1
ATI NGN Leadership Exam – Actual
Case-Based Questions with Verified
Answers and Detailed Clinical
Justifications (2024/2025)
Delegation
Scenario 1: Emergency Department
A nurse manager in the emergency department is assigning tasks during a busy shift with
multiple trauma patients. The team includes an RN, an LPN, and a UAP. A client with a
suspected fracture needs vital signs, a client with chest pain requires an ECG, and a client with a
laceration needs wound cleaning.
1. Which task should the nurse manager delegate to the UAP?
a. Perform the ECG for the client with chest pain
b. Obtain vital signs for the client with a suspected fracture
c. Clean the laceration for the client
d. Assess the chest pain client’s cardiac status
Justification: Obtaining vital signs is within the UAP’s scope of practice, as it is a non-
invasive task that does not require clinical judgment. Performing an ECG (a), cleaning a
laceration (c), and assessing cardiac status (d) require clinical skills and are reserved for
licensed nurses (RN or LPN).
2. Which task should the nurse manager assign to the LPN?
a. Interpret the ECG results
b. Clean the laceration for the client
c. Develop a care plan for the trauma patient
d. Administer IV pain medication
Justification: Cleaning a laceration is within the LPN’s scope, as it involves basic wound
care under RN supervision. Interpreting ECGs (a) and developing care plans (c) require
RN-level judgment, and IV medication administration (d) may be outside the LPN’s
scope depending on state regulations.
3. The RN is overwhelmed with tasks. Which action by the nurse manager demonstrates
effective delegation?
a. Assign all tasks to the RN to ensure accuracy
b. Delegate routine tasks to the LPN and UAP while the RN prioritizes
assessments
c. Have the RN complete all tasks independently
d. Assign the UAP to perform ECGs to save time
Justification: Effective delegation involves assigning tasks based on scope of practice,
, 2
allowing the RN to focus on high-priority assessments and interventions (b). Options a
and c overburden the RN, and option d assigns a task outside the UAP’s scope.
Scenario 2: Medical-Surgical Unit
A charge nurse is delegating tasks for a 12-hour shift. The team includes two RNs, one LPN, and
one UAP. Clients include a post-op patient needing pain assessment, a patient requiring a
dressing change, and a patient needing assistance with ambulation.
4. Which task is appropriate to delegate to the UAP?
a. Perform the dressing change
b. Assist the patient with ambulation
c. Assess the post-op patient’s pain level
d. Administer oral pain medication
Justification: Assisting with ambulation (b) is within the UAP’s scope, as it involves
basic physical assistance. Dressing changes (a), pain assessments (c), and medication
administration (d) require licensed nurse skills.
5. Which task should the charge nurse assign to the LPN?
a. Develop a discharge plan
b. Perform the dressing change
c. Evaluate the effectiveness of pain medication
d. Coordinate the interdisciplinary team meeting
Justification: Dressing changes (b) are within the LPN’s scope under RN supervision.
Developing discharge plans (a), evaluating medication effectiveness (c), and coordinating
meetings (d) require RN-level judgment.
6. The charge nurse notices the LPN struggling with time management. What is the best
action?
a. Reassign all LPN tasks to the RN
b. Provide guidance on prioritizing tasks and monitor progress
c. Ignore the issue to avoid conflict
d. Delegate additional tasks to the UAP
Justification: Offering guidance and monitoring (b) supports the LPN’s development
while ensuring client safety. Reassigning tasks (a), ignoring the issue (c), or overloading
the UAP (d) is ineffective or unsafe.
Supervision
Scenario 3: Long-Term Care Facility
A nurse supervisor oversees a team caring for residents with dementia. A new RN is
administering medications, a UAP is assisting with ADLs, and an LPN is monitoring a resident
with a new feeding tube.
7. Which action by the UAP requires immediate intervention by the supervisor?
a. Assisting a resident with bathing
, 3
b. Attempting to adjust the feeding tube flow rate
c. Helping a resident with ambulation
d. Reporting a resident’s complaint of pain
Justification: Adjusting a feeding tube (b) is outside the UAP’s scope and could harm the
resident. Bathing (a), ambulation (c), and reporting pain (d) are within the UAP’s role.
