RN ATI Capstone Proctored Comprehensive Assessment A | NCLEX-RN Readiness Review 2026/2027 Edition
RN ATI CAPSTONE PROCTORED COMPREHENSIVE
ASSESSMENT A
NCLEX-RN Readiness and Pre-Graduation Predictor Review
Complete Exam with 85 Verified Questions and 100% Correct Answers (Graded A+)
Aligned with 2026/2027 ATI Capstone Testing Standards and the NCLEX-RN Test Plan
Sections 1-7 | 85 Items | 75-Minute Allotment | Cognitive Levels: 25% Recall, 50% Application, 25% Analysis
SECTION 1: MEDICAL-SURGICAL NURSING
Cardiovascular, Respiratory, Neurological, Renal, Gastrointestinal, Endocrine, and Immunologic Disorders | Questions 1-17
Q1: A nurse enters the room of a client with acute decompensated heart failure. The client is dyspneic, has bilateral
crackles in the lower lobes, jugular venous distention, and 3+ pitting edema of the lower extremities. Which action
should the nurse take first?
A. Position the client in high-Fowler's position [CORRECT]
B. Administer the prescribed IV furosemide
C. Begin dietary teaching about a 2-gram sodium restriction
D. Obtain a daily weight using the same scale and time of day
Correct Answer: A
Rationale: Positioning a dyspneic client in high-Fowler's maximizes thoracic expansion and venous pooling in the
lower extremities, which immediately improves ventilation and is the priority action guided by the ABC framework.
The loop diuretic reduces preload and pulmonary congestion, but it is administered after airway and breathing are
supported. Dietary teaching and daily weight monitoring are important for long-term fluid management, yet neither
addresses the client's current respiratory compromise. This item tests intervention sequencing: immediate
physiological support precedes pharmacological and educational interventions.
Q2: A client is admitted to the emergency department with chest pressure radiating to the left arm that began 3 hours
ago. Which laboratory result is most specific for confirming myocardial injury?
A. Elevated white blood cell count
B. Elevated serum myoglobin
C. Elevated C-reactive protein
D. Elevated troponin I [CORRECT]
Correct Answer: D
Rationale: Cardiac troponin I is the most specific and sensitive biomarker of myocardial cell injury; it rises within 2
to 4 hours of injury, peaks around 24 hours, and remains elevated for up to 10 days. Serum myoglobin is one of the
earliest markers to rise but lacks cardiac specificity because it also elevates with any skeletal muscle damage. An
elevated white blood cell count and C-reactive protein are nonspecific indicators of inflammation that can be seen in
many conditions. ATI emphasizes that troponin monitoring guides both the diagnosis and ongoing management of
acute coronary syndromes.
1
,RN ATI Capstone Proctored Comprehensive Assessment A | NCLEX-RN Readiness Review 2026/2027 Edition
Q3: A nurse is providing discharge teaching to a client who has a new prescription for lisinopril. Which client
statement indicates a correct understanding of the teaching?
A. I will use a salt substitute to season my food
B. I will stop the medication once my blood pressure returns to normal
C. I will report any swelling of my lips or face right away [CORRECT]
D. I will skip a dose if I feel dizzy when standing up
Correct Answer: C
Rationale: Angioedema involving the lips, face, or tongue is a life-threatening adverse effect of ACE inhibitors that
requires emergency care, so immediate reporting is the safety-critical behavior. Salt substitutes commonly contain
potassium chloride, and ACE inhibitors promote potassium retention, creating a risk of hyperkalemia. Hypertension is
a chronic condition managed with continuous therapy, so stopping the medication after improvement leads to rebound
elevation. Dizziness on standing reflects orthostatic hypotension, which warrants positional-change precautions and
provider notification rather than self-adjusting doses.
Q4: A client admitted with atrial fibrillation has an irregular apical pulse of 132 per minute and reports
lightheadedness. The client is hemodynamically stable. Which prescription should the nurse anticipate first to reduce
the client's risk of complications?
