ATI Comprehensive Practice B2026/2027 /RN ATI
Capstone Proctored Comprehensive Assessment
, Questions, answers and Rationales All verified
1. A patient suddenly develops crushing chest pain radiating to the jaw with diaphoresis
and shortness of breath. Blood pressure is 82/50 mmHg and heart rate is 118/min. ECG
shows ST elevation in leads II, III, and aVF.
A. Administer aspirin
B. Start IV heparin
C. Administer oxygen
D. Obtain cardiac enzymes
Rationale:
ST-elevation with hypotension indicates acute STEMI. Oxygen improves myocardial oxygen
supply, reducing ischemic injury immediately. While aspirin and heparin are important, oxygen
is the first intervention according to ABC priority.
2. A 68-year-old develops sudden dyspnea, tachycardia, and pleuritic chest pain two days
after hip replacement. Oxygen saturation is 85% on room air, and blood pressure is 90/58
mmHg.
A. Administer morphine
B. Encourage ambulation
C. Notify provider for suspected pulmonary embolism
D. Apply warm compress to leg
Rationale:
Sudden hypoxia, tachycardia, and pleuritic pain postoperatively suggest pulmonary embolism.
Immediate medical evaluation is needed to prevent hemodynamic collapse. Leg interventions
alone will not address life-threatening emboli.
3. A newborn exhibits grunting, nasal flaring, and retractions shortly after preterm birth.
Oxygen saturation is 88% despite blow-by oxygen. Blood glucose is normal, and
temperature is 36.8°C.
A. Administer IV antibiotics
B. Provide oral glucose
C. Prepare for surfactant therapy
D. Perform chest physiotherapy
Rationale:
Preterm infants lack surfactant, leading to alveolar collapse and respiratory distress syndrome.
,Surfactant replacement improves oxygenation and lung compliance. Antibiotics or glucose do
not address primary respiratory failure.
4. A patient receiving IV insulin for diabetic ketoacidosis has potassium 5.6 mEq/L and
blood glucose 640 mg/dL. pH is 7.21, and bicarbonate is 14 mEq/L.
A. Administer IV potassium
B. Start isotonic fluids before insulin
C. Give sodium bicarbonate immediately
D. Administer oral glucose
Rationale:
Fluid resuscitation restores circulating volume, improving perfusion and facilitating insulin
delivery. Potassium must be monitored but is not immediately given until fluids stabilize.
Sodium bicarbonate is reserved for pH < 6.9.
5. A postpartum patient 30 minutes after delivery reports urinary retention. The uterus is
soft, boggy, and deviated to the right. Moderate lochia is present, and vital signs are stable.
A. Massage the fundus
B. Administer oxytocin
C. Assist the patient to void
D. Notify provider
Rationale:
Bladder distention prevents uterine contraction, causing atony and bleeding. Assisting voiding
restores uterine tone. Fundal massage without emptying bladder will not correct underlying
cause.
6. A patient presents with sudden-onset unilateral calf pain, swelling, and warmth. The leg
is tender to palpation, and Homan’s sign is positive. The patient is otherwise
hemodynamically stable.
A. Massage the calf
B. Apply heat
C. Keep limb elevated and notify provider for DVT
D. Encourage ambulation
Rationale:
Findings indicate deep vein thrombosis. Massaging could dislodge a clot, causing pulmonary
embolism. Elevation and prompt medical evaluation prevent progression and complications.
7. A patient has absent deep tendon reflexes, respiratory rate 8/min, and received
magnesium sulfate for preeclampsia. Blood pressure is 112/72 mmHg, and urine output is
adequate.
,A. Administer oxytocin
B. Administer calcium gluconate
C. Increase magnesium infusion
D. Provide respiratory support only
Rationale:
These are classic signs of magnesium toxicity. Calcium gluconate reverses neuromuscular
blockade and protects respiratory function. Support alone does not reverse toxicity.
8. A telemetry strip shows wide-complex tachycardia at 180/min with blood pressure 78/46
mmHg. The patient is conscious but dizzy and chest pain is reported.
A. Administer IV amiodarone
B. Obtain 12-lead ECG
C. Prepare for synchronized cardioversion
D. Encourage deep breathing
Rationale:
Unstable VT with pulse requires immediate synchronized cardioversion per ACLS. Medications
are secondary in unstable patients. Delay can lead to cardiac arrest.
9. A patient with type 1 diabetes becomes unconscious after missing a meal. Blood glucose
is 28 mg/dL, and no IV access is available.
