ATI Capstone Exam Study Guide | NCLEX-RN Practice Questions,
Answers & Rationales | 2026–2027 Edition
Prepare for the ATI Capstone Exam with this comprehensive NCLEX-RN study guide featuring original
practice questions, accurate answers, and detailed rationales. Covers fundamentals, adult medical-
surgical nursing, pharmacology, maternal-newborn, pediatrics, mental health, leadership, community
health, and clinical judgment concepts. Perfect for focused review, self-assessment, and building
confidence before your ATI Capstone assessment and NCLEX-RN preparation.
Q1. A nurse is reviewing the prescription for a client who is at 39 weeks of
gestation and is undergoing labor induction with oxytocin. The fetal heart rate
monitor shows late decelerations with three consecutive contractions. Which of
the following actions should the nurse take first?
A) Elevate the client's legs to a 45-degree angle
B) Increase the main line intravenous fluid infusion rate
C) Discontinue the continuous oxytocin infusion immediately
D) Administer supplemental oxygen via a simple face mask
Answer: C) Discontinue the continuous oxytocin infusion immediately
Rationale: Late decelerations indicate uteroplacental insufficiency, meaning the fetus is
not receiving enough oxygen during contractions. The absolute priority first action when
late decelerations occur during an oxytocin infusion is to stop the infusion immediately.
This removes the uterine hyperstimulation, allows the uterus to relax, and improves
blood flow to the placenta. Other intrauterine resuscitation measures (fluids, oxygen,
turning the patient) should follow immediately after.
Q2. A nurse is caring for a client who is 24 hours postpartum following a vaginal
delivery. Which of the following findings should the nurse report to the provider?
A) Lochia rubra with small clots
B) Maternal temperature of 37.9°C (100.2°F)
C) Fundus 1 cm below the umbilicus
D) Calf tenderness and localized warmth
Answer: D) Calf tenderness and localized warmth
Rationale: Calf tenderness, localized warmth, and redness are clinical manifestations of
a deep vein thrombosis (DVT). Postpartum clients are at an increased risk for
thromboembolic disease due to hypercoagulability and venous stasis. A DVT requires
immediate medical intervention to prevent a pulmonary embolism. Lochia rubra, a mild
,temperature elevation under 38°C (100.4°F) due to dehydration, and a fundus located 1
cm below the umbilicus are all expected findings 24 hours postpartum.
Q3. A nurse is assessing a client who is at 34 weeks of gestation and reports
sudden, severe abdominal pain and dark red vaginal bleeding. The nurse notes
that the client's uterus is rigid and tender. Which of the following complications
should the nurse suspect?
A) Placenta previa
B) Abruptio placentae
C) Incompetent cervix
D) Uterine rupture
Answer: B) Abruptio placentae
Rationale: Abruptio placentae is the premature separation of the placenta from the
uterine wall. Classic manifestations include sudden, severe abdominal pain, dark red
vaginal bleeding, uterine tenderness, and a rigid, board-like abdomen. In contrast,
placenta previa presents as painless, bright red vaginal bleeding. An incompetent cervix
causes painless dilation in the second trimester, and uterine rupture typically occurs
during active labor, often featuring a loss of fetal station.
Q4. A nurse in a prenatal clinic is providing education to a client at 28 weeks of
gestation who has a new diagnosis of gestational diabetes mellitus. Which of the
following instructions should the nurse prioritize?
A) Maintain fasting blood glucose levels below 95 mg/dL
B) Avoid all carbohydrates and caloric sweeteners in the diet
C) Exercise intensely for 60 minutes after every main meal
D) Check urine ketones daily before eating dinner
Answer: A) Maintain fasting blood glucose levels below 95 mg/dL
Rationale: Strict glycemic control is vital in gestational diabetes to minimize the risk of
fetal macrosomia, neonatal hypoglycemia, and maternal preeclampsia. The target
fasting blood glucose level is strictly less than 95 mg/dL, and 2-hour postprandial levels
should be below 120 mg/dL. Carbohydrates should be regulated and distributed
throughout the day, not completely eliminated. Intense exercise is unsafe; moderate
activity is recommended.
