NGN ATI FUNDAMENTALS PROCTORED EXAM (2026/2027) | QUESTIONS & ANSWERS
WITH RATIONALES
ATI Fundamentals Proctored Examination with Next Generation NCLEX® (NGN) Integration | Core
Domains: Nursing Process & Clinical Judgment Measurement Model (CJMM), Basic Care & Comfort,
Safety & Infection Control, Health Promotion & Maintenance, Psychosocial Integrity, Pharmacological
& Parenteral Therapies, Reduction of Risk Potential, Physiological Adaptation, and NGN Item Types
(Case Studies, Bow-Tie, Extended Multiple Response) | Foundational Nursing Competency Focus |
NGN-Enhanced Proctored Exam Format
Exam Structure
The NGN ATI Fundamentals Proctored Exam for the 2026/2027 academic cycle is a 100-question,
multiple-choice question (MCQ) and NGN item-type examination.
Introduction
This NGN ATI Fundamentals Proctored Exam guide for the 2026/2027 cycle prepares nursing students
for the high-stakes proctored assessment that integrates Next Generation NCLEX® (NGN) style
questions. The content tests foundational nursing knowledge through complex, unfolding scenarios that
require the application of the Clinical Judgment Measurement Model, emphasizing safety, prioritization,
and evidence-based care essential for NCLEX-RN® readiness.
Answer Format
All correct answers and nursing judgments must be presented in bold and green, followed by detailed
rationales that apply the steps of the NGN Clinical Judgment Measurement Model (Recognize Cues,
Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes), integrate
fundamental nursing principles, prioritize patient safety, and explain the reasoning within NGN case
study frameworks.
Questions (100 Total)
1. A nurse is caring for four clients. Which client should the nurse assess first?
A. Client with type 2 diabetes requesting a snack
B. Client with heart failure reporting sudden shortness of breath and SpO₂ 88%
C. Client with constipation asking for stool softener
D. Client with mild anxiety before discharge teaching
Rationale (NGN Clinical Judgment – Prioritize Hypotheses): Using ABCs (Airway, Breathing,
Circulation), the client with dyspnea and hypoxia has an immediate threat to oxygenation. This requires
urgent assessment and intervention (e.g., oxygen, HOB elevation). Other needs are non-urgent.
,2. A client reports pain as “8 out of 10” and is diaphoretic and tachycardic. What is the nurse’s best
action?
A. Offer distraction techniques only
B. Administer prescribed analgesic and reassess in 30 minutes
C. Tell the client to relax
D. Delay medication until vital signs normalize
Rationale (NGN – Take Action): Pain is subjective and can cause physiological stress responses.
Administering prescribed analgesics promptly is appropriate. Reassess effectiveness after the expected
onset time. Non-pharmacologic measures are adjunctive, not primary, for severe pain.
3. A client refuses a prescribed medication. What should the nurse do first?
A. Administer it when the client is asleep
B. Respect the refusal, document it, and notify the provider
C. Convince the client it’s necessary
D. Withhold all future medications
Rationale (NGN – Ethical Practice): Patients have the legal right to refuse treatment based on
autonomy. The nurse must honor this decision, document clearly (including time, medication, and
patient’s statement), and report to the RN or provider. Coercion violates ethical and legal standards.
4. A client with diabetes has a blood glucose of 52 mg/dL. The client is awake and able to swallow. What
should the nurse do first?
A. Administer glucagon IM
B. Give 15 grams of fast-acting carbohydrate (e.g., 4 oz orange juice)
C. Notify the provider and wait
D. Offer a protein snack
Rationale (NGN – Recognize & Analyze Cues): For conscious hypoglycemic patients, the Rule of
15 applies: give 15 g fast-acting carb (e.g., 4 oz juice, regular soda), recheck glucose in 15 minutes.
Glucagon is for unconscious/unresponsive patients. Delaying treatment risks seizure or coma.
5. Which action demonstrates proper hand hygiene according to CDC guidelines?
,A. Using hand sanitizer after visible soiling with blood
B. Washing hands with soap and water for at least 20 seconds when visibly soiled
C. Rinsing hands quickly under warm water
D. Wearing gloves instead of washing
Rationale (NGN – Safety & Infection Control): CDC guidelines require soap and water when
hands are visibly soiled or after caring for patients with C. difficile. Hand sanitizer is acceptable for
routine care when hands are not soiled. Gloves do not replace hand hygiene; hands must be cleaned
before gloving and after removal.
6. A postoperative client has a respiratory rate of 8 breaths per minute and SpO₂ of 89% on room air.
What is the priority action?
