ATI CMS Fundamentals Exam:
250+ Questions and Answers with Rationales
Graded A+ | 2026/2027 Edition | Aligned with the ATI CMS Fundamentals Blueprint
255 Questions Across 8 Content Domains | Answer Key with Detailed Rationales Included | Cognitive Mix: 25% Recall,
55% Application, 20% Analysis | Format: ATI-Style Multiple Choice (A-D), One Best Answer
SECTION 1 | Safe, Effective Care Environment: Management of Care
(Questions 1-45)
Client rights, advocacy, informed consent, advance directives, HIPAA, delegation and supervision, legal and ethical
practice, prioritization frameworks, continuity of care, collaboration, and quality improvement.
Q1: A nurse is assigned to a newly admitted client with heart failure. When applying the steps of the
nursing process, which action should the nurse take first?
A. Establish measurable goals for the client's plan of care.
B. Determine whether the client's goals have been achieved.
C. Complete a comprehensive assessment of the client's needs. [CORRECT]
D. Implement the prescribed diuretic therapy.
Correct Answer: C
Rationale: Assessment is the first step of the nursing process (ADPIE), and all subsequent steps depend on
complete, accurate data collection. Establishing goals is part of planning, which cannot occur until assessment data
are gathered. Implementing therapy or evaluating outcomes before assessment places the client at risk for missed
problems and inappropriate interventions.
Q2: A charge nurse is reviewing the acuity of four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client who is 1 day postoperative following thoracic surgery with new loud wheezing and an oxygen
saturation of 88% on room air [CORRECT]
B. A client with heart failure who reports a weight gain of 0.5 kg (1 lb) over the past 24 hr
C. A client with type 2 diabetes whose fasting blood glucose is 155 mg/dL
D. A client requesting PRN medication for a headache rated 4 on a 0 to 10 pain scale
Correct Answer: A
Rationale: The ABC framework (airway, breathing, circulation) always guides prioritization. New wheezing with
an oxygen saturation of 88% indicates an immediate breathing compromise that can deteriorate rapidly. Mild weight
gain, a glucose of 155 mg/dL, and moderate headache are expected or nonurgent findings that can be addressed
after the unstable client is stabilized.
ATI CMS Fundamentals | 2026/2027 Edition 1
,ATI CMS Fundamentals Exam | 250+ Questions and Answers with Rationales | Graded A+ | 2026/2027 Edition
Q3: A nurse-manager is determining assignments for the assistive personnel (AP) on a medical unit.
Which task is appropriate for the nurse to delegate to the AP?
A. Assisting a stable client with a complete bed bath [CORRECT]
B. Reinforcing low-sodium diet teaching with a client who has hypertension
C. Assessing a client who reports new chest pain
D. Administering oral medications to a stable client
Correct Answer: A
Rationale: Hygiene and bathing for stable clients fall within the AP scope of practice and require no licensure.
Medication administration and reinforcement of teaching require licensed personnel, and assessment is a core RN
function that is never delegated. Delegation must match the task to the education and legal scope of the team
member.
Q4: A nurse is caring for a competent adult client who is scheduled for a thoracentesis. Which action is
the nurse's responsibility regarding informed consent?
A. Explain the risks and benefits of the procedure to the client.
B. Verify that the client understands the information provided and witness the client's signature on the
consent form. [CORRECT]
C. Sign the consent form attesting that the nurse personally explained the procedure.
D. Obtain consent from the client's adult child because the client is hospitalized.
Correct Answer: B
Rationale: The provider performing the procedure is responsible for explaining the risks, benefits, and alternatives,
while the nurse verifies the client's understanding and witnesses the signature. The nurse should clarify questions
and notify the provider if the client does not understand. A competent adult client signs their own consent, and a
family member cannot consent unless legally designated.
Q5: A friend who is not involved in a client's care asks the nurse for details about the client's recent
surgery. Which response by the nurse demonstrates compliance with HIPAA?
A. Share a brief summary because the friend is a registered nurse.
B. Decline to share any information and state that client information is confidential. [CORRECT]
C. Post a general update about the client's condition on the unit's message board.
D. Print a copy of the client's record for the friend to review privately.
Correct Answer: B
Rationale: HIPAA requires that protected health information be shared only with those involved in care, for
treatment purposes, or with the client's authorization. Sharing any details, posting information publicly, or allowing
access to the record by unauthorized persons constitutes a privacy violation. The minimum necessary standard
applies to every disclosure.
