Exam Guide
ATI Leadership Proctored Exam 2026: Study Guide + Practice Questions
The ATI RN Leadership proctored exam is the one nursing students underestimate. It has no drug math and no lab values to memorize, so it feels "soft" until you sit down and every question asks you to pick between four defensible answers. This guide covers what the exam tests, how proficiency levels work, the five content domains with the high-yield facts for each, 30 original practice questions with full rationales, and a 2-week and 4-week study plan.
At a glance
What the ATI Leadership proctored exam looks like
The RN Leadership exam is part of ATI's Content Mastery Series. It is delivered on a computer under proctored conditions (in a testing center or with remote proctoring), and it covers the management-of-care content from your Leadership course: who does what on the unit, what to do first, what is legal, what is ethical, and how to fix problems at the system level.
Question count and time. Students and faculty commonly describe the exam as roughly 60–70 items with about an hour to complete it. Because ATI can update the specification, treat those numbers as typical rather than guaranteed and check the exact figures in your program's exam announcement or the ATI student portal before test day.
RN vs. PN. There is no separate PN Leadership proctored exam in the same sense. PN students see leadership, delegation, and legal/ethical content folded into the PN Fundamentals and PN Comprehensive Predictor exams instead. If you are a PN student, start with PN Fundamentals.
2026 vs. 2023 versions. The 2023 form is mostly classic multiple choice and select-all-that-apply. The 2026 form adds more Next Generation NCLEX (NGN)-style formats — extended multiple response, drag-and-drop ordering, and short clinical-judgment case studies with several linked questions. The content is the same; the 2026 version simply asks you to show your reasoning in more steps. We have a dedicated practice exam for each: RN Leadership 2026 and RN Leadership 2023.
What Level 1, 2, and 3 mean
ATI does not report a percentage pass/fail. Your raw score is converted to a proficiency level:
The cut scores that separate the levels are set by ATI and are not published as a fixed percentage, and the score your program requires is a program policy. If your syllabus says "Level 2 required," that is the number that matters.
The five content domains (and the facts that keep showing up)
The exam does not publish exact weights, but across our own item-writing and student reports the same five areas account for nearly everything. We organize all of our RN Leadership study material around them.
1. Delegation & prioritization
- Five rights of delegation: right task, right circumstance, right person, right direction/communication, right supervision. The RN keeps accountability for the outcome even after delegating.
- Assistive personnel (AP/UAP) can do routine, predictable tasks on stable clients: vital signs, I&O, ambulation, hygiene, feeding, repositioning, and reporting what they observe. They cannot assess, teach, evaluate, or make judgments about abnormal findings.
- LPN/LVN can perform focused reassessment of stable clients, reinforce teaching the RN already started, administer most routine oral/IM/SC medications, do sterile dressing changes, and insert urinary catheters. They cannot do the initial admission assessment, create or evaluate the care plan, do initial teaching, or (in most states) administer IV push medications or blood.
- Prioritization frameworks: ABCs first, then Maslow, then acute-before-chronic, unstable-before-stable, actual-before-potential. A new or changing symptom beats a known, expected one.
- Floating: a floated nurse should accept the assignment, tell the charge nurse which tasks they are not competent to perform, and be given the most stable clients whose needs match the nurse's usual skill set.
- Time management: start the shift by assessing the highest-acuity client, cluster care, and do the time-sensitive items (blood, insulin, pre-op prep) before flexible ones.
2. Legal & ethical issues
- Negligence = a reasonable, prudent nurse would have acted differently (e.g., not checking equipment). Malpractice = professional negligence that causes harm. Battery = touching without consent, including giving a refused medication. Assault = threatening to. False imprisonment = restraints or confinement without justification.
- Informed consent: the provider explains the procedure, risks, benefits, and alternatives; the nurse witnesses the signature and confirms the client is competent, unpressured, and says they understand. If the client does not understand, stop and notify the provider — do not explain the surgery yourself.
- Advance directives: ask every client on admission; document the answer; a living will guides care when the client cannot speak, and a durable power of attorney names who decides.
- HIPAA: share only with people directly involved in care who need the information. Logging off a computer, not discussing clients in elevators, and confirming a caller's identity are all protections.
