Exam Guide

ATI Proctored Exams: How to Study, Prepare & Pass

ATI proctored exams are standardized nursing assessments used to evaluate a student's mastery of a specific nursing subject — Fundamentals, Pharmacology, Adult Medical-Surgical, Maternal Newborn and so on. They are taken under supervision, they are timed, and they are harder than most classroom tests because they measure application and clinical judgment rather than simple recall. This guide explains how ATI proctored exams work, what the proficiency levels mean, how the exams are graded, how to study for them, what to do in the final days, and the mistakes that cost students the most points.

What Are ATI Proctored Exams?

A proctored assessment is any exam taken while a proctor watches you — in person in a campus computer lab, or remotely through a webcam and screen-recording tool. Assessment Technologies Institute (ATI) builds a secure version of each of its nursing content exams specifically for this setting. Your school schedules the exam, controls access to it, and receives your results.

The exams most students mean when they say "ATI proctored exam" belong to the Content Mastery Series (CMS): one secure assessment per nursing subject, taken at the end of the course that covers that subject. Two other ATI assessments are also proctored — the Comprehensive Predictor taken near graduation, and the TEAS entrance exam taken before nursing school — but this guide focuses on the CMS subject exams.

How proctored exams differ from ATI practice assessments

Every CMS subject comes with practice assessments (usually labelled Practice A and Practice B) that are not proctored. Practice assessments are open-book by nature, can be taken from home, and are meant as a rehearsal. The proctored version is a different, secure question set. You cannot see it in advance, you cannot pause it, and your result goes straight to your program. Students who assume the proctored exam will feel like the practice version are usually surprised by how much more it emphasizes prioritization and clinical decision-making.

Who takes them and why schools use them

Most pre-licensure RN and PN/VN programs in the United States use ATI proctored exams as course benchmarks. Schools use them for three reasons:

Standardized comparison. Your score is compared with a national sample of nursing students who took the same assessment, which tells faculty how their cohort measures up.
NCLEX readiness. ATI items are written to the same client-need categories as the NCLEX, so a student's CMS trajectory is a rough early warning system for licensure.
Remediation. After the exam, ATI generates a Focused Review that lists the topics you missed. Programs use it to direct remediation before the course ends.

What students should expect

Expect a computer-based exam of roughly 60 to 70 scored items (some assessments include unscored pilot items), delivered in a single sitting of about one to two hours. Expect multiple-choice questions alongside select-all-that-apply, ordered response, dosage calculation, hot-spot and, on the newer 2023 and later versions, Next Generation NCLEX-style case items. Expect questions that describe a client and ask what the nurse should do first, which finding is most concerning, or which client to see before the others. And expect to receive a percentage score plus a proficiency level rather than a simple pass or fail.

How Do ATI Proctored Exams Work?

Students often ask how ATI proctored exams work because the process is controlled by the school and the details are rarely spelled out until the week before. Here is the sequence from a student's point of view. Details vary by program, so treat this as the typical flow and confirm specifics with your instructor.

1. Preparation

Your program tells you which content area is being tested and roughly when. Most programs give a window of a few weeks and expect you to have completed the relevant practice assessments and, often, a Focused Review on those practice results first.

2. Registration and access

You do not register for a CMS exam the way you register for the TEAS. Your school builds the exam into your ATI account, and on test day your proctor gives you an assessment ID or password to unlock it. If you log in early and cannot see the exam, that is normal — it appears once the proctor releases it.

3. Testing environment

On campus, you sit in a computer lab with other students, hand over phones, smart watches and notes, and are usually allowed one piece of blank scratch paper plus the on-screen calculator. Remotely, you take the exam on a laptop or desktop with a webcam, using a proctoring tool (ATI uses Proctorio for its own remote proctoring; some schools use Respondus, Honorlock or their own live proctors instead). Tablets and phones are not allowed for remote testing.

4. Proctoring

In person, an instructor or lab proctor walks the room. Remotely, you show photo ID to the camera, pan the camera around your desk and room, and are recorded on video, audio and screen for the whole attempt. The software flags behaviour such as looking away from the screen, another person entering the room, or switching browser tabs. Our article on whether ATI can detect cheating on proctored exams goes through this in detail.

5. Completing the assessment

The exam is timed and linear. On most CMS exams you can move back and forth between items until you submit, but you cannot pause the clock, and once the time expires the exam submits itself. There is no penalty for guessing, so never leave an item blank.