ATI CMS Fundamentals | 2026/2027 Edition 2
,ATI CMS Fundamentals Exam | 250+ Questions and Answers with Rationales | Graded A+ | 2026/2027 Edition
Q6: A client with terminal cancer has a valid do-not-resuscitate (DNR) order in the medical record and is
now found pulseless and apneic. Which action should the nurse take?
A. Do not initiate CPR and remain with the client while providing support to the family. [CORRECT]
B. Begin CPR while awaiting confirmation of the DNR order by the provider.
C. Ask the family whether they want resuscitation to be initiated.
D. Activate the rapid response team and prepare for intubation.
Correct Answer: A
Rationale: A valid DNR order directs the team to withhold CPR and advanced life support when cardiopulmonary
arrest occurs. Beginning resuscitation or delaying to confirm the order violates the documented wishes of the client.
The family does not make resuscitation decisions during an arrest, and the nurse must remain to provide emotional
support and postmortem care.
Q7: A home health nurse is prioritizing the needs of a client during the first home visit. Using Maslow's
hierarchy, which need should the nurse address first?
A. The client's report of chest pressure that began 30 min ago [CORRECT]
B. The client's expressed feelings of loneliness since retirement
C. The client's interest in joining a neighborhood walking group
D. The client's questions about completing advance directives
Correct Answer: A
Rationale: Maslow's hierarchy places physiological needs, including oxygenation and cardiac function, at the base
of the pyramid, making chest pressure the immediate priority. Psychosocial needs such as loneliness and
socialization are addressed only after physiological and safety needs are met. Advance directive education is
important but is never prioritized over an active physiological complaint.
Q8: A nurse fails to monitor a client receiving a heparin infusion at the prescribed frequency, and the
client develops a serious bleed. Which element of malpractice does this situation demonstrate?
A. The nurse intended the best outcome for the client.
B. The unit was short-staffed on the day of the event.
C. The client sustained damages because the nurse breached the standard of care. [CORRECT]
D. The nurse had never received the annual heparin competency review.
Correct Answer: C
Rationale: Professional negligence (malpractice) requires duty, breach of the standard of care, causation, and
damages. Failure to monitor as prescribed is a breach that directly caused client injury, satisfying all elements. Good
intentions, staffing issues, and incomplete competencies may be contributing factors but do not replace the required
legal elements.
ATI CMS Fundamentals | 2026/2027 Edition 3
, ATI CMS Fundamentals Exam | 250+ Questions and Answers with Rationales | Graded A+ | 2026/2027 Edition
Q9: A client falls while ambulating unassisted to the bathroom. Which action should the nurse take first?
A. Assess the client for injuries, vital signs, and neurological status. [CORRECT]
B. Complete the incident report before touching the client.
C. Notify the client's family of the fall immediately.
D. Document in the medical record that an incident report was filed.
Correct Answer: A
Rationale: Client assessment always precedes paperwork because injury detection and stabilization are the
immediate priorities after any fall. The incident report is completed after the client is evaluated and is an internal,
confidential document that is never referenced in the medical record. Family notification occurs after the client's
condition is addressed and per facility policy.
Q10: A nurse is preparing assignments for the licensed practical nurse (LPN) on a medical unit. Which
client is appropriate to assign to the LPN?
A. A stable client with cellulitis who needs scheduled oral antibiotics and a routine dressing change
[CORRECT]
B. A client who is 2 hr post cardiac catheterization with a femoral access site
C. A client with sepsis who received the first dose of IV antibiotics 10 min ago
D. A client newly admitted with chest pain who requires serial assessments
Correct Answer: A
Rationale: LPNs can safely care for clients whose condition is stable and predictable, including administering oral
medications and performing routine dressings within their scope. Clients who are newly admitted, immediately
postprocedure, or newly septic are unpredictable and require the assessment and clinical judgment of the RN.
Assignment must always match client stability with staff scope of practice.
Q11: A nurse-manager is teaching a group of new graduate nurses about discharge planning. Which
statement accurately describes when discharge planning should begin?
A. On the day the provider writes the discharge order
B. At the time of the client's admission to the facility [CORRECT]
C. Once the client's acute symptoms have fully resolved
D. During the final teaching session before dismissal
Correct Answer: B
Rationale: Discharge planning is a continuous, collaborative process that begins at admission to allow adequate
coordination of teaching, equipment, follow-up appointments, and referrals. Waiting until the discharge order or
symptom resolution compresses the process and increases the risk of readmission. Early identification of needs
improves transitions of care.
