CHAMBERLAIN COLLEGE OF NURSING — RN ATI LEADERSHIP COMPREHENSIVE FINAL EXAM FALL 2026
CHAMBERLAIN COLLEGE OF NURSING
RN ATI LEADERSHIP AND MANAGEMENT COMPREHENSIVE FINAL EXAM — FALL 2026
Course: NR-446 Leadership & Management Total Questions: 150 Multiple Choice
Exam Form: Comprehensive Final (NGN Edition) Time Allowed: 180 Minutes
Student Name: ___________________________ Date: ______________
EXAMINATION INSTRUCTIONS: Select the best answer (A, B, C, or D) for each item. Correct answers are indicated with a green tick (✔)
and complete evidence-based rationales are highlighted in yellow for review and self-assessment.
Question 1 of 150
A nurse manager is reviewing the principles of delegation with a new charge nurse. Which of the following
statements by the new charge nurse indicates an understanding of the five rights of delegation?
[ ] A. I can delegate blood transfusions to LPNs as long as an RN co-signs.
[ ] B. I should allow the delegatee to determine their own level of supervision required.
[ ] C. I must delegate initial patient assessments to experienced assistive personnel.
[✔] D. I must ensure the right task, right circumstance, right person, right direction/communication, and right supervision.
(Correct Answer ✔)
Yellow Rationale Review: The five rights of delegation (right task, right circumstance, right person, right direction/communication, right
supervision/evaluation) are foundational to safe nursing practice and ensure patient safety.
Question 2 of 150
A charge nurse on a medical-surgical unit is planning care assignments for a client with a new diagnosis of diabetes
mellitus. Which of the following tasks should the charge nurse assign to a licensed practical nurse (LPN)?
[✔] A. Administering subcutaneous insulin to a stable client according to a sliding scale. (Correct Answer ✔)
[ ] B. Performing the comprehensive initial admission assessment and nursing diagnosis.
[ ] C. Evaluating complex blood glucose trends to adjust baseline basal insulin dosing.
[ ] D. Developing the initial comprehensive discharge teaching plan for insulin administration.
Yellow Rationale Review: LPNs can administer subcutaneous insulin to stable clients with predictable outcomes. Initial teaching, initial
assessment, and complex clinical evaluation require RN scope of practice.
Question 3 of 150
A nurse manager observes a newly licensed graduate RN caring for a client with a chest tube drainage system.
Which of the following actions by the graduate RN requires immediate intervention by the manager? (Select all that
apply / Select incorrect actions)
[✔] A. Clamping the chest tube during client transport and emptying the drainage collection chamber without wearing
gloves. (Correct Answer ✔)
[ ] B. Keeping the chest tube drainage system below the level of the client's chest at all times.
[ ] C. Checking the water seal chamber for continuous bubbling and reporting it to the provider.
[ ] D. Documenting the volume and color of drainage at the end of each shift.
Yellow Rationale Review: Chest tubes should never be clamped during transport because it can cause a tension pneumothorax.
Standard precautions require gloves when handling drainage systems.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 1
,CHAMBERLAIN COLLEGE OF NURSING — RN ATI LEADERSHIP COMPREHENSIVE FINAL EXAM FALL 2026
Question 4 of 150
A charge nurse discovers a staff nurse administering a packed red blood cell transfusion to an alert client without
having obtained written informed consent. Which of the following actions should the charge nurse take first?
[ ] A. Ask the provider to speak with the client about the consent requirement.
[ ] B. Complete an incident report and notify risk management at the end of the shift.
[✔] C. Stop the blood transfusion immediately. (Correct Answer ✔)
[ ] D. Instruct the staff nurse to obtain consent after the transfusion finishes.
Yellow Rationale Review: Patient safety and legal rights are paramount. Administering blood without consent is a legal violation
(battery); stopping the procedure immediately protects the client.
Question 5 of 150
A nurse manager is reviewing disaster triage principles following a mass casualty incident. Which of the following
clients should receive a black triage tag (expectant)?
