RN ATI Capstone Proctored Comprehensive
Assessment 2026/2027 – Form A & B | 110+
Actual Exam Questions with NGN Format
and Detailed Rationales | Rated A
FORM A (Questions 1–85)
Clinical Judgment & NGN-Style Items (Questions 1–21)
Q1: A nurse is caring for a patient who was admitted with community-acquired pneumonia. During the
initial assessment, the nurse notes the patient is confused, has a respiratory rate of 28, and an SpO2 of
89% on room air. The nurse recognizes these cues as indicating which priority problem?
A. Anxiety related to hospitalization
B. Impaired gas exchange [CORRECT]
C. Risk for falls
D. Ineffective coping
Correct Answer: B
Rationale: Confusion, tachypnea, and hypoxemia are the classic triad for impaired gas exchange—this is
a life-threatening situation that requires immediate oxygenation support before any other nursing
diagnoses are addressed.
Q2: A nurse is reviewing the morning laboratory values for four assigned patients. Which result requires
immediate follow-up?
A. Patient A: Potassium 4.2 mEq/L
B. Patient B: Hemoglobin 11.5 g/dL
C. Patient C: Potassium 6.8 mEq/L [CORRECT]
D. Patient D: Blood glucose 140 mg/dL
Correct Answer: C
,Rationale: A potassium of 6.8 mEq/L is critically high and can cause fatal cardiac arrhythmias—this needs
immediate ECG monitoring, calcium administration, and provider notification, while the other values are
within acceptable or mildly abnormal ranges.
Q3: A nurse enters a patient's room and finds the patient unresponsive, not breathing, and without a
pulse. After calling for help and initiating CPR, what is the nurse's next action?
A. Insert an oropharyngeal airway
B. Apply the AED and follow prompts [CORRECT]
C. Establish IV access
D. Administer epinephrine
Correct Answer: B
Rationale: In cardiac arrest, early defibrillation is the key to survival—applying the AED immediately and
following its prompts takes priority over airway adjuncts, IV access, or medications in the first minutes of
resuscitation.
Q4: A nurse is caring for a patient who received a blood transfusion 30 minutes ago. The patient reports
chills, back pain, and a temperature of 101.5°F. The nurse analyzes these cues and determines the
patient is experiencing:
A. A mild allergic reaction
B. An acute hemolytic transfusion reaction [CORRECT]
C. Circulatory overload
D. Febrile non-hemolytic reaction
Correct Answer: B
Rationale: Chills, back pain, and fever within the first 15–30 minutes of transfusion are the hallmark cues
of acute hemolytic reaction—this is a medical emergency requiring immediate transfusion cessation and
aggressive intervention.
Q5: A nurse is caring for a patient with heart failure who has gained 4 pounds in 2 days, has crackles in
the lung bases, and reports increased shortness of breath when lying flat. The nurse's priority nursing
action is:
,A. Encourage the patient to perform deep breathing exercises
B. Elevate the head of the bed and notify the provider [CORRECT]
C. Increase oral fluid intake
D. Ambulate the patient to improve circulation
Correct Answer: B
Rationale: Rapid weight gain, crackles, and orthopnea signal acute fluid overload and possible
pulmonary edema—elevating the head reduces venous return to the heart and improves breathing,
while provider notification gets diuretic therapy started urgently.
Q6: A nurse is assigned to four patients. Patient A has a new onset of atrial fibrillation with a heart rate
of 150. Patient B is postoperative day 1 with stable vital signs requesting pain medication. Patient C has
a potassium of 2.8 mEq/L with muscle weakness. Patient D is stable and due for a routine dressing
change. Which patient should the nurse see first?
A. Patient A
B. Patient B
C. Patient C [CORRECT]
D. Patient D
Correct Answer: C
Rationale: A potassium of 2.8 mEq/L with muscle weakness is life-threatening—hypokalemia can cause
fatal ventricular arrhythmias and respiratory failure from diaphragm weakness, making this the most
urgent patient to assess and treat.
