ATI260 ATI Leadership Proctored Exam – ATI
Leadership Nursing Study Guide, Original Practice
Questions & Answers, Comprehensive Assessment
Preparation, Nursing Leadership & Management
Review, Delegation, Prioritization, Supervision,
Conflict Resolution, Communication, Patient Safety,
Quality Improvement, Ethical & Legal
Responsibilities, Case Management, Staffing,
Disaster Triage & NGN-Style Clinical Judgment
Question 1: A charge nurse is assigning patient rooms for a new admission.
Which patient should be assigned to a negative-pressure airborne infection
isolation room?
A. A patient with active pulmonary tuberculosis
B. A patient with methicillin-resistant Staphylococcus aureus (MRSA) in a wound
C. A patient with Clostridium difficile diarrhea
D. A patient with a neutropenic fever
CORRECT ANSWER: A. A patient with active pulmonary tuberculosis
Rationale: Active pulmonary tuberculosis requires airborne precautions, which
necessitate a negative-pressure isolation room. MRSA requires contact precautions, C.
difficile requires contact precautions, and a neutropenic fever patient requires protective
isolation (positive pressure) to prevent infection, not negative pressure.
Question 2: A nurse manager is implementing a new electronic health record
(EHR) system. Which of the following is the most effective initial strategy to
ensure staff adoption?
A. Offer a one-time, mandatory training session for all staff.
B. Identify and train early adopters who can serve as super-users and peer mentors.
C. Implement the system in all units simultaneously to avoid confusion.
D. Provide a detailed manual for staff to read on their own time.
CORRECT ANSWER: B. Identify and train early adopters who can serve as
super-users and peer mentors.
Rationale: Change theory supports the use of early adopters as champions to facilitate
adoption. This peer-to-peer approach provides ongoing, accessible support, which is
more effective than a one-time training or self-study. A phased implementation is
generally preferred over simultaneous implementation to manage issues as they arise.
Question 3: A client is prescribed 500 mL of 0.9% Normal Saline to infuse over
4 hours. The IV tubing has a drop factor of 15 gtt/mL. At what rate in gtt/min
should the nurse set the infusion?
A. 21 gtt/min
B. 31 gtt/min
,C. 42 gtt/min
D. 125 gtt/min
CORRECT ANSWER: B. 31 gtt/min
Rationale: The formula is (Total volume in mL / Time in minutes) x Drop factor. Total
volume = 500 mL; Time = 4 hours x 60 minutes = 240 minutes. (500 mL / 240 min) x 15
gtt/mL = 31.25 gtt/min, which rounds down to 31 gtt/min.
Question 4: A nurse is caring for a client who is post-operative day 1 following
a right total hip arthroplasty. Which action is most important for the nurse to
include in the plan of care?
A. Maintain the client in a low-Fowler's position for meals.
B. Adduct the right leg to prevent dislocation.
C. Prevent internal rotation and adduction of the operative leg.
D. Place a pillow under the right knee to reduce pain.
CORRECT ANSWER: C. Prevent internal rotation and adduction of the
operative leg.
Rationale: After a hip arthroplasty, the operative leg must be kept in a position of
abduction and neutral rotation to prevent dislocation. Internal rotation and adduction
are the primary movements that put the new joint at risk for dislocation. A pillow under
the knee could promote flexion contracture and is not a standard precaution.
Question 5: Which of the following actions by a nursing assistant requires the
nurse to intervene immediately?
A. The nursing assistant checks a client's blood pressure in the arm with a dialysis
fistula.
B. The nursing assistant offers a bedpan to a client who is incontinent.
C. The nursing assistant records a client's intake and output accurately.
D. The nursing assistant assists a client with oral hygiene.
CORRECT ANSWER: A. The nursing assistant checks a client's blood pressure
in the arm with a dialysis fistula.
Rationale: Taking blood pressure in an arm with a dialysis fistula is contraindicated due
to the risk of thrombus formation and damage to the fistula. This requires immediate
intervention to prevent a serious adverse event. The other options are appropriate tasks
within the nursing assistant's scope of practice.
Question 6: A nurse is preparing a client for discharge. The client has a new
prescription for enoxaparin (Lovenox) subcutaneously. Which of the following
statements indicates the client understands the teaching?