,Q5. A nurse is monitoring a postpartum client who is 4 hours following an
uncomplicated vaginal delivery. The nurse observes that the perineal pad is
completely saturated within 15 minutes. Which of the following actions should
the nurse perform first?
A) Check the client's blood pressure and pulse rate
B) Notify the provider of a potential laceration
C) Massage the fundus firmly to stimulate contraction
D) Insert an indwelling urinary catheter to empty the bladder
Answer: C) Massage the fundus firmly to stimulate contraction
Rationale: Saturating a perineal pad in 15 minutes or less indicates severe postpartum
hemorrhage, most frequently caused by uterine atony (a boggy, uncontracted uterus).
The nurse's first action must be to firmly massage the fundus to stimulate uterine
smooth muscle contraction, which compresses the bleeding vessels at the placental
site. Assessing vital signs and notifying the provider are secondary to stabilizing the
bleeding.
Q6. A nurse is providing discharge teaching to a postpartum client regarding the
administration of the Rho(D) immune globulin injection. Which of the following
statements by the nurse indicates correct clinical teaching?
A) "The medication prevents the breakdown of red blood cells in future babies if you are
Rh-positive."
B) "You will receive this injection within 72 hours of birth if your baby is Rh-positive and
you are Rh-negative."
C) "The injection provides permanent immunity against Rh blood incompatibility for all
subsequent pregnancies."
D) "This medication must be given directly to your newborn intramuscularly within 24
hours of delivery."
Answer: B) "You will receive this injection within 72 hours of birth if your baby is
Rh-positive and you are Rh-negative."
Rationale: Rho(D) immune globulin is administered intramuscularly to an Rh-negative
mother within 72 hours of delivery if her newborn is Rh-positive. This passive
immunization prevents the mother's immune system from forming permanent antibodies
against Rh-positive blood, protecting future pregnancies. It is given to the mother, not
the newborn, and must be repeated with each pregnancy or potential exposure event.
Q7. A nurse is performing an assessment on a newborn 15 minutes after birth.
Which of the following clinical findings requires immediate notification to the
, provider?
A) Acrocyanosis of the hands and feet
B) Heart rate of 145 beats per minute during crying
C) Substernal retractions and expiratory grunting
D) Overlapping cranial sutures at the fontanels
Answer: C) Substernal retractions and expiratory grunting
Rationale: Substernal retractions, expiratory grunting, nasal flaring, and tachypnea are
definitive signs of neonatal respiratory distress syndrome, which requires immediate
medical intervention. Acrocyanosis (bluish hands and feet) is a normal peripheral
circulatory finding in the first 24 to 48 hours of life. A heart rate of 145 bpm is within the
expected newborn range (110–160 bpm), and molded, overlapping cranial sutures are a
common result of passing through the birth canal.
Q8. A nurse is providing discharge instructions to the parent of an infant who has
a new prescription for liquid oral iron supplements. Which of the following
instructions should the nurse include?
A) Administer the iron with a glass of whole milk
B) Give the medication using a dropper toward the back of the mouth
C) Stop the medication if the infant's stools turn dark green
D) Administer the iron immediately after a large meal
Answer: B) Give the medication using a dropper toward the back of the mouth
Rationale: Liquid oral iron preparations can easily and permanently stain a child's
developing teeth. Parents should administer the medication using a syringe or dropper
placed toward the back of the mouth, past the teeth. Iron is best absorbed on an empty
stomach with a source of vitamin C (like citrus juice). Dairy products and milk inhibit iron
absorption. Parents should be reassured that dark green or black stools are an
expected, harmless side effect.
Q9. A nurse is assessing a child who has autism spectrum disorder. Which of the
following behavioral findings should the nurse expect?
