ATI RN Capstone Final Comprehensive
Review 2026/2027 | Nursing Study Guide,
Practice Questions & Answers | ATI
Capstone & NCLEX-RN Exam Prep
ATI RN CAPSTONE FINAL COMPREHENSIVE REVIEW 2026/2027
DOCUMENT OVERVIEW
• This comprehensive review contains 200 practice questions designed to simulate
ATI Capstone and NCLEX-RN level content across all major nursing domains—use
this material to assess knowledge gaps, build test-taking endurance, and identify
weak areas requiring further study.
• Study strategically by working through 20-30 questions per session, reviewing
rationales thoroughly before moving forward, and revisiting incorrect answers to
reinforce critical thinking and clinical reasoning patterns.
QUESTION 1
A nurse is caring for a 68-year-old client with acute myocardial infarction
(AMI) who is experiencing chest pain radiating to the left arm and jaw. The
client's blood pressure is 160/95 mmHg, heart rate is 102 bpm, and respiratory
rate is 24 breaths/min. Which intervention should the nurse prioritize
immediately?
A) Administer aspirin 325 mg orally and obtain a 12-lead ECG
B) Establish IV access and prepare for thrombolytic therapy
C) Apply oxygen via nasal cannula at 2 L/min and monitor continuously
D) Place the client in semi-Fowler's position and reassure the client
E) Draw blood for troponin levels and await results before intervention
✓ CORRECT ANSWER: B) Establish IV access and prepare for thrombolytic
therapy
Rationale: In acute myocardial infarction, time is myocardium—the primary goal is
reperfusion therapy (thrombolytics or PCI). While aspirin and ECG are important,
,establishing IV access and preparing for thrombolytic therapy addresses the most
critical intervention to minimize myocardial necrosis and improve outcomes. The
client's symptoms and vital signs indicate acute MI requiring immediate
reperfusion. Nasal cannula oxygen at only 2 L/min is insufficient; higher
concentrations are needed. Troponin confirmation delays critical intervention.
QUESTION 2
A nurse is assessing a client with chronic obstructive pulmonary disease
(COPD) who is experiencing an acute exacerbation. The client's ABG results
show: pH 7.32, PaCO2 52 mmHg, HCO3- 26 mEq/L, and PaO2 58 mmHg. Which
acid-base disturbance is the client experiencing?
A) Metabolic acidosis with respiratory compensation
B) Respiratory acidosis with partial metabolic compensation
C) Metabolic alkalosis with respiratory cause
D) Respiratory alkalosis with metabolic compensation
E) Mixed acidosis with no compensation
✓ CORRECT ANSWER: B) Respiratory acidosis with partial metabolic
compensation
Rationale: The pH is low (7.32), indicating acidosis. The elevated PaCO2 (52 mmHg,
normal 35-45) confirms the primary problem is respiratory acidosis. The HCO3- is
elevated (26 mEq/L, normal 22-24), indicating the kidneys are attempting metabolic
compensation by retaining bicarbonate, though this compensation is incomplete.
The low PaO2 (58 mmHg) confirms ventilation problems. This pattern is classic for
COPD exacerbation where CO2 retention occurs faster than metabolic
compensation can develop.
QUESTION 3
,A nurse is preparing to administer a blood transfusion to a client with a
hemoglobin of 6.5 g/dL. Which action is most important before initiating the
transfusion?
A) Warm the blood to body temperature using a microwave
B) Verify the client's identity using two identifiers and compare with the blood
product label
C) Start the transfusion rapidly to restore hemoglobin quickly
D) Premedicate the client with acetaminophen and diphenhydramine
E) Administer the blood through a peripheral IV without a filter
✓ CORRECT ANSWER: B) Verify the client's identity using two identifiers and
compare with the blood product label
Rationale: Accurate identification is the most critical safety measure in blood
transfusion—ABO incompatibility causes hemolytic transfusion reactions that can
be fatal. Using two identifiers (name and medical record number, or name and date
of birth) and comparing them with blood product labels prevents fatal errors.
Warming blood in microwave damages red blood cells and is contraindicated.
Blood should infuse over 2-4 hours. While premedication may be indicated for
certain clients, verification of identity is the absolute priority. A filter must always be
used.
