1
ATI COMPREHENSIVE PREDICTOR / RN ATI CAPSTONE PROCTORED
COMPREHENSIVE ASSESSMENT 2016 B
CASE STUDY 1: THE SURGICAL FLOOR (Questions 1-5)
EHR Panel:
• Patient: David Chen, 68 years old, M.
• Admission: Post-op Day 1 from an open cholecystectomy.
• History: Hypertension (HTN), Type 2 Diabetes Mellitus (T2DM).
• Vitals: HR 88, BP 142/88, RR 18, Temp 99.4°F (37.4°C), SpO2 96% on 2L NC.
• Morning Labs: WBC 12,500/mm³, Glucose 165 mg/dL, Hgb 14.2 g/dL.
• Assessment: Abdomen soft, bowel sounds hypoactive. JP drain in place with 30 mL
serosanguinous output. Reports incisional pain (7/10). PCN: Ampicillin-Sulbactam,
Lantus, Lisinopril, PRN Hydromorphone.
QUESTION 1: IMMEDIATE POST-OP ASSESSMENT
• Question: The nurse is performing a focused assessment on Mr. Chen. Which finding is
the earliest indicator of a potential postoperative complication?
• Options:
A. Incisional pain rated 7/10.
B. Decreased bowel sounds.
C. Temperature of 99.4°F (37.4°C).
D. Heart rate of 88 bpm.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: While a low-grade fever can be normal post-op
(atypical), it is the earliest and most sensitive indicator of infection or an
inflammatory process before other symptoms manifest.
o Distractor Pitfalls: A: Pain is expected but not an "early" indicator of a new
complication. B: Decreased bowel sounds are expected due to anesthesia and
manipulation. D: HR is within normal limits.
QUESTION 2: MEDICATION ADMINISTRATION
• Question: Mr. Chen's blood pressure is 150/90 mmHg. The provider orders an IV push of
hydralazine 10 mg. Which action is most important for the nurse to take prior to
administering this medication?
, 2
• Options:
A. Check the client's heart rhythm.
B. Verify the client's allergy status.
C. Administer a bolus of IV fluids.
D. Assess for a headache.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Hydralazine is a vasodilator. The priority is to
verify the baseline HR and rhythm to anticipate and monitor for reflex
tachycardia, a common side effect.
o Distractor Pitfalls: B: Allergies are important but secondary. C: Fluids are not
indicated unless hypotensive. D: Headache may be a side effect but is not the
priority action prior to administration.
QUESTION 3: WOUND CARE MANAGEMENT
• Question: The nurse is preparing to change the dressing on Mr. Chen's surgical incision.
Which of the following actions should the nurse take first? (Select all that apply.)
• Options:
A. Assess the amount, color, and odor of the wound drainage.
B. Apply sterile gloves.
C. Perform hand hygiene.
D. Remove the old dressing and note any exudate.
E. Don a mask and eye protection.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C, E
o Pathophysiology Summary: The priority is standard precautions and infection
prevention. Hand hygiene is the single most effective way to prevent infection.
Eye protection is necessary as the wound is new and may have splashing
potential.
o Distractor Pitfalls: A & D are assessment steps but are not the first action. B:
Sterile gloves are worn after performing hand hygiene and donning PPE.
QUESTION 4: PAIN MANAGEMENT
• Question: Mr. Chen is due for his PRN hydromorphone for pain. His respiratory rate is
10 breaths/min. What is the nurse's priority action?
, 3
• Options:
A. Administer half the ordered dose.
B. Hold the medication and notify the provider.
C. Administer naloxone immediately.
D. Encourage the client to take deep breaths.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: A respiratory rate of 10 is a contraindication to
administering an opioid. The nurse must hold the dose to prevent further
respiratory depression and notify the provider for a new order.
o Distractor Pitfalls: A: Never administer half a dose without a new order. C:
Naloxone is for acute reversal of respiratory depression. It is indicated only if the
client stops breathing or has severe hypoxia. D: This is supportive but not the
priority.
QUESTION 5: BLOOD GLUCOSE MANAGEMENT
• Question: Mr. Chen is a Type 2 diabetic. His glucose is 250 mg/dL. The sliding scale
order is: Glucose >200: 6 units of Humalog. Which action should the nurse take first?
