ATI RN Leadership Proctored Examination 70 Questions | 2026-2027 Content Alignment
LEADERSHIP ATI PROCTORED EXAM
ATI Leadership Proctored Real Exam | 70 Questions and Correct Answers | A Grade
Aligned with 2026-2027 ATI RN Leadership Proctored Content Outline and NCSBN NGN Clinical Judgment Standards
Cognitive Levels: 25% Recall, 55% Application,
Total Questions: 70 Format: Multiple Choice (A-D)
20% Analysis
Section 1: Management of Care & Prioritization (ABCDE Framework, Unstable vs.
Stable, Clinical Judgment) - Q1-Q20
Q1: A nurse on a medical-surgical unit receives morning report on four clients. Which client should the nurse assess
first?
A. A client who is postoperative day 1 following a total knee replacement and reports pain of 4 on a scale of 0 to 10
B. A client who was admitted with pneumonia and has a new onset of confusion and restlessness [CORRECT]
C. A client with heart failure who reports mild dyspnea on exertion that is relieved by rest
D. A client with type 2 diabetes mellitus who has a fasting blood glucose of 180 mg/dL
Correct Answer: B
Rationale: A new onset of confusion and restlessness in a client with pneumonia indicates hypoxia or impending respiratory failure,
which is an acute change in level of consciousness (LOC). The ABCDE framework prioritizes airway and breathing, and an acute
change in LOC is the earliest and most sensitive sign of neurological deterioration. The postoperative client's pain is stable and
manageable, the heart failure client's dyspnea is relieved by rest (stable chronic condition), and the diabetic client's glucose is elevated
but not at a critical level requiring immediate intervention.
Q2: A nurse is caring for a client who is 6 hours postoperative following abdominal surgery. The client's heart rate has
increased from 88 to 120/min over the past 2 hours. What is the priority nursing action?
A. Administer the prescribed PRN analgesic medication
B. Assess the surgical incision site and drain output for signs of hemorrhage [CORRECT]
C. Instruct the client to use the incentive spirometer every hour
D. Document the findings and continue to monitor the client
Correct Answer: B
Rationale: Sustained tachycardia (HR 120) in a postoperative client is a red flag for hypovolemic shock secondary to hemorrhage or
sepsis. The nurse must first assess for the underlying cause before intervening. Assessment is always the first step of the nursing
process. While pain management and incentive spirometry are important, neither addresses the potentially life-threatening cause of
tachycardia. Simply documenting and monitoring delays necessary intervention for what could be an emerging emergency.
Q3: A nurse receives a change-of-shift report on four clients. Which client should the nurse plan to assess first?
A. A client with a Stage 3 pressure injury who needs a dressing change
B. A client who is 1 day postoperative from a cholecystectomy and has not yet passed flatus
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,ATI RN Leadership Proctored Examination 70 Questions | 2026-2027 Content Alignment
C. A client with chronic obstructive pulmonary disease (COPD) whose oxygen saturation is 88% on room air
[CORRECT]
D. A client with depression who refuses to attend group therapy sessions
Correct Answer: C
Rationale: An SpO2 of 88% indicates significant hypoxia and requires immediate assessment and intervention according to the
ABCDE framework. Airway and breathing take precedence over all other needs. The client with COPD is at risk for respiratory
failure. The Stage 3 pressure injury, postoperative lack of flatus (expected finding), and the client's refusal of therapy (psychosocial
need) are lower priority compared to an acute physiological compromise. Maslow's hierarchy places physiological needs above
psychosocial concerns.
Q4: A charge nurse is making client assignments for the shift. Which client is most appropriate to assign to a newly
licensed RN?
A. A client who is 2 hours postoperative from a thoracotomy with a chest tube
B. A client who is receiving a continuous heparin infusion with a target aPTT
C. A client who is 1 day postoperative from an appendectomy and has stable vital signs [CORRECT]
D. A client who was just admitted with a new tracheostomy and requires frequent suctioning
Correct Answer: C
Rationale: A stable postoperative client who is 1 day following an appendectomy with stable vital signs is appropriate for a newly
licensed RN. This client requires standard postoperative monitoring that is within the scope of a new graduate. Clients with chest tubes,
continuous heparin infusions, or new tracheostomies require more experienced clinical judgment, as these involve complex assessments
and higher-risk interventions. The charge nurse should match client acuity to the nurse's level of experience.
Q5: A nurse is preparing to obtain informed consent from a client for a colonoscopy. Which action should the nurse
take?
