ATI Comprehensive Practice B /RN 2026/2027, ATI
Capstone Proctored Comprehensive Assessment
Questions, answers and Rationales All verified
1. A 67-year-old adult presents with crushing chest pain radiating to the left shoulder,
nausea, and diaphoresis while gardening. Blood pressure is 86/52 mmHg, and ECG
shows ST-segment elevation in anterior leads. Which intervention should be performed
first?
A. Administer sublingual nitroglycerin
B. Start IV heparin
C. (CORRECT) Administer oxygen
D. Give morphine
Rationale: ST-elevation myocardial infarction with hypotension requires immediate
attention to oxygen delivery to prevent further myocardial ischemia. Oxygen restores tissue
perfusion and prevents worsening hypoxia. While nitroglycerin, morphine, and
anticoagulation are important, oxygenation is the first priority according to ABC principles.
2. Forty-eight hours after knee replacement, a patient experiences sudden dyspnea,
pleuritic chest pain, and a drop in oxygen saturation to 82%. Heart rate is 126/min.
Which complication should be suspected?
A. Pneumonia
B. Myocardial infarction
C. Pulmonary embolism
D. Atelectasis
Rationale: Postoperative immobility increases thromboembolism risk. Sudden onset
hypoxia, tachycardia, and pleuritic chest pain strongly indicate pulmonary embolism. Early
recognition allows timely anticoagulation, reducing risk of mortality. Pneumonia or
atelectasis usually develop gradually and are less acute in presentation.
3. An adult is found unconscious at home with a blood glucose of 28 mg/dL. IV access is
not available. What is the safest and most effective intervention to rapidly raise blood
glucose?
A. Oral glucose gel
B. Dextrose 50% IV
C. Regular insulin
D. Glucagon IM
,Rationale: Unconscious patients cannot safely receive oral glucose due to aspiration risk.
Without IV access, intramuscular glucagon stimulates hepatic glycogenolysis to raise blood
glucose levels quickly. Insulin would worsen hypoglycemia. Rapid intervention prevents
neurological injury and life-threatening complications.
4. A patient is found unresponsive with pulseless ventricular fibrillation on telemetry.
Immediate intervention is necessary. What should be done first?
A. Administer amiodarone
B. Insert an airway
C. Defibrillate immediately
D. Check blood pressure
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation.
CPR should continue until defibrillation. Medications like amiodarone are secondary
interventions. Immediate action prevents sudden cardiac death and restores perfusion.
5. A 55-year-old presents with severe headache, nuchal rigidity, photophobia, and
fever. Before performing lumbar puncture, which assessment is essential to prevent
life-threatening complications?
A. Hypoglycemia
B. Sepsis
C. Increased intracranial pressure
D. Dehydration
Rationale: Performing lumbar puncture in the presence of elevated ICP can precipitate brain
herniation. Neurological assessment and imaging, such as CT scan, should precede LP. Early
identification ensures safe diagnostic procedures and prevents catastrophic neurological
outcomes.
6. Twenty minutes after vaginal delivery, a patient experiences heavy uterine bleeding
and a soft, boggy uterus. Vital signs show hypotension and tachycardia. What is the
immediate intervention?
A. Administer antibiotics
B. Insert urinary catheter
C. Prepare for blood transfusion
D. Massage the fundus
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. Fundal massage
stimulates uterine contraction and rapidly reduces bleeding. Early intervention prevents
hypovolemic shock and ensures maternal safety. Preparatory steps such as transfusions are
secondary to immediate mechanical stimulation.
,7. Laboratory results show potassium 6.8 mEq/L with peaked T waves on ECG. Which
intervention protects the myocardium immediately?
A. Insulin with dextrose
B. Sodium polystyrene sulfonate
C. Furosemide
D. Calcium gluconate
Rationale: Hyperkalemia with ECG changes increases risk for fatal arrhythmias. Calcium
gluconate stabilizes cardiac membranes instantly. Insulin lowers potassium gradually but
does not provide immediate protection. Prompt recognition reduces cardiac morbidity and
mortality.
