ATI RN CAPSTONE COMPREHENSIVE PREDICTOR EXIT PROCTORED
EXAM WITH NGN ACTUAL 2026 EXAM
180 Exam-Level Questions with Correct Answers and Detailed Rationales
1. A charge nurse is making assignments for a float nurse from the medical unit to the
pediatric unit. Which client is appropriate to assign to the float nurse?
A) A 10-year-old with pneumonia receiving respiratory treatments
B) A 4-year-old with a Wilms tumor receiving chemotherapy
C) An 8-month-old scheduled for surgical repair of a ventricular septal defect
D) A 14-year-old scheduled for discharge following placement of a Harrington rod
Correct Answer: A
Rationale: A float nurse from a medical unit is most competent to care for a client with
pneumonia, a condition commonly managed on medical units. The other options require
specialized pediatric oncology, cardiac, or orthopedic surgical expertise. Assignment should
match the nurse's competency with the client's needs.
2. A nurse is caring for a client with antisocial personality disorder. Which behavior should the
nurse identify as consistent with this disorder?
A) Compulsive attention to details
B) Avoids interacting with others
C) Uses others for personal gain
D) Socially awkward in group situations
Correct Answer: C
Rationale: Clients with antisocial personality disorder characteristically manipulate others for
personal gain, show disregard for social norms, and lack empathy. The other options are more
consistent with obsessive-compulsive, avoidant, or schizotypal personality disorders.
3. A 68-year-old male is admitted with acute exacerbation of COPD. His oxygen saturation is
86% on room air. The nurse initiates oxygen at 2 L/min via nasal cannula. Fifteen minutes
later, the patient becomes drowsy and his respiratory rate drops from 22 to 8 breaths/min.
What is the priority nursing action?
A) Increase oxygen to 4 L/min to improve saturation
B) Place the patient in Trendelenburg position
,C) Decrease oxygen to 1 L/min and reassess
D) Prepare for immediate intubation
Correct Answer: C
Rationale: COPD patients with chronic hypercapnia rely on hypoxic drive. Too much oxygen can
cause respiratory depression. The priority action is to decrease the oxygen and reassess the
patient. Aim for SpO₂ 88–92% in COPD patients. This reflects the principle that high-flow oxygen
can eliminate the hypoxic drive, leading to respiratory arrest.
4. A nurse is caring for a patient receiving continuous tube feeding via a nasogastric tube. The
nurse notes that the residual volume is 400 mL after 4 hours of feeding. Which action should
the nurse take first?
A) Discard the residual and continue the feeding
B) Hold the feeding and reassess abdominal assessment
C) Increase the infusion rate to compensate
D) Flush the tube with 30 mL of warm water
Correct Answer: B
Rationale: A residual greater than 250–300 mL suggests delayed gastric emptying. The nurse
should hold the feeding, assess for distension and nausea, and notify the provider. Continuing
the feeding could increase the risk of aspiration. This follows the standard of care for enteral
feeding management.
5. A nurse is reviewing laboratory results for a patient receiving spironolactone. Which finding
indicates a therapeutic response?
A) Serum potassium decreases from 6.1 to 4.8 mEq/L
B) Serum sodium increases from 135 to 140 mEq/L
C) Blood pressure decreases from 150/90 to 130/80 mm Hg
D) Urine output increases from 20 to 60 mL/hour
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic used for hypertension and heart
failure. A decrease in blood pressure is the intended therapeutic response. Monitoring
potassium for hyperkalemia is important for safety, not efficacy. The medication works by
blocking aldosterone, promoting sodium and water excretion while conserving potassium.
,6. A nurse is assessing a newborn immediately after birth. Which finding requires further
intervention?
A) Apical heart rate of 90 beats per minute
B) Acrocyanosis of the hands and feet
C) Respiratory rate of 50 breaths per minute
D) Sunken anterior fontanel
Correct Answer: A
Rationale: Normal newborn heart rate is 110–160 beats per minute. A heart rate of 90 bpm is
bradycardic and requires further intervention. Acrocyanosis (bluish discoloration of hands and
feet) is normal in the first 24 hours. Respiratory rate of 30–60 breaths/min is normal for a
newborn. A sunken fontanel indicates dehydration and requires monitoring but is not the
immediate priority.
7. A nurse is providing teaching about the use of crutches using a three-point gait to a client
who has a tibia fracture. Which of the following actions by the client indicates an
understanding of the teaching?
A) Positioning both hands on the grips with elbows slightly flexed
B) Supporting body weight while leaning on the axillary crutch pads
C) Stepping with the affected leg first when going up stairs
D) Moving both crutches with the stronger leg forward
Correct Answer: A
Rationale: Proper crutch fit requires elbows flexed at 15–30 degrees with hands on the grips.
