ATI RN Fundamentals - NGN Style Qs and Verified Rationales | 2026/2027 Updated Page 1
ATI RN Fundamentals Exam
NGN Style Qs and Verified Rationales | 2026/2027 UPDATED
Actual 70 Questions and Answers - Aligned with ATI Proctored Standards & NCJMM
Total Questions: 70 | Cognitive Distribution: 30% Recall - 50% Application - 20% Analysis
Format: 80% Scenario-Based (incl. NGN case studies) - 20% Direct Recall | Item Type: Multiple Choice (A-D, single best
answer)
NCJMM Integration: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate
Outcomes.
Apply clinical judgment, prioritization frameworks (ABC, Maslow, Safety, Least Restrictive), and the Five Rights of
Delegation to select the single best answer for each item.
Section 1: Management of Care (Advocacy, Delegation, Ethics, Legal Issues, & Continuity
of Care) - Q1-Q11
Q1. A nurse on a medical-surgical unit is assigned four clients. Which client should the nurse assess FIRST?
A. A client 2 days post-op requesting pain medication
B. A client with chronic kidney disease whose serum potassium is 5.8 mEq/L and reports muscle
weakness [CORRECT]
C. A client with type 2 diabetes awaiting breakfast
D. A client with osteoarthritis requesting assistance to the bathroom
Correct Answer: B
Rationale: A potassium level of 5.8 mEq/L with muscle weakness is a potential medical emergency (hyperkalemia can cause
life-threatening cardiac dysrhythmias) and requires immediate assessment and provider notification. Using ABC + Maslow +
acute-versus-chronic frameworks, the nurse prioritizes the unstable client. Test-taking strategy: identify the client with the
most immediate life threat (here, hyperkalemia with cardiac risk).
Q2. A charge nurse is delegating tasks for the shift. Which task is appropriate to assign to a UAP (unlicensed
assistive personnel)?
A. Teaching a newly diagnosed diabetic client about insulin administration
B. Measuring vital signs and recording intake/output on stable clients [CORRECT]
C. Assessing a surgical wound for signs of infection
D. Administering oral medications to a stable client
Correct Answer: B
Rationale: UAP scope of practice includes basic care activities such as measuring vital signs, recording I&O;, ambulation,
hygiene, and feeding on stable clients. Teaching, assessment, and medication administration require the licensure and
judgment of an RN (or LPN for routine meds depending on state). The Five Rights of Delegation: right task, right
circumstance, right person, right direction, right supervision. Test-taking strategy: UAP = ADLs + vitals + I&O; never
teaching, assessment, or med pass.
Q3. A nurse is caring for a client who refuses a prescribed blood transfusion due to religious beliefs. The
client is competent and aware of the risks. Which action by the nurse is MOST appropriate?
A. Administer the transfusion anyway because the provider ordered it
B. Respect the client's autonomy, ensure informed refusal is documented, and notify the provider
[CORRECT]
C. Call the ethics committee to override the refusal
D. Ask the family to convince the client to accept the transfusion
Actual 70 Questions and Answers - ATI Proctored Standard ATI RN Fundamentals - 70 Items
,ATI RN Fundamentals - NGN Style Qs and Verified Rationales | 2026/2027 Updated Page 2
Correct Answer: B
Rationale: A competent adult has the legal and ethical right to refuse treatment, even if refusal may result in death. The
nurse's role is to ensure the client understands the consequences, respect the decision, document the informed refusal, and
notify the provider. Autonomy overrides beneficence when a competent client refuses. Test-taking strategy: competent adult
refusal = respect + document + notify provider; never coerce or override.
Q4. A nurse witnesses a colleague make a medication error but the colleague fails to document or report it.
Which action by the nurse is MOST appropriate?
A. Ignore the error since the colleague is responsible
B. Report the error to the charge nurse and complete an incident report per facility policy [CORRECT]
C. Confront the colleague publicly in the nurse's station
D. Document the error in the client's chart on the colleague's behalf
Correct Answer: B
Rationale: Patient safety requires reporting all medication errors, regardless of who made them. The nurse should report the
error through the chain of command (charge nurse) and complete an incident/variance report per facility policy. Incident
reports are internal quality improvement documents and should not be filed in the client's medical record. Test-taking strategy:
error + non-reporting = escalate to charge nurse + file incident report; never document another nurse's error in the chart.
Q5. A client is scheduled for surgery and the surgeon has explained the procedure, risks, and alternatives.
The client signs the consent form. The nurse's role in informed consent is to:
A. Explain the surgical procedure in detail
B. Witness the client's signature and verify the client's understanding and voluntary consent
[CORRECT]
C. Ensure the client understands the surgical technique
D. Cancel the surgery if the client has any questions
Correct Answer: B
Rationale: The nurse's role in informed consent is to witness the signature, verify the client's understanding (can verbalize the
procedure, risks, alternatives), confirm the client is competent and consenting voluntarily, and notify the provider if the client
has unanswered questions. The surgeon (provider) is responsible for explaining the procedure. Test-taking strategy: nurse =
witness + verify understanding + notify provider of gaps; surgeon = explains + obtains consent.