8. The new RN administers a medication without checking the client’s ID band. What
should the supervisor do?
a. Ignore the error to maintain morale
b. Provide immediate feedback and review the five rights of medication
administration
c. Report the RN to the state board
d. Reassign the RN to non-clinical duties
Justification: Immediate feedback and education (b) address the error and promote safety.
Ignoring (a), reporting without correction (c), or reassigning (d) does not address the
issue effectively.
9. The LPN reports the feeding tube resident has increased respiratory rate. What should the
supervisor do?
a. Instruct the LPN to adjust the tube
b. Assess the resident and collaborate with the RN
c. Tell the LPN to monitor without action
d. Administer oxygen immediately
Justification: The supervisor, likely an RN, must assess the resident (b) to determine the
cause and collaborate for appropriate action. Adjusting the tube (a), monitoring without
action (c), or administering oxygen without assessment (d) is unsafe.
Scenario 4: Pediatric Unit
A nurse leader supervises a team caring for children with chronic conditions. An RN is teaching
a family about diabetes management, an LPN is administering oral medications, and a UAP is
assisting with feeding.
10. Which action by the UAP requires the nurse leader’s intervention?
a. Feeding a child with a spoon
b. Checking a child’s blood glucose level
c. Assisting a child to the bathroom
d. Reporting a child’s refusal to eat
Justification: Checking blood glucose (b) is a clinical task outside the UAP’s scope.
Feeding (a), assisting with mobility (c), and reporting observations (d) are appropriate
UAP tasks.
11. The LPN administers a medication 30 minutes late. What should the nurse leader do?
a. Discipline the LPN immediately
b. Review the situation and provide education on timely administration
c. Ignore the delay as it is minor
d. Reassign the LPN to non-medication tasks
Justification: Reviewing and educating (b) addresses the error constructively.
ATI NGN Leadership Exam – Actual
Case-Based Questions with Verified
Answers and Detailed Clinical
Justifications (2024/2025)
Delegation
Scenario 1: Emergency Department
A nurse manager in the emergency department is assigning tasks during a busy shift with
multiple trauma patients. The team includes an RN, an LPN, and a UAP. A client with a
suspected fracture needs vital signs, a client with chest pain requires an ECG, and a client with a
laceration needs wound cleaning.
1. Which task should the nurse manager delegate to the UAP?
a. Perform the ECG for the client with chest pain
b. Obtain vital signs for the client with a suspected fracture
c. Clean the laceration for the client
d. Assess the chest pain client’s cardiac status
Justification: Obtaining vital signs is within the UAP’s scope of practice, as it is a non-
invasive task that does not require clinical judgment. Performing an ECG (a), cleaning a
laceration (c), and assessing cardiac status (d) require clinical skills and are reserved for
licensed nurses (RN or LPN).
2. Which task should the nurse manager assign to the LPN?
a. Interpret the ECG results
b. Clean the laceration for the client
c. Develop a care plan for the trauma patient
d. Administer IV pain medication
Justification: Cleaning a laceration is within the LPN’s scope, as it involves basic wound
care under RN supervision. Interpreting ECGs (a) and developing care plans (c) require
RN-level judgment, and IV medication administration (d) may be outside the LPN’s
scope depending on state regulations.
3. The RN is overwhelmed with tasks. Which action by the nurse manager demonstrates
effective delegation?
a. Assign all tasks to the RN to ensure accuracy
b. Delegate routine tasks to the LPN and UAP while the RN prioritizes
assessments
c. Have the RN complete all tasks independently
d. Assign the UAP to perform ECGs to save time
Justification: Effective delegation involves assigning tasks based on scope of practice,
, 2
allowing the RN to focus on high-priority assessments and interventions (b). Options a
and c overburden the RN, and option d assigns a task outside the UAP’s scope.
