1|Page
2026 ATI RN LEADERSHIP CMS
PROCTORED EXAM WITH NGN |
UPDATE | 70 MOST FREQUENTLY
TESTED TOPICS | ADVANCED
PRACTICE QUESTIONS 1–100 |
DETAILED RATIONALES
INTRODUCTION
This comprehensive ATI RN Leadership practice bank is designed for nursing students preparing
for leadership and management-focused assessments involving delegation, prioritization,
assignment, communication, safety, quality improvement, legal and ethical responsibilities,
conflict management, informatics, and professional practice. The questions emphasize clinical
judgment and application rather than simple memorization.
Leadership questions frequently require the nurse to determine which client should receive
immediate attention, which task can safely be delegated, how to respond to an unsafe practice, or
which communication strategy best addresses a developing problem. Effective preparation
therefore requires more than remembering definitions; students must recognize priorities,
evaluate risks, apply scope-of-practice principles, and make decisions based on client acuity and
available resources.
The following 100 questions are written as advanced practice items using realistic nursing
leadership scenarios. Several questions incorporate NGN-style clinical reasoning principles,
including recognizing cues, analyzing relevant information, prioritizing hypotheses, selecting
appropriate actions, and evaluating outcomes. Each answer includes a detailed rationale
explaining the correct choice and why the alternatives are less appropriate. Students should use
the rationales to identify knowledge gaps and strengthen decision-making before taking their
course or standardized assessment.
CONTENT AREA OVERVIEW
Approx.
Content Area Questions Key Topics
Weight
Prioritization & Clinical ABCs, acuity, unstable clients,
Q1–15 15%
Judgment emergencies, reassessment
RN/LPN/UAP roles, scope,
Delegation & Assignment Q16–30 15%
supervision, appropriate assignment
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Approx.
Content Area Questions Key Topics
Weight
Leadership styles, staffing,
Leadership & Management Q31–42 12%
supervision, change management
SBAR, therapeutic communication,
Communication & Conflict Q43–53 11%
conflict resolution, teamwork
Incident reporting, root-cause
Safety & Quality Improvement Q54–65 12%
analysis, fall prevention, QI
Consent, confidentiality, negligence,
Legal & Ethical Nursing Practice Q66–75 10%
advocacy, ethics
EHR, documentation, privacy,
Informatics & Documentation Q76–82 7%
clinical technology
Professional Practice & Workplace violence, staffing,
Q83–90 8%
Workplace Issues advocacy, professional boundaries
Disaster/Emergency & NGN Triage, disaster response, systems
Q91–100 10%
Leadership Scenarios thinking, evaluation
QUESTIONS 1–100
PRIORITIZATION & CLINICAL JUDGMENT
Q1: A charge nurse receives report on four clients. Which client should the nurse assess
first?
A) A client with chronic heart failure who has bilateral 2+ ankle edema
B) A client who developed sudden stridor and difficulty speaking after receiving a
medication
C) A client with pneumonia whose temperature is 38.1°C (100.6°F)
D) A client requesting assistance with discharge paperwork
Rationale: The correct answer is B because sudden stridor and difficulty speaking after
medication exposure suggest acute airway compromise, potentially from anaphylaxis. Airway
threats take priority. Option A represents a chronic finding without evidence of acute
deterioration. Option C requires assessment but does not supersede an immediate airway
emergency. Option D is important but can safely be delayed.
Q2: A nurse on a medical-surgical unit receives four assignments. Which client requires
immediate assessment?
A) A client reporting incisional pain rated 7/10 two hours after surgery
B) A client with diabetes whose premeal glucose is 218 mg/dL
C) A client who suddenly becomes confused and has an oxygen saturation of 84%
D) A client awaiting assistance with ambulation
, 3|Page
Rationale: The correct answer is C because acute confusion accompanied by significant
hypoxemia indicates possible respiratory compromise and requires immediate intervention.
