1
RN ATI CAPSTONE PROCTORED COMPREHENSIVE ASSESSMENT 2024 B | 150
NGN-STYLE PRACTICE QUESTIONS WITH DETAILED RATIONALES & PARTIAL
CREDIT SCORING | COMPREHENSIVE NCLEX-RN REVIEW
CASE STUDY 1: EMERGENCY DEPARTMENT TRIAGE (Questions 1-5)
EHR Panel:
• Patient: Emily Rodriguez, 45 years old, F.
• Admission: Emergency Department.
• History: Hypertension, Type 2 Diabetes Mellitus.
• Vitals: HR 120, BP 88/52, RR 28, Temp 103.2°F (39.6°C), SpO2 86% on RA.
• Labs: WBC 26,000/mm³, Lactate 5.8 mmol/L, Creatinine 2.8 mg/dL.
• Assessment: Reports sudden onset of severe abdominal pain, nausea, and vomiting for 3
days. Abdomen is rigid and tender to palpation. Patient appears pale and diaphoretic.
QUESTION 1: SEPSIS IDENTIFICATION
• Question: The nurse is assessing a client who presents with abdominal pain, fever, and
hypotension. Which finding would most strongly indicate that the client is experiencing
sepsis?
• Options:
A. Temperature of 103.2°F.
B. Blood pressure of 88/52 mmHg.
C. Elevated lactate of 5.8 mmol/L.
D. White blood cell count of 26,000/mm³.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: An elevated lactate (> 2 mmol/L) indicates tissue
hypoperfusion and anaerobic metabolism, a hallmark of sepsis. It is a strong
predictor of mortality.
o Distractor Pitfalls: A: Fever is a sign of infection, not necessarily sepsis. B:
Hypotension is a late sign of septic shock, not always present. D: Elevated WBC
is a sign of infection, not specific to sepsis.
QUESTION 2: SEPSIS BUNDLE INTERVENTIONS
, 2
• Question: The provider suspects sepsis. Which of the following actions should the nurse
anticipate as part of the 1-hour sepsis bundle? (Select all that apply.)
• Options:
A. Obtain blood cultures before administering antibiotics.
B. Administer broad-spectrum antibiotics within 1 hour.
C. Administer 30 mL/kg of crystalloid fluid for hypotension.
D. Administer an antipyretic to reduce fever.
E. Maintain a mean arterial pressure (MAP) ≥ 65 mmHg.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A, B, C, E
o Pathophysiology Summary: The 1-hour sepsis bundle includes: measuring
lactate, obtaining blood cultures before antibiotics, administering broad-spectrum
antibiotics, rapid fluid resuscitation (30 mL/kg), and vasopressors to maintain
MAP ≥ 65 mmHg.
o Distractor Pitfalls: D: Antipyretics are supportive but not part of the critical 1-
hour bundle.
QUESTION 3: FLUID RESUSCITATION
• Question: The client is prescribed 30 mL/kg of normal saline bolus. The client weighs 85
kg. How many mL should the nurse administer?
• Options:
A. 1700 mL.
B. 2125 mL.
C. 2550 mL.
D. 3400 mL.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: 30 mL/kg × 85 kg = 2550 mL. This is the
recommended initial fluid bolus for sepsis.
o Distractor Pitfalls: A: 1700 mL is 20 mL/kg. B: 2125 mL is 25 mL/kg. D: 3400
mL is 40 mL/kg.
QUESTION 4: ANTIBIOTIC ADMINISTRATION
• Question: The provider orders IV vancomycin and piperacillin-tazobactam. What is the
priority nursing action before administering vancomycin?
, 3
• Options:
A. Check the client's BUN and creatinine.
B. Administer a test dose.
C. Assess for a history of penicillin allergy.
D. Infuse over 30 minutes.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Vancomycin is nephrotoxic and ototoxic. The nurse
must assess renal function (BUN/Creatinine) before administration to determine if
the dose needs adjustment.
o Distractor Pitfalls: B: Test doses are not standard for vancomycin. C:
Piperacillin-tazobactam has penicillin cross-reactivity. D: Vancomycin must be
infused over at least 60 minutes.