[ ] A. A client with deep partial-thickness burns covering 15% of the body.
[ ] B. A client with a sucking chest wound and acute respiratory distress.
[ ] C. A client with an open fracture of the right femur with active bleeding controlled by a pressure dressing.
[✔] D. A client with agonal respirations and an absence of a palpable carotid pulse. (Correct Answer ✔)
Yellow Rationale Review: A black tag indicates expectant death where resources cannot save the client. Agonal breathing and absent
carotid pulse signify impending/actual death in mass casualty conditions.
Question 6 of 150
A quality improvement team reviews unit fall data and notes that 80% of falls occurred on night shift in rooms
farthest from the nurses' station. After implementing hourly rounding, falls decreased by 50%. Which of the following
actions should the team take next?
[ ] A. Request additional full-time nursing staff for night shifts.
[ ] B. Discontinue hourly rounding immediately since the problem is resolved.
[✔] C. Present the outcome data at the unit council meeting and re-evaluate fall rates in one month. (Correct Answer ✔)
[ ] D. Install motion-sensor floor mats in all unit client rooms.
Yellow Rationale Review: Sustaining quality improvement gains requires sharing outcomes with staff to reinforce positive behavior and
conducting ongoing data audits to confirm sustained compliance.
Question 7 of 150
A nurse is delegating care tasks to an LPN and an assistive personnel (AP). Which of the following tasks are
appropriate to delegate to the LPN?
[ ] A. Formulating the initial plan of care for a newly admitted client.
[ ] B. Administering intravenous push bolus morphine for severe acute pain.
[✔] C. Suctioning a client's stable tracheostomy and changing a sterile dressing on a stage 3 pressure injury. (Correct
Answer ✔)
[ ] D. Obtaining a clean-catch urine specimen from an ambulatory client.
Yellow Rationale Review: LPN scope includes tracheostomy suctioning for stable clients and sterile dressing changes on chronic
wounds. IV push narcotics and initial care plans require RN scope.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 2
,CHAMBERLAIN COLLEGE OF NURSING — RN ATI LEADERSHIP COMPREHENSIVE FINAL EXAM FALL 2026
Question 8 of 150
A charge nurse is managing a 28-bed medical-surgical unit staffed by four RNs, one LPN, and two APs. Which of the
following clients should be assigned to the LPN?
[✔] A. A stable client with a urinary catheter who requires routine catheter care and strict I&O; monitoring. (Correct Answer
✔)
[ ] B. A client with severe diabetic ketoacidosis receiving a continuous insulin infusion.
[ ] C. A newly admitted client transferred from the ICU following a severe acute myocardial infarction.
[ ] D. A post-operative client 2 hours post-thyroidectomy reporting tingling around the mouth.
Yellow Rationale Review: LPNs are assigned to stable clients with predictable outcomes. Unstable, post-surgical assessment, or
continuous IV titration clients require RN care.
Question 9 of 150
A nurse manager notices ongoing interpersonal conflict between two staff nurses regarding task completion and
documentation. Which of the following conflict-resolution strategies should the manager utilize first?
[ ] A. Reassign one nurse to a different shift to avoid further contact.
[✔] B. Facilitate a collaborative, interest-based negotiation session with both nurses. (Correct Answer ✔)
[ ] C. Force both nurses to adhere strictly to the schedule without input.
[ ] D. Ignore the disagreement and allow the nurses to settle it independently.
Yellow Rationale Review: Collaboration (win-win) brings conflicting parties together to discuss underlying concerns, identify common
goals, and reach a sustainable agreement.
Question 10 of 150
A medical-surgical RN is floated to an intensive care unit (ICU) for the first time. The nurse expresses anxiety
regarding caring for a client on a mechanical ventilator. Which of the following actions should the ICU charge nurse
take?
[ ] A. Send the float RN back to their home unit and work short-staffed.
[ ] B. Require the float RN to assume full independent responsibility for two ventilated clients.