Q6. A client has a living will and durable power of attorney for health care. The client becomes incapacitated
and requires life-sustaining treatment that the living will refuses. Which action is MOST appropriate?
A. Administer life-sustaining treatment as the provider orders
B. Honor the living will and durable power of attorney; notify the provider and designated surrogate
[CORRECT]
C. Call the ethics committee before making any decisions
D. Continue treatment until family consensus is reached
Correct Answer: B
Rationale: Advance directives (living will + durable power of attorney) guide care when the client is incapacitated. The nurse
should honor the directives, notify the provider, and consult the designated surrogate for decisions not explicitly addressed.
The Patient Self-Determination Act requires facilities to inform clients of their rights regarding advance directives.
Test-taking strategy: advance directive + incapacitated client = follow directive + involve surrogate + notify provider.
Q7. A nurse is caring for a client whose family member asks for information about the client's diagnosis.
Which response by the nurse is MOST appropriate, according to HIPAA regulations?
A. "I can share the information if you are a family member."
B. "I cannot share the client's health information without the client's permission. Let me ask the client if
they would like to share this with you." [CORRECT]
C. "I can only share information if the client has signed a HIPAA release form authorizing disclosure to you."
Actual 70 Questions and Answers - ATI Proctored Standard ATI RN Fundamentals - 70 Items
, ATI RN Fundamentals - NGN Style Qs and Verified Rationales | 2026/2027 Updated Page 3
D. "The provider will discuss this with you later."
Correct Answer: B
Rationale: HIPAA protects client privacy; the nurse cannot share protected health information (PHI) without the client's
consent. The nurse should ask the client if they wish to share information with the family member. If the client consents,
information may be shared; if not, the nurse must respect the client's decision. Test-taking strategy: HIPAA = client
permission required; the client controls disclosure, not the family.
Q8. A nurse suspects child abuse in a 4-year-old client brought to the emergency department. Which action by
the nurse is legally required?
A. Discuss the suspicion with the parents before reporting
B. Report the suspicion to the appropriate child protective services agency immediately per mandatory
reporting laws [CORRECT]
C. Wait until discharge to report the suspicion
D. Document the suspicion but not report it
Correct Answer: B
Rationale: All 50 states require nurses (and other healthcare professionals) to report suspected child abuse to child protective
services. The nurse does not need to prove abuse; suspicion is sufficient. The report should be made promptly, and the nurse is
legally protected from retaliation. Delaying or failing to report is a violation of mandatory reporting laws. Test-taking strategy:
suspected child/elder abuse = report immediately to CPS/APS; document; do not investigate or notify suspected abuser first.
Q9. A nurse is preparing to discharge a client after hospitalization. Which action best ensures continuity of
care?
A. Providing written discharge instructions only
B. Coordinating follow-up appointments, reconciling medications, communicating with the next care
provider, and arranging home health services as needed [CORRECT]
C. Telling the client to follow up with their PCP when they feel better
D. Documenting the discharge in the medical record
Correct Answer: B
Rationale: Continuity of care requires comprehensive discharge planning: medication reconciliation, follow-up appointment
scheduling, communication with the next care provider (SBAR handoff), arranging home health services, and written/verbal
instructions. Inadequate transitions increase readmission risk. Test-taking strategy: discharge = "MADSTAR" - Meds,
Appointment, Services, Teaching, Advice, Return precautions.
Q10. A new graduate RN is orienting to a medical-surgical unit. Which client assignment is MOST
appropriate for the new graduate?
A. A client with septic shock on a norepinephrine drip
B. A stable client 3 days post-operative from an appendectomy requiring routine care [CORRECT]
C. A client with acute decompensated heart failure requiring IV nitroglycerin
D. A client 6 hours post-thyroidectomy requiring frequent airway assessment
Correct Answer: B
Rationale: New graduate RNs should be assigned stable clients with predictable needs. The stable post-appendectomy client is
appropriate. Septic shock on pressors, acute decompensated heart failure on IV nitroglycerin, and recent thyroidectomy with
airway risk all require advanced assessment skills and experience. Test-taking strategy: new graduate = stable + predictable +
low-acuity; avoid critical care, titrated drips, and high-risk assessments.
