2023 ATI RN Leadership Proctored Exam – NGN Exam
Guide Questions and Answers.
Complete Question & Answer Bank with NGN Case Studies | Nursing Leadership &
Management
EXAM OVERVIEW
Parameter Details
Exam Type ATI RN Leadership Proctored Exam (NGN)
Year 2023 (Current for 2026 preparation)
Total Questions 85-95 (including NGN case studies)
Time Limit 2 hours (120 minutes)
Passing Score Typically 65-72% (varies by school)
Key Focus Areas Management of Care, Safety, Ethics, Delegation, Resource Management
PART 1: NGN CASE STUDIES
CASE STUDY 1: STAFFING ALLOCATION ON A MEDICAL-SURGICAL UNIT
Scenario: You are the charge nurse on a 36-bed medical-surgical unit. You have the following
staff for the night shift: 3 RNs (including yourself), 2 LPNs, and 4 UAPs (CNAs). You have 34
patients currently admitted. The acuity of the unit is as follows: 8 high-acuity (need frequent
assessment), 18 medium-acuity, and 8 low-acuity patients.
Sub-question 1 (Bow-Tie):
,Complete the bow-tie by identifying the priority risk to patient safety and the intervention that
addresses this risk, plus an outcome to monitor.
Condition/Event Patient Acuity Mismatch with Staffing Levels
Potential Inadequate monitoring of high-acuity patients leading to deterioration or failure
Complication/Risk rescue
Reassign UAP tasks to RNs; prioritize RN-to-patient assignment for high-acuity
Intervention
patients
All high-acuity patients have vital signs reassessed according to protocol with no
Outcome to Monitor
missed assessments
Correct Answer: Risk: Failure to rescue / Intervention: Assign RNs to high-acuity patients /
Outcome: Vitals reassessed per protocol [CORRECT]
Sub-question 2 (Matrix/Grid):
Assign each patient to the appropriate staff member based on acuity and scope of practice.
Patient Description Acuity RN LPN UAP
New post-op day 1 following CABG, unstable vitals,
High
needing frequent neurovascular checks
Diabetic with stable glucose, needs insulin
Medium
administration and dressing change
Ambulatory patient admitted for observation, needs
Low
assistance with bathing and meals
Patient with pneumonia requiring IV antibiotics q6h
Medium
and respiratory assessment
,Rationale: RNs care for high-acuity and unstable patients; LPNs can administer medications and
perform wound care for stable patients; UAPs provide ADL assistance under RN supervision.
Sub-question 3 (Ordered Response):
Place the following delegation steps in the correct order for assigning a UAP to obtain vital signs
for multiple patients.
Order Step
1 Communicate the specific task (which patients, how often)
2 Verify the UAP's competency to perform vital signs
3 Provide clear instructions for abnormal findings (when to report)
4 Monitor and supervise performance
5 Provide feedback after completion
Correct Order: 2 → 1 → 3 → 4 → 5 [CORRECT]
Sub-question 4 (Select All That Apply):
Which tasks can be safely delegated to an LPN on this medical-surgical unit? (Select all that
apply)
• Administer IV push morphine to a stable post-op patient
• Perform initial admission assessment on a new patient (RN responsibility)
• Insert a urinary catheter for a patient with urinary retention
• Administer enteral tube feeding via PEG tube
• Develop the patient's plan of care (RN responsibility)
• Perform tracheostomy suctioning on a stable patient
, Correct Answers: A, C, D, F [CORRECT]
CASE STUDY 2: PATIENT FALL WITH INJURY – SENTINEL EVENT
Scenario: An 82-year-old patient with a history of dementia and falls was found on the floor
next to his bed at 0300. The patient sustained a hip fracture requiring surgical repair. The
incident report revealed that bed alarms were not activated, side rails were down, and hourly
rounding was not documented for the past 3 hours.
Sub-question 1 (Matrix):
Match each root cause factor to the appropriate corrective action.
Root Cause Corrective Action
Bed alarms not activated Implement checklist for shift report including alarm verification
Side rails found in down position Retrain staff on fall prevention protocols and document education
Hourly rounding not documented Revise rounding documentation form and audit compliance weekly
No fall risk assessment on admission Require fall risk assessment within 1 hour of admission using Morse S
[CORRECT] Each action directly addresses the specific root cause.
Sub-question 2 (Bow-Tie):
Condition/Event Sentinel Event – Patient Fall with Injury
Inadequate fall risk assessment; failure to implement fall precautions; lack
Contributing Factors
hourly rounding
Guide Questions and Answers.
