ATI Leadership RN 2019 Proctored Exam Version 2: 70 Questions with Verified
Answers and Rationales for Nursing Students 2023–2026
Question 1
A nurse is assessing pressure ulcers on four clients to evaluate the effectiveness of a change in the wound care procedure. Which of
the following findings indicates wound healing?
A. Erythema on the skin surrounding a client's wound
B. Deep red color on the center of the client's wound
C. Inflammation noted on the tissue edges of a client's wound
D. Increase in serosanguineous exudate from the client's wound
Correct Answer: D
Explanation: A moderate increase in serosanguineous (bloody-tinged) drainage indicates active healing with granulation tissue
formation. Erythema (A) suggests infection or inflammation. Deep red (B) can indicate vascular congestion or necrosis. Inflammation
(C) suggests infection, not healing.
Question 2
A nurse receives change-of-shift report at 0700 for four clients. Which of the following actions should the nurse perform first?
A. Obtain a breakfast tray for a client who is receiving a morning dose of insulin aspart
B. Administer pain medication to a client who has rheumatoid arthritis and received the last dose at 0400
C. Restart an infiltrated IV for a client whose IV antibiotic is scheduled for 0900
D. Replace a client's enteral nutrition feeding solution that has been hanging for 24 hours
Correct Answer: A
Explanation: This patient needs a breakfast tray to prevent hypoglycemia after insulin administration. Insulin aspart peaks in 1-3 hours
and requires food intake. Patient safety (hypoglycemia prevention) takes priority over pain management (B), IV access (C), or feeding
solution (D), though all are important.
Question 3
A nurse is orienting a newly licensed nurse on the neurological unit. Which of the following clients should the nurse assign to the
newly licensed nurse?
A. A client who has multiple sclerosis and ataxia
B. A client who has a brain tumor and is admitted for chemotherapy
C. A client who has Guillain-Barré syndrome and a tracheostomy
D. A client who sustained a concussion and is being monitored for complications
Correct Answer: D
Explanation: The concussion patient is the most stable and predictable, appropriate for a newly licensed nurse. MS with ataxia (A)
requires fall precautions and complex mobility assessment. Brain tumor on chemo (B) requires specialized knowledge of side effects.
Guillain-Barré with tracheostomy (C) requires airway management expertise.
,Question 4
A nurse is providing teaching to a client about advance directives. Which of the following statements by the client indicates an
understanding of the teaching?
A. "Once I sign my living will, a family member must co-sign it."
B. "I will wait until I have a serious health problem to sign my advance directive."
C. "My doctor will need to provide approval for the decisions outlined in my living will."
D. "My durable power of attorney for health care is part of my advance directive."
Correct Answer: D
Explanation: A durable power of attorney for health care is a type of advance directive that designates someone to make decisions if
the patient becomes incapacitated. Family co-signature (A) is not required. Advance directives should be completed BEFORE serious
illness (B). Doctor approval (C) is not needed—the document reflects patient wishes.
Question 5
A nurse is chairing a committee about preventing infant abduction in a new birth care center. Which of the following quality control
tasks should the nurse assign to be completed first?
A. Identify the industry standards for infant safety
B. Evaluate the selected infant safety system
C. Choose an infant safety system
D. Establish measurement criteria for infant safety systems
Correct Answer: A
Explanation: The first step in quality improvement is identifying standards and benchmarks. You cannot evaluate (B), choose (C), or
establish criteria (D) without first knowing what the standards are. This follows the Plan-Do-Study-Act (PDSA) model where planning
comes first.
Question 6
A nurse notes that a client is eating about half of the food on his plate and coughs frequently during meals. The nurse plans to
perform dysphagia screening to determine the client's need for a referral to which of the following providers?
A. Physical therapist
B. Respiratory therapist
C. Speech therapist
D. Occupational therapist
Correct Answer: C
Explanation: Speech-language pathologists (speech therapists) specialize in swallowing disorders (dysphagia). Physical therapists (A)
focus on mobility. Respiratory therapists (B) focus on breathing treatments. Occupational therapists (D) focus on activities of daily
living.
Question 7
, A nurse manager is planning to assign care for four clients on a medical-surgical unit. Which of the following clients should the nurse
assign to an LPN?
