ATI RN Capstone Proctored Pre-Assessment - 180 Questions & Verified Answers 2026 Updated | NCLEX-RN Review
ATI RN CAPSTONE PROCTORED
PRE-ASSESSMENT
ACTUAL EXAM | 2026 UPDATED
Complete Questions with Verified Correct Answers & Detailed Rationales
Ultimate NCLEX-RN Review | Comprehensive ATI-Style Proctored Preparation
Cognitive Distribution: 25% Recall | 55% Application | 20% Analysis • Format: 4-Option Multiple Choice •
Style: 80% Scenario-Based, 20% Recall/Calculation
Examination Overview. This 180-question comprehensive examination mirrors the structure, cognitive demand,
and clinical reasoning expectations of the ATI RN Capstone Proctored Pre-Assessment and aligns with the current
NCLEX-RN test plan. Items are distributed across the eight NCLEX Client Need categories and integrate Next
Generation NCLEX clinical judgment (recognizing cues, analyzing cues, prioritizing hypotheses, generating
solutions, taking action, evaluating outcomes). Each item provides a single verified correct answer, three field-tested
distractors representing the most common ATI Capstone pitfalls, and a detailed rationale grounded in ATI testing
strategies, prioritization frameworks (ABCs, Maslow, Safety, Least Restrictive, Delegation), and evidence-based
practice.
How to Use This Exam. Complete each section in sequence. After selecting your answer, review the rationale to
identify the ATI testing strategy or prioritization framework that determined the correct response. The rationales
emphasize the nursing process, ABC prioritization, Maslow's hierarchy, the Five Rights of Delegation, Six Rights of
Medication Administration, standard and transmission-based precautions, and clinical judgment cues that signal
deterioration.
Section 1: Management of Care
Advocacy | Delegation | Ethics | Legal | Case Management
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 1
,ATI RN Capstone Proctored Pre-Assessment - 180 Questions & Verified Answers 2026 Updated | NCLEX-RN Review
Q1: A nurse on a medical-surgical unit is caring for four clients. Which client should the nurse
assess first?
A. A client who is 2 days postoperative requesting pain medication for incisional pain rated 6/10
B. A client with chronic obstructive pulmonary disease (COPD) whose oxygen saturation dropped from
92% to 86% on room air [CORRECT]
C. A client with type 1 diabetes who is scheduled to receive their morning insulin and is requesting breakfast
D. A client admitted with pneumonia who is scheduled to be discharged today and needs discharge teaching
Correct Answer: B
Rationale: Using the ABC priority framework, the COPD client with a dropping oxygen saturation (86%) represents
an airway/breathing compromise requiring immediate assessment and intervention. Option A is pain, which is
important but follows ABC. Option C is a scheduled medication with a safety concern (insulin before breakfast) but
is not as acute as hypoxia. Option D is important but routine. ATI testing strategy: when multiple clients need
attention, always identify the one whose airway, breathing, or circulation is compromised and assess that client first.
Q2: A registered nurse (RN) is delegating tasks to a licensed practical nurse (LPN) and an
unlicensed assistive personnel (UAP). Which task is most appropriate to assign to the UAP?
A. Reinforcing teaching about a low-sodium diet for a client with heart failure
B. Measuring vital signs on a stable client 2 days after an appendectomy [CORRECT]
C. Administering an oral antibiotic to a client with a stable infection
D. Assessing a client's surgical incision for signs of infection
Correct Answer: B
Rationale: Measuring vital signs on a stable postoperative client is within the UAP scope of practice because it is a
routine, predictable task that does not require clinical judgment. Option A (teaching) requires nursing knowledge and
must be done by an RN. Option C (medication administration) is outside the UAP scope. Option D (assessment)
requires nursing judgment and cannot be delegated to UAP. The Five Rights of Delegation include right task, right
circumstance, right person, right direction, and right supervision; vital signs on a stable client meet these criteria.
Q3: A client scheduled for an elective cholecystectomy refuses to sign the surgical consent after
the surgeon has explained the procedure, risks, and alternatives. The client states, 'I need more
time to think about it.' What is the nurse's most appropriate action?