A. Administer oral glucose
B. Administer glucagon IM
C. Give insulin
D. Encourage fluids
Rationale:
Unconscious patients cannot safely take oral glucose due to aspiration risk. IM glucagon rapidly
raises blood glucose. Insulin would worsen hypoglycemia.
10. A patient develops clear fluid drainage from the nose after head trauma. Vital signs are
stable, and there is no epistaxis.
A. Administer nasal spray
B. Suspect cerebrospinal fluid leak
C. Monitor temperature only
D. Apply nasal packing
Rationale:
Clear, watery drainage after trauma suggests CSF leak. Early recognition prevents meningitis.
Nasal packing is contraindicated and may worsen complications.
, 11. A patient reports sudden, severe right flank pain radiating to the groin with hematuria.
Vital signs reveal mild tachycardia but stable blood pressure.
A. Appendicitis
B. Kidney stones
C. Pyelonephritis
D. Urinary tract infection
Rationale:
Colicky flank pain with hematuria indicates renal calculi. Immediate pain management and
hydration prevent complications. Infection or appendicitis is less likely with these symptoms.
12. A patient receiving heparin has an aPTT of 120 seconds with oozing from IV sites. The
patient is hemodynamically stable.
A. Continue infusion
B. Increase infusion
C. Stop infusion and prepare protamine
D. Administer vitamin K
Rationale:
aPTT above therapeutic range indicates heparin overdose. Protamine neutralizes heparin to
prevent bleeding complications. Vitamin K does not reverse heparin.
13. A patient after thyroidectomy develops sudden stridor and difficulty breathing. Oxygen
saturation is 89% on room air, and swelling is noted at the surgical site.
A. Administer corticosteroids
B. Provide humidified oxygen
C. Prepare for immediate airway intervention
D. Monitor for 30 minutes
Rationale:
Airway compromise post-thyroidectomy is a life-threatening emergency. Immediate intervention
(intubation or surgical airway) prevents hypoxia. Observation is inadequate.
14. A patient on ACE inhibitors develops facial swelling, tongue swelling, and shortness of
breath. Blood pressure is 88/52 mmHg.
A. Administer corticosteroids
B. Treat angioedema with epinephrine
C. Provide antihistamine only
D. Monitor airway
Capstone Proctored Comprehensive Assessment
, Questions, answers and Rationales All verified
1. A patient suddenly develops crushing chest pain radiating to the jaw with diaphoresis
and shortness of breath. Blood pressure is 82/50 mmHg and heart rate is 118/min. ECG
shows ST elevation in leads II, III, and aVF.
A. Administer aspirin
B. Start IV heparin
C. Administer oxygen
D. Obtain cardiac enzymes
Rationale:
ST-elevation with hypotension indicates acute STEMI. Oxygen improves myocardial oxygen
supply, reducing ischemic injury immediately. While aspirin and heparin are important, oxygen
is the first intervention according to ABC priority.
2. A 68-year-old develops sudden dyspnea, tachycardia, and pleuritic chest pain two days
after hip replacement. Oxygen saturation is 85% on room air, and blood pressure is 90/58
mmHg.
A. Administer morphine
B. Encourage ambulation
C. Notify provider for suspected pulmonary embolism
D. Apply warm compress to leg
Rationale:
Sudden hypoxia, tachycardia, and pleuritic pain postoperatively suggest pulmonary embolism.
Immediate medical evaluation is needed to prevent hemodynamic collapse. Leg interventions
alone will not address life-threatening emboli.
3. A newborn exhibits grunting, nasal flaring, and retractions shortly after preterm birth.
Oxygen saturation is 88% despite blow-by oxygen. Blood glucose is normal, and
temperature is 36.8°C.
A. Administer IV antibiotics
B. Provide oral glucose
C. Prepare for surfactant therapy
D. Perform chest physiotherapy
Rationale:
Preterm infants lack surfactant, leading to alveolar collapse and respiratory distress syndrome.
,Surfactant replacement improves oxygenation and lung compliance. Antibiotics or glucose do
not address primary respiratory failure.
4. A patient receiving IV insulin for diabetic ketoacidosis has potassium 5.6 mEq/L and
blood glucose 640 mg/dL. pH is 7.21, and bicarbonate is 14 mEq/L.
A. Administer IV potassium
B. Start isotonic fluids before insulin
C. Give sodium bicarbonate immediately
D. Administer oral glucose
Rationale:
Fluid resuscitation restores circulating volume, improving perfusion and facilitating insulin
delivery. Potassium must be monitored but is not immediately given until fluids stabilize.