- Mandatory reporting: suspected abuse of children, older adults, or vulnerable adults; certain communicable diseases to the public health department; impaired coworkers to the supervisor.
- Ethical principles: autonomy (the client decides), beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), veracity (tell the truth).
3. Quality improvement & incident reporting
- Incident (occurrence) reports are filed for every error or near miss, even with no harm. Document the facts objectively in the chart; do not mention the incident report in the chart.
- Root cause analysis asks "what in the system allowed this?" after a sentinel event — it is not about blaming an individual.
- QI tools: benchmarking (comparing your unit's data with a best-practice standard), audits (checking records against a criterion), and PDSA cycles (plan-do-study-act).
- Evidence-based practice starts with a clearly defined clinical question, then a literature search, then critical appraisal, then a pilot.
- Equipment safety: remove faulty equipment from service, tag it, and report it — do not "work around" it.
4. Conflict management & team communication
- Conflict strategies: collaborating (win-win, best long-term), compromising (each gives a little), accommodating (one side yields), competing (one side wins), avoiding (nobody addresses it). Avoidance is almost never the exam's answer.
- Chain of command: address the person directly first, then the charge nurse, then the nurse manager, then the director. Skipping steps is only appropriate when a client is in immediate danger.
- Change-of-shift report: use a structured format (SBAR/I-PASS), include changes in condition, pending tests, and outstanding orders; leave out opinions and routine, unchanged data.
- Telephone orders: write it down, read it back, get confirmation, and have the provider sign within the agency's time frame.
- Interpreters: use a trained medical interpreter, not family, for consent, teaching, and assessments.
- Leadership styles: authoritarian (leader decides — best in emergencies), democratic (team input — best for buy-in), laissez-faire (hands off — works only with expert self-directed teams), transformational (inspires shared vision).
5. Scope of practice & regulatory bodies
- State Board of Nursing defines the Nurse Practice Act, licenses nurses, and disciplines them. It is who you notify about an impaired or unsafe nurse after your supervisor.
- The Joint Commission accredits facilities and publishes the National Patient Safety Goals (two identifiers, read-back, medication reconciliation, fall prevention, hand hygiene).
- OSHA covers workplace safety for staff; CDC issues infection-control guidance; CMS ties reimbursement to quality (hospital-acquired pressure injuries and falls are not reimbursed).
- Case managers coordinate care across settings and control costs; client advocacy means speaking up for the client's expressed wishes, even to a provider.
- Disaster triage: red/immediate (treatable life threats) first, yellow/delayed, green/minor, black/expectant. In an evacuation, ambulatory clients go first, then wheelchair, then bedbound.
30 original practice questions with rationales
Each question is original and written to the difficulty of a proctored exam. Answer it in your head (or on paper for the select-all and ordering items), then tap Show answer. Read the rationale even when you were right — the reasoning is what transfers to new questions.
A charge nurse on a medical unit is making assignments for the shift. Which of the following tasks are appropriate to delegate to assistive personnel (AP)? (Select all that apply.)
- A. Ambulating a client who is 2 days postoperative following hip arthroplasty
- B. Measuring the intake and output of a client who has heart failure
- C. Reinforcing teaching about a low-sodium diet with a newly diagnosed client
- D. Obtaining vital signs on a client who is scheduled for discharge
- E. Assessing a client's pain 30 minutes after an opioid was given
Show answer
Correct answer: A, B, D
AP can perform routine, predictable tasks on stable clients: ambulation of an established postoperative client, I&O, and vital signs. Reinforcing teaching requires nursing judgment and is within the LPN's or RN's scope, not the AP's. Assessing pain after an intervention is an evaluation and must be done by the RN.
A nurse receives report on four clients. Which client should the nurse assess first?
- A. A client who has bacterial meningitis and reports a headache of 6 on a scale of 0 to 10
- B. A client who is 1 day postoperative and has a new onset of confusion and a respiratory rate of 28/min
- C. A client who has type 1 diabetes and a fasting blood glucose of 190 mg/dL
- D. A client who has a chest tube and reports discomfort at the insertion site
Show answer
Correct answer: B
New confusion with tachypnea signals a possible airway or breathing problem such as hypoxia, atelectasis, or pulmonary embolism — an ABC priority and an acute change. Headache is expected with meningitis, an elevated glucose of 190 is not an emergency, and chest-tube site discomfort is anticipated.
