ATI Comprehensive Practice B /RN ATI Capstone
Proctored Comprehensive Assessment
2026/2027, Questions, answers and Rationales All
verified
1. A nurse in the emergency department is assessing a 62-year-old client who presents with
crushing substernal chest pain that began 30 minutes ago while resting at home. The pain
radiates to the left arm and jaw and is associated with diaphoresis and nausea. Vital signs
are BP 86/58 mmHg, HR 118/min, RR 24/min, and SpO₂ 89% on room air. Which action
should the nurse take first?
A. Administer IV morphine sulfate for pain
B. Obtain a 12-lead electrocardiogram
C. Initiate a large-bore IV line
D. (CORRECT) Apply oxygen at 4 L/min via nasal cannula
Rationale:
Using the ABC priority framework, airway and breathing must be addressed before circulation
and diagnostic procedures. The client’s oxygen saturation is below normal, indicating
hypoxemia. Myocardial tissue is already ischemic, and reduced oxygen supply can worsen
infarction size. Supplemental oxygen increases arterial oxygen content and improves myocardial
oxygenation. Although obtaining an ECG is critical for diagnosing STEMI and initiating
reperfusion therapy, correcting hypoxia is the immediate priority. Morphine may worsen
hypotension, and IV access is important but follows stabilization of oxygenation.
2. A nurse is caring for a client who is 10 hours postoperative following a total
thyroidectomy. The client reports tingling around the mouth and in the fingertips and is
experiencing muscle cramping. On assessment, the nurse notes facial twitching when
tapping the cheek. Which action should the nurse take?
A. Document the finding as expected
B. Administer prescribed opioid analgesic
C. (CORRECT) Prepare to administer IV calcium gluconate
D. Encourage oral fluid intake
Rationale:
Tingling sensations and facial twitching (positive Chvostek’s sign) indicate hypocalcemia,
commonly caused by accidental removal or damage to the parathyroid glands during thyroid
surgery. Hypocalcemia can progress rapidly to tetany, seizures, and laryngospasm, which may
obstruct the airway. Immediate calcium replacement is required to prevent life-threatening
,complications. These findings are not expected and should not be simply documented. Pain
medication does not address the underlying electrolyte imbalance.
3. A nurse is caring for a client admitted with diabetic ketoacidosis. Laboratory findings
reveal blood glucose 560 mg/dL, potassium 5.5 mEq/L, bicarbonate 14 mEq/L, and arterial
pH 7.26. The client is lethargic and reports excessive thirst and frequent urination prior to
admission. Which intervention should the nurse initiate first?
A. Administer IV potassium chloride
B. (CORRECT) Begin IV regular insulin infusion
C. Administer sodium bicarbonate IV push
D. Administer long-acting insulin subcutaneously
Rationale:
DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis. The priority
intervention is continuous IV regular insulin to stop ketone production and lower serum glucose.
Although potassium is elevated, insulin will shift potassium into cells, often lowering serum
levels quickly. Potassium replacement is initiated only when levels fall below normal. Sodium
bicarbonate is reserved for severe acidosis (pH less than 7.0). Long-acting insulin is not used for
acute correction.
4. A postpartum client is 1 hour after a spontaneous vaginal delivery. The uterus is firm
and midline at the level of the umbilicus. However, the client has saturated two perineal
pads within 20 minutes and reports feeling lightheaded. Which action should the nurse
take first?
A. Massage the uterine fundus
B. Increase the oxytocin infusion
C. (CORRECT) Inspect the perineum for lacerations
D. Encourage breastfeeding
Rationale:
A firm, midline fundus indicates adequate uterine contraction. Excessive bleeding despite good
uterine tone suggests trauma, such as cervical or vaginal lacerations. The priority is identifying
the bleeding source so that it can be repaired. Fundal massage is indicated for uterine atony,
which is not present here. Although oxytocin supports uterine tone, it will not correct bleeding
caused by lacerations.
5. A nurse is monitoring a client receiving magnesium sulfate for severe preeclampsia. The
client’s deep tendon reflexes are absent, respiratory rate is 10/min, and urine output over
the past hour is 20 mL. Which action should the nurse take immediately?