A. Explain the risks and benefits of the procedure to the client
B. Witness the client's signature on the consent form after the provider has explained the procedure [CORRECT]
C. Obtain the signed consent form and place it in the client's chart without verifying understanding
D. Tell the client that signing the consent form is optional and can be done after the procedure
Correct Answer: B
Rationale: The nurse's role in informed consent is to witness the client's signature and confirm that the client understands the
information provided by the provider. It is the provider's responsibility to explain the risks, benefits, and alternatives of the procedure.
The nurse should not independently explain the procedure details (A) or obtain consent without verifying understanding (C). Informed
consent is a legal requirement that must be obtained before the procedure, not after (D). The client has the right to withdraw consent
at any time.
Q6: A nurse is caring for four clients on a medical unit. Which client finding requires the most immediate follow-up?
A. A client with deep vein thrombosis (DVT) who has calf tenderness and mild edema
B. A client with a chest tube who has continuous bubbling in the water-seal chamber [CORRECT]
C. A client with heart failure who has gained 1 kg over the past 2 days
D. A client with a urinary catheter whose urine output is 40 mL/hr
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber of a chest tube indicates an air leak in the pleural space, which requires
immediate intervention to prevent tension pneumothorax. This is an acute, potentially life-threatening finding. The client with DVT
has expected findings (calf tenderness, edema). The heart failure client's weight gain is concerning but not emergent. Urine output of
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, ATI RN Leadership Proctored Examination 70 Questions | 2026-2027 Content Alignment
40 mL/hr is within normal limits (greater than 30 mL/hr). ABCDE framework prioritizes the client with a breathing compromise.
Q7: A client who has a do-not-resuscitate (DNR) order is experiencing cardiac arrest. Which action should the nurse
take?
A. Initiate cardiopulmonary resuscitation (CPR) immediately and then verify the DNR order
B. Contact the provider to confirm the DNR order before taking any action
C. Honor the DNR order and provide comfort measures only, documenting the event [CORRECT]
D. Ask the family if they want to override the DNR order and proceed with resuscitation
Correct Answer: C
Rationale: A DNR order is a legal medical order that must be followed. The nurse must honor the client's wishes as documented in the
DNR order and provide comfort measures, such as pain management and dignified care. Initiating CPR would violate the client's
legal right to refuse treatment. While verifying the order is good practice, a valid DNR in the chart should be honored immediately.
The nurse should not ask the family to override a valid DNR, as this undermines the client's autonomy and legal rights. The nurse
must advocate for the client's expressed wishes.
Q8: A nurse is triaging clients in the emergency department. Which client should be classified as emergent?
A. A client who sustained a sprained ankle 2 hours ago and has swelling and bruising
B. A client with severe epistaxis whose blood pressure is 90/60 mm Hg and heart rate is 130/min [CORRECT]
C. A client with a laceration on the forearm that is 4 cm long with controlled bleeding
D. A client with a temperature of 39.2 degrees C (102.6 degrees F) and a productive cough
Correct Answer: B
Rationale: A client with severe epistaxis accompanied by hypotension (90/60 mm Hg) and tachycardia (130/min) is showing signs of
hypovolemic shock and requires emergent, immediate intervention. This is a life-threatening situation that falls under the Circulation
component of the ABCDE framework. The other clients have urgent or non-urgent conditions: a sprained ankle is non-urgent, a
controlled laceration is urgent but not emergent, and a fever with cough is urgent but the client is hemodynamically stable.
Q9: A client tells the nurse, 'I want to leave the hospital against medical advice.' Which nursing action is most
appropriate?
A. Call security to prevent the client from leaving the unit
B. Inform the client of the risks of leaving, have them sign an AMA form, and notify the provider [CORRECT]
C. Tell the client they cannot leave until the provider discharges them
D. Restrict the client to the room until the family can be contacted
Correct Answer: B
Rationale: Clients have the legal right to leave the hospital against medical advice (AMA). The nurse must inform the client of the
specific risks associated with leaving, have them sign the AMA form to document the decision, and notify the provider. Restricting the
client, calling security, or preventing them from leaving constitutes false imprisonment. The nurse must respect the client's autonomy
while ensuring the client makes an informed decision about the consequences of leaving.
Q10: A nurse is caring for a client following a cerebrovascular accident (CVA). The client's level of consciousness
has decreased from alert to lethargic over the past hour. What is the priority nursing action?