A nurse from the pediatric unit is floated to an adult medical-surgical unit. Which client is the most appropriate assignment for this nurse?
- A. A client receiving a continuous heparin infusion who needs aPTT monitoring
- B. A client who is 1 day postoperative following an appendectomy and is ready for discharge teaching
- C. A client with a new tracheostomy who requires frequent suctioning
- D. A client admitted 1 hour ago with chest pain awaiting cardiac enzymes
Show answer
Correct answer: B
A floated nurse should receive stable clients whose needs overlap with the nurse's usual competencies. A stable postoperative appendectomy client is predictable and discharge teaching is a general nursing skill. Heparin titration, a fresh tracheostomy, and a new chest-pain admission all require specialized adult skills and ongoing complex assessment.
A nurse is planning care for the first hour of the shift. Which action should the nurse complete first?
- A. Change the dressing on a client's stage 2 pressure injury
- B. Assess a client who is receiving a blood transfusion that was started 10 minutes ago
- C. Complete discharge paperwork for a client whose ride arrives at 1000
- D. Reinforce insulin self-injection teaching with a client
Show answer
Correct answer: B
The first 15 minutes of a transfusion is when acute hemolytic and anaphylactic reactions are most likely, so this client is the least stable and most time-sensitive. The other tasks are important but can safely wait.
A nurse is using a color-coded triage tag system at a mass-casualty event. Which client should the nurse treat first?
- A. A client with an open femur fracture who is alert with a palpable radial pulse (yellow tag)
- B. A client with a sucking chest wound and a respiratory rate of 34/min (red tag)
- C. A client with full-thickness burns over 90% of the body who is unresponsive (black tag)
- D. A client with a sprained ankle who is walking and talking (green tag)
Show answer
Correct answer: B
In disaster triage, red/immediate clients have life-threatening but treatable injuries and are seen first. The open fracture is urgent but can wait (yellow). The client with 90% burns and no response is classified expectant (black) because resources are directed to survivable injuries. Green clients are minor.
A fire is reported on a hospital unit and the charge nurse orders a horizontal evacuation. In which order should the nurse evacuate clients?
- A. Clients who are bedbound, then clients in wheelchairs, then ambulatory clients
- B. Ambulatory clients, then clients in wheelchairs, then bedbound clients
- C. Clients closest to the nurses' station first, regardless of mobility
- D. Clients receiving oxygen first, then all others
Show answer
Correct answer: B
Evacuating ambulatory clients first moves the largest number of people to safety fastest and clears the hallways. Wheelchair clients follow, and bedbound clients, who need the most staff, are moved last. Clients in immediate danger from the fire itself are the exception and are moved first regardless of mobility.
A nurse uses an IV pump that was flagged for calibration problems the previous shift. The pump delivers double the prescribed rate and the client develops fluid overload. Which legal concept best describes the nurse's action?
- A. Assault
- B. Negligence
- C. False imprisonment
- D. Defamation
Show answer
Correct answer: B
Negligence is failing to act as a reasonable, prudent nurse would — here, using equipment known to be faulty instead of removing it from service. Because the client was harmed, this could also rise to malpractice. Assault, false imprisonment, and defamation are intentional torts that do not fit the scenario.
A nurse enters a room to witness a client signing consent for a colonoscopy. The client says, "I'm not really sure what they're going to do." Which action should the nurse take?
- A. Explain the procedure, risks, and benefits to the client and then witness the signature
- B. Ask the client to sign and note the concern in the chart
- C. Notify the provider that the client needs further explanation before signing
- D. Ask a family member to explain the procedure to the client
Show answer
Correct answer: C
The provider performing the procedure is responsible for the informed part of informed consent. The nurse's role is to verify the client is competent, consenting voluntarily, and understands. When understanding is missing, the nurse stops the process and contacts the provider. Explaining the procedure or letting the client sign anyway exposes the nurse and the agency to liability.
A nurse manager is teaching staff about protecting clients' personal health information. Which action should the manager include as an example of protecting privacy?