Q11. A nurse is caring for a client who asks, "Am I going to die?" The nurse's BEST therapeutic response is:
A. "Don't worry, everything will be fine."
B. "That must be a difficult thought to have. Can you tell me more about what you're feeling?"
[CORRECT]
Actual 70 Questions and Answers - ATI Proctored Standard ATI RN Fundamentals - 70 Items
ATI RN Fundamentals Exam
NGN Style Qs and Verified Rationales | 2026/2027 UPDATED
Actual 70 Questions and Answers - Aligned with ATI Proctored Standards & NCJMM
Total Questions: 70 | Cognitive Distribution: 30% Recall - 50% Application - 20% Analysis
Format: 80% Scenario-Based (incl. NGN case studies) - 20% Direct Recall | Item Type: Multiple Choice (A-D, single best
answer)
NCJMM Integration: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate
Outcomes.
Apply clinical judgment, prioritization frameworks (ABC, Maslow, Safety, Least Restrictive), and the Five Rights of
Delegation to select the single best answer for each item.
Section 1: Management of Care (Advocacy, Delegation, Ethics, Legal Issues, & Continuity
of Care) - Q1-Q11
Q1. A nurse on a medical-surgical unit is assigned four clients. Which client should the nurse assess FIRST?
A. A client 2 days post-op requesting pain medication
B. A client with chronic kidney disease whose serum potassium is 5.8 mEq/L and reports muscle
weakness [CORRECT]
C. A client with type 2 diabetes awaiting breakfast
D. A client with osteoarthritis requesting assistance to the bathroom
Correct Answer: B
Rationale: A potassium level of 5.8 mEq/L with muscle weakness is a potential medical emergency (hyperkalemia can cause
life-threatening cardiac dysrhythmias) and requires immediate assessment and provider notification. Using ABC + Maslow +
acute-versus-chronic frameworks, the nurse prioritizes the unstable client. Test-taking strategy: identify the client with the
most immediate life threat (here, hyperkalemia with cardiac risk).
Q2. A charge nurse is delegating tasks for the shift. Which task is appropriate to assign to a UAP (unlicensed
assistive personnel)?
A. Teaching a newly diagnosed diabetic client about insulin administration
B. Measuring vital signs and recording intake/output on stable clients [CORRECT]
C. Assessing a surgical wound for signs of infection
D. Administering oral medications to a stable client
Correct Answer: B
Rationale: UAP scope of practice includes basic care activities such as measuring vital signs, recording I&O;, ambulation,
hygiene, and feeding on stable clients. Teaching, assessment, and medication administration require the licensure and
judgment of an RN (or LPN for routine meds depending on state). The Five Rights of Delegation: right task, right
circumstance, right person, right direction, right supervision. Test-taking strategy: UAP = ADLs + vitals + I&O; never
teaching, assessment, or med pass.
Q3. A nurse is caring for a client who refuses a prescribed blood transfusion due to religious beliefs. The
client is competent and aware of the risks. Which action by the nurse is MOST appropriate?
A. Administer the transfusion anyway because the provider ordered it
B. Respect the client's autonomy, ensure informed refusal is documented, and notify the provider
[CORRECT]
C. Call the ethics committee to override the refusal
D. Ask the family to convince the client to accept the transfusion
Actual 70 Questions and Answers - ATI Proctored Standard ATI RN Fundamentals - 70 Items
,ATI RN Fundamentals - NGN Style Qs and Verified Rationales | 2026/2027 Updated Page 2
Correct Answer: B
Rationale: A competent adult has the legal and ethical right to refuse treatment, even if refusal may result in death. The
nurse's role is to ensure the client understands the consequences, respect the decision, document the informed refusal, and
notify the provider. Autonomy overrides beneficence when a competent client refuses. Test-taking strategy: competent adult
refusal = respect + document + notify provider; never coerce or override.
Q4. A nurse witnesses a colleague make a medication error but the colleague fails to document or report it.
Which action by the nurse is MOST appropriate?
A. Ignore the error since the colleague is responsible
B. Report the error to the charge nurse and complete an incident report per facility policy [CORRECT]
C. Confront the colleague publicly in the nurse's station
D. Document the error in the client's chart on the colleague's behalf
Correct Answer: B
Rationale: Patient safety requires reporting all medication errors, regardless of who made them. The nurse should report the
error through the chain of command (charge nurse) and complete an incident/variance report per facility policy. Incident
reports are internal quality improvement documents and should not be filed in the client's medical record. Test-taking strategy:
error + non-reporting = escalate to charge nurse + file incident report; never document another nurse's error in the chart.
Q5. A client is scheduled for surgery and the surgeon has explained the procedure, risks, and alternatives.
The client signs the consent form. The nurse's role in informed consent is to:
A. Explain the surgical procedure in detail
B. Witness the client's signature and verify the client's understanding and voluntary consent
[CORRECT]
C. Ensure the client understands the surgical technique
D. Cancel the surgery if the client has any questions
Correct Answer: B
Rationale: The nurse's role in informed consent is to witness the signature, verify the client's understanding (can verbalize the
procedure, risks, alternatives), confirm the client is competent and consenting voluntarily, and notify the provider if the client
has unanswered questions. The surgeon (provider) is responsible for explaining the procedure. Test-taking strategy: nurse =
witness + verify understanding + notify provider of gaps; surgeon = explains + obtains consent.
