NCLEX-STYLE PROCTORED PRACTICE EXAMINATION WITH ANSWER KEY AND RATIONALES
ATI Fundamentals CMS
Proctored Exam
210 Verified Questions with Correct Answers | Latest 2026/2027 Edition
100% Accurate and A+ Graded | Aligned with the ATI CMS Fundamentals Blueprint
Standards
210 Questions | 8 Content Domains | Cognitive Levels: 30% Recall - 50% Application - 20% Analysis
Format: Multiple Choice (A-D), One Correct Answer | 75% Scenario-Based, 25% Direct Recall and
Calculations
SECTION 1: Safe, Effective Care Environment - Management of
Care
Client Rights, Advocacy, Delegation, Legal and Ethical Issues, and Leadership | Questions 1 through 45
Q1. A nurse is caring for a postoperative client who reports incisional pain rated 7 on a scale of 0 to 10. The
client has an as-needed order for morphine. According to the nursing process, which action should the nurse take
first?
A. Reassess the pain rating in 30 minutes to determine severity trends.
B. Administer the prescribed morphine as quickly as possible.
C. Obtain additional data about the pain, including location, quality, and onset. [CORRECT]
D. Document the pain rating and notify the provider in the morning.
Correct Answer: C
Rationale: Assessment is the first step of the nursing process (ADPIE), and the nurse must collect comprehensive
data before implementing interventions. Completing a PQRST pain assessment establishes a baseline and guides
safe analgesic selection and later evaluation. Administering medication before assessment (option B) skips the
assessment phase, and simply reassessing in 30 minutes (option A) delays relief without gathering data.
Documentation (option D) is important but occurs after the assessment is completed.
Q2. A nurse set an expected outcome that a client will ambulate 50 feet with a rolling walker by the time of
discharge. On the discharge day, the nurse reviews the client's activity log and determines the client ambulated
60 feet daily for the past 3 days. Which phase of the nursing process does this review represent?
A. Planning
B. Diagnosis
C. Implementation
D. Evaluation [CORRECT]
Correct Answer: D
Rationale: Evaluation is the final step of the nursing process and involves comparing the client's actual outcomes
against the expected outcomes that were established during planning. The nurse determined the goal was met
1
,ATI Fundamentals CMS Proctored Exam | 210 Verified Questions | Latest 2026/2027 Edition
because the client exceeded the 50-foot target, which may lead to continuation, revision, or termination of the plan
of care. Planning (option A) occurs when goals are written, implementation (option C) is the performance of
interventions such as ambulating with the client, and diagnosis (option B) is the analysis of assessment data to
identify problems.
Q3. A nurse is reviewing morning assessment data for four assigned clients. Which finding requires the nurse to
take immediate action?
A. A client with heart failure who has 1+ bilateral ankle edema, unchanged from yesterday.
B. A client who had a hip replacement 2 days ago and reports incision pain of 4 on a 0 to 10 scale.
C. A client with pneumonia who has a respiratory rate of 30 breaths per minute and new confusion.
[CORRECT]
D. A client who is 1 day postoperative and reports not having a bowel movement since surgery.
Correct Answer: C
Rationale: Tachypnea with new confusion indicates hypoxia and possible respiratory deterioration, making this
client the highest priority using the ABC priority-setting framework. New-onset confusion in a client with
pneumonia frequently signals inadequate oxygenation and requires immediate intervention such as oxygen
administration and provider notification. The client with stable, chronic ankle edema (option A) and the client
reporting controlled postoperative pain (option B) have findings consistent with expected trajectories. Absence of a
bowel movement 1 day after surgery (option D) is common after anesthesia and opioids and is not an emergent
finding.
Q4. A nurse is writing an expected outcome for a client recovering from a stroke who has left-sided weakness.
Which statement is an appropriately written expected outcome?
A. The client will improve mobility gradually over time.
B. The nurse will encourage the client to walk in the hallway twice each shift.
C. The client will understand the importance of physical therapy.
D. The client will ambulate 100 feet with a rolling walker without assistance by discharge in 5 days.
[CORRECT]
Correct Answer: D
Rationale: A well-written expected outcome is client-focused, measurable, realistic, and time-limited; ambulating
100 feet with a specified assistive device by a stated date meets all of these criteria. Option A lacks measurable
criteria and a time frame, making evaluation impossible. Option C is neither measurable nor observable, and option
B describes a nursing intervention rather than a client outcome, since expected outcomes must always describe
client behavior rather than nurse actions.