A. "I will need to have my blood drawn frequently to check my blood thickness."
B. "I will massage the injection site to help the medicine absorb."
,C. "I will administer the injection in my abdomen, rotating sites."
D. "I will take this medication with my morning meal."
CORRECT ANSWER: C. "I will administer the injection in my abdomen,
rotating sites."
Rationale: Enoxaparin is administered subcutaneously in the abdomen and sites should
be rotated to prevent bruising and hematoma formation. It does not require routine
monitoring of INR/PTT like heparin, the site should not be massaged, and it is not taken
orally or with food.
Question 7: A nurse manager is providing an in-service on crisis management.
The manager identifies which of the following as the first priority when a staff
member is experiencing a crisis?
A. Ensure the safety of the staff member, patients, and others.
B. Arrange for a referral to an employee assistance program.
C. Conduct a root cause analysis of the incident.
D. Complete an incident report.
CORRECT ANSWER: A. Ensure the safety of the staff member, patients, and
others.
Rationale: The first priority in any crisis is safety. A safe environment must be
established before any other interventions, such as referrals, analysis, or documentation,
can take place.
Question 8: A nurse is assessing a client who has been prescribed a new
antihypertensive medication. Which finding would indicate a therapeutic
response to the medication?
A. A drop in the client's heart rate from 88 bpm to 60 bpm.
B. A decrease in the client's systolic blood pressure by 15 mm Hg.
C. An increase in the client's urinary output.
D. A report of decreased episodes of angina.
CORRECT ANSWER: B. A decrease in the client's systolic blood pressure by 15
mm Hg.
Rationale: The therapeutic response to an antihypertensive is a reduction in blood
pressure. A decrease of 10-15 mm Hg is a typical target. The other options could be side
effects or other unrelated findings, but the primary goal is blood pressure reduction.
Question 9: A charge nurse is evaluating the care provided by a new graduate
nurse. Which action by the new graduate requires the charge nurse to
intervene?
A. The nurse verifies a client's identity using two patient identifiers.
B. The nurse administers a medication through a nasogastric tube.
C. The nurse delegates a sterile wound dressing change to a licensed
, practical/vocational nurse (LPN/LVN).
D. The nurse delegates a patient's personal hygiene to a certified nursing assistant.
CORRECT ANSWER: C. The nurse delegates a sterile wound dressing change to
a licensed practical/vocational nurse (LPN/LVN).
Rationale: Sterile wound dressing changes that involve assessment of the wound require
the skill and knowledge of a registered nurse (RN). While LPN/LVNs can perform sterile
procedures, initial assessment of a complex wound and subsequent sterile dressing
changes that require assessment are typically beyond their scope. However, this is a
nuanced area; the delegation is inappropriate for a new RN to delegate without a valid
order or protocol. The most critical point is that the RN is responsible for assessment,
and a sterile dressing change involving assessment should be performed by the RN.
Question 10: A client is on fall precautions. Which of the following
interventions is most appropriate to include in the client's plan of care?
A. Keep all side rails up on the bed at all times.
B. Place the client's call light within easy reach.
C. Restrain the client to prevent falls.
D. Keep the bed in the highest position.
CORRECT ANSWER: B. Place the client's call light within easy reach.
Rationale: This is a key environmental intervention to prevent falls. It empowers the
client to call for assistance when needed. Side rails up can be a restraint and increase
injury risk, restraints are a last resort, and the bed should be in the lowest position.
Question 11: A nurse is planning care for a client who is post-operative
following a colon resection. Which of the following findings would indicate a
potential complication and should be reported to the provider?
A. The client's heart rate is 92 bpm.
B. The client's incision site is pink and well-approximated.
C. The client's nasogastric tube is draining 120 mL of green fluid.
D. The client's abdomen is firm and distended.
CORRECT ANSWER: D. The client's abdomen is firm and distended.
Rationale: A firm, distended abdomen post-colon resection is a sign of an ileus or
possible anastomotic leak, a serious complication that must be reported. The other
options are within expected findings: HR up to 100 is acceptable, a pink wound is
healing, and 120 mL of NG drainage could be normal.
Question 12: When preparing to administer a blood transfusion, which of the
following actions is most important for the nurse to take?
A. Verify the blood product with another nurse or using a two-person verification
system.