Body weight should be supported on the hands, not the axillae, to avoid nerve damage. When
going up stairs, the unaffected leg goes first ("up with the good"). In a three-point gait, both
crutches and the affected leg move forward together, then the stronger leg follows.
8. A nurse is assessing a client following an ischemic stroke. Which of the following findings is
the priority for the nurse to report to the provider?
A) The client reports a metallic taste in his mouth
B) The client reports a decreased appetite
C) The client coughs after swallowing
D) The client has poor fitting dentures
Correct Answer: C
Rationale: Coughing after swallowing indicates dysphagia and places the client at high risk for
aspiration pneumonia. This is the priority finding to report. The other options are important but
, do not represent an immediate safety threat. Post-stroke dysphagia requires immediate
intervention including speech therapy evaluation and aspiration precautions.
9. A nurse is preparing to insert an indwelling urinary catheter. Which action maintains sterile
technique?
A) Opening the catheter package and setting it on the bedside table
B) Opening the sterile drape with the non-dominant hand and placing it on the sterile field
C) Using clean gloves to open the sterile catheter package
D) Placing the sterile field at the edge of the bed for easier access
Correct Answer: B
Rationale: The outer surface of the sterile drape package is considered contaminated, so
opening it with the non-dominant hand maintains sterility of the dominant hand. The sterile
field should be at waist level or higher, never at the edge of the bed. Sterile technique requires
that only sterile items touch the sterile field.
10. A nurse is caring for a client with end-stage renal disease who is scheduled for
hemodialysis. Which laboratory value should the nurse report to the provider before the
procedure?
A) Serum potassium 5.8 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.2 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Rationale: A serum potassium of 5.8 mEq/L indicates hyperkalemia, which places the client at
risk for cardiac dysrhythmias. The normal potassium range is 3.5–5.0 mEq/L. Hemodialysis may
be indicated for severe hyperkalemia. The other values are within normal limits.
11. A client is prescribed warfarin for atrial fibrillation. Which instruction should the nurse
include in the discharge teaching?
A) "Take ibuprofen for minor pain"
B) "Increase intake of green leafy vegetables"
C) "Report any unusual bleeding or bruising"
D) "Monitor blood glucose levels daily"
Correct Answer: C
EXAM WITH NGN ACTUAL 2026 EXAM
180 Exam-Level Questions with Correct Answers and Detailed Rationales
1. A charge nurse is making assignments for a float nurse from the medical unit to the
pediatric unit. Which client is appropriate to assign to the float nurse?
A) A 10-year-old with pneumonia receiving respiratory treatments
B) A 4-year-old with a Wilms tumor receiving chemotherapy
C) An 8-month-old scheduled for surgical repair of a ventricular septal defect
D) A 14-year-old scheduled for discharge following placement of a Harrington rod
Correct Answer: A
Rationale: A float nurse from a medical unit is most competent to care for a client with
pneumonia, a condition commonly managed on medical units. The other options require
specialized pediatric oncology, cardiac, or orthopedic surgical expertise. Assignment should
match the nurse's competency with the client's needs.
2. A nurse is caring for a client with antisocial personality disorder. Which behavior should the
nurse identify as consistent with this disorder?
A) Compulsive attention to details
B) Avoids interacting with others
C) Uses others for personal gain
D) Socially awkward in group situations
Correct Answer: C
Rationale: Clients with antisocial personality disorder characteristically manipulate others for
personal gain, show disregard for social norms, and lack empathy. The other options are more
consistent with obsessive-compulsive, avoidant, or schizotypal personality disorders.
3. A 68-year-old male is admitted with acute exacerbation of COPD. His oxygen saturation is
86% on room air. The nurse initiates oxygen at 2 L/min via nasal cannula. Fifteen minutes
later, the patient becomes drowsy and his respiratory rate drops from 22 to 8 breaths/min.
What is the priority nursing action?
A) Increase oxygen to 4 L/min to improve saturation
B) Place the patient in Trendelenburg position
,C) Decrease oxygen to 1 L/min and reassess
D) Prepare for immediate intubation
Correct Answer: C
Rationale: COPD patients with chronic hypercapnia rely on hypoxic drive. Too much oxygen can
cause respiratory depression. The priority action is to decrease the oxygen and reassess the
patient. Aim for SpO₂ 88–92% in COPD patients. This reflects the principle that high-flow oxygen
can eliminate the hypoxic drive, leading to respiratory arrest.