Q5. A nurse is caring for an older adult client who has an indwelling urinary catheter and is scheduled for major
abdominal surgery. When writing the plan of care, which nursing diagnosis takes priority?
A. Risk for infection related to the presence of an indwelling urinary catheter [CORRECT]
B. Deficient knowledge regarding the surgical procedure
C. Disturbed body image related to anticipated surgical incision
D. Risk for impaired skin integrity related to limited mobility
Correct Answer: A
Rationale: Prioritization for a preoperative client focuses on physiological threats to safety, and an indwelling
catheter plus planned major surgery creates the highest infection risk with the greatest potential impact on
outcomes. A urinary tract infection before or after major surgery can lead to sepsis, delayed healing, and increased
mortality. Deficient knowledge (option B) is important for informed consent and should be addressed, but it does
2
,ATI Fundamentals CMS Proctored Exam | 210 Verified Questions | Latest 2026/2027 Edition
not pose the same immediate physiological threat. Disturbed body image (option C) and skin integrity risk (option
D) are valid concerns but rank below infection risk in this scenario.
Q6. Which statement is a correctly written nursing diagnosis?
A. Pneumonia with productive cough
B. Encourage deep breathing and coughing every hour
C. Client needs to increase daily fluid intake
D. Activity intolerance related to imbalance between oxygen supply and demand [CORRECT]
Correct Answer: D
Rationale: A nursing diagnosis follows the PES-related format of problem, etiology (related factors), and when
applicable, defining characteristics, and it must describe a human response that nurses are licensed to treat. Activity
intolerance related to imbalance between oxygen supply and demand correctly links the problem to its cause.
Option A is a medical diagnosis, which nurses cannot independently treat, option C is written as a need rather than a
diagnostic statement, and option B is a nursing intervention, not a diagnosis.
Q7. A nurse enters a client's room 30 minutes after administering a new antihypertensive medication, and the
client reports feeling lightheaded when sitting up. Which action should the nurse take first?
A. Notify the provider that the medication is causing adverse effects.
B. Document the report of lightheadedness in the medical record.
C. Instruct the client to avoid getting out of bed for the remainder of the day.
D. Take the client's blood pressure and heart rate while lying and standing. [CORRECT]
Correct Answer: D
Rationale: Assessment always precedes intervention when a client's condition changes, and orthostatic vital sign
measurement will confirm whether the client is experiencing medication-induced hypotension. The nurse needs
objective data before notifying the provider so the report includes specific findings and effective interventions can
be planned. Restricting the client to bed (option C) may be part of the plan but is premature without assessment,
and documentation (option B) should follow the assessment and interventions rather than replace them.
Q8. A preoperative client signs an informed consent form for a cholecystectomy. Which responsibility of the
nurse is demonstrated when the nurse confirms that the client understands the risks, benefits, and alternatives of
the procedure?
A. Obtaining the consent by explaining the surgical technique in detail
B. Providing a summary of the surgeon's fee schedule before signature
C. Recommending that the client decline the surgery if risks seem high
D. Witnessing the client's signature and verifying voluntary, informed agreement [CORRECT]
Correct Answer: D
Rationale: The surgeon is responsible for explaining the procedure, risks, benefits, and alternatives, while the
nurse is responsible for witnessing the signature and verifying that the client is informed, competent, and acting
voluntarily. The nurse clarifies information by contacting the provider if the client has questions but does not
perform the provider's informed-consent discussion. Explaining surgical technique (option A) exceeds nursing
scope, advising the client to refuse (option C) violates neutrality, and fees (option B) are not part of the nursing role
in consent.
3
, ATI Fundamentals CMS Proctored Exam | 210 Verified Questions | Latest 2026/2027 Edition
Q9. A nurse prepares a client for surgery and notes in the medication administration record that the client
received an opioid analgesic 20 minutes ago for anxiety. The client must sign the surgical consent form now.
Which action should the nurse take?
A. Ask the client to sign the consent form because consent was discussed during admission.
B. Read the consent form aloud and request the client's signature.
C. Withhold the consent process and notify the surgeon that the client received a sedating medication.
[CORRECT]
D. Ask the client's adult child to sign the consent form in place of the client.
Correct Answer: C
Rationale: A consent signed under the influence of a sedating medication such as an opioid is not legally valid
because the medication can impair judgment and decision-making capacity. The nurse must delay the consent
process, ensure the client's safety, and notify the provider so that signing can occur when the medication effect has
cleared. Option A is incorrect because sedation invalidates consent regardless of prior discussions, and option B
compounds the problem by proceeding with an impaired client. Option D is incorrect because the adult child cannot
sign for a competent adult client without legal authority such as healthcare proxy status.