[✔] C. Assign the float RN a stable client and pair them with an experienced ICU nurse for guidance. (Correct Answer ✔)
[ ] D. Report the float RN to the nursing supervisor for refusing an assignment.
Yellow Rationale Review: Client safety requires matching client acuity with nurse competency. Pairing a float nurse with an experienced
preceptor ensures safe practice and adequate support.
Question 11 of 150
A nurse manager conducts a root cause analysis (RCA) following a sentinel event involving a medication
administration error. Which of the following system factors should be addressed to prevent future occurrences?
[ ] A. Mandating that nurses administer medications without double-checking patient identifiers.
[✔] B. Implementing barcode medication scanning and establishing a quiet zone for medication preparation. (Correct
Answer ✔)
[ ] C. Terminating the nurse involved in the error immediately without investigation.
[ ] D. Increasing the number of oral medications administered per hour.
Yellow Rationale Review: Root cause analysis focuses on system flaws (e.g., distractions, lack of technology) rather than individual
blame to design safer clinical processes.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 3
, CHAMBERLAIN COLLEGE OF NURSING — RN ATI LEADERSHIP COMPREHENSIVE FINAL EXAM FALL 2026
Question 12 of 150
A nurse manager is preparing a unit operating budget under a prospective payment system based on
Diagnosis-Related Groups (DRGs). How does this system impact healthcare delivery?
[ ] A. Insurance reimbursement increases automatically the longer a client remains hospitalized.
[ ] B. Hospitals are reimbursed for all itemized costs incurred during a client's stay regardless of total amount.
[✔] C. Facilities receive a fixed reimbursement rate per diagnosis, incentivizing efficient, cost-effective care and reduced
length of stay. (Correct Answer ✔)
[ ] D. Providers can bill unlimited fees for each daily diagnostic test performed.
Yellow Rationale Review: DRGs establish set payment amounts based on diagnosis regardless of actual hospital expenses, driving
institutions to eliminate unnecessary costs and streamline discharge.
Question 13 of 150
A charge nurse overhears an assistive personnel (AP) telling an agitated client, 'If you get out of bed one more time, I
will tie you down in restraints.' Which of the following actions should the charge nurse take first?
[✔] A. Intervene immediately, stop the AP, and speak with them privately regarding the threat. (Correct Answer ✔)
[ ] B. Ignore the comment as long as physical restraints were not applied.
[ ] C. Wait until the shift performance evaluation to document the statement.
[ ] D. Obtain a prescription for wrist restraints from the provider immediately.
Yellow Rationale Review: The AP's threat constitutes assault and a violation of client rights. The charge nurse must intervene
immediately to protect the client and address the non-professional behavior.
Question 14 of 150
Following the implementation of a nurse-driven urinary catheter removal protocol, a hospital unit's CAUTI rate
decreased from 4.2 to 1.8 per 1,000 catheter days. What is the priority next step for the quality improvement nurse?
[ ] A. Remove all urinary catheters from the unit stock supplies.
[ ] B. Formulate a new committee to replace the current protocol.
[ ] C. Discontinue monitoring catheter days since the protocol was successful.
[✔] D. Sustain the gains by conducting ongoing audits, reinforcing staff education, and updating unit policy. (Correct
Answer ✔)
Yellow Rationale Review: The final stage of the quality improvement cycle is sustaining improvements through continuous monitoring,
auditing, and policy integration.
Question 15 of 150
A charge nurse is making shift assignments on a surgical floor. Which of the following clients is most appropriate to
assign to a newly licensed RN working with a preceptor?
[ ] A. A client exhibiting sudden neurological changes and suspected acute stroke.
[ ] B. A client with severe septic shock receiving multiple continuous vasopressor infusions.
[ ] C. A client who is 1 hour post-operative following a total laryngectomy with excessive tracheal bleeding.