A. Continue the infusion and reassess in 30 minutes
B. Increase IV fluids
C. (CORRECT) Stop the magnesium infusion and prepare calcium gluconate
D. Place the client in Trendelenburg position
, Rationale:
Absent reflexes, respiratory depression, and decreased urine output indicate magnesium toxicity.
Magnesium is excreted through the kidneys, so reduced urine output increases risk of
accumulation. Immediate discontinuation of the infusion is required. Calcium gluconate is the
antidote and should be readily available. Continuing the infusion may lead to respiratory arrest
and cardiac complications.
6. A nurse is caring for a client with chronic kidney disease who has a potassium level of 6.7
mEq/L and ECG changes showing peaked T waves. The client reports muscle weakness
and palpitations. Which intervention is the priority?
A. Administer sodium polystyrene sulfonate orally
B. Restrict dietary potassium
C. (CORRECT) Administer IV calcium gluconate
D. Encourage ambulation
Rationale:
Severe hyperkalemia can lead to life-threatening cardiac dysrhythmias. IV calcium gluconate
stabilizes cardiac cell membranes and reduces risk of ventricular arrhythmias. Although sodium
polystyrene removes potassium from the body, it acts more slowly. Dietary restriction is
preventive but not immediate treatment.
7. A nurse is assessing a client with suspected meningitis who presents with fever, stiff neck,
and photophobia. During assessment, the client becomes increasingly confused and difficult
to arouse. What is the nurse’s priority action?
A. Administer prescribed acetaminophen
B. Dim the lights in the room
C. (CORRECT) Prepare for airway management and notify the provider
D. Encourage oral fluid intake
Rationale:
A decreasing level of consciousness suggests rising intracranial pressure, which can compromise
airway and cerebral perfusion. Protecting the airway and notifying the provider are immediate
priorities. While reducing stimuli may provide comfort, it does not address potential neurological
deterioration.
8. A client with COPD is admitted for pneumonia and is receiving oxygen at 6 L/min via
nasal cannula. After one hour, the client becomes drowsy and has shallow respirations.
Which condition is most likely occurring?
A. Hypoglycemia
B. Pulmonary embolism
C. (CORRECT) Carbon dioxide retention
D. Anxiety reaction
Proctored Comprehensive Assessment
2026/2027, Questions, answers and Rationales All
verified
1. A nurse in the emergency department is assessing a 62-year-old client who presents with
crushing substernal chest pain that began 30 minutes ago while resting at home. The pain
radiates to the left arm and jaw and is associated with diaphoresis and nausea. Vital signs
are BP 86/58 mmHg, HR 118/min, RR 24/min, and SpO₂ 89% on room air. Which action
should the nurse take first?
A. Administer IV morphine sulfate for pain
B. Obtain a 12-lead electrocardiogram
C. Initiate a large-bore IV line
D. (CORRECT) Apply oxygen at 4 L/min via nasal cannula
Rationale:
Using the ABC priority framework, airway and breathing must be addressed before circulation
and diagnostic procedures. The client’s oxygen saturation is below normal, indicating
hypoxemia. Myocardial tissue is already ischemic, and reduced oxygen supply can worsen
infarction size. Supplemental oxygen increases arterial oxygen content and improves myocardial
oxygenation. Although obtaining an ECG is critical for diagnosing STEMI and initiating
reperfusion therapy, correcting hypoxia is the immediate priority. Morphine may worsen
hypotension, and IV access is important but follows stabilization of oxygenation.
2. A nurse is caring for a client who is 10 hours postoperative following a total
thyroidectomy. The client reports tingling around the mouth and in the fingertips and is
experiencing muscle cramping. On assessment, the nurse notes facial twitching when
tapping the cheek. Which action should the nurse take?
A. Document the finding as expected
B. Administer prescribed opioid analgesic
C. (CORRECT) Prepare to administer IV calcium gluconate
D. Encourage oral fluid intake
Rationale:
Tingling sensations and facial twitching (positive Chvostek’s sign) indicate hypocalcemia,
commonly caused by accidental removal or damage to the parathyroid glands during thyroid
surgery. Hypocalcemia can progress rapidly to tetany, seizures, and laryngospasm, which may
obstruct the airway. Immediate calcium replacement is required to prevent life-threatening
,complications. These findings are not expected and should not be simply documented. Pain
medication does not address the underlying electrolyte imbalance.
