ATI Fundamentals CMS Proctored Exam Actual Exam 2026/2027:
Complete Exam-Style Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Foundations of Nursing Practice | Q1 – Q18
Section 2 | Health Promotion & Maintenance | Q19 – Q35
Section 3 | Psychosocial Integrity | Q36 – Q53
Section 4 | Physiological Integrity | Q54 – Q70
Instructions: Choose the single best answer. Pass: Level 2 proficiency in 90 minutes.
══════════════════════════════════════
SECTION 1: FOUNDATIONS OF NURSING PRACTICE Q1 – Q18
══════════════════════════════════════
Question 1 of 70
A 68-year-old client with a history of heart failure is admitted to the medical-surgical
unit. The unlicensed assistive personnel (UAP) reports that the client has 2+ pitting
edema in both lower extremities and has gained 3 lb since yesterday. The nurse is also
caring for a postoperative client who just returned from the PACU and a client with
newly diagnosed diabetes who needs discharge teaching. The nurse should prioritize
which action first?
A. Delegate the discharge teaching to the charge nurse so the nurse can assess the
heart failure client
B. Perform a focused cardiopulmonary assessment on the client with heart failure ✓
CORRECT
C. Instruct the UAP to reweigh the heart failure client after lunch to confirm the weight
gain
D. Complete the initial postoperative assessment on the PACU client before checking on
the others
,Correct Answer: B
Rationale: The client with heart failure showing acute weight gain and worsening edema
is experiencing a potential fluid volume overload, which can rapidly progress to
pulmonary edema and respiratory compromise. While the postoperative client needs
timely assessment, they are already stable enough to have left PACU, whereas the heart
failure client shows active deterioration. The nurse should always address
life-threatening physiologic instability before routine postoperative checks or teaching.
Question 2 of 70
During morning rounds on a busy orthopedic unit, the nurse notices that a 54-year-old
client who had a total knee replacement yesterday has not yet received the ordered
physical therapy evaluation. The client states they are eager to begin ambulation. The
nurse also notes that the client's 0800 dose of celecoxib was administered 2 hours late.
When reviewing the situation with the charge nurse, the nurse identifies this as a quality
improvement issue. The most appropriate next step is to:
A. Document the delay in the client's medical record and notify the surgeon
B. Complete an incident report and place it in the client's chart for legal protection
C. Verbally reprimand the physical therapy department for missing the scheduled
session
D. Complete a variance report through the unit's quality improvement system ✓
CORRECT
Correct Answer: D
Rationale: Variance reports are the standard mechanism for tracking system issues,
delays, and near-misses within a quality improvement framework without assigning
blame to individual staff. Incident reports are typically reserved for actual errors or
adverse events, not routine delays, and should never be placed in the client's chart. The
goal of quality improvement is to identify patterns and improve systems, not to
document blame in the legal record or resort to verbal reprimands.
,Question 3 of 70
A registered nurse is supervising a licensed practical nurse (LPN) and a UAP on a
rehabilitation unit. The nurse needs to delegate several tasks for the afternoon shift.
According to the scope of practice and delegation principles, which task is most
appropriate to assign to the LPN?
A. Administer an enema to a client who has not had a bowel movement in 4 days ✓
CORRECT
B. Perform the initial admission assessment on a client just transferred from the ICU
C. Develop the plan of care for a client newly diagnosed with Parkinson disease
D. Educate a client with a new colostomy about proper pouching techniques
Correct Answer: A
Rationale: Administering an enema is a standard procedure that falls within the LPN
scope of practice in most states, provided the client is stable and the procedure is
routine. Initial admission assessments, care plan development, and complex client
education—particularly for life-altering conditions like a new colostomy—require the
critical thinking and clinical judgment of a registered nurse and cannot be delegated to
an LPN.
