ATI RN Fundamentals CMS — 2026 Updated 70 Questions • NGN-Enhanced • A+ Graded
ATI RN Fundamentals Proctored Exam
with Next Generation NCLEX (NGN) • 70 Questions and Answers
2026 Updated Edition • A+ Graded • All Questions Correctly Answered
ATI RN Fundamentals Proctored Examination • 70
Questions and Answers
with Next Generation NCLEX (NGN) Enhanced Item Types
Blueprint: Safe Effective Care Environment • Safety & Infection Control • Health Promotion • Psychosocial Integrity •
Basic Care & Comfort • Pharmacological Therapies • Reduction of Risk Potential • Physiological Adaptation • NGN
Clinical Judgment
SECTION 1 — Safe, Effective Care Environment (Q1–Q15)
Management of Care • Client Rights • Advocacy • Delegation • Legal/Ethical Issues
NGN CLINICAL JUDGMENT — DELEGATION & SCOPE OF PRACTICE
A 36-bed medical-surgical unit has one RN, two LPNs, and one UAP for the shift. Apply the Five Rights of
Delegation to assign clients to the most appropriate team member.
Q1. A registered nurse (RN) on a medical-surgical unit is planning client assignments for the shift. The team
consists of one RN, two LPNs, and one UAP. Which client should the RN assign to themselves rather than
delegate to an LPN?
A. A stable postoperative day-2 client receiving oral analgesics and advancing to a regular diet.
B. A client admitted 1 hour ago with acute GI bleeding who requires vasopressor titration and
serial hemoglobin checks. [CORRECT]
C. A client with a chronic stage III pressure injury requiring a dressing change.
D. A client with stable chronic heart failure receiving daily oral furosemide and daily weights.
Correct Answer: B — A client admitted 1 hour ago with acute GI bleeding who requires vasopressor titration
and serial hemoglobin checks.
Rationale: The RN must retain accountability for clients with unstable, complex, or rapidly changing conditions requiring
frequent assessment and clinical judgment. The client with acute GI bleeding on vasopressors (B) requires continuous
RN-level assessment and titration. Stable postoperative (A), chronic wound care (C), and stable CHF (D) clients are
appropriate for LPN assignment under RN supervision. The Five Rights of Delegation (right task, circumstance, person,
direction/communication, supervision/evaluation) guide this assignment. The RN retains accountability for the outcome of
delegated tasks even when performed by others.
NGN CLINICAL JUDGMENT — AUTONOMY & INFORMED REFUSAL
A 55-year-old Jehovah's Witness with severe anemia (Hgb 5.8 g/dL) refuses a recommended blood transfusion,
citing religious beliefs.
Q2. A competent adult client refuses a prescribed blood transfusion due to religious beliefs, even after being
informed of potential life-threatening consequences. Which action by the RN demonstrates ethical and legal
practice?
Page 1 • © 2026 ATI RN Fundamentals Practice Resource • For Educational Use
,ATI RN Fundamentals CMS — 2026 Updated 70 Questions • NGN-Enhanced • A+ Graded
A. Administer the transfusion anyway because it is life-saving.
B. Notify the provider, document the client's refusal and the education provided, ensure the
client understands the risks, and respect their autonomous decision. [CORRECT]
C. Obtain a court order to override the refusal.
D. Restrain the client and administer the transfusion.
Correct Answer: B — Notify the provider, document the client's refusal and the education provided, ensure
the client understands the risks, and respect their au...
Rationale: A competent adult has the legal and ethical right to refuse any treatment, including life-saving measures, based
on autonomy and the Patient Self-Determination Act. The RN must ensure the client is fully informed (informed refusal),
notify the provider, document thoroughly, and respect the decision (B). Forced transfusion (A, D) constitutes battery.
Seeking a court order (C) is reserved for situations involving minors or incompetent adults where the refusal is not in their
best interest. Religious refusals (e.g., Jehovah's Witnesses) are generally respected for competent adults.
NGN CLINICAL JUDGMENT — FIVE RIGHTS OF DELEGATION
An RN is making assignments for a 12-hour shift. Identify which assessment corresponds to 'Right Circumstance'.
Q3. An RN is preparing to delegate tasks for the shift. According to the Five Rights of Delegation, which
question addresses 'Right Circumstance'?
A. Is the client's health status stable enough for the delegated task? [CORRECT]
B. Does the delegatee have the knowledge and skill to perform the task?
C. Has the RN communicated clear directions and expectations?
D. Will the RN be available to evaluate the outcome of the task?
Correct Answer: A — Is the client's health status stable enough for the delegated task?