- A. Discussing a client's lab results with a family member who calls the unit
- B. Logging off the computer before walking away from the workstation
- C. Leaving a printed medication administration record at the bedside
- D. Posting the unit's census with diagnoses on a whiteboard in the hallway
Show answer
Correct answer: B
Logging off prevents anyone else from viewing the record. Sharing results with a caller whose identity and authorization have not been verified, leaving records at the bedside, and displaying diagnoses publicly are all HIPAA violations.
A nurse in a clinic confirms that a client has a new diagnosis of active tuberculosis. Which action is the nurse legally required to take?
- A. Notify the client's employer so coworkers can be tested
- B. Report the case to the local or state public health department
- C. Inform the client's family members of the diagnosis
- D. Place the client's name on a facility-wide alert list
Show answer
Correct answer: B
Certain communicable diseases, including tuberculosis, are mandatory reports to public health authorities so contact tracing can occur. Notifying an employer or family directly without the client's consent violates confidentiality; contact tracing is the health department's role.
A nurse manager audits records on an oncology unit and finds that 6 of 15 charts contain no documentation about advance directives. Which action should the manager take first?
- A. Ask the primary nurses to have each of the six clients sign a living will
- B. Determine whether each of the six clients was asked about advance directives on admission
- C. Schedule an in-service on advance directives for the entire staff
- D. Report the unit to the facility's ethics committee
Show answer
Correct answer: B
The first step is to gather data: were the clients asked and the answer not recorded, or were they never asked? That determines whether the problem is documentation or process. Clients cannot be required to complete a living will, and an in-service or ethics referral is premature until the cause is known.
A provider calls the unit and gives a nurse a telephone prescription for a new medication. Which action should the nurse take?
- A. Enter the prescription and ask the provider to sign it at the next visit within a week
- B. Write the prescription down, read it back to the provider, and obtain confirmation
- C. Ask the unit secretary to take the prescription while the nurse finishes an assessment
- D. Decline the prescription and require the provider to enter it electronically
Show answer
Correct answer: B
Write-down, read-back, and confirmation is the safety standard for verbal and telephone prescriptions. Only a licensed nurse may accept them, and the provider must sign within the agency's required time frame — usually 24 hours, not a week. Telephone prescriptions are permitted, so refusing is inappropriate unless the situation is not urgent and policy requires electronic entry.
A nurse gives a client a medication 2 hours late and the client experiences no adverse effect. Place the nurse's actions in the correct order.
- A. Assess the client for any effect of the delay
- B. Notify the provider
- C. Document the medication time and the client's condition in the medical record
- D. Complete an incident report according to facility policy
Show answer
Correct order: A → B → C → D
Client safety comes first: assess, then notify the provider so the plan can be adjusted. Document objectively what happened and the client's response in the chart, without referring to the incident report. Finally, complete the incident report so the agency can track and analyze the error. Reports are required even when no harm occurs.
A nurse is leading a project to reduce emergency-department wait times using benchmarking. Which action is part of benchmarking?
- A. Comparing the department's average wait time with the times of high-performing hospitals
- B. Interviewing staff to identify who is responsible for the delays
- C. Asking clients to rate their satisfaction with their nurse
- D. Reviewing a single client's record after a complaint
Show answer
Correct answer: A
Benchmarking compares your unit's performance data with an external best-practice standard to identify the gap. Assigning blame is contrary to QI principles, satisfaction surveys measure a different outcome, and a single-record review is a case review, not benchmarking.
A client falls after receiving a sedative, sustaining a hip fracture. The nurse manager initiates a root cause analysis. Which statement by a staff nurse indicates understanding of the purpose of the analysis?
- A. "They want to know which nurse forgot to put the bed alarm on."
- B. "They're looking at the whole process to find what allowed the fall to happen."
- C. "This is how the hospital decides whether to report us to the board."
- D. "It's a formality; the incident report already explains it."
Show answer
Correct answer: B
A root cause analysis is a systems-focused review of a sentinel event that asks what in the process (staffing, equipment, policy, communication) made the error possible, so it can be redesigned. It is explicitly non-punitive and is separate from the incident report.
A nurse notices that a coworker has slurred speech, frequently volunteers to give opioids, and has clients who report unrelieved pain. Which action should the nurse take?