A. An older adult who has lung cancer and has periodic episodes of severe dyspnea
B. A middle adult client who has a below-the-knee amputation and requires a dressing change
C. A young adult client who is postoperative, receiving morphine via epidural, and reports pruritus
D. An adolescent who requires teaching regarding insulin administration
Correct Answer: B
Explanation: Routine dressing changes are within LPN scope. The lung cancer patient with dyspnea (A) is unstable and requires RN
assessment. Epidural morphine (C) requires RN monitoring for respiratory depression. Initial insulin teaching (D) is RN responsibility
(LPNs reinforce only).
Question 8
While auditing medical records on an oncology unit, the nurse manager finds that six of the 15 records lack documentation regarding
advance directives. Which of the following is the priority action for the nurse to take?
A. Remind nurses to obtain this information during the admission process
B. Reinforce the potential consequences of not having this information on record to the nursing staff
C. Meet with nursing staff to review the policy regarding advance directives
D. Ask nurses who are caring for clients without this information to obtain it
Correct Answer: B
Explanation: The priority is to educate staff on WHY this matters—so they understand consequences and change behavior. Simply
reminding (A) or asking nurses to obtain it (D) doesn't address knowledge gaps. Meeting to review policy (C) is helpful but secondary
to explaining consequences.
Question 9
A nurse is caring for a group of clients. Which of the following should the nurse see first?
A. A client who is postoperative and has a fever
B. A client whose pressure ulcer has serosanguineous drainage on the dressing
C. A client who has diabetes mellitus and is diaphoretic
D. A client who has a fractured hip and reports a pain level of 7 on a scale from 0-10
Correct Answer: C
Explanation: Diaphoresis in a diabetic patient suggests hypoglycemia (possible blood glucose <70 mg/dL), which is a medical
emergency requiring immediate treatment. Post-op fever (A) is concerning but not immediate. Serosanguineous drainage (B) is normal
healing. Pain 7/10 (D) requires intervention but is not life-threatening.
Question 10
A nurse is receiving change-of-shift report for four clients. Which of the following clients should the nurse care for first?
A. A client who is 4 hours postoperative following a hernia repair and has pitting edema of the right leg
B. A client who is scheduled for an intermittent enteral feeding in 2 hours and reports diarrhea
C. A client who has pneumonia and requires a tracheostomy dressing change
Answers and Rationales for Nursing Students 2023–2026
Question 1
A nurse is assessing pressure ulcers on four clients to evaluate the effectiveness of a change in the wound care procedure. Which of
the following findings indicates wound healing?
A. Erythema on the skin surrounding a client's wound
B. Deep red color on the center of the client's wound
C. Inflammation noted on the tissue edges of a client's wound
D. Increase in serosanguineous exudate from the client's wound
Correct Answer: D
Explanation: A moderate increase in serosanguineous (bloody-tinged) drainage indicates active healing with granulation tissue
formation. Erythema (A) suggests infection or inflammation. Deep red (B) can indicate vascular congestion or necrosis. Inflammation
(C) suggests infection, not healing.
Question 2
A nurse receives change-of-shift report at 0700 for four clients. Which of the following actions should the nurse perform first?
A. Obtain a breakfast tray for a client who is receiving a morning dose of insulin aspart
B. Administer pain medication to a client who has rheumatoid arthritis and received the last dose at 0400
C. Restart an infiltrated IV for a client whose IV antibiotic is scheduled for 0900
D. Replace a client's enteral nutrition feeding solution that has been hanging for 24 hours
Correct Answer: A
Explanation: This patient needs a breakfast tray to prevent hypoglycemia after insulin administration. Insulin aspart peaks in 1-3 hours
and requires food intake. Patient safety (hypoglycemia prevention) takes priority over pain management (B), IV access (C), or feeding
solution (D), though all are important.
Question 3
A nurse is orienting a newly licensed nurse on the neurological unit. Which of the following clients should the nurse assign to the
newly licensed nurse?
A. A client who has multiple sclerosis and ataxia
B. A client who has a brain tumor and is admitted for chemotherapy
C. A client who has Guillain-Barré syndrome and a tracheostomy
D. A client who sustained a concussion and is being monitored for complications
Correct Answer: D
Explanation: The concussion patient is the most stable and predictable, appropriate for a newly licensed nurse. MS with ataxia (A)
requires fall precautions and complex mobility assessment. Brain tumor on chemo (B) requires specialized knowledge of side effects.