• Options:
A. Administer the insulin dose.
B. Ask the client if he ate his breakfast.
C. Notify the provider for a change in order.
D. Double-check the order with another nurse.
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: Insulin is a high-alert medication. The nurse must
verify the high-risk order with a second licensed professional before
administration to prevent a fatal medication error.
o Distractor Pitfalls: A: Administering without a double-check is unsafe. B:
Pertinent, but verifying the order is a higher safety priority. C: The order is
appropriate, so notification is unnecessary.
CASE STUDY 2: THE CARDIAC FLOOR (Questions 6-10)
EHR Panel:
, 4
• Patient: Maria Sanchez, 72 years old, F.
• Admission: Rule out Myocardial Infarction (R/O MI).
• History: Hyperlipidemia, CAD.
• Vitals: HR 102, BP 160/98, RR 22, Temp 98.8°F, SpO2 94%.
• Labs: Troponin I: 4.5 ng/mL (High), BNP: 890 pg/mL.
• ECG: Sinus tachycardia, ST depression in leads V2-V4.
• Assessment: Reports mid-sternal chest pressure radiating to the jaw, rating 6/10. Short of
breath. 2+ pitting edema in lower extremities.
QUESTION 6: TROPONIN INTERPRETATION
• Question: The nurse is reviewing Ms. Sanchez's troponin results. Which statement is true
regarding this finding?
• Options:
A. Troponin is a non-specific marker.
B. A positive troponin confirms myocardial necrosis.
C. Troponin levels peak immediately after a cardiac event.
D. This level is expected for a patient with angina.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Troponin I and T are cardiac-specific proteins
released into the bloodstream when myocardial necrosis occurs. An elevated
troponin is the "gold standard" for diagnosing an MI.
o Distractor Pitfalls: A: Troponin is highly specific to cardiac muscle. C: Troponin
levels peak 12-24 hours post-MI. D: Unstable angina may show elevated levels,
but this is not an "expected" result; it is a pathological result.
QUESTION 7: ACTIVITY ORDERS
• Question: The provider orders "Bed rest with bedside commode." The nurse assists the
client to the commode. Which action is most important for the nurse to take?
• Options:
A. Assess for orthostatic hypotension.
B. Monitor the telemetry rhythm continuously.
C. Provide a high-calorie snack after.
D. Encourage the client to push during a BM.
ATI COMPREHENSIVE PREDICTOR / RN ATI CAPSTONE PROCTORED
COMPREHENSIVE ASSESSMENT 2016 B
CASE STUDY 1: THE SURGICAL FLOOR (Questions 1-5)
EHR Panel:
• Patient: David Chen, 68 years old, M.
• Admission: Post-op Day 1 from an open cholecystectomy.
• History: Hypertension (HTN), Type 2 Diabetes Mellitus (T2DM).
• Vitals: HR 88, BP 142/88, RR 18, Temp 99.4°F (37.4°C), SpO2 96% on 2L NC.
• Morning Labs: WBC 12,500/mm³, Glucose 165 mg/dL, Hgb 14.2 g/dL.
• Assessment: Abdomen soft, bowel sounds hypoactive. JP drain in place with 30 mL
serosanguinous output. Reports incisional pain (7/10). PCN: Ampicillin-Sulbactam,
Lantus, Lisinopril, PRN Hydromorphone.
QUESTION 1: IMMEDIATE POST-OP ASSESSMENT
• Question: The nurse is performing a focused assessment on Mr. Chen. Which finding is
the earliest indicator of a potential postoperative complication?
• Options:
A. Incisional pain rated 7/10.
B. Decreased bowel sounds.
C. Temperature of 99.4°F (37.4°C).
D. Heart rate of 88 bpm.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: While a low-grade fever can be normal post-op
(atypical), it is the earliest and most sensitive indicator of infection or an
inflammatory process before other symptoms manifest.
o Distractor Pitfalls: A: Pain is expected but not an "early" indicator of a new
complication. B: Decreased bowel sounds are expected due to anesthesia and
manipulation. D: HR is within normal limits.
QUESTION 2: MEDICATION ADMINISTRATION
• Question: Mr. Chen's blood pressure is 150/90 mmHg. The provider orders an IV push of
hydralazine 10 mg. Which action is most important for the nurse to take prior to
administering this medication?
, 2
• Options:
A. Check the client's heart rhythm.
B. Verify the client's allergy status.
C. Administer a bolus of IV fluids.
D. Assess for a headache.
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Hydralazine is a vasodilator. The priority is to
verify the baseline HR and rhythm to anticipate and monitor for reflex
tachycardia, a common side effect.
o Distractor Pitfalls: B: Allergies are important but secondary. C: Fluids are not
indicated unless hypotensive. D: Headache may be a side effect but is not the
priority action prior to administration.
