ATI RN Leadership
2026 Updated NGN Exam-Style
70 Questions with Detailed Rationales
Exam Information
Questions: 70 Multiple-Choice | Format: NGN Exam-Style
Covers: Delegation, Prioritization, Leadership, Conflict Resolution,
Quality Improvement, Ethics/Legal, Communication, Staffing
Answers with detailed rationales follow each question
Instructions:
1. Read each question carefully before selecting your answer.
2. Select the best answer from the four options provided.
3. Each question is followed by the correct answer and a detailed rationale.
4. Rationales explain why the correct answer is right and why other options are incorrect.
5. This exam covers all major RN Leadership topic areas tested on the NCLEX-RN.
6. Topics
include delegation, prioritization, leadership, conflict resolution, quality
improvement, ethical/legal issues, communication, and staffing management.
7. Usethis as a self-study tool to identify knowledge gaps and strengthen clinical
reasoning.
, ATI RN Leadership 2025/2026 | NGN Exam-Style | 70 Questions
Question 1 [Delegation]
A charge nurse is assigning tasks for the shift. Which task is most appropriate to
delegate to a licensed practical nurse (LPN)?
A. Performing the initial admission assessment on a newly admitted client
with chest pain
B. Administering oral medications to stable clients as prescribed
C. Developing the nursing care plan for a client newly diagnosed with diabetes
D. Providing discharge teaching to a client going home on anticoagulation
therapy
Answer & Rationale:
Administering oral medications to stable clients is within the LPN's scope of practice
and is a routine, predictable task. The LPN has received the education and training
necessary to safely administer medications, and the task does not require the
complex clinical judgment that would necessitate an RN.
Why the other options are incorrect:
Option A is incorrect because an initial admission assessment requires the
comprehensive assessment skills and clinical judgment of a registered nurse,
particularly for a client with chest pain, which could indicate an acute cardiac event.
Option C is incorrect because developing a nursing care plan requires critical
thinking, analysis of assessment data, and establishment of outcomes, which are RN-
level responsibilities. Option D is incorrect because discharge teaching, especially
for high-risk medications like anticoagulants, requires the RN's assessment of the
client's understanding and ability to manage the medication safely at home.
Question 2 [Delegation]
A registered nurse (RN) is caring for four clients on a medical-surgical unit. Which
client should the RN assign to an unlicensed assistive personnel (UAP)?
A. A client who is 1 day postoperative following abdominal surgery with a
Jackson-Pratt drain
B. A client who was just admitted with acute exacerbation of heart failure and
is reporting dyspnea
C. A client who requires assistance with ambulation to the bathroom and
morning hygiene care
D. A client who is receiving a continuous heparin infusion and needs frequent
aPTT monitoring
Page 2
, ATI RN Leadership 2025/2026 | NGN Exam-Style | 70 Questions
Answer & Rationale:
A client who needs assistance with ambulation and hygiene care represents a stable,
predictable situation that is appropriate for delegation to UAP. These are routine
activities of daily living that do not require nursing assessment or clinical judgment,
making them ideal tasks for unlicensed personnel under RN supervision.
Why the other options are incorrect:
Option A is incorrect because the postoperative client with a drain requires
assessment of the surgical site, monitoring for complications such as bleeding or
infection, and evaluation of the drain output, all of which require RN-level
assessment skills. Option B is incorrect because a client with acute heart failure
exacerbation is unstable and requires frequent respiratory and cardiac assessment,
oxygen therapy management, and potential medication adjustments by the RN.
Option D is incorrect because a client on a continuous heparin infusion is at high
risk for bleeding complications and requires frequent laboratory monitoring and
dose adjustments that only an RN can perform.
Question 3 [Delegation]
Which statement by a nurse manager best demonstrates the principle of the 'five rights
of delegation'?
A. 'I delegated the task to the most experienced nurse on the unit regardless
of the patient's needs.'