A) Constant desire for physical contact
B) Repetitive body movements and rocking
C) Early development of language milestones
D) High level of sustained eye contact
Answer: B) Repetitive body movements and rocking
Answers & Rationales | 2026–2027 Edition
Prepare for the ATI Capstone Exam with this comprehensive NCLEX-RN study guide featuring original
practice questions, accurate answers, and detailed rationales. Covers fundamentals, adult medical-
surgical nursing, pharmacology, maternal-newborn, pediatrics, mental health, leadership, community
health, and clinical judgment concepts. Perfect for focused review, self-assessment, and building
confidence before your ATI Capstone assessment and NCLEX-RN preparation.
Q1. A nurse is reviewing the prescription for a client who is at 39 weeks of
gestation and is undergoing labor induction with oxytocin. The fetal heart rate
monitor shows late decelerations with three consecutive contractions. Which of
the following actions should the nurse take first?
A) Elevate the client's legs to a 45-degree angle
B) Increase the main line intravenous fluid infusion rate
C) Discontinue the continuous oxytocin infusion immediately
D) Administer supplemental oxygen via a simple face mask
Answer: C) Discontinue the continuous oxytocin infusion immediately
Rationale: Late decelerations indicate uteroplacental insufficiency, meaning the fetus is
not receiving enough oxygen during contractions. The absolute priority first action when
late decelerations occur during an oxytocin infusion is to stop the infusion immediately.
This removes the uterine hyperstimulation, allows the uterus to relax, and improves
blood flow to the placenta. Other intrauterine resuscitation measures (fluids, oxygen,
turning the patient) should follow immediately after.
Q2. A nurse is caring for a client who is 24 hours postpartum following a vaginal
delivery. Which of the following findings should the nurse report to the provider?
A) Lochia rubra with small clots
B) Maternal temperature of 37.9°C (100.2°F)
C) Fundus 1 cm below the umbilicus
D) Calf tenderness and localized warmth
Answer: D) Calf tenderness and localized warmth
Rationale: Calf tenderness, localized warmth, and redness are clinical manifestations of
a deep vein thrombosis (DVT). Postpartum clients are at an increased risk for
thromboembolic disease due to hypercoagulability and venous stasis. A DVT requires
immediate medical intervention to prevent a pulmonary embolism. Lochia rubra, a mild
,temperature elevation under 38°C (100.4°F) due to dehydration, and a fundus located 1
cm below the umbilicus are all expected findings 24 hours postpartum.
Q3. A nurse is assessing a client who is at 34 weeks of gestation and reports
sudden, severe abdominal pain and dark red vaginal bleeding. The nurse notes
that the client's uterus is rigid and tender. Which of the following complications
should the nurse suspect?
A) Placenta previa
B) Abruptio placentae
C) Incompetent cervix
D) Uterine rupture
Answer: B) Abruptio placentae
Rationale: Abruptio placentae is the premature separation of the placenta from the
uterine wall. Classic manifestations include sudden, severe abdominal pain, dark red
vaginal bleeding, uterine tenderness, and a rigid, board-like abdomen. In contrast,
placenta previa presents as painless, bright red vaginal bleeding. An incompetent cervix
causes painless dilation in the second trimester, and uterine rupture typically occurs
during active labor, often featuring a loss of fetal station.
Q4. A nurse in a prenatal clinic is providing education to a client at 28 weeks of
gestation who has a new diagnosis of gestational diabetes mellitus. Which of the
following instructions should the nurse prioritize?
A) Maintain fasting blood glucose levels below 95 mg/dL
B) Avoid all carbohydrates and caloric sweeteners in the diet
C) Exercise intensely for 60 minutes after every main meal
D) Check urine ketones daily before eating dinner
Answer: A) Maintain fasting blood glucose levels below 95 mg/dL
Rationale: Strict glycemic control is vital in gestational diabetes to minimize the risk of
fetal macrosomia, neonatal hypoglycemia, and maternal preeclampsia. The target
fasting blood glucose level is strictly less than 95 mg/dL, and 2-hour postprandial levels
should be below 120 mg/dL. Carbohydrates should be regulated and distributed
throughout the day, not completely eliminated. Intense exercise is unsafe; moderate
activity is recommended.