A. Encourage deep breathing
B. Administer naloxone and prepare for possible intubation
C. Offer sips of water
D. Elevate the head of bed
Rationale (NGN – Prioritize Hypotheses): Bradypnea and hypoxia suggest opioid-induced
respiratory depression. Naloxone (an opioid antagonist) is indicated. Prepare for airway support if
unresponsive. Deep breathing is ineffective if the patient is too sedated.
7. When communicating with a hearing-impaired patient, the nurse should:
A. Shout loudly
B. Face the patient, speak clearly, and use written communication if needed
C. Only talk to family members
D. Avoid communication to reduce frustration
Rationale (NGN – Psychosocial Integrity): Effective communication includes facing the patient
(for lip reading), speaking clearly (not shouting), reducing background noise, and using writing or
visual aids. Always address the patient directly. This supports therapeutic relationships and informed
consent.
8. A client’s radial pulse is irregular and difficult to count. What should the nurse do next?
A. Record “irregular” and move on
, B. Assess the apical pulse for a full minute using a stethoscope
C. Use a pulse oximeter only
D. Skip pulse measurement this shift
Rationale (NGN – Recognize Cues): When the radial pulse is irregular, the apical pulse (over the
heart’s apex) provides a more accurate rate and rhythm. It must be counted for a full 60 seconds. This is
especially important before administering cardiac medications like digoxin.
9. A nurse is preparing to administer furosemide 40 mg IV. The vial contains 10 mg/mL. How many mL
should the nurse administer?
A. 2 mL
B. 4 mL
C. 6 mL
D. 10 mL
Rationale (NGN – Safe Medication Administration): Desired dose = 40 mg. Concentration = 10
mg/mL. Volume = 40 ÷ 10 = 4 mL. Always verify calculations using dimensional analysis. Double-check
high-alert medications like diuretics with a second nurse when required.
10. A client says, “I can’t go on anymore.” What is the nurse’s best response?
A. “Things will get better.”
B. “Are you thinking about hurting yourself?”
C. “You have so much to live for.”
D. “Let’s talk about something happier.”
Rationale (NGN – Crisis Intervention): Directly asking about suicidal ideation does not increase
risk—it opens dialogue and allows for immediate safety assessment. Minimizing statements block
communication and delay intervention. Safety is the priority.
11. According to USPSTF, colorectal cancer screening should begin at age:
A. 40
B. 45
C. 50
WITH RATIONALES
ATI Fundamentals Proctored Examination with Next Generation NCLEX® (NGN) Integration | Core
Domains: Nursing Process & Clinical Judgment Measurement Model (CJMM), Basic Care & Comfort,
Safety & Infection Control, Health Promotion & Maintenance, Psychosocial Integrity, Pharmacological
& Parenteral Therapies, Reduction of Risk Potential, Physiological Adaptation, and NGN Item Types
(Case Studies, Bow-Tie, Extended Multiple Response) | Foundational Nursing Competency Focus |
NGN-Enhanced Proctored Exam Format
Exam Structure
The NGN ATI Fundamentals Proctored Exam for the 2026/2027 academic cycle is a 100-question,
multiple-choice question (MCQ) and NGN item-type examination.
Introduction
This NGN ATI Fundamentals Proctored Exam guide for the 2026/2027 cycle prepares nursing students
for the high-stakes proctored assessment that integrates Next Generation NCLEX® (NGN) style
questions. The content tests foundational nursing knowledge through complex, unfolding scenarios that
require the application of the Clinical Judgment Measurement Model, emphasizing safety, prioritization,
and evidence-based care essential for NCLEX-RN® readiness.
Answer Format
All correct answers and nursing judgments must be presented in bold and green, followed by detailed
rationales that apply the steps of the NGN Clinical Judgment Measurement Model (Recognize Cues,
Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes), integrate
fundamental nursing principles, prioritize patient safety, and explain the reasoning within NGN case
study frameworks.
Questions (100 Total)
1. A nurse is caring for four clients. Which client should the nurse assess first?
A. Client with type 2 diabetes requesting a snack
B. Client with heart failure reporting sudden shortness of breath and SpO₂ 88%
C. Client with constipation asking for stool softener
D. Client with mild anxiety before discharge teaching
Rationale (NGN Clinical Judgment – Prioritize Hypotheses): Using ABCs (Airway, Breathing,
Circulation), the client with dyspnea and hypoxia has an immediate threat to oxygenation. This requires
urgent assessment and intervention (e.g., oxygen, HOB elevation). Other needs are non-urgent.
,2. A client reports pain as “8 out of 10” and is diaphoretic and tachycardic. What is the nurse’s best
action?
