ATI CMS FUNDAMENTALS EXAM 2026/2027 | Content
Mastery Series | 250+ Questions with Rationales | Graded A+
| Pass Guaranteed - A+ Graded
Section 1: Safe & Effective Care Environment (Q1-65)
Subsection 1A: Management of Care (Delegation, Prioritization, Ethics, Legal) (Q1-40)
Q1. A nurse is caring for four patients on a medical-surgical unit. Which patient should
the nurse assess FIRST?
A. A patient with pneumonia who has a temperature of 38.2°C (100.8°F) and productive
cough
B. A patient 2 hours postoperative with 50 mL of serosanguineous drainage on the
surgical dressing
C. A patient with a new onset of confusion and oxygen saturation of 88% on room air
D. A patient scheduled for discharge who needs discharge teaching completed
Correct Answer: C. A patient with a new onset of confusion and oxygen saturation of
88% on room air [CORRECT]
Rationale: Using the ABC priority framework, oxygen saturation of 88% indicates severe
hypoxemia and new confusion suggests inadequate cerebral oxygenation, representing
an immediate threat to airway/breathing. Option A is an expected finding in pneumonia,
Option B is an expected postoperative drainage amount, and Option D is nonurgent and
can be delegated or delayed.
Q2. The charge nurse is delegating tasks on a busy unit. Which task is MOST
appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Assessing a postoperative patient for signs of hemorrhage
B. Administering oral antibiotics to a stable patient
C. Obtaining vital signs on a patient admitted 24 hours ago for hypertension
D. Educating a newly diagnosed diabetic patient about insulin administration
Correct Answer: C. Obtaining vital signs on a patient admitted 24 hours ago for
hypertension [CORRECT]
,Rationale: The 5 rights of delegation permit UAPs to obtain vital signs on stable,
established patients; this task is routine and does not require nursing judgment. Option
A requires nursing assessment, Option B is medication administration outside UAP
scope, and Option D requires nursing education and evaluation of understanding.
Q3. A nurse is caring for a patient who is refusing a life-saving blood transfusion based
on religious beliefs. The patient's family insists the nurse administer the transfusion
anyway. What is the nurse's MOST appropriate action?
A. Administer the transfusion because the family has medical power of attorney
B. Respect the patient's autonomy and notify the provider of the refusal
C. Ask the hospital chaplain to convince the patient to accept the transfusion
D. Administer the transfusion slowly to minimize the patient's awareness
Correct Answer: B. Respect the patient's autonomy and notify the provider of the refusal
[CORRECT]
Rationale: A competent patient has the right to refuse treatment based on autonomy
and religious freedom; the nurse must respect this decision and communicate it to the
provider. Option A violates patient rights unless the patient is incompetent, Option C is
coercive, and Option D is assault and battery.
Q4. Which task should the nurse assign to a licensed practical/vocational nurse
(LPN/LVN) rather than a UAP?
A. Feeding a patient who had a stroke 3 days ago
B. Performing sterile dressing changes on a patient with a Stage 2 pressure injury
C. Transporting a patient to radiology for a chest x-ray
D. Making an occupied bed for a patient on bed rest
Correct Answer: B. Performing sterile dressing changes on a patient with a Stage 2
pressure injury [CORRECT]
Rationale: LPN/LVN scope includes sterile procedures for stable patients with
predictable outcomes; UAPs cannot perform sterile techniques. Options A, C, and D are
nonsterile, routine tasks within UAP scope.
Q5. A nurse receives a change-of-shift report on four patients. Which patient requires
the nurse's immediate attention?
,A. A patient with heart failure who has 2+ pitting edema in bilateral lower extremities
B. A patient with a nasogastric tube who has 400 mL of green bile-colored output in 8
hours
C. A patient with a chest tube who has intermittent bubbling in the water seal chamber
D. A patient with a potassium level of 5.8 mEq/L and new peaked T waves on the ECG
Correct Answer: D. A patient with a potassium level of 5.8 mEq/L and new peaked T
waves on the ECG [CORRECT]
Rationale: A potassium of 5.8 mEq/L with peaked T waves indicates life-threatening
hyperkalemia that can cause fatal dysrhythmias and requires immediate intervention.
Option A is chronic heart failure management, Option B is expected NG output, and
Option C is normal intermittent bubbling with respiration.
Q6. [Prioritization Scenario] The nurse is caring for four patients. Which patient should
the nurse see FIRST?
A. A patient requesting a PRN pain medication for a headache rated 3/10
B. A patient with a blood pressure of 210/110 mmHg who reports a severe headache
and blurred vision
C. A patient who needs assistance ambulating to the bathroom
D. A patient whose family has questions about the diet plan
Correct Answer: B. A patient with a blood pressure of 210/110 mmHg who reports a
severe headache and blurred vision [CORRECT]
Rationale: This patient presents with a hypertensive emergency (BP >180/120 with
symptoms of end-organ damage) requiring immediate assessment and intervention to
prevent stroke. Option A is mild pain, Option C can be delegated to UAP, and Option D is
nonurgent education.
