COMPREHENSIVE NURSING EXAMINATION SERIES
ATI CMS Fundamentals
Exam Questions & Answers
with Comprehensive Rationales
Graded A+ | 2026–2027 Edition
Aligned with 2026–2027 ATI CMS Fundamentals Competencies
150 7 A+
Total Questions ATI Content Sections Graded Rationales
EXAM CONTENT BLUEPRINT
COGNITIVE LEVEL DISTRIBUTION
Section 1: Safe, Effective Care Environment (Q1–30)
25% Recall | 55% Application | 20% Analysis
Section 2: Health Promotion and Maintenance (Q31–50)
Section 3: Psychosocial Integrity (Q51–65)
Section 4: Basic Care and Comfort (Q66–85)
Section 5: Pharmacological and Parenteral Therapies (Q86–110)
Section 6: Reduction of Risk Potential (Q111–130)
Section 7: Physiological Adaptation (Q131–150)
ATI CMS Fundamentals | Comprehensive Rationales | Evidence-Based Practice
Aligned with ATI Testing Standards and NCLEX Test Plan Competencies
,ATI CMS Fundamentals Exam | Questions & Answers with Rationales | 2026–2027 | Graded A+
SECTION 1
Safe, Effective Care Environment
Safe, Effective Care Environment (Q1–Q30)
Q1. A 78-year-old client with stage IV ovarian cancer tells the nurse, 'I do not want any more chemotherapy or heroic
measures if my heart stops.' The client's daughter insists the mother 'would want everything done.' Which action by the
nurse is most appropriate?
A. Follow the daughter's wishes because she is the closest living relative.
B. Continue chemotherapy as ordered until the client signs a formal refusal form.
C. Advocate for the client's autonomy by ensuring an advance directive is documented and communicated to
the team. [CORRECT]
D. Transfer the client to the ICU for closer monitoring.
Correct Answer: C
Rationale
The Patient Self-Determination Act establishes the client's right to make autonomous health care decisions and to have advance
directives honored, regardless of family opposition. The nurse's role as client advocate is to ensure the client's expressed wishes
are documented and shared with the interdisciplinary team. The daughter cannot override a competent client's decision (rules
out A); continuing unwanted treatment violates informed consent (rules out B); ICU transfer is not indicated by the client's
request (rules out D).
Q2. A client is scheduled for an elective cholecystectomy in the morning. The surgeon hands the client a consent form
and leaves the room. The client tells the nurse, 'I really don't understand what they're going to do.' What is the nurse's best
action?
A. Witness the signature and reassure the client that the surgeon knows best.
B. Notify the surgeon that informed consent has not been obtained and request the surgeon return to explain
the procedure. [CORRECT]
C. Explain the surgical procedure, risks, and benefits to the client, then witness the signature.
D. Cancel the surgery and reschedule it for a later date.
Correct Answer: B
Rationale
Informed consent requires that the provider explain the procedure, risks, benefits, and alternatives so the client can make an
informed decision; it is the surgeon's legal responsibility, not the nurse's (rules out C). The nurse's role is to witness the
signature and verify the client's understanding, and to advocate by notifying the surgeon when understanding is lacking.
Signing anyway (A) is negligent; cancellation (D) is premature before the surgeon addresses the gap.
Comprehensive ATI CMS Fundamentals Exam Preparation Page 2
,ATI CMS Fundamentals Exam | Questions & Answers with Rationales | 2026–2027 | Graded A+
Q3. Which client situation requires the RN to complete a formal incident report?
A. A client refuses their 0900 antihypertensive medication.
B. A UAP reports that a client identified as a different client before receiving their medication. [CORRECT]
C. A visitor asks the nurse for an update on a client's condition.
D. A client requests a second pillow for comfort.
Correct Answer: B
Rationale
An incident (variance) report is mandatory for any event that compromises client safety, including a near-miss or actual patient
misidentification, which is a sentinel event under The Joint Commission National Patient Safety Goals. A client's right to refuse
medication (A) requires documentation but not an incident report; visitor inquiries (C) require HIPAA-compliant responses;
comfort requests (D) are routine care. Option B indicates a breakdown in the Two-Client Identifier standard and must be
reported and analyzed to prevent recurrence.
