2026-2027 ATI RN LEADERSHIP
PROCTORED EXAM (NCLEX LEVEL)
Exam) 70 Multiple Choice Questions
with Verified Answers and Detailed
Explanations
1. A client involved in a motor vehicle crash refuses to provide a urine
specimen despite suspicion of drug use. What should the nurse do?
A. Force the client to comply
B. Document the refusal in the chart ✅
C. Notify law enforcement
D. Apply restraints
Explanation: Clients have the legal right to refuse care. Documentation
protects the nurse legally.
2. A nurse manager notices increased conflict among staff on the evening
shift. Which leadership style is most effective to address this situation?
A. Laissez-faire
B. Autocratic
C. Democratic ✅
D. Passive
Explanation: Democratic leadership encourages staff participation in
problem-solving, which can reduce conflict and improve team cohesion.
3. A charge nurse is making assignments for a medical-surgical unit. Which
patient should be assigned to the most experienced RN?
A. A 45-year-old with pneumonia requiring IV antibiotics
B. A 60-year-old post-operative day 2 hip replacement
C. A 30-year-old with diabetic ketoacidosis and unstable vital signs ✅
, D. A 70-year-old with stable angina
Explanation: The unstable patient (DKA with changing vitals) requires
advanced assessment and intervention skills.
4. A nurse witnesses another nurse taking a patient’s opioid medication for
personal use. What is the nurse’s legal responsibility?
A. Ignore the behavior to avoid conflict
B. Confront the nurse privately
C. Report the observation to the nurse manager immediately ✅
D. Call the police first
Explanation: Reporting to the nurse manager follows facility policy and
legal mandates for impaired practice; the manager then notifies the board
of nursing.
5. A unit is experiencing a high rate of catheter-associated urinary tract
infections (CAUTI). Which action demonstrates quality improvement?
A. Placing blame on individual nurses
B. Reviewing insertion and maintenance protocols with the team ✅
C. Increasing the number of catheters inserted
D. Discontinuing all urinary catheters regardless of need
Explanation: Quality improvement involves data review, education, and
process change, not punishment.
6. A nurse is preparing to delegate vital signs to a UAP. Which instruction is
most appropriate?
A. “Take vital signs on all patients and report anything abnormal.”
B. “Take vital signs on Mr. Jones in Room 212 and tell me if his blood
pressure is above 140/90.” ✅
C. “Take vital signs whenever you have time.”
D. “Take vital signs and document them; I’ll check later.”
Explanation: Delegation requires clear, specific instructions including what
to report and when.
7. A charge nurse is organizing care during a disaster drill with multiple
casualties. Which triage category should be assigned to a patient who is
breathing but unconscious with a weak pulse?
A. Immediate (red) ✅
, B. Delayed (yellow)
C. Minor (green)
D. Deceased (black)
Explanation: Unconscious with weak pulse indicates life-threatening but
salvageable condition – immediate (red) triage.
8. A nurse manager is evaluating staff compliance with hand hygiene. Which
type of power is most effective in promoting long-term behavior change?
A. Coercive power
B. Reward power
C. Legitimate power
D. Expert power ✅
Explanation: Expert power (based on knowledge and respect) leads to
internal motivation and sustained change.
9. A nurse receives a telephone order from a physician for a medication. What
is the most appropriate action?
A. Ask the physician to come to the unit to write the order
B. Write the order in the chart and sign “TO”
C. Write the order, read it back to the physician, and obtain verbal
confirmation ✅
D. Refuse to take telephone orders
Explanation: Read-back is a safety standard to prevent errors; the order
must then be signed by the physician within 24 hours.
10.A nurse is caring for a patient who refuses a blood transfusion for religious
reasons. The nurse’s action should be based on which ethical principle?
A. Beneficence
B. Nonmaleficence
C. Autonomy ✅
D. Justice
Explanation: Autonomy respects the patient’s right to make their own
healthcare decisions.
11.A staff nurse is asked to float to a neurology unit. The nurse has no
experience in neurology. What is the most appropriate response?
A. Refuse to float and go home
PROCTORED EXAM (NCLEX LEVEL)
Exam) 70 Multiple Choice Questions
with Verified Answers and Detailed
Explanations
1. A client involved in a motor vehicle crash refuses to provide a urine
specimen despite suspicion of drug use. What should the nurse do?
A. Force the client to comply
B. Document the refusal in the chart ✅
C. Notify law enforcement
D. Apply restraints
Explanation: Clients have the legal right to refuse care. Documentation
protects the nurse legally.
2. A nurse manager notices increased conflict among staff on the evening
shift. Which leadership style is most effective to address this situation?
A. Laissez-faire
B. Autocratic
C. Democratic ✅
D. Passive
Explanation: Democratic leadership encourages staff participation in
problem-solving, which can reduce conflict and improve team cohesion.
3. A charge nurse is making assignments for a medical-surgical unit. Which
patient should be assigned to the most experienced RN?
A. A 45-year-old with pneumonia requiring IV antibiotics
B. A 60-year-old post-operative day 2 hip replacement
C. A 30-year-old with diabetic ketoacidosis and unstable vital signs ✅
, D. A 70-year-old with stable angina
Explanation: The unstable patient (DKA with changing vitals) requires
advanced assessment and intervention skills.
4. A nurse witnesses another nurse taking a patient’s opioid medication for
personal use. What is the nurse’s legal responsibility?
A. Ignore the behavior to avoid conflict
B. Confront the nurse privately
C. Report the observation to the nurse manager immediately ✅
D. Call the police first
Explanation: Reporting to the nurse manager follows facility policy and
legal mandates for impaired practice; the manager then notifies the board
of nursing.
5. A unit is experiencing a high rate of catheter-associated urinary tract
infections (CAUTI). Which action demonstrates quality improvement?
A. Placing blame on individual nurses
B. Reviewing insertion and maintenance protocols with the team ✅
C. Increasing the number of catheters inserted
D. Discontinuing all urinary catheters regardless of need
Explanation: Quality improvement involves data review, education, and
process change, not punishment.
6. A nurse is preparing to delegate vital signs to a UAP. Which instruction is
most appropriate?
A. “Take vital signs on all patients and report anything abnormal.”
B. “Take vital signs on Mr. Jones in Room 212 and tell me if his blood
pressure is above 140/90.” ✅
C. “Take vital signs whenever you have time.”
D. “Take vital signs and document them; I’ll check later.”
Explanation: Delegation requires clear, specific instructions including what
to report and when.
7. A charge nurse is organizing care during a disaster drill with multiple
casualties. Which triage category should be assigned to a patient who is
breathing but unconscious with a weak pulse?
A. Immediate (red) ✅
, B. Delayed (yellow)
C. Minor (green)
D. Deceased (black)
Explanation: Unconscious with weak pulse indicates life-threatening but
salvageable condition – immediate (red) triage.
8. A nurse manager is evaluating staff compliance with hand hygiene. Which
type of power is most effective in promoting long-term behavior change?
A. Coercive power
B. Reward power
C. Legitimate power
D. Expert power ✅
Explanation: Expert power (based on knowledge and respect) leads to
internal motivation and sustained change.
9. A nurse receives a telephone order from a physician for a medication. What
is the most appropriate action?
A. Ask the physician to come to the unit to write the order
B. Write the order in the chart and sign “TO”
C. Write the order, read it back to the physician, and obtain verbal
confirmation ✅
D. Refuse to take telephone orders
Explanation: Read-back is a safety standard to prevent errors; the order
must then be signed by the physician within 24 hours.
10.A nurse is caring for a patient who refuses a blood transfusion for religious
reasons. The nurse’s action should be based on which ethical principle?
A. Beneficence
B. Nonmaleficence
C. Autonomy ✅
D. Justice
Explanation: Autonomy respects the patient’s right to make their own
healthcare decisions.
11.A staff nurse is asked to float to a neurology unit. The nurse has no
experience in neurology. What is the most appropriate response?
A. Refuse to float and go home
