ATI RN Capstone Proctored
Comprehensive Assessment
NEWEST 2026/2027 Edition | 150 Questions
NGN Clinical Judgment Measurement Model (NCJMM) Integrated
Comprehensive Coverage: Management of Care | Pharmacology | Medical-Surgical Nursing |
Maternal-Newborn | Pediatric Nursing | Mental Health | Safety and Infection Control |
Health Promotion and Maintenance | Community Health | NGN Case Studies
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Style: 75% Scenario-Based | 20% Direct Recall | 5% Clinical Analysis
Page 1
, Section 1: Management of Care (Prioritization, Delegation, Assignment,
Leadership, and Ethical/Legal Issues) | Q1-25
1. A nurse on a medical-surgical unit receives the following change-of-shift report. Which client should the nurse
assess first?
A. A client who is 2 days postoperative following a cholecystectomy and reports pain at the incision site
B. A client who has heart failure and has gained 2 kg (4.4 lb) in the past 24 hours [CORRECT]
C. A client who has type 2 diabetes mellitus and a fasting blood glucose of 198 mg/dL
D. A client who has a nasogastric tube and reports nausea
Correct Answer: B
Rationale: The client with heart failure who gained 2 kg in 24 hours is exhibiting fluid retention, which indicates worsening
cardiac output and potential pulmonary edema, a life-threatening complication requiring immediate assessment (ABCs -
Circulation). This client is the least stable and has the greatest risk of deterioration. The postoperative client's pain and the
diabetic client's elevated glucose, while requiring intervention, are not immediately life-threatening. The client with nausea also
requires assessment but is more stable than the client with acute fluid overload.
2. A charge nurse is making assignments for the upcoming shift. Which task is most appropriate to delegate to a
licensed practical nurse (LPN)?
A. Perform the initial admission assessment on a newly transferred client
B. Administer oral medications to a stable client with hypertension [CORRECT]
C. Develop the nursing care plan for a client with a new diagnosis of cancer
D. Evaluate the effectiveness of a client's pain management regimen
Correct Answer: B
Rationale: Administering oral medications to a stable client is within the LPN scope of practice. The RN must perform initial
assessments, develop care plans, and evaluate outcomes, as these require advanced clinical judgment and critical thinking. LPNs
can reinforce teaching, perform sterile dressing changes, administer routine non-IV medications, and monitor stable clients.
Delegating initial assessment, care planning, or evaluation to an LPN would exceed their scope and compromise patient safety.
3. A nurse is caring for a client who refuses a blood transfusion based on religious beliefs. The client's spouse insists
the nurse administer the blood. What is the nurse's best action?
A. Administer the blood transfusion as the spouse requests
B. Honor the client's refusal and document the refusal in the medical record [CORRECT]
C. Ask the healthcare provider to override the client's decision
D. Call the hospital ethics committee before taking any action
Correct Answer: B
Rationale: A competent adult has the legal right to refuse any treatment, including life-saving interventions, based on informed
consent principles. The nurse must honor the client's autonomous decision and document the refusal thoroughly, including that
the client was informed of the risks and consequences. The spouse cannot consent on behalf of a competent adult. The provider
cannot override a competent client's decision. While involving the ethics committee may be appropriate in complex situations,
the immediate action is to respect the client's right to refuse.
Page 2
,4. A nurse is preparing to apply wrist restraints to a client who is confused and attempting to pull out an IV
catheter. Which action should the nurse take first?
A. Apply the restraints and obtain a provider order within 1 hour
B. Attempt less restrictive interventions before applying restraints [CORRECT]
C. Notify the family that restraints will be applied
D. Document the client's behavior that necessitates restraint use
Correct Answer: B
Rationale: The least restrictive intervention principle requires that the nurse attempt alternative measures (reorientation,
distraction, 1:1 sitter, hiding tubes) before applying restraints. Restraints should only be used as a last resort when less
restrictive measures have failed. A provider order is required before or within 1 hour of application, but attempting alternatives
comes first. Documentation and family notification are important but are not the first action. The nurse must also ensure
face-to-face evaluation within 1 hour of restraint application.