A. Remind the client that the operating room is scheduled and encourage signing to avoid delays
B. Notify the surgeon of the client's refusal and document the client's statement verbatim in the medical
record [CORRECT]
C. Explain the risks again using simpler language to ensure the client understands
D. Sign the consent as a witness to verify the client's decision-making capacity
Correct Answer: B
Rationale: Informed consent is the surgeon's legal responsibility, and a competent adult has the absolute right to
refuse even after explanation. The nurse's role is to notify the surgeon of the refusal and document the client's
statement verbatim. Option A is coercion and violates autonomy. Option C oversteps the nurse's scope;
re-explanation is the surgeon's responsibility. Option D misrepresents the consent process; witnessing confirms
identity and voluntary signature, not capacity assessment. ATI strategy: respect client autonomy and document
refusals thoroughly.
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 2
,ATI RN Capstone Proctored Pre-Assessment - 180 Questions & Verified Answers 2026 Updated | NCLEX-RN Review
Q4: A client with a terminal illness tells the nurse, 'I want my daughter to make decisions for me if I
can't speak for myself.' Which document should the nurse help the client complete?
A. Informed consent
B. Durable power of attorney for health care [CORRECT]
C. Do-not-resuscitate (DNR) order
D. Incident report
Correct Answer: B
Rationale: A durable power of attorney for health care (healthcare proxy) is a legal document that designates a
surrogate decision-maker if the client becomes unable to make decisions. Option A (informed consent) is for specific
procedures. Option C (DNR) addresses resuscitation only. Option D (incident report) is an internal document for
unexpected events. ATI tip: an advance directive is a general term that includes both the living will (instructions) and
the durable power of attorney (proxy designation).
Q5: A nurse notices that a coworker appears impaired and is preparing to administer medications.
What is the nurse's most appropriate action?
A. Discuss the observation privately with the coworker to offer support
B. Report the observation to the nursing supervisor immediately per facility policy [CORRECT]
C. Wait until the end of the shift to see if the coworker's condition improves
D. Ask another coworker to confirm the observation before reporting
Correct Answer: B
Rationale: Patient safety is the priority; a nurse who appears impaired poses an immediate risk to clients. The nurse
must report the observation to the nursing supervisor immediately per facility policy and chain of command. Option
A delays safety action and may allow continued impairment. Option C allows continued unsafe practice. Option D
delays intervention; the reporting nurse does not need confirmation to escalate a safety concern. ATI ethical
principle: the duty to protect clients supersedes loyalty to colleagues.
Q6: An older adult client with dementia repeatedly attempts to climb out of bed despite the bed
alarm being activated. The family requests wrist restraints. Which nursing action best
demonstrates least-restrictive care?
A. Apply wrist restraints per the family's request
B. Implement scheduled toileting, frequent reorientation, and move the client closer to the nurses' station
[CORRECT]
C. Request a sedative medication order to keep the client calm
D. Raise all four side rails to prevent the client from climbing out
Correct Answer: B
Rationale: Least-restrictive interventions must be tried before restraints; scheduled toileting, reorientation, and
proximity to the nurses' station address underlying unmet needs (a common cause of restlessness in dementia).
Option A (restraints) is the most restrictive and should be a last resort. Option C (sedative) is chemical restraint and
increases fall/delirium risk. Option D (four side rails) is considered a restraint and can cause entrapment injury. ATI
strategy: always assess for underlying causes (pain, toileting, hunger, fear) before implementing restrictive measures.
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 3
, ATI RN Capstone Proctored Pre-Assessment - 180 Questions & Verified Answers 2026 Updated | NCLEX-RN Review
Q7: A client with active pulmonary tuberculosis is admitted to the medical-surgical unit. Which
infection control precautions should the nurse implement?
A. Standard precautions only
B. Airborne precautions with a negative-pressure room and N95 respirator [CORRECT]
C. Droplet precautions with a private room and surgical mask
D. Contact precautions with gown and gloves
Correct Answer: B
Rationale: Pulmonary tuberculosis is transmitted via airborne droplet nuclei smaller than 5 microns that remain
suspended in air, requiring airborne precautions: a negative-pressure AIIR room and an N95 (or higher) respirator for
all who enter. Option A is insufficient. Option C (droplet) is for larger particles (influenza, meningococcal). Option D
(contact) is for direct contact transmission (MRSA, C. difficile). The client wears a surgical mask only during
transport. ATI tip: know the three transmission-based precaution types and their PPE requirements cold.