Q4. An RN on a medical-surgical unit is caring for four clients. Which client should the RN assess first?
A. A client 2 days postoperative reporting incisional pain rated 6/10.
B. A client with chronic heart failure reporting dyspnea that increased over the last hour. [CORRECT]
C. A client awaiting discharge who needs final medication teaching.
D. A client with a urinary catheter draining 50 mL/hour of straw-colored urine.
Correct Answer: B
Rationale
Using the ABC (Airway-Breathing-Circulation) prioritization framework and the acute-versus-chronic principle, the client with
new or worsening dyspnea is the most unstable and poses the greatest threat to airway and oxygenation. Postoperative pain (A)
is important but not life-threatening; discharge teaching (C) and stable catheter output (D) are routine. Worsening dyspnea in
heart failure may signal pulmonary edema and requires immediate RN assessment and provider notification.
Q5. Which task is most appropriate for the RN to delegate to a UAP (unlicensed assistive personnel)?
A. Teaching a newly diagnosed diabetic client how to self-administer insulin.
B. Assessing a stage 3 pressure ulcer for signs of infection.
C. Ambulating a stable postoperative client who has a gait belt in place. [CORRECT]
D. Evaluating a client's response to a new IV opioid analgesic.
Correct Answer: C
Rationale
Under the Five Rights of Delegation, the RN may delegate tasks that are within the UAP scope, do not require nursing
judgment, and have a predictable outcome. Ambulating a stable client with a gait belt is a routine ADL task appropriate for a
UAP. Teaching (A), assessment (B), and evaluation of medication response (D) all require nursing knowledge and judgment
and cannot be delegated to unlicensed personnel.
Comprehensive ATI CMS Fundamentals Exam Preparation Page 3
, ATI CMS Fundamentals Exam | Questions & Answers with Rationales | 2026–2027 | Graded A+
Q6. A nurse suspects that a 4-year-old child admitted with a fractured femur may be a victim of physical abuse. What is
the nurse's priority action?
A. Confront the parents with the suspicion and ask for an explanation.
B. Document the findings and report the suspicion to child protective services per mandatory reporting laws.
[CORRECT]
C. Wait until the physician confirms the suspicion before taking action.
D. Discuss the suspicion with the charge nurse only and continue monitoring.
Correct Answer: B
Rationale
Nurses are mandated reporters of suspected child abuse and must report directly to child protective services or law
enforcement; reporting is required by law when abuse is suspected, not after it is proven. Documentation must be objective and
factual. Confronting parents (A) may endanger the child or escalate the situation; waiting for physician confirmation (C) delays
legal protection; reporting only to the charge nurse (D) does not meet mandatory reporting obligations.
Q7. A client asks the nurse, 'Can you tell me how my roommate, Mrs. Lee, is doing after her surgery?' What is the nurse's
most appropriate response?
A. Mrs. Lee is recovering well; she just needs some rest.
B. I cannot share information about another client. Have you asked Mrs. Lee herself? [CORRECT]
C. Mrs. Lee had a cholecystectomy this morning and is in the PACU.
D. Let me check her chart and get back to you.
Correct Answer: B
Rationale
Under HIPAA Privacy Rule, nurses may not disclose any protected health information about a client to other clients, family, or
visitors without that client's authorization. The therapeutic response acknowledges the request while redirecting the inquirer to
the client herself. Sharing any clinical detail (A, C) violates HIPAA, and checking the chart for a non-care reason (D) is an
inappropriate access of PHI.
Q8. A client with a documented DNR order goes into cardiac arrest. A new graduate nurse begins to call a code. What is
the most appropriate action?
A. Continue the code because the client is in the hospital.
B. Stop the code immediately and verify the DNR is current and signed. [CORRECT]
C. Call the family to ask what they want done before proceeding.
D. Continue CPR but withhold advanced cardiac life support measures.
Correct Answer: B
Rationale
A valid, current DNR (Do-Not-Resuscitate) order must be honored in all care settings; initiating resuscitation violates the
client's autonomy and the physician's order. The nurse should immediately stop the code and verify the DNR is in the chart and
signed by the provider. Family preference (C) does not override a documented DNR, and partial resuscitation (D) is not
consistent with the order.
