1
RN ATI Capstone Proctored Comprehensive
Assessment A ACTUAL EXAM 2026/2027 | 180
Verified Questions | Integrative Clinical
Judgment & NCLEX-RN® Predictive | Pass
Guaranteed - A+ Graded
INTEGRATED QUESTIONS 1-180 (Mixed Content)
Question 1 (NGN - Matrix/Grid) A 68-year-old patient with heart failure, type 2 diabetes, and
chronic kidney disease (eGFR 35 mL/min) is admitted with exacerbation. The nurse is reviewing
morning medications. For each medication below, click to specify if the nurse should
Administer as prescribed, Hold and notify provider, or Question the dose/route.
Table
Copy
Administer as Hold and notify Question the
Medication prescribed provider dose/route
Metformin 1000 mg PO
daily ☐ ☐ ☐
Furosemide 80 mg IV
push now ☐ ☐ ☐
Lisinopril 10 mg PO
daily ☐ ☐ ☐
,2
Administer as Hold and notify Question the
Medication prescribed provider dose/route
Digoxin 0.25 mg PO
daily ☐ ☐ ☐
Correct Answer:
• Metformin: Hold and notify provider (contraindicated eGFR <30, use caution <45; hold
during acute illness/contrast)
• Furosemide: Administer as prescribed (appropriate for HF exacerbation)
• Lisinopril: Question the dose/route (hold or reduce in acute kidney injury; hyperkalemia
risk)
• Digoxin: Hold and notify provider (toxicity risk with renal impairment; check level)
Rationale: This matrix requires integration of pharmacology, renal physiology, and safety.
Metformin is contraindicated with eGFR <30 and during acute illness due to lactic acidosis risk.
Furosemide is indicated for fluid overload. ACE inhibitors worsen AKI and cause hyperkalemia.
Digoxin is renally cleared with narrow therapeutic index—levels required with eGFR 35.
Capstone Insight: Always cross-reference renal function with medication clearance pathways;
acute illness changes risk-benefit calculations for chronic medications.
Question 2 The nurse receives report on four patients. Which patient requires the first
assessment?
A. 45-year-old post-appendectomy, pain 2/10, stable vital signs
B. 72-year-old with new-onset atrial fibrillation, rate 140, BP 98/62
C. 58-year-old COPD patient, SpO2 91% on 2L NC, scheduled for discharge
D. 35-year-old with migraine, pain 8/10, requesting medication
Correct Answer: B
Rationale: Prioritization follows the "ABC" framework modified for instability: hemodynamic
compromise (hypotension + tachycardia) with new arrhythmia indicates possible shock,
embolism risk, and cardiovascular collapse. While all patients need care, the patient with new
AFib, rapid ventricular response, and borderline hypotension requires immediate ECG, possible
cardioversion, and hemodynamic monitoring. Pain (A, D) and stable hypoxemia (C) are lower
priority than potential cardiovascular collapse.
,3
Capstone Insight: New-onset arrhythmia with hemodynamic instability always trumps stable
post-op and chronic conditions—think "threat to life" first.
Question 3 (NGN - Multiple Select) A nurse is caring for a patient with syndrome of
inappropriate antidiuretic hormone (SIADH). Select all nursing interventions that are appropriate
for this patient:
[ ] Restrict fluid intake to 800-1200 mL/day
[ ] Monitor for signs of fluid overload
[ ] Administer 3% saline if ordered for severe symptoms
[ ] Encourage oral sodium replacement
[ ] Weigh daily
[ ] Monitor neurologic status frequently
[ ] Administer loop diuretics to promote diuresis
[ ] Assess for lung crackles and edema
Correct Answer: Restrict fluid, Monitor fluid overload, 3% saline if ordered, Weigh daily,
Monitor neuro status, Assess crackles/edema (DO NOT SELECT: oral sodium replacement, loop
diuretics)
Rationale: SIADH treatment centers on free water restriction (800-1200 mL/day) to correct
dilutional hyponatremia. Severe symptoms (seizures, altered mental status) require hypertonic
(3%) saline with careful monitoring. Daily weights and neuro checks assess severity/progression.
Fluid overload signs (crackles, edema) indicate severity. Oral sodium replacement is ineffective
(dilutional problem, not sodium deficiency); loop diuretics worsen hyponatremia by causing free
water clearance impairment.
Capstone Insight: SIADH is a dilutional, not depletional, hyponatremia—treatment is restriction,
not replacement.
Question 4 A 16-year-old is admitted with diabetic ketoacidosis (DKA). The parents are
divorced, and both arrive demanding information. The patient previously told the nurse "don't
tell my dad about my marijuana use." What is the nurse's best action?