Q7. [Prioritization Scenario] In the emergency department, four patients arrive
simultaneously. Which patient should the triage nurse see FIRST?
A. A 5-year-old with a temperature of 39.4°C (103°F) and a rash on the torso
B. A 45-year-old with chest pain radiating to the left arm and diaphoresis
C. A 25-year-old with a sprained ankle after a sports injury
D. A 60-year-old with a blood glucose of 240 mg/dL and no symptoms
, Correct Answer: B. A 45-year-old with chest pain radiating to the left arm and
diaphoresis [CORRECT]
Rationale: Chest pain with radiation and diaphoresis suggests acute coronary
syndrome, a life-threatening condition requiring immediate ECG and intervention. Option
A is urgent but stable fever, Option C is nonurgent musculoskeletal injury, and Option D
is asymptomatic hyperglycemia.
Q8. [Prioritization Scenario] A nurse is caring for a group of patients. Which finding
requires IMMEDIATE nursing intervention?
A. A patient with a Foley catheter who has 900 mL of clear yellow urine in 4 hours
B. A patient with a serum sodium of 128 mEq/L who is lethargic and confused
C. A patient who is 1 day postoperative and requests ice chips
D. A patient with a healing surgical incision who needs staples removed today
Correct Answer: B. A patient with a serum sodium of 128 mEq/L who is lethargic and
confused [CORRECT]
Rationale: Hyponatremia (Na+ <135) with neurological symptoms indicates cerebral
edema and requires immediate intervention to prevent seizures. Option A is normal
urine output, Option C is a comfort measure, and Option D is a routine provider task.
Q9. [Prioritization Scenario] Four patients are waiting for the nurse. Which patient is the
HIGHEST priority using Maslow's hierarchy of needs?
A. A patient who is anxious about an upcoming colonoscopy and needs pre-procedure
teaching
B. A patient with a respiratory rate of 8 breaths/min and pinpoint pupils after receiving
morphine
C. A patient who is lonely and requests a call to their family
D. A patient who wants to discuss advance directive options
Correct Answer: B. A patient with a respiratory rate of 8 breaths/min and pinpoint pupils
after receiving morphine [CORRECT]
Rationale: Physiological needs (breathing) are the highest priority per Maslow;
respiratory depression from opioid overdose is life-threatening and requires immediate
naloxone and airway support. Options A, C, and D address safety, love/belonging, or
self-actualization needs, which are lower priority than physiological compromise.
Mastery Series | 250+ Questions with Rationales | Graded A+
| Pass Guaranteed - A+ Graded
Section 1: Safe & Effective Care Environment (Q1-65)
Subsection 1A: Management of Care (Delegation, Prioritization, Ethics, Legal) (Q1-40)
Q1. A nurse is caring for four patients on a medical-surgical unit. Which patient should
the nurse assess FIRST?
A. A patient with pneumonia who has a temperature of 38.2°C (100.8°F) and productive
cough
B. A patient 2 hours postoperative with 50 mL of serosanguineous drainage on the
surgical dressing
C. A patient with a new onset of confusion and oxygen saturation of 88% on room air
D. A patient scheduled for discharge who needs discharge teaching completed
Correct Answer: C. A patient with a new onset of confusion and oxygen saturation of
88% on room air [CORRECT]
Rationale: Using the ABC priority framework, oxygen saturation of 88% indicates severe
hypoxemia and new confusion suggests inadequate cerebral oxygenation, representing
an immediate threat to airway/breathing. Option A is an expected finding in pneumonia,
Option B is an expected postoperative drainage amount, and Option D is nonurgent and
can be delegated or delayed.
Q2. The charge nurse is delegating tasks on a busy unit. Which task is MOST
appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Assessing a postoperative patient for signs of hemorrhage
B. Administering oral antibiotics to a stable patient
C. Obtaining vital signs on a patient admitted 24 hours ago for hypertension
D. Educating a newly diagnosed diabetic patient about insulin administration
Correct Answer: C. Obtaining vital signs on a patient admitted 24 hours ago for
hypertension [CORRECT]
,Rationale: The 5 rights of delegation permit UAPs to obtain vital signs on stable,
established patients; this task is routine and does not require nursing judgment. Option
A requires nursing assessment, Option B is medication administration outside UAP
scope, and Option D requires nursing education and evaluation of understanding.
Q3. A nurse is caring for a patient who is refusing a life-saving blood transfusion based
on religious beliefs. The patient's family insists the nurse administer the transfusion
anyway. What is the nurse's MOST appropriate action?
A. Administer the transfusion because the family has medical power of attorney
B. Respect the patient's autonomy and notify the provider of the refusal
C. Ask the hospital chaplain to convince the patient to accept the transfusion
D. Administer the transfusion slowly to minimize the patient's awareness
Correct Answer: B. Respect the patient's autonomy and notify the provider of the refusal
[CORRECT]
Rationale: A competent patient has the right to refuse treatment based on autonomy
and religious freedom; the nurse must respect this decision and communicate it to the
provider. Option A violates patient rights unless the patient is incompetent, Option C is
coercive, and Option D is assault and battery.