Q10. A client with terminal cancer has a valid do-not-resuscitate (DNR) order in the medical record. During
visitation, the client's adult son angrily tells the nurse that the care team must perform full resuscitation if his
father stops breathing. Which action by the nurse is most appropriate?
A. Explain that the client's wishes and the documented DNR order must be honored, and offer to arrange a
family meeting with the provider. [CORRECT]
B. Contact the rapid response team to be on standby in case the client stops breathing.
C. Inform the son that family members can revoke a DNR order at any time.
D. Tell the son that resuscitation will be performed only if the client arrests during visiting hours.
Correct Answer: A
Rationale: A valid DNR order reflects the client's autonomous, documented decision and must be honored
regardless of family objection, while the nurse advocates by facilitating communication through a family meeting
with the provider. The son needs education about the order's meaning and emotional support for his grief rather
than a change in care. Option B is inappropriate because resuscitation preparation contradicts the order. Option C is
legally false since a DNR can only be revoked by the client or a legally designated decision-maker, and option D
misrepresents care by implying conditional compliance with the order.
Q11. Which action by a nurse violates the Health Insurance Portability and Accountability Act (HIPAA)?
A. Reviewing the medical record of an assigned client with the unit's charge nurse.
B. Using a whiteboard that displays only the client's first name and room number.
C. Providing a copy of the client's medical record to the insurance company upon the client's signed
request.
D. Discussing a client's HIV status with a coworker in the hospital elevator. [CORRECT]
Correct Answer: D
Rationale: HIPAA requires that protected health information be shared only for treatment, payment, or operations
purposes with individuals directly involved, and a public elevator conversation can be overheard by visitors with no
need to know. Discussing a client's HIV status in a public area is a reportable privacy breach. Option A is permitted
because the charge nurse is involved in the client's care management, option C is a permitted disclosure supported
by client authorization, and option B is an approved practice because limited identifiers on a unit whiteboard are an
accepted privacy exception.
4
ATI Fundamentals CMS
Proctored Exam
210 Verified Questions with Correct Answers | Latest 2026/2027 Edition
100% Accurate and A+ Graded | Aligned with the ATI CMS Fundamentals Blueprint
Standards
210 Questions | 8 Content Domains | Cognitive Levels: 30% Recall - 50% Application - 20% Analysis
Format: Multiple Choice (A-D), One Correct Answer | 75% Scenario-Based, 25% Direct Recall and
Calculations
SECTION 1: Safe, Effective Care Environment - Management of
Care
Client Rights, Advocacy, Delegation, Legal and Ethical Issues, and Leadership | Questions 1 through 45
Q1. A nurse is caring for a postoperative client who reports incisional pain rated 7 on a scale of 0 to 10. The
client has an as-needed order for morphine. According to the nursing process, which action should the nurse take
first?
A. Reassess the pain rating in 30 minutes to determine severity trends.
B. Administer the prescribed morphine as quickly as possible.
C. Obtain additional data about the pain, including location, quality, and onset. [CORRECT]
D. Document the pain rating and notify the provider in the morning.
Correct Answer: C
Rationale: Assessment is the first step of the nursing process (ADPIE), and the nurse must collect comprehensive
data before implementing interventions. Completing a PQRST pain assessment establishes a baseline and guides
safe analgesic selection and later evaluation. Administering medication before assessment (option B) skips the
assessment phase, and simply reassessing in 30 minutes (option A) delays relief without gathering data.
Documentation (option D) is important but occurs after the assessment is completed.
Q2. A nurse set an expected outcome that a client will ambulate 50 feet with a rolling walker by the time of
discharge. On the discharge day, the nurse reviews the client's activity log and determines the client ambulated
60 feet daily for the past 3 days. Which phase of the nursing process does this review represent?
A. Planning
B. Diagnosis
C. Implementation
D. Evaluation [CORRECT]
Correct Answer: D
Rationale: Evaluation is the final step of the nursing process and involves comparing the client's actual outcomes
against the expected outcomes that were established during planning. The nurse determined the goal was met
1
,ATI Fundamentals CMS Proctored Exam | 210 Verified Questions | Latest 2026/2027 Edition
because the client exceeded the 50-foot target, which may lead to continuation, revision, or termination of the plan
of care. Planning (option A) occurs when goals are written, implementation (option C) is the performance of
interventions such as ambulating with the client, and diagnosis (option B) is the analysis of assessment data to
identify problems.
