ATI Leadership Proctored Exam V1–V3 (2026/2027) –
NGN-Style Qs, Scenarios, Answers & Rationales
Nursing Leadership & Management (Next Generation NCLEX Focus) | Key Domains: Leadership &
Management Principles, Prioritization & Delegation, Ethical & Legal Issues, Quality Improvement &
Patient Safety, Conflict Resolution & Collaboration, Healthcare Systems & Policy, and Professional
Identity | Expert-Aligned Structure | Multi-Version Exam Format
Introduction
This structured ATI Leadership Proctored Exam for 2026/2027 provides three distinct versions of
Next Generation NCLEX-style scenario questions with correct answers and rationales. It emphasizes
clinical judgment in management situations, applying leadership theories, making safe staffing and
delegation decisions, navigating ethical dilemmas, and utilizing quality improvement processes to
enhance patient care and team performance.
Exam Structure:
• Version 1: (60 NGN-STYLE SCENARIOS)
• Version 2: (60 NGN-STYLE SCENARIOS)
• Version 3: (60 NGN-STYLE SCENARIOS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the leadership or management principle applied, the clinical judgment used for
prioritization or delegation, the ethical or legal reasoning, the quality improvement strategy, and
why alternative options demonstrate poor judgment, unsafe practice, or ineffective leadership.
ATI Leadership Proctored Exam – Version 1
1. The charge nurse is assigning clients for the shift. Which client is most appropriate to
assign to a licensed practical nurse (LPN)?
A. A client with heart failure who is receiving an IV infusion of dobutamine
B. A client who is 12 hours postoperative following a total hip arthroplasty
C. A client who has a new diagnosis of pulmonary embolism and is on heparin infusion
, D. A client admitted with diabetic ketoacidosis requiring hourly blood glucose checks
B. A client who is 12 hours postoperative following a total hip arthroplasty
An LPN may care for stable postoperative clients with predictable outcomes. Clients on IV vasoactive
drips (A), anticoagulants (C), or with unstable metabolic conditions (D) require RN-level assessment
and intervention. The hip arthroplasty client is stable and within LPN scope under RN supervision.
2. A nurse manager is implementing a new electronic health record (EHR) system. Several
staff members express anxiety about the change. What should the nurse manager do first?
A. Mandate attendance at training sessions
B. Explain the legal requirement for EHR use
C. Hold a staff meeting to discuss concerns and provide education
D. Assign super-users to monitor compliance
C. Hold a staff meeting to discuss concerns and provide education
Effective change management begins with communication and addressing staff fears. Lewin’s change
theory emphasizes “unfreezing” by creating awareness and reducing resistance. Mandating (A), citing
laws (B), or monitoring (D) without buy-in increases anxiety and reduces adoption.
3. A client with decisional capacity refuses a blood transfusion for religious reasons. The
family insists the nurse proceed. What is the nurse’s best action?
A. Administer the transfusion to prevent death
B. Respect the client’s autonomy and notify the provider
C. Ask the family to sign consent as next of kin
D. Delay until the client loses capacity
B. Respect the client’s autonomy and notify the provider
,Competent adults have the legal right to refuse treatment under the ethical principle of autonomy and
Common Law. The nurse must honor this decision and inform the provider for documentation and
possible ethics consultation. Administering without consent (A) is battery. Family cannot override (C).
Delaying (D) is unethical.
ATI Leadership Proctored Exam – Version 2
61. A newly licensed RN is assigned to care for a client with a chest tube. The nurse states,
“I’ve never managed one before.” What should the charge nurse do?
A. Reassign the client to a more experienced nurse
B. Provide direct supervision and assess competency
C. Give the nurse the procedure manual and allow independent care
D. Ask the nurse to observe another nurse first
B. Provide direct supervision and assess competency
Per NCSBN guidelines, delegation to a new nurse requires instruction, supervision, and evaluation of
competence. The charge nurse must ensure safety through direct oversight. Reassigning (A) limits
learning. Independent care (C) is unsafe. Observation (D) is insufficient without hands-on assessment.
62. A unit has a high rate of central line-associated bloodstream infections (CLABSI). What is
the first step in a quality improvement project?
A. Punish staff who violate protocol
B. Benchmark against national data
C. Form a multidisciplinary team
D. Implement a new central line kit
C. Form a multidisciplinary team
, Quality improvement begins with team formation (IHI Model). A multidisciplinary team (nursing,
medicine, infection control) ensures diverse perspectives and shared ownership. Benchmarking (B) and
new kits (D) come later. Punishment (A) undermines a just culture.
63. Two nurses are in conflict over scheduling fairness. One says, “You always get weekends
off.” What should the manager do first?
A. Implement a computerized scheduling system
B. Meet with both nurses to understand their perspectives
C. Assign weekends based on seniority
D. Require them to resolve it without management
B. Meet with both nurses to understand their perspectives
Collaborative conflict resolution starts with active listening to identify root causes (e.g., perceived
inequity, family needs). This builds trust and mutual solutions. Imposing systems (A, C) or avoidance
(D) fails to address underlying issues and may escalate tension.
ATI Leadership Proctored Exam – Version 3
121. A nurse witnesses a colleague taking narcotics from the medication cart. What is the
nurse’s legal and ethical duty?
A. Confront the colleague privately
B. Report to the supervisor and state board of nursing
C. Document the incident in the client’s medical record
D. Wait for repeated incidents before acting
B. Report to the supervisor and state board of nursing
Nurses have a legal and ethical duty to report diversion under state Nurse Practice Acts. Reporting
protects patients and upholds professional integrity. Confrontation (A) or delay (D) enables harm.
