ATI RN Capstone Proctored Comprehensive Assessment
2025–2026 | Complete Questions and Verified Answers
| Updated Nursing Test Bank
1. A nurse is preparing to administer a blood transfusion. Which action is the priority before
starting the infusion?
A. Obtain the client's vital signs
B. Verify the blood product with a second nurse
C. Prime the tubing with 0.9% sodium chloride
D. Check the client's IV site for patency
Correct Answer: B
Rationale: Verifying the blood product with a second nurse at the bedside is the priority
safety action to prevent a hemolytic transfusion reaction. Vital signs establish a baseline but do
not prevent the most lethal error (wrong blood type). Priming with normal saline and checking
IV patency are important but secondary to product verification.
2. A nurse is caring for a client on fall precautions. Which intervention is most effective in
preventing falls?
A. Apply a bed alarm
B. Keep the bed in the lowest position
C. Round on the client every 2 hours
D. Place the call light within reach
Correct Answer: B
Rationale: Keeping the bed in the lowest position reduces the distance and impact of a fall
and is a core environmental safety measure. Bed alarms, rounding, and call lights are helpful
adjuncts but do not physically reduce fall risk the way bed height does.
3. (SATA) A nurse is teaching a client about hand hygiene. Which statements indicate
understanding?
A. "I will wash my hands for at least 20 seconds."
B. "Alcohol-based rub is effective against C. difficile."
C. "I should wash hands before eating."
D. "I can use alcohol rub when hands are visibly soiled."
E. "I will rub all surfaces of my hands and wrists."
, Correct Answers: A, C, E
Rationale: 20 seconds, before eating, and covering all surfaces are correct. Alcohol rub is
not effective against C. difficile spores (requires soap and water), and alcohol rub should not be
used when hands are visibly soiled.
4. A nurse is assessing a client for dehydration. Which finding is most indicative?
A. Bounding pulse
B. Crackles in the lungs
C. Poor skin turgor
D. Weight gain
Correct Answer: C
Rationale: Poor skin turgor reflects decreased interstitial fluid and is a classic sign of
dehydration. Bounding pulse, crackles, and weight gain indicate fluid overload.
5. A nurse is preparing to insert an indwelling urinary catheter. Which action reduces the risk of
CAUTI?
A. Use sterile technique during insertion
B. Irrigate the catheter daily
C. Change the catheter every 48 hours
D. Keep the drainage bag below the bladder
Correct Answer: A
Rationale: Sterile technique during insertion is the single most important intervention to
prevent catheter-associated UTI. Routine irrigation and frequent catheter changes increase
infection risk. Keeping the bag below the bladder prevents backflow but is not the primary
prevention measure during insertion.
6. A nurse is caring for a client with a new colostomy. Which finding requires immediate
intervention?
A. Stoma is pink and moist
B. Stoma is dark purple and dry
C. Small amount of bleeding at the stoma
D. Output is liquid 24 hours post-op
Correct Answer: B
Rationale: A dark purple, dry stoma indicates ischemia/necrosis and requires immediate
notification of the provider. Pink/moist is normal, slight bleeding is expected, and liquid output
is normal initially.
,7. (SATA) Which clients are at increased risk for pressure injuries?
A. A client with a Braden score of 12
B. A client who is incontinent of urine
C. A client who ambulates independently
D. A client with malnutrition
E. A client with a spinal cord injury
Correct Answers: A, B, D, E
Rationale: Low Braden scores, incontinence, malnutrition, and immobility (SCI) all increase
pressure injury risk. Independent ambulation is protective.
8. A nurse is teaching a client about a low-sodium diet. Which food should the client avoid?
A. Fresh apples
B. Canned soup
C. Brown rice
D. Grilled chicken
Correct Answer: B
Rationale: Canned soups are high in sodium due to preservation. Fresh fruits, plain grains,
and unprocessed meats are low in sodium.
