RN Fundamentals ATI Proctored Exam
NGN Style 70 Questions & Case Scenarios • 2026/2027
Aligned with the ATI Proctored Assessment Blueprint & Next Generation NCLEX (NGN) Item Types
70 Questions Across 8 Domains • Cognitive Mix: 30% Recall, 50% Application, 20% Analysis • 80% Scenario-Based
(including NGN case studies) • Verified Answers + ATI-Specific Rationales + Test-Taking Strategies
Each question is followed by four options (A–D), one verified correct answer marked [CORRECT], the correct answer letter,
a 2–4 sentence rationale integrating clinical judgment, safety considerations, and ATI test-taking strategy.
Section 1: Management of Care (Advocacy, Delegation, Ethics, Legal
Issues, & Continuity of Care)
NGN Case Scenario: A 67-year-old female with community-acquired pneumonia is admitted to a medical-surgical unit.
The RN is assigned four clients today: (1) a 24-h postoperative appendectomy client ready to ambulate; (2) a client with
type 1 diabetes whose 11:00 AM capillary glucose is 58 mg/dL; (3) a client newly admitted with chest pain and ST
elevation; and (4) a stable client with a Foley catheter.
Q1: Using the ABC priority framework and Maslow's hierarchy, which client should the RN assess FIRST
after receiving handoff report?
A. The 24-h postoperative client to assess readiness to ambulate.
B. The client with type 1 diabetes and capillary glucose 58 mg/dL.
C. The newly admitted client with chest pain and ST elevation. [CORRECT]
D. The stable client with a Foley catheter.
Correct Answer: C
Rationale: The ABC framework (Airway, Breathing, Circulation) plus acute-vs-chronic prioritization directs the nurse to
assess the client with chest pain and ST elevation first — a potential acute myocardial infarction is a circulation emergency
that may rapidly deteriorate to cardiac arrest. The hypoglycemic client (B) is the second priority because hypoglycemia can
cause seizures/brain injury but is more rapidly reversible than a STEMI. Postoperative ambulation (A) and stable Foley care
(D) are lower-acuity needs. Test-taking tip: when ABCs are at risk, that client goes first.
Test-Taking Strategy: Use ABCs first, then acute-vs-chronic. STEMI is acute and life-threatening; hypoglycemia is acute but
rapidly correctable; the other two are routine.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 1
, Q2: Which task is most appropriate for the RN to delegate to an unlicensed assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic client how to self-inject insulin.
B. Measuring vital signs on a stable postoperative client and reporting results to the RN [CORRECT]
C. Assessing a wound for signs of infection.
D. Administering oral acetaminophen to a client with a headache.
Correct Answer: B
Rationale: The Five Rights of Delegation require that the task be within the delegatee's scope, require minimal clinical
judgment, have a predictable outcome, and have a clearly defined procedure. Measuring vital signs on a stable client and
reporting findings to the RN fits these criteria and is within UAP scope. Teaching (A), assessment (C), and medication
administration (D) require RN scope of practice and clinical judgment and cannot be delegated to UAP.
Test-Taking Strategy: Apply the 5 Rights of Delegation: Right task, Right circumstance, Right person, Right
direction/communication, Right supervision/evaluation. Anything requiring nursing judgment (assessment, teaching, med
administration) stays with the RN.
NGN Case Scenario: An RN is leading a team on a medical-surgical unit with one LPN/LVN and one UAP. Clients
include: (1) a 2-day postoperative client needing a complex dressing change; (2) a stable client with a chronic wound
requiring dressing reinforcement; (3) a newly admitted client with acute GI bleeding; (4) a client needing assistance with
ambulation.
Q3: Which assignment is most appropriate for the LPN/LVN?
A. Care for the newly admitted GI bleed client.
B. Care for the stable client with a chronic wound requiring dressing reinforcement [CORRECT]
C. Perform the initial assessment of the newly admitted client.
D. Assist with ambulation of the postoperative client.
Correct Answer: B
Rationale: The LPN/LVN scope of practice includes caring for stable clients with predictable outcomes and performing
routine procedures such as dressing changes for chronic wounds. Initial assessments of newly admitted clients (C), unstable
clients (A), and complex teaching or IV push medications require RN scope. UAP can assist with ambulation (D). RN retains
responsibility for assessment, teaching, and care of unstable clients.
Test-Taking Strategy: Match client acuity to LPN/LVN scope: stable, predictable, chronic conditions are appropriate. Initial
assessments and unstable clients always stay with the RN.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 2
, Q4: A client scheduled for an emergency appendectomy is unable to sign the consent form because of altered
mental status. The client's spouse is present but no advance directive exists. Which action by the RN is
correct?
