ATI CAPSTONE PRE ASSESSMENT
PRACTICE EXAM 100 QUESTIONS WITH
RATIONALES STUDY GUIDE
ATI Capstone Pre-Assessment Practice Exam
1. A nurse is caring for a client who is 24 hours
postoperative following an abdominal hysterectomy.
Which of the following findings should the nurse report
to the provider immediately?
• A. Incisional pain rated as 6 on a scale of 0 to 10
• B. Decreased bowel sounds in all four quadrants
• C. Urinary output of 20 mL/hr over the past 2 hours
• D. Serosanguineous drainage on the abdominal dressing
Answer: C
rAtionAle: Using the ABC (Airway, Breathing,
Circulation) priority framework and the rules of
perfusion, a urinary output of less than 30 mL/hr
indicates potential hypovolemia, shock, or acute kidney
injury. This requires immediate intervention. Incisional
pain, decreased bowel sounds, and serosanguineous
drainage are expected findings 24 hours postoperatively.
2. A nurse is reviewing the laboratory results of a client
who is receiving a continuous intravenous heparin
infusion for a deep vein thrombosis. Which of the
,following laboratory values indicates the nurse should
adjust the infusion rate?
• A. PT of 12 seconds
• B. INR of 1.2
• C. aPTT of 95 seconds
• D. Platelet count of 180,000/mm³
Answer: C
rAtionAle: The therapeutic range for aPTT during
heparin therapy is typically 1.5 to 2.5 times the normal
control value (normal is roughly 30 to 40 seconds,
making therapeutic range about 60 to 80 seconds). An
aPTT of 95 seconds indicates over-anticoagulation,
placing the client at high risk for bleeding, and requires
holding or down-titrating the infusion per protocol. PT
and INR are used to monitor warfarin, and the platelet
count is within the normal reference range.
3. A nurse is assessing a client who has a chest tube
connected to a water-seal drainage system. The nurse
notes continuous bubbling in the water-seal chamber.
Which of the following actions should the nurse take?
• A. Check the system for an air leak.
• B. Lower the drainage system below the client's chest.
• C. Clamp the chest tube immediately near the insertion site.
• D. Document this as an expected finding.
,Answer: A
rAtionAle: Continuous bubbling in the water-seal
chamber indicates an air leak in the system, which must
be located and corrected. Intermittent bubbling is
normal during expiration or coughing. Clamping a chest
tube without a specific order or indication can cause a
tension pneumothorax. The drainage system should
already be below the client's chest level.
4. A nurse in an emergency department is caring for a
client who has a prescription for a transfusion of packed
red blood cells (RBCs). Which of the following actions
should the nurse take first?
• A. Ensure a 20-gauge or larger IV catheter is patent.
• B. Verify the client's identity and blood compatibility with a
second nurse.
• C. Obtain the client's baseline vital signs.
• D. Prime the blood administration tubing with 0.9% sodium
chloride.
Answer: B
rAtionAle: Safety is the highest priority during a
blood transfusion. Preventing an incompatible blood
transfusion reaction by verifying the client's identity and
the blood product with a second licensed nurse is the
most critical safety check. While establishing IV access,
taking vital signs, and priming tubing are all necessary
steps, verification is the ultimate safety barrier.
, 5. A nurse is caring for a client who is in the active phase
of labor. The fetal monitor tracing shows late
decelerations. Which of the following actions should the
nurse take first?
• A. Turn the client onto her left side.
• B. Increase the rate of the primary IV infusion.
• C. Administer oxygen via a nonrebreather face mask.
• D. Discontinue the oxytocin infusion.
Answer: A
rAtionAle: Late decelerations indicate uteroplacental
insufficiency. The immediate priority action is to turn
the client to her side (preferably left side) to relieve vena
cava compression and improve placental perfusion.
While discontinuing oxytocin, increasing IV fluids, and
giving oxygen are also standard components of
intrauterine resuscitation, repositioning is the
immediate first action to maximize blood flow.
6. A nurse is teaching the parent of a 4-year-old child
who has a new prescription for liquid oral iron
supplements. Which of the following instructions should
the nurse include?
• A. Administer the medication with a glass of milk to prevent
gastric upset.
• B. Give the medication through a straw and rinse the mouth
afterward.