Q7: A nurse is caring for a patient with a nasogastric tube who is receiving continuous tube feeding. The
nurse checks the gastric residual and finds 500 mL. The patient's baseline has been 75–100 mL. The
nurse's priority action is:
A. Return the residual to the stomach and continue the feeding
B. Hold the feeding and notify the provider per protocol [CORRECT]
C. Flush the tube with 200 mL of water and restart the feeding
D. Decrease the feeding rate by half and continue
, Correct Answer: B
Rationale: A residual of 500 mL when baseline is 75–100 mL signals severe delayed gastric emptying and
high aspiration risk—holding the feeding and following protocol protects the patient from potentially
fatal aspiration pneumonia.
Q8: A nurse is caring for a patient who is 2 hours postpartum and has saturated three perineal pads in
the past hour. The patient reports feeling dizzy and lightheaded. The nurse's priority action is:
A. Change the perineal pad and reassess in 30 minutes
B. Assess vital signs, check fundal firmness, and notify the provider [CORRECT]
C. Encourage the patient to drink fluids
D. Administer pain medication
Correct Answer: B
Rationale: Saturating three pads in an hour with dizziness signals postpartum hemorrhage—assessing
fundal tone identifies uterine atony versus laceration, and immediate provider notification is critical for
preventing hypovolemic shock.
Q9: A nurse is caring for a patient with diabetes who has a blood glucose of 45 mg/dL. The patient is
awake, alert, and able to swallow. What is the nurse's best action?
A. Administer 1 mg glucagon IM
B. Give 15 grams of fast-acting carbohydrate and recheck in 15 minutes [CORRECT]
C. Start D50 IV push
D. Give a protein snack
Correct Answer: B
Rationale: The 15-15 rule treats conscious hypoglycemia with 15 grams of fast carbs, waits 15 minutes,
and rechecks—glucagon and IV dextrose are for unconscious patients, and protein doesn't raise glucose
fast enough for acute hypoglycemia.
Q10: A nurse is caring for a patient who is receiving heparin IV. The aPTT is 110 seconds (therapeutic
range 60–80 seconds). The patient has no active bleeding. The nurse's best action is:
Assessment 2026/2027 – Form A & B | 110+
Actual Exam Questions with NGN Format
and Detailed Rationales | Rated A
FORM A (Questions 1–85)
Clinical Judgment & NGN-Style Items (Questions 1–21)
Q1: A nurse is caring for a patient who was admitted with community-acquired pneumonia. During the
initial assessment, the nurse notes the patient is confused, has a respiratory rate of 28, and an SpO2 of
89% on room air. The nurse recognizes these cues as indicating which priority problem?
A. Anxiety related to hospitalization
B. Impaired gas exchange [CORRECT]
C. Risk for falls
D. Ineffective coping
Correct Answer: B
Rationale: Confusion, tachypnea, and hypoxemia are the classic triad for impaired gas exchange—this is
a life-threatening situation that requires immediate oxygenation support before any other nursing
diagnoses are addressed.
Q2: A nurse is reviewing the morning laboratory values for four assigned patients. Which result requires
immediate follow-up?
A. Patient A: Potassium 4.2 mEq/L
B. Patient B: Hemoglobin 11.5 g/dL
C. Patient C: Potassium 6.8 mEq/L [CORRECT]
D. Patient D: Blood glucose 140 mg/dL
Correct Answer: C
,Rationale: A potassium of 6.8 mEq/L is critically high and can cause fatal cardiac arrhythmias—this needs
immediate ECG monitoring, calcium administration, and provider notification, while the other values are
within acceptable or mildly abnormal ranges.
Q3: A nurse enters a patient's room and finds the patient unresponsive, not breathing, and without a
pulse. After calling for help and initiating CPR, what is the nurse's next action?
A. Insert an oropharyngeal airway
B. Apply the AED and follow prompts [CORRECT]
C. Establish IV access
D. Administer epinephrine
Correct Answer: B
Rationale: In cardiac arrest, early defibrillation is the key to survival—applying the AED immediately and
following its prompts takes priority over airway adjuncts, IV access, or medications in the first minutes of
resuscitation.