- A. Confront the coworker privately and offer to cover the rest of the shift
- B. Report the observations to the nurse manager immediately
- C. Wait until the pattern has been observed on several more shifts
- D. Warn the clients not to accept medications from the coworker
Show answer
Correct answer: B
Suspected impairment is a client-safety issue and must be reported to the supervisor right away; the nurse has a legal and ethical duty to do so. Confronting or covering for the coworker delays intervention, waiting exposes clients to harm, and alerting clients violates the coworker's privacy and bypasses the chain of command.
Two nurses on a unit repeatedly argue about who is responsible for restocking the supply cart, and the tension is affecting the team. Which conflict-resolution strategy should the charge nurse use to reach a lasting solution?
- A. Avoiding: allow the nurses to work it out on their own
- B. Competing: decide who is responsible and inform them
- C. Collaborating: meet with both nurses to identify the underlying problem and agree on a solution together
- D. Accommodating: ask one nurse to take on the task to keep the peace
Show answer
Correct answer: C
Collaboration is the win-win approach that addresses the underlying issue and produces a solution both parties own, which is the most durable outcome. Avoiding lets the conflict grow, competing creates a winner and a loser, and accommodating leaves one nurse resentful.
A nurse manager asks the unit staff for input before choosing a new scheduling system and then makes the decision based on the group's feedback. Which leadership style is the manager demonstrating?
- A. Autocratic
- B. Laissez-faire
- C. Democratic
- D. Bureaucratic
Show answer
Correct answer: C
A democratic (participative) leader involves the team in decision-making and considers their input, which builds buy-in. Autocratic leaders decide alone, laissez-faire leaders give little direction, and bureaucratic leaders rely strictly on rules and policies.
A nurse believes a provider's prescription for a medication dose is unsafe. The provider refuses to change it after the nurse expresses concern. Which action should the nurse take next?
- A. Administer the medication as prescribed and document the concern
- B. Notify the charge nurse or nurse manager
- C. Call the facility's chief medical officer
- D. Hold the medication and document that the provider was uncooperative
Show answer
Correct answer: B
After speaking with the provider directly, the next step in the chain of command is the nurse's immediate supervisor. A nurse should never give a medication they believe is unsafe, and jumping to the chief medical officer skips the chain. Holding the medication is appropriate while the concern is escalated, but the chart should contain facts, not characterizations.
A client who is postoperative reports pain of 8 on a scale of 0 to 10 and says the provider told her she "just needs to tough it out." Which action best demonstrates client advocacy?
- A. Tell the client that the provider knows best and offer a distraction
- B. Contact the provider to discuss the client's pain and request a change in the pain-management plan
- C. Give the client an extra dose of the prescribed analgesic
- D. Document the client's statement and reassess in 4 hours
Show answer
Correct answer: B
Advocacy means acting on the client's behalf to have her needs met, which here requires communicating with the provider about inadequate pain control. Dismissing the pain, giving an unprescribed dose, or simply documenting all fail the client.
A nurse is preparing to teach a client who speaks limited English about a new anticoagulant. The client's adult son offers to translate. Which action should the nurse take?
- A. Allow the son to translate because he knows the client best
- B. Arrange for a trained medical interpreter
- C. Give the client written instructions in English to review later
- D. Delay the teaching until the client can bring a bilingual friend
Show answer
Correct answer: B
Medication teaching requires accuracy, and a trained medical interpreter is the standard for teaching, consent, and assessment. Family members may edit, omit, or misunderstand information, and using them also compromises privacy. English-only written materials do not address the barrier.
A nurse is giving change-of-shift report on a client who had a thoracotomy. Which information should the nurse include? (Select all that apply.)
- A. The client's chest-tube output over the last 8 hours
- B. That the client's daughter was rude to the unit secretary
- C. A pending arterial blood gas result
- D. The client's admission weight from 4 days ago
- E. A new prescription for a PRN antiemetic entered 30 minutes ago
Show answer
Correct answer: A, C, E
Report should communicate current status, trends, pending results, and new or changed prescriptions so the oncoming nurse can act. Subjective comments about family and stale, unchanged data belong in the record, not in a focused handoff.
A charge nurse is deciding which task to assign to an LPN. Which task is within the LPN's scope of practice?