3. A nurse is caring for a client admitted with diabetic ketoacidosis. Laboratory findings
reveal blood glucose 560 mg/dL, potassium 5.5 mEq/L, bicarbonate 14 mEq/L, and arterial
pH 7.26. The client is lethargic and reports excessive thirst and frequent urination prior to
admission. Which intervention should the nurse initiate first?
A. Administer IV potassium chloride
B. (CORRECT) Begin IV regular insulin infusion
C. Administer sodium bicarbonate IV push
D. Administer long-acting insulin subcutaneously
Rationale:
DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis. The priority
intervention is continuous IV regular insulin to stop ketone production and lower serum glucose.
Although potassium is elevated, insulin will shift potassium into cells, often lowering serum
levels quickly. Potassium replacement is initiated only when levels fall below normal. Sodium
bicarbonate is reserved for severe acidosis (pH less than 7.0). Long-acting insulin is not used for
acute correction.
4. A postpartum client is 1 hour after a spontaneous vaginal delivery. The uterus is firm
and midline at the level of the umbilicus. However, the client has saturated two perineal
pads within 20 minutes and reports feeling lightheaded. Which action should the nurse
take first?
A. Massage the uterine fundus
B. Increase the oxytocin infusion
C. (CORRECT) Inspect the perineum for lacerations
D. Encourage breastfeeding
Rationale:
A firm, midline fundus indicates adequate uterine contraction. Excessive bleeding despite good
uterine tone suggests trauma, such as cervical or vaginal lacerations. The priority is identifying
the bleeding source so that it can be repaired. Fundal massage is indicated for uterine atony,
which is not present here. Although oxytocin supports uterine tone, it will not correct bleeding
caused by lacerations.
5. A nurse is monitoring a client receiving magnesium sulfate for severe preeclampsia. The
client’s deep tendon reflexes are absent, respiratory rate is 10/min, and urine output over
the past hour is 20 mL. Which action should the nurse take immediately?
A. Continue the infusion and reassess in 30 minutes
B. Increase IV fluids
C. (CORRECT) Stop the magnesium infusion and prepare calcium gluconate
D. Place the client in Trendelenburg position
, Rationale:
Absent reflexes, respiratory depression, and decreased urine output indicate magnesium toxicity.
Magnesium is excreted through the kidneys, so reduced urine output increases risk of
accumulation. Immediate discontinuation of the infusion is required. Calcium gluconate is the
antidote and should be readily available. Continuing the infusion may lead to respiratory arrest
and cardiac complications.
6. A nurse is caring for a client with chronic kidney disease who has a potassium level of 6.7
mEq/L and ECG changes showing peaked T waves. The client reports muscle weakness
and palpitations. Which intervention is the priority?
A. Administer sodium polystyrene sulfonate orally
B. Restrict dietary potassium
C. (CORRECT) Administer IV calcium gluconate
D. Encourage ambulation
Rationale:
Severe hyperkalemia can lead to life-threatening cardiac dysrhythmias. IV calcium gluconate
stabilizes cardiac cell membranes and reduces risk of ventricular arrhythmias. Although sodium
polystyrene removes potassium from the body, it acts more slowly. Dietary restriction is
preventive but not immediate treatment.
7. A nurse is assessing a client with suspected meningitis who presents with fever, stiff neck,
and photophobia. During assessment, the client becomes increasingly confused and difficult
to arouse. What is the nurse’s priority action?
A. Administer prescribed acetaminophen
B. Dim the lights in the room
C. (CORRECT) Prepare for airway management and notify the provider
D. Encourage oral fluid intake
Rationale:
A decreasing level of consciousness suggests rising intracranial pressure, which can compromise
airway and cerebral perfusion. Protecting the airway and notifying the provider are immediate
priorities. While reducing stimuli may provide comfort, it does not address potential neurological
deterioration.
8. A client with COPD is admitted for pneumonia and is receiving oxygen at 6 L/min via
nasal cannula. After one hour, the client becomes drowsy and has shallow respirations.
Which condition is most likely occurring?
A. Hypoglycemia
B. Pulmonary embolism
C. (CORRECT) Carbon dioxide retention
D. Anxiety reaction