ATI CMS Fundamentals | 2026/2027 Edition 4
250+ Questions and Answers with Rationales
Graded A+ | 2026/2027 Edition | Aligned with the ATI CMS Fundamentals Blueprint
255 Questions Across 8 Content Domains | Answer Key with Detailed Rationales Included | Cognitive Mix: 25% Recall,
55% Application, 20% Analysis | Format: ATI-Style Multiple Choice (A-D), One Best Answer
SECTION 1 | Safe, Effective Care Environment: Management of Care
(Questions 1-45)
Client rights, advocacy, informed consent, advance directives, HIPAA, delegation and supervision, legal and ethical
practice, prioritization frameworks, continuity of care, collaboration, and quality improvement.
Q1: A nurse is assigned to a newly admitted client with heart failure. When applying the steps of the
nursing process, which action should the nurse take first?
A. Establish measurable goals for the client's plan of care.
B. Determine whether the client's goals have been achieved.
C. Complete a comprehensive assessment of the client's needs. [CORRECT]
D. Implement the prescribed diuretic therapy.
Correct Answer: C
Rationale: Assessment is the first step of the nursing process (ADPIE), and all subsequent steps depend on
complete, accurate data collection. Establishing goals is part of planning, which cannot occur until assessment data
are gathered. Implementing therapy or evaluating outcomes before assessment places the client at risk for missed
problems and inappropriate interventions.
Q2: A charge nurse is reviewing the acuity of four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client who is 1 day postoperative following thoracic surgery with new loud wheezing and an oxygen
saturation of 88% on room air [CORRECT]
B. A client with heart failure who reports a weight gain of 0.5 kg (1 lb) over the past 24 hr
C. A client with type 2 diabetes whose fasting blood glucose is 155 mg/dL
D. A client requesting PRN medication for a headache rated 4 on a 0 to 10 pain scale
Correct Answer: A
Rationale: The ABC framework (airway, breathing, circulation) always guides prioritization. New wheezing with
an oxygen saturation of 88% indicates an immediate breathing compromise that can deteriorate rapidly. Mild weight
gain, a glucose of 155 mg/dL, and moderate headache are expected or nonurgent findings that can be addressed
after the unstable client is stabilized.
ATI CMS Fundamentals | 2026/2027 Edition 1
,ATI CMS Fundamentals Exam | 250+ Questions and Answers with Rationales | Graded A+ | 2026/2027 Edition
Q3: A nurse-manager is determining assignments for the assistive personnel (AP) on a medical unit.
Which task is appropriate for the nurse to delegate to the AP?
A. Assisting a stable client with a complete bed bath [CORRECT]
B. Reinforcing low-sodium diet teaching with a client who has hypertension
C. Assessing a client who reports new chest pain
D. Administering oral medications to a stable client
Correct Answer: A
Rationale: Hygiene and bathing for stable clients fall within the AP scope of practice and require no licensure.
Medication administration and reinforcement of teaching require licensed personnel, and assessment is a core RN
function that is never delegated. Delegation must match the task to the education and legal scope of the team
member.
Q4: A nurse is caring for a competent adult client who is scheduled for a thoracentesis. Which action is
the nurse's responsibility regarding informed consent?
A. Explain the risks and benefits of the procedure to the client.
B. Verify that the client understands the information provided and witness the client's signature on the
consent form. [CORRECT]
C. Sign the consent form attesting that the nurse personally explained the procedure.
D. Obtain consent from the client's adult child because the client is hospitalized.
Correct Answer: B
Rationale: The provider performing the procedure is responsible for explaining the risks, benefits, and alternatives,
while the nurse verifies the client's understanding and witnesses the signature. The nurse should clarify questions
and notify the provider if the client does not understand. A competent adult client signs their own consent, and a
family member cannot consent unless legally designated.
Q5: A friend who is not involved in a client's care asks the nurse for details about the client's recent
surgery. Which response by the nurse demonstrates compliance with HIPAA?
A. Share a brief summary because the friend is a registered nurse.
B. Decline to share any information and state that client information is confidential. [CORRECT]
C. Post a general update about the client's condition on the unit's message board.
D. Print a copy of the client's record for the friend to review privately.
Correct Answer: B
Rationale: HIPAA requires that protected health information be shared only with those involved in care, for
treatment purposes, or with the client's authorization. Sharing any details, posting information publicly, or allowing
access to the record by unauthorized persons constitutes a privacy violation. The minimum necessary standard
applies to every disclosure.