4. A nurse is caring for a patient receiving continuous tube feeding via a nasogastric tube. The
nurse notes that the residual volume is 400 mL after 4 hours of feeding. Which action should
the nurse take first?
A) Discard the residual and continue the feeding
B) Hold the feeding and reassess abdominal assessment
C) Increase the infusion rate to compensate
D) Flush the tube with 30 mL of warm water
Correct Answer: B
Rationale: A residual greater than 250–300 mL suggests delayed gastric emptying. The nurse
should hold the feeding, assess for distension and nausea, and notify the provider. Continuing
the feeding could increase the risk of aspiration. This follows the standard of care for enteral
feeding management.
5. A nurse is reviewing laboratory results for a patient receiving spironolactone. Which finding
indicates a therapeutic response?
A) Serum potassium decreases from 6.1 to 4.8 mEq/L
B) Serum sodium increases from 135 to 140 mEq/L
C) Blood pressure decreases from 150/90 to 130/80 mm Hg
D) Urine output increases from 20 to 60 mL/hour
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic used for hypertension and heart
failure. A decrease in blood pressure is the intended therapeutic response. Monitoring
potassium for hyperkalemia is important for safety, not efficacy. The medication works by
blocking aldosterone, promoting sodium and water excretion while conserving potassium.
,6. A nurse is assessing a newborn immediately after birth. Which finding requires further
intervention?
A) Apical heart rate of 90 beats per minute
B) Acrocyanosis of the hands and feet
C) Respiratory rate of 50 breaths per minute
D) Sunken anterior fontanel
Correct Answer: A
Rationale: Normal newborn heart rate is 110–160 beats per minute. A heart rate of 90 bpm is
bradycardic and requires further intervention. Acrocyanosis (bluish discoloration of hands and
feet) is normal in the first 24 hours. Respiratory rate of 30–60 breaths/min is normal for a
newborn. A sunken fontanel indicates dehydration and requires monitoring but is not the
immediate priority.
7. A nurse is providing teaching about the use of crutches using a three-point gait to a client
who has a tibia fracture. Which of the following actions by the client indicates an
understanding of the teaching?
A) Positioning both hands on the grips with elbows slightly flexed
B) Supporting body weight while leaning on the axillary crutch pads
C) Stepping with the affected leg first when going up stairs
D) Moving both crutches with the stronger leg forward
Correct Answer: A
Rationale: Proper crutch fit requires elbows flexed at 15–30 degrees with hands on the grips.
Body weight should be supported on the hands, not the axillae, to avoid nerve damage. When
going up stairs, the unaffected leg goes first ("up with the good"). In a three-point gait, both
crutches and the affected leg move forward together, then the stronger leg follows.
8. A nurse is assessing a client following an ischemic stroke. Which of the following findings is
the priority for the nurse to report to the provider?
A) The client reports a metallic taste in his mouth
B) The client reports a decreased appetite
C) The client coughs after swallowing
D) The client has poor fitting dentures
Correct Answer: C
Rationale: Coughing after swallowing indicates dysphagia and places the client at high risk for
aspiration pneumonia. This is the priority finding to report. The other options are important but
, do not represent an immediate safety threat. Post-stroke dysphagia requires immediate
intervention including speech therapy evaluation and aspiration precautions.
9. A nurse is preparing to insert an indwelling urinary catheter. Which action maintains sterile
technique?
A) Opening the catheter package and setting it on the bedside table
B) Opening the sterile drape with the non-dominant hand and placing it on the sterile field
C) Using clean gloves to open the sterile catheter package
D) Placing the sterile field at the edge of the bed for easier access
Correct Answer: B
Rationale: The outer surface of the sterile drape package is considered contaminated, so
opening it with the non-dominant hand maintains sterility of the dominant hand. The sterile
field should be at waist level or higher, never at the edge of the bed. Sterile technique requires
that only sterile items touch the sterile field.
10. A nurse is caring for a client with end-stage renal disease who is scheduled for
hemodialysis. Which laboratory value should the nurse report to the provider before the
procedure?
A) Serum potassium 5.8 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.2 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Rationale: A serum potassium of 5.8 mEq/L indicates hyperkalemia, which places the client at
risk for cardiac dysrhythmias. The normal potassium range is 3.5–5.0 mEq/L. Hemodialysis may
be indicated for severe hyperkalemia. The other values are within normal limits.
11. A client is prescribed warfarin for atrial fibrillation. Which instruction should the nurse
include in the discharge teaching?
A) "Take ibuprofen for minor pain"
B) "Increase intake of green leafy vegetables"
C) "Report any unusual bleeding or bruising"
D) "Monitor blood glucose levels daily"
Correct Answer: C