6. Submission

When you finish, you submit the exam and, for remote attempts, close the proctoring session. Your proctor may ask you to show your scratch paper to the camera or hand it in before you leave.

7. Receiving results

Your percentage score and proficiency level are usually available in your ATI account immediately or within a few hours, together with an individual performance profile and a Focused Review. Your school then decides what that result means for your course grade — which is where the levels come in.

Are All ATI Proctored Exams the Same?

No. Every ATI proctored exam is built to a different blueprint. The subject, the number of items in each content category, the difficulty, and the expectations for a passing result all differ from one assessment to the next. Pharmacology is heavy on medication classes and adverse effects; Leadership is heavy on delegation and legal issues; Maternal Newborn expects you to know normal findings well enough to spot the abnormal one. Even the same subject has multiple versions (for example the 2019 and 2023 RN editions), and the newer editions add NGN-style case items that the older ones lack.

What is the same across all of them is the style: client scenarios, priority-setting language, and rationales grounded in the ATI review modules and current standards of care. Study methods therefore transfer between exams, even though the content does not.

The nine RN Content Mastery subjects

These are the RN CMS exams most programs use. Each links to our dedicated study guide and practice questions for that subject.

Fundamentals — safety, infection control, basic care and comfort, communication, and the nursing process.
Pharmacology — medication classes, adverse effects, interactions, safe administration and dosage calculation.
Adult Medical-Surgical — the largest blueprint: cardiac, respiratory, endocrine, renal, neuro, GI, musculoskeletal, oncology and perioperative care.
Maternal Newborn — antepartum, intrapartum, postpartum and newborn care, including complications.
Nursing Care of Children — growth and development, pediatric medications and dosing, and common childhood conditions.
Mental Health — therapeutic communication, psychiatric disorders, psychopharmacology and crisis intervention.
Nutrition — therapeutic diets, nutrition across the lifespan, enteral and parenteral feeding.
Community Health — population health, epidemiology, disaster nursing, and vulnerable groups.
Leadership and Management — delegation, prioritization, legal and ethical issues, quality improvement.

PN/VN programs use a parallel series written to the practical-nurse scope of practice; see our PN Fundamentals guide for the PN equivalents.

What Are the ATI Proctored Exam Levels?

Alongside your percentage, ATI reports a proficiency level: Below Level 1, Level 1, Level 2 or Level 3. The levels are ATI's way of translating a raw percentage into a judgment about how ready you are in that content area. Importantly, the percentage that corresponds to each level is set separately for each assessment, so a 70% might be Level 2 on one exam and Level 1 on another. Do not assume the thresholds you hear from a classmate who took a different exam apply to yours.

Here is how to interpret the ATI levels for proctored exams in practice:

Level	What it generally indicates	What the student should do
Below Level 1	Performance below the minimum ATI expects for the content area; a student at this level is likely to struggle with related NCLEX content.	Complete the full Focused Review, meet with faculty, and rebuild the weakest categories from the review module before any retake.
Level 1	Basic or limited mastery. Meets the absolute minimum but is likely to need additional preparation.	Review weak areas identified in the performance profile and practise application-style questions in those topics.
Level 2	Satisfactory mastery. The student is fairly certain to meet NCLEX-RN standards in this content area. This is the benchmark most programs set.	Continue targeted practice in the two or three lowest-scoring categories to move toward Level 3.
Level 3	Strong mastery. The student exceeds most expectations and is likely to exceed NCLEX standards in the content area.	Maintain preparation with periodic mixed-topic practice; shift study time to weaker subjects.

Two cautions. First, the levels describe readiness in one content area, not overall NCLEX readiness — that is what the Comprehensive Predictor is for. Second, ATI publishes proficiency level definitions and cut scores per assessment version, and your school may set its own expectation on top of them. Our ATI proficiency levels explainer covers the definitions in more depth.

How Are ATI Proctored Exams Graded?

Students ask how ATI proctored exams are graded because the answer has two halves — what ATI reports, and what the school does with it.

What ATI reports

Percentage score. The proportion of scored items you answered correctly. Unscored pilot items do not count.
Proficiency level. Your percentage mapped to Below Level 1, Level 1, Level 2 or Level 3 using the cut scores for that specific assessment.
Comparison data. Your score against the national mean and the program mean for the same exam.
Category breakdown. Your performance in each NCLEX client-need category and in each topic area of the blueprint, with the topics you missed listed for Focused Review.