ATI CMS Fundamentals | 2026/2027 Edition 2
,ATI CMS Fundamentals Exam | 250+ Questions and Answers with Rationales | Graded A+ | 2026/2027 Edition
Q6: A client with terminal cancer has a valid do-not-resuscitate (DNR) order in the medical record and is
now found pulseless and apneic. Which action should the nurse take?
A. Do not initiate CPR and remain with the client while providing support to the family. [CORRECT]
B. Begin CPR while awaiting confirmation of the DNR order by the provider.
C. Ask the family whether they want resuscitation to be initiated.
D. Activate the rapid response team and prepare for intubation.
Correct Answer: A
Rationale: A valid DNR order directs the team to withhold CPR and advanced life support when cardiopulmonary
arrest occurs. Beginning resuscitation or delaying to confirm the order violates the documented wishes of the client.
The family does not make resuscitation decisions during an arrest, and the nurse must remain to provide emotional
support and postmortem care.
Q7: A home health nurse is prioritizing the needs of a client during the first home visit. Using Maslow's
hierarchy, which need should the nurse address first?
A. The client's report of chest pressure that began 30 min ago [CORRECT]
B. The client's expressed feelings of loneliness since retirement
C. The client's interest in joining a neighborhood walking group
D. The client's questions about completing advance directives
Correct Answer: A
Rationale: Maslow's hierarchy places physiological needs, including oxygenation and cardiac function, at the base
of the pyramid, making chest pressure the immediate priority. Psychosocial needs such as loneliness and
socialization are addressed only after physiological and safety needs are met. Advance directive education is
important but is never prioritized over an active physiological complaint.
Q8: A nurse fails to monitor a client receiving a heparin infusion at the prescribed frequency, and the
client develops a serious bleed. Which element of malpractice does this situation demonstrate?
A. The nurse intended the best outcome for the client.
B. The unit was short-staffed on the day of the event.
C. The client sustained damages because the nurse breached the standard of care. [CORRECT]
D. The nurse had never received the annual heparin competency review.
Correct Answer: C
Rationale: Professional negligence (malpractice) requires duty, breach of the standard of care, causation, and
damages. Failure to monitor as prescribed is a breach that directly caused client injury, satisfying all elements. Good
intentions, staffing issues, and incomplete competencies may be contributing factors but do not replace the required
legal elements.
ATI CMS Fundamentals | 2026/2027 Edition 3
, ATI CMS Fundamentals Exam | 250+ Questions and Answers with Rationales | Graded A+ | 2026/2027 Edition
Q9: A client falls while ambulating unassisted to the bathroom. Which action should the nurse take first?
A. Assess the client for injuries, vital signs, and neurological status. [CORRECT]
B. Complete the incident report before touching the client.
C. Notify the client's family of the fall immediately.
D. Document in the medical record that an incident report was filed.
Correct Answer: A
Rationale: Client assessment always precedes paperwork because injury detection and stabilization are the
immediate priorities after any fall. The incident report is completed after the client is evaluated and is an internal,
confidential document that is never referenced in the medical record. Family notification occurs after the client's
condition is addressed and per facility policy.
Q10: A nurse is preparing assignments for the licensed practical nurse (LPN) on a medical unit. Which
client is appropriate to assign to the LPN?
A. A stable client with cellulitis who needs scheduled oral antibiotics and a routine dressing change
[CORRECT]
B. A client who is 2 hr post cardiac catheterization with a femoral access site
C. A client with sepsis who received the first dose of IV antibiotics 10 min ago
D. A client newly admitted with chest pain who requires serial assessments
Correct Answer: A
Rationale: LPNs can safely care for clients whose condition is stable and predictable, including administering oral
medications and performing routine dressings within their scope. Clients who are newly admitted, immediately
postprocedure, or newly septic are unpredictable and require the assessment and clinical judgment of the RN.
Assignment must always match client stability with staff scope of practice.
Q11: A nurse-manager is teaching a group of new graduate nurses about discharge planning. Which
statement accurately describes when discharge planning should begin?
A. On the day the provider writes the discharge order
B. At the time of the client's admission to the facility [CORRECT]
C. Once the client's acute symptoms have fully resolved
D. During the final teaching session before dismissal
Correct Answer: B
Rationale: Discharge planning is a continuous, collaborative process that begins at admission to allow adequate
coordination of teaching, equipment, follow-up appointments, and referrals. Waiting until the discharge order or
symptom resolution compresses the process and increases the risk of readmission. Early identification of needs
improves transitions of care.
ATI CMS Fundamentals | 2026/2027 Edition 4