Comprehensive ATI CMS Fundamentals Exam Preparation Page 4
ATI CMS Fundamentals
Exam Questions & Answers
with Comprehensive Rationales
Graded A+ | 2026–2027 Edition
Aligned with 2026–2027 ATI CMS Fundamentals Competencies
150 7 A+
Total Questions ATI Content Sections Graded Rationales
EXAM CONTENT BLUEPRINT
COGNITIVE LEVEL DISTRIBUTION
Section 1: Safe, Effective Care Environment (Q1–30)
25% Recall | 55% Application | 20% Analysis
Section 2: Health Promotion and Maintenance (Q31–50)
Section 3: Psychosocial Integrity (Q51–65)
Section 4: Basic Care and Comfort (Q66–85)
Section 5: Pharmacological and Parenteral Therapies (Q86–110)
Section 6: Reduction of Risk Potential (Q111–130)
Section 7: Physiological Adaptation (Q131–150)
ATI CMS Fundamentals | Comprehensive Rationales | Evidence-Based Practice
Aligned with ATI Testing Standards and NCLEX Test Plan Competencies
,ATI CMS Fundamentals Exam | Questions & Answers with Rationales | 2026–2027 | Graded A+
SECTION 1
Safe, Effective Care Environment
Safe, Effective Care Environment (Q1–Q30)
Q1. A 78-year-old client with stage IV ovarian cancer tells the nurse, 'I do not want any more chemotherapy or heroic
measures if my heart stops.' The client's daughter insists the mother 'would want everything done.' Which action by the
nurse is most appropriate?
A. Follow the daughter's wishes because she is the closest living relative.
B. Continue chemotherapy as ordered until the client signs a formal refusal form.
C. Advocate for the client's autonomy by ensuring an advance directive is documented and communicated to
the team. [CORRECT]
D. Transfer the client to the ICU for closer monitoring.
Correct Answer: C
Rationale
The Patient Self-Determination Act establishes the client's right to make autonomous health care decisions and to have advance
directives honored, regardless of family opposition. The nurse's role as client advocate is to ensure the client's expressed wishes
are documented and shared with the interdisciplinary team. The daughter cannot override a competent client's decision (rules
out A); continuing unwanted treatment violates informed consent (rules out B); ICU transfer is not indicated by the client's
request (rules out D).
Q2. A client is scheduled for an elective cholecystectomy in the morning. The surgeon hands the client a consent form
and leaves the room. The client tells the nurse, 'I really don't understand what they're going to do.' What is the nurse's best
action?
A. Witness the signature and reassure the client that the surgeon knows best.
B. Notify the surgeon that informed consent has not been obtained and request the surgeon return to explain
the procedure. [CORRECT]
C. Explain the surgical procedure, risks, and benefits to the client, then witness the signature.
D. Cancel the surgery and reschedule it for a later date.
Correct Answer: B
Rationale
Informed consent requires that the provider explain the procedure, risks, benefits, and alternatives so the client can make an
informed decision; it is the surgeon's legal responsibility, not the nurse's (rules out C). The nurse's role is to witness the
signature and verify the client's understanding, and to advocate by notifying the surgeon when understanding is lacking.
Signing anyway (A) is negligent; cancellation (D) is premature before the surgeon addresses the gap.
Comprehensive ATI CMS Fundamentals Exam Preparation Page 2
,ATI CMS Fundamentals Exam | Questions & Answers with Rationales | 2026–2027 | Graded A+
Q3. Which client situation requires the RN to complete a formal incident report?
A. A client refuses their 0900 antihypertensive medication.
B. A UAP reports that a client identified as a different client before receiving their medication. [CORRECT]
C. A visitor asks the nurse for an update on a client's condition.
D. A client requests a second pillow for comfort.
Correct Answer: B
Rationale
An incident (variance) report is mandatory for any event that compromises client safety, including a near-miss or actual patient
misidentification, which is a sentinel event under The Joint Commission National Patient Safety Goals. A client's right to refuse
medication (A) requires documentation but not an incident report; visitor inquiries (C) require HIPAA-compliant responses;
comfort requests (D) are routine care. Option B indicates a breakdown in the Two-Client Identifier standard and must be
reported and analyzed to prevent recurrence.
Q4. An RN on a medical-surgical unit is caring for four clients. Which client should the RN assess first?
A. A client 2 days postoperative reporting incisional pain rated 6/10.
B. A client with chronic heart failure reporting dyspnea that increased over the last hour. [CORRECT]
C. A client awaiting discharge who needs final medication teaching.
D. A client with a urinary catheter draining 50 mL/hour of straw-colored urine.
Correct Answer: B
Rationale
Using the ABC (Airway-Breathing-Circulation) prioritization framework and the acute-versus-chronic principle, the client with
new or worsening dyspnea is the most unstable and poses the greatest threat to airway and oxygenation. Postoperative pain (A)
is important but not life-threatening; discharge teaching (C) and stable catheter output (D) are routine. Worsening dyspnea in
heart failure may signal pulmonary edema and requires immediate RN assessment and provider notification.
Q5. Which task is most appropriate for the RN to delegate to a UAP (unlicensed assistive personnel)?
A. Teaching a newly diagnosed diabetic client how to self-administer insulin.
B. Assessing a stage 3 pressure ulcer for signs of infection.
C. Ambulating a stable postoperative client who has a gait belt in place. [CORRECT]
D. Evaluating a client's response to a new IV opioid analgesic.
Correct Answer: C
Rationale
Under the Five Rights of Delegation, the RN may delegate tasks that are within the UAP scope, do not require nursing
judgment, and have a predictable outcome. Ambulating a stable client with a gait belt is a routine ADL task appropriate for a
UAP. Teaching (A), assessment (B), and evaluation of medication response (D) all require nursing knowledge and judgment
and cannot be delegated to unlicensed personnel.
Comprehensive ATI CMS Fundamentals Exam Preparation Page 3
, ATI CMS Fundamentals Exam | Questions & Answers with Rationales | 2026–2027 | Graded A+
Q6. A nurse suspects that a 4-year-old child admitted with a fractured femur may be a victim of physical abuse. What is
the nurse's priority action?
A. Confront the parents with the suspicion and ask for an explanation.
B. Document the findings and report the suspicion to child protective services per mandatory reporting laws.
[CORRECT]
C. Wait until the physician confirms the suspicion before taking action.
D. Discuss the suspicion with the charge nurse only and continue monitoring.
Correct Answer: B
Rationale
Nurses are mandated reporters of suspected child abuse and must report directly to child protective services or law
enforcement; reporting is required by law when abuse is suspected, not after it is proven. Documentation must be objective and
factual. Confronting parents (A) may endanger the child or escalate the situation; waiting for physician confirmation (C) delays
legal protection; reporting only to the charge nurse (D) does not meet mandatory reporting obligations.
Q7. A client asks the nurse, 'Can you tell me how my roommate, Mrs. Lee, is doing after her surgery?' What is the nurse's
most appropriate response?
A. Mrs. Lee is recovering well; she just needs some rest.
B. I cannot share information about another client. Have you asked Mrs. Lee herself? [CORRECT]
C. Mrs. Lee had a cholecystectomy this morning and is in the PACU.
D. Let me check her chart and get back to you.
Correct Answer: B
Rationale
Under HIPAA Privacy Rule, nurses may not disclose any protected health information about a client to other clients, family, or
visitors without that client's authorization. The therapeutic response acknowledges the request while redirecting the inquirer to
the client herself. Sharing any clinical detail (A, C) violates HIPAA, and checking the chart for a non-care reason (D) is an
inappropriate access of PHI.
Q8. A client with a documented DNR order goes into cardiac arrest. A new graduate nurse begins to call a code. What is
the most appropriate action?
A. Continue the code because the client is in the hospital.
B. Stop the code immediately and verify the DNR is current and signed. [CORRECT]
C. Call the family to ask what they want done before proceeding.
D. Continue CPR but withhold advanced cardiac life support measures.
Correct Answer: B
Rationale
A valid, current DNR (Do-Not-Resuscitate) order must be honored in all care settings; initiating resuscitation violates the
client's autonomy and the physician's order. The nurse should immediately stop the code and verify the DNR is in the chart and
signed by the provider. Family preference (C) does not override a documented DNR, and partial resuscitation (D) is not
consistent with the order.
Comprehensive ATI CMS Fundamentals Exam Preparation Page 4