QUESTION 3: WOUND CARE MANAGEMENT
• Question: The nurse is preparing to change the dressing on Mr. Chen's surgical incision.
Which of the following actions should the nurse take first? (Select all that apply.)
• Options:
A. Assess the amount, color, and odor of the wound drainage.
B. Apply sterile gloves.
C. Perform hand hygiene.
D. Remove the old dressing and note any exudate.
E. Don a mask and eye protection.
• Zero-Flip Premium Rationale Box:
o Correct Answer: C, E
o Pathophysiology Summary: The priority is standard precautions and infection
prevention. Hand hygiene is the single most effective way to prevent infection.
Eye protection is necessary as the wound is new and may have splashing
potential.
o Distractor Pitfalls: A & D are assessment steps but are not the first action. B:
Sterile gloves are worn after performing hand hygiene and donning PPE.
QUESTION 4: PAIN MANAGEMENT
• Question: Mr. Chen is due for his PRN hydromorphone for pain. His respiratory rate is
10 breaths/min. What is the nurse's priority action?
, 3
• Options:
A. Administer half the ordered dose.
B. Hold the medication and notify the provider.
C. Administer naloxone immediately.
D. Encourage the client to take deep breaths.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: A respiratory rate of 10 is a contraindication to
administering an opioid. The nurse must hold the dose to prevent further
respiratory depression and notify the provider for a new order.
o Distractor Pitfalls: A: Never administer half a dose without a new order. C:
Naloxone is for acute reversal of respiratory depression. It is indicated only if the
client stops breathing or has severe hypoxia. D: This is supportive but not the
priority.
QUESTION 5: BLOOD GLUCOSE MANAGEMENT
• Question: Mr. Chen is a Type 2 diabetic. His glucose is 250 mg/dL. The sliding scale
order is: Glucose >200: 6 units of Humalog. Which action should the nurse take first?
• Options:
A. Administer the insulin dose.
B. Ask the client if he ate his breakfast.
C. Notify the provider for a change in order.
D. Double-check the order with another nurse.
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: Insulin is a high-alert medication. The nurse must
verify the high-risk order with a second licensed professional before
administration to prevent a fatal medication error.
o Distractor Pitfalls: A: Administering without a double-check is unsafe. B:
Pertinent, but verifying the order is a higher safety priority. C: The order is
appropriate, so notification is unnecessary.
CASE STUDY 2: THE CARDIAC FLOOR (Questions 6-10)
EHR Panel:
, 4
• Patient: Maria Sanchez, 72 years old, F.
• Admission: Rule out Myocardial Infarction (R/O MI).
• History: Hyperlipidemia, CAD.
• Vitals: HR 102, BP 160/98, RR 22, Temp 98.8°F, SpO2 94%.
• Labs: Troponin I: 4.5 ng/mL (High), BNP: 890 pg/mL.
• ECG: Sinus tachycardia, ST depression in leads V2-V4.
• Assessment: Reports mid-sternal chest pressure radiating to the jaw, rating 6/10. Short of
breath. 2+ pitting edema in lower extremities.
QUESTION 6: TROPONIN INTERPRETATION
• Question: The nurse is reviewing Ms. Sanchez's troponin results. Which statement is true
regarding this finding?
• Options:
A. Troponin is a non-specific marker.
B. A positive troponin confirms myocardial necrosis.
C. Troponin levels peak immediately after a cardiac event.
D. This level is expected for a patient with angina.
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Troponin I and T are cardiac-specific proteins
released into the bloodstream when myocardial necrosis occurs. An elevated
troponin is the "gold standard" for diagnosing an MI.
o Distractor Pitfalls: A: Troponin is highly specific to cardiac muscle. C: Troponin
levels peak 12-24 hours post-MI. D: Unstable angina may show elevated levels,
but this is not an "expected" result; it is a pathological result.
QUESTION 7: ACTIVITY ORDERS
• Question: The provider orders "Bed rest with bedside commode." The nurse assists the
client to the commode. Which action is most important for the nurse to take?
• Options:
A. Assess for orthostatic hypotension.
B. Monitor the telemetry rhythm continuously.
C. Provide a high-calorie snack after.
D. Encourage the client to push during a BM.
