2026/2027, ATI Comprehensive Practice B /RN
ATI Capstone Proctored Comprehensive
Assessment
Questions, answers and Rationales All verified
1. A 58-year-old adult experiences sudden crushing substernal chest pain radiating to
the left arm and jaw while climbing stairs. The person becomes pale, diaphoretic, and
reports dizziness. Blood pressure is 84/50 mmHg, and cardiac telemetry reveals ST-
segment elevation in leads II, III, and aVF. What is the immediate priority intervention
to prevent further myocardial damage?
A. Obtain cardiac enzymes
B. Start IV heparin
C. Administer morphine
D. (CORRECT) Administer oxygen
Rationale: This scenario represents an acute ST-elevation myocardial infarction (STEMI)
with hypotension. Following the ABC (Airway, Breathing, Circulation) priority, restoring
oxygenation is critical to prevent ongoing myocardial ischemia. Morphine for pain relief and
anticoagulation are important, but oxygen delivery to compromised cardiac tissue takes
precedence. Prompt intervention reduces infarct size and improves patient outcomes.
2. A 65-year-old post-hip arthroplasty suddenly develops acute dyspnea, pleuritic chest
pain, and tachycardia 48 hours after surgery. Oxygen saturation falls to 86%,
respiratory rate is 28/min, and the patient appears anxious and pale. What
complication is most likely responsible for these findings?
A. Atelectasis
B. Myocardial infarction
C. (CORRECT) Pulmonary embolism
D. Pneumonia
Rationale: Orthopedic surgery significantly increases the risk of venous thromboembolism
due to immobility, endothelial injury, and hypercoagulability. Sudden dyspnea, hypoxia,
tachycardia, and pleuritic chest pain are hallmark signs of pulmonary embolism. Prompt
recognition and treatment with anticoagulation prevent progression to cardiopulmonary
collapse. Gradual-onset conditions like pneumonia or atelectasis are less likely in this acute
scenario.
,3. An adult is found unconscious with a blood glucose of 32 mg/dL. No IV access is
available. The patient is unresponsive and cannot swallow safely. Which intervention
will rapidly restore blood glucose levels?
A. Oral glucose gel
B. Dextrose 50% IV
C. Regular insulin
D. (CORRECT) Glucagon IM
Rationale: When a patient is unconscious, oral glucose administration is unsafe due to
aspiration risk. Without IV access, intramuscular glucagon is the preferred treatment as it
stimulates hepatic glycogen breakdown, raising blood glucose levels effectively. Insulin
would exacerbate hypoglycemia. Prompt intervention prevents neuronal injury and life-
threatening complications.
4. During cardiac monitoring, a patient is noted to be in ventricular fibrillation,
pulseless and unresponsive. Immediate action is required to prevent death. Which
intervention should be performed first?
A. Administer amiodarone
B. Check blood pressure
C. Insert airway
D. (CORRECT) Defibrillate immediately
Rationale: Ventricular fibrillation is a shockable rhythm associated with sudden cardiac
arrest. Immediate unsynchronized defibrillation is the first-line intervention to restore
perfusing rhythm. Medications like amiodarone are administered only after defibrillation
attempts. Delay in defibrillation significantly increases the risk of mortality.
5. A patient presents with severe headache, nuchal rigidity, photophobia, and fever. A
lumbar puncture is considered for diagnosis. Before the procedure, which assessment is
essential to prevent life-threatening complications?
A. Hypoglycemia
B. Sepsis
C. (CORRECT) Increased intracranial pressure
D. Dehydration
Rationale: Performing a lumbar puncture in a patient with elevated intracranial pressure can
precipitate brain herniation, which is fatal. Neurological assessment and imaging, such as a
CT scan, should be performed first to evaluate ICP. Ruling out increased ICP ensures that
diagnostic procedures are safe and prevents catastrophic neurologic outcomes.