Q4. Which task should the nurse assign to a licensed practical/vocational nurse
(LPN/LVN) rather than a UAP?
A. Feeding a patient who had a stroke 3 days ago
B. Performing sterile dressing changes on a patient with a Stage 2 pressure injury
C. Transporting a patient to radiology for a chest x-ray
D. Making an occupied bed for a patient on bed rest
Correct Answer: B. Performing sterile dressing changes on a patient with a Stage 2
pressure injury [CORRECT]
Rationale: LPN/LVN scope includes sterile procedures for stable patients with
predictable outcomes; UAPs cannot perform sterile techniques. Options A, C, and D are
nonsterile, routine tasks within UAP scope.
Q5. A nurse receives a change-of-shift report on four patients. Which patient requires
the nurse's immediate attention?
,A. A patient with heart failure who has 2+ pitting edema in bilateral lower extremities
B. A patient with a nasogastric tube who has 400 mL of green bile-colored output in 8
hours
C. A patient with a chest tube who has intermittent bubbling in the water seal chamber
D. A patient with a potassium level of 5.8 mEq/L and new peaked T waves on the ECG
Correct Answer: D. A patient with a potassium level of 5.8 mEq/L and new peaked T
waves on the ECG [CORRECT]
Rationale: A potassium of 5.8 mEq/L with peaked T waves indicates life-threatening
hyperkalemia that can cause fatal dysrhythmias and requires immediate intervention.
Option A is chronic heart failure management, Option B is expected NG output, and
Option C is normal intermittent bubbling with respiration.
Q6. [Prioritization Scenario] The nurse is caring for four patients. Which patient should
the nurse see FIRST?
A. A patient requesting a PRN pain medication for a headache rated 3/10
B. A patient with a blood pressure of 210/110 mmHg who reports a severe headache
and blurred vision
C. A patient who needs assistance ambulating to the bathroom
D. A patient whose family has questions about the diet plan
Correct Answer: B. A patient with a blood pressure of 210/110 mmHg who reports a
severe headache and blurred vision [CORRECT]
Rationale: This patient presents with a hypertensive emergency (BP >180/120 with
symptoms of end-organ damage) requiring immediate assessment and intervention to
prevent stroke. Option A is mild pain, Option C can be delegated to UAP, and Option D is
nonurgent education.
Q7. [Prioritization Scenario] In the emergency department, four patients arrive
simultaneously. Which patient should the triage nurse see FIRST?
A. A 5-year-old with a temperature of 39.4°C (103°F) and a rash on the torso
B. A 45-year-old with chest pain radiating to the left arm and diaphoresis
C. A 25-year-old with a sprained ankle after a sports injury
D. A 60-year-old with a blood glucose of 240 mg/dL and no symptoms
, Correct Answer: B. A 45-year-old with chest pain radiating to the left arm and
diaphoresis [CORRECT]
Rationale: Chest pain with radiation and diaphoresis suggests acute coronary
syndrome, a life-threatening condition requiring immediate ECG and intervention. Option
A is urgent but stable fever, Option C is nonurgent musculoskeletal injury, and Option D
is asymptomatic hyperglycemia.
Q8. [Prioritization Scenario] A nurse is caring for a group of patients. Which finding
requires IMMEDIATE nursing intervention?
A. A patient with a Foley catheter who has 900 mL of clear yellow urine in 4 hours
B. A patient with a serum sodium of 128 mEq/L who is lethargic and confused
C. A patient who is 1 day postoperative and requests ice chips
D. A patient with a healing surgical incision who needs staples removed today
Correct Answer: B. A patient with a serum sodium of 128 mEq/L who is lethargic and
confused [CORRECT]
Rationale: Hyponatremia (Na+ <135) with neurological symptoms indicates cerebral
edema and requires immediate intervention to prevent seizures. Option A is normal
urine output, Option C is a comfort measure, and Option D is a routine provider task.
Q9. [Prioritization Scenario] Four patients are waiting for the nurse. Which patient is the
HIGHEST priority using Maslow's hierarchy of needs?
A. A patient who is anxious about an upcoming colonoscopy and needs pre-procedure
teaching
B. A patient with a respiratory rate of 8 breaths/min and pinpoint pupils after receiving
morphine
C. A patient who is lonely and requests a call to their family
D. A patient who wants to discuss advance directive options
Correct Answer: B. A patient with a respiratory rate of 8 breaths/min and pinpoint pupils
after receiving morphine [CORRECT]
Rationale: Physiological needs (breathing) are the highest priority per Maslow;
respiratory depression from opioid overdose is life-threatening and requires immediate
naloxone and airway support. Options A, C, and D address safety, love/belonging, or
self-actualization needs, which are lower priority than physiological compromise.