Client records (C) are not for staff misconduct.
NGN-Style Qs, Scenarios, Answers & Rationales
Nursing Leadership & Management (Next Generation NCLEX Focus) | Key Domains: Leadership &
Management Principles, Prioritization & Delegation, Ethical & Legal Issues, Quality Improvement &
Patient Safety, Conflict Resolution & Collaboration, Healthcare Systems & Policy, and Professional
Identity | Expert-Aligned Structure | Multi-Version Exam Format
Introduction
This structured ATI Leadership Proctored Exam for 2026/2027 provides three distinct versions of
Next Generation NCLEX-style scenario questions with correct answers and rationales. It emphasizes
clinical judgment in management situations, applying leadership theories, making safe staffing and
delegation decisions, navigating ethical dilemmas, and utilizing quality improvement processes to
enhance patient care and team performance.
Exam Structure:
• Version 1: (60 NGN-STYLE SCENARIOS)
• Version 2: (60 NGN-STYLE SCENARIOS)
• Version 3: (60 NGN-STYLE SCENARIOS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the leadership or management principle applied, the clinical judgment used for
prioritization or delegation, the ethical or legal reasoning, the quality improvement strategy, and
why alternative options demonstrate poor judgment, unsafe practice, or ineffective leadership.
ATI Leadership Proctored Exam – Version 1
1. The charge nurse is assigning clients for the shift. Which client is most appropriate to
assign to a licensed practical nurse (LPN)?
A. A client with heart failure who is receiving an IV infusion of dobutamine
B. A client who is 12 hours postoperative following a total hip arthroplasty
C. A client who has a new diagnosis of pulmonary embolism and is on heparin infusion
, D. A client admitted with diabetic ketoacidosis requiring hourly blood glucose checks
B. A client who is 12 hours postoperative following a total hip arthroplasty
An LPN may care for stable postoperative clients with predictable outcomes. Clients on IV vasoactive
drips (A), anticoagulants (C), or with unstable metabolic conditions (D) require RN-level assessment
and intervention. The hip arthroplasty client is stable and within LPN scope under RN supervision.
2. A nurse manager is implementing a new electronic health record (EHR) system. Several
staff members express anxiety about the change. What should the nurse manager do first?
A. Mandate attendance at training sessions
B. Explain the legal requirement for EHR use
C. Hold a staff meeting to discuss concerns and provide education
D. Assign super-users to monitor compliance
C. Hold a staff meeting to discuss concerns and provide education
Effective change management begins with communication and addressing staff fears. Lewin’s change
theory emphasizes “unfreezing” by creating awareness and reducing resistance. Mandating (A), citing
laws (B), or monitoring (D) without buy-in increases anxiety and reduces adoption.
3. A client with decisional capacity refuses a blood transfusion for religious reasons. The
family insists the nurse proceed. What is the nurse’s best action?
A. Administer the transfusion to prevent death
B. Respect the client’s autonomy and notify the provider
C. Ask the family to sign consent as next of kin
D. Delay until the client loses capacity
B. Respect the client’s autonomy and notify the provider
,Competent adults have the legal right to refuse treatment under the ethical principle of autonomy and
Common Law. The nurse must honor this decision and inform the provider for documentation and
possible ethics consultation. Administering without consent (A) is battery. Family cannot override (C).
Delaying (D) is unethical.
ATI Leadership Proctored Exam – Version 2
61. A newly licensed RN is assigned to care for a client with a chest tube. The nurse states,
“I’ve never managed one before.” What should the charge nurse do?
A. Reassign the client to a more experienced nurse
B. Provide direct supervision and assess competency
C. Give the nurse the procedure manual and allow independent care
D. Ask the nurse to observe another nurse first
B. Provide direct supervision and assess competency
Per NCSBN guidelines, delegation to a new nurse requires instruction, supervision, and evaluation of
competence. The charge nurse must ensure safety through direct oversight. Reassigning (A) limits
learning. Independent care (C) is unsafe. Observation (D) is insufficient without hands-on assessment.
62. A unit has a high rate of central line-associated bloodstream infections (CLABSI). What is
the first step in a quality improvement project?
A. Punish staff who violate protocol
B. Benchmark against national data
C. Form a multidisciplinary team
D. Implement a new central line kit
C. Form a multidisciplinary team
, Quality improvement begins with team formation (IHI Model). A multidisciplinary team (nursing,
medicine, infection control) ensures diverse perspectives and shared ownership. Benchmarking (B) and
new kits (D) come later. Punishment (A) undermines a just culture.
63. Two nurses are in conflict over scheduling fairness. One says, “You always get weekends
off.” What should the manager do first?
A. Implement a computerized scheduling system
B. Meet with both nurses to understand their perspectives
C. Assign weekends based on seniority
D. Require them to resolve it without management
B. Meet with both nurses to understand their perspectives
Collaborative conflict resolution starts with active listening to identify root causes (e.g., perceived
inequity, family needs). This builds trust and mutual solutions. Imposing systems (A, C) or avoidance
(D) fails to address underlying issues and may escalate tension.
ATI Leadership Proctored Exam – Version 3
121. A nurse witnesses a colleague taking narcotics from the medication cart. What is the
nurse’s legal and ethical duty?
A. Confront the colleague privately
B. Report to the supervisor and state board of nursing
C. Document the incident in the client’s medical record
D. Wait for repeated incidents before acting
B. Report to the supervisor and state board of nursing
Nurses have a legal and ethical duty to report diversion under state Nurse Practice Acts. Reporting
protects patients and upholds professional integrity. Confrontation (A) or delay (D) enables harm.
Client records (C) are not for staff misconduct.
