ATI Capstone Exam Study Guide | NCLEX-RN Practice Questions,
Answers & Rationales | 2026 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.
Question 1
A nurse is caring for a client who expresses anxiety about an upcoming surgery. Which
of the following responses should the nurse make?
A) "Don't worry, everything will be fine."
B) "Tell me more about what concerns you."
C) "You should trust your surgeon."
D) "Many people have this surgery and do well."
Rationale: Asking the client to describe their feelings is a therapeutic communication technique that
encourages expression of concerns. It validates the client's emotions and allows the nurse to assess the
source of anxiety. Dismissive or overly reassuring responses (A, C, D) block communication and do not
address the client's underlying concerns.
Question 2
A nurse is preparing to perform a sterile dressing change for a client with a surgical
wound. Which action should the nurse take to prevent contamination during the
procedure?
A) Pour sterile solution from a bottle directly onto the sterile field
B) Restart the procedure if sterile solution splashes onto the sterile field
C) Use clean gloves instead of sterile gloves
D) Keep the sterile field below waist level
,Rationale: If sterile solution splashes onto the sterile field, the field is contaminated and must be
re-established. Pouring sterile solution directly onto the field (A) can cause splashing and contamination;
sterile solution should be poured into a sterile basin. Clean gloves (C) are not appropriate for sterile
procedures. The sterile field must be kept above waist level (D) to prevent contamination.
Question 3
A nurse is assisting a client who signed an informed consent form for surgery but has
since expressed doubts about the need for the surgery. Which statement should the
nurse make?
A) "You already signed the consent form."
B) "I will cancel the surgery for you."
C) "The surgeon will answer your questions before surgery."
D) "You should discuss this with your family."
Rationale: Informed consent is an ongoing process. The client has the right to ask questions and
reconsider. The nurse should support the client's autonomy and ensure the surgeon is available to
address any concerns before the procedure. Telling the client they already signed the form (A) is
dismissive and incorrect, as consent can be withdrawn at any time.
Question 4
A nurse is reviewing information about advance directives with a newly admitted client.
Which statement by the client indicates an understanding of the teaching?
A) "I have a living will that outlines my wishes when I am unable to make a
decision."
B) "Advance directives are only for older adults."
C) "My family can make all my healthcare decisions without a document."
D) "A living will is the same as a power of attorney."
Rationale: A living will is a legal document that specifies a person's wishes regarding medical treatment
when they are unable to communicate. Advance directives apply to all competent adults (B), not just
older adults. Family members require legal authority (healthcare proxy or durable power of attorney) to
make decisions (C). A living will and healthcare proxy serve different functions (D).
,Question 5
A nurse is admitting a client who has meningococcal meningitis. Which action should
the nurse take first?
A) Place the client in a private room with negative pressure
B) Initiate droplet precautions
C) Wear an N95 respirator
D) Administer prophylactic antibiotics to all staff
Rationale: Meningococcal meningitis is transmitted via respiratory droplets. The nurse should initiate
droplet precautions immediately upon admission to prevent transmission. Negative pressure (A) is
required for airborne precautions, not droplet precautions. N95 respirators (C) are for airborne
precautions. Prophylactic antibiotics (D) may be indicated for close contacts but are not the first action.
Question 6
A nurse is caring for a client who is scheduled for cataract surgery and states, "I see just
fine and have decided to cancel my surgery." Which response should the nurse make?
A) "You need this surgery to prevent blindness."
B) "I will notify the surgeon that you are canceling."
C) "Your doctor knows what is best for you."
D) "Tell me more about the thoughts that are concerning you."
Rationale: The nurse should use therapeutic communication to explore the client's concerns. This
response validates the client's feelings and allows the nurse to assess the reasons for the client's
decision. Dismissing the client's concerns (A, C) is not therapeutic. Notifying the surgeon (B) is
appropriate but should occur after exploring the client's concerns.
Question 7
A nurse is preparing to administer a medication via metered-dose inhaler (MDI). Which
instruction should the nurse include in the teaching?
, A) Inhale the medication deeply for 3-5 seconds
B) Hold the breath for 10 seconds after inhalation
C) Shake the inhaler after each puff
D) Place the mouthpiece directly against the lips
Rationale: After inhaling the medication, the client should hold their breath for 10 seconds to allow the
medication to deposit in the airways. Inhalation should be slow and deep (A). The inhaler should be
shaken before the first puff (C). The mouthpiece should be placed 1-2 inches in front of the mouth (D).
Question 8
A nurse is teaching a group of assistive personnel about expected integumentary
changes in older adults. Which finding should the nurse include?
A) Decrease in skin elasticity
B) Increased subcutaneous tissue
C) Decreased pigmentation
D) Increased moisture levels
Rationale: Aging causes decreased skin elasticity due to loss of collagen and elastin. Subcutaneous tissue
decreases (B), pigmentation often increases (C), and moisture levels decrease (D).
Question 9
A nurse is monitoring a client receiving intermittent enteral feedings. Which finding
should the nurse identify as an intolerance to the feeding?
A) Nausea
B) Increased appetite
C) Normal bowel sounds
D) Weight gain
Rationale: Nausea, vomiting, abdominal distention, and dumping syndrome are signs of feeding
intolerance. Increased appetite, normal bowel sounds, and weight gain are expected or positive findings.