- A. Performing the admission assessment on a newly admitted client
- B. Administering an IV push dose of morphine
- C. Changing a sterile dressing on a client's abdominal wound
- D. Developing the discharge teaching plan for a client with new heart failure
Show answer
Correct answer: C
An LPN can perform sterile dressing changes and other skills on stable clients. The initial admission assessment, creation of a teaching plan, and (in most states) IV push opioids require RN scope or are prohibited for LPNs.
A nurse manager is asked to reduce unit costs without compromising care. Which action is the most appropriate?
- A. Reduce the frequency of turning immobile clients to every 4 hours
- B. Implement a standardized supply list so that only needed items are opened for each procedure
- C. Stop offering discharge teaching handouts to clients
- D. Ask nurses to reuse single-use suction catheters when they appear clean
Show answer
Correct answer: B
Cost-effective care eliminates waste, not care. Standardizing supplies reduces items that are opened and discarded. Less frequent turning increases pressure injuries, cutting teaching increases readmissions, and reusing single-use devices risks infection — all of which cost more and harm clients.
A nurse is explaining the role of a case manager to a client who has a new spinal cord injury. Which statement is accurate?
- A. "The case manager will provide your daily nursing care while you are here."
- B. "The case manager coordinates your care across the hospital, rehab, and home, and works with your insurance."
- C. "The case manager decides which medications your provider can prescribe."
- D. "The case manager is only involved if you have a complaint about your care."
Show answer
Correct answer: B
Case managers coordinate services across settings and providers, plan for transitions, and manage resource use and reimbursement. They do not deliver bedside care, control prescribing, or handle complaints.
A nurse wants to change the unit's protocol for preventing catheter-associated urinary tract infections using evidence-based practice. Which action should the nurse take first?
- A. Implement the protocol used by a neighboring hospital
- B. Write a specific clinical question about the problem
- C. Present the change to the unit council for a vote
- D. Collect infection rates for 6 months after the change
Show answer
Correct answer: B
The EBP process begins with a focused, answerable clinical question (often in PICO format), followed by searching and appraising evidence, planning and piloting the change, and then evaluating outcomes. Adopting another hospital's protocol skips the appraisal step.
A nurse discovers that she administered a medication to the wrong client. The client shows no adverse effects, and no one else is aware of the error. The nurse reports it anyway. Which ethical principle is the nurse demonstrating?
- A. Justice
- B. Autonomy
- C. Veracity
- D. Fidelity
Show answer
Correct answer: C
Veracity is the duty to tell the truth, including about one's own errors. Justice is fairness in distributing care, autonomy is the client's right to decide, and fidelity is keeping commitments.
A family asks a nurse to continue full aggressive treatment for a client who has terminal cancer and has a signed living will requesting comfort care only. The client can no longer communicate. Which action should the nurse take?
- A. Follow the family's wishes because they are now the decision makers
- B. Advocate for the client's documented wishes and notify the provider and, if needed, the ethics committee
- C. Ask the family to sign a new consent form for aggressive treatment
- D. Provide aggressive care until the family reaches agreement
Show answer
Correct answer: B
A valid living will expresses the client's autonomous choices and takes precedence over family preferences when the client cannot speak. The nurse advocates for the client, involves the provider, and uses the ethics committee to resolve conflicts.
A charge nurse is assigning a client who is on airborne precautions for tuberculosis. Which task can the nurse delegate to an AP?
- A. Teaching the client why the door must stay closed
- B. Assisting the client with a bed bath while wearing an N95 respirator
- C. Evaluating whether the client is using the tissue and hygiene measures correctly
- D. Determining whether the client can be removed from isolation
Show answer
Correct answer: B
Hygiene care is within AP scope, and the AP should use the same precautions as the nurse. Teaching, evaluating, and deciding to discontinue isolation require nursing judgment.
A client receiving hospice care has severe pain and is prescribed an opioid infusion. The client's daughter asks the nurse to lower the dose because "it might make her stop breathing." The client is alert and requests the medication. Which response by the nurse is best?
- A. "I'll lower the dose a little so we can be safe."
- B. "Your mother has the right to have her pain controlled; let's talk about what you're worried about."
- C. "The doctor ordered it, so I have to give it."
- D. "Respiratory depression is not a concern with hospice medications."
Show answer
Correct answer: B
The alert client's autonomy and the goal of comfort in hospice take priority, while the nurse also acknowledges the daughter's fear and opens a conversation. Reducing the dose ignores the client's wishes, citing the order avoids the issue, and denying the risk is untrue.