A. Place the client in a side-lying position to prevent aspiration
B. Obtain a full set of vital signs and notify the provider immediately [CORRECT]
C. Reassess the client in 30 minutes to see if the lethargy progresses
Page 3
LEADERSHIP ATI PROCTORED EXAM
ATI Leadership Proctored Real Exam | 70 Questions and Correct Answers | A Grade
Aligned with 2026-2027 ATI RN Leadership Proctored Content Outline and NCSBN NGN Clinical Judgment Standards
Cognitive Levels: 25% Recall, 55% Application,
Total Questions: 70 Format: Multiple Choice (A-D)
20% Analysis
Section 1: Management of Care & Prioritization (ABCDE Framework, Unstable vs.
Stable, Clinical Judgment) - Q1-Q20
Q1: A nurse on a medical-surgical unit receives morning report on four clients. Which client should the nurse assess
first?
A. A client who is postoperative day 1 following a total knee replacement and reports pain of 4 on a scale of 0 to 10
B. A client who was admitted with pneumonia and has a new onset of confusion and restlessness [CORRECT]
C. A client with heart failure who reports mild dyspnea on exertion that is relieved by rest
D. A client with type 2 diabetes mellitus who has a fasting blood glucose of 180 mg/dL
Correct Answer: B
Rationale: A new onset of confusion and restlessness in a client with pneumonia indicates hypoxia or impending respiratory failure,
which is an acute change in level of consciousness (LOC). The ABCDE framework prioritizes airway and breathing, and an acute
change in LOC is the earliest and most sensitive sign of neurological deterioration. The postoperative client's pain is stable and
manageable, the heart failure client's dyspnea is relieved by rest (stable chronic condition), and the diabetic client's glucose is elevated
but not at a critical level requiring immediate intervention.
Q2: A nurse is caring for a client who is 6 hours postoperative following abdominal surgery. The client's heart rate has
increased from 88 to 120/min over the past 2 hours. What is the priority nursing action?
A. Administer the prescribed PRN analgesic medication
B. Assess the surgical incision site and drain output for signs of hemorrhage [CORRECT]
C. Instruct the client to use the incentive spirometer every hour
D. Document the findings and continue to monitor the client
Correct Answer: B
Rationale: Sustained tachycardia (HR 120) in a postoperative client is a red flag for hypovolemic shock secondary to hemorrhage or
sepsis. The nurse must first assess for the underlying cause before intervening. Assessment is always the first step of the nursing
process. While pain management and incentive spirometry are important, neither addresses the potentially life-threatening cause of
tachycardia. Simply documenting and monitoring delays necessary intervention for what could be an emerging emergency.
Q3: A nurse receives a change-of-shift report on four clients. Which client should the nurse plan to assess first?
A. A client with a Stage 3 pressure injury who needs a dressing change
B. A client who is 1 day postoperative from a cholecystectomy and has not yet passed flatus
Page 1
,ATI RN Leadership Proctored Examination 70 Questions | 2026-2027 Content Alignment
C. A client with chronic obstructive pulmonary disease (COPD) whose oxygen saturation is 88% on room air
[CORRECT]
D. A client with depression who refuses to attend group therapy sessions
Correct Answer: C
Rationale: An SpO2 of 88% indicates significant hypoxia and requires immediate assessment and intervention according to the
ABCDE framework. Airway and breathing take precedence over all other needs. The client with COPD is at risk for respiratory
failure. The Stage 3 pressure injury, postoperative lack of flatus (expected finding), and the client's refusal of therapy (psychosocial
need) are lower priority compared to an acute physiological compromise. Maslow's hierarchy places physiological needs above
psychosocial concerns.
Q4: A charge nurse is making client assignments for the shift. Which client is most appropriate to assign to a newly
licensed RN?
A. A client who is 2 hours postoperative from a thoracotomy with a chest tube
B. A client who is receiving a continuous heparin infusion with a target aPTT
C. A client who is 1 day postoperative from an appendectomy and has stable vital signs [CORRECT]
D. A client who was just admitted with a new tracheostomy and requires frequent suctioning
Correct Answer: C
Rationale: A stable postoperative client who is 1 day following an appendectomy with stable vital signs is appropriate for a newly
licensed RN. This client requires standard postoperative monitoring that is within the scope of a new graduate. Clients with chest tubes,
continuous heparin infusions, or new tracheostomies require more experienced clinical judgment, as these involve complex assessments
and higher-risk interventions. The charge nurse should match client acuity to the nurse's level of experience.
Q5: A nurse is preparing to obtain informed consent from a client for a colonoscopy. Which action should the nurse
take?
A. Explain the risks and benefits of the procedure to the client
B. Witness the client's signature on the consent form after the provider has explained the procedure [CORRECT]
C. Obtain the signed consent form and place it in the client's chart without verifying understanding
D. Tell the client that signing the consent form is optional and can be done after the procedure
Correct Answer: B
Rationale: The nurse's role in informed consent is to witness the client's signature and confirm that the client understands the
information provided by the provider. It is the provider's responsibility to explain the risks, benefits, and alternatives of the procedure.
The nurse should not independently explain the procedure details (A) or obtain consent without verifying understanding (C). Informed
consent is a legal requirement that must be obtained before the procedure, not after (D). The client has the right to withdraw consent
at any time.
Q6: A nurse is caring for four clients on a medical unit. Which client finding requires the most immediate follow-up?
A. A client with deep vein thrombosis (DVT) who has calf tenderness and mild edema
B. A client with a chest tube who has continuous bubbling in the water-seal chamber [CORRECT]
C. A client with heart failure who has gained 1 kg over the past 2 days
D. A client with a urinary catheter whose urine output is 40 mL/hr
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber of a chest tube indicates an air leak in the pleural space, which requires
immediate intervention to prevent tension pneumothorax. This is an acute, potentially life-threatening finding. The client with DVT
has expected findings (calf tenderness, edema). The heart failure client's weight gain is concerning but not emergent. Urine output of
Page 2
, ATI RN Leadership Proctored Examination 70 Questions | 2026-2027 Content Alignment
40 mL/hr is within normal limits (greater than 30 mL/hr). ABCDE framework prioritizes the client with a breathing compromise.
Q7: A client who has a do-not-resuscitate (DNR) order is experiencing cardiac arrest. Which action should the nurse
take?
A. Initiate cardiopulmonary resuscitation (CPR) immediately and then verify the DNR order
B. Contact the provider to confirm the DNR order before taking any action
C. Honor the DNR order and provide comfort measures only, documenting the event [CORRECT]
D. Ask the family if they want to override the DNR order and proceed with resuscitation
Correct Answer: C
Rationale: A DNR order is a legal medical order that must be followed. The nurse must honor the client's wishes as documented in the
DNR order and provide comfort measures, such as pain management and dignified care. Initiating CPR would violate the client's
legal right to refuse treatment. While verifying the order is good practice, a valid DNR in the chart should be honored immediately.
The nurse should not ask the family to override a valid DNR, as this undermines the client's autonomy and legal rights. The nurse
must advocate for the client's expressed wishes.
Q8: A nurse is triaging clients in the emergency department. Which client should be classified as emergent?
A. A client who sustained a sprained ankle 2 hours ago and has swelling and bruising
B. A client with severe epistaxis whose blood pressure is 90/60 mm Hg and heart rate is 130/min [CORRECT]
C. A client with a laceration on the forearm that is 4 cm long with controlled bleeding
D. A client with a temperature of 39.2 degrees C (102.6 degrees F) and a productive cough
Correct Answer: B
Rationale: A client with severe epistaxis accompanied by hypotension (90/60 mm Hg) and tachycardia (130/min) is showing signs of
hypovolemic shock and requires emergent, immediate intervention. This is a life-threatening situation that falls under the Circulation
component of the ABCDE framework. The other clients have urgent or non-urgent conditions: a sprained ankle is non-urgent, a
controlled laceration is urgent but not emergent, and a fever with cough is urgent but the client is hemodynamically stable.
Q9: A client tells the nurse, 'I want to leave the hospital against medical advice.' Which nursing action is most
appropriate?
A. Call security to prevent the client from leaving the unit
B. Inform the client of the risks of leaving, have them sign an AMA form, and notify the provider [CORRECT]
C. Tell the client they cannot leave until the provider discharges them
D. Restrict the client to the room until the family can be contacted
Correct Answer: B
Rationale: Clients have the legal right to leave the hospital against medical advice (AMA). The nurse must inform the client of the
specific risks associated with leaving, have them sign the AMA form to document the decision, and notify the provider. Restricting the
client, calling security, or preventing them from leaving constitutes false imprisonment. The nurse must respect the client's autonomy
while ensuring the client makes an informed decision about the consequences of leaving.
Q10: A nurse is caring for a client following a cerebrovascular accident (CVA). The client's level of consciousness
has decreased from alert to lethargic over the past hour. What is the priority nursing action?
A. Place the client in a side-lying position to prevent aspiration
B. Obtain a full set of vital signs and notify the provider immediately [CORRECT]
C. Reassess the client in 30 minutes to see if the lethargy progresses
Page 3
