ATI RN Leadership Proctored Exam 2023-2026
with NGN
Complete Practice Exam – 70 Questions with
Answers & Rationales
Updated for 2025-2026 | Next Generation
NCLEX (NGN) Style Included
EXAM OVERVIEW
Component Details
Total
70 scored items + NGN case studies
Questions
Time Limit Approximately 2-3 hours
Key Content Delegation (5 Rights), Prioritization, Conflict Resolution, Legal/Ethical Issues, Client Advocac
Areas Quality Improvement, Safety Protocols, Resource Management
SECTION 1: PRIORITIZATION & CLINICAL JUDGMENT (Questions 1-12)
Question 1
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 received 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
Answer: A) Obtain a breakfast tray for a client who received a morning dose of insulin aspart
Rationale: Insulin aspart is a rapid-acting insulin that peaks in 1-3 hours. The client must eat
within 15-30 minutes of administration to prevent hypoglycemia. This is the priority safety
concern as hypoglycemia can be life-threatening and occurs rapidly. The other tasks are
important but do not present immediate safety risks.
Question 2
A nurse in the emergency department is assessing several clients. Which of the following clients
is the highest priority?
A) A client who reports shortness of breath and left neck and shoulder pain
B) A client who has a blood pressure of 210/110 mmHg and is asymptomatic
C) A client who has a laceration on the forearm with minimal bleeding
D) A client who reports abdominal pain rated 4 on a 0-10 scale
Answer: A) A client who reports shortness of breath and left neck and shoulder pain
Rationale: Shortness of breath with left neck and shoulder pain may indicate a myocardial
infarction or pulmonary embolism, which are life-threatening conditions requiring immediate
intervention. Asymptomatic hypertension (B) requires treatment but is not immediately life-
threatening. The other options are stable.
Question 3
A nurse is caring for four clients. Which of the following clients should the nurse assess first?
A) A client who has new-onset restlessness
B) A client who has a blood glucose of 180 mg/dL
C) A client who has a temperature of 38.3°C (101°F)
D) A client who reports pain rated 3 on a 0-10 scale
Answer: A) A client who has new-onset restlessness
,Rationale: New-onset restlessness may indicate hypoxia, hemorrhage, or other acute
deterioration. This change in mental status requires immediate assessment as it can precede
respiratory or cardiac arrest.
Question 4
NGN Case Study – Hemorrhage Recognition
A client, 6 hours postoperative from abdominal surgery, was resting comfortably with a pain
level of 4 and moderate serosanguineous drainage. Later, the client becomes restless, short of
breath, and reports severe abdominal pain (8/10) with an abdominal dressing saturated in
bright red blood.
Which combination of new findings most likely indicates hemorrhage requiring immediate
provider notification?
A) Slight pain increase, stable heart rate, unchanged respiratory rate, elevated temperature,
normal O2 saturation, pink-tinged drainage
B) Decreased blood pressure, increased respiratory rate, pain 8/10, large amount of bright red
drainage, decreased oxygen saturation, increased heart rate
C) Moderate serosanguineous drainage, heat at incision site, stable respiratory rate, stable
blood pressure, pain 5/10, normal O2 saturation
D) Unchanged blood pressure, no new drainage, decreased pain, shortness of breath resolved,
normal heart rate, mild nausea
Answer: B) Decreased blood pressure, increased respiratory rate, pain 8/10, large amount of
bright red drainage, decreased oxygen saturation, increased heart rate
Rationale: Sudden changes of tachycardia, tachypnea, hypotension, severe pain, large amounts
of bright red blood, and decreased O2 saturation are classic signs of hemorrhage. This
combination requires immediate provider notification and intervention.
Question 5
A nurse in a rehabilitation facility is administering medications to a client who was admitted
earlier that day. The client refuses two of the medications, stating, "I've never taken these
before." Which of the following actions should the nurse take first?
A) Compare the client's medication administration record with the prescriptions of the transfer
order
, B) Call the provider to clarify the client's prescribed medications
C) Review the intended purpose of the prescribed medications with the client
D) Consult the pharmacist about the client's prescribed medications
Answer: A) Compare the client's medication administration record with the prescriptions of the
transfer order
Rationale: The nurse must first verify that the medications on the MAR match the transfer
orders. Medication discrepancies during care transitions are common and can cause serious
errors. After verification, further actions may be needed.
Question 6
A nurse in the emergency department is performing triage. To which of the following clients
should the nurse assign priority?
A) A client who has a sprained ankle and reports pain of 4/10
B) A client who has soot markings around each naris following a house fire
C) A client who has a laceration requiring 5 stitches
D) A client who reports nausea after eating spoiled food
Answer: B) A client who has soot markings around each naris following a house fire
Rationale: Soot markings around the nares indicate potential inhalation injury and carbon
monoxide poisoning, a life-threatening emergency requiring immediate intervention. This client
is at risk for airway compromise. The other clients have stable conditions.
Question 7
A nurse is caring for a client and notices fraying on the electrical cord of the client's IV pump.
Which of the following actions is the priority for the nurse to take?