Want the full-length version?
70-question RN Leadership practice exams with rationales
Timed, original, and organized by the same five domains. The 2026 edition uses NGN-style case items; the 2023 edition uses classic formats. Both are independent study materials, not ATI content.
Study plans
Leadership rewards pattern recognition, not memorization. Both plans below are built on the same loop: learn the rule, do questions, read every rationale (including for the ones you got right), then write down the rule you missed in your own words.
2-week plan (about 1–1.5 hours a day)
| Days | Focus | Do |
|---|---|---|
| 1–2 | Delegation & prioritization | Make a one-page AP / LPN / RN scope chart. Memorize the five rights of delegation and the priority hierarchy (ABC → Maslow → acute vs. chronic). Do the delegation questions on this page. |
| 3–4 | Legal & ethical | Work through the 16 free legal and ethics Q&A pages. Build a torts table (negligence, malpractice, assault, battery, false imprisonment, defamation) and a principles table (autonomy, beneficence, nonmaleficence, justice, fidelity, veracity). |
| 5–6 | QI, incident reporting, safety | Learn the incident-report sequence, RCA vs. incident report, benchmarking, EBP steps, and the National Patient Safety Goals. |
| 7 | Practice exam 1 | Take the 2023 practice exam timed. Log every miss by domain. |
| 8–9 | Conflict, communication, leadership styles | Conflict strategies, chain of command, SBAR, telephone orders, interpreters, leadership styles. Redo your day-7 misses. |
| 10–11 | Scope, regulatory bodies, disaster | Board of Nursing vs. Joint Commission vs. OSHA vs. CMS. Triage colors and evacuation order. Case management and advocacy. |
| 12 | Practice exam 2 | Take the 2026 practice exam timed to get used to NGN case formats. |
| 13–14 | Remediate & rest | Review only your weakest two domains. Re-read your own notes, not new material. Sleep the night before. |
4-week plan (about 45 minutes a day)
How to use ATI's own practice assessments and remediation
Most programs give you access to ATI's Leadership Practice Assessment A and B through your student account, and many require a Focused Review before the proctored exam. Use them this way:
- Take Practice A early (end of week 1 or 2) as a diagnostic, without notes. The individual performance profile tells you which topics ATI weighs most for you.
- Do the Focused Review honestly. Open the linked review-module pages for every missed topic and write the key rule in your own words. This is what your instructor is checking when they require "remediation."
- Save Practice B for the last 3–5 days and take it timed. If your score improved in the topics you remediated, your method is working; if not, your notes are too passive — switch to doing more questions.
- Read the item rationales for correct answers too. Half of Leadership misses come from picking a "good" answer over the "best" one; the rationales show you how ATI distinguishes them.
Our practice exams are designed to sit alongside those official assessments, not replace them. They are original questions written to the same domains, so you get extra reps without ever seeing a repeated item.
Frequently asked questions
Is the ATI Leadership proctored exam hard?
Students usually rate it as easier than Med-Surg or Pharmacology in content but harder in question style, because most items have two or three reasonable answers and you must pick the best one. Learning the decision rules (delegation rights, priority frameworks, chain of command) matters more than memorizing facts.
How many questions are on the ATI Leadership exam?
The exam is commonly described as 60–70 items in one proctored sitting of about an hour. ATI can revise the specification, so confirm the current item count and time limit with your program before test day. Our 2026 and 2023 practice exams each contain 70 original questions to match that length.
What is the difference between the 2023 and 2026 versions?
The content domains are the same. The 2026 version includes more Next Generation NCLEX-style items — extended multiple response, ordering, and short case studies — while the 2023 version is mostly traditional multiple choice and select-all-that-apply.
What score or proficiency level do I need?
ATI reports a proficiency level (Level 1, 2, or 3) rather than a percentage. Level 2 is the benchmark most programs require, but the requirement, and any course points attached to it, are set by your program. Check your syllabus.
Can I retake the ATI Leadership proctored exam?
Retake policies belong to your nursing program, not ATI. Many programs allow one retake after documented remediation, often with a cap on the grade awarded for the retake. Ask your course coordinator early so you know the rules before the first attempt.
Are these real ATI questions?
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