ATI Capstone Exam Study Guide | NCLEX-RN Practice Questions,
Answers & Rationales | 2026–2027 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.
Q1. A nurse is caring for a client who is 4 hours postoperative following an open
abdominal aortic aneurysm (AAA) repair. Which of the following assessment
findings should the nurse report to the provider immediately?
A) Trace pedal edema in both lower extremities
B) Urinary output of 20 mL over the past hour
C) Hypoactive bowel sounds in all four quadrants
D) Severe pain at the abdominal incision site
Answer: B) Urinary output of 20 mL over the past hour
Rationale: During an open AAA repair, the renal arteries are cross-clamped, which
poses a significant risk for acute kidney injury (AKI) due to ischemia. A urinary output of
less than 30 mL/hr is a critical indicator of poor renal perfusion or arterial occlusion and
requires immediate provider notification. Hypoactive bowel sounds are an expected
finding 4 hours post-laparotomy due to surgical manipulation and anesthesia. Trace
edema and incisional pain are expected postoperative findings.
Q2. A nurse is caring for a client with a history of deep vein thrombosis (DVT)
who suddenly reports sharp chest pain and shortness of breath. The client's
oxygen saturation drops from 96% to 88% on room air. Which of the following
actions should the nurse take first?
A) Obtain an arterial blood gas (ABG) specimen
B) Initiate oxygen therapy via a nasal cannula or face mask
C) Administer a prescribed PRN intravenous analgesic
D) Prepare the client for a ventilation-perfusion (V/Q) scan
Answer: B) Initiate oxygen therapy via a nasal cannula or face mask
Rationale: The client's sudden onset of chest pain, dyspnea, and hypoxia strongly
points to a pulmonary embolism (PE), a life-threatening complication of a DVT. Airway
and breathing are the immediate nursing priorities. Administering oxygen is the quickest
and most effective initial step to treat the hypoxia and stabilize the client before
diagnostic tests or pain management are initiated.
,Q3. A nurse is reviewing the arterial blood gas (ABG) results of a client with
severe emphysema: pH 7.32, PaCO₂ 56 mmHg, HCO₃⁻ 28 mEq/L. Which of the
following acid-base imbalances does this represent?
A) Partially compensated respiratory acidosis
B) Uncompensated metabolic acidosis
C) Fully compensated respiratory acidosis
D) Partially compensated metabolic alkalosis
Answer: A) Partially compensated respiratory acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO₂ is elevated above 45
mmHg, establishing a respiratory origin. The HCO₃⁻ is elevated above 26 mEq/L, which
demonstrates that the kidneys are actively retaining bicarbonate to compensate for the
respiratory failure. Because the pH has not yet returned to the normal range, the
compensation is partial.
Q4. A nurse is caring for a client with a chest tube connected to a water-seal
drainage system. The nurse notes that the fluid level in the water-seal chamber
fluctuates up and down with the client's respirations. Which of the following
interpretations should the nurse make?
A) The drainage system has an active air leak
B) The chest tube is obstructed by a blood clot
C) The client's lung has fully re-expanded
D) The system is functioning normally
Answer: D) The system is functioning normally
Rationale: Tidaling—the rise and fall of the fluid level in the water-seal chamber with
inspiration and expiration—is an expected and normal finding. It demonstrates that the
drainage system is patent and responding to intrapleural pressure changes. Continuous
bubbling indicates a leak, while a total stop in tidaling suggests either an obstruction or
full lung re-expansion.
Q5. A nurse is assessing a client who is 12 hours postoperative following a total
thyroidectomy. The nurse notes a positive Chvostek's sign. Which of the
following laboratory values explains this finding?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 132 mEq/L
,C) Serum calcium 7.4 mg/dL
D) Serum magnesium 1.2 mEq/L
Answer: C) Serum calcium 7.4 mg/dL
Rationale: A positive Chvostek's sign (facial muscle twitching elicited by tapping the
facial nerve) indicates hypocalcemia. This is a common and dangerous complication of
a thyroidectomy due to accidental trauma or removal of the parathyroid glands. Normal
serum calcium is 9.0 to 10.5 mg/dL. A value of 7.4 mg/dL confirms hypocalcemia,
requiring immediate intervention to prevent tetany.
Q6. A nurse is planning care for a client who is scheduled for a lumbar puncture.
Which of the following pre-procedural interventions should the nurse include?
A) Keep the client NPO for 8 hours prior to the procedure
B) Verify that the client has emptied their bladder
C) Administer a high-dose prophylactic anticoagulant
D) Position the client prone on the examination table
Answer: B) Verify that the client has emptied their bladder
Rationale: Instructing the client to void immediately before a lumbar puncture promotes
comfort and minimizes the risk of accidental bladder injury during the procedure. The
client does not need to be NPO. Anticoagulants are stopped before the procedure to
prevent spinal hematomas. The client is positioned in a lateral recumbent (fetal) or
sitting position, not prone.