B. Pre-medicate the client with an antihistamine to prevent a reaction.
Leadership Nursing Study Guide, Original Practice
Questions & Answers, Comprehensive Assessment
Preparation, Nursing Leadership & Management
Review, Delegation, Prioritization, Supervision,
Conflict Resolution, Communication, Patient Safety,
Quality Improvement, Ethical & Legal
Responsibilities, Case Management, Staffing,
Disaster Triage & NGN-Style Clinical Judgment
Question 1: A charge nurse is assigning patient rooms for a new admission.
Which patient should be assigned to a negative-pressure airborne infection
isolation room?
A. A patient with active pulmonary tuberculosis
B. A patient with methicillin-resistant Staphylococcus aureus (MRSA) in a wound
C. A patient with Clostridium difficile diarrhea
D. A patient with a neutropenic fever
CORRECT ANSWER: A. A patient with active pulmonary tuberculosis
Rationale: Active pulmonary tuberculosis requires airborne precautions, which
necessitate a negative-pressure isolation room. MRSA requires contact precautions, C.
difficile requires contact precautions, and a neutropenic fever patient requires protective
isolation (positive pressure) to prevent infection, not negative pressure.
Question 2: A nurse manager is implementing a new electronic health record
(EHR) system. Which of the following is the most effective initial strategy to
ensure staff adoption?
A. Offer a one-time, mandatory training session for all staff.
B. Identify and train early adopters who can serve as super-users and peer mentors.
C. Implement the system in all units simultaneously to avoid confusion.
D. Provide a detailed manual for staff to read on their own time.
CORRECT ANSWER: B. Identify and train early adopters who can serve as
super-users and peer mentors.
Rationale: Change theory supports the use of early adopters as champions to facilitate
adoption. This peer-to-peer approach provides ongoing, accessible support, which is
more effective than a one-time training or self-study. A phased implementation is
generally preferred over simultaneous implementation to manage issues as they arise.
Question 3: A client is prescribed 500 mL of 0.9% Normal Saline to infuse over
4 hours. The IV tubing has a drop factor of 15 gtt/mL. At what rate in gtt/min
should the nurse set the infusion?
A. 21 gtt/min
B. 31 gtt/min
,C. 42 gtt/min
D. 125 gtt/min
CORRECT ANSWER: B. 31 gtt/min
Rationale: The formula is (Total volume in mL / Time in minutes) x Drop factor. Total
volume = 500 mL; Time = 4 hours x 60 minutes = 240 minutes. (500 mL / 240 min) x 15
gtt/mL = 31.25 gtt/min, which rounds down to 31 gtt/min.
Question 4: A nurse is caring for a client who is post-operative day 1 following
a right total hip arthroplasty. Which action is most important for the nurse to
include in the plan of care?
A. Maintain the client in a low-Fowler's position for meals.
B. Adduct the right leg to prevent dislocation.
C. Prevent internal rotation and adduction of the operative leg.
D. Place a pillow under the right knee to reduce pain.
CORRECT ANSWER: C. Prevent internal rotation and adduction of the
operative leg.
Rationale: After a hip arthroplasty, the operative leg must be kept in a position of
abduction and neutral rotation to prevent dislocation. Internal rotation and adduction
are the primary movements that put the new joint at risk for dislocation. A pillow under
the knee could promote flexion contracture and is not a standard precaution.
Question 5: Which of the following actions by a nursing assistant requires the
nurse to intervene immediately?
A. The nursing assistant checks a client's blood pressure in the arm with a dialysis
fistula.
B. The nursing assistant offers a bedpan to a client who is incontinent.
C. The nursing assistant records a client's intake and output accurately.
D. The nursing assistant assists a client with oral hygiene.
CORRECT ANSWER: A. The nursing assistant checks a client's blood pressure
in the arm with a dialysis fistula.
Rationale: Taking blood pressure in an arm with a dialysis fistula is contraindicated due
to the risk of thrombus formation and damage to the fistula. This requires immediate
intervention to prevent a serious adverse event. The other options are appropriate tasks
within the nursing assistant's scope of practice.
Question 6: A nurse is preparing a client for discharge. The client has a new
prescription for enoxaparin (Lovenox) subcutaneously. Which of the following
statements indicates the client understands the teaching?