Q8: A client who is Jehovah's Witness refuses a life-saving blood transfusion, citing religious
beliefs. The client's spouse begs the nurse to administer the blood anyway. What is the nurse's
best response?
A. 'I'll notify the healthcare provider so the ethics committee can review the case.'
B. 'A competent adult's refusal must be honored; I cannot override the client's documented wishes.'
[CORRECT]
C. 'If the client becomes unconscious, we can administer the blood as an emergency.'
D. 'Let me contact pastoral care to see if an exception can be made.'
Correct Answer: B
Rationale: A competent adult's informed refusal must be honored, even in life-threatening situations; spouse wishes
cannot override client autonomy. Option A (ethics committee) is appropriate only if capacity is in question, not as a
primary action. Option C violates informed consent and constitutes battery. Option D (pastoral care) cannot grant
religious exceptions. ATI ethical principle: respect for autonomy — the client has the right to refuse any treatment,
including life-saving ones, after being fully informed of consequences.
Q9: A nurse is caring for a client with a suspected bowel obstruction. The healthcare provider
orders a nasogastric (NG) tube to low intermittent suction. The client refuses, stating, 'I don't want
that tube.' What is the nurse's most appropriate initial action?
A. Insert the NG tube as ordered because the healthcare provider prescribed it
B. Explore the client's reasons for refusing and provide education about the tube's purpose [CORRECT]
C. Document the refusal and discontinue the order
D. Notify the healthcare provider that the client is noncompliant
Correct Answer: B
Rationale: The nurse's initial action is to explore the client's concerns and provide education to ensure informed
refusal; the client has the right to refuse treatment. Option A violates informed consent. Option C is premature; the
nurse should first try to understand and address the refusal. Option D may be needed eventually but only after the
nurse has explored the client's reasoning and provided education. ATI strategy: when a client refuses, assess
understanding first, then educate, then document and notify.
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 4
ATI RN CAPSTONE PROCTORED
PRE-ASSESSMENT
ACTUAL EXAM | 2026 UPDATED
Complete Questions with Verified Correct Answers & Detailed Rationales
Ultimate NCLEX-RN Review | Comprehensive ATI-Style Proctored Preparation
Cognitive Distribution: 25% Recall | 55% Application | 20% Analysis • Format: 4-Option Multiple Choice •
Style: 80% Scenario-Based, 20% Recall/Calculation
Examination Overview. This 180-question comprehensive examination mirrors the structure, cognitive demand,
and clinical reasoning expectations of the ATI RN Capstone Proctored Pre-Assessment and aligns with the current
NCLEX-RN test plan. Items are distributed across the eight NCLEX Client Need categories and integrate Next
Generation NCLEX clinical judgment (recognizing cues, analyzing cues, prioritizing hypotheses, generating
solutions, taking action, evaluating outcomes). Each item provides a single verified correct answer, three field-tested
distractors representing the most common ATI Capstone pitfalls, and a detailed rationale grounded in ATI testing
strategies, prioritization frameworks (ABCs, Maslow, Safety, Least Restrictive, Delegation), and evidence-based
practice.
How to Use This Exam. Complete each section in sequence. After selecting your answer, review the rationale to
identify the ATI testing strategy or prioritization framework that determined the correct response. The rationales
emphasize the nursing process, ABC prioritization, Maslow's hierarchy, the Five Rights of Delegation, Six Rights of
Medication Administration, standard and transmission-based precautions, and clinical judgment cues that signal
deterioration.
Section 1: Management of Care
Advocacy | Delegation | Ethics | Legal | Case Management
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 1
,ATI RN Capstone Proctored Pre-Assessment - 180 Questions & Verified Answers 2026 Updated | NCLEX-RN Review
Q1: A nurse on a medical-surgical unit is caring for four clients. Which client should the nurse
assess first?