9. A nurse is preparing to administer enoxaparin. Which site is appropriate for injection?
A. Deltoid
B. Ventrogluteal
C. Abdomen, 2 inches from umbilicus
D. Anterolateral thigh
Correct Answer: C
Rationale: Enoxaparin is a subcutaneous anticoagulant injected into the abdomen at least 2
inches from the umbilicus to avoid major vessels. The other sites are for IM injections.
10. A nurse is caring for a client with an NG tube. Which action is correct before administering
feedings?
A. Verify placement by aspirating gastric contents and checking pH
B. Instill 100 mL of air and auscultate
C. Flush with sterile water
D. Position the client supine
Correct Answer: A
Rationale: Checking gastric pH (≤5.5) confirms gastric placement. The auscultation
, "whoosh" method is unreliable. Sterile water is not required for flushing, and the client should
be upright.
11. A nurse is assessing a client's pain. Which tool is best for a nonverbal client with dementia?
A. Numeric rating scale
B. Wong-Baker FACES scale
C. PAINAD scale
D. Visual analog scale
Correct Answer: C
Rationale: PAINAD is validated for nonverbal clients with dementia, assessing breathing,
vocalization, facial expression, body language, and consolability. Numeric and visual analog
scales require abstract reasoning.
12. A nurse is preparing to administer a rectal suppository. Which position is best?
A. Sims' position
B. Supine
C. Prone
D. Trendelenburg
Correct Answer: A
Rationale: Sims' position (left lateral with right knee flexed) facilitates rectal suppository
insertion and retention.
13. (SATA) Which findings indicate a possible infection at a surgical incision?
A. Warmth
B. Serosanguineous drainage on day 1
C. Redness
D. Purulent drainage
E. Approximated wound edges
Correct Answers: A, C, D
Rationale: Warmth, redness, and purulent drainage indicate infection. Serosanguineous
drainage on day 1 is normal, and approximated edges indicate healing.
14. A nurse is caring for a client on seizure precautions. Which item should be at the bedside?
A. Oral airway
B. Suction equipment
C. Wrist restraints
D. Tongue blade
2025–2026 | Complete Questions and Verified Answers
| Updated Nursing Test Bank
1. A nurse is preparing to administer a blood transfusion. Which action is the priority before
starting the infusion?
A. Obtain the client's vital signs
B. Verify the blood product with a second nurse
C. Prime the tubing with 0.9% sodium chloride
D. Check the client's IV site for patency
Correct Answer: B
Rationale: Verifying the blood product with a second nurse at the bedside is the priority
safety action to prevent a hemolytic transfusion reaction. Vital signs establish a baseline but do
not prevent the most lethal error (wrong blood type). Priming with normal saline and checking
IV patency are important but secondary to product verification.
2. A nurse is caring for a client on fall precautions. Which intervention is most effective in
preventing falls?
A. Apply a bed alarm
B. Keep the bed in the lowest position
C. Round on the client every 2 hours
D. Place the call light within reach
Correct Answer: B
Rationale: Keeping the bed in the lowest position reduces the distance and impact of a fall
and is a core environmental safety measure. Bed alarms, rounding, and call lights are helpful
adjuncts but do not physically reduce fall risk the way bed height does.
3. (SATA) A nurse is teaching a client about hand hygiene. Which statements indicate
understanding?
A. "I will wash my hands for at least 20 seconds."
B. "Alcohol-based rub is effective against C. difficile."
C. "I should wash hands before eating."
D. "I can use alcohol rub when hands are visibly soiled."
E. "I will rub all surfaces of my hands and wrists."
, Correct Answers: A, C, E
Rationale: 20 seconds, before eating, and covering all surfaces are correct. Alcohol rub is
not effective against C. difficile spores (requires soap and water), and alcohol rub should not be
used when hands are visibly soiled.
4. A nurse is assessing a client for dehydration. Which finding is most indicative?
A. Bounding pulse
B. Crackles in the lungs
C. Poor skin turgor
D. Weight gain
Correct Answer: C
Rationale: Poor skin turgor reflects decreased interstitial fluid and is a classic sign of
dehydration. Bounding pulse, crackles, and weight gain indicate fluid overload.