5. A nurse is receiving a telephone order from a healthcare provider. Which action is most important for the nurse
to take?
A. Read back the order to the provider for verification [CORRECT]
B. Ask the provider to come to the unit to write the order
C. Have a second nurse listen to the telephone order
D. Document the order immediately in the client's chart
Correct Answer: A
Rationale: The Joint Commission requires that all telephone orders be read back (repeated verbatim) to the prescribing provider
for verification, and the provider must confirm accuracy. This 'read-back' process is the single most important safety step to
prevent medication and treatment errors. Having a second nurse listen is a good practice but does not replace the read-back
requirement. Asking the provider to come to the unit is impractical in emergencies. Documentation follows verification.
6. A nurse manager is implementing a quality improvement project using the PDSA cycle. In which phase of the
cycle should the nurse evaluate whether the change resulted in the desired outcome?
A. Plan
B. Do
C. Study [CORRECT]
D. Act
Correct Answer: C
Rationale: The 'Study' phase of the PDSA (Plan-Do-Study-Act) cycle involves collecting and analyzing data to determine whether
the implemented change achieved the desired outcome. The Plan phase involves designing the change, the Do phase involves
implementing the change on a small scale, and the Act phase involves adopting, adapting, or abandoning the change based on
the Study findings. Understanding PDSA is essential for NCLEX and for real-world quality improvement in healthcare settings.
Page 3
, 7. A nurse is caring for four clients. Which client should the nurse assign to an unlicensed assistive personnel (UAP)?
A. A client who is 1 day postoperative following abdominal surgery and needs a wound assessment
B. A client who has a new diagnosis of chronic obstructive pulmonary disease and needs teaching about inhaler use
C. A client who is stable and requires assistance with bathing and ambulation [CORRECT]
D. A client who has acute chest pain and needs continuous cardiac monitoring
Correct Answer: C
Rationale: UAPs can assist with activities of daily living (ADLs), bathing, and ambulation for stable clients. Assigning a stable
client who needs ADL assistance is within the UAP scope of practice. Postoperative wound assessment requires an RN. Teaching
about inhaler use requires nursing assessment and evaluation by an RN. A client with acute chest pain needs continuous
monitoring and assessment by an RN. Delegating clinical assessment, teaching, or unstable client care to a UAP is inappropriate
and unsafe.
8. A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which statement by
the client indicates an understanding of the teaching?
A. 'I will eat large amounts of green leafy vegetables every day.'
B. 'I will take an aspirin each day to prevent blood clots.'
C. 'I will have my blood checked regularly to monitor the effects of the medication.' [CORRECT]
D. 'I will use garlic supplements to help lower my cholesterol.'
Correct Answer: C
Rationale: The client should have regular blood tests (PT/INR) to monitor the therapeutic effects of warfarin, with a target INR of
2-3 for most indications. Green leafy vegetables contain vitamin K, which counteracts warfarin; large amounts would reduce
effectiveness. Aspirin increases bleeding risk when combined with warfarin and should be avoided unless specifically prescribed.
Garlic supplements also increase bleeding risk due to antiplatelet properties. Regular INR monitoring is essential for safe
warfarin therapy.
9. A nurse is using the SBAR communication tool to report a client's condition to a healthcare provider. Which
information should the nurse include in the 'A' (Assessment) component?
A. The client's name, age, and admitting diagnosis
B. The nurse's clinical judgment about the client's current condition [CORRECT]
C. The specific treatments or interventions the nurse recommends
D. The events leading up to the current situation
Correct Answer: B
Rationale: In SBAR communication, the 'A' stands for Assessment, which includes the nurse's clinical evaluation of the client's
current condition, such as 'I believe the client is experiencing early signs of sepsis.' Situation (S) describes the current problem,
Background (B) provides relevant history, and Recommendation (R) suggests specific actions. Placing background information or
recommendations in the Assessment section would misrepresent the communication structure and potentially delay appropriate
care.
