ATI CAPSTONE AND NCLEX-RN COMPLETE
EXAM PREP STUDY GUIDE HIGH-YIELD
QUESTIONS, ANSWERS, AND RATIONALES
This comprehensive ATI Capstone and NCLEX-RN study guide features high-yield
multiple-choice questions complete with correct answers and bold-italic
rationales immediately following each item. The resource systematically covers
critical testing domains including Medical-Surgical nursing, advanced
pharmacology, maternal-newborn care, pediatrics, and management delegation.
It serves as an optimized, all-in-one preparation tool designed to help nursing
students identify knowledge gaps, master prioritization frameworks, and pass
their board exams on the first attempt.
Question 1
A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which of the following actions should the nurse take to prevent deep
vein thrombosis (DVT)?
A. Place a pillow directly under the client's knees.
B. Apply sequential compression devices (SCDs) to both lower extremities.
C. Maintain the client on strict bed rest for 48 hours.
D. Massage the client’s calves daily during morning care.
Answer: B
Rationale: Sequential compression devices promote venous return and prevent
venous stasis, which is the priority intervention to reduce the risk of DVT in
postoperative clients. Placing a pillow under the knees can compress the
popliteal vessels and increase stasis. Early ambulation, rather than strict bed
,rest, is indicated. Massaging the calves is strictly contraindicated because it can
dislodge an undetected clot, leading to a pulmonary embolism.
Question 2
A nurse is assessing a client who has a history of severe cirrhosis and is exhibiting
confusion. The nurse notes a flapping tremor of the hands when the client
extends their arms. Which of the following laboratory values should the nurse
anticipate?
A. Elevated serum ammonia
B. Elevated serum lipase
C. Decreased serum creatinine
D. Decreased total bilirubin
Answer: A
Rationale: A flapping tremor of the hands (asterixis) coupled with confusion is a
classic sign of hepatic encephalopathy, which is caused by the accumulation of
toxins, primarily serum ammonia, due to liver failure. Lipase is elevated in
pancreatitis. Creatinine measures renal function, which may be elevated if
hepatorenal syndrome occurs. Total bilirubin would be elevated, not decreased,
in a client with severe cirrhosis.
Question 3
A nurse is preparing to administer an intravenous bolus of regular insulin to a
client with diabetic ketoacidosis (DKA). Which of the following actions should the
nurse perform first?
A. Obtain a prescription for subcutaneous glargine insulin.
B. Check the client's current serum potassium level.
C. Administer 100 mL of 5% dextrose in water.
D. Assess the client’s deep tendon reflexes.
,Answer: B
Rationale: Regular insulin causes potassium to shift from the extracellular fluid
into the intracellular fluid, which can rapidly lower serum potassium levels. If the
client is already hypokalemic, administering insulin can precipitate dangerous
cardiac dysrhythmias. Therefore, checking the potassium level is the priority.
Long-acting glargine is not used for acute DKA management. Dextrose is added
to IV fluids only after blood glucose drops to around 250 mg/dL. DTRs are
monitored during magnesium sulfate therapy, not insulin therapy.
Question 4
A nurse in the emergency department is assessing a child who has a high fever, a
muffled voice, and is drooling while sitting in a tripod position. Which of the
following interventions is the priority?
A. Obtain a throat culture using a sterile swab.
B. Initiate an intravenous line for antibiotic delivery.
C. Arrange for immediate transport to radiology for a lateral neck X-ray.
D. Maintain a calm environment and prepare for emergency airway management.
Answer: D
Rationale: The child is exhibiting classic signs of epiglottitis (fever, drooling,
tripod position, muffled voice), which is a medical emergency due to the risk of
abrupt airway obstruction. The priority is to keep the child calm to prevent
laryngospasm and prepare for emergency intubation. Inserting a throat swab or
stressing the child with transport to radiology can cause total airway closure
and is strictly contraindicated until the airway is secured. IV access should be
established only after airway tools are at the bedside.
Question 5
A charge nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which of the following assignments is appropriate for the UAP?
A. Feeding a client who has dysphagia following a recent stroke.
, B. Transporting a stable client to the direct observation unit via wheelchair.
C. Re-applying a sterile dressing that became dislodged from a central line.
D. Evaluating a client's pain level 30 minutes after medication administration.
Answer: B
Rationale: Transporting a stable client is within the scope of practice for a UAP
because it requires no specialized nursing assessment, clinical judgment, or
evaluation. Feeding a client with dysphagia poses an aspiration risk and requires
nursing judgment. Sterile dressing changes and evaluating pain are professional
nursing responsibilities that cannot be delegated to assistive personnel.
Question 6
A nurse is caring for a client who is receiving a continuous intravenous infusion of
heparin for a pulmonary embolism. The client's activated partial thromboplastin
time (aPTT) is 110 seconds. Which of the following actions should the nurse
anticipate taking?
A. Increase the heparin infusion rate by 100 units/hour.
B. Stop the infusion and prepare to administer protamine sulfate.
C. Maintain the current infusion rate and recheck the aPTT in 4 hours.
D. Prepare an intravenous bolus of vitamin K.
Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5
to 2.5 times the normal control value (about 60 to 80 seconds). An aPTT of 110
seconds indicates critical over-anticoagulation and a high risk for spontaneous
bleeding. The nurse must stop the infusion and prepare the antidote, protamine
sulfate. Vitamin K is the antidote for warfarin, not heparin. Increasing or
maintaining the rate would put the client at severe risk.