Guillain-Barré with tracheostomy (C) requires airway management expertise.
,Question 4
A nurse is providing teaching to a client about advance directives. Which of the following statements by the client indicates an
understanding of the teaching?
A. "Once I sign my living will, a family member must co-sign it."
B. "I will wait until I have a serious health problem to sign my advance directive."
C. "My doctor will need to provide approval for the decisions outlined in my living will."
D. "My durable power of attorney for health care is part of my advance directive."
Correct Answer: D
Explanation: A durable power of attorney for health care is a type of advance directive that designates someone to make decisions if
the patient becomes incapacitated. Family co-signature (A) is not required. Advance directives should be completed BEFORE serious
illness (B). Doctor approval (C) is not needed—the document reflects patient wishes.
Question 5
A nurse is chairing a committee about preventing infant abduction in a new birth care center. Which of the following quality control
tasks should the nurse assign to be completed first?
A. Identify the industry standards for infant safety
B. Evaluate the selected infant safety system
C. Choose an infant safety system
D. Establish measurement criteria for infant safety systems
Correct Answer: A
Explanation: The first step in quality improvement is identifying standards and benchmarks. You cannot evaluate (B), choose (C), or
establish criteria (D) without first knowing what the standards are. This follows the Plan-Do-Study-Act (PDSA) model where planning
comes first.
Question 6
A nurse notes that a client is eating about half of the food on his plate and coughs frequently during meals. The nurse plans to
perform dysphagia screening to determine the client's need for a referral to which of the following providers?
A. Physical therapist
B. Respiratory therapist
C. Speech therapist
D. Occupational therapist
Correct Answer: C
Explanation: Speech-language pathologists (speech therapists) specialize in swallowing disorders (dysphagia). Physical therapists (A)
focus on mobility. Respiratory therapists (B) focus on breathing treatments. Occupational therapists (D) focus on activities of daily
living.
Question 7
, A nurse manager is planning to assign care for four clients on a medical-surgical unit. Which of the following clients should the nurse
assign to an LPN?
A. An older adult who has lung cancer and has periodic episodes of severe dyspnea
B. A middle adult client who has a below-the-knee amputation and requires a dressing change
C. A young adult client who is postoperative, receiving morphine via epidural, and reports pruritus
D. An adolescent who requires teaching regarding insulin administration
Correct Answer: B
Explanation: Routine dressing changes are within LPN scope. The lung cancer patient with dyspnea (A) is unstable and requires RN
assessment. Epidural morphine (C) requires RN monitoring for respiratory depression. Initial insulin teaching (D) is RN responsibility
(LPNs reinforce only).
Question 8
While auditing medical records on an oncology unit, the nurse manager finds that six of the 15 records lack documentation regarding
advance directives. Which of the following is the priority action for the nurse to take?
A. Remind nurses to obtain this information during the admission process
B. Reinforce the potential consequences of not having this information on record to the nursing staff
C. Meet with nursing staff to review the policy regarding advance directives
D. Ask nurses who are caring for clients without this information to obtain it
Correct Answer: B
Explanation: The priority is to educate staff on WHY this matters—so they understand consequences and change behavior. Simply
reminding (A) or asking nurses to obtain it (D) doesn't address knowledge gaps. Meeting to review policy (C) is helpful but secondary
to explaining consequences.
Question 9
A nurse is caring for a group of clients. Which of the following should the nurse see first?
A. A client who is postoperative and has a fever
B. A client whose pressure ulcer has serosanguineous drainage on the dressing
C. A client who has diabetes mellitus and is diaphoretic
D. A client who has a fractured hip and reports a pain level of 7 on a scale from 0-10
Correct Answer: C
Explanation: Diaphoresis in a diabetic patient suggests hypoglycemia (possible blood glucose <70 mg/dL), which is a medical
emergency requiring immediate treatment. Post-op fever (A) is concerning but not immediate. Serosanguineous drainage (B) is normal
healing. Pain 7/10 (D) requires intervention but is not life-threatening.
Question 10
A nurse is receiving change-of-shift report for four clients. Which of the following clients should the nurse care for first?
A. A client who is 4 hours postoperative following a hernia repair and has pitting edema of the right leg
B. A client who is scheduled for an intermittent enteral feeding in 2 hours and reports diarrhea
C. A client who has pneumonia and requires a tracheostomy dressing change
