ATI Leadership RN 2019 Proctored Exam Version 3: 70 Questions with Verified Answers and
Rationales for Nursing Students 2023–2026
Question 1
A charge nurse is assigning client care for four clients. Which client should the charge nurse assign to a newly licensed registered nurse?
A. A client who had a myocardial infarction 3 days ago and is requesting discharge teaching
B. A client who is 2 days post-operative following a laparoscopic cholecystectomy and has stable vital signs
C. A client who has a new diagnosis of diabetes mellitus and requires initial insulin teaching
D. A client who has a chest tube and is experiencing intermittent bubbling in the water seal chamber
Correct Answer: B
Explanation: The stable post-operative patient is appropriate for a newly licensed RN. Discharge teaching after MI (A) and initial insulin teaching (C) require
experience. Chest tube with bubbling (D) requires assessment for air leak.
Question 2
A nurse is caring for a client who has a terminal illness and is approaching death. The client's adult child asks the nurse, "Why are you putting a cool
compress on my parent's forehead?" Which of the following responses should the nurse give?
A. "Your parent's temperature is elevated."
B. "It will help your parent feel more comfortable."
C. "I am trying to prevent a pressure injury from forming."
D. "I am required to provide this care."
Correct Answer: B
Explanation: Cool compresses in end-of-life care are for comfort, not fever management (A). Pressure injury prevention (C) is not the primary reason.
Required care (D) is inaccurate and dismissive.
Question 3
A nurse is caring for a client who has a tracheostomy. Which of the following actions should the nurse take first when performing tracheostomy care?
A. Don clean gloves
B. Obtain a new tracheostomy inner cannula
C. Set up a sterile field
D. Oxygenate with a manual resuscitation bag
Correct Answer: A
Explanation: Donning clean gloves is the first step to protect the nurse from secretions before handling equipment or touching the patient. Oxygenation
(D) is important but not first. Inner cannula (B) and sterile field (C) come after gloves.
Question 4
A nurse is caring for a client who is in a restraining device. Which of the following actions should the nurse take?
A. Remove the device at least every 2 hours
B. Keep the device loose enough for the client to remove
C. Document the client's behavior every 4 hours
D. Tie the restraint to the side rail of the bed
Correct Answer: A
,Explanation: Restraints must be removed every 2 hours for ROM, skin assessment, hydration, and toileting. Restraints should be secure (not loose enough
to remove—B wrong). Documentation should be more frequent than q4h (C). Restraints are tied to bed frame, NOT side rails (D—safety hazard).
Question 5
A nurse is planning care for a client who has a new diagnosis of diabetes mellitus. Which of the following actions should the nurse include in the plan of
care?
A. Refer the client to a diabetes educator after discharge
B. Provide the client with written instructions about insulin administration
C. Wait until the client's family arrives to begin teaching
D. Ask the provider to explain the diagnosis
Correct Answer: B
Explanation: Written instructions reinforce learning and provide a reference at home. Referral to educator (A) is appropriate but not the initial action.
Waiting for family (C) may delay care. Provider explains medical aspects but nurse provides education (D is incorrect).
Question 6
A charge nurse is observing a newly licensed nurse perform a sterile dressing change. Which of the following actions by the newly licensed nurse requires
intervention?
A. The nurse places the sterile field at waist level
B. The nurse holds sterile objects at waist level
C. The nurse places the sterile field 1 inch from the edge of the table
D. The nurse uses a sterile cotton ball to clean the wound
Correct Answer: A
Explanation: The sterile field should be above waist level—placing it at waist level increases contamination risk. Holding sterile objects at waist level (B) is
correct. 1-inch border from edge (C) is correct. Using sterile cotton balls (D) is correct for wound cleaning.
Question 7
A nurse is reviewing a client's medical record and notes a do-not-resuscitate (DNR) order. The nurse should recognize that which of the following actions is
consistent with a DNR order?
A. Withholding all medical treatment
B. Providing oxygen therapy
C. Stopping enteral feedings
D. Administering pain medication only if the client requests it
Correct Answer: B
Explanation: DNR means no CPR—oxygen therapy and other treatments continue. Withholding all treatment (A) is incorrect. Enteral feedings (C) continue.
Pain medication should be given routinely, not just on request (D is incorrect).
Question 8
A nurse is planning an in-service about the use of restraints. Which of the following statements should the nurse include?