,Q5. A nurse is monitoring a postpartum client who is 4 hours following an
uncomplicated vaginal delivery. The nurse observes that the perineal pad is
completely saturated within 15 minutes. Which of the following actions should
the nurse perform first?
A) Check the client's blood pressure and pulse rate
B) Notify the provider of a potential laceration
C) Massage the fundus firmly to stimulate contraction
D) Insert an indwelling urinary catheter to empty the bladder
Answer: C) Massage the fundus firmly to stimulate contraction
Rationale: Saturating a perineal pad in 15 minutes or less indicates severe postpartum
hemorrhage, most frequently caused by uterine atony (a boggy, uncontracted uterus).
The nurse's first action must be to firmly massage the fundus to stimulate uterine
smooth muscle contraction, which compresses the bleeding vessels at the placental
site. Assessing vital signs and notifying the provider are secondary to stabilizing the
bleeding.
Q6. A nurse is providing discharge teaching to a postpartum client regarding the
administration of the Rho(D) immune globulin injection. Which of the following
statements by the nurse indicates correct clinical teaching?
A) "The medication prevents the breakdown of red blood cells in future babies if you are
Rh-positive."
B) "You will receive this injection within 72 hours of birth if your baby is Rh-positive and
you are Rh-negative."
C) "The injection provides permanent immunity against Rh blood incompatibility for all
subsequent pregnancies."
D) "This medication must be given directly to your newborn intramuscularly within 24
hours of delivery."
Answer: B) "You will receive this injection within 72 hours of birth if your baby is
Rh-positive and you are Rh-negative."
Rationale: Rho(D) immune globulin is administered intramuscularly to an Rh-negative
mother within 72 hours of delivery if her newborn is Rh-positive. This passive
immunization prevents the mother's immune system from forming permanent antibodies
against Rh-positive blood, protecting future pregnancies. It is given to the mother, not
the newborn, and must be repeated with each pregnancy or potential exposure event.
Q7. A nurse is performing an assessment on a newborn 15 minutes after birth.
Which of the following clinical findings requires immediate notification to the
, provider?
A) Acrocyanosis of the hands and feet
B) Heart rate of 145 beats per minute during crying
C) Substernal retractions and expiratory grunting
D) Overlapping cranial sutures at the fontanels
Answer: C) Substernal retractions and expiratory grunting
Rationale: Substernal retractions, expiratory grunting, nasal flaring, and tachypnea are
definitive signs of neonatal respiratory distress syndrome, which requires immediate
medical intervention. Acrocyanosis (bluish hands and feet) is a normal peripheral
circulatory finding in the first 24 to 48 hours of life. A heart rate of 145 bpm is within the
expected newborn range (110–160 bpm), and molded, overlapping cranial sutures are a
common result of passing through the birth canal.
Q8. A nurse is providing discharge instructions to the parent of an infant who has
a new prescription for liquid oral iron supplements. Which of the following
instructions should the nurse include?
A) Administer the iron with a glass of whole milk
B) Give the medication using a dropper toward the back of the mouth
C) Stop the medication if the infant's stools turn dark green
D) Administer the iron immediately after a large meal
Answer: B) Give the medication using a dropper toward the back of the mouth
Rationale: Liquid oral iron preparations can easily and permanently stain a child's
developing teeth. Parents should administer the medication using a syringe or dropper
placed toward the back of the mouth, past the teeth. Iron is best absorbed on an empty
stomach with a source of vitamin C (like citrus juice). Dairy products and milk inhibit iron
absorption. Parents should be reassured that dark green or black stools are an
expected, harmless side effect.
Q9. A nurse is assessing a child who has autism spectrum disorder. Which of the
following behavioral findings should the nurse expect?
A) Constant desire for physical contact
B) Repetitive body movements and rocking
C) Early development of language milestones
D) High level of sustained eye contact
Answer: B) Repetitive body movements and rocking