B. 'I chose to delegate this task because the delegatee has the appropriate
education, training, and skill.'
C. 'I assigned this task to a new graduate nurse to help her learn the
procedure.'
Page 3
, ATI RN Leadership 2025/2026 | NGN Exam-Style | 70 Questions
D. 'I delegate all routine tasks to the LPN so I can focus on documentation.'
Answer & Rationale:
The five rights of delegation include: right task, right circumstance, right person,
right direction/communication, and right supervision/evaluation. Choosing a
delegatee who has the appropriate education, training, and skill addresses the 'right
person' component and ensures patient safety. Effective delegation requires the nurse
to match the task to the qualified individual, not just the most available or convenient
person.
Why the other options are incorrect:
Option A is incorrect because delegation should be based on matching the right
person with the right task and circumstance, not simply choosing the most
experienced person. Option C is incorrect because delegation is not appropriate as a
teaching strategy for new procedures; learning opportunities should occur through
precepting or supervised practice, not delegation of patient care tasks. Option D is
incorrect because delegation should be based on patient needs and the
appropriateness of the task for the delegatee, not as a way to offload all routine
work.
Question 4 [Delegation]
A nurse is supervising a UAP who is assisting with feeding a client who had a left-
sided cerebrovascular accident (stroke). Which action by the UAP requires immediate
intervention by the nurse?
A. Positioning the client upright at a 90-degree angle before feeding
B. Placing food on the unaffected side of the client's mouth
C. Offering the client thin liquids to drink first to assess swallowing ability
D. Allowing the client adequate time to chew and swallow between bites
Answer & Rationale:
Offering thin liquids to a stroke patient to assess swallowing is extremely dangerous
because patients with dysphagia following a cerebrovascular accident are at high
risk for aspiration, especially with thin liquids. A swallowing evaluation by speech
therapy should be performed before any oral intake, and the nurse should intervene
immediately to prevent potential aspiration pneumonia, which can be life-
threatening.
Why the other options are incorrect:
Page 4
2026 Updated NGN Exam-Style
70 Questions with Detailed Rationales
Exam Information
Questions: 70 Multiple-Choice | Format: NGN Exam-Style
Covers: Delegation, Prioritization, Leadership, Conflict Resolution,
Quality Improvement, Ethics/Legal, Communication, Staffing
Answers with detailed rationales follow each question
Instructions:
1. Read each question carefully before selecting your answer.
2. Select the best answer from the four options provided.
3. Each question is followed by the correct answer and a detailed rationale.
4. Rationales explain why the correct answer is right and why other options are incorrect.
5. This exam covers all major RN Leadership topic areas tested on the NCLEX-RN.
6. Topics
include delegation, prioritization, leadership, conflict resolution, quality
improvement, ethical/legal issues, communication, and staffing management.
7. Usethis as a self-study tool to identify knowledge gaps and strengthen clinical
reasoning.
, ATI RN Leadership 2025/2026 | NGN Exam-Style | 70 Questions
Question 1 [Delegation]
A charge nurse is assigning tasks for the shift. Which task is most appropriate to
delegate to a licensed practical nurse (LPN)?
A. Performing the initial admission assessment on a newly admitted client
with chest pain
B. Administering oral medications to stable clients as prescribed
C. Developing the nursing care plan for a client newly diagnosed with diabetes
D. Providing discharge teaching to a client going home on anticoagulation
therapy
Answer & Rationale:
Administering oral medications to stable clients is within the LPN's scope of practice
and is a routine, predictable task. The LPN has received the education and training
necessary to safely administer medications, and the task does not require the
complex clinical judgment that would necessitate an RN.
Why the other options are incorrect:
Option A is incorrect because an initial admission assessment requires the
comprehensive assessment skills and clinical judgment of a registered nurse,
particularly for a client with chest pain, which could indicate an acute cardiac event.
Option C is incorrect because developing a nursing care plan requires critical
thinking, analysis of assessment data, and establishment of outcomes, which are RN-
level responsibilities. Option D is incorrect because discharge teaching, especially
for high-risk medications like anticoagulants, requires the RN's assessment of the
client's understanding and ability to manage the medication safely at home.
Question 2 [Delegation]
A registered nurse (RN) is caring for four clients on a medical-surgical unit. Which
client should the RN assign to an unlicensed assistive personnel (UAP)?
A. A client who is 1 day postoperative following abdominal surgery with a
Jackson-Pratt drain
B. A client who was just admitted with acute exacerbation of heart failure and
is reporting dyspnea
C. A client who requires assistance with ambulation to the bathroom and
morning hygiene care
D. A client who is receiving a continuous heparin infusion and needs frequent
aPTT monitoring
Page 2
, ATI RN Leadership 2025/2026 | NGN Exam-Style | 70 Questions
Answer & Rationale:
A client who needs assistance with ambulation and hygiene care represents a stable,
predictable situation that is appropriate for delegation to UAP. These are routine
activities of daily living that do not require nursing assessment or clinical judgment,
making them ideal tasks for unlicensed personnel under RN supervision.
Why the other options are incorrect:
Option A is incorrect because the postoperative client with a drain requires
assessment of the surgical site, monitoring for complications such as bleeding or
infection, and evaluation of the drain output, all of which require RN-level
assessment skills. Option B is incorrect because a client with acute heart failure
exacerbation is unstable and requires frequent respiratory and cardiac assessment,
oxygen therapy management, and potential medication adjustments by the RN.
Option D is incorrect because a client on a continuous heparin infusion is at high
risk for bleeding complications and requires frequent laboratory monitoring and
dose adjustments that only an RN can perform.
Question 3 [Delegation]
Which statement by a nurse manager best demonstrates the principle of the 'five rights
of delegation'?
A. 'I delegated the task to the most experienced nurse on the unit regardless
of the patient's needs.'
B. 'I chose to delegate this task because the delegatee has the appropriate
education, training, and skill.'
C. 'I assigned this task to a new graduate nurse to help her learn the
procedure.'
Page 3
, ATI RN Leadership 2025/2026 | NGN Exam-Style | 70 Questions
D. 'I delegate all routine tasks to the LPN so I can focus on documentation.'
Answer & Rationale:
The five rights of delegation include: right task, right circumstance, right person,
right direction/communication, and right supervision/evaluation. Choosing a
delegatee who has the appropriate education, training, and skill addresses the 'right
person' component and ensures patient safety. Effective delegation requires the nurse
to match the task to the qualified individual, not just the most available or convenient
person.
Why the other options are incorrect:
Option A is incorrect because delegation should be based on matching the right
person with the right task and circumstance, not simply choosing the most
experienced person. Option C is incorrect because delegation is not appropriate as a
teaching strategy for new procedures; learning opportunities should occur through
precepting or supervised practice, not delegation of patient care tasks. Option D is
incorrect because delegation should be based on patient needs and the
appropriateness of the task for the delegatee, not as a way to offload all routine
work.
Question 4 [Delegation]
A nurse is supervising a UAP who is assisting with feeding a client who had a left-
sided cerebrovascular accident (stroke). Which action by the UAP requires immediate
intervention by the nurse?
A. Positioning the client upright at a 90-degree angle before feeding
B. Placing food on the unaffected side of the client's mouth
C. Offering the client thin liquids to drink first to assess swallowing ability
D. Allowing the client adequate time to chew and swallow between bites
Answer & Rationale:
Offering thin liquids to a stroke patient to assess swallowing is extremely dangerous
because patients with dysphagia following a cerebrovascular accident are at high
risk for aspiration, especially with thin liquids. A swallowing evaluation by speech
therapy should be performed before any oral intake, and the nurse should intervene
immediately to prevent potential aspiration pneumonia, which can be life-
threatening.
Why the other options are incorrect:
Page 4