A. A client who is 2 days postoperative requesting pain medication for incisional pain rated 6/10
B. A client with chronic obstructive pulmonary disease (COPD) whose oxygen saturation dropped from
92% to 86% on room air [CORRECT]
C. A client with type 1 diabetes who is scheduled to receive their morning insulin and is requesting breakfast
D. A client admitted with pneumonia who is scheduled to be discharged today and needs discharge teaching
Correct Answer: B
Rationale: Using the ABC priority framework, the COPD client with a dropping oxygen saturation (86%) represents
an airway/breathing compromise requiring immediate assessment and intervention. Option A is pain, which is
important but follows ABC. Option C is a scheduled medication with a safety concern (insulin before breakfast) but
is not as acute as hypoxia. Option D is important but routine. ATI testing strategy: when multiple clients need
attention, always identify the one whose airway, breathing, or circulation is compromised and assess that client first.
Q2: A registered nurse (RN) is delegating tasks to a licensed practical nurse (LPN) and an
unlicensed assistive personnel (UAP). Which task is most appropriate to assign to the UAP?
A. Reinforcing teaching about a low-sodium diet for a client with heart failure
B. Measuring vital signs on a stable client 2 days after an appendectomy [CORRECT]
C. Administering an oral antibiotic to a client with a stable infection
D. Assessing a client's surgical incision for signs of infection
Correct Answer: B
Rationale: Measuring vital signs on a stable postoperative client is within the UAP scope of practice because it is a
routine, predictable task that does not require clinical judgment. Option A (teaching) requires nursing knowledge and
must be done by an RN. Option C (medication administration) is outside the UAP scope. Option D (assessment)
requires nursing judgment and cannot be delegated to UAP. The Five Rights of Delegation include right task, right
circumstance, right person, right direction, and right supervision; vital signs on a stable client meet these criteria.
Q3: A client scheduled for an elective cholecystectomy refuses to sign the surgical consent after
the surgeon has explained the procedure, risks, and alternatives. The client states, 'I need more
time to think about it.' What is the nurse's most appropriate action?
A. Remind the client that the operating room is scheduled and encourage signing to avoid delays
B. Notify the surgeon of the client's refusal and document the client's statement verbatim in the medical
record [CORRECT]
C. Explain the risks again using simpler language to ensure the client understands
D. Sign the consent as a witness to verify the client's decision-making capacity
Correct Answer: B
Rationale: Informed consent is the surgeon's legal responsibility, and a competent adult has the absolute right to
refuse even after explanation. The nurse's role is to notify the surgeon of the refusal and document the client's
statement verbatim. Option A is coercion and violates autonomy. Option C oversteps the nurse's scope;
re-explanation is the surgeon's responsibility. Option D misrepresents the consent process; witnessing confirms
identity and voluntary signature, not capacity assessment. ATI strategy: respect client autonomy and document
refusals thoroughly.
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 2
,ATI RN Capstone Proctored Pre-Assessment - 180 Questions & Verified Answers 2026 Updated | NCLEX-RN Review
Q4: A client with a terminal illness tells the nurse, 'I want my daughter to make decisions for me if I
can't speak for myself.' Which document should the nurse help the client complete?
A. Informed consent
B. Durable power of attorney for health care [CORRECT]
C. Do-not-resuscitate (DNR) order
D. Incident report
Correct Answer: B
Rationale: A durable power of attorney for health care (healthcare proxy) is a legal document that designates a
surrogate decision-maker if the client becomes unable to make decisions. Option A (informed consent) is for specific
procedures. Option C (DNR) addresses resuscitation only. Option D (incident report) is an internal document for
unexpected events. ATI tip: an advance directive is a general term that includes both the living will (instructions) and
the durable power of attorney (proxy designation).
Q5: A nurse notices that a coworker appears impaired and is preparing to administer medications.
What is the nurse's most appropriate action?
A. Discuss the observation privately with the coworker to offer support
B. Report the observation to the nursing supervisor immediately per facility policy [CORRECT]
C. Wait until the end of the shift to see if the coworker's condition improves
D. Ask another coworker to confirm the observation before reporting
Correct Answer: B
Rationale: Patient safety is the priority; a nurse who appears impaired poses an immediate risk to clients. The nurse
must report the observation to the nursing supervisor immediately per facility policy and chain of command. Option
A delays safety action and may allow continued impairment. Option C allows continued unsafe practice. Option D
delays intervention; the reporting nurse does not need confirmation to escalate a safety concern. ATI ethical
principle: the duty to protect clients supersedes loyalty to colleagues.
