# ATI RN Leadership Proctored Exam 2019 – Combined
Versions 1, 2 & 3---
### Section 1: Delegation, Assignment, and Supervision
**1. A nurse is delegating care for a group of clients. Which of the following clients should the nurse
assign to a licensed practical nurse (LPN)?**
A) A client who is scheduled for an endoscopy later today and requires an enema.
B) A client who has had a myocardial infarction and will be transferring to the ICU.
C) A newly admitted client who has diabetes mellitus and requires initial teaching on self-
administration of insulin.
D) A client who is 2 days post-operative and requires reinforcement of insulin injection technique.
**Answer: A**
*Rationale:* An LPN can perform tasks such as administering enemas and providing routine care to
stable clients . Reinforcing teaching is within the LPN's scope, but initial teaching and the care of
unstable clients should be performed by an RN .
**2. A nurse is planning care for a group of clients and can delegate tasks to an LPN and assistive
personnel (AP). Which of the following tasks should the nurse assign to the LPN?**
A) Ambulating a client who is scheduled for discharge later in the day.
B) Reinforcing teaching with a client who is learning to self-administer insulin.
C) Administering morphine IV bolus to a client who is 1-hour post-operative.
D) Admitting a new client who has chronic back pain to the unit.
**Answer: B**
*Rationale:* An LPN can reinforce teaching that has been previously initiated by an RN . Ambulating a
client is a task for AP . Administering IV medications and admitting a new client are RN responsibilities
due to the need for assessment and evaluation.
**3. A nurse is supervising a newly licensed nurse who is performing surgical asepsis. After donning a
sterile gown and gloves, which of the following actions by the newly licensed nurse demonstrates
correct aseptic technique?**
A) The nurse applies goggles.
B) The nurse turns her back to the sterile field.
C) The nurse holds her hands above her waist.
D) The nurse puts on a face mask.
,**Answer: C**
*Rationale:* The gown and sterile gloves are considered sterile only from the chest to the waist in the
front. Sterile hands should be kept above the waist and in front of the body .
**4. A nurse who is caring for a group of clients delegates collection of vital signs to an AP. Which of
the following actions should the nurse take to evaluate the delegated task?**
A) Review vital sign trends at the end of the shift.
B) Recheck vital signs that are outside the expected reference range.
C) Ask the AP to write a summary of the delegated tasks during the shift.
D) Compare the vital signs the AP obtained with those taken by another AP on a previous shift.
**Answer: B**
*Rationale:* The nurse is responsible for supervising and evaluating delegated tasks. Rechecking
abnormal vital signs is a key part of this evaluation to confirm accuracy and assess client status .
**5. A nurse is preparing to delegate bathing and turning of a newly admitted client who has end-
stage bone cancer to an experienced AP. Which of the following assessments should the nurse make
before delegating care?**
A) Has the AP checked the client's pain level prior to turning her?
B) Is the client's family present so the AP can show them how to turn the client?
C) Has data been collected about specific client needs related to turning?
D) Does the AP have the time to change the client's central IV line dressing after turning her?
**Answer: C**
*Rationale:* Before delegating, the nurse must assess the client's specific needs to ensure the AP has
the information necessary to provide safe care. This is a key step in the delegation process .
---
### Section 2: Prioritization and Clinical Judgment
**6. A nurse is providing care for 4 post-operative clients. Which client should the nurse assess
first?**
A) Whose pulse has been steadily increasing during the past shift.
B) Who is reporting a pain level of 8 on a scale of 0 to 10.
C) Whose urine output averaged 32 mL/hr for the past 24 hr.
D) Who is reporting nausea after the prescribed antiemetic was administered.
, **Answer: A**
*Rationale:* A steadily increasing pulse rate is an early sign of potential complications such as
hemorrhage, infection, or shock. This finding requires the most immediate assessment .
**7. A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that
which client is the highest priority?**
A) A client who has peripheral vascular disease and has an absent pedal pulse in the right foot.
B) A client who has COPD and an oxygen saturation of 90%.
C) A client who had abdominal surgery 6 hours ago and a heart rate of 120/min for the last 2 hours.
D) A client with a fractured hip who reports pain of 6 on a scale of 0 to 10.
**Answer: C**
*Rationale:* A client who is 6 hours post-operative with a sustained tachycardia of 120/min is at risk
for hemorrhage or shock. This is a more acute and unstable finding than the other options .
**8. A nurse is receiving change-of-shift report on four clients. Which of the following clients should
the nurse assess first?**
A) A client who reports a headache with sensitivity to light.
B) A client who reports an urge to void but has not urinated during the prior shift.
C) A client who reports indigestion and pain in her jaw.
D) A client who reports feeling lightheaded when he stands up from a lying position.
**Answer: C**
*Rationale:* Indigestion and jaw pain are atypical signs of a myocardial infarction in women. These
symptoms represent a potential life-threatening emergency that requires immediate assessment .
**9. You are the charge nurse in a busy medical-surgical unit. Based on the following client situations,
which client is the priority to assess first?**
A) A client with multiple sclerosis who reports ataxia.
B) A client with right lower quadrant pain and rebound tenderness.
C) A client with deep vein thrombosis (DVT) who requires daily aPTT readings.
D) A client with amylase and lipase levels twice the expected values.
**Answer: B**
*Rationale:* Rebound tenderness and right lower quadrant pain are classic signs of appendicitis,
which is a surgical emergency. This client is in the most acute distress and requires immediate
assessment .
Versions 1, 2 & 3---
### Section 1: Delegation, Assignment, and Supervision
**1. A nurse is delegating care for a group of clients. Which of the following clients should the nurse
assign to a licensed practical nurse (LPN)?**
A) A client who is scheduled for an endoscopy later today and requires an enema.
B) A client who has had a myocardial infarction and will be transferring to the ICU.
C) A newly admitted client who has diabetes mellitus and requires initial teaching on self-
administration of insulin.
D) A client who is 2 days post-operative and requires reinforcement of insulin injection technique.
**Answer: A**
*Rationale:* An LPN can perform tasks such as administering enemas and providing routine care to
stable clients . Reinforcing teaching is within the LPN's scope, but initial teaching and the care of
unstable clients should be performed by an RN .
**2. A nurse is planning care for a group of clients and can delegate tasks to an LPN and assistive
personnel (AP). Which of the following tasks should the nurse assign to the LPN?**
A) Ambulating a client who is scheduled for discharge later in the day.
B) Reinforcing teaching with a client who is learning to self-administer insulin.
C) Administering morphine IV bolus to a client who is 1-hour post-operative.
D) Admitting a new client who has chronic back pain to the unit.
**Answer: B**
*Rationale:* An LPN can reinforce teaching that has been previously initiated by an RN . Ambulating a
client is a task for AP . Administering IV medications and admitting a new client are RN responsibilities
due to the need for assessment and evaluation.
**3. A nurse is supervising a newly licensed nurse who is performing surgical asepsis. After donning a
sterile gown and gloves, which of the following actions by the newly licensed nurse demonstrates
correct aseptic technique?**
A) The nurse applies goggles.
B) The nurse turns her back to the sterile field.
C) The nurse holds her hands above her waist.
D) The nurse puts on a face mask.
,**Answer: C**
*Rationale:* The gown and sterile gloves are considered sterile only from the chest to the waist in the
front. Sterile hands should be kept above the waist and in front of the body .
**4. A nurse who is caring for a group of clients delegates collection of vital signs to an AP. Which of
the following actions should the nurse take to evaluate the delegated task?**
A) Review vital sign trends at the end of the shift.
B) Recheck vital signs that are outside the expected reference range.
C) Ask the AP to write a summary of the delegated tasks during the shift.
D) Compare the vital signs the AP obtained with those taken by another AP on a previous shift.
**Answer: B**
*Rationale:* The nurse is responsible for supervising and evaluating delegated tasks. Rechecking
abnormal vital signs is a key part of this evaluation to confirm accuracy and assess client status .
**5. A nurse is preparing to delegate bathing and turning of a newly admitted client who has end-
stage bone cancer to an experienced AP. Which of the following assessments should the nurse make
before delegating care?**
A) Has the AP checked the client's pain level prior to turning her?
B) Is the client's family present so the AP can show them how to turn the client?
C) Has data been collected about specific client needs related to turning?
D) Does the AP have the time to change the client's central IV line dressing after turning her?
**Answer: C**
*Rationale:* Before delegating, the nurse must assess the client's specific needs to ensure the AP has
the information necessary to provide safe care. This is a key step in the delegation process .
---
### Section 2: Prioritization and Clinical Judgment
**6. A nurse is providing care for 4 post-operative clients. Which client should the nurse assess
first?**
A) Whose pulse has been steadily increasing during the past shift.
B) Who is reporting a pain level of 8 on a scale of 0 to 10.
C) Whose urine output averaged 32 mL/hr for the past 24 hr.
D) Who is reporting nausea after the prescribed antiemetic was administered.
, **Answer: A**
*Rationale:* A steadily increasing pulse rate is an early sign of potential complications such as
hemorrhage, infection, or shock. This finding requires the most immediate assessment .
**7. A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that
which client is the highest priority?**
A) A client who has peripheral vascular disease and has an absent pedal pulse in the right foot.
B) A client who has COPD and an oxygen saturation of 90%.
C) A client who had abdominal surgery 6 hours ago and a heart rate of 120/min for the last 2 hours.
D) A client with a fractured hip who reports pain of 6 on a scale of 0 to 10.
**Answer: C**
*Rationale:* A client who is 6 hours post-operative with a sustained tachycardia of 120/min is at risk
for hemorrhage or shock. This is a more acute and unstable finding than the other options .
**8. A nurse is receiving change-of-shift report on four clients. Which of the following clients should
the nurse assess first?**
A) A client who reports a headache with sensitivity to light.
B) A client who reports an urge to void but has not urinated during the prior shift.
C) A client who reports indigestion and pain in her jaw.
D) A client who reports feeling lightheaded when he stands up from a lying position.
**Answer: C**
*Rationale:* Indigestion and jaw pain are atypical signs of a myocardial infarction in women. These
symptoms represent a potential life-threatening emergency that requires immediate assessment .
**9. You are the charge nurse in a busy medical-surgical unit. Based on the following client situations,
which client is the priority to assess first?**
A) A client with multiple sclerosis who reports ataxia.
B) A client with right lower quadrant pain and rebound tenderness.
C) A client with deep vein thrombosis (DVT) who requires daily aPTT readings.
D) A client with amylase and lipase levels twice the expected values.
**Answer: B**
*Rationale:* Rebound tenderness and right lower quadrant pain are classic signs of appendicitis,
which is a surgical emergency. This client is in the most acute distress and requires immediate
assessment .
