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ATI RN Leadership Proctored Exam – Comprehensive
Nursing Leadership, Management, Delegation,
Prioritization, Communication & Clinical Decision-Making
Review
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Exam Coverage Summary
This comprehensive review covers essential nursing leadership and management concepts
including delegation principles, prioritization frameworks (ABCs, Maslow's Hierarchy,
Safety/Infection Control), legal and ethical considerations (informed consent, HIPAA, advance
directives, mandatory reporting), communication strategies (SBAR, conflict resolution,
therapeutic communication), disaster management and triage, quality improvement initiatives,
staffing assignments based on scope of practice, client advocacy, ethical principles
(nonmaleficence, autonomy, beneficence, justice), medication administration safety, infection
control precautions (contact, droplet, airborne), cultural competence, end-of-life care
considerations, documentation requirements, pain management protocols, emergency response
procedures, and clinical decision-making across various healthcare settings including medical-
surgical units, emergency departments, long-term care facilities, and home health environments.
1. A charge nurse is making shift assignments on a medical-surgical unit. Which of the
following clients should the nurse assign to a licensed practical nurse?
• A client who requires administration of a nasogastric tube feeding
• A client who needs initial assessment of chest pain
• A client who requires complex wound care with packing
• A client who needs discharge teaching about anticoagulants
Rationale: LPNs can administer enteral feedings and perform stable procedures within their
scope of practice. RNs are responsible for initial assessments, complex wound care, and
discharge teaching which require comprehensive nursing judgment and evaluation.
2. A nurse enters a client's room and discovers the IV pump is malfunctioning, delivering
excessive fluid. Which action should the nurse take first?
• Auscultate the client's lungs
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• Notify the provider immediately
• Document the pump malfunction
• Stop the IV infusion
Rationale: Assessment is the priority action to determine if fluid overload has occurred.
Auscultating lungs provides immediate data about potential pulmonary edema before
implementing other interventions.
3. A nurse preceptor is evaluating a newly licensed nurse during sterile procedure setup.
Which action indicates proper sterile technique?
• Opens the sterile pack by unfolding the top flap away from her body
• Places sterile items near the edge of the sterile field
• Reaches across the sterile field to retrieve an item
• Sets up sterile field and leaves to obtain additional supplies
Rationale: Opening the top flap away from the body prevents contamination by maintaining
distance from non-sterile areas. The other options represent breaks in sterile technique that
could introduce microorganisms.
4. A client repeatedly refuses to provide a voided urine specimen for drug screening
following a motor vehicle crash. What is the appropriate nursing action?
• Document the client's refusal in the medical record
• Notify law enforcement of the refusal
• Restrain the client to obtain the specimen
• Ask family members to encourage compliance
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Rationale: Clients have the right to refuse procedures. Documentation of refusal is legally
required and protects both the nurse and healthcare facility. Force or coercion violates patient
rights and ethical principles.
5. A nurse is planning care and can delegate to an LPN and AP. Which task should the
nurse assign to the LPN?
• Reinforcing teaching with a client learning self-administer insulin
• Bathing a client who has mobility limitations
• Obtaining vital signs on four stable clients
• Assisting a client with ambulation to the bathroom
Rationale: LPNs can reinforce teaching that has been initiated by RNs. Bathing, vital signs, and
ambulation assistance are appropriate for AP delegation as they do not require nursing
judgment.
6. A nurse is supervising surgical asepsis. After donning sterile gown and gloves, which
action demonstrates correct technique?
• The nurse holds her hands above her waist
• The nurse places hands below waist level
• The nurse folds arms across the chest
• The nurse turns back to the sterile field
Rationale: Hands must remain above waist level in the sterile field to maintain sterility. Below
waist level is considered contaminated, and turning away from the sterile field risks
contamination of the gown.
ATI RN Leadership Proctored Exam – Comprehensive
Nursing Leadership, Management, Delegation,
Prioritization, Communication & Clinical Decision-Making
Review
,2|Page
Exam Coverage Summary
This comprehensive review covers essential nursing leadership and management concepts
including delegation principles, prioritization frameworks (ABCs, Maslow's Hierarchy,
Safety/Infection Control), legal and ethical considerations (informed consent, HIPAA, advance
directives, mandatory reporting), communication strategies (SBAR, conflict resolution,
therapeutic communication), disaster management and triage, quality improvement initiatives,
staffing assignments based on scope of practice, client advocacy, ethical principles
(nonmaleficence, autonomy, beneficence, justice), medication administration safety, infection
control precautions (contact, droplet, airborne), cultural competence, end-of-life care
considerations, documentation requirements, pain management protocols, emergency response
procedures, and clinical decision-making across various healthcare settings including medical-
surgical units, emergency departments, long-term care facilities, and home health environments.
1. A charge nurse is making shift assignments on a medical-surgical unit. Which of the
following clients should the nurse assign to a licensed practical nurse?
• A client who requires administration of a nasogastric tube feeding
• A client who needs initial assessment of chest pain
• A client who requires complex wound care with packing
• A client who needs discharge teaching about anticoagulants
Rationale: LPNs can administer enteral feedings and perform stable procedures within their
scope of practice. RNs are responsible for initial assessments, complex wound care, and
discharge teaching which require comprehensive nursing judgment and evaluation.
2. A nurse enters a client's room and discovers the IV pump is malfunctioning, delivering
excessive fluid. Which action should the nurse take first?
• Auscultate the client's lungs
,3|Page
• Notify the provider immediately
• Document the pump malfunction
• Stop the IV infusion
Rationale: Assessment is the priority action to determine if fluid overload has occurred.
Auscultating lungs provides immediate data about potential pulmonary edema before
implementing other interventions.
3. A nurse preceptor is evaluating a newly licensed nurse during sterile procedure setup.
Which action indicates proper sterile technique?
• Opens the sterile pack by unfolding the top flap away from her body
• Places sterile items near the edge of the sterile field
• Reaches across the sterile field to retrieve an item
• Sets up sterile field and leaves to obtain additional supplies
Rationale: Opening the top flap away from the body prevents contamination by maintaining
distance from non-sterile areas. The other options represent breaks in sterile technique that
could introduce microorganisms.
4. A client repeatedly refuses to provide a voided urine specimen for drug screening
following a motor vehicle crash. What is the appropriate nursing action?
• Document the client's refusal in the medical record
• Notify law enforcement of the refusal
• Restrain the client to obtain the specimen
• Ask family members to encourage compliance
, 4|Page
Rationale: Clients have the right to refuse procedures. Documentation of refusal is legally
required and protects both the nurse and healthcare facility. Force or coercion violates patient
rights and ethical principles.
5. A nurse is planning care and can delegate to an LPN and AP. Which task should the
nurse assign to the LPN?
• Reinforcing teaching with a client learning self-administer insulin
• Bathing a client who has mobility limitations
• Obtaining vital signs on four stable clients
• Assisting a client with ambulation to the bathroom
Rationale: LPNs can reinforce teaching that has been initiated by RNs. Bathing, vital signs, and
ambulation assistance are appropriate for AP delegation as they do not require nursing
judgment.
6. A nurse is supervising surgical asepsis. After donning sterile gown and gloves, which
action demonstrates correct technique?
• The nurse holds her hands above her waist
• The nurse places hands below waist level
• The nurse folds arms across the chest
• The nurse turns back to the sterile field
Rationale: Hands must remain above waist level in the sterile field to maintain sterility. Below
waist level is considered contaminated, and turning away from the sterile field risks
contamination of the gown.
