1
ATI LEADERSHIP PROCTORED EXAM 2020 (5 VERSIONS) | 150 NGN-STYLE
PRACTICE QUESTIONS WITH DETAILED RATIONALES & PARTIAL CREDIT
SCORING | RN LEADERSHIP & MANAGEMENT REVIEW
CASE STUDY 1: STAFF SCHEDULING & CHANGE MANAGEMENT (Questions 1-5)
EHR Panel:
• Scenario: Medical-Surgical Unit. The nurse manager is implementing a new self-
scheduling system for the unit.
• Staff: 15 nurses. Several nurses have expressed concern about the change.
• Current Process: Manager-created schedule.
QUESTION 1: CHANGE MANAGEMENT
• Question: A nurse manager is preparing to institute a new system for scheduling staff.
Several nurses have verbalized their concern over the possible changes that will occur.
Which of the following is an appropriate method to facilitate the adoption of the new
scheduling system?
• Options:
A. Identify nurses who accept the change to help influence other staff nurses.
B. Provide a brief overview of the new scheduling system immediately before it
implementation.
C. Introduce the new scheduling system by describing how it will save the institution
money.
D. Offer to reassign staff who do not support the change to another unit.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Utilizing change champions (nurses who accept the
change) helps to influence others through peer support and positive
reinforcement.
o Distractor Pitfalls: B: Introducing the system abruptly may increase resistance.
C: Focusing on cost savings may not address staff concerns. D: Reassigning staff
is punitive and may increase resistance.
QUESTION 2: VARIANCE REPORT
• Question: A client who is febrile is admitted to the hospital for treatment of pneumonia.
In accordance with the care pathway, antibiotic therapy is prescribed. Which of the
, 2
following situations requires the nurse to complete a variance report with regard to the
care pathway?
• Options:
A. Antibiotic therapy was initiated 2 hr after implementation of the care pathway.
B. A blood culture was obtained after antibiotic therapy has been initiated.
C. The route of antibiotic therapy on the care pathway was changed from IV to PO.
D. An allergy to penicillin required an alternative antibiotic to be prescribed.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: A variance report is completed when there is a
deviation from the care pathway. Obtaining a blood culture after the
administration of antibiotics is a deviation from the standard of care, which is to
obtain the culture before starting antibiotics to prevent false-negative results.
o Distractor Pitfalls: A: Antibiotics within 2 hours is within the acceptable
timeframe. C: Changing route is a normal part of the care pathway. D: Changing
to an alternative antibiotic is also a normal part of care for allergies.
QUESTION 3: INCIDENT REPORT
• Question: A nurse should recognize that an incident report is required when:
• Options:
A. A client refuses to attend physical therapy.
B. A visitor pinches his finger in the client's bed frame.
C. A client throws a box of tissues at a nurse.
D. A nurse gives a medication 30 min late.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: An incident report is required for any unusual
occurrence, including visitor injuries. A visitor injuring themselves on equipment
must be documented for safety and liability purposes.
o Distractor Pitfalls: A: Refusing therapy is a client right, not an incident. C: This
is a behavioral issue, not an incident. D: Medication administration within 30
minutes is generally acceptable.
QUESTION 4: QUALITY INDICATOR
, 3
• Question: Client satisfactory surveys from a med-surg unit indicate the pain is not being
adequately relieved during the first 12 hr post-op. The unit manager decides to identify
post-op pain as a quality indicator. Which of the following data sources will be helpful in
determining the reason why clients are not receiving adequate pain management after
surgery?
• Options:
A. Prospective chart audit.
B. Retrospective chart audit.
C. Postoperative care policy.
D. Pain assessment policy.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: A retrospective chart audit reviews existing records
to identify gaps in care, such as whether pain assessments were done and
medications were administered.
o Distractor Pitfalls: A: Prospective audits monitor current patients. C, D:
Reviewing policies is helpful but does not reveal actual practice gaps.
QUESTION 5: RESTRAINT USE
• Question: A nurse precepting a newly licensed nurse who is caring for a client who is
confused and has an IV infusion. The newly licensed nurse has placed the client in wrist
restraints to prevent dislodging the IV catheter. Which of the following questions should
the precepting nurse ask?