Answers & Rationales | 2026 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.
Question 1
A nurse is caring for a client who expresses anxiety about an upcoming surgery. Which
of the following responses should the nurse make?
A) "Don't worry, everything will be fine."
B) "Tell me more about what concerns you."
C) "You should trust your surgeon."
D) "Many people have this surgery and do well."
Rationale: Asking the client to describe their feelings is a therapeutic communication technique that
encourages expression of concerns. It validates the client's emotions and allows the nurse to assess the
source of anxiety. Dismissive or overly reassuring responses (A, C, D) block communication and do not
address the client's underlying concerns.
Question 2
A nurse is preparing to perform a sterile dressing change for a client with a surgical
wound. Which action should the nurse take to prevent contamination during the
procedure?
A) Pour sterile solution from a bottle directly onto the sterile field
B) Restart the procedure if sterile solution splashes onto the sterile field
C) Use clean gloves instead of sterile gloves
D) Keep the sterile field below waist level
,Rationale: If sterile solution splashes onto the sterile field, the field is contaminated and must be
re-established. Pouring sterile solution directly onto the field (A) can cause splashing and contamination;
sterile solution should be poured into a sterile basin. Clean gloves (C) are not appropriate for sterile
procedures. The sterile field must be kept above waist level (D) to prevent contamination.
Question 3
A nurse is assisting a client who signed an informed consent form for surgery but has
since expressed doubts about the need for the surgery. Which statement should the
nurse make?
A) "You already signed the consent form."
B) "I will cancel the surgery for you."
C) "The surgeon will answer your questions before surgery."
D) "You should discuss this with your family."
Rationale: Informed consent is an ongoing process. The client has the right to ask questions and
reconsider. The nurse should support the client's autonomy and ensure the surgeon is available to
address any concerns before the procedure. Telling the client they already signed the form (A) is
dismissive and incorrect, as consent can be withdrawn at any time.
Question 4
A nurse is reviewing information about advance directives with a newly admitted client.
Which statement by the client indicates an understanding of the teaching?
A) "I have a living will that outlines my wishes when I am unable to make a
decision."
B) "Advance directives are only for older adults."
C) "My family can make all my healthcare decisions without a document."
D) "A living will is the same as a power of attorney."
Rationale: A living will is a legal document that specifies a person's wishes regarding medical treatment
when they are unable to communicate. Advance directives apply to all competent adults (B), not just
older adults. Family members require legal authority (healthcare proxy or durable power of attorney) to
make decisions (C). A living will and healthcare proxy serve different functions (D).
,Question 5
A nurse is admitting a client who has meningococcal meningitis. Which action should
the nurse take first?
A) Place the client in a private room with negative pressure
B) Initiate droplet precautions
C) Wear an N95 respirator
D) Administer prophylactic antibiotics to all staff
Rationale: Meningococcal meningitis is transmitted via respiratory droplets. The nurse should initiate
droplet precautions immediately upon admission to prevent transmission. Negative pressure (A) is
required for airborne precautions, not droplet precautions. N95 respirators (C) are for airborne
precautions. Prophylactic antibiotics (D) may be indicated for close contacts but are not the first action.
Question 6
A nurse is caring for a client who is scheduled for cataract surgery and states, "I see just
fine and have decided to cancel my surgery." Which response should the nurse make?
A) "You need this surgery to prevent blindness."
B) "I will notify the surgeon that you are canceling."
C) "Your doctor knows what is best for you."
D) "Tell me more about the thoughts that are concerning you."
Rationale: The nurse should use therapeutic communication to explore the client's concerns. This
response validates the client's feelings and allows the nurse to assess the reasons for the client's
decision. Dismissing the client's concerns (A, C) is not therapeutic. Notifying the surgeon (B) is
appropriate but should occur after exploring the client's concerns.
Question 7
A nurse is preparing to administer a medication via metered-dose inhaler (MDI). Which
instruction should the nurse include in the teaching?
, A) Inhale the medication deeply for 3-5 seconds
B) Hold the breath for 10 seconds after inhalation
C) Shake the inhaler after each puff
D) Place the mouthpiece directly against the lips
Rationale: After inhaling the medication, the client should hold their breath for 10 seconds to allow the
medication to deposit in the airways. Inhalation should be slow and deep (A). The inhaler should be
shaken before the first puff (C). The mouthpiece should be placed 1-2 inches in front of the mouth (D).
Question 8
A nurse is teaching a group of assistive personnel about expected integumentary
changes in older adults. Which finding should the nurse include?
A) Decrease in skin elasticity
B) Increased subcutaneous tissue
C) Decreased pigmentation
D) Increased moisture levels
Rationale: Aging causes decreased skin elasticity due to loss of collagen and elastin. Subcutaneous tissue
decreases (B), pigmentation often increases (C), and moisture levels decrease (D).
Question 9
A nurse is monitoring a client receiving intermittent enteral feedings. Which finding
should the nurse identify as an intolerance to the feeding?
A) Nausea
B) Increased appetite
C) Normal bowel sounds
D) Weight gain
Rationale: Nausea, vomiting, abdominal distention, and dumping syndrome are signs of feeding
intolerance. Increased appetite, normal bowel sounds, and weight gain are expected or positive findings.