Question 4 of 70
A nurse enters the room of a 42-year-old client who is 1 day postoperative after an open
cholecystectomy and finds the client diaphoretic, confused, and complaining of severe
abdominal pain. The client's blood pressure is 88/52 mmHg, heart rate is 128
beats/min, and respiratory rate is 24 breaths/min. The surgeon is in another procedure
and cannot be reached immediately. The nurse's best action is to:
A. Increase the client's IV fluid rate and continue attempting to contact the surgeon
B. Administer the ordered PRN morphine to address the severe pain
C. Activate the rapid response team and stay with the client ✓ CORRECT
D. Document the vital signs and reassess in 15 minutes
, Correct Answer: C
Rationale: The client is showing clear signs of hemorrhagic shock—hypotension,
tachycardia, diaphoresis, and altered mental status—which is a medical emergency
requiring immediate multidisciplinary intervention. Waiting for the surgeon, giving
morphine that could mask deterioration, or simply documenting and reassessing delays
critical care. The rapid response team is specifically designed to bring critical expertise
to the bedside when a physician is unavailable.
Question 5 of 70
The nurse is caring for a 79-year-old client with advanced dementia who lives in a
long-term care facility. The client's daughter, who holds medical power of attorney,
insists that her mother should not receive any pain medication because she believes it
will hasten death. The client is moaning, grimacing, and guarding her abdomen. The
nurse's initial response should be to:
A. Honor the daughter's wishes because she is the legally authorized decision maker
B. Explain that untreated pain can cause physiologic harm and offer to discuss goals of
care with the interdisciplinary team ✓ CORRECT
C. Administer the PRN analgesic without informing the daughter to avoid conflict
D. Document the daughter's refusal and tell the client there is nothing more the nurse
can do
Correct Answer: B
Rationale: While the daughter holds medical power of attorney, a request that causes
foreseeable harm to the client warrants further discussion and possible ethics
consultation rather than blind compliance. Untreated pain in older adults can lead to
delirium, immobility, and decreased quality of life, so the nurse must advocate for the
client while respecting the family's role in decision making. Covertly medicating the
client or abandoning advocacy would violate both ethical and professional standards.
Question 6 of 70
Complete Exam-Style Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Foundations of Nursing Practice | Q1 – Q18
Section 2 | Health Promotion & Maintenance | Q19 – Q35
Section 3 | Psychosocial Integrity | Q36 – Q53
Section 4 | Physiological Integrity | Q54 – Q70
Instructions: Choose the single best answer. Pass: Level 2 proficiency in 90 minutes.
══════════════════════════════════════
SECTION 1: FOUNDATIONS OF NURSING PRACTICE Q1 – Q18
══════════════════════════════════════
Question 1 of 70
A 68-year-old client with a history of heart failure is admitted to the medical-surgical
unit. The unlicensed assistive personnel (UAP) reports that the client has 2+ pitting
edema in both lower extremities and has gained 3 lb since yesterday. The nurse is also
caring for a postoperative client who just returned from the PACU and a client with
newly diagnosed diabetes who needs discharge teaching. The nurse should prioritize
which action first?
A. Delegate the discharge teaching to the charge nurse so the nurse can assess the
heart failure client
B. Perform a focused cardiopulmonary assessment on the client with heart failure ✓
CORRECT
C. Instruct the UAP to reweigh the heart failure client after lunch to confirm the weight
gain
D. Complete the initial postoperative assessment on the PACU client before checking on
the others
,Correct Answer: B
Rationale: The client with heart failure showing acute weight gain and worsening edema
is experiencing a potential fluid volume overload, which can rapidly progress to
pulmonary edema and respiratory compromise. While the postoperative client needs
timely assessment, they are already stable enough to have left PACU, whereas the heart
failure client shows active deterioration. The nurse should always address
life-threatening physiologic instability before routine postoperative checks or teaching.
Question 2 of 70
During morning rounds on a busy orthopedic unit, the nurse notices that a 54-year-old
client who had a total knee replacement yesterday has not yet received the ordered
physical therapy evaluation. The client states they are eager to begin ambulation. The
nurse also notes that the client's 0800 dose of celecoxib was administered 2 hours late.