Question 7
EXAM PREP STUDY GUIDE HIGH-YIELD
QUESTIONS, ANSWERS, AND RATIONALES
This comprehensive ATI Capstone and NCLEX-RN study guide features high-yield
multiple-choice questions complete with correct answers and bold-italic
rationales immediately following each item. The resource systematically covers
critical testing domains including Medical-Surgical nursing, advanced
pharmacology, maternal-newborn care, pediatrics, and management delegation.
It serves as an optimized, all-in-one preparation tool designed to help nursing
students identify knowledge gaps, master prioritization frameworks, and pass
their board exams on the first attempt.
Question 1
A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which of the following actions should the nurse take to prevent deep
vein thrombosis (DVT)?
A. Place a pillow directly under the client's knees.
B. Apply sequential compression devices (SCDs) to both lower extremities.
C. Maintain the client on strict bed rest for 48 hours.
D. Massage the client’s calves daily during morning care.
Answer: B
Rationale: Sequential compression devices promote venous return and prevent
venous stasis, which is the priority intervention to reduce the risk of DVT in
postoperative clients. Placing a pillow under the knees can compress the
popliteal vessels and increase stasis. Early ambulation, rather than strict bed
,rest, is indicated. Massaging the calves is strictly contraindicated because it can
dislodge an undetected clot, leading to a pulmonary embolism.
Question 2
A nurse is assessing a client who has a history of severe cirrhosis and is exhibiting
confusion. The nurse notes a flapping tremor of the hands when the client
extends their arms. Which of the following laboratory values should the nurse
anticipate?
A. Elevated serum ammonia
B. Elevated serum lipase
C. Decreased serum creatinine
D. Decreased total bilirubin
Answer: A
Rationale: A flapping tremor of the hands (asterixis) coupled with confusion is a
classic sign of hepatic encephalopathy, which is caused by the accumulation of
toxins, primarily serum ammonia, due to liver failure. Lipase is elevated in
pancreatitis. Creatinine measures renal function, which may be elevated if
hepatorenal syndrome occurs. Total bilirubin would be elevated, not decreased,
in a client with severe cirrhosis.
Question 3
A nurse is preparing to administer an intravenous bolus of regular insulin to a
client with diabetic ketoacidosis (DKA). Which of the following actions should the
nurse perform first?
A. Obtain a prescription for subcutaneous glargine insulin.
B. Check the client's current serum potassium level.
C. Administer 100 mL of 5% dextrose in water.
D. Assess the client’s deep tendon reflexes.
,Answer: B
Rationale: Regular insulin causes potassium to shift from the extracellular fluid
into the intracellular fluid, which can rapidly lower serum potassium levels. If the
client is already hypokalemic, administering insulin can precipitate dangerous
cardiac dysrhythmias. Therefore, checking the potassium level is the priority.
Long-acting glargine is not used for acute DKA management. Dextrose is added
to IV fluids only after blood glucose drops to around 250 mg/dL. DTRs are
monitored during magnesium sulfate therapy, not insulin therapy.
Question 4
A nurse in the emergency department is assessing a child who has a high fever, a
muffled voice, and is drooling while sitting in a tripod position. Which of the
following interventions is the priority?
A. Obtain a throat culture using a sterile swab.
B. Initiate an intravenous line for antibiotic delivery.
C. Arrange for immediate transport to radiology for a lateral neck X-ray.
D. Maintain a calm environment and prepare for emergency airway management.
Answer: D
Rationale: The child is exhibiting classic signs of epiglottitis (fever, drooling,
tripod position, muffled voice), which is a medical emergency due to the risk of
abrupt airway obstruction. The priority is to keep the child calm to prevent
laryngospasm and prepare for emergency intubation. Inserting a throat swab or
stressing the child with transport to radiology can cause total airway closure
and is strictly contraindicated until the airway is secured. IV access should be
established only after airway tools are at the bedside.
Question 5
A charge nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which of the following assignments is appropriate for the UAP?
A. Feeding a client who has dysphagia following a recent stroke.
, B. Transporting a stable client to the direct observation unit via wheelchair.
C. Re-applying a sterile dressing that became dislodged from a central line.
D. Evaluating a client's pain level 30 minutes after medication administration.
Answer: B
Rationale: Transporting a stable client is within the scope of practice for a UAP
because it requires no specialized nursing assessment, clinical judgment, or
evaluation. Feeding a client with dysphagia poses an aspiration risk and requires
nursing judgment. Sterile dressing changes and evaluating pain are professional
nursing responsibilities that cannot be delegated to assistive personnel.
Question 6
A nurse is caring for a client who is receiving a continuous intravenous infusion of
heparin for a pulmonary embolism. The client's activated partial thromboplastin
time (aPTT) is 110 seconds. Which of the following actions should the nurse
anticipate taking?
A. Increase the heparin infusion rate by 100 units/hour.
B. Stop the infusion and prepare to administer protamine sulfate.
C. Maintain the current infusion rate and recheck the aPTT in 4 hours.
D. Prepare an intravenous bolus of vitamin K.
Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5
to 2.5 times the normal control value (about 60 to 80 seconds). An aPTT of 110
seconds indicates critical over-anticoagulation and a high risk for spontaneous
bleeding. The nurse must stop the infusion and prepare the antidote, protamine
sulfate. Vitamin K is the antidote for warfarin, not heparin. Increasing or
maintaining the rate would put the client at severe risk.
Question 7