How schools may use results

Programs use ATI results in very different ways, and this is the single most important thing to find out before the exam. Common approaches include:

Converting the proficiency level to a course grade or a fixed number of points (for example Level 3 = full marks, Level 2 = most of the marks, Level 1 = partial credit with mandatory remediation).
Requiring a minimum level — usually Level 2 — to pass the course or progress, with a retake allowed after remediation.
Using the exam purely for feedback, with remediation required but no grade impact.

Why the raw percentage alone does not tell the whole story

Because the cut scores differ by assessment, two students with identical percentages on different exams can receive different levels. And because programs weight results differently, the same level can be a comfortable pass at one school and a required retake at another. Always read your result as percentage plus level plus your program's policy.

Remediation

Most programs require a Focused Review after a proctored exam regardless of the score. This means spending a set number of hours (often tied to your level — more hours for lower levels) reading the review module sections linked to the questions you missed, then submitting proof, sometimes in the form of an active-learning template for each topic. Treat remediation as part of the exam rather than a punishment: the topics it lists are exactly the ones that will reappear on the Comprehensive Predictor and the NCLEX.

So what score do you need?

Whatever your school's grading policy says. For most students the practical target is Level 2, and aiming for Level 3 gives you a margin for a bad day. Find your syllabus statement on ATI benchmarks, ask your instructor for the percentage cut scores for your specific exam version, and set your target from there.

One more point that shapes everything below: the best way to improve your result is not to memorize a list of answers, but to identify the content areas you are weak in and practise questions that require you to apply that content. That is how the exam is written, and it is how you should prepare.

How to Study for ATI Proctored Exams

The best way to study for ATI proctored exams is a repeatable method rather than a pile of resources. The six steps below are the method we recommend; our separate guide on how to study for ATI proctored exams turns them into a week-by-week plan.

Step 1: Know the exam content

Do not study everything at random. Each ATI assessment has a published blueprint — the content categories and roughly how many items come from each. Get it from your instructor or your ATI account, and let it decide where your hours go. On a Med-Surg exam, cardiovascular and respiratory content deserves far more time than a single rare disorder.

Step 2: Start with ATI materials

Use the legitimate ATI resources your program has already paid for: the review module for the subject, the Practice A and B assessments, and the Focused Review generated from those practice attempts. ATI writes its exams from its own review modules, so those books define what a "correct" answer looks like even when other textbooks differ slightly.

Step 3: Identify weak areas

Take a practice assessment or a set of practice questions before you start re-reading, and keep an error log. For each question you miss, record:

the topic;
the question type (priority, safety, delegation, assessment, intervention, medication, teaching);
why you got it wrong — a knowledge gap, a misread, or a reasoning error;
the correct concept in one sentence;
what confused you about the distractors.

After 50 to 100 questions the log will show a pattern, and that pattern is your study plan.

Step 4: Practise application

ATI questions rarely ask you to define something. They ask what a nurse should do with that knowledge. Focus your practice on the question patterns that dominate every CMS exam:

Priority questions — which client first, which action first, which finding to report immediately.
Safety — falls, restraints, infection control, medication errors, environmental hazards.
Delegation — what can go to an LPN/LVN or assistive personnel, and what cannot.
Assessment — expected versus unexpected findings, and what to assess before an intervention.
Intervention — the specific nursing action that follows from a finding.
Pharmacology — class, action, key adverse effect, monitoring, and the one thing to teach.
Patient education — which statement shows the client understood, or needs further teaching.
Clinical judgment — recognizing cues, analysing them, and choosing an action in NGN-style cases.

Step 5: Use timed practice

Simulate the exam environment at least a few times before the real attempt: a fixed number of questions, a clock, no notes, no phone. Pacing is a skill. Students who only ever practise untimed are the ones who run out of time on the last ten items.

Step 6: Review rationales

Do not just count correct answers. Read the rationale for every question — including the ones you got right, because a right answer for the wrong reason is a gap you have not found yet. The rationale is where the exam teaches you how ATI thinks about priority and safety. Every practice question on this site is written by us with a full rationale for exactly this reason; try a free set of ATI-style practice questions in your subject.

If you want a full-length dress rehearsal, our ATI proctored exam practice tests and study guides are original question sets written to each exam's content areas, with a rationale for every answer.

How to Prepare in the Final Days

How you spend the last week matters more than most students think, because it determines whether you arrive tired and scattered or rested and sharp.