QUESTION 4
A nurse is caring for a client who is 2 days post-operative from abdominal
surgery. The client reports pain level 8/10 and appears anxious. Vital signs
show HR 110 bpm, BP 145/92 mmHg, RR 24 breaths/min, and temperature
38.1°C (100.6°F). What is the nurse's priority action?
A) Notify the provider immediately and hold all pain medications
B) Administer prescribed analgesics and assess for surgical complications
C) Apply cool compresses and encourage deep breathing exercises
, D) Restrict fluids and increase monitoring frequency
E) Document findings and reassess in 2 hours
✓ CORRECT ANSWER: B) Administer prescribed analgesics and assess for
surgical complications
Rationale: Elevated vital signs, fever, and pain on postoperative day 2 could
indicate infection or other complications. However, the immediate priority is
managing acute pain (8/10), which is contributing to sympathetic activation
(elevated HR, BP, RR). After administering ordered analgesics, thorough assessment
for complications (fever, wound status, drainage, infection signs) is essential.
Holding medications is contraindicated as inadequate pain control increases
complications. Fluids should not be restricted; hydration supports healing. While
escalation may be needed, pain management and assessment should occur first.
QUESTION 5
A nurse is teaching a client with type 2 diabetes about insulin injection
technique. Which statement by the client indicates a need for further
teaching?
A) "I will rotate injection sites in a systematic pattern to prevent lipodystrophy"
B) "I can reuse the same syringe after cleaning the needle with alcohol"
C) "I should store unopened insulin vials in the refrigerator"
D) "I will allow the insulin to reach room temperature before injecting"
E) "I should inject at a 90-degree angle into subcutaneous tissue"
✓ CORRECT ANSWER: B) I can reuse the same syringe after cleaning the needle
with alcohol
Rationale: Insulin syringes and needles are single-use devices and should never be
reused, even after cleaning with alcohol. Reuse increases infection risk, dulls the
needle causing tissue trauma, and affects medication sterility. All other statements
are correct: site rotation prevents lipodystrophy and lipohypertrophy, unopened
Review 2026/2027 | Nursing Study Guide,
Practice Questions & Answers | ATI
Capstone & NCLEX-RN Exam Prep
ATI RN CAPSTONE FINAL COMPREHENSIVE REVIEW 2026/2027
DOCUMENT OVERVIEW
• This comprehensive review contains 200 practice questions designed to simulate
ATI Capstone and NCLEX-RN level content across all major nursing domains—use
this material to assess knowledge gaps, build test-taking endurance, and identify
weak areas requiring further study.
• Study strategically by working through 20-30 questions per session, reviewing
rationales thoroughly before moving forward, and revisiting incorrect answers to
reinforce critical thinking and clinical reasoning patterns.
QUESTION 1
A nurse is caring for a 68-year-old client with acute myocardial infarction
(AMI) who is experiencing chest pain radiating to the left arm and jaw. The
client's blood pressure is 160/95 mmHg, heart rate is 102 bpm, and respiratory
rate is 24 breaths/min. Which intervention should the nurse prioritize
immediately?
A) Administer aspirin 325 mg orally and obtain a 12-lead ECG
B) Establish IV access and prepare for thrombolytic therapy
C) Apply oxygen via nasal cannula at 2 L/min and monitor continuously
D) Place the client in semi-Fowler's position and reassure the client
E) Draw blood for troponin levels and await results before intervention
✓ CORRECT ANSWER: B) Establish IV access and prepare for thrombolytic
therapy
Rationale: In acute myocardial infarction, time is myocardium—the primary goal is
reperfusion therapy (thrombolytics or PCI). While aspirin and ECG are important,
,establishing IV access and preparing for thrombolytic therapy addresses the most
critical intervention to minimize myocardial necrosis and improve outcomes. The
client's symptoms and vital signs indicate acute MI requiring immediate
reperfusion. Nasal cannula oxygen at only 2 L/min is insufficient; higher
concentrations are needed. Troponin confirmation delays critical intervention.