, 6. Twenty minutes after vaginal delivery, a patient experiences heavy uterine bleeding.
The fundus is soft and boggy on palpation, and vital signs show a mild drop in blood
pressure. What is the immediate nursing intervention to control bleeding?
A. Administer antibiotics
B. Insert urinary catheter
C. Prepare blood transfusion
D. (CORRECT) Massage the fundus
Rationale: Uterine atony is the most common cause of postpartum hemorrhage. Fundal
massage stimulates uterine contraction, helping to reduce bleeding rapidly. While preparation
for transfusion and antibiotics may be necessary, immediate mechanical stimulation of the
uterus is the priority to prevent hypovolemic shock and preserve maternal life.
7. A laboratory report shows a potassium level of 6.7 mEq/L with peaked T waves
visible on ECG. Which medication should be administered immediately to stabilize
cardiac membranes?
A. Insulin with dextrose
B. Sodium polystyrene sulfonate
C. Furosemide
D. (CORRECT) Calcium gluconate
Rationale: Hyperkalemia with ECG changes such as peaked T waves can precipitate fatal
arrhythmias. Calcium gluconate stabilizes the cardiac membrane instantly, preventing
ventricular fibrillation and cardiac arrest. Other interventions like insulin lower potassium
levels gradually but do not provide immediate protection for the myocardium. Rapid
recognition and treatment are life-saving.
8. Following thyroidectomy, a patient develops sudden stridor, drooling, and difficulty
swallowing. Vital signs reveal mild hypoxia and tachypnea. Which complication should
be suspected and managed immediately?
A. Hypocalcemia
B. Thyroid storm
C. (CORRECT) Airway obstruction
D. Laryngeal paralysis
Rationale: Postoperative stridor is an emergency, often caused by airway edema or
hematoma. Immediate airway assessment and preparation for interventions, including
intubation if necessary, are essential. Delayed recognition can result in complete airway
obstruction and death. Hypocalcemia and thyroid storm may coexist but do not cause
immediate airway compromise.
ATI Capstone Proctored Comprehensive
Assessment
Questions, answers and Rationales All verified
1. A 58-year-old adult experiences sudden crushing substernal chest pain radiating to
the left arm and jaw while climbing stairs. The person becomes pale, diaphoretic, and
reports dizziness. Blood pressure is 84/50 mmHg, and cardiac telemetry reveals ST-
segment elevation in leads II, III, and aVF. What is the immediate priority intervention
to prevent further myocardial damage?
A. Obtain cardiac enzymes
B. Start IV heparin
C. Administer morphine
D. (CORRECT) Administer oxygen
Rationale: This scenario represents an acute ST-elevation myocardial infarction (STEMI)
with hypotension. Following the ABC (Airway, Breathing, Circulation) priority, restoring
oxygenation is critical to prevent ongoing myocardial ischemia. Morphine for pain relief and
anticoagulation are important, but oxygen delivery to compromised cardiac tissue takes
precedence. Prompt intervention reduces infarct size and improves patient outcomes.
2. A 65-year-old post-hip arthroplasty suddenly develops acute dyspnea, pleuritic chest
pain, and tachycardia 48 hours after surgery. Oxygen saturation falls to 86%,
respiratory rate is 28/min, and the patient appears anxious and pale. What
complication is most likely responsible for these findings?
A. Atelectasis
B. Myocardial infarction
C. (CORRECT) Pulmonary embolism
D. Pneumonia
Rationale: Orthopedic surgery significantly increases the risk of venous thromboembolism
due to immobility, endothelial injury, and hypercoagulability. Sudden dyspnea, hypoxia,
tachycardia, and pleuritic chest pain are hallmark signs of pulmonary embolism. Prompt
recognition and treatment with anticoagulation prevent progression to cardiopulmonary
collapse. Gradual-onset conditions like pneumonia or atelectasis are less likely in this acute
scenario.