QUESTION 5: VASOPRESSOR THERAPY
• Question: The client remains hypotensive despite fluid resuscitation. The provider orders
norepinephrine. Which action should the nurse take when administering this medication?
• Options:
A. Administer via a peripheral IV line.
B. Administer via a central line.
C. Administer as a rapid IV push.
D. Monitor for hypertension.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Norepinephrine is a potent vasopressor. It is a
vesicant and can cause severe tissue necrosis if it infiltrates. It must be
administered through a central venous catheter.
o Distractor Pitfalls: A: Peripheral administration is a last resort due to the risk of
extravasation. C: It is administered as a continuous infusion, not a bolus. D:
Norepinephrine can cause hypertension, but hypotension is the primary effect.
CASE STUDY 2: CARDIAC EMERGENCY (Questions 6-10)
EHR Panel:
• Patient: William Chen, 70 years old, M.
, 4
• Admission: Chest Pain.
• History: Smoking, Hyperlipidemia, Family history of CAD.
• Vitals: HR 112, BP 165/95, RR 26, SpO2 92% on RA.
• ECG: ST-segment elevation in leads V1-V4.
• Assessment: Reports crushing substernal chest pain radiating to the left arm, rated 10/10.
Appears anxious and diaphoretic.
QUESTION 6: PRIORITY INTERVENTION
• Question: The client is experiencing an ST-segment elevation myocardial infarction
(STEMI). What is the priority nursing action?
• Options:
A. Administer sublingual nitroglycerin.
B. Prepare for percutaneous coronary intervention (PCI).
C. Administer aspirin 324 mg.
D. Obtain a 12-lead ECG.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: The priority for a STEMI is rapid reperfusion. The
goal is to perform PCI within 90 minutes of arrival.
o Distractor Pitfalls: A: Nitroglycerin is indicated but not the priority. C: Aspirin is
indicated but not the priority. D: An ECG has already been done.
QUESTION 7: MEDICATION ADMINISTRATION
• Question: Which medication should the nurse administer first to a client with a suspected
MI?
• Options:
A. Morphine sulfate.
B. Aspirin.
C. Heparin.
D. Nitroglycerin.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
RN ATI CAPSTONE PROCTORED COMPREHENSIVE ASSESSMENT 2024 B | 150
NGN-STYLE PRACTICE QUESTIONS WITH DETAILED RATIONALES & PARTIAL
CREDIT SCORING | COMPREHENSIVE NCLEX-RN REVIEW
CASE STUDY 1: EMERGENCY DEPARTMENT TRIAGE (Questions 1-5)
EHR Panel:
• Patient: Emily Rodriguez, 45 years old, F.
• Admission: Emergency Department.
• History: Hypertension, Type 2 Diabetes Mellitus.
• Vitals: HR 120, BP 88/52, RR 28, Temp 103.2°F (39.6°C), SpO2 86% on RA.
• Labs: WBC 26,000/mm³, Lactate 5.8 mmol/L, Creatinine 2.8 mg/dL.
• Assessment: Reports sudden onset of severe abdominal pain, nausea, and vomiting for 3
days. Abdomen is rigid and tender to palpation. Patient appears pale and diaphoretic.
QUESTION 1: SEPSIS IDENTIFICATION
• Question: The nurse is assessing a client who presents with abdominal pain, fever, and
hypotension. Which finding would most strongly indicate that the client is experiencing
sepsis?
• Options:
A. Temperature of 103.2°F.
B. Blood pressure of 88/52 mmHg.
C. Elevated lactate of 5.8 mmol/L.
D. White blood cell count of 26,000/mm³.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: An elevated lactate (> 2 mmol/L) indicates tissue
hypoperfusion and anaerobic metabolism, a hallmark of sepsis. It is a strong
predictor of mortality.
o Distractor Pitfalls: A: Fever is a sign of infection, not necessarily sepsis. B:
Hypotension is a late sign of septic shock, not always present. D: Elevated WBC
is a sign of infection, not specific to sepsis.
QUESTION 2: SEPSIS BUNDLE INTERVENTIONS
, 2
• Question: The provider suspects sepsis. Which of the following actions should the nurse
anticipate as part of the 1-hour sepsis bundle? (Select all that apply.)