A. Sign the consent form as a witness on behalf of the client.
B. Proceed with surgery without consent because it is an emergency and the spouse is present
C. Notify the provider, who should obtain consent from the spouse as the legally authorized surrogate;
document the situation, the provider's actions, and time [CORRECT]
D. Delay surgery indefinitely until the client regains capacity.
Correct Answer: C
Rationale: Informed consent is the provider's legal responsibility to obtain. When the client lacks capacity and no advance
directive exists, the provider must obtain consent from a legally authorized surrogate (usually spouse, then adult child, then
parent, then sibling) per state law. The RN's role is to witness the signature, ensure the client/surrogate understands, and
document. In a true life-threatening emergency with no surrogate available, implied consent allows treatment — but
appendectomy is urgent, not always emergent, so surrogate consent is appropriate.
Test-Taking Strategy: Consent = provider's responsibility. RN witnesses and ensures voluntariness/understanding. Emergency
exception applies only when delay threatens life.
Q5: A client with end-stage heart failure tells the nurse, "I don't want to be on a ventilator if my heart stops."
The client has no written advance directive. What is the most appropriate nursing action?
A. Document the statement and notify the provider; initiate discussion of advance directives, including a living
will and durable power of attorney for health care [CORRECT]
B. Ignore the statement because no written document exists.
C. Place a do-not-resuscitate order in the chart based on the verbal statement.
D. Tell the client that nurses cannot discuss advance directives.
Correct Answer: A
Rationale: The Patient Self-Determination Act requires healthcare facilities to inform clients of their right to make advance
directives. Verbal statements should be documented and shared with the provider to facilitate formal advance directive
completion. Nurses cannot write DNR orders (Option C) — these require a provider order based on client/surrogate wishes.
The nurse's role is advocacy, education, documentation, and communication with the healthcare team.
Test-Taking Strategy: Patient Self-Determination Act → discuss advance directives, document, notify provider. Only providers
write DNR orders.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 3
, Q6: A charge nurse notices that a colleague's breath smells of alcohol during a shift. Which action is most
appropriate?
A. Confront the colleague privately and send them home; report to the supervisor/nursing manager
[CORRECT]
B. Ignore it because it is a personal matter.
C. Post about it on social media to alert other nurses.
D. Quietly take over the colleague's clients without notifying anyone.
Correct Answer: A
Rationale: Impaired practice threatens client safety. The charge nurse has a professional obligation to remove the impaired
nurse from client care immediately and report to the supervisor/nurse manager per facility policy and state Board of Nursing
requirements. Silence (Option B) endangers clients. Social media posting (Option C) violates HIPAA and professional
boundaries. Taking over clients without reporting (Option D) conceals unsafe practice and fails to address the underlying
problem.
Test-Taking Strategy: Client safety first → remove from care → report to supervisor. Mandatory reporting rules and Board of
Nursing obligations apply.
Q7: A client requests a copy of their medical record. Which response by the nurse is most appropriate?
A. Decline because medical records are confidential to the provider.
B. Inform the client of their right under HIPAA to access their medical record and direct them to the medical
records department to submit a written request [CORRECT]
C. Provide the chart immediately from the nursing station.
D. Tell the client only the physician can grant access.
Correct Answer: B
Rationale: Under HIPAA, clients have the right to access, inspect, and obtain a copy of their medical record. Facilities
typically require a written request routed through Health Information Management/Medical Records, with the facility
required to respond within 30 days. The nurse's role is to inform the client of this right and direct them appropriately.
Immediate access (Option C) bypasses proper procedures; physicians do not control access (Option D).
Test-Taking Strategy: HIPAA grants clients access to their records. Direct to medical records department; follow facility policy.
Nurses should never photocopy charts at the bedside.
Q8: A nurse suspects child abuse in a 3-year-old client with patterned bruises and a fractured femur. The
parents' explanation is inconsistent with the injury. What is the nurse's priority action?
A. Confront the parents about suspected abuse.
B. Document objective findings, notify the provider, and report to Child Protective Services per state
mandatory reporting laws [CORRECT]
C. Wait for additional visits to confirm the suspicion.
D. Discharge the child home with safety education.
Correct Answer: B
Rationale: Nurses are mandatory reporters of suspected child abuse. The legal standard is reasonable suspicion, not
certainty. The nurse must document objective findings, notify the provider, and report to Child Protective Services (or state
equivalent) per state law. Confronting parents (Option A) may endanger the child or escalate the situation. Waiting (Option
C) delays protection. Discharging home (Option D) places the child at continued risk; the child should be kept in a safe
environment pending evaluation.