Q6. A client has a living will and durable power of attorney for health care. The client becomes incapacitated
and requires life-sustaining treatment that the living will refuses. Which action is MOST appropriate?
A. Administer life-sustaining treatment as the provider orders
B. Honor the living will and durable power of attorney; notify the provider and designated surrogate
[CORRECT]
C. Call the ethics committee before making any decisions
D. Continue treatment until family consensus is reached
Correct Answer: B
Rationale: Advance directives (living will + durable power of attorney) guide care when the client is incapacitated. The nurse
should honor the directives, notify the provider, and consult the designated surrogate for decisions not explicitly addressed.
The Patient Self-Determination Act requires facilities to inform clients of their rights regarding advance directives.
Test-taking strategy: advance directive + incapacitated client = follow directive + involve surrogate + notify provider.
Q7. A nurse is caring for a client whose family member asks for information about the client's diagnosis.
Which response by the nurse is MOST appropriate, according to HIPAA regulations?
A. "I can share the information if you are a family member."
B. "I cannot share the client's health information without the client's permission. Let me ask the client if
they would like to share this with you." [CORRECT]
C. "I can only share information if the client has signed a HIPAA release form authorizing disclosure to you."
Actual 70 Questions and Answers - ATI Proctored Standard ATI RN Fundamentals - 70 Items
, ATI RN Fundamentals - NGN Style Qs and Verified Rationales | 2026/2027 Updated Page 3
D. "The provider will discuss this with you later."
Correct Answer: B
Rationale: HIPAA protects client privacy; the nurse cannot share protected health information (PHI) without the client's
consent. The nurse should ask the client if they wish to share information with the family member. If the client consents,
information may be shared; if not, the nurse must respect the client's decision. Test-taking strategy: HIPAA = client
permission required; the client controls disclosure, not the family.
Q8. A nurse suspects child abuse in a 4-year-old client brought to the emergency department. Which action by
the nurse is legally required?
A. Discuss the suspicion with the parents before reporting
B. Report the suspicion to the appropriate child protective services agency immediately per mandatory
reporting laws [CORRECT]
C. Wait until discharge to report the suspicion
D. Document the suspicion but not report it
Correct Answer: B
Rationale: All 50 states require nurses (and other healthcare professionals) to report suspected child abuse to child protective
services. The nurse does not need to prove abuse; suspicion is sufficient. The report should be made promptly, and the nurse is
legally protected from retaliation. Delaying or failing to report is a violation of mandatory reporting laws. Test-taking strategy:
suspected child/elder abuse = report immediately to CPS/APS; document; do not investigate or notify suspected abuser first.
Q9. A nurse is preparing to discharge a client after hospitalization. Which action best ensures continuity of
care?
A. Providing written discharge instructions only
B. Coordinating follow-up appointments, reconciling medications, communicating with the next care
provider, and arranging home health services as needed [CORRECT]
C. Telling the client to follow up with their PCP when they feel better
D. Documenting the discharge in the medical record
Correct Answer: B
Rationale: Continuity of care requires comprehensive discharge planning: medication reconciliation, follow-up appointment
scheduling, communication with the next care provider (SBAR handoff), arranging home health services, and written/verbal
instructions. Inadequate transitions increase readmission risk. Test-taking strategy: discharge = "MADSTAR" - Meds,
Appointment, Services, Teaching, Advice, Return precautions.
Q10. A new graduate RN is orienting to a medical-surgical unit. Which client assignment is MOST
appropriate for the new graduate?
A. A client with septic shock on a norepinephrine drip
B. A stable client 3 days post-operative from an appendectomy requiring routine care [CORRECT]
C. A client with acute decompensated heart failure requiring IV nitroglycerin
D. A client 6 hours post-thyroidectomy requiring frequent airway assessment
Correct Answer: B
Rationale: New graduate RNs should be assigned stable clients with predictable needs. The stable post-appendectomy client is
appropriate. Septic shock on pressors, acute decompensated heart failure on IV nitroglycerin, and recent thyroidectomy with
airway risk all require advanced assessment skills and experience. Test-taking strategy: new graduate = stable + predictable +
low-acuity; avoid critical care, titrated drips, and high-risk assessments.
Q11. A nurse is caring for a client who asks, "Am I going to die?" The nurse's BEST therapeutic response is:
A. "Don't worry, everything will be fine."
B. "That must be a difficult thought to have. Can you tell me more about what you're feeling?"
[CORRECT]
Actual 70 Questions and Answers - ATI Proctored Standard ATI RN Fundamentals - 70 Items