5. A nurse is preparing to insert an indwelling urinary catheter. Which action reduces the risk of
CAUTI?
A. Use sterile technique during insertion
B. Irrigate the catheter daily
C. Change the catheter every 48 hours
D. Keep the drainage bag below the bladder
Correct Answer: A
Rationale: Sterile technique during insertion is the single most important intervention to
prevent catheter-associated UTI. Routine irrigation and frequent catheter changes increase
infection risk. Keeping the bag below the bladder prevents backflow but is not the primary
prevention measure during insertion.
6. A nurse is caring for a client with a new colostomy. Which finding requires immediate
intervention?
A. Stoma is pink and moist
B. Stoma is dark purple and dry
C. Small amount of bleeding at the stoma
D. Output is liquid 24 hours post-op
Correct Answer: B
Rationale: A dark purple, dry stoma indicates ischemia/necrosis and requires immediate
notification of the provider. Pink/moist is normal, slight bleeding is expected, and liquid output
is normal initially.
,7. (SATA) Which clients are at increased risk for pressure injuries?
A. A client with a Braden score of 12
B. A client who is incontinent of urine
C. A client who ambulates independently
D. A client with malnutrition
E. A client with a spinal cord injury
Correct Answers: A, B, D, E
Rationale: Low Braden scores, incontinence, malnutrition, and immobility (SCI) all increase
pressure injury risk. Independent ambulation is protective.
8. A nurse is teaching a client about a low-sodium diet. Which food should the client avoid?
A. Fresh apples
B. Canned soup
C. Brown rice
D. Grilled chicken
Correct Answer: B
Rationale: Canned soups are high in sodium due to preservation. Fresh fruits, plain grains,
and unprocessed meats are low in sodium.
9. A nurse is preparing to administer enoxaparin. Which site is appropriate for injection?
A. Deltoid
B. Ventrogluteal
C. Abdomen, 2 inches from umbilicus
D. Anterolateral thigh
Correct Answer: C
Rationale: Enoxaparin is a subcutaneous anticoagulant injected into the abdomen at least 2
inches from the umbilicus to avoid major vessels. The other sites are for IM injections.
10. A nurse is caring for a client with an NG tube. Which action is correct before administering
feedings?
A. Verify placement by aspirating gastric contents and checking pH
B. Instill 100 mL of air and auscultate
C. Flush with sterile water
D. Position the client supine
Correct Answer: A
Rationale: Checking gastric pH (≤5.5) confirms gastric placement. The auscultation
, "whoosh" method is unreliable. Sterile water is not required for flushing, and the client should
be upright.
11. A nurse is assessing a client's pain. Which tool is best for a nonverbal client with dementia?
A. Numeric rating scale
B. Wong-Baker FACES scale
C. PAINAD scale
D. Visual analog scale
Correct Answer: C
Rationale: PAINAD is validated for nonverbal clients with dementia, assessing breathing,
vocalization, facial expression, body language, and consolability. Numeric and visual analog
scales require abstract reasoning.
12. A nurse is preparing to administer a rectal suppository. Which position is best?
A. Sims' position
B. Supine
C. Prone
D. Trendelenburg
Correct Answer: A
Rationale: Sims' position (left lateral with right knee flexed) facilitates rectal suppository
insertion and retention.
13. (SATA) Which findings indicate a possible infection at a surgical incision?
A. Warmth
B. Serosanguineous drainage on day 1
C. Redness
D. Purulent drainage
E. Approximated wound edges
Correct Answers: A, C, D
Rationale: Warmth, redness, and purulent drainage indicate infection. Serosanguineous
drainage on day 1 is normal, and approximated edges indicate healing.
14. A nurse is caring for a client on seizure precautions. Which item should be at the bedside?
A. Oral airway
B. Suction equipment
C. Wrist restraints
D. Tongue blade