Test-Taking Strategy: Mandatory reporter standard = reasonable suspicion, not proof. Document objectively, notify provider,
report to CPS, keep child safe.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 4
NGN Style 70 Questions & Case Scenarios • 2026/2027
Aligned with the ATI Proctored Assessment Blueprint & Next Generation NCLEX (NGN) Item Types
70 Questions Across 8 Domains • Cognitive Mix: 30% Recall, 50% Application, 20% Analysis • 80% Scenario-Based
(including NGN case studies) • Verified Answers + ATI-Specific Rationales + Test-Taking Strategies
Each question is followed by four options (A–D), one verified correct answer marked [CORRECT], the correct answer letter,
a 2–4 sentence rationale integrating clinical judgment, safety considerations, and ATI test-taking strategy.
Section 1: Management of Care (Advocacy, Delegation, Ethics, Legal
Issues, & Continuity of Care)
NGN Case Scenario: A 67-year-old female with community-acquired pneumonia is admitted to a medical-surgical unit.
The RN is assigned four clients today: (1) a 24-h postoperative appendectomy client ready to ambulate; (2) a client with
type 1 diabetes whose 11:00 AM capillary glucose is 58 mg/dL; (3) a client newly admitted with chest pain and ST
elevation; and (4) a stable client with a Foley catheter.
Q1: Using the ABC priority framework and Maslow's hierarchy, which client should the RN assess FIRST
after receiving handoff report?
A. The 24-h postoperative client to assess readiness to ambulate.
B. The client with type 1 diabetes and capillary glucose 58 mg/dL.
C. The newly admitted client with chest pain and ST elevation. [CORRECT]
D. The stable client with a Foley catheter.
Correct Answer: C
Rationale: The ABC framework (Airway, Breathing, Circulation) plus acute-vs-chronic prioritization directs the nurse to
assess the client with chest pain and ST elevation first — a potential acute myocardial infarction is a circulation emergency
that may rapidly deteriorate to cardiac arrest. The hypoglycemic client (B) is the second priority because hypoglycemia can
cause seizures/brain injury but is more rapidly reversible than a STEMI. Postoperative ambulation (A) and stable Foley care
(D) are lower-acuity needs. Test-taking tip: when ABCs are at risk, that client goes first.
Test-Taking Strategy: Use ABCs first, then acute-vs-chronic. STEMI is acute and life-threatening; hypoglycemia is acute but
rapidly correctable; the other two are routine.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 1
, Q2: Which task is most appropriate for the RN to delegate to an unlicensed assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic client how to self-inject insulin.
B. Measuring vital signs on a stable postoperative client and reporting results to the RN [CORRECT]
C. Assessing a wound for signs of infection.
D. Administering oral acetaminophen to a client with a headache.
Correct Answer: B
Rationale: The Five Rights of Delegation require that the task be within the delegatee's scope, require minimal clinical
judgment, have a predictable outcome, and have a clearly defined procedure. Measuring vital signs on a stable client and
reporting findings to the RN fits these criteria and is within UAP scope. Teaching (A), assessment (C), and medication
administration (D) require RN scope of practice and clinical judgment and cannot be delegated to UAP.
Test-Taking Strategy: Apply the 5 Rights of Delegation: Right task, Right circumstance, Right person, Right
direction/communication, Right supervision/evaluation. Anything requiring nursing judgment (assessment, teaching, med
administration) stays with the RN.
NGN Case Scenario: An RN is leading a team on a medical-surgical unit with one LPN/LVN and one UAP. Clients
include: (1) a 2-day postoperative client needing a complex dressing change; (2) a stable client with a chronic wound
requiring dressing reinforcement; (3) a newly admitted client with acute GI bleeding; (4) a client needing assistance with
ambulation.
Q3: Which assignment is most appropriate for the LPN/LVN?
A. Care for the newly admitted GI bleed client.
B. Care for the stable client with a chronic wound requiring dressing reinforcement [CORRECT]
C. Perform the initial assessment of the newly admitted client.
D. Assist with ambulation of the postoperative client.
Correct Answer: B
Rationale: The LPN/LVN scope of practice includes caring for stable clients with predictable outcomes and performing
routine procedures such as dressing changes for chronic wounds. Initial assessments of newly admitted clients (C), unstable
clients (A), and complex teaching or IV push medications require RN scope. UAP can assist with ambulation (D). RN retains
responsibility for assessment, teaching, and care of unstable clients.
Test-Taking Strategy: Match client acuity to LPN/LVN scope: stable, predictable, chronic conditions are appropriate. Initial
assessments and unstable clients always stay with the RN.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 2
, Q4: A client scheduled for an emergency appendectomy is unable to sign the consent form because of altered
mental status. The client's spouse is present but no advance directive exists. Which action by the RN is
correct?