A) Report the problem to the engineering team
B) Check the expiration date of the inspection sticker
C) Request a replacement IV pump
D) Remove the IV pump from the client's room
Answer: D) Remove the IV pump from the client's room
with NGN
Complete Practice Exam – 70 Questions with
Answers & Rationales
Updated for 2025-2026 | Next Generation
NCLEX (NGN) Style Included
EXAM OVERVIEW
Component Details
Total
70 scored items + NGN case studies
Questions
Time Limit Approximately 2-3 hours
Key Content Delegation (5 Rights), Prioritization, Conflict Resolution, Legal/Ethical Issues, Client Advocac
Areas Quality Improvement, Safety Protocols, Resource Management
SECTION 1: PRIORITIZATION & CLINICAL JUDGMENT (Questions 1-12)
Question 1
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 received 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
Answer: A) Obtain a breakfast tray for a client who received a morning dose of insulin aspart
Rationale: Insulin aspart is a rapid-acting insulin that peaks in 1-3 hours. The client must eat
within 15-30 minutes of administration to prevent hypoglycemia. This is the priority safety
concern as hypoglycemia can be life-threatening and occurs rapidly. The other tasks are
important but do not present immediate safety risks.
Question 2
A nurse in the emergency department is assessing several clients. Which of the following clients
is the highest priority?
A) A client who reports shortness of breath and left neck and shoulder pain
B) A client who has a blood pressure of 210/110 mmHg and is asymptomatic
C) A client who has a laceration on the forearm with minimal bleeding
D) A client who reports abdominal pain rated 4 on a 0-10 scale
Answer: A) A client who reports shortness of breath and left neck and shoulder pain
Rationale: Shortness of breath with left neck and shoulder pain may indicate a myocardial
infarction or pulmonary embolism, which are life-threatening conditions requiring immediate
intervention. Asymptomatic hypertension (B) requires treatment but is not immediately life-
threatening. The other options are stable.
Question 3
A nurse is caring for four clients. Which of the following clients should the nurse assess first?
A) A client who has new-onset restlessness
B) A client who has a blood glucose of 180 mg/dL
C) A client who has a temperature of 38.3°C (101°F)
D) A client who reports pain rated 3 on a 0-10 scale
Answer: A) A client who has new-onset restlessness
,Rationale: New-onset restlessness may indicate hypoxia, hemorrhage, or other acute
deterioration. This change in mental status requires immediate assessment as it can precede
respiratory or cardiac arrest.
Question 4
NGN Case Study – Hemorrhage Recognition
A client, 6 hours postoperative from abdominal surgery, was resting comfortably with a pain
level of 4 and moderate serosanguineous drainage. Later, the client becomes restless, short of
breath, and reports severe abdominal pain (8/10) with an abdominal dressing saturated in
bright red blood.
Which combination of new findings most likely indicates hemorrhage requiring immediate
provider notification?
A) Slight pain increase, stable heart rate, unchanged respiratory rate, elevated temperature,
normal O2 saturation, pink-tinged drainage
B) Decreased blood pressure, increased respiratory rate, pain 8/10, large amount of bright red
drainage, decreased oxygen saturation, increased heart rate
C) Moderate serosanguineous drainage, heat at incision site, stable respiratory rate, stable
blood pressure, pain 5/10, normal O2 saturation
D) Unchanged blood pressure, no new drainage, decreased pain, shortness of breath resolved,
normal heart rate, mild nausea
Answer: B) Decreased blood pressure, increased respiratory rate, pain 8/10, large amount of
bright red drainage, decreased oxygen saturation, increased heart rate
Rationale: Sudden changes of tachycardia, tachypnea, hypotension, severe pain, large amounts
of bright red blood, and decreased O2 saturation are classic signs of hemorrhage. This
combination requires immediate provider notification and intervention.
Question 5
A nurse in a rehabilitation facility is administering medications to a client who was admitted
earlier that day. The client refuses two of the medications, stating, "I've never taken these
before." Which of the following actions should the nurse take first?
A) Compare the client's medication administration record with the prescriptions of the transfer
order
, B) Call the provider to clarify the client's prescribed medications
C) Review the intended purpose of the prescribed medications with the client
D) Consult the pharmacist about the client's prescribed medications
Answer: A) Compare the client's medication administration record with the prescriptions of the
transfer order
Rationale: The nurse must first verify that the medications on the MAR match the transfer
orders. Medication discrepancies during care transitions are common and can cause serious
errors. After verification, further actions may be needed.
Question 6
A nurse in the emergency department is performing triage. To which of the following clients
should the nurse assign priority?
A) A client who has a sprained ankle and reports pain of 4/10
B) A client who has soot markings around each naris following a house fire
C) A client who has a laceration requiring 5 stitches
D) A client who reports nausea after eating spoiled food
Answer: B) A client who has soot markings around each naris following a house fire
Rationale: Soot markings around the nares indicate potential inhalation injury and carbon
monoxide poisoning, a life-threatening emergency requiring immediate intervention. This client
is at risk for airway compromise. The other clients have stable conditions.
Question 7
A nurse is caring for a client and notices fraying on the electrical cord of the client's IV pump.
Which of the following actions is the priority for the nurse to take?
A) Report the problem to the engineering team
B) Check the expiration date of the inspection sticker
C) Request a replacement IV pump
D) Remove the IV pump from the client's room
Answer: D) Remove the IV pump from the client's room