A. Provide information to both parents equally
B. Ask the patient which parent should receive information
C. Explain to both parents that the patient has privacy rights
D. Tell the father only medical information, not social history
Correct Answer: C
, 4
Rationale: Minors generally cannot consent for treatment, but they do have privacy rights
regarding certain sensitive information (mental health, substance use, reproductive health)
depending on state laws. The nurse must balance family involvement with adolescent privacy
rights. Explaining privacy rights to both parents maintains professional boundaries while
acknowledging legal protections. Asking the patient (B) places burden on them during crisis;
selective disclosure (D) violates trust; equal disclosure (A) breaches confidentiality.
Capstone Insight: Adolescent privacy in healthcare is legally and ethically complex—know your
state laws and institutional policies regarding minor consent and confidentiality.
Question 5 The charge nurse is assigning patients on a medical-surgical unit. Which patient is
most appropriate for a licensed practical nurse (LPN)?
A. 55-year-old 2 days post-MI with new-onset chest pain
B. 42-year-old with stable Crohn's disease, teaching for home medication administration
C. 78-year-old with heart failure receiving IV dobutamine titration
D. 30-year-old with asthma exacerbation, first dose of new IV corticosteroid
Correct Answer: B
Rationale: LPN scope includes stable patients requiring monitoring and routine care, not
complex assessment, titration, or unstable conditions. The Crohn's patient is stable with
predictable needs—medication teaching (within LPN scope with RN oversight). Post-MI with
new chest pain (A) requires RN assessment for reinfarction; dobutamine titration (C) requires
continuous monitoring and titration beyond LPN scope; first dose IV steroid with potential
reaction (D) requires RN assessment.
Capstone Insight: Delegation decisions hinge on stability, predictability, and scope of practice—
when in doubt, assign complex assessment and unstable patients to RNs.
Question 6 (NGN - Extended Drag-and-Drop/Ordered Response) Place the following nursing
actions in priority order for a patient with suspected pulmonary embolism (PE) who is
dyspneic, tachypneic (RR 34), and anxious:
Available Actions:
• Administer supplemental oxygen
• Obtain 12-lead ECG
• Prepare for CT pulmonary angiography
• Establish IV access
RN ATI Capstone Proctored Comprehensive
Assessment A ACTUAL EXAM 2026/2027 | 180
Verified Questions | Integrative Clinical
Judgment & NCLEX-RN® Predictive | Pass
Guaranteed - A+ Graded
INTEGRATED QUESTIONS 1-180 (Mixed Content)
Question 1 (NGN - Matrix/Grid) A 68-year-old patient with heart failure, type 2 diabetes, and
chronic kidney disease (eGFR 35 mL/min) is admitted with exacerbation. The nurse is reviewing
morning medications. For each medication below, click to specify if the nurse should
Administer as prescribed, Hold and notify provider, or Question the dose/route.
Table
Copy
Administer as Hold and notify Question the
Medication prescribed provider dose/route
Metformin 1000 mg PO
daily ☐ ☐ ☐
Furosemide 80 mg IV
push now ☐ ☐ ☐
Lisinopril 10 mg PO
daily ☐ ☐ ☐
,2
Administer as Hold and notify Question the
Medication prescribed provider dose/route
Digoxin 0.25 mg PO
daily ☐ ☐ ☐
Correct Answer:
• Metformin: Hold and notify provider (contraindicated eGFR <30, use caution <45; hold
during acute illness/contrast)
• Furosemide: Administer as prescribed (appropriate for HF exacerbation)
• Lisinopril: Question the dose/route (hold or reduce in acute kidney injury; hyperkalemia
risk)
• Digoxin: Hold and notify provider (toxicity risk with renal impairment; check level)
Rationale: This matrix requires integration of pharmacology, renal physiology, and safety.
Metformin is contraindicated with eGFR <30 and during acute illness due to lactic acidosis risk.
Furosemide is indicated for fluid overload. ACE inhibitors worsen AKI and cause hyperkalemia.
Digoxin is renally cleared with narrow therapeutic index—levels required with eGFR 35.
Capstone Insight: Always cross-reference renal function with medication clearance pathways;
acute illness changes risk-benefit calculations for chronic medications.
Question 2 The nurse receives report on four patients. Which patient requires the first
assessment?