Rationale: Right Circumstance considers the client's stability, environment, and available resources (A). Right Person (B)
addresses the delegatee's qualifications. Right Direction/Communication (C) involves clear instructions. Right
Supervision/Evaluation (D) requires appropriate oversight. The Five Rights of Delegation framework guides safe
assignment. Right Circumstance evaluates whether the client condition (stable vs. unstable) and environment are
appropriate for delegation. Unstable clients or complex circumstances warrant RN-level care.
NGN CLINICAL JUDGMENT — INFORMED CONSENT
A client is scheduled for an elective cholecystectomy in 90 minutes and verbalizes lack of understanding about the
procedure.
Q4. A client is scheduled for an elective cholecystectomy. The provider has explained the procedure, risks,
benefits, and alternatives. The client signs the consent form. As the RN witnesses the signature, the client
states, 'I am not sure what the doctor will do exactly.' Which is the most appropriate nursing action?
A. Witness the signature since the client already signed the form.
B. Notify the provider so they can return and provide additional explanation, because the
client does not appear to fully understand the procedure. [CORRECT]
C. Explain the surgical procedure to the client in detail using a medical reference book.
D. Cancel the surgery and notify the anesthesiologist.
Correct Answer: B — Notify the provider so they can return and provide additional explanation, because the
client does not appear to fully understand the proced...
Rationale: Valid informed consent requires that the client understands the procedure, risks, benefits, and alternatives. The
nurse's role is to witness the signature and verify understanding, NOT to obtain consent. If the client cannot demonstrate
Page 2 • © 2026 ATI RN Fundamentals Practice Resource • For Educational Use
, ATI RN Fundamentals CMS — 2026 Updated 70 Questions • NGN-Enhanced • A+ Graded
understanding, the nurse must notify the provider (B) so they can re-explain the procedure. The nurse's signature (A) only
confirms identity, not understanding. Explaining the procedure (C) is the provider's responsibility; the RN reinforces but
does not replace the provider's explanation. Cancelling surgery (D) is beyond nursing scope.
NGN CLINICAL JUDGMENT — HIPAA & CONFIDENTIALITY
An RN prepares to discuss a new HIV diagnosis with a client in a semi-private room with a visitor present.
Q5. Which nursing action demonstrates compliance with HIPAA Privacy Rule standards when discussing a
client's plan of care?
A. Discussing the client's diagnosis in a crowded elevator with another nurse.
B. Sharing lab results with a family member not listed on the disclosure form.
C. Closing the door, pulling the privacy curtain, and lowering one's voice before discussing
care with the client. [CORRECT]
D. Leaving a computer screen with client information visible at the nurses' station while answering a
phone call.
Correct Answer: C — Closing the door, pulling the privacy curtain, and lowering one's voice before
discussing care with the client.
Rationale: HIPAA requires reasonable safeguards to protect Protected Health Information (PHI) including acoustic
privacy (closing doors, lowering voice), visual privacy (curtains, screens), and electronic privacy (password protection,
screen lock). Option C demonstrates proper safeguards. Elevator discussions (A) violate acoustic privacy. Sharing with
unauthorized family (B) requires the client's permission. Visible screens (D) expose PHI to anyone walking by. The Privacy
Rule applies to all forms of PHI: verbal, written, electronic, and imaging. The minimum necessary standard requires using
only the PHI needed for the task at hand.
NGN CLINICAL JUDGMENT — PROFESSIONAL CONDUCT & MANDATORY REPORTING
An RN observes a colleague documenting vital signs for a client the colleague has not yet assessed.
Q6. An RN observes a nursing colleague documenting vital signs that were never obtained. Which action
should the RN take first?
A. Confront the colleague directly and demand they stop.
B. Report the observation to the nursing supervisor immediately per the chain of command.
[CORRECT]
C. Ignore the situation since it is not the RN's responsibility.
D. Post about the situation on social media to alert other nurses.
Correct Answer: B — Report the observation to the nursing supervisor immediately per the chain of
command.
Rationale: Falsifying documentation is professional misconduct, a patient safety violation, and grounds for license
revocation. The RN has an ethical and legal obligation to report through the chain of command (B). Direct confrontation
(A) is informal and may not lead to a proper resolution or protect patients. Ignoring (C) makes the RN complicit in the
unsafe practice. Social media (D) violates HIPAA and professional conduct standards. Just Culture principles support
reporting to allow systemic improvement while addressing individual accountability.
NGN CLINICAL JUDGMENT — ADVANCE DIRECTIVES & END-OF-LIFE CARE
A 78-year-old client with metastatic cancer and a documented DNR becomes apneic and pulseless. The spouse begs
the nurse to 'do everything.'
Page 3 • © 2026 ATI RN Fundamentals Practice Resource • For Educational Use
ATI RN Fundamentals Proctored Exam
with Next Generation NCLEX (NGN) • 70 Questions and Answers
2026 Updated Edition • A+ Graded • All Questions Correctly Answered
ATI RN Fundamentals Proctored Examination • 70
Questions and Answers
with Next Generation NCLEX (NGN) Enhanced Item Types
Blueprint: Safe Effective Care Environment • Safety & Infection Control • Health Promotion • Psychosocial Integrity •
Basic Care & Comfort • Pharmacological Therapies • Reduction of Risk Potential • Physiological Adaptation • NGN
Clinical Judgment
SECTION 1 — Safe, Effective Care Environment (Q1–Q15)
Management of Care • Client Rights • Advocacy • Delegation • Legal/Ethical Issues
NGN CLINICAL JUDGMENT — DELEGATION & SCOPE OF PRACTICE
A 36-bed medical-surgical unit has one RN, two LPNs, and one UAP for the shift. Apply the Five Rights of
Delegation to assign clients to the most appropriate team member.
Q1. A registered nurse (RN) on a medical-surgical unit is planning client assignments for the shift. The team
consists of one RN, two LPNs, and one UAP. Which client should the RN assign to themselves rather than
delegate to an LPN?
A. A stable postoperative day-2 client receiving oral analgesics and advancing to a regular diet.
B. A client admitted 1 hour ago with acute GI bleeding who requires vasopressor titration and
serial hemoglobin checks. [CORRECT]
C. A client with a chronic stage III pressure injury requiring a dressing change.
D. A client with stable chronic heart failure receiving daily oral furosemide and daily weights.
Correct Answer: B — A client admitted 1 hour ago with acute GI bleeding who requires vasopressor titration
and serial hemoglobin checks.
Rationale: The RN must retain accountability for clients with unstable, complex, or rapidly changing conditions requiring
frequent assessment and clinical judgment. The client with acute GI bleeding on vasopressors (B) requires continuous
RN-level assessment and titration. Stable postoperative (A), chronic wound care (C), and stable CHF (D) clients are
appropriate for LPN assignment under RN supervision. The Five Rights of Delegation (right task, circumstance, person,
direction/communication, supervision/evaluation) guide this assignment. The RN retains accountability for the outcome of
delegated tasks even when performed by others.
NGN CLINICAL JUDGMENT — AUTONOMY & INFORMED REFUSAL
A 55-year-old Jehovah's Witness with severe anemia (Hgb 5.8 g/dL) refuses a recommended blood transfusion,
citing religious beliefs.
Q2. A competent adult client refuses a prescribed blood transfusion due to religious beliefs, even after being
informed of potential life-threatening consequences. Which action by the RN demonstrates ethical and legal
practice?
Page 1 • © 2026 ATI RN Fundamentals Practice Resource • For Educational Use
,ATI RN Fundamentals CMS — 2026 Updated 70 Questions • NGN-Enhanced • A+ Graded
A. Administer the transfusion anyway because it is life-saving.
B. Notify the provider, document the client's refusal and the education provided, ensure the
client understands the risks, and respect their autonomous decision. [CORRECT]
C. Obtain a court order to override the refusal.
D. Restrain the client and administer the transfusion.
Correct Answer: B — Notify the provider, document the client's refusal and the education provided, ensure
the client understands the risks, and respect their au...
Rationale: A competent adult has the legal and ethical right to refuse any treatment, including life-saving measures, based
on autonomy and the Patient Self-Determination Act. The RN must ensure the client is fully informed (informed refusal),
notify the provider, document thoroughly, and respect the decision (B). Forced transfusion (A, D) constitutes battery.
Seeking a court order (C) is reserved for situations involving minors or incompetent adults where the refusal is not in their
best interest. Religious refusals (e.g., Jehovah's Witnesses) are generally respected for competent adults.
NGN CLINICAL JUDGMENT — FIVE RIGHTS OF DELEGATION
An RN is making assignments for a 12-hour shift. Identify which assessment corresponds to 'Right Circumstance'.
Q3. An RN is preparing to delegate tasks for the shift. According to the Five Rights of Delegation, which
question addresses 'Right Circumstance'?
A. Is the client's health status stable enough for the delegated task? [CORRECT]
B. Does the delegatee have the knowledge and skill to perform the task?
C. Has the RN communicated clear directions and expectations?
D. Will the RN be available to evaluate the outcome of the task?
Correct Answer: A — Is the client's health status stable enough for the delegated task?
Rationale: Right Circumstance considers the client's stability, environment, and available resources (A). Right Person (B)
addresses the delegatee's qualifications. Right Direction/Communication (C) involves clear instructions. Right
Supervision/Evaluation (D) requires appropriate oversight. The Five Rights of Delegation framework guides safe
assignment. Right Circumstance evaluates whether the client condition (stable vs. unstable) and environment are
appropriate for delegation. Unstable clients or complex circumstances warrant RN-level care.
NGN CLINICAL JUDGMENT — INFORMED CONSENT
A client is scheduled for an elective cholecystectomy in 90 minutes and verbalizes lack of understanding about the
procedure.
Q4. A client is scheduled for an elective cholecystectomy. The provider has explained the procedure, risks,
benefits, and alternatives. The client signs the consent form. As the RN witnesses the signature, the client
states, 'I am not sure what the doctor will do exactly.' Which is the most appropriate nursing action?
A. Witness the signature since the client already signed the form.
B. Notify the provider so they can return and provide additional explanation, because the
client does not appear to fully understand the procedure. [CORRECT]
C. Explain the surgical procedure to the client in detail using a medical reference book.
D. Cancel the surgery and notify the anesthesiologist.
Correct Answer: B — Notify the provider so they can return and provide additional explanation, because the
client does not appear to fully understand the proced...
Rationale: Valid informed consent requires that the client understands the procedure, risks, benefits, and alternatives. The
nurse's role is to witness the signature and verify understanding, NOT to obtain consent. If the client cannot demonstrate
Page 2 • © 2026 ATI RN Fundamentals Practice Resource • For Educational Use
, ATI RN Fundamentals CMS — 2026 Updated 70 Questions • NGN-Enhanced • A+ Graded
understanding, the nurse must notify the provider (B) so they can re-explain the procedure. The nurse's signature (A) only
confirms identity, not understanding. Explaining the procedure (C) is the provider's responsibility; the RN reinforces but
does not replace the provider's explanation. Cancelling surgery (D) is beyond nursing scope.
NGN CLINICAL JUDGMENT — HIPAA & CONFIDENTIALITY
An RN prepares to discuss a new HIV diagnosis with a client in a semi-private room with a visitor present.
Q5. Which nursing action demonstrates compliance with HIPAA Privacy Rule standards when discussing a
client's plan of care?
A. Discussing the client's diagnosis in a crowded elevator with another nurse.
B. Sharing lab results with a family member not listed on the disclosure form.
C. Closing the door, pulling the privacy curtain, and lowering one's voice before discussing
care with the client. [CORRECT]
D. Leaving a computer screen with client information visible at the nurses' station while answering a
phone call.
Correct Answer: C — Closing the door, pulling the privacy curtain, and lowering one's voice before
discussing care with the client.
Rationale: HIPAA requires reasonable safeguards to protect Protected Health Information (PHI) including acoustic
privacy (closing doors, lowering voice), visual privacy (curtains, screens), and electronic privacy (password protection,
screen lock). Option C demonstrates proper safeguards. Elevator discussions (A) violate acoustic privacy. Sharing with
unauthorized family (B) requires the client's permission. Visible screens (D) expose PHI to anyone walking by. The Privacy
Rule applies to all forms of PHI: verbal, written, electronic, and imaging. The minimum necessary standard requires using
only the PHI needed for the task at hand.
NGN CLINICAL JUDGMENT — PROFESSIONAL CONDUCT & MANDATORY REPORTING
An RN observes a colleague documenting vital signs for a client the colleague has not yet assessed.
Q6. An RN observes a nursing colleague documenting vital signs that were never obtained. Which action
should the RN take first?
A. Confront the colleague directly and demand they stop.
B. Report the observation to the nursing supervisor immediately per the chain of command.
[CORRECT]
C. Ignore the situation since it is not the RN's responsibility.
D. Post about the situation on social media to alert other nurses.
Correct Answer: B — Report the observation to the nursing supervisor immediately per the chain of
command.
Rationale: Falsifying documentation is professional misconduct, a patient safety violation, and grounds for license
revocation. The RN has an ethical and legal obligation to report through the chain of command (B). Direct confrontation
(A) is informal and may not lead to a proper resolution or protect patients. Ignoring (C) makes the RN complicit in the
unsafe practice. Social media (D) violates HIPAA and professional conduct standards. Just Culture principles support
reporting to allow systemic improvement while addressing individual accountability.
NGN CLINICAL JUDGMENT — ADVANCE DIRECTIVES & END-OF-LIFE CARE
A 78-year-old client with metastatic cancer and a documented DNR becomes apneic and pulseless. The spouse begs
the nurse to 'do everything.'
Page 3 • © 2026 ATI RN Fundamentals Practice Resource • For Educational Use