Complete Question & Answer Bank with NGN Case Studies | Nursing Leadership &
Management
EXAM OVERVIEW
Parameter Details
Exam Type ATI RN Leadership Proctored Exam (NGN)
Year 2023 (Current for 2026 preparation)
Total Questions 85-95 (including NGN case studies)
Time Limit 2 hours (120 minutes)
Passing Score Typically 65-72% (varies by school)
Key Focus Areas Management of Care, Safety, Ethics, Delegation, Resource Management
PART 1: NGN CASE STUDIES
CASE STUDY 1: STAFFING ALLOCATION ON A MEDICAL-SURGICAL UNIT
Scenario: You are the charge nurse on a 36-bed medical-surgical unit. You have the following
staff for the night shift: 3 RNs (including yourself), 2 LPNs, and 4 UAPs (CNAs). You have 34
patients currently admitted. The acuity of the unit is as follows: 8 high-acuity (need frequent
assessment), 18 medium-acuity, and 8 low-acuity patients.
Sub-question 1 (Bow-Tie):
,Complete the bow-tie by identifying the priority risk to patient safety and the intervention that
addresses this risk, plus an outcome to monitor.
Condition/Event Patient Acuity Mismatch with Staffing Levels
Potential Inadequate monitoring of high-acuity patients leading to deterioration or failure
Complication/Risk rescue
Reassign UAP tasks to RNs; prioritize RN-to-patient assignment for high-acuity
Intervention
patients
All high-acuity patients have vital signs reassessed according to protocol with no
Outcome to Monitor
missed assessments
Correct Answer: Risk: Failure to rescue / Intervention: Assign RNs to high-acuity patients /
Outcome: Vitals reassessed per protocol [CORRECT]
Sub-question 2 (Matrix/Grid):
Assign each patient to the appropriate staff member based on acuity and scope of practice.
Patient Description Acuity RN LPN UAP
New post-op day 1 following CABG, unstable vitals,
High
needing frequent neurovascular checks
Diabetic with stable glucose, needs insulin
Medium
administration and dressing change
Ambulatory patient admitted for observation, needs
Low
assistance with bathing and meals
Patient with pneumonia requiring IV antibiotics q6h
Medium
and respiratory assessment
,Rationale: RNs care for high-acuity and unstable patients; LPNs can administer medications and
perform wound care for stable patients; UAPs provide ADL assistance under RN supervision.
Sub-question 3 (Ordered Response):
Place the following delegation steps in the correct order for assigning a UAP to obtain vital signs
for multiple patients.
Order Step
1 Communicate the specific task (which patients, how often)
2 Verify the UAP's competency to perform vital signs
3 Provide clear instructions for abnormal findings (when to report)
4 Monitor and supervise performance
5 Provide feedback after completion
Correct Order: 2 → 1 → 3 → 4 → 5 [CORRECT]
Sub-question 4 (Select All That Apply):
Which tasks can be safely delegated to an LPN on this medical-surgical unit? (Select all that
apply)
• Administer IV push morphine to a stable post-op patient
• Perform initial admission assessment on a new patient (RN responsibility)
• Insert a urinary catheter for a patient with urinary retention
• Administer enteral tube feeding via PEG tube
• Develop the patient's plan of care (RN responsibility)
• Perform tracheostomy suctioning on a stable patient
, Correct Answers: A, C, D, F [CORRECT]
CASE STUDY 2: PATIENT FALL WITH INJURY – SENTINEL EVENT
Scenario: An 82-year-old patient with a history of dementia and falls was found on the floor
next to his bed at 0300. The patient sustained a hip fracture requiring surgical repair. The
incident report revealed that bed alarms were not activated, side rails were down, and hourly
rounding was not documented for the past 3 hours.
Sub-question 1 (Matrix):
Match each root cause factor to the appropriate corrective action.
Root Cause Corrective Action
Bed alarms not activated Implement checklist for shift report including alarm verification
Side rails found in down position Retrain staff on fall prevention protocols and document education
Hourly rounding not documented Revise rounding documentation form and audit compliance weekly
No fall risk assessment on admission Require fall risk assessment within 1 hour of admission using Morse S
[CORRECT] Each action directly addresses the specific root cause.
Sub-question 2 (Bow-Tie):
Condition/Event Sentinel Event – Patient Fall with Injury
Inadequate fall risk assessment; failure to implement fall precautions; lack
Contributing Factors
hourly rounding