A. 45-year-old post-appendectomy, pain 2/10, stable vital signs
B. 72-year-old with new-onset atrial fibrillation, rate 140, BP 98/62
C. 58-year-old COPD patient, SpO2 91% on 2L NC, scheduled for discharge
D. 35-year-old with migraine, pain 8/10, requesting medication
Correct Answer: B
Rationale: Prioritization follows the "ABC" framework modified for instability: hemodynamic
compromise (hypotension + tachycardia) with new arrhythmia indicates possible shock,
embolism risk, and cardiovascular collapse. While all patients need care, the patient with new
AFib, rapid ventricular response, and borderline hypotension requires immediate ECG, possible
cardioversion, and hemodynamic monitoring. Pain (A, D) and stable hypoxemia (C) are lower
priority than potential cardiovascular collapse.
,3
Capstone Insight: New-onset arrhythmia with hemodynamic instability always trumps stable
post-op and chronic conditions—think "threat to life" first.
Question 3 (NGN - Multiple Select) A nurse is caring for a patient with syndrome of
inappropriate antidiuretic hormone (SIADH). Select all nursing interventions that are appropriate
for this patient:
[ ] Restrict fluid intake to 800-1200 mL/day
[ ] Monitor for signs of fluid overload
[ ] Administer 3% saline if ordered for severe symptoms
[ ] Encourage oral sodium replacement
[ ] Weigh daily
[ ] Monitor neurologic status frequently
[ ] Administer loop diuretics to promote diuresis
[ ] Assess for lung crackles and edema
Correct Answer: Restrict fluid, Monitor fluid overload, 3% saline if ordered, Weigh daily,
Monitor neuro status, Assess crackles/edema (DO NOT SELECT: oral sodium replacement, loop
diuretics)
Rationale: SIADH treatment centers on free water restriction (800-1200 mL/day) to correct
dilutional hyponatremia. Severe symptoms (seizures, altered mental status) require hypertonic
(3%) saline with careful monitoring. Daily weights and neuro checks assess severity/progression.
Fluid overload signs (crackles, edema) indicate severity. Oral sodium replacement is ineffective
(dilutional problem, not sodium deficiency); loop diuretics worsen hyponatremia by causing free
water clearance impairment.
Capstone Insight: SIADH is a dilutional, not depletional, hyponatremia—treatment is restriction,
not replacement.
Question 4 A 16-year-old is admitted with diabetic ketoacidosis (DKA). The parents are
divorced, and both arrive demanding information. The patient previously told the nurse "don't
tell my dad about my marijuana use." What is the nurse's best action?
A. Provide information to both parents equally
B. Ask the patient which parent should receive information
C. Explain to both parents that the patient has privacy rights
D. Tell the father only medical information, not social history
Correct Answer: C
, 4
Rationale: Minors generally cannot consent for treatment, but they do have privacy rights
regarding certain sensitive information (mental health, substance use, reproductive health)
depending on state laws. The nurse must balance family involvement with adolescent privacy
rights. Explaining privacy rights to both parents maintains professional boundaries while
acknowledging legal protections. Asking the patient (B) places burden on them during crisis;
selective disclosure (D) violates trust; equal disclosure (A) breaches confidentiality.
Capstone Insight: Adolescent privacy in healthcare is legally and ethically complex—know your
state laws and institutional policies regarding minor consent and confidentiality.
Question 5 The charge nurse is assigning patients on a medical-surgical unit. Which patient is
most appropriate for a licensed practical nurse (LPN)?
A. 55-year-old 2 days post-MI with new-onset chest pain
B. 42-year-old with stable Crohn's disease, teaching for home medication administration
C. 78-year-old with heart failure receiving IV dobutamine titration
D. 30-year-old with asthma exacerbation, first dose of new IV corticosteroid
Correct Answer: B
Rationale: LPN scope includes stable patients requiring monitoring and routine care, not
complex assessment, titration, or unstable conditions. The Crohn's patient is stable with
predictable needs—medication teaching (within LPN scope with RN oversight). Post-MI with
new chest pain (A) requires RN assessment for reinfarction; dobutamine titration (C) requires
continuous monitoring and titration beyond LPN scope; first dose IV steroid with potential
reaction (D) requires RN assessment.
Capstone Insight: Delegation decisions hinge on stability, predictability, and scope of practice—
when in doubt, assign complex assessment and unstable patients to RNs.
Question 6 (NGN - Extended Drag-and-Drop/Ordered Response) Place the following nursing
actions in priority order for a patient with suspected pulmonary embolism (PE) who is
dyspneic, tachypneic (RR 34), and anxious:
Available Actions:
• Administer supplemental oxygen
• Obtain 12-lead ECG
• Prepare for CT pulmonary angiography
• Establish IV access