A. "A provider's prescription must be obtained before applying restraints."
B. "Restraints should be applied as a first-line intervention for agitation."
C. "Restraints can be applied by an AP under the supervision of a nurse."
D. "A client's family member cannot request the use of restraints."
Correct Answer: A
, Explanation: A provider order is required for restraints (except emergencies). Restraints are LAST resort, not first-line (B). Only nurses apply restraints (C is
incorrect). Family can request restraints but order still required (D is incorrect).
Question 9
A nurse is caring for a client who has a history of falls. Which of the following actions should the nurse take first?
A. Keep the client's bed in the lowest position
B. Assess the client's risk for falls
C. Place a fall risk sign on the client's door
D. Have the client wear non-skid footwear
Correct Answer: B
Explanation: Assess first to identify specific risk factors before implementing interventions. Bed position (A), signs (C), and non-skid footwear (D) are
interventions that follow assessment.
Question 10
A nurse is preparing a client for a lumbar puncture. Which of the following actions should the nurse take?
A. Position the client in a side-lying position with the head extended
B. Position the client in a side-lying position with the knees flexed toward the chest
C. Position the client in a prone position with the arms extended above the head
D. Position the client in a supine position with a pillow under the head
Correct Answer: B
Explanation: The fetal position (knees to chest) opens the lumbar vertebrae for needle insertion. Head extended (A) is incorrect. Prone (C) and supine with
pillow (D) do not provide adequate spinal access.
Question 11
A nurse is preparing to administer a blood transfusion. Which of the following actions should the nurse take first?
A. Verify the client's blood type with a second nurse
B. Check the expiration date on the blood product
C. Obtain the client's vital signs
D. Prime the blood administration tubing with normal saline
Correct Answer: C
Explanation: Obtain baseline vital signs first to compare during transfusion for reaction signs. Verification (A), expiration (B), and priming (D) come after or
concurrently with baseline vitals.
Question 12
A charge nurse is making assignments for a medical-surgical unit. Which of the following clients should the charge nurse assign to a licensed practical
nurse (LPN)?
A. A client who is 1 day post-operative following a coronary artery bypass graft
B. A client who requires a urinary catheterization for a neurogenic bladder
C. A client who has a new diagnosis of stroke with dysphagia
D. A client who is receiving IV antibiotics for sepsis
Correct Answer: B
Explanation: Urinary catheterization is a stable, predictable task within LPN scope. CABG (A) is unstable. New stroke with dysphagia (C) requires RN
assessment. Sepsis with IV antibiotics (D) is unstable.
Rationales for Nursing Students 2023–2026
Question 1
A charge nurse is assigning client care for four clients. Which client should the charge nurse assign to a newly licensed registered nurse?
A. A client who had a myocardial infarction 3 days ago and is requesting discharge teaching
B. A client who is 2 days post-operative following a laparoscopic cholecystectomy and has stable vital signs
C. A client who has a new diagnosis of diabetes mellitus and requires initial insulin teaching
D. A client who has a chest tube and is experiencing intermittent bubbling in the water seal chamber
Correct Answer: B
Explanation: The stable post-operative patient is appropriate for a newly licensed RN. Discharge teaching after MI (A) and initial insulin teaching (C) require
experience. Chest tube with bubbling (D) requires assessment for air leak.
Question 2
A nurse is caring for a client who has a terminal illness and is approaching death. The client's adult child asks the nurse, "Why are you putting a cool
compress on my parent's forehead?" Which of the following responses should the nurse give?
A. "Your parent's temperature is elevated."
B. "It will help your parent feel more comfortable."
C. "I am trying to prevent a pressure injury from forming."
D. "I am required to provide this care."
Correct Answer: B
Explanation: Cool compresses in end-of-life care are for comfort, not fever management (A). Pressure injury prevention (C) is not the primary reason.
Required care (D) is inaccurate and dismissive.
Question 3
A nurse is caring for a client who has a tracheostomy. Which of the following actions should the nurse take first when performing tracheostomy care?
A. Don clean gloves
B. Obtain a new tracheostomy inner cannula
C. Set up a sterile field
D. Oxygenate with a manual resuscitation bag
Correct Answer: A
Explanation: Donning clean gloves is the first step to protect the nurse from secretions before handling equipment or touching the patient. Oxygenation
(D) is important but not first. Inner cannula (B) and sterile field (C) come after gloves.
Question 4
A nurse is caring for a client who is in a restraining device. Which of the following actions should the nurse take?
A. Remove the device at least every 2 hours
B. Keep the device loose enough for the client to remove
C. Document the client's behavior every 4 hours
D. Tie the restraint to the side rail of the bed
Correct Answer: A
,Explanation: Restraints must be removed every 2 hours for ROM, skin assessment, hydration, and toileting. Restraints should be secure (not loose enough
to remove—B wrong). Documentation should be more frequent than q4h (C). Restraints are tied to bed frame, NOT side rails (D—safety hazard).