• Options:
A. "Did you secure the restraints to the side rails of the bed?"
B. "Are you able to insert two fingers between the restraint and the client's skin?"
C. "Did you tie the restraints using a double knot?"
D. "Are you removing the client's restraints every 4 hr?"
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: The priority safety check is to ensure the restraint is
not too tight. The nurse should be able to insert two fingers between the restraint
and the client's skin to prevent circulation impairment.
o Distractor Pitfalls: A: Restraints should be secured to the bed frame, not the side
rails, which could cause injury if the side rail is lowered. C: Double knots are
, 4
used to prevent the knot from slipping, but the main concern is safety. D:
Restraints should be removed and reassessed every 2 hours for adults, not 4 hours.
CASE STUDY 2: CONSULTATION & LEGAL ISSUES (Questions 6-10)
EHR Panel:
• Patient: Older adult client.
• Assessment: Stage III pressure ulcer on the coccyx.
QUESTION 6: CONSULTATION
• Question: A nurse is caring for an older adult client who has stage III pressure ulcer. The
nurse requests a consultation with the wound care specialist. Which of the following
actions by the nurse is appropriate when working with a consultant?
• Options:
A. Arrange the consultation for a time when the nurse is caring for the client is able to be
present for consultation.
B. Provide the consultant with subjective opinions and beliefs about the client's wound
care.
C. Request the consultation after several wound care treatments have been tried.
D. Arrange for the wound care nurse specialist to see the client daily to provide the
recommended treatment.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: The nurse should be present during the consultation
to ensure accurate information is exchanged and to learn from the specialist.
o Distractor Pitfalls: B: Nurses should provide objective data and observations,
not subjective opinions. C: Consults should be requested promptly, not after
multiple failed attempts. D: The WOCN may provide recommendations but does
not typically provide daily care.
QUESTION 7: TB ADMISSION
• Question: A client is admitted with TB and placed in a negative pressure room. Which of
the following actions is appropriate?
• Options:
A. Notify the local health department of the admission.
B. Place a sign on the client's door with the diagnosis.
ATI LEADERSHIP PROCTORED EXAM 2020 (5 VERSIONS) | 150 NGN-STYLE
PRACTICE QUESTIONS WITH DETAILED RATIONALES & PARTIAL CREDIT
SCORING | RN LEADERSHIP & MANAGEMENT REVIEW
CASE STUDY 1: STAFF SCHEDULING & CHANGE MANAGEMENT (Questions 1-5)
EHR Panel:
• Scenario: Medical-Surgical Unit. The nurse manager is implementing a new self-
scheduling system for the unit.
• Staff: 15 nurses. Several nurses have expressed concern about the change.
• Current Process: Manager-created schedule.
QUESTION 1: CHANGE MANAGEMENT
• Question: A nurse manager is preparing to institute a new system for scheduling staff.
Several nurses have verbalized their concern over the possible changes that will occur.
Which of the following is an appropriate method to facilitate the adoption of the new
scheduling system?
• Options:
A. Identify nurses who accept the change to help influence other staff nurses.
B. Provide a brief overview of the new scheduling system immediately before it
implementation.
C. Introduce the new scheduling system by describing how it will save the institution
money.
D. Offer to reassign staff who do not support the change to another unit.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Utilizing change champions (nurses who accept the
change) helps to influence others through peer support and positive
reinforcement.
o Distractor Pitfalls: B: Introducing the system abruptly may increase resistance.
C: Focusing on cost savings may not address staff concerns. D: Reassigning staff
is punitive and may increase resistance.
QUESTION 2: VARIANCE REPORT
• Question: A client who is febrile is admitted to the hospital for treatment of pneumonia.
In accordance with the care pathway, antibiotic therapy is prescribed. Which of the
, 2
following situations requires the nurse to complete a variance report with regard to the
care pathway?
