1 day
post-appendectomy with stable vital signs who needs wound care and ambulation is appropriate for LPN assignment. Postoperative
thyroidectomy requires RN-level airway assessment due to risk of hemorrhage and tracheal compression. New-onset dyspnea in
heart failure and DKA with continuous insulin infusion require RN-level assessment, clinical judgment, and monitoring for
complications.
Q7: A nurse is giving a telephone report to a home health nurse about a client who is being discharged. The nurse
verifies that she is speaking to the correct home health nurse by asking for the nurse's name and agency. Which of the
following additional actions is required before providing the report?
A. Obtain a written authorization from the client before sharing any information [CORRECT]
B. Request the home health nurse's license number and verify it with the state board
3
, C. Provide the report since the home health nurse has a legitimate need to know for continuity of care
D. Ask the client's family member to confirm the home health agency before proceeding
Correct Answer: A
Rationale: HIPAA permits sharing protected health information (PHI) for treatment, payment, and healthcare operations without
specific written authorization. The home health nurse has a legitimate need to know for the purpose of continuity of care, which
falls under the treatment exception. Verifying the nurse's identity and agency is sufficient. A separate written authorization is not
required when disclosure is for treatment purposes. Asking for a license number or family confirmation adds unnecessary barriers
to care coordination.
Q8: A client with end-stage chronic obstructive pulmonary disease (COPD) has a do-not-resuscitate (DNR) order in
place. The client develops acute respiratory distress and the family insists that the nurse 'do everything possible.'
Which of the following is the nurse's best response?
A. Initiate resuscitation measures because the family is requesting them
B. Explain that the DNR order is legally binding and resuscitation will not be performed
C. Contact the charge nurse and the provider to review the DNR order with the family [CORRECT]
D. Ask the family to leave the room while the nurse provides comfort measures only
Correct Answer: C
Rationale: When family requests conflict with an existing DNR order, the nurse should involve the charge nurse and provider to
facilitate a discussion with the family about the client's previously expressed wishes. The DNR order was established by the client
(or surrogate) and remains in effect unless formally revoked. The nurse cannot unilaterally override a valid DNR, but should not
simply dismiss the family's concerns. Initiating resuscitation against a valid DNR order would violate the client's autonomous
decision and could constitute battery.
Q9: A nurse is caring for a 4-year-old child who is brought to the emergency department with multiple bruises in
various stages of healing on the back and buttocks. The parent states the child 'falls a lot.' Which of the following
actions should the nurse take?
A. Confront the parent about the suspected abuse and demand an explanation
B. Document the findings and report the suspected abuse to the appropriate state agency [CORRECT]
C. Wait for the provider to assess the child before making any report
D. Ask the child privately who caused the bruises to confirm abuse before reporting
Correct Answer: B
Rationale: Nurses are mandatory reporters of suspected child abuse. The nurse must report suspected abuse to the appropriate
state agency (such as Child Protective Services) based on clinical findings. The location of bruises (back and buttocks) and varying
stages of healing are consistent with non-accidental trauma. The nurse does not need to prove abuse before reporting, only have
reasonable suspicion. Confronting the parent may escalate the situation. Waiting for the provider or trying to confirm abuse
through the child delays the legally required report.
Q10: A nurse receives change-of-shift report on four clients. Which of the following clients should the nurse assess
first?
A. A client with type 2 diabetes who has a blood glucose of 180 mg/dL and is awaiting breakfast
B. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L and is scheduled for dialysis
C. A client with pneumonia who has a temperature of 38.9 degrees C (102 degrees F) and a productive cough
D. A client with heart failure who reports new-onset dyspnea at rest and has gained 2 kg in 2 days [CORRECT]
Correct Answer: D
Rationale: New-onset dyspnea at rest and rapid weight gain (2 kg in 2 days) indicate acute fluid overload and possible
decompensated heart failure, which is a life-threatening condition requiring immediate assessment and intervention using the ABC
(airway, breathing, circulation) framework. The other clients have findings that, while requiring intervention, are not immediately
4