A. "I will need to have my blood drawn frequently to check my blood thickness."
B. "I will massage the injection site to help the medicine absorb."
,C. "I will administer the injection in my abdomen, rotating sites."
D. "I will take this medication with my morning meal."
CORRECT ANSWER: C. "I will administer the injection in my abdomen,
rotating sites."
Rationale: Enoxaparin is administered subcutaneously in the abdomen and sites should
be rotated to prevent bruising and hematoma formation. It does not require routine
monitoring of INR/PTT like heparin, the site should not be massaged, and it is not taken
orally or with food.
Question 7: A nurse manager is providing an in-service on crisis management.
The manager identifies which of the following as the first priority when a staff
member is experiencing a crisis?
A. Ensure the safety of the staff member, patients, and others.
B. Arrange for a referral to an employee assistance program.
C. Conduct a root cause analysis of the incident.
D. Complete an incident report.
CORRECT ANSWER: A. Ensure the safety of the staff member, patients, and
others.
Rationale: The first priority in any crisis is safety. A safe environment must be
established before any other interventions, such as referrals, analysis, or documentation,
can take place.
Question 8: A nurse is assessing a client who has been prescribed a new
antihypertensive medication. Which finding would indicate a therapeutic
response to the medication?
A. A drop in the client's heart rate from 88 bpm to 60 bpm.
B. A decrease in the client's systolic blood pressure by 15 mm Hg.
C. An increase in the client's urinary output.
D. A report of decreased episodes of angina.
CORRECT ANSWER: B. A decrease in the client's systolic blood pressure by 15
mm Hg.
Rationale: The therapeutic response to an antihypertensive is a reduction in blood
pressure. A decrease of 10-15 mm Hg is a typical target. The other options could be side
effects or other unrelated findings, but the primary goal is blood pressure reduction.
Question 9: A charge nurse is evaluating the care provided by a new graduate
nurse. Which action by the new graduate requires the charge nurse to
intervene?
A. The nurse verifies a client's identity using two patient identifiers.
B. The nurse administers a medication through a nasogastric tube.
C. The nurse delegates a sterile wound dressing change to a licensed
, practical/vocational nurse (LPN/LVN).
D. The nurse delegates a patient's personal hygiene to a certified nursing assistant.
CORRECT ANSWER: C. The nurse delegates a sterile wound dressing change to
a licensed practical/vocational nurse (LPN/LVN).
Rationale: Sterile wound dressing changes that involve assessment of the wound require
the skill and knowledge of a registered nurse (RN). While LPN/LVNs can perform sterile
procedures, initial assessment of a complex wound and subsequent sterile dressing
changes that require assessment are typically beyond their scope. However, this is a
nuanced area; the delegation is inappropriate for a new RN to delegate without a valid
order or protocol. The most critical point is that the RN is responsible for assessment,
and a sterile dressing change involving assessment should be performed by the RN.
Question 10: A client is on fall precautions. Which of the following
interventions is most appropriate to include in the client's plan of care?
A. Keep all side rails up on the bed at all times.
B. Place the client's call light within easy reach.
C. Restrain the client to prevent falls.
D. Keep the bed in the highest position.
CORRECT ANSWER: B. Place the client's call light within easy reach.
Rationale: This is a key environmental intervention to prevent falls. It empowers the
client to call for assistance when needed. Side rails up can be a restraint and increase
injury risk, restraints are a last resort, and the bed should be in the lowest position.
Question 11: A nurse is planning care for a client who is post-operative
following a colon resection. Which of the following findings would indicate a
potential complication and should be reported to the provider?
A. The client's heart rate is 92 bpm.
B. The client's incision site is pink and well-approximated.
C. The client's nasogastric tube is draining 120 mL of green fluid.
D. The client's abdomen is firm and distended.
CORRECT ANSWER: D. The client's abdomen is firm and distended.
Rationale: A firm, distended abdomen post-colon resection is a sign of an ileus or
possible anastomotic leak, a serious complication that must be reported. The other
options are within expected findings: HR up to 100 is acceptable, a pink wound is
healing, and 120 mL of NG drainage could be normal.
Question 12: When preparing to administer a blood transfusion, which of the
following actions is most important for the nurse to take?
A. Verify the blood product with another nurse or using a two-person verification
system.
B. Pre-medicate the client with an antihistamine to prevent a reaction.