Option A requires pain management but is not the highest priority. Option B represents
hyperglycemia that requires management but is not immediately life-threatening at this value
alone. Option D is a routine care need.
Q3: During handoff, which statement should cause the receiving nurse to immediately
reassess the client?
A) “The client has not had a bowel movement for two days.”
B) “The client requests a different meal.”
C) “The client's respiratory rate increased from 18/min to 30/min during the last hour.”
D) “The client wants to speak with the social worker.”
Rationale: The correct answer is C because a rapidly increasing respiratory rate can be an early
indicator of clinical deterioration. Option A may require intervention but is not immediately
threatening. Option B is nonurgent. Option D is important but can wait until physiologic stability
is ensured.
Q4: A nurse is caring for four clients. Which client should be seen first?
A) A client with chronic kidney disease who has a potassium level of 5.3 mEq/L
B) A client with COPD whose oxygen saturation is 91% and unchanged from baseline
C) A client with a new onset of unilateral weakness and difficulty speaking
D) A postoperative client requesting an antiemetic
Rationale: The correct answer is C because sudden unilateral weakness and speech difficulty are
concerning for an acute stroke and require immediate assessment and intervention. Option A is
mildly elevated and requires monitoring but is not the highest priority without dysrhythmia or
other acute findings. Option B is consistent with the client's reported baseline. Option D is
symptomatic but not immediately life-threatening.
Q5: A charge nurse notices that a newly admitted client has no documented allergy
information, and the medication administration record contains several new prescriptions.
What action should occur first?
A) Administer all medications as prescribed.
B) Ask the client about allergies after the medications are administered.
C) Verify allergy status before administering medications with potential allergy risks.
D) Delay all care until the physician completes the entire admission history.
Rationale: The correct answer is C because medication administration should not proceed when
a potentially serious allergy history is unknown. Option A creates preventable risk. Option B
delays critical safety verification until after exposure. Option D unnecessarily delays other
aspects of care while the immediate medication-safety issue can be addressed.
2026 ATI RN LEADERSHIP CMS
PROCTORED EXAM WITH NGN |
UPDATE | 70 MOST FREQUENTLY
TESTED TOPICS | ADVANCED
PRACTICE QUESTIONS 1–100 |
DETAILED RATIONALES
INTRODUCTION
This comprehensive ATI RN Leadership practice bank is designed for nursing students preparing
for leadership and management-focused assessments involving delegation, prioritization,
assignment, communication, safety, quality improvement, legal and ethical responsibilities,
conflict management, informatics, and professional practice. The questions emphasize clinical
judgment and application rather than simple memorization.
Leadership questions frequently require the nurse to determine which client should receive
immediate attention, which task can safely be delegated, how to respond to an unsafe practice, or
which communication strategy best addresses a developing problem. Effective preparation
therefore requires more than remembering definitions; students must recognize priorities,
evaluate risks, apply scope-of-practice principles, and make decisions based on client acuity and
available resources.
The following 100 questions are written as advanced practice items using realistic nursing
leadership scenarios. Several questions incorporate NGN-style clinical reasoning principles,
including recognizing cues, analyzing relevant information, prioritizing hypotheses, selecting
appropriate actions, and evaluating outcomes. Each answer includes a detailed rationale
explaining the correct choice and why the alternatives are less appropriate. Students should use
the rationales to identify knowledge gaps and strengthen decision-making before taking their
course or standardized assessment.
CONTENT AREA OVERVIEW
Approx.
Content Area Questions Key Topics
Weight
Prioritization & Clinical ABCs, acuity, unstable clients,
Q1–15 15%
Judgment emergencies, reassessment
RN/LPN/UAP roles, scope,
Delegation & Assignment Q16–30 15%
supervision, appropriate assignment
,2|Page
Approx.