Q4: A nurse is caring for a patient who received a blood transfusion 30 minutes ago. The patient reports
chills, back pain, and a temperature of 101.5°F. The nurse analyzes these cues and determines the
patient is experiencing:
A. A mild allergic reaction
B. An acute hemolytic transfusion reaction [CORRECT]
C. Circulatory overload
D. Febrile non-hemolytic reaction
Correct Answer: B
Rationale: Chills, back pain, and fever within the first 15–30 minutes of transfusion are the hallmark cues
of acute hemolytic reaction—this is a medical emergency requiring immediate transfusion cessation and
aggressive intervention.
Q5: A nurse is caring for a patient with heart failure who has gained 4 pounds in 2 days, has crackles in
the lung bases, and reports increased shortness of breath when lying flat. The nurse's priority nursing
action is:
,A. Encourage the patient to perform deep breathing exercises
B. Elevate the head of the bed and notify the provider [CORRECT]
C. Increase oral fluid intake
D. Ambulate the patient to improve circulation
Correct Answer: B
Rationale: Rapid weight gain, crackles, and orthopnea signal acute fluid overload and possible
pulmonary edema—elevating the head reduces venous return to the heart and improves breathing,
while provider notification gets diuretic therapy started urgently.
Q6: A nurse is assigned to four patients. Patient A has a new onset of atrial fibrillation with a heart rate
of 150. Patient B is postoperative day 1 with stable vital signs requesting pain medication. Patient C has
a potassium of 2.8 mEq/L with muscle weakness. Patient D is stable and due for a routine dressing
change. Which patient should the nurse see first?
A. Patient A
B. Patient B
C. Patient C [CORRECT]
D. Patient D
Correct Answer: C
Rationale: A potassium of 2.8 mEq/L with muscle weakness is life-threatening—hypokalemia can cause
fatal ventricular arrhythmias and respiratory failure from diaphragm weakness, making this the most
urgent patient to assess and treat.
Q7: A nurse is caring for a patient with a nasogastric tube who is receiving continuous tube feeding. The
nurse checks the gastric residual and finds 500 mL. The patient's baseline has been 75–100 mL. The
nurse's priority action is:
A. Return the residual to the stomach and continue the feeding
B. Hold the feeding and notify the provider per protocol [CORRECT]
C. Flush the tube with 200 mL of water and restart the feeding
D. Decrease the feeding rate by half and continue
, Correct Answer: B
Rationale: A residual of 500 mL when baseline is 75–100 mL signals severe delayed gastric emptying and
high aspiration risk—holding the feeding and following protocol protects the patient from potentially
fatal aspiration pneumonia.
Q8: A nurse is caring for a patient who is 2 hours postpartum and has saturated three perineal pads in
the past hour. The patient reports feeling dizzy and lightheaded. The nurse's priority action is:
A. Change the perineal pad and reassess in 30 minutes
B. Assess vital signs, check fundal firmness, and notify the provider [CORRECT]
C. Encourage the patient to drink fluids
D. Administer pain medication
Correct Answer: B
Rationale: Saturating three pads in an hour with dizziness signals postpartum hemorrhage—assessing
fundal tone identifies uterine atony versus laceration, and immediate provider notification is critical for
preventing hypovolemic shock.
Q9: A nurse is caring for a patient with diabetes who has a blood glucose of 45 mg/dL. The patient is
awake, alert, and able to swallow. What is the nurse's best action?
A. Administer 1 mg glucagon IM
B. Give 15 grams of fast-acting carbohydrate and recheck in 15 minutes [CORRECT]
C. Start D50 IV push
D. Give a protein snack
Correct Answer: B
Rationale: The 15-15 rule treats conscious hypoglycemia with 15 grams of fast carbs, waits 15 minutes,
and rechecks—glucagon and IV dextrose are for unconscious patients, and protein doesn't raise glucose
fast enough for acute hypoglycemia.
Q10: A nurse is caring for a patient who is receiving heparin IV. The aPTT is 110 seconds (therapeutic
range 60–80 seconds). The patient has no active bleeding. The nurse's best action is:
