ATI RN FUNDAMENTALS 2026 LEVEL 3 PROCTORED
EXAM
Comprehensive Practice Assessment & Next Generation NCLEX (NGN) Case Studies
70 Clinical Questions with Detailed Rationales
EXAM OVERVIEW & INSTRUCTIONS:
This document contains 70 rigorous practice questions modeled after the ATI RN Fundamentals Level 3
Proctored Assessment and 2026 NGN item types (Matrix, Bowtie, Highlight, Multiple Response). Topics
include Nursing Process, Clinical Judgment (CJMM), Infection Control, Safety, Medication Administration,
Fluid & Electrolytes, Perioperative Care, Wound Care, and Mobility. Use this study guide to master
rationales and clinical reasoning.
Section 1: Nursing Process & Clinical Judgment (Questions 1 - 10)
Question 1: A nurse is caring for a client who has a new prescription for an antihypertensive
medication. Prior to administering the medication, which of the following actions should the nurse
take according to the nursing process?
A. Evaluate the client's understanding of the medication.
B. Measure the client's blood pressure.
C. Educate the client about potential side effects.
D. Document the administration immediately.
Correct Answer: B. Measure the client's blood pressure.
Rationale: Assessment is the first step of the nursing process and must occur prior to intervention. Measuring
blood pressure establishes a baseline and ensures it is safe to administer an antihypertensive.
Question 2: A nurse is prioritizing care for four clients at the beginning of a shift. Which of the
following clients should the nurse assess first?
A. A client requesting pain medication following a laparoscopic cholecystectomy.
B. A client with type 2 diabetes mellitus reporting a fasting blood glucose of 145 mg/dL.
C. A client with chronic heart failure who has 2+ pitting edema in bilateral lower extremities.
D. A client who is postoperative day 1 following a thyroidectomy and reports neck tightness.
Correct Answer: D. A client who is postoperative day 1 following a thyroidectomy and reports neck
tightness.
Rationale: Using the ABC / urgent vs. non-urgent prioritization framework, neck tightness following a
thyroidectomy indicates potential airway compromise due to hemorrhage or laryngeal edema, which is an
immediate airway emergency.
,Question 3: A nurse is formulating a plan of care for a client who is immobile. Which of the
following is an example of an appropriately written client-oriented goal?
A. The nurse will turn the client every 2 hours.
B. The client will ambulate 50 feet with assistance by end of shift.
C. The client will understand the importance of skin care.
D. The nurse will apply barrier cream to sacral skin daily.
Correct Answer: B. The client will ambulate 50 feet with assistance by end of shift.
Rationale: An appropriately written goal/outcome must be client-centered, measurable, attainable, and include
a specific time frame. Options A and D are nurse-centered interventions, and Option C is not measurable.
Question 4: A nurse is reviewing the clinical judgment measurement model (CJMM). Which of the
following cognitive skills involves noticing cues in a clinical situation?
A. Generating solutions
B. Taking action
C. Recognizing cues
D. Evaluating outcomes
Correct Answer: C. Recognizing cues
Rationale: Recognizing cues (noticing) is the first step in the CJMM where the nurse filters and identifies
relevant clinical data from the client situation.
Question 5: A nurse is documenting client care in an electronic health record. Which of the
following charting entries represents accurate and legally protective documentation?
A. 'Client appeared angry and uncooperative during morning care.'
B. 'Administered morphine 4 mg IV push at 0830 for reported pain of 8 out of 10.'
C. 'Client slept poorly throughout the night due to severe anxiety.'
D. 'Wound dressing changed without difficulty; wound looks good.'
Correct Answer: B. 'Administered morphine 4 mg IV push at 0830 for reported pain of 8 out of 10.'
Rationale: Accurate documentation is objective, specific, includes exact times, dosages, and measurable clinical
indicators. Options A, C, and D contain subjective interpretations ('appeared angry', 'slept poorly', 'looks good')
rather than objective behavioral or anatomical descriptions.
Question 6: A nurse is caring for a client who refuses to take a prescribed antibiotic. Which of the
following ethical principles is the nurse upholding by supporting the client's decision?