Question 5
A nurse is planning care for a client who has a new diagnosis of diabetes mellitus. Which of the following actions should the nurse include in the plan of
care?
A. Refer the client to a diabetes educator after discharge
B. Provide the client with written instructions about insulin administration
C. Wait until the client's family arrives to begin teaching
D. Ask the provider to explain the diagnosis
Correct Answer: B
Explanation: Written instructions reinforce learning and provide a reference at home. Referral to educator (A) is appropriate but not the initial action.
Waiting for family (C) may delay care. Provider explains medical aspects but nurse provides education (D is incorrect).
Question 6
A charge nurse is observing a newly licensed nurse perform a sterile dressing change. Which of the following actions by the newly licensed nurse requires
intervention?
A. The nurse places the sterile field at waist level
B. The nurse holds sterile objects at waist level
C. The nurse places the sterile field 1 inch from the edge of the table
D. The nurse uses a sterile cotton ball to clean the wound
Correct Answer: A
Explanation: The sterile field should be above waist level—placing it at waist level increases contamination risk. Holding sterile objects at waist level (B) is
correct. 1-inch border from edge (C) is correct. Using sterile cotton balls (D) is correct for wound cleaning.
Question 7
A nurse is reviewing a client's medical record and notes a do-not-resuscitate (DNR) order. The nurse should recognize that which of the following actions is
consistent with a DNR order?
A. Withholding all medical treatment
B. Providing oxygen therapy
C. Stopping enteral feedings
D. Administering pain medication only if the client requests it
Correct Answer: B
Explanation: DNR means no CPR—oxygen therapy and other treatments continue. Withholding all treatment (A) is incorrect. Enteral feedings (C) continue.
Pain medication should be given routinely, not just on request (D is incorrect).
Question 8
A nurse is planning an in-service about the use of restraints. Which of the following statements should the nurse include?
A. "A provider's prescription must be obtained before applying restraints."
B. "Restraints should be applied as a first-line intervention for agitation."
C. "Restraints can be applied by an AP under the supervision of a nurse."
D. "A client's family member cannot request the use of restraints."
Correct Answer: A
, Explanation: A provider order is required for restraints (except emergencies). Restraints are LAST resort, not first-line (B). Only nurses apply restraints (C is
incorrect). Family can request restraints but order still required (D is incorrect).
Question 9
A nurse is caring for a client who has a history of falls. Which of the following actions should the nurse take first?
A. Keep the client's bed in the lowest position
B. Assess the client's risk for falls
C. Place a fall risk sign on the client's door
D. Have the client wear non-skid footwear
Correct Answer: B
Explanation: Assess first to identify specific risk factors before implementing interventions. Bed position (A), signs (C), and non-skid footwear (D) are
interventions that follow assessment.
Question 10
A nurse is preparing a client for a lumbar puncture. Which of the following actions should the nurse take?
A. Position the client in a side-lying position with the head extended
B. Position the client in a side-lying position with the knees flexed toward the chest
C. Position the client in a prone position with the arms extended above the head
D. Position the client in a supine position with a pillow under the head
Correct Answer: B
Explanation: The fetal position (knees to chest) opens the lumbar vertebrae for needle insertion. Head extended (A) is incorrect. Prone (C) and supine with
pillow (D) do not provide adequate spinal access.
Question 11
A nurse is preparing to administer a blood transfusion. Which of the following actions should the nurse take first?
A. Verify the client's blood type with a second nurse
B. Check the expiration date on the blood product
C. Obtain the client's vital signs
D. Prime the blood administration tubing with normal saline
Correct Answer: C
Explanation: Obtain baseline vital signs first to compare during transfusion for reaction signs. Verification (A), expiration (B), and priming (D) come after or
concurrently with baseline vitals.
Question 12
A charge nurse is making assignments for a medical-surgical unit. Which of the following clients should the charge nurse assign to a licensed practical
nurse (LPN)?
A. A client who is 1 day post-operative following a coronary artery bypass graft
B. A client who requires a urinary catheterization for a neurogenic bladder
C. A client who has a new diagnosis of stroke with dysphagia
D. A client who is receiving IV antibiotics for sepsis
Correct Answer: B
Explanation: Urinary catheterization is a stable, predictable task within LPN scope. CABG (A) is unstable. New stroke with dysphagia (C) requires RN
assessment. Sepsis with IV antibiotics (D) is unstable.