A. Administer IV atropine
B. Initiate anticoagulation therapy [CORRECT]
C. Prepare for synchronized cardioversion under moderate sedation
D. Administer a fluid bolus of normal saline
Correct Answer: B
Rationale: Stasis of blood in the fibrillating atria promotes thrombus formation, and anticoagulation is the first-line
strategy for stroke prevention in stable atrial fibrillation; cardioversion may follow once the duration of the rhythm is
established and adequate anticoagulation achieved. Atropine is indicated for symptomatic bradycardia, which is the
opposite of this client's tachydysrhythmia. Emergent synchronized cardioversion is reserved for unstable clients with
hypotension, altered mental status, or signs of shock. A fluid bolus does not address the thromboembolic risk and
could worsen pulmonary congestion in a client with compromised cardiac function.
Q5: A client admitted with a COPD exacerbation has a SpO2 of 86 percent on room air and an elevated PaCO2 on
arterial blood gas analysis. Which prescription should the nurse implement?
A. Titrate low-flow oxygen to maintain SpO2 between 88 and 92 percent [CORRECT]
B. Apply a nonrebreather mask at 10 L/min
C. Administer a PRN benzodiazepine to decrease the work of breathing
D. Encourage prolonged purse-lip breathing without supplemental oxygen
Correct Answer: A
Rationale: Clients with chronic hypercapnia depend on hypoxic respiratory drive, so oxygen is titrated cautiously
with a target saturation of 88 to 92 percent to correct hypoxemia while avoiding carbon dioxide narcosis.
High-concentration oxygen via nonrebreather can suppress the respiratory drive in this population and cause
worsening hypercapnia. Sedatives further depress the respiratory center and are contraindicated in a client with
elevated PaCO2. Purse-lip breathing helps reduce air trapping but does not replace the need for controlled
supplemental oxygen during an exacerbation.
2
, RN ATI Capstone Proctored Comprehensive Assessment A | NCLEX-RN Readiness Review 2026/2027 Edition
Q6: A nurse is evaluating the effectiveness of therapy for a client who has asthma. Which finding indicates that the
client's current medication regimen is inadequate?
A. Peak flow readings consistently at 95 percent of personal best
B. Use of a short-acting beta agonist before exercise only
C. Clear breath sounds between exacerbations
D. Awakening at night with wheezing twice each week [CORRECT]
Correct Answer: D
Rationale: Nocturnal awakenings from asthma symptoms occurring more than twice per month indicate persistent
uncontrolled disease and the need for stepped-up anti-inflammatory therapy per current guidelines. Pre-exercise use
of a short-acting beta agonist is appropriate preventive behavior for exercise-induced bronchospasm. A peak flow at
95 percent of personal best reflects well-controlled airway function, and clear breath sounds between exacerbations
indicate the absence of ongoing bronchospasm. Recognizing control versus poor control is an ATI-tested clinical
judgment skill in respiratory pharmacology.
Q7: Two days after abdominal surgery, a client suddenly becomes dyspneic and reports sharp chest pain. The client's
respiratory rate is 32, HR 118, and SpO2 is 88 percent. Which action should the nurse take first?
A. Call the provider to request a ventilation-perfusion scan
B. Position the client in high-Fowler's and apply supplemental oxygen [CORRECT]
C. Start a heparin infusion at the standard rate
D. Instruct the client to cough and deep breathe every hour
Correct Answer: B
Rationale: The presentation is classic for pulmonary embolism, and immediate management follows the ABCs:
maximize oxygenation by positioning upright in high-Fowler's and administering oxygen while the provider is notified
and diagnostics are arranged. Requesting imaging is appropriate but delayed until the client's oxygenation is
supported. Heparin is anticipated after the diagnosis is confirmed and prescribed; initiating a high-risk infusion
without an order violates medication safety. Coughing and deep breathing address atelectasis, not embolic obstruction,
and delay definitive action.
Q8: A nurse is monitoring a client with acute respiratory distress syndrome who is receiving mechanical ventilation.
Which finding indicates the syndrome is progressing?
A. PaO2 remains below 60 mm Hg despite increasing fractions of inspired oxygen [CORRECT]
B. Productive cough with thick yellow sputum
C. Fever and elevated white blood cell count
D. Gradual resolution of bilateral crackles
Correct Answer: A
Rationale: The hallmark of worsening ARDS is refractory hypoxemia, in which arterial oxygenation cannot be
corrected even with escalating inspired oxygen concentrations because of widespread alveolar collapse and
noncardiogenic pulmonary edema. Purulent sputum and fever suggest infection such as ventilator-associated
pneumonia but are not defining markers of ARDS progression. Resolution of crackles would suggest improvement
rather than deterioration. Identifying refractory hypoxemia supports timely escalation to prone positioning or
advanced ventilation strategies.
3
RN ATI CAPSTONE PROCTORED COMPREHENSIVE
ASSESSMENT A
NCLEX-RN Readiness and Pre-Graduation Predictor Review
Complete Exam with 85 Verified Questions and 100% Correct Answers (Graded A+)
Aligned with 2026/2027 ATI Capstone Testing Standards and the NCLEX-RN Test Plan
Sections 1-7 | 85 Items | 75-Minute Allotment | Cognitive Levels: 25% Recall, 50% Application, 25% Analysis
SECTION 1: MEDICAL-SURGICAL NURSING
Cardiovascular, Respiratory, Neurological, Renal, Gastrointestinal, Endocrine, and Immunologic Disorders | Questions 1-17
Q1: A nurse enters the room of a client with acute decompensated heart failure. The client is dyspneic, has bilateral
crackles in the lower lobes, jugular venous distention, and 3+ pitting edema of the lower extremities. Which action
should the nurse take first?
A. Position the client in high-Fowler's position [CORRECT]
B. Administer the prescribed IV furosemide
C. Begin dietary teaching about a 2-gram sodium restriction
D. Obtain a daily weight using the same scale and time of day
Correct Answer: A
Rationale: Positioning a dyspneic client in high-Fowler's maximizes thoracic expansion and venous pooling in the
lower extremities, which immediately improves ventilation and is the priority action guided by the ABC framework.
The loop diuretic reduces preload and pulmonary congestion, but it is administered after airway and breathing are
supported. Dietary teaching and daily weight monitoring are important for long-term fluid management, yet neither
addresses the client's current respiratory compromise. This item tests intervention sequencing: immediate
physiological support precedes pharmacological and educational interventions.
Q2: A client is admitted to the emergency department with chest pressure radiating to the left arm that began 3 hours
ago. Which laboratory result is most specific for confirming myocardial injury?
A. Elevated white blood cell count
B. Elevated serum myoglobin
C. Elevated C-reactive protein
D. Elevated troponin I [CORRECT]
Correct Answer: D
Rationale: Cardiac troponin I is the most specific and sensitive biomarker of myocardial cell injury; it rises within 2
to 4 hours of injury, peaks around 24 hours, and remains elevated for up to 10 days. Serum myoglobin is one of the
earliest markers to rise but lacks cardiac specificity because it also elevates with any skeletal muscle damage. An
elevated white blood cell count and C-reactive protein are nonspecific indicators of inflammation that can be seen in
many conditions. ATI emphasizes that troponin monitoring guides both the diagnosis and ongoing management of
acute coronary syndromes.
1
,RN ATI Capstone Proctored Comprehensive Assessment A | NCLEX-RN Readiness Review 2026/2027 Edition
Q3: A nurse is providing discharge teaching to a client who has a new prescription for lisinopril. Which client
statement indicates a correct understanding of the teaching?
A. I will use a salt substitute to season my food
B. I will stop the medication once my blood pressure returns to normal
C. I will report any swelling of my lips or face right away [CORRECT]
D. I will skip a dose if I feel dizzy when standing up
Correct Answer: C
Rationale: Angioedema involving the lips, face, or tongue is a life-threatening adverse effect of ACE inhibitors that
requires emergency care, so immediate reporting is the safety-critical behavior. Salt substitutes commonly contain
potassium chloride, and ACE inhibitors promote potassium retention, creating a risk of hyperkalemia. Hypertension is
a chronic condition managed with continuous therapy, so stopping the medication after improvement leads to rebound
elevation. Dizziness on standing reflects orthostatic hypotension, which warrants positional-change precautions and
provider notification rather than self-adjusting doses.
Q4: A client admitted with atrial fibrillation has an irregular apical pulse of 132 per minute and reports
lightheadedness. The client is hemodynamically stable. Which prescription should the nurse anticipate first to reduce
the client's risk of complications?
A. Administer IV atropine
B. Initiate anticoagulation therapy [CORRECT]
C. Prepare for synchronized cardioversion under moderate sedation
D. Administer a fluid bolus of normal saline
Correct Answer: B
Rationale: Stasis of blood in the fibrillating atria promotes thrombus formation, and anticoagulation is the first-line
strategy for stroke prevention in stable atrial fibrillation; cardioversion may follow once the duration of the rhythm is
established and adequate anticoagulation achieved. Atropine is indicated for symptomatic bradycardia, which is the
opposite of this client's tachydysrhythmia. Emergent synchronized cardioversion is reserved for unstable clients with
hypotension, altered mental status, or signs of shock. A fluid bolus does not address the thromboembolic risk and
could worsen pulmonary congestion in a client with compromised cardiac function.