• Options:
A. Obtain blood cultures before administering antibiotics.
B. Administer broad-spectrum antibiotics within 1 hour.
C. Administer 30 mL/kg of crystalloid fluid for hypotension.
D. Administer an antipyretic to reduce fever.
E. Maintain a mean arterial pressure (MAP) ≥ 65 mmHg.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A, B, C, E
o Pathophysiology Summary: The 1-hour sepsis bundle includes: measuring
lactate, obtaining blood cultures before antibiotics, administering broad-spectrum
antibiotics, rapid fluid resuscitation (30 mL/kg), and vasopressors to maintain
MAP ≥ 65 mmHg.
o Distractor Pitfalls: D: Antipyretics are supportive but not part of the critical 1-
hour bundle.
QUESTION 3: FLUID RESUSCITATION
• Question: The client is prescribed 30 mL/kg of normal saline bolus. The client weighs 85
kg. How many mL should the nurse administer?
• Options:
A. 1700 mL.
B. 2125 mL.
C. 2550 mL.
D. 3400 mL.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: 30 mL/kg × 85 kg = 2550 mL. This is the
recommended initial fluid bolus for sepsis.
o Distractor Pitfalls: A: 1700 mL is 20 mL/kg. B: 2125 mL is 25 mL/kg. D: 3400
mL is 40 mL/kg.
QUESTION 4: ANTIBIOTIC ADMINISTRATION
• Question: The provider orders IV vancomycin and piperacillin-tazobactam. What is the
priority nursing action before administering vancomycin?
, 3
• Options:
A. Check the client's BUN and creatinine.
B. Administer a test dose.
C. Assess for a history of penicillin allergy.
D. Infuse over 30 minutes.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Vancomycin is nephrotoxic and ototoxic. The nurse
must assess renal function (BUN/Creatinine) before administration to determine if
the dose needs adjustment.
o Distractor Pitfalls: B: Test doses are not standard for vancomycin. C:
Piperacillin-tazobactam has penicillin cross-reactivity. D: Vancomycin must be
infused over at least 60 minutes.
QUESTION 5: VASOPRESSOR THERAPY
• Question: The client remains hypotensive despite fluid resuscitation. The provider orders
norepinephrine. Which action should the nurse take when administering this medication?
• Options:
A. Administer via a peripheral IV line.
B. Administer via a central line.
C. Administer as a rapid IV push.
D. Monitor for hypertension.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Norepinephrine is a potent vasopressor. It is a
vesicant and can cause severe tissue necrosis if it infiltrates. It must be
administered through a central venous catheter.
o Distractor Pitfalls: A: Peripheral administration is a last resort due to the risk of
extravasation. C: It is administered as a continuous infusion, not a bolus. D:
Norepinephrine can cause hypertension, but hypotension is the primary effect.
CASE STUDY 2: CARDIAC EMERGENCY (Questions 6-10)
EHR Panel:
• Patient: William Chen, 70 years old, M.
, 4
• Admission: Chest Pain.
• History: Smoking, Hyperlipidemia, Family history of CAD.
• Vitals: HR 112, BP 165/95, RR 26, SpO2 92% on RA.
• ECG: ST-segment elevation in leads V1-V4.
• Assessment: Reports crushing substernal chest pain radiating to the left arm, rated 10/10.
Appears anxious and diaphoretic.
QUESTION 6: PRIORITY INTERVENTION
• Question: The client is experiencing an ST-segment elevation myocardial infarction
(STEMI). What is the priority nursing action?
• Options:
A. Administer sublingual nitroglycerin.
B. Prepare for percutaneous coronary intervention (PCI).
C. Administer aspirin 324 mg.
D. Obtain a 12-lead ECG.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: The priority for a STEMI is rapid reperfusion. The
goal is to perform PCI within 90 minutes of arrival.
o Distractor Pitfalls: A: Nitroglycerin is indicated but not the priority. C: Aspirin is
indicated but not the priority. D: An ECG has already been done.
QUESTION 7: MEDICATION ADMINISTRATION
• Question: Which medication should the nurse administer first to a client with a suspected
MI?
• Options:
A. Morphine sulfate.
B. Aspirin.
C. Heparin.
D. Nitroglycerin.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