When reviewing the situation with the charge nurse, the nurse identifies this as a quality
improvement issue. The most appropriate next step is to:
A. Document the delay in the client's medical record and notify the surgeon
B. Complete an incident report and place it in the client's chart for legal protection
C. Verbally reprimand the physical therapy department for missing the scheduled
session
D. Complete a variance report through the unit's quality improvement system ✓
CORRECT
Correct Answer: D
Rationale: Variance reports are the standard mechanism for tracking system issues,
delays, and near-misses within a quality improvement framework without assigning
blame to individual staff. Incident reports are typically reserved for actual errors or
adverse events, not routine delays, and should never be placed in the client's chart. The
goal of quality improvement is to identify patterns and improve systems, not to
document blame in the legal record or resort to verbal reprimands.
,Question 3 of 70
A registered nurse is supervising a licensed practical nurse (LPN) and a UAP on a
rehabilitation unit. The nurse needs to delegate several tasks for the afternoon shift.
According to the scope of practice and delegation principles, which task is most
appropriate to assign to the LPN?
A. Administer an enema to a client who has not had a bowel movement in 4 days ✓
CORRECT
B. Perform the initial admission assessment on a client just transferred from the ICU
C. Develop the plan of care for a client newly diagnosed with Parkinson disease
D. Educate a client with a new colostomy about proper pouching techniques
Correct Answer: A
Rationale: Administering an enema is a standard procedure that falls within the LPN
scope of practice in most states, provided the client is stable and the procedure is
routine. Initial admission assessments, care plan development, and complex client
education—particularly for life-altering conditions like a new colostomy—require the
critical thinking and clinical judgment of a registered nurse and cannot be delegated to
an LPN.
Question 4 of 70
A nurse enters the room of a 42-year-old client who is 1 day postoperative after an open
cholecystectomy and finds the client diaphoretic, confused, and complaining of severe
abdominal pain. The client's blood pressure is 88/52 mmHg, heart rate is 128
beats/min, and respiratory rate is 24 breaths/min. The surgeon is in another procedure
and cannot be reached immediately. The nurse's best action is to:
A. Increase the client's IV fluid rate and continue attempting to contact the surgeon
B. Administer the ordered PRN morphine to address the severe pain
C. Activate the rapid response team and stay with the client ✓ CORRECT
D. Document the vital signs and reassess in 15 minutes
, Correct Answer: C
Rationale: The client is showing clear signs of hemorrhagic shock—hypotension,
tachycardia, diaphoresis, and altered mental status—which is a medical emergency
requiring immediate multidisciplinary intervention. Waiting for the surgeon, giving
morphine that could mask deterioration, or simply documenting and reassessing delays
critical care. The rapid response team is specifically designed to bring critical expertise
to the bedside when a physician is unavailable.
Question 5 of 70
The nurse is caring for a 79-year-old client with advanced dementia who lives in a
long-term care facility. The client's daughter, who holds medical power of attorney,
insists that her mother should not receive any pain medication because she believes it
will hasten death. The client is moaning, grimacing, and guarding her abdomen. The
nurse's initial response should be to:
A. Honor the daughter's wishes because she is the legally authorized decision maker
B. Explain that untreated pain can cause physiologic harm and offer to discuss goals of
care with the interdisciplinary team ✓ CORRECT
C. Administer the PRN analgesic without informing the daughter to avoid conflict
D. Document the daughter's refusal and tell the client there is nothing more the nurse
can do
Correct Answer: B
Rationale: While the daughter holds medical power of attorney, a request that causes
foreseeable harm to the client warrants further discussion and possible ethics
consultation rather than blind compliance. Untreated pain in older adults can lead to
delirium, immobility, and decreased quality of life, so the nurse must advocate for the
client while respecting the family's role in decision making. Covertly medicating the
client or abandoning advocacy would violate both ethical and professional standards.
Question 6 of 70