Content Area Questions Key Topics
Weight
Leadership styles, staffing,
Leadership & Management Q31–42 12%
supervision, change management
SBAR, therapeutic communication,
Communication & Conflict Q43–53 11%
conflict resolution, teamwork
Incident reporting, root-cause
Safety & Quality Improvement Q54–65 12%
analysis, fall prevention, QI
Consent, confidentiality, negligence,
Legal & Ethical Nursing Practice Q66–75 10%
advocacy, ethics
EHR, documentation, privacy,
Informatics & Documentation Q76–82 7%
clinical technology
Professional Practice & Workplace violence, staffing,
Q83–90 8%
Workplace Issues advocacy, professional boundaries
Disaster/Emergency & NGN Triage, disaster response, systems
Q91–100 10%
Leadership Scenarios thinking, evaluation
QUESTIONS 1–100
PRIORITIZATION & CLINICAL JUDGMENT
Q1: A charge nurse receives report on four clients. Which client should the nurse assess
first?
A) A client with chronic heart failure who has bilateral 2+ ankle edema
B) A client who developed sudden stridor and difficulty speaking after receiving a
medication
C) A client with pneumonia whose temperature is 38.1°C (100.6°F)
D) A client requesting assistance with discharge paperwork
Rationale: The correct answer is B because sudden stridor and difficulty speaking after
medication exposure suggest acute airway compromise, potentially from anaphylaxis. Airway
threats take priority. Option A represents a chronic finding without evidence of acute
deterioration. Option C requires assessment but does not supersede an immediate airway
emergency. Option D is important but can safely be delayed.
Q2: A nurse on a medical-surgical unit receives four assignments. Which client requires
immediate assessment?
A) A client reporting incisional pain rated 7/10 two hours after surgery
B) A client with diabetes whose premeal glucose is 218 mg/dL
C) A client who suddenly becomes confused and has an oxygen saturation of 84%
D) A client awaiting assistance with ambulation
, 3|Page
Rationale: The correct answer is C because acute confusion accompanied by significant
hypoxemia indicates possible respiratory compromise and requires immediate intervention.
Option A requires pain management but is not the highest priority. Option B represents
hyperglycemia that requires management but is not immediately life-threatening at this value
alone. Option D is a routine care need.
Q3: During handoff, which statement should cause the receiving nurse to immediately
reassess the client?
A) “The client has not had a bowel movement for two days.”
B) “The client requests a different meal.”
C) “The client's respiratory rate increased from 18/min to 30/min during the last hour.”
D) “The client wants to speak with the social worker.”
Rationale: The correct answer is C because a rapidly increasing respiratory rate can be an early
indicator of clinical deterioration. Option A may require intervention but is not immediately
threatening. Option B is nonurgent. Option D is important but can wait until physiologic stability
is ensured.
Q4: A nurse is caring for four clients. Which client should be seen first?
A) A client with chronic kidney disease who has a potassium level of 5.3 mEq/L
B) A client with COPD whose oxygen saturation is 91% and unchanged from baseline
C) A client with a new onset of unilateral weakness and difficulty speaking
D) A postoperative client requesting an antiemetic
Rationale: The correct answer is C because sudden unilateral weakness and speech difficulty are
concerning for an acute stroke and require immediate assessment and intervention. Option A is
mildly elevated and requires monitoring but is not the highest priority without dysrhythmia or
other acute findings. Option B is consistent with the client's reported baseline. Option D is
symptomatic but not immediately life-threatening.
Q5: A charge nurse notices that a newly admitted client has no documented allergy
information, and the medication administration record contains several new prescriptions.
What action should occur first?
A) Administer all medications as prescribed.
B) Ask the client about allergies after the medications are administered.
C) Verify allergy status before administering medications with potential allergy risks.
D) Delay all care until the physician completes the entire admission history.
Rationale: The correct answer is C because medication administration should not proceed when
a potentially serious allergy history is unknown. Option A creates preventable risk. Option B
delays critical safety verification until after exposure. Option D unnecessarily delays other
aspects of care while the immediate medication-safety issue can be addressed.