Q7. A nurse is caring for a client who has a permanent pacemaker. The nurse
notes a pacing spike on the ECG monitor immediately followed by a QRS
complex. Which of the following pacemaker functions does this indicate?
A) Failure to capture
B) Failure to sense
C) Successful capture
D) Oversensing
Answer: C) Successful capture
Rationale: Capture occurs when the pacemaker's electrical impulse successfully
depolarizes the myocardium. On an ECG, this is visualized as a pacemaker spike
immediately followed by the appropriate waveform (a QRS complex for ventricular
pacing). Failure to capture would show spikes without subsequent QRS complexes.
, Q8. A nurse is performing an admission assessment on a client with a history of
advanced liver cirrhosis. Which of the following clinical findings should the nurse
expect?
A) Hypernatremia and dry skin
B) Petechiae and dark tarry stools
C) Decreased abdominal girth and weight loss
D) Normal prothrombin time (PT)
Answer: B) Petechiae and dark tarry stools
Rationale: The liver synthesizes essential clotting factors. In advanced cirrhosis, liver
function is impaired, leading to a prolonged prothrombin time (PT/INR) and an
increased risk of bleeding. This manifests as petechiae, ecchymosis, and melena (dark
tarry stools from gastrointestinal bleeding, often related to esophageal varices).
Q9. A nurse is caring for a client who is experiencing an acute exacerbation of
ulcerative colitis. Which of the following dietary choices should the nurse select
for this client?
A) Grilled chicken breast, white rice, and canned peaches
B) Roast beef, brown rice, and a raw spinach salad
C) Fried fish, french fries, and a whole wheat roll
D) Oatmeal with raisins, milk, and a glass of prune juice
Answer: A) Grilled chicken breast, white rice, and canned peaches
Rationale: During an acute flare-up of ulcerative colitis, the bowel needs rest. A low-
residue, low-fiber, high-protein diet is indicated to minimize bowel stimulation and
reduce the frequency of stools. Raw vegetables, whole grains, fried foods, and dried
fruits (like raisins or prunes) exacerbate inflammation and must be avoided.
Q10. A nurse is providing discharge instructions to a client who has a new
diagnosis of chronic venous insufficiency. Which of the following instructions
should the nurse emphasize?
A) Avoid elevating the legs above the level of the heart
B) Wear graduated compression stockings throughout the day
C) Apply ice packs to the calves when swelling occurs
D) Restrict daily walking and remain on complete bed rest
Answer: B) Wear graduated compression stockings throughout the day
Rationale: Chronic venous insufficiency results from incompetent venous valves,
causing blood to pool in the lower extremities. Compression stockings promote venous
Answers & Rationales | 2026–2027 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.
Q1. A nurse is caring for a client who is 4 hours postoperative following an open
abdominal aortic aneurysm (AAA) repair. Which of the following assessment
findings should the nurse report to the provider immediately?
A) Trace pedal edema in both lower extremities
B) Urinary output of 20 mL over the past hour
C) Hypoactive bowel sounds in all four quadrants
D) Severe pain at the abdominal incision site
Answer: B) Urinary output of 20 mL over the past hour
Rationale: During an open AAA repair, the renal arteries are cross-clamped, which
poses a significant risk for acute kidney injury (AKI) due to ischemia. A urinary output of
less than 30 mL/hr is a critical indicator of poor renal perfusion or arterial occlusion and
requires immediate provider notification. Hypoactive bowel sounds are an expected
finding 4 hours post-laparotomy due to surgical manipulation and anesthesia. Trace
edema and incisional pain are expected postoperative findings.
Q2. A nurse is caring for a client with a history of deep vein thrombosis (DVT)
who suddenly reports sharp chest pain and shortness of breath. The client's
oxygen saturation drops from 96% to 88% on room air. Which of the following
actions should the nurse take first?
A) Obtain an arterial blood gas (ABG) specimen
B) Initiate oxygen therapy via a nasal cannula or face mask
C) Administer a prescribed PRN intravenous analgesic
D) Prepare the client for a ventilation-perfusion (V/Q) scan
Answer: B) Initiate oxygen therapy via a nasal cannula or face mask
Rationale: The client's sudden onset of chest pain, dyspnea, and hypoxia strongly
points to a pulmonary embolism (PE), a life-threatening complication of a DVT. Airway
and breathing are the immediate nursing priorities. Administering oxygen is the quickest
and most effective initial step to treat the hypoxia and stabilize the client before
diagnostic tests or pain management are initiated.
,Q3. A nurse is reviewing the arterial blood gas (ABG) results of a client with
severe emphysema: pH 7.32, PaCO₂ 56 mmHg, HCO₃⁻ 28 mEq/L. Which of the
following acid-base imbalances does this represent?
A) Partially compensated respiratory acidosis
B) Uncompensated metabolic acidosis
C) Fully compensated respiratory acidosis
D) Partially compensated metabolic alkalosis
Answer: A) Partially compensated respiratory acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO₂ is elevated above 45
mmHg, establishing a respiratory origin. The HCO₃⁻ is elevated above 26 mEq/L, which
demonstrates that the kidneys are actively retaining bicarbonate to compensate for the
respiratory failure. Because the pH has not yet returned to the normal range, the
compensation is partial.