,3. An adult is found unconscious with a blood glucose of 32 mg/dL. No IV access is
available. The patient is unresponsive and cannot swallow safely. Which intervention
will rapidly restore blood glucose levels?
A. Oral glucose gel
B. Dextrose 50% IV
C. Regular insulin
D. (CORRECT) Glucagon IM
Rationale: When a patient is unconscious, oral glucose administration is unsafe due to
aspiration risk. Without IV access, intramuscular glucagon is the preferred treatment as it
stimulates hepatic glycogen breakdown, raising blood glucose levels effectively. Insulin
would exacerbate hypoglycemia. Prompt intervention prevents neuronal injury and life-
threatening complications.
4. During cardiac monitoring, a patient is noted to be in ventricular fibrillation,
pulseless and unresponsive. Immediate action is required to prevent death. Which
intervention should be performed first?
A. Administer amiodarone
B. Check blood pressure
C. Insert airway
D. (CORRECT) Defibrillate immediately
Rationale: Ventricular fibrillation is a shockable rhythm associated with sudden cardiac
arrest. Immediate unsynchronized defibrillation is the first-line intervention to restore
perfusing rhythm. Medications like amiodarone are administered only after defibrillation
attempts. Delay in defibrillation significantly increases the risk of mortality.
5. A patient presents with severe headache, nuchal rigidity, photophobia, and fever. A
lumbar puncture is considered for diagnosis. Before the procedure, which assessment is
essential to prevent life-threatening complications?
A. Hypoglycemia
B. Sepsis
C. (CORRECT) Increased intracranial pressure
D. Dehydration
Rationale: Performing a lumbar puncture in a patient with elevated intracranial pressure can
precipitate brain herniation, which is fatal. Neurological assessment and imaging, such as a
CT scan, should be performed first to evaluate ICP. Ruling out increased ICP ensures that
diagnostic procedures are safe and prevents catastrophic neurologic outcomes.
, 6. Twenty minutes after vaginal delivery, a patient experiences heavy uterine bleeding.
The fundus is soft and boggy on palpation, and vital signs show a mild drop in blood
pressure. What is the immediate nursing intervention to control bleeding?
A. Administer antibiotics
B. Insert urinary catheter
C. Prepare blood transfusion
D. (CORRECT) Massage the fundus
Rationale: Uterine atony is the most common cause of postpartum hemorrhage. Fundal
massage stimulates uterine contraction, helping to reduce bleeding rapidly. While preparation
for transfusion and antibiotics may be necessary, immediate mechanical stimulation of the
uterus is the priority to prevent hypovolemic shock and preserve maternal life.
7. A laboratory report shows a potassium level of 6.7 mEq/L with peaked T waves
visible on ECG. Which medication should be administered immediately to stabilize
cardiac membranes?
A. Insulin with dextrose
B. Sodium polystyrene sulfonate
C. Furosemide
D. (CORRECT) Calcium gluconate
Rationale: Hyperkalemia with ECG changes such as peaked T waves can precipitate fatal
arrhythmias. Calcium gluconate stabilizes the cardiac membrane instantly, preventing
ventricular fibrillation and cardiac arrest. Other interventions like insulin lower potassium
levels gradually but do not provide immediate protection for the myocardium. Rapid
recognition and treatment are life-saving.
8. Following thyroidectomy, a patient develops sudden stridor, drooling, and difficulty
swallowing. Vital signs reveal mild hypoxia and tachypnea. Which complication should
be suspected and managed immediately?
A. Hypocalcemia
B. Thyroid storm
C. (CORRECT) Airway obstruction
D. Laryngeal paralysis
Rationale: Postoperative stridor is an emergency, often caused by airway edema or
hematoma. Immediate airway assessment and preparation for interventions, including
intubation if necessary, are essential. Delayed recognition can result in complete airway
obstruction and death. Hypocalcemia and thyroid storm may coexist but do not cause
immediate airway compromise.