A. Offer distraction techniques only
B. Administer prescribed analgesic and reassess in 30 minutes
C. Tell the client to relax
D. Delay medication until vital signs normalize
Rationale (NGN – Take Action): Pain is subjective and can cause physiological stress responses.
Administering prescribed analgesics promptly is appropriate. Reassess effectiveness after the expected
onset time. Non-pharmacologic measures are adjunctive, not primary, for severe pain.
3. A client refuses a prescribed medication. What should the nurse do first?
A. Administer it when the client is asleep
B. Respect the refusal, document it, and notify the provider
C. Convince the client it’s necessary
D. Withhold all future medications
Rationale (NGN – Ethical Practice): Patients have the legal right to refuse treatment based on
autonomy. The nurse must honor this decision, document clearly (including time, medication, and
patient’s statement), and report to the RN or provider. Coercion violates ethical and legal standards.
4. A client with diabetes has a blood glucose of 52 mg/dL. The client is awake and able to swallow. What
should the nurse do first?
A. Administer glucagon IM
B. Give 15 grams of fast-acting carbohydrate (e.g., 4 oz orange juice)
C. Notify the provider and wait
D. Offer a protein snack
Rationale (NGN – Recognize & Analyze Cues): For conscious hypoglycemic patients, the Rule of
15 applies: give 15 g fast-acting carb (e.g., 4 oz juice, regular soda), recheck glucose in 15 minutes.
Glucagon is for unconscious/unresponsive patients. Delaying treatment risks seizure or coma.
5. Which action demonstrates proper hand hygiene according to CDC guidelines?
,A. Using hand sanitizer after visible soiling with blood
B. Washing hands with soap and water for at least 20 seconds when visibly soiled
C. Rinsing hands quickly under warm water
D. Wearing gloves instead of washing
Rationale (NGN – Safety & Infection Control): CDC guidelines require soap and water when
hands are visibly soiled or after caring for patients with C. difficile. Hand sanitizer is acceptable for
routine care when hands are not soiled. Gloves do not replace hand hygiene; hands must be cleaned
before gloving and after removal.
6. A postoperative client has a respiratory rate of 8 breaths per minute and SpO₂ of 89% on room air.
What is the priority action?
A. Encourage deep breathing
B. Administer naloxone and prepare for possible intubation
C. Offer sips of water
D. Elevate the head of bed
Rationale (NGN – Prioritize Hypotheses): Bradypnea and hypoxia suggest opioid-induced
respiratory depression. Naloxone (an opioid antagonist) is indicated. Prepare for airway support if
unresponsive. Deep breathing is ineffective if the patient is too sedated.
7. When communicating with a hearing-impaired patient, the nurse should:
A. Shout loudly
B. Face the patient, speak clearly, and use written communication if needed
C. Only talk to family members
D. Avoid communication to reduce frustration
Rationale (NGN – Psychosocial Integrity): Effective communication includes facing the patient
(for lip reading), speaking clearly (not shouting), reducing background noise, and using writing or
visual aids. Always address the patient directly. This supports therapeutic relationships and informed
consent.
8. A client’s radial pulse is irregular and difficult to count. What should the nurse do next?
A. Record “irregular” and move on
, B. Assess the apical pulse for a full minute using a stethoscope
C. Use a pulse oximeter only
D. Skip pulse measurement this shift
Rationale (NGN – Recognize Cues): When the radial pulse is irregular, the apical pulse (over the
heart’s apex) provides a more accurate rate and rhythm. It must be counted for a full 60 seconds. This is
especially important before administering cardiac medications like digoxin.
9. A nurse is preparing to administer furosemide 40 mg IV. The vial contains 10 mg/mL. How many mL
should the nurse administer?
A. 2 mL
B. 4 mL
C. 6 mL
D. 10 mL
Rationale (NGN – Safe Medication Administration): Desired dose = 40 mg. Concentration = 10
mg/mL. Volume = 40 ÷ 10 = 4 mL. Always verify calculations using dimensional analysis. Double-check
high-alert medications like diuretics with a second nurse when required.
10. A client says, “I can’t go on anymore.” What is the nurse’s best response?
A. “Things will get better.”
B. “Are you thinking about hurting yourself?”
C. “You have so much to live for.”
D. “Let’s talk about something happier.”
Rationale (NGN – Crisis Intervention): Directly asking about suicidal ideation does not increase
risk—it opens dialogue and allows for immediate safety assessment. Minimizing statements block
communication and delay intervention. Safety is the priority.
11. According to USPSTF, colorectal cancer screening should begin at age:
A. 40
B. 45
C. 50