[✔] D. A client who is 2 days post-operative following an uncomplicated laparoscopic cholecystectomy preparing for
discharge. (Correct Answer ✔)
Yellow Rationale Review: Newly licensed nurses off orientation should care for stable clients with predictable outcomes to build clinical
confidence before managing high-acuity cases.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 4
CHAMBERLAIN COLLEGE OF NURSING
RN ATI LEADERSHIP AND MANAGEMENT COMPREHENSIVE FINAL EXAM — FALL 2026
Course: NR-446 Leadership & Management Total Questions: 150 Multiple Choice
Exam Form: Comprehensive Final (NGN Edition) Time Allowed: 180 Minutes
Student Name: ___________________________ Date: ______________
EXAMINATION INSTRUCTIONS: Select the best answer (A, B, C, or D) for each item. Correct answers are indicated with a green tick (✔)
and complete evidence-based rationales are highlighted in yellow for review and self-assessment.
Question 1 of 150
A nurse manager is reviewing the principles of delegation with a new charge nurse. Which of the following
statements by the new charge nurse indicates an understanding of the five rights of delegation?
[ ] A. I can delegate blood transfusions to LPNs as long as an RN co-signs.
[ ] B. I should allow the delegatee to determine their own level of supervision required.
[ ] C. I must delegate initial patient assessments to experienced assistive personnel.
[✔] D. I must ensure the right task, right circumstance, right person, right direction/communication, and right supervision.
(Correct Answer ✔)
Yellow Rationale Review: The five rights of delegation (right task, right circumstance, right person, right direction/communication, right
supervision/evaluation) are foundational to safe nursing practice and ensure patient safety.
Question 2 of 150
A charge nurse on a medical-surgical unit is planning care assignments for a client with a new diagnosis of diabetes
mellitus. Which of the following tasks should the charge nurse assign to a licensed practical nurse (LPN)?
[✔] A. Administering subcutaneous insulin to a stable client according to a sliding scale. (Correct Answer ✔)
[ ] B. Performing the comprehensive initial admission assessment and nursing diagnosis.
[ ] C. Evaluating complex blood glucose trends to adjust baseline basal insulin dosing.
[ ] D. Developing the initial comprehensive discharge teaching plan for insulin administration.
Yellow Rationale Review: LPNs can administer subcutaneous insulin to stable clients with predictable outcomes. Initial teaching, initial
assessment, and complex clinical evaluation require RN scope of practice.
Question 3 of 150
A nurse manager observes a newly licensed graduate RN caring for a client with a chest tube drainage system.
Which of the following actions by the graduate RN requires immediate intervention by the manager? (Select all that
apply / Select incorrect actions)
[✔] A. Clamping the chest tube during client transport and emptying the drainage collection chamber without wearing
gloves. (Correct Answer ✔)
[ ] B. Keeping the chest tube drainage system below the level of the client's chest at all times.
[ ] C. Checking the water seal chamber for continuous bubbling and reporting it to the provider.
[ ] D. Documenting the volume and color of drainage at the end of each shift.
Yellow Rationale Review: Chest tubes should never be clamped during transport because it can cause a tension pneumothorax.
Standard precautions require gloves when handling drainage systems.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 1
,CHAMBERLAIN COLLEGE OF NURSING — RN ATI LEADERSHIP COMPREHENSIVE FINAL EXAM FALL 2026
Question 4 of 150
A charge nurse discovers a staff nurse administering a packed red blood cell transfusion to an alert client without
having obtained written informed consent. Which of the following actions should the charge nurse take first?
[ ] A. Ask the provider to speak with the client about the consent requirement.
[ ] B. Complete an incident report and notify risk management at the end of the shift.
[✔] C. Stop the blood transfusion immediately. (Correct Answer ✔)
[ ] D. Instruct the staff nurse to obtain consent after the transfusion finishes.
Yellow Rationale Review: Patient safety and legal rights are paramount. Administering blood without consent is a legal violation
(battery); stopping the procedure immediately protects the client.
Question 5 of 150
A nurse manager is reviewing disaster triage principles following a mass casualty incident. Which of the following
clients should receive a black triage tag (expectant)?
[ ] A. A client with deep partial-thickness burns covering 15% of the body.
[ ] B. A client with a sucking chest wound and acute respiratory distress.