QUESTION 2
A nurse is assessing a client with chronic obstructive pulmonary disease
(COPD) who is experiencing an acute exacerbation. The client's ABG results
show: pH 7.32, PaCO2 52 mmHg, HCO3- 26 mEq/L, and PaO2 58 mmHg. Which
acid-base disturbance is the client experiencing?
A) Metabolic acidosis with respiratory compensation
B) Respiratory acidosis with partial metabolic compensation
C) Metabolic alkalosis with respiratory cause
D) Respiratory alkalosis with metabolic compensation
E) Mixed acidosis with no compensation
✓ CORRECT ANSWER: B) Respiratory acidosis with partial metabolic
compensation
Rationale: The pH is low (7.32), indicating acidosis. The elevated PaCO2 (52 mmHg,
normal 35-45) confirms the primary problem is respiratory acidosis. The HCO3- is
elevated (26 mEq/L, normal 22-24), indicating the kidneys are attempting metabolic
compensation by retaining bicarbonate, though this compensation is incomplete.
The low PaO2 (58 mmHg) confirms ventilation problems. This pattern is classic for
COPD exacerbation where CO2 retention occurs faster than metabolic
compensation can develop.
QUESTION 3
,A nurse is preparing to administer a blood transfusion to a client with a
hemoglobin of 6.5 g/dL. Which action is most important before initiating the
transfusion?
A) Warm the blood to body temperature using a microwave
B) Verify the client's identity using two identifiers and compare with the blood
product label
C) Start the transfusion rapidly to restore hemoglobin quickly
D) Premedicate the client with acetaminophen and diphenhydramine
E) Administer the blood through a peripheral IV without a filter
✓ CORRECT ANSWER: B) Verify the client's identity using two identifiers and
compare with the blood product label
Rationale: Accurate identification is the most critical safety measure in blood
transfusion—ABO incompatibility causes hemolytic transfusion reactions that can
be fatal. Using two identifiers (name and medical record number, or name and date
of birth) and comparing them with blood product labels prevents fatal errors.
Warming blood in microwave damages red blood cells and is contraindicated.
Blood should infuse over 2-4 hours. While premedication may be indicated for
certain clients, verification of identity is the absolute priority. A filter must always be
used.
QUESTION 4
A nurse is caring for a client who is 2 days post-operative from abdominal
surgery. The client reports pain level 8/10 and appears anxious. Vital signs
show HR 110 bpm, BP 145/92 mmHg, RR 24 breaths/min, and temperature
38.1°C (100.6°F). What is the nurse's priority action?
A) Notify the provider immediately and hold all pain medications
B) Administer prescribed analgesics and assess for surgical complications
C) Apply cool compresses and encourage deep breathing exercises
, D) Restrict fluids and increase monitoring frequency
E) Document findings and reassess in 2 hours
✓ CORRECT ANSWER: B) Administer prescribed analgesics and assess for
surgical complications
Rationale: Elevated vital signs, fever, and pain on postoperative day 2 could
indicate infection or other complications. However, the immediate priority is
managing acute pain (8/10), which is contributing to sympathetic activation
(elevated HR, BP, RR). After administering ordered analgesics, thorough assessment
for complications (fever, wound status, drainage, infection signs) is essential.
Holding medications is contraindicated as inadequate pain control increases
complications. Fluids should not be restricted; hydration supports healing. While
escalation may be needed, pain management and assessment should occur first.
QUESTION 5
A nurse is teaching a client with type 2 diabetes about insulin injection
technique. Which statement by the client indicates a need for further
teaching?
A) "I will rotate injection sites in a systematic pattern to prevent lipodystrophy"
B) "I can reuse the same syringe after cleaning the needle with alcohol"
C) "I should store unopened insulin vials in the refrigerator"
D) "I will allow the insulin to reach room temperature before injecting"
E) "I should inject at a 90-degree angle into subcutaneous tissue"
✓ CORRECT ANSWER: B) I can reuse the same syringe after cleaning the needle
with alcohol
Rationale: Insulin syringes and needles are single-use devices and should never be
reused, even after cleaning with alcohol. Reuse increases infection risk, dulls the
needle causing tissue trauma, and affects medication sterility. All other statements
are correct: site rotation prevents lipodystrophy and lipohypertrophy, unopened