Seven to five days out: take your final full-length timed practice set. Use the result to choose two or three topics for a last targeted review. Do not open new material after this point.
Four to two days out: work through your error log. Re-answer every question you originally missed and check that you can explain the correct answer without looking. Review your medication class summaries and lab value ranges.
The day before: light review only — an hour of flashcards or a short mixed quiz. Confirm your exam time, room or remote-proctoring setup, and photo ID. Sleep is worth more than a late-night cram; memory consolidation happens while you sleep.
Exam day: eat, arrive or log in early, and use the first minute to settle. On remote exams, restart your computer beforehand, close every other program, and test your webcam and internet connection.

How to Improve Your Chances of Passing

Beyond the study method itself, a few habits separate students who reach Level 2 and above from those who do not.

Read the question for the ask. Underline (mentally) the verb and the qualifier: first, best, priority, immediately, further teaching. Most wrong answers on ATI exams are correct nursing actions that do not answer the question that was asked.
Use a framework for priority items. Airway–breathing–circulation, then safety, then Maslow's hierarchy, then the nursing process (assess before you act). If two options seem right, the framework breaks the tie.
Treat select-all-that-apply as a series of true/false statements. Judge each option independently against the stem rather than trying to guess how many are correct.
Know normal ranges cold. Vital signs, common lab values, fetal heart rate baselines, developmental milestones. You cannot recognize an abnormal finding without them, and NGN case items lean heavily on them.
Answer every question. There is no penalty for guessing. Flag hard items, move on, and return if time allows.
Manage the clock. Divide the time by the number of items to get a per-question budget, and check your pace at the quarter marks.

Our companion guide on how to pass ATI proctored exams expands these into fifteen specific strategies, including what to do the day before and during the exam.

Common Mistakes Students Make

Studying the practice assessment answers instead of the concepts. The proctored exam is a different question set. Memorizing Practice B does not help you with an item you have never seen.
Re-reading the review module cover to cover. Passive reading feels productive but does not build the retrieval and application skills the exam tests. Read to fix a specific gap your error log found, not as your main study activity.
Ignoring the blueprint. Spending equal time on every chapter means over-preparing for low-weight topics and under-preparing for high-weight ones.
Skipping rationales for correct answers. Lucky guesses hide gaps.
Never practising under time pressure. Pacing problems are only discovered in timed conditions.
Not knowing the school's policy. Students who discover the required level after the exam cannot plan for it.
Looking for shortcuts. Searching for leaked exams or ways around proctoring wastes study time and puts your place in the program at risk — see our article on how closely ATI proctored exams are monitored.
Cramming the night before. Fatigue costs more points than the extra hour gains.

Frequently Asked Questions

How long are ATI proctored exams?

Most Content Mastery Series exams are a single sitting of roughly 60 to 70 items with about one to two hours allowed; the exact time is set for each assessment and confirmed by your instructor. The RN Comprehensive Predictor is longer, at 180 items over about three hours.

How many ATI proctored exams are there?

The RN Content Mastery Series has nine subject exams; the PN series has a parallel set. Most programs also add the Comprehensive Predictor near graduation. How many you actually take depends on which your school has adopted — some use all of them, some use only four or five.

How are ATI proctored exams graded?

ATI reports a percentage and a proficiency level (Below Level 1 to Level 3) based on cut scores specific to that assessment. Your school converts that into a grade, a pass/fail decision or a remediation requirement according to its own policy.

Are all ATI proctored exams the same?

No. Each subject has its own blueprint, difficulty and cut scores, and newer editions include NGN-style items. The question style is consistent across subjects, so study skills transfer even though the content does not.

What is the best way to study for ATI proctored exams?

Start with the blueprint, use your ATI review module and practice assessments, keep an error log to identify weak areas, practise application-style questions under time, and read every rationale. Then rest before the exam.

How do I do well on ATI proctored exams if I struggle with test anxiety?

Timed practice is the most effective treatment because it makes the real exam feel familiar. Arrive early, use the first minute to breathe and read the instructions, and remember that a flagged question you come back to later is not a failure.

For more long-tail questions, see our ATI proctored exams FAQ.

Practise Before Test Day

Every question on this site is original, written to the ATI style, and comes with a full rationale. Try a free ATI-style practice quiz in your subject, or browse the printable PDF study guides for a structured review of each content area.

Start with the free ATI proctored exam practice quizzes on our homepage, then pick the RN or PN study guide for your next exam.