Sodium bicarbonate is reserved for pH < 6.9.
5. A postpartum patient 30 minutes after delivery reports urinary retention. The uterus is
soft, boggy, and deviated to the right. Moderate lochia is present, and vital signs are stable.
A. Massage the fundus
B. Administer oxytocin
C. Assist the patient to void
D. Notify provider
Rationale:
Bladder distention prevents uterine contraction, causing atony and bleeding. Assisting voiding
restores uterine tone. Fundal massage without emptying bladder will not correct underlying
cause.
6. A patient presents with sudden-onset unilateral calf pain, swelling, and warmth. The leg
is tender to palpation, and Homan’s sign is positive. The patient is otherwise
hemodynamically stable.
A. Massage the calf
B. Apply heat
C. Keep limb elevated and notify provider for DVT
D. Encourage ambulation
Rationale:
Findings indicate deep vein thrombosis. Massaging could dislodge a clot, causing pulmonary
embolism. Elevation and prompt medical evaluation prevent progression and complications.
7. A patient has absent deep tendon reflexes, respiratory rate 8/min, and received
magnesium sulfate for preeclampsia. Blood pressure is 112/72 mmHg, and urine output is
adequate.
,A. Administer oxytocin
B. Administer calcium gluconate
C. Increase magnesium infusion
D. Provide respiratory support only
Rationale:
These are classic signs of magnesium toxicity. Calcium gluconate reverses neuromuscular
blockade and protects respiratory function. Support alone does not reverse toxicity.
8. A telemetry strip shows wide-complex tachycardia at 180/min with blood pressure 78/46
mmHg. The patient is conscious but dizzy and chest pain is reported.
A. Administer IV amiodarone
B. Obtain 12-lead ECG
C. Prepare for synchronized cardioversion
D. Encourage deep breathing
Rationale:
Unstable VT with pulse requires immediate synchronized cardioversion per ACLS. Medications
are secondary in unstable patients. Delay can lead to cardiac arrest.
9. A patient with type 1 diabetes becomes unconscious after missing a meal. Blood glucose
is 28 mg/dL, and no IV access is available.
A. Administer oral glucose
B. Administer glucagon IM
C. Give insulin
D. Encourage fluids
Rationale:
Unconscious patients cannot safely take oral glucose due to aspiration risk. IM glucagon rapidly
raises blood glucose. Insulin would worsen hypoglycemia.
10. A patient develops clear fluid drainage from the nose after head trauma. Vital signs are
stable, and there is no epistaxis.
A. Administer nasal spray
B. Suspect cerebrospinal fluid leak
C. Monitor temperature only
D. Apply nasal packing
Rationale:
Clear, watery drainage after trauma suggests CSF leak. Early recognition prevents meningitis.
Nasal packing is contraindicated and may worsen complications.
, 11. A patient reports sudden, severe right flank pain radiating to the groin with hematuria.
Vital signs reveal mild tachycardia but stable blood pressure.
A. Appendicitis
B. Kidney stones
C. Pyelonephritis
D. Urinary tract infection
Rationale:
Colicky flank pain with hematuria indicates renal calculi. Immediate pain management and
hydration prevent complications. Infection or appendicitis is less likely with these symptoms.
12. A patient receiving heparin has an aPTT of 120 seconds with oozing from IV sites. The
patient is hemodynamically stable.
A. Continue infusion
B. Increase infusion
C. Stop infusion and prepare protamine
D. Administer vitamin K
Rationale:
aPTT above therapeutic range indicates heparin overdose. Protamine neutralizes heparin to
prevent bleeding complications. Vitamin K does not reverse heparin.
13. A patient after thyroidectomy develops sudden stridor and difficulty breathing. Oxygen
saturation is 89% on room air, and swelling is noted at the surgical site.
A. Administer corticosteroids
B. Provide humidified oxygen
C. Prepare for immediate airway intervention
D. Monitor for 30 minutes
Rationale:
Airway compromise post-thyroidectomy is a life-threatening emergency. Immediate intervention
(intubation or surgical airway) prevents hypoxia. Observation is inadequate.
14. A patient on ACE inhibitors develops facial swelling, tongue swelling, and shortness of
breath. Blood pressure is 88/52 mmHg.
A. Administer corticosteroids
B. Treat angioedema with epinephrine
C. Provide antihistamine only
D. Monitor airway