Q6: An older adult client with dementia repeatedly attempts to climb out of bed despite the bed
alarm being activated. The family requests wrist restraints. Which nursing action best
demonstrates least-restrictive care?
A. Apply wrist restraints per the family's request
B. Implement scheduled toileting, frequent reorientation, and move the client closer to the nurses' station
[CORRECT]
C. Request a sedative medication order to keep the client calm
D. Raise all four side rails to prevent the client from climbing out
Correct Answer: B
Rationale: Least-restrictive interventions must be tried before restraints; scheduled toileting, reorientation, and
proximity to the nurses' station address underlying unmet needs (a common cause of restlessness in dementia).
Option A (restraints) is the most restrictive and should be a last resort. Option C (sedative) is chemical restraint and
increases fall/delirium risk. Option D (four side rails) is considered a restraint and can cause entrapment injury. ATI
strategy: always assess for underlying causes (pain, toileting, hunger, fear) before implementing restrictive measures.
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 3
, ATI RN Capstone Proctored Pre-Assessment - 180 Questions & Verified Answers 2026 Updated | NCLEX-RN Review
Q7: A client with active pulmonary tuberculosis is admitted to the medical-surgical unit. Which
infection control precautions should the nurse implement?
A. Standard precautions only
B. Airborne precautions with a negative-pressure room and N95 respirator [CORRECT]
C. Droplet precautions with a private room and surgical mask
D. Contact precautions with gown and gloves
Correct Answer: B
Rationale: Pulmonary tuberculosis is transmitted via airborne droplet nuclei smaller than 5 microns that remain
suspended in air, requiring airborne precautions: a negative-pressure AIIR room and an N95 (or higher) respirator for
all who enter. Option A is insufficient. Option C (droplet) is for larger particles (influenza, meningococcal). Option D
(contact) is for direct contact transmission (MRSA, C. difficile). The client wears a surgical mask only during
transport. ATI tip: know the three transmission-based precaution types and their PPE requirements cold.
Q8: A client who is Jehovah's Witness refuses a life-saving blood transfusion, citing religious
beliefs. The client's spouse begs the nurse to administer the blood anyway. What is the nurse's
best response?
A. 'I'll notify the healthcare provider so the ethics committee can review the case.'
B. 'A competent adult's refusal must be honored; I cannot override the client's documented wishes.'
[CORRECT]
C. 'If the client becomes unconscious, we can administer the blood as an emergency.'
D. 'Let me contact pastoral care to see if an exception can be made.'
Correct Answer: B
Rationale: A competent adult's informed refusal must be honored, even in life-threatening situations; spouse wishes
cannot override client autonomy. Option A (ethics committee) is appropriate only if capacity is in question, not as a
primary action. Option C violates informed consent and constitutes battery. Option D (pastoral care) cannot grant
religious exceptions. ATI ethical principle: respect for autonomy — the client has the right to refuse any treatment,
including life-saving ones, after being fully informed of consequences.
Q9: A nurse is caring for a client with a suspected bowel obstruction. The healthcare provider
orders a nasogastric (NG) tube to low intermittent suction. The client refuses, stating, 'I don't want
that tube.' What is the nurse's most appropriate initial action?
A. Insert the NG tube as ordered because the healthcare provider prescribed it
B. Explore the client's reasons for refusing and provide education about the tube's purpose [CORRECT]
C. Document the refusal and discontinue the order
D. Notify the healthcare provider that the client is noncompliant
Correct Answer: B
Rationale: The nurse's initial action is to explore the client's concerns and provide education to ensure informed
refusal; the client has the right to refuse treatment. Option A violates informed consent. Option C is premature; the
nurse should first try to understand and address the refusal. Option D may be needed eventually but only after the
nurse has explored the client's reasoning and provided education. ATI strategy: when a client refuses, assess
understanding first, then educate, then document and notify.
ATI RN Capstone | Ultimate NCLEX-RN Review | 2026 Edition Page 4