A. Beneficence
B. Nonmaleficence
C. Autonomy
D. Justice
, Correct Answer: C. Autonomy
Rationale: Autonomy refers to the right of competent clients to make their own healthcare decisions, including
refusing treatment.
Question 7: A nurse observes a newly licensed nurse failing to perform hand hygiene before
entering a client's room. Which of the following actions should the nurse take first?
A. Report the incident to the nursing supervisor.
B. Discuss the observation privately with the newly licensed nurse.
C. Document the safety violation in an incident report.
D. Correct the nurse publicly in front of the client.
Correct Answer: B. Discuss the observation privately with the newly licensed nurse.
Rationale: Peer feedback should be handled professionally, privately, and constructively as an educational
opportunity before escalating to management, unless immediate client harm is occurring.
Question 8: A nurse is conducting an admission assessment on an older adult client. Which of the
following physiological changes should the nurse expect due to normal aging?
A. Increased glomerular filtration rate (GFR)
B. Decreased arterial compliance
C. Increased vital capacity
D. Decreased gastric pH
Correct Answer: B. Decreased arterial compliance
Rationale: Aging causes progressive stiffening of arterial walls (decreased arterial compliance), leading to
higher systolic blood pressure. GFR and vital capacity decrease, and gastric pH increases (becomes less acidic).
Question 9: A nurse is caring for a client who is legally blind. Which of the following actions should
the nurse take when communicating and assisting the client?
A. Stand directly behind the client when speaking.
B. Use a loud, elevated tone of voice.
C. Orient the client to the room using the clock face method.
D. Move personal items frequently to stimulate adaptation.
Correct Answer: C. Orient the client to the room using the clock face method.
Rationale: The clock face method provides a reliable spatial reference system for visually impaired clients (e.g.,
'your water is at the 2 o'clock position').
Question 10: A nurse is using the SBAR communication tool while handing off a client to the
intensive care unit. Which of the following statements belongs in the 'Assessment' section?
A. 'The client was admitted yesterday with severe sepsis.'
EXAM
Comprehensive Practice Assessment & Next Generation NCLEX (NGN) Case Studies
70 Clinical Questions with Detailed Rationales
EXAM OVERVIEW & INSTRUCTIONS:
This document contains 70 rigorous practice questions modeled after the ATI RN Fundamentals Level 3
Proctored Assessment and 2026 NGN item types (Matrix, Bowtie, Highlight, Multiple Response). Topics
include Nursing Process, Clinical Judgment (CJMM), Infection Control, Safety, Medication Administration,
Fluid & Electrolytes, Perioperative Care, Wound Care, and Mobility. Use this study guide to master
rationales and clinical reasoning.
Section 1: Nursing Process & Clinical Judgment (Questions 1 - 10)
Question 1: A nurse is caring for a client who has a new prescription for an antihypertensive
medication. Prior to administering the medication, which of the following actions should the nurse
take according to the nursing process?
A. Evaluate the client's understanding of the medication.
B. Measure the client's blood pressure.
C. Educate the client about potential side effects.
D. Document the administration immediately.
Correct Answer: B. Measure the client's blood pressure.
Rationale: Assessment is the first step of the nursing process and must occur prior to intervention. Measuring
blood pressure establishes a baseline and ensures it is safe to administer an antihypertensive.
Question 2: A nurse is prioritizing care for four clients at the beginning of a shift. Which of the
following clients should the nurse assess first?
A. A client requesting pain medication following a laparoscopic cholecystectomy.
B. A client with type 2 diabetes mellitus reporting a fasting blood glucose of 145 mg/dL.
C. A client with chronic heart failure who has 2+ pitting edema in bilateral lower extremities.
D. A client who is postoperative day 1 following a thyroidectomy and reports neck tightness.
Correct Answer: D. A client who is postoperative day 1 following a thyroidectomy and reports neck
tightness.
Rationale: Using the ABC / urgent vs. non-urgent prioritization framework, neck tightness following a
thyroidectomy indicates potential airway compromise due to hemorrhage or laryngeal edema, which is an
immediate airway emergency.
,Question 3: A nurse is formulating a plan of care for a client who is immobile. Which of the
following is an example of an appropriately written client-oriented goal?
A. The nurse will turn the client every 2 hours.
B. The client will ambulate 50 feet with assistance by end of shift.
C. The client will understand the importance of skin care.
D. The nurse will apply barrier cream to sacral skin daily.
Correct Answer: B. The client will ambulate 50 feet with assistance by end of shift.
Rationale: An appropriately written goal/outcome must be client-centered, measurable, attainable, and include
a specific time frame. Options A and D are nurse-centered interventions, and Option C is not measurable.
Question 4: A nurse is reviewing the clinical judgment measurement model (CJMM). Which of the
following cognitive skills involves noticing cues in a clinical situation?
A. Generating solutions
B. Taking action
C. Recognizing cues
D. Evaluating outcomes
Correct Answer: C. Recognizing cues
Rationale: Recognizing cues (noticing) is the first step in the CJMM where the nurse filters and identifies
relevant clinical data from the client situation.
Question 5: A nurse is documenting client care in an electronic health record. Which of the
following charting entries represents accurate and legally protective documentation?
A. 'Client appeared angry and uncooperative during morning care.'
B. 'Administered morphine 4 mg IV push at 0830 for reported pain of 8 out of 10.'
C. 'Client slept poorly throughout the night due to severe anxiety.'
D. 'Wound dressing changed without difficulty; wound looks good.'
Correct Answer: B. 'Administered morphine 4 mg IV push at 0830 for reported pain of 8 out of 10.'
Rationale: Accurate documentation is objective, specific, includes exact times, dosages, and measurable clinical
indicators. Options A, C, and D contain subjective interpretations ('appeared angry', 'slept poorly', 'looks good')
rather than objective behavioral or anatomical descriptions.
Question 6: A nurse is caring for a client who refuses to take a prescribed antibiotic. Which of the
following ethical principles is the nurse upholding by supporting the client's decision?
A. Beneficence
B. Nonmaleficence
C. Autonomy
D. Justice
, Correct Answer: C. Autonomy
Rationale: Autonomy refers to the right of competent clients to make their own healthcare decisions, including
refusing treatment.
Question 7: A nurse observes a newly licensed nurse failing to perform hand hygiene before
entering a client's room. Which of the following actions should the nurse take first?
A. Report the incident to the nursing supervisor.
B. Discuss the observation privately with the newly licensed nurse.
C. Document the safety violation in an incident report.
D. Correct the nurse publicly in front of the client.
Correct Answer: B. Discuss the observation privately with the newly licensed nurse.
Rationale: Peer feedback should be handled professionally, privately, and constructively as an educational
opportunity before escalating to management, unless immediate client harm is occurring.
Question 8: A nurse is conducting an admission assessment on an older adult client. Which of the
following physiological changes should the nurse expect due to normal aging?
A. Increased glomerular filtration rate (GFR)
B. Decreased arterial compliance
C. Increased vital capacity
D. Decreased gastric pH
Correct Answer: B. Decreased arterial compliance
Rationale: Aging causes progressive stiffening of arterial walls (decreased arterial compliance), leading to
higher systolic blood pressure. GFR and vital capacity decrease, and gastric pH increases (becomes less acidic).
Question 9: A nurse is caring for a client who is legally blind. Which of the following actions should
the nurse take when communicating and assisting the client?
A. Stand directly behind the client when speaking.
B. Use a loud, elevated tone of voice.
C. Orient the client to the room using the clock face method.
D. Move personal items frequently to stimulate adaptation.
Correct Answer: C. Orient the client to the room using the clock face method.
Rationale: The clock face method provides a reliable spatial reference system for visually impaired clients (e.g.,
'your water is at the 2 o'clock position').
Question 10: A nurse is using the SBAR communication tool while handing off a client to the
intensive care unit. Which of the following statements belongs in the 'Assessment' section?
A. 'The client was admitted yesterday with severe sepsis.'