[ ] C. A client with an open fracture of the right femur with active bleeding controlled by a pressure dressing.
[✔] D. A client with agonal respirations and an absence of a palpable carotid pulse. (Correct Answer ✔)
Yellow Rationale Review: A black tag indicates expectant death where resources cannot save the client. Agonal breathing and absent
carotid pulse signify impending/actual death in mass casualty conditions.
Question 6 of 150
A quality improvement team reviews unit fall data and notes that 80% of falls occurred on night shift in rooms
farthest from the nurses' station. After implementing hourly rounding, falls decreased by 50%. Which of the following
actions should the team take next?
[ ] A. Request additional full-time nursing staff for night shifts.
[ ] B. Discontinue hourly rounding immediately since the problem is resolved.
[✔] C. Present the outcome data at the unit council meeting and re-evaluate fall rates in one month. (Correct Answer ✔)
[ ] D. Install motion-sensor floor mats in all unit client rooms.
Yellow Rationale Review: Sustaining quality improvement gains requires sharing outcomes with staff to reinforce positive behavior and
conducting ongoing data audits to confirm sustained compliance.
Question 7 of 150
A nurse is delegating care tasks to an LPN and an assistive personnel (AP). Which of the following tasks are
appropriate to delegate to the LPN?
[ ] A. Formulating the initial plan of care for a newly admitted client.
[ ] B. Administering intravenous push bolus morphine for severe acute pain.
[✔] C. Suctioning a client's stable tracheostomy and changing a sterile dressing on a stage 3 pressure injury. (Correct
Answer ✔)
[ ] D. Obtaining a clean-catch urine specimen from an ambulatory client.
Yellow Rationale Review: LPN scope includes tracheostomy suctioning for stable clients and sterile dressing changes on chronic
wounds. IV push narcotics and initial care plans require RN scope.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 2
,CHAMBERLAIN COLLEGE OF NURSING — RN ATI LEADERSHIP COMPREHENSIVE FINAL EXAM FALL 2026
Question 8 of 150
A charge nurse is managing a 28-bed medical-surgical unit staffed by four RNs, one LPN, and two APs. Which of the
following clients should be assigned to the LPN?
[✔] A. A stable client with a urinary catheter who requires routine catheter care and strict I&O; monitoring. (Correct Answer
✔)
[ ] B. A client with severe diabetic ketoacidosis receiving a continuous insulin infusion.
[ ] C. A newly admitted client transferred from the ICU following a severe acute myocardial infarction.
[ ] D. A post-operative client 2 hours post-thyroidectomy reporting tingling around the mouth.
Yellow Rationale Review: LPNs are assigned to stable clients with predictable outcomes. Unstable, post-surgical assessment, or
continuous IV titration clients require RN care.
Question 9 of 150
A nurse manager notices ongoing interpersonal conflict between two staff nurses regarding task completion and
documentation. Which of the following conflict-resolution strategies should the manager utilize first?
[ ] A. Reassign one nurse to a different shift to avoid further contact.
[✔] B. Facilitate a collaborative, interest-based negotiation session with both nurses. (Correct Answer ✔)
[ ] C. Force both nurses to adhere strictly to the schedule without input.
[ ] D. Ignore the disagreement and allow the nurses to settle it independently.
Yellow Rationale Review: Collaboration (win-win) brings conflicting parties together to discuss underlying concerns, identify common
goals, and reach a sustainable agreement.
Question 10 of 150
A medical-surgical RN is floated to an intensive care unit (ICU) for the first time. The nurse expresses anxiety
regarding caring for a client on a mechanical ventilator. Which of the following actions should the ICU charge nurse
take?
[ ] A. Send the float RN back to their home unit and work short-staffed.
[ ] B. Require the float RN to assume full independent responsibility for two ventilated clients.
[✔] C. Assign the float RN a stable client and pair them with an experienced ICU nurse for guidance. (Correct Answer ✔)
[ ] D. Report the float RN to the nursing supervisor for refusing an assignment.