8. After thyroidectomy, a patient develops stridor, drooling, and difficulty swallowing.
Oxygen saturation is 88%, respiratory rate is 28/min. What complication should be
managed immediately?
A. Hypocalcemia
B. Thyroid storm
C. Airway obstruction
D. Laryngeal paralysis
Rationale: Postoperative stridor indicates airway compromise, possibly from swelling or
hematoma. Immediate airway assessment and intervention prevent complete obstruction.
Delayed management can be fatal. Hypocalcemia or thyroid storm may co-occur but do not
pose immediate airway threat.
9. A child presents sitting upright, leaning forward, drooling, and refusing to speak.
Vital signs reveal fever and tachypnea. Which action should be avoided to prevent
airway collapse?
A. Prepare for intubation
B. Provide humidified oxygen
C. Administer IV antibiotics
D. Inspect throat with tongue depressor
Rationale: These findings suggest epiglottitis. Throat inspection may trigger complete
airway obstruction. Airway stabilization and oxygen support are priority. Rapid IV
antibiotics reduce infection progression. Safe management prevents respiratory failure.
10. After major trauma, a patient presents with hypotension (BP 70/40 mmHg),
tachycardia (HR 132/min), and cool, clammy skin. Which type of shock is most likely
occurring?
, A. Cardiogenic
B. Neurogenic
C. Septic
D. Hypovolemic
Rationale: Trauma with hypotension, tachycardia, and signs of hypoperfusion indicates
hypovolemic shock from blood loss. Rapid fluid resuscitation and blood transfusion restore
circulating volume and perfusion. Other types of shock present differently and would require
alternative interventions.
11. A patient suddenly develops right-sided facial droop, slurred speech, and right arm
weakness. Symptoms began 20 minutes ago. Which intervention is the immediate
priority?
A. Administer aspirin
B. Lower blood pressure immediately
C. Prepare for urgent CT scan
D. Provide oral fluids
Rationale: Early neuroimaging is required to differentiate ischemic from hemorrhagic
stroke. Thrombolytic therapy depends on stroke type. Administering medications before
diagnosis may be harmful. Rapid imaging maximizes neurological recovery.
12. During insulin infusion for diabetic ketoacidosis, which electrolyte imbalance is
most likely to develop?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
Rationale: Insulin shifts potassium into cells, decreasing serum potassium. Hypokalemia can
cause life-threatening arrhythmias. Frequent monitoring and replacement prevent cardiac
complications during DKA management.
13. A patient receiving magnesium sulfate for preeclampsia exhibits absent deep tendon
reflexes and respiratory rate of 7/min. Which intervention is required immediately?
A. Epinephrine
B. Naloxone
C. Atropine
D. Calcium gluconate
Capstone Proctored Comprehensive Assessment
Questions, answers and Rationales All verified
1. A 67-year-old adult presents with crushing chest pain radiating to the left shoulder,
nausea, and diaphoresis while gardening. Blood pressure is 86/52 mmHg, and ECG
shows ST-segment elevation in anterior leads. Which intervention should be performed
first?
A. Administer sublingual nitroglycerin
B. Start IV heparin
C. (CORRECT) Administer oxygen
D. Give morphine
Rationale: ST-elevation myocardial infarction with hypotension requires immediate
attention to oxygen delivery to prevent further myocardial ischemia. Oxygen restores tissue
perfusion and prevents worsening hypoxia. While nitroglycerin, morphine, and
anticoagulation are important, oxygenation is the first priority according to ABC principles.
2. Forty-eight hours after knee replacement, a patient experiences sudden dyspnea,
pleuritic chest pain, and a drop in oxygen saturation to 82%. Heart rate is 126/min.
Which complication should be suspected?
A. Pneumonia
B. Myocardial infarction
C. Pulmonary embolism
D. Atelectasis
Rationale: Postoperative immobility increases thromboembolism risk. Sudden onset
hypoxia, tachycardia, and pleuritic chest pain strongly indicate pulmonary embolism. Early
recognition allows timely anticoagulation, reducing risk of mortality. Pneumonia or
atelectasis usually develop gradually