Q5: A client admitted with a COPD exacerbation has a SpO2 of 86 percent on room air and an elevated PaCO2 on
arterial blood gas analysis. Which prescription should the nurse implement?
A. Titrate low-flow oxygen to maintain SpO2 between 88 and 92 percent [CORRECT]
B. Apply a nonrebreather mask at 10 L/min
C. Administer a PRN benzodiazepine to decrease the work of breathing
D. Encourage prolonged purse-lip breathing without supplemental oxygen
Correct Answer: A
Rationale: Clients with chronic hypercapnia depend on hypoxic respiratory drive, so oxygen is titrated cautiously
with a target saturation of 88 to 92 percent to correct hypoxemia while avoiding carbon dioxide narcosis.
High-concentration oxygen via nonrebreather can suppress the respiratory drive in this population and cause
worsening hypercapnia. Sedatives further depress the respiratory center and are contraindicated in a client with
elevated PaCO2. Purse-lip breathing helps reduce air trapping but does not replace the need for controlled
supplemental oxygen during an exacerbation.
2
, RN ATI Capstone Proctored Comprehensive Assessment A | NCLEX-RN Readiness Review 2026/2027 Edition
Q6: A nurse is evaluating the effectiveness of therapy for a client who has asthma. Which finding indicates that the
client's current medication regimen is inadequate?
A. Peak flow readings consistently at 95 percent of personal best
B. Use of a short-acting beta agonist before exercise only
C. Clear breath sounds between exacerbations
D. Awakening at night with wheezing twice each week [CORRECT]
Correct Answer: D
Rationale: Nocturnal awakenings from asthma symptoms occurring more than twice per month indicate persistent
uncontrolled disease and the need for stepped-up anti-inflammatory therapy per current guidelines. Pre-exercise use
of a short-acting beta agonist is appropriate preventive behavior for exercise-induced bronchospasm. A peak flow at
95 percent of personal best reflects well-controlled airway function, and clear breath sounds between exacerbations
indicate the absence of ongoing bronchospasm. Recognizing control versus poor control is an ATI-tested clinical
judgment skill in respiratory pharmacology.
Q7: Two days after abdominal surgery, a client suddenly becomes dyspneic and reports sharp chest pain. The client's
respiratory rate is 32, HR 118, and SpO2 is 88 percent. Which action should the nurse take first?
A. Call the provider to request a ventilation-perfusion scan
B. Position the client in high-Fowler's and apply supplemental oxygen [CORRECT]
C. Start a heparin infusion at the standard rate
D. Instruct the client to cough and deep breathe every hour
Correct Answer: B
Rationale: The presentation is classic for pulmonary embolism, and immediate management follows the ABCs:
maximize oxygenation by positioning upright in high-Fowler's and administering oxygen while the provider is notified
and diagnostics are arranged. Requesting imaging is appropriate but delayed until the client's oxygenation is
supported. Heparin is anticipated after the diagnosis is confirmed and prescribed; initiating a high-risk infusion
without an order violates medication safety. Coughing and deep breathing address atelectasis, not embolic obstruction,
and delay definitive action.
Q8: A nurse is monitoring a client with acute respiratory distress syndrome who is receiving mechanical ventilation.
Which finding indicates the syndrome is progressing?
A. PaO2 remains below 60 mm Hg despite increasing fractions of inspired oxygen [CORRECT]
B. Productive cough with thick yellow sputum
C. Fever and elevated white blood cell count
D. Gradual resolution of bilateral crackles
Correct Answer: A
Rationale: The hallmark of worsening ARDS is refractory hypoxemia, in which arterial oxygenation cannot be
corrected even with escalating inspired oxygen concentrations because of widespread alveolar collapse and
noncardiogenic pulmonary edema. Purulent sputum and fever suggest infection such as ventilator-associated
pneumonia but are not defining markers of ARDS progression. Resolution of crackles would suggest improvement
rather than deterioration. Identifying refractory hypoxemia supports timely escalation to prone positioning or
advanced ventilation strategies.
3