• Options:
A. Antibiotic therapy was initiated 2 hr after implementation of the care pathway.
B. A blood culture was obtained after antibiotic therapy has been initiated.
C. The route of antibiotic therapy on the care pathway was changed from IV to PO.
D. An allergy to penicillin required an alternative antibiotic to be prescribed.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: A variance report is completed when there is a
deviation from the care pathway. Obtaining a blood culture after the
administration of antibiotics is a deviation from the standard of care, which is to
obtain the culture before starting antibiotics to prevent false-negative results.
o Distractor Pitfalls: A: Antibiotics within 2 hours is within the acceptable
timeframe. C: Changing route is a normal part of the care pathway. D: Changing
to an alternative antibiotic is also a normal part of care for allergies.
QUESTION 3: INCIDENT REPORT
• Question: A nurse should recognize that an incident report is required when:
• Options:
A. A client refuses to attend physical therapy.
B. A visitor pinches his finger in the client's bed frame.
C. A client throws a box of tissues at a nurse.
D. A nurse gives a medication 30 min late.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: An incident report is required for any unusual
occurrence, including visitor injuries. A visitor injuring themselves on equipment
must be documented for safety and liability purposes.
o Distractor Pitfalls: A: Refusing therapy is a client right, not an incident. C: This
is a behavioral issue, not an incident. D: Medication administration within 30
minutes is generally acceptable.
QUESTION 4: QUALITY INDICATOR
, 3
• Question: Client satisfactory surveys from a med-surg unit indicate the pain is not being
adequately relieved during the first 12 hr post-op. The unit manager decides to identify
post-op pain as a quality indicator. Which of the following data sources will be helpful in
determining the reason why clients are not receiving adequate pain management after
surgery?
• Options:
A. Prospective chart audit.
B. Retrospective chart audit.
C. Postoperative care policy.
D. Pain assessment policy.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: A retrospective chart audit reviews existing records
to identify gaps in care, such as whether pain assessments were done and
medications were administered.
o Distractor Pitfalls: A: Prospective audits monitor current patients. C, D:
Reviewing policies is helpful but does not reveal actual practice gaps.
QUESTION 5: RESTRAINT USE
• Question: A nurse precepting a newly licensed nurse who is caring for a client who is
confused and has an IV infusion. The newly licensed nurse has placed the client in wrist
restraints to prevent dislodging the IV catheter. Which of the following questions should
the precepting nurse ask?
• Options:
A. "Did you secure the restraints to the side rails of the bed?"
B. "Are you able to insert two fingers between the restraint and the client's skin?"
C. "Did you tie the restraints using a double knot?"
D. "Are you removing the client's restraints every 4 hr?"
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: The priority safety check is to ensure the restraint is
not too tight. The nurse should be able to insert two fingers between the restraint
and the client's skin to prevent circulation impairment.
o Distractor Pitfalls: A: Restraints should be secured to the bed frame, not the side
rails, which could cause injury if the side rail is lowered. C: Double knots are
, 4
used to prevent the knot from slipping, but the main concern is safety. D:
Restraints should be removed and reassessed every 2 hours for adults, not 4 hours.
CASE STUDY 2: CONSULTATION & LEGAL ISSUES (Questions 6-10)
EHR Panel:
• Patient: Older adult client.
• Assessment: Stage III pressure ulcer on the coccyx.
QUESTION 6: CONSULTATION
• Question: A nurse is caring for an older adult client who has stage III pressure ulcer. The
nurse requests a consultation with the wound care specialist. Which of the following
actions by the nurse is appropriate when working with a consultant?
• Options:
A. Arrange the consultation for a time when the nurse is caring for the client is able to be
present for consultation.
B. Provide the consultant with subjective opinions and beliefs about the client's wound
care.
C. Request the consultation after several wound care treatments have been tried.
D. Arrange for the wound care nurse specialist to see the client daily to provide the
recommended treatment.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: The nurse should be present during the consultation
to ensure accurate information is exchanged and to learn from the specialist.
o Distractor Pitfalls: B: Nurses should provide objective data and observations,
not subjective opinions. C: Consults should be requested promptly, not after
multiple failed attempts. D: The WOCN may provide recommendations but does
not typically provide daily care.
QUESTION 7: TB ADMISSION
• Question: A client is admitted with TB and placed in a negative pressure room. Which of
the following actions is appropriate?
• Options:
A. Notify the local health department of the admission.
B. Place a sign on the client's door with the diagnosis.