Q3. A nurse is reviewing morning assessment data for four assigned clients. Which finding requires the nurse to
take immediate action?
A. A client with heart failure who has 1+ bilateral ankle edema, unchanged from yesterday.
B. A client who had a hip replacement 2 days ago and reports incision pain of 4 on a 0 to 10 scale.
C. A client with pneumonia who has a respiratory rate of 30 breaths per minute and new confusion.
[CORRECT]
D. A client who is 1 day postoperative and reports not having a bowel movement since surgery.
Correct Answer: C
Rationale: Tachypnea with new confusion indicates hypoxia and possible respiratory deterioration, making this
client the highest priority using the ABC priority-setting framework. New-onset confusion in a client with
pneumonia frequently signals inadequate oxygenation and requires immediate intervention such as oxygen
administration and provider notification. The client with stable, chronic ankle edema (option A) and the client
reporting controlled postoperative pain (option B) have findings consistent with expected trajectories. Absence of a
bowel movement 1 day after surgery (option D) is common after anesthesia and opioids and is not an emergent
finding.
Q4. A nurse is writing an expected outcome for a client recovering from a stroke who has left-sided weakness.
Which statement is an appropriately written expected outcome?
A. The client will improve mobility gradually over time.
B. The nurse will encourage the client to walk in the hallway twice each shift.
C. The client will understand the importance of physical therapy.
D. The client will ambulate 100 feet with a rolling walker without assistance by discharge in 5 days.
[CORRECT]
Correct Answer: D
Rationale: A well-written expected outcome is client-focused, measurable, realistic, and time-limited; ambulating
100 feet with a specified assistive device by a stated date meets all of these criteria. Option A lacks measurable
criteria and a time frame, making evaluation impossible. Option C is neither measurable nor observable, and option
B describes a nursing intervention rather than a client outcome, since expected outcomes must always describe
client behavior rather than nurse actions.
Q5. A nurse is caring for an older adult client who has an indwelling urinary catheter and is scheduled for major
abdominal surgery. When writing the plan of care, which nursing diagnosis takes priority?
A. Risk for infection related to the presence of an indwelling urinary catheter [CORRECT]
B. Deficient knowledge regarding the surgical procedure
C. Disturbed body image related to anticipated surgical incision
D. Risk for impaired skin integrity related to limited mobility
Correct Answer: A
Rationale: Prioritization for a preoperative client focuses on physiological threats to safety, and an indwelling
catheter plus planned major surgery creates the highest infection risk with the greatest potential impact on
outcomes. A urinary tract infection before or after major surgery can lead to sepsis, delayed healing, and increased
mortality. Deficient knowledge (option B) is important for informed consent and should be addressed, but it does
2
,ATI Fundamentals CMS Proctored Exam | 210 Verified Questions | Latest 2026/2027 Edition
not pose the same immediate physiological threat. Disturbed body image (option C) and skin integrity risk (option
D) are valid concerns but rank below infection risk in this scenario.
Q6. Which statement is a correctly written nursing diagnosis?
A. Pneumonia with productive cough
B. Encourage deep breathing and coughing every hour
C. Client needs to increase daily fluid intake
D. Activity intolerance related to imbalance between oxygen supply and demand [CORRECT]
Correct Answer: D
Rationale: A nursing diagnosis follows the PES-related format of problem, etiology (related factors), and when
applicable, defining characteristics, and it must describe a human response that nurses are licensed to treat. Activity
intolerance related to imbalance between oxygen supply and demand correctly links the problem to its cause.
Option A is a medical diagnosis, which nurses cannot independently treat, option C is written as a need rather than a
diagnostic statement, and option B is a nursing intervention, not a diagnosis.
Q7. A nurse enters a client's room 30 minutes after administering a new antihypertensive medication, and the
client reports feeling lightheaded when sitting up. Which action should the nurse take first?