Yellow Rationale Review: Client safety requires matching client acuity with nurse competency. Pairing a float nurse with an experienced
preceptor ensures safe practice and adequate support.
Question 11 of 150
A nurse manager conducts a root cause analysis (RCA) following a sentinel event involving a medication
administration error. Which of the following system factors should be addressed to prevent future occurrences?
[ ] A. Mandating that nurses administer medications without double-checking patient identifiers.
[✔] B. Implementing barcode medication scanning and establishing a quiet zone for medication preparation. (Correct
Answer ✔)
[ ] C. Terminating the nurse involved in the error immediately without investigation.
[ ] D. Increasing the number of oral medications administered per hour.
Yellow Rationale Review: Root cause analysis focuses on system flaws (e.g., distractions, lack of technology) rather than individual
blame to design safer clinical processes.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 3
, CHAMBERLAIN COLLEGE OF NURSING — RN ATI LEADERSHIP COMPREHENSIVE FINAL EXAM FALL 2026
Question 12 of 150
A nurse manager is preparing a unit operating budget under a prospective payment system based on
Diagnosis-Related Groups (DRGs). How does this system impact healthcare delivery?
[ ] A. Insurance reimbursement increases automatically the longer a client remains hospitalized.
[ ] B. Hospitals are reimbursed for all itemized costs incurred during a client's stay regardless of total amount.
[✔] C. Facilities receive a fixed reimbursement rate per diagnosis, incentivizing efficient, cost-effective care and reduced
length of stay. (Correct Answer ✔)
[ ] D. Providers can bill unlimited fees for each daily diagnostic test performed.
Yellow Rationale Review: DRGs establish set payment amounts based on diagnosis regardless of actual hospital expenses, driving
institutions to eliminate unnecessary costs and streamline discharge.
Question 13 of 150
A charge nurse overhears an assistive personnel (AP) telling an agitated client, 'If you get out of bed one more time, I
will tie you down in restraints.' Which of the following actions should the charge nurse take first?
[✔] A. Intervene immediately, stop the AP, and speak with them privately regarding the threat. (Correct Answer ✔)
[ ] B. Ignore the comment as long as physical restraints were not applied.
[ ] C. Wait until the shift performance evaluation to document the statement.
[ ] D. Obtain a prescription for wrist restraints from the provider immediately.
Yellow Rationale Review: The AP's threat constitutes assault and a violation of client rights. The charge nurse must intervene
immediately to protect the client and address the non-professional behavior.
Question 14 of 150
Following the implementation of a nurse-driven urinary catheter removal protocol, a hospital unit's CAUTI rate
decreased from 4.2 to 1.8 per 1,000 catheter days. What is the priority next step for the quality improvement nurse?
[ ] A. Remove all urinary catheters from the unit stock supplies.
[ ] B. Formulate a new committee to replace the current protocol.
[ ] C. Discontinue monitoring catheter days since the protocol was successful.
[✔] D. Sustain the gains by conducting ongoing audits, reinforcing staff education, and updating unit policy. (Correct
Answer ✔)
Yellow Rationale Review: The final stage of the quality improvement cycle is sustaining improvements through continuous monitoring,
auditing, and policy integration.
Question 15 of 150
A charge nurse is making shift assignments on a surgical floor. Which of the following clients is most appropriate to
assign to a newly licensed RN working with a preceptor?
[ ] A. A client exhibiting sudden neurological changes and suspected acute stroke.
[ ] B. A client with severe septic shock receiving multiple continuous vasopressor infusions.
[ ] C. A client who is 1 hour post-operative following a total laryngectomy with excessive tracheal bleeding.
[✔] D. A client who is 2 days post-operative following an uncomplicated laparoscopic cholecystectomy preparing for
discharge. (Correct Answer ✔)
Yellow Rationale Review: Newly licensed nurses off orientation should care for stable clients with predictable outcomes to build clinical
confidence before managing high-acuity cases.
CONFIDENTIAL — OFFICIAL ATI RN LEADERSHIP EXAMINATION Page 4