Page 4
Comprehensive Assessment
NEWEST 2026/2027 Edition | 150 Questions
NGN Clinical Judgment Measurement Model (NCJMM) Integrated
Comprehensive Coverage: Management of Care | Pharmacology | Medical-Surgical Nursing |
Maternal-Newborn | Pediatric Nursing | Mental Health | Safety and Infection Control |
Health Promotion and Maintenance | Community Health | NGN Case Studies
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Style: 75% Scenario-Based | 20% Direct Recall | 5% Clinical Analysis
Page 1
, Section 1: Management of Care (Prioritization, Delegation, Assignment,
Leadership, and Ethical/Legal Issues) | Q1-25
1. A nurse on a medical-surgical unit receives the following change-of-shift report. Which client should the nurse
assess first?
A. A client who is 2 days postoperative following a cholecystectomy and reports pain at the incision site
B. A client who has heart failure and has gained 2 kg (4.4 lb) in the past 24 hours [CORRECT]
C. A client who has type 2 diabetes mellitus and a fasting blood glucose of 198 mg/dL
D. A client who has a nasogastric tube and reports nausea
Correct Answer: B
Rationale: The client with heart failure who gained 2 kg in 24 hours is exhibiting fluid retention, which indicates worsening
cardiac output and potential pulmonary edema, a life-threatening complication requiring immediate assessment (ABCs -
Circulation). This client is the least stable and has the greatest risk of deterioration. The postoperative client's pain and the
diabetic client's elevated glucose, while requiring intervention, are not immediately life-threatening. The client with nausea also
requires assessment but is more stable than the client with acute fluid overload.
2. A charge nurse is making assignments for the upcoming shift. Which task is most appropriate to delegate to a
licensed practical nurse (LPN)?
A. Perform the initial admission assessment on a newly transferred client
B. Administer oral medications to a stable client with hypertension [CORRECT]
C. Develop the nursing care plan for a client with a new diagnosis of cancer
D. Evaluate the effectiveness of a client's pain management regimen
Correct Answer: B
Rationale: Administering oral medications to a stable client is within the LPN scope of practice. The RN must perform initial
assessments, develop care plans, and evaluate outcomes, as these require advanced clinical judgment and critical thinking. LPNs
can reinforce teaching, perform sterile dressing changes, administer routine non-IV medications, and monitor stable clients.
Delegating initial assessment, care planning, or evaluation to an LPN would exceed their scope and compromise patient safety.
3. A nurse is caring for a client who refuses a blood transfusion based on religious beliefs. The client's spouse insists
the nurse administer the blood. What is the nurse's best action?
A. Administer the blood transfusion as the spouse requests
B. Honor the client's refusal and document the refusal in the medical record [CORRECT]
C. Ask the healthcare provider to override the client's decision
D. Call the hospital ethics committee before taking any action
Correct Answer: B
Rationale: A competent adult has the legal right to refuse any treatment, including life-saving interventions, based on informed
consent principles. The nurse must honor the client's autonomous decision and document the refusal thoroughly, including that
the client was informed of the risks and consequences. The spouse cannot consent on behalf of a competent adult. The provider
cannot override a competent client's decision. While involving the ethics committee may be appropriate in complex situations,
the immediate action is to respect the client's right to refuse.
Page 2
,4. A nurse is preparing to apply wrist restraints to a client who is confused and attempting to pull out an IV
catheter. Which action should the nurse take first?
A. Apply the restraints and obtain a provider order within 1 hour
B. Attempt less restrictive interventions before applying restraints [CORRECT]
C. Notify the family that restraints will be applied
D. Document the client's behavior that necessitates restraint use
Correct Answer: B
Rationale: The least restrictive intervention principle requires that the nurse attempt alternative measures (reorientation,
distraction, 1:1 sitter, hiding tubes) before applying restraints. Restraints should only be used as a last resort when less
restrictive measures have failed. A provider order is required before or within 1 hour of application, but attempting alternatives
comes first. Documentation and family notification are important but are not the first action. The nurse must also ensure
face-to-face evaluation within 1 hour of restraint application.