A. Notify the provider that the medication is causing adverse effects.
B. Document the report of lightheadedness in the medical record.
C. Instruct the client to avoid getting out of bed for the remainder of the day.
D. Take the client's blood pressure and heart rate while lying and standing. [CORRECT]
Correct Answer: D
Rationale: Assessment always precedes intervention when a client's condition changes, and orthostatic vital sign
measurement will confirm whether the client is experiencing medication-induced hypotension. The nurse needs
objective data before notifying the provider so the report includes specific findings and effective interventions can
be planned. Restricting the client to bed (option C) may be part of the plan but is premature without assessment,
and documentation (option B) should follow the assessment and interventions rather than replace them.
Q8. A preoperative client signs an informed consent form for a cholecystectomy. Which responsibility of the
nurse is demonstrated when the nurse confirms that the client understands the risks, benefits, and alternatives of
the procedure?
A. Obtaining the consent by explaining the surgical technique in detail
B. Providing a summary of the surgeon's fee schedule before signature
C. Recommending that the client decline the surgery if risks seem high
D. Witnessing the client's signature and verifying voluntary, informed agreement [CORRECT]
Correct Answer: D
Rationale: The surgeon is responsible for explaining the procedure, risks, benefits, and alternatives, while the
nurse is responsible for witnessing the signature and verifying that the client is informed, competent, and acting
voluntarily. The nurse clarifies information by contacting the provider if the client has questions but does not
perform the provider's informed-consent discussion. Explaining surgical technique (option A) exceeds nursing
scope, advising the client to refuse (option C) violates neutrality, and fees (option B) are not part of the nursing role
in consent.
3
, ATI Fundamentals CMS Proctored Exam | 210 Verified Questions | Latest 2026/2027 Edition
Q9. A nurse prepares a client for surgery and notes in the medication administration record that the client
received an opioid analgesic 20 minutes ago for anxiety. The client must sign the surgical consent form now.
Which action should the nurse take?
A. Ask the client to sign the consent form because consent was discussed during admission.
B. Read the consent form aloud and request the client's signature.
C. Withhold the consent process and notify the surgeon that the client received a sedating medication.
[CORRECT]
D. Ask the client's adult child to sign the consent form in place of the client.
Correct Answer: C
Rationale: A consent signed under the influence of a sedating medication such as an opioid is not legally valid
because the medication can impair judgment and decision-making capacity. The nurse must delay the consent
process, ensure the client's safety, and notify the provider so that signing can occur when the medication effect has
cleared. Option A is incorrect because sedation invalidates consent regardless of prior discussions, and option B
compounds the problem by proceeding with an impaired client. Option D is incorrect because the adult child cannot
sign for a competent adult client without legal authority such as healthcare proxy status.
Q10. A client with terminal cancer has a valid do-not-resuscitate (DNR) order in the medical record. During
visitation, the client's adult son angrily tells the nurse that the care team must perform full resuscitation if his
father stops breathing. Which action by the nurse is most appropriate?
A. Explain that the client's wishes and the documented DNR order must be honored, and offer to arrange a
family meeting with the provider. [CORRECT]
B. Contact the rapid response team to be on standby in case the client stops breathing.
C. Inform the son that family members can revoke a DNR order at any time.
D. Tell the son that resuscitation will be performed only if the client arrests during visiting hours.
Correct Answer: A
Rationale: A valid DNR order reflects the client's autonomous, documented decision and must be honored
regardless of family objection, while the nurse advocates by facilitating communication through a family meeting
with the provider. The son needs education about the order's meaning and emotional support for his grief rather
than a change in care. Option B is inappropriate because resuscitation preparation contradicts the order. Option C is
legally false since a DNR can only be revoked by the client or a legally designated decision-maker, and option D
misrepresents care by implying conditional compliance with the order.
Q11. Which action by a nurse violates the Health Insurance Portability and Accountability Act (HIPAA)?
A. Reviewing the medical record of an assigned client with the unit's charge nurse.
B. Using a whiteboard that displays only the client's first name and room number.
C. Providing a copy of the client's medical record to the insurance company upon the client's signed
request.
D. Discussing a client's HIV status with a coworker in the hospital elevator. [CORRECT]
Correct Answer: D
Rationale: HIPAA requires that protected health information be shared only for treatment, payment, or operations
purposes with individuals directly involved, and a public elevator conversation can be overheard by visitors with no
need to know. Discussing a client's HIV status in a public area is a reportable privacy breach. Option A is permitted
because the charge nurse is involved in the client's care management, option C is a permitted disclosure supported
by client authorization, and option B is an approved practice because limited identifiers on a unit whiteboard are an
accepted privacy exception.
4