Q4. A nurse is caring for a client with a chest tube connected to a water-seal
drainage system. The nurse notes that the fluid level in the water-seal chamber
fluctuates up and down with the client's respirations. Which of the following
interpretations should the nurse make?
A) The drainage system has an active air leak
B) The chest tube is obstructed by a blood clot
C) The client's lung has fully re-expanded
D) The system is functioning normally
Answer: D) The system is functioning normally
Rationale: Tidaling—the rise and fall of the fluid level in the water-seal chamber with
inspiration and expiration—is an expected and normal finding. It demonstrates that the
drainage system is patent and responding to intrapleural pressure changes. Continuous
bubbling indicates a leak, while a total stop in tidaling suggests either an obstruction or
full lung re-expansion.
Q5. A nurse is assessing a client who is 12 hours postoperative following a total
thyroidectomy. The nurse notes a positive Chvostek's sign. Which of the
following laboratory values explains this finding?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 132 mEq/L
,C) Serum calcium 7.4 mg/dL
D) Serum magnesium 1.2 mEq/L
Answer: C) Serum calcium 7.4 mg/dL
Rationale: A positive Chvostek's sign (facial muscle twitching elicited by tapping the
facial nerve) indicates hypocalcemia. This is a common and dangerous complication of
a thyroidectomy due to accidental trauma or removal of the parathyroid glands. Normal
serum calcium is 9.0 to 10.5 mg/dL. A value of 7.4 mg/dL confirms hypocalcemia,
requiring immediate intervention to prevent tetany.
Q6. A nurse is planning care for a client who is scheduled for a lumbar puncture.
Which of the following pre-procedural interventions should the nurse include?
A) Keep the client NPO for 8 hours prior to the procedure
B) Verify that the client has emptied their bladder
C) Administer a high-dose prophylactic anticoagulant
D) Position the client prone on the examination table
Answer: B) Verify that the client has emptied their bladder
Rationale: Instructing the client to void immediately before a lumbar puncture promotes
comfort and minimizes the risk of accidental bladder injury during the procedure. The
client does not need to be NPO. Anticoagulants are stopped before the procedure to
prevent spinal hematomas. The client is positioned in a lateral recumbent (fetal) or
sitting position, not prone.
Q7. A nurse is caring for a client who has a permanent pacemaker. The nurse
notes a pacing spike on the ECG monitor immediately followed by a QRS
complex. Which of the following pacemaker functions does this indicate?
A) Failure to capture
B) Failure to sense
C) Successful capture
D) Oversensing
Answer: C) Successful capture
Rationale: Capture occurs when the pacemaker's electrical impulse successfully
depolarizes the myocardium. On an ECG, this is visualized as a pacemaker spike
immediately followed by the appropriate waveform (a QRS complex for ventricular
pacing). Failure to capture would show spikes without subsequent QRS complexes.
, Q8. A nurse is performing an admission assessment on a client with a history of
advanced liver cirrhosis. Which of the following clinical findings should the nurse
expect?
A) Hypernatremia and dry skin
B) Petechiae and dark tarry stools
C) Decreased abdominal girth and weight loss
D) Normal prothrombin time (PT)
Answer: B) Petechiae and dark tarry stools
Rationale: The liver synthesizes essential clotting factors. In advanced cirrhosis, liver
function is impaired, leading to a prolonged prothrombin time (PT/INR) and an
increased risk of bleeding. This manifests as petechiae, ecchymosis, and melena (dark
tarry stools from gastrointestinal bleeding, often related to esophageal varices).
Q9. A nurse is caring for a client who is experiencing an acute exacerbation of
ulcerative colitis. Which of the following dietary choices should the nurse select
for this client?
A) Grilled chicken breast, white rice, and canned peaches
B) Roast beef, brown rice, and a raw spinach salad
C) Fried fish, french fries, and a whole wheat roll
D) Oatmeal with raisins, milk, and a glass of prune juice
Answer: A) Grilled chicken breast, white rice, and canned peaches
Rationale: During an acute flare-up of ulcerative colitis, the bowel needs rest. A low-
residue, low-fiber, high-protein diet is indicated to minimize bowel stimulation and
reduce the frequency of stools. Raw vegetables, whole grains, fried foods, and dried
fruits (like raisins or prunes) exacerbate inflammation and must be avoided.
Q10. A nurse is providing discharge instructions to a client who has a new
diagnosis of chronic venous insufficiency. Which of the following instructions
should the nurse emphasize?
A) Avoid elevating the legs above the level of the heart
B) Wear graduated compression stockings throughout the day
C) Apply ice packs to the calves when swelling occurs
D) Restrict daily walking and remain on complete bed rest
Answer: B) Wear graduated compression stockings throughout the day
Rationale: Chronic venous insufficiency results from incompetent venous valves,
causing blood to pool in the lower extremities. Compression stockings promote venous