5. A nurse is receiving a telephone order from a healthcare provider. Which action is most important for the nurse
to take?
A. Read back the order to the provider for verification [CORRECT]
B. Ask the provider to come to the unit to write the order
C. Have a second nurse listen to the telephone order
D. Document the order immediately in the client's chart
Correct Answer: A
Rationale: The Joint Commission requires that all telephone orders be read back (repeated verbatim) to the prescribing provider
for verification, and the provider must confirm accuracy. This 'read-back' process is the single most important safety step to
prevent medication and treatment errors. Having a second nurse listen is a good practice but does not replace the read-back
requirement. Asking the provider to come to the unit is impractical in emergencies. Documentation follows verification.
6. A nurse manager is implementing a quality improvement project using the PDSA cycle. In which phase of the
cycle should the nurse evaluate whether the change resulted in the desired outcome?
A. Plan
B. Do
C. Study [CORRECT]
D. Act
Correct Answer: C
Rationale: The 'Study' phase of the PDSA (Plan-Do-Study-Act) cycle involves collecting and analyzing data to determine whether
the implemented change achieved the desired outcome. The Plan phase involves designing the change, the Do phase involves
implementing the change on a small scale, and the Act phase involves adopting, adapting, or abandoning the change based on
the Study findings. Understanding PDSA is essential for NCLEX and for real-world quality improvement in healthcare settings.
Page 3
, 7. A nurse is caring for four clients. Which client should the nurse assign to an unlicensed assistive personnel (UAP)?
A. A client who is 1 day postoperative following abdominal surgery and needs a wound assessment
B. A client who has a new diagnosis of chronic obstructive pulmonary disease and needs teaching about inhaler use
C. A client who is stable and requires assistance with bathing and ambulation [CORRECT]
D. A client who has acute chest pain and needs continuous cardiac monitoring
Correct Answer: C
Rationale: UAPs can assist with activities of daily living (ADLs), bathing, and ambulation for stable clients. Assigning a stable
client who needs ADL assistance is within the UAP scope of practice. Postoperative wound assessment requires an RN. Teaching
about inhaler use requires nursing assessment and evaluation by an RN. A client with acute chest pain needs continuous
monitoring and assessment by an RN. Delegating clinical assessment, teaching, or unstable client care to a UAP is inappropriate
and unsafe.
8. A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which statement by
the client indicates an understanding of the teaching?
A. 'I will eat large amounts of green leafy vegetables every day.'
B. 'I will take an aspirin each day to prevent blood clots.'
C. 'I will have my blood checked regularly to monitor the effects of the medication.' [CORRECT]
D. 'I will use garlic supplements to help lower my cholesterol.'
Correct Answer: C
Rationale: The client should have regular blood tests (PT/INR) to monitor the therapeutic effects of warfarin, with a target INR of
2-3 for most indications. Green leafy vegetables contain vitamin K, which counteracts warfarin; large amounts would reduce
effectiveness. Aspirin increases bleeding risk when combined with warfarin and should be avoided unless specifically prescribed.
Garlic supplements also increase bleeding risk due to antiplatelet properties. Regular INR monitoring is essential for safe
warfarin therapy.
9. A nurse is using the SBAR communication tool to report a client's condition to a healthcare provider. Which
information should the nurse include in the 'A' (Assessment) component?
A. The client's name, age, and admitting diagnosis
B. The nurse's clinical judgment about the client's current condition [CORRECT]
C. The specific treatments or interventions the nurse recommends
D. The events leading up to the current situation
Correct Answer: B
Rationale: In SBAR communication, the 'A' stands for Assessment, which includes the nurse's clinical evaluation of the client's
current condition, such as 'I believe the client is experiencing early signs of sepsis.' Situation (S) describes the current problem,
Background (B) provides relevant history, and Recommendation (R) suggests specific actions. Placing background information or
recommendations in the Assessment section would misrepresent the communication structure and potentially delay appropriate
care.
Page 4