• C. Expect the child’s stools to become bright red or pink.
PRACTICE EXAM 100 QUESTIONS WITH
RATIONALES STUDY GUIDE
ATI Capstone Pre-Assessment Practice Exam
1. A nurse is caring for a client who is 24 hours
postoperative following an abdominal hysterectomy.
Which of the following findings should the nurse report
to the provider immediately?
• A. Incisional pain rated as 6 on a scale of 0 to 10
• B. Decreased bowel sounds in all four quadrants
• C. Urinary output of 20 mL/hr over the past 2 hours
• D. Serosanguineous drainage on the abdominal dressing
Answer: C
rAtionAle: Using the ABC (Airway, Breathing,
Circulation) priority framework and the rules of
perfusion, a urinary output of less than 30 mL/hr
indicates potential hypovolemia, shock, or acute kidney
injury. This requires immediate intervention. Incisional
pain, decreased bowel sounds, and serosanguineous
drainage are expected findings 24 hours postoperatively.
2. A nurse is reviewing the laboratory results of a client
who is receiving a continuous intravenous heparin
infusion for a deep vein thrombosis. Which of the
,following laboratory values indicates the nurse should
adjust the infusion rate?
• A. PT of 12 seconds
• B. INR of 1.2
• C. aPTT of 95 seconds
• D. Platelet count of 180,000/mm³
Answer: C
rAtionAle: The therapeutic range for aPTT during
heparin therapy is typically 1.5 to 2.5 times the normal
control value (normal is roughly 30 to 40 seconds,
making therapeutic range about 60 to 80 seconds). An
aPTT of 95 seconds indicates over-anticoagulation,
placing the client at high risk for bleeding, and requires
holding or down-titrating the infusion per protocol. PT
and INR are used to monitor warfarin, and the platelet
count is within the normal reference range.
3. A nurse is assessing a client who has a chest tube
connected to a water-seal drainage system. The nurse
notes continuous bubbling in the water-seal chamber.
Which of the following actions should the nurse take?
• A. Check the system for an air leak.
• B. Lower the drainage system below the client's chest.
• C. Clamp the chest tube immediately near the insertion site.
• D. Document this as an expected finding.
,Answer: A
rAtionAle: Continuous bubbling in the water-seal
chamber indicates an air leak in the system, which must
be located and corrected. Intermittent bubbling is
normal during expiration or coughing. Clamping a chest
tube without a specific order or indication can cause a
tension pneumothorax. The drainage system should
already be below the client's chest level.
4. A nurse in an emergency department is caring for a
client who has a prescription for a transfusion of packed
red blood cells (RBCs). Which of the following actions
should the nurse take first?
• A. Ensure a 20-gauge or larger IV catheter is patent.
• B. Verify the client's identity and blood compatibility with a
second nurse.
• C. Obtain the client's baseline vital signs.
• D. Prime the blood administration tubing with 0.9% sodium
chloride.
Answer: B
rAtionAle: Safety is the highest priority during a
blood transfusion. Preventing an incompatible blood
transfusion reaction by verifying the client's identity and
the blood product with a second licensed nurse is the
most critical safety check. While establishing IV access,
taking vital signs, and priming tubing are all necessary
steps, verification is the ultimate safety barrier.
, 5. A nurse is caring for a client who is in the active phase
of labor. The fetal monitor tracing shows late
decelerations. Which of the following actions should the
nurse take first?
• A. Turn the client onto her left side.
• B. Increase the rate of the primary IV infusion.
• C. Administer oxygen via a nonrebreather face mask.
• D. Discontinue the oxytocin infusion.
Answer: A
rAtionAle: Late decelerations indicate uteroplacental
insufficiency. The immediate priority action is to turn
the client to her side (preferably left side) to relieve vena
cava compression and improve placental perfusion.
While discontinuing oxytocin, increasing IV fluids, and
giving oxygen are also standard components of
intrauterine resuscitation, repositioning is the
immediate first action to maximize blood flow.
6. A nurse is teaching the parent of a 4-year-old child
who has a new prescription for liquid oral iron
supplements. Which of the following instructions should
the nurse include?
• A. Administer the medication with a glass of milk to prevent
gastric upset.
• B. Give the medication through a straw and rinse the mouth
afterward.
• C. Expect the child’s stools to become bright red or pink.