A. Sign the consent form as a witness on behalf of the client.
B. Proceed with surgery without consent because it is an emergency and the spouse is present
C. Notify the provider, who should obtain consent from the spouse as the legally authorized surrogate;
document the situation, the provider's actions, and time [CORRECT]
D. Delay surgery indefinitely until the client regains capacity.
Correct Answer: C
Rationale: Informed consent is the provider's legal responsibility to obtain. When the client lacks capacity and no advance
directive exists, the provider must obtain consent from a legally authorized surrogate (usually spouse, then adult child, then
parent, then sibling) per state law. The RN's role is to witness the signature, ensure the client/surrogate understands, and
document. In a true life-threatening emergency with no surrogate available, implied consent allows treatment — but
appendectomy is urgent, not always emergent, so surrogate consent is appropriate.
Test-Taking Strategy: Consent = provider's responsibility. RN witnesses and ensures voluntariness/understanding. Emergency
exception applies only when delay threatens life.
Q5: A client with end-stage heart failure tells the nurse, "I don't want to be on a ventilator if my heart stops."
The client has no written advance directive. What is the most appropriate nursing action?
A. Document the statement and notify the provider; initiate discussion of advance directives, including a living
will and durable power of attorney for health care [CORRECT]
B. Ignore the statement because no written document exists.
C. Place a do-not-resuscitate order in the chart based on the verbal statement.
D. Tell the client that nurses cannot discuss advance directives.
Correct Answer: A
Rationale: The Patient Self-Determination Act requires healthcare facilities to inform clients of their right to make advance
directives. Verbal statements should be documented and shared with the provider to facilitate formal advance directive
completion. Nurses cannot write DNR orders (Option C) — these require a provider order based on client/surrogate wishes.
The nurse's role is advocacy, education, documentation, and communication with the healthcare team.
Test-Taking Strategy: Patient Self-Determination Act → discuss advance directives, document, notify provider. Only providers
write DNR orders.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 3
, Q6: A charge nurse notices that a colleague's breath smells of alcohol during a shift. Which action is most
appropriate?
A. Confront the colleague privately and send them home; report to the supervisor/nursing manager
[CORRECT]
B. Ignore it because it is a personal matter.
C. Post about it on social media to alert other nurses.
D. Quietly take over the colleague's clients without notifying anyone.
Correct Answer: A
Rationale: Impaired practice threatens client safety. The charge nurse has a professional obligation to remove the impaired
nurse from client care immediately and report to the supervisor/nurse manager per facility policy and state Board of Nursing
requirements. Silence (Option B) endangers clients. Social media posting (Option C) violates HIPAA and professional
boundaries. Taking over clients without reporting (Option D) conceals unsafe practice and fails to address the underlying
problem.
Test-Taking Strategy: Client safety first → remove from care → report to supervisor. Mandatory reporting rules and Board of
Nursing obligations apply.
Q7: A client requests a copy of their medical record. Which response by the nurse is most appropriate?
A. Decline because medical records are confidential to the provider.
B. Inform the client of their right under HIPAA to access their medical record and direct them to the medical
records department to submit a written request [CORRECT]
C. Provide the chart immediately from the nursing station.
D. Tell the client only the physician can grant access.
Correct Answer: B
Rationale: Under HIPAA, clients have the right to access, inspect, and obtain a copy of their medical record. Facilities
typically require a written request routed through Health Information Management/Medical Records, with the facility
required to respond within 30 days. The nurse's role is to inform the client of this right and direct them appropriately.
Immediate access (Option C) bypasses proper procedures; physicians do not control access (Option D).
Test-Taking Strategy: HIPAA grants clients access to their records. Direct to medical records department; follow facility policy.
Nurses should never photocopy charts at the bedside.
Q8: A nurse suspects child abuse in a 3-year-old client with patterned bruises and a fractured femur. The
parents' explanation is inconsistent with the injury. What is the nurse's priority action?
A. Confront the parents about suspected abuse.
B. Document objective findings, notify the provider, and report to Child Protective Services per state
mandatory reporting laws [CORRECT]
C. Wait for additional visits to confirm the suspicion.
D. Discharge the child home with safety education.
Correct Answer: B
Rationale: Nurses are mandatory reporters of suspected child abuse. The legal standard is reasonable suspicion, not
certainty. The nurse must document objective findings, notify the provider, and report to Child Protective Services (or state
equivalent) per state law. Confronting parents (Option A) may endanger the child or escalate the situation. Waiting (Option
C) delays protection. Discharging home (Option D) places the child at continued risk; the child should be kept in a safe
environment pending evaluation.
Test-Taking Strategy: Mandatory reporter standard = reasonable suspicion, not proof. Document objectively, notify provider,
report to CPS, keep child safe.
RN Fundamentals ATI Proctored Exam | NGN Style 70 Questions & Case Scenarios | 2026/2027 Page 4