Scenario 2: Medical-Surgical Unit
A charge nurse is delegating tasks for a 12-hour shift. The team includes two RNs, one LPN, and
one UAP. Clients include a post-op patient needing pain assessment, a patient requiring a
dressing change, and a patient needing assistance with ambulation.
4. Which task is appropriate to delegate to the UAP?
a. Perform the dressing change
b. Assist the patient with ambulation
c. Assess the post-op patient’s pain level
d. Administer oral pain medication
Justification: Assisting with ambulation (b) is within the UAP’s scope, as it involves
basic physical assistance. Dressing changes (a), pain assessments (c), and medication
administration (d) require licensed nurse skills.
5. Which task should the charge nurse assign to the LPN?
a. Develop a discharge plan
b. Perform the dressing change
c. Evaluate the effectiveness of pain medication
d. Coordinate the interdisciplinary team meeting
Justification: Dressing changes (b) are within the LPN’s scope under RN supervision.
Developing discharge plans (a), evaluating medication effectiveness (c), and coordinating
meetings (d) require RN-level judgment.
6. The charge nurse notices the LPN struggling with time management. What is the best
action?
a. Reassign all LPN tasks to the RN
b. Provide guidance on prioritizing tasks and monitor progress
c. Ignore the issue to avoid conflict
d. Delegate additional tasks to the UAP
Justification: Offering guidance and monitoring (b) supports the LPN’s development
while ensuring client safety. Reassigning tasks (a), ignoring the issue (c), or overloading
the UAP (d) is ineffective or unsafe.
Supervision
Scenario 3: Long-Term Care Facility
A nurse supervisor oversees a team caring for residents with dementia. A new RN is
administering medications, a UAP is assisting with ADLs, and an LPN is monitoring a resident
with a new feeding tube.
7. Which action by the UAP requires immediate intervention by the supervisor?
a. Assisting a resident with bathing
, 3
b. Attempting to adjust the feeding tube flow rate
c. Helping a resident with ambulation
d. Reporting a resident’s complaint of pain
Justification: Adjusting a feeding tube (b) is outside the UAP’s scope and could harm the
resident. Bathing (a), ambulation (c), and reporting pain (d) are within the UAP’s role.
8. The new RN administers a medication without checking the client’s ID band. What
should the supervisor do?
a. Ignore the error to maintain morale
b. Provide immediate feedback and review the five rights of medication
administration
c. Report the RN to the state board
d. Reassign the RN to non-clinical duties
Justification: Immediate feedback and education (b) address the error and promote safety.
Ignoring (a), reporting without correction (c), or reassigning (d) does not address the
issue effectively.
9. The LPN reports the feeding tube resident has increased respiratory rate. What should the
supervisor do?
a. Instruct the LPN to adjust the tube
b. Assess the resident and collaborate with the RN
c. Tell the LPN to monitor without action
d. Administer oxygen immediately
Justification: The supervisor, likely an RN, must assess the resident (b) to determine the
cause and collaborate for appropriate action. Adjusting the tube (a), monitoring without
action (c), or administering oxygen without assessment (d) is unsafe.
Scenario 4: Pediatric Unit
A nurse leader supervises a team caring for children with chronic conditions. An RN is teaching
a family about diabetes management, an LPN is administering oral medications, and a UAP is
assisting with feeding.
10. Which action by the UAP requires the nurse leader’s intervention?
a. Feeding a child with a spoon
b. Checking a child’s blood glucose level
c. Assisting a child to the bathroom
d. Reporting a child’s refusal to eat
Justification: Checking blood glucose (b) is a clinical task outside the UAP’s scope.
Feeding (a), assisting with mobility (c), and reporting observations (d) are appropriate
UAP tasks.
11. The LPN administers a medication 30 minutes late. What should the nurse leader do?
a. Discipline the LPN immediately
b. Review the situation and provide education on timely administration
c. Ignore the delay as it is minor
d. Reassign the LPN to non-medication tasks
Justification: Reviewing and educating (b) addresses the error constructively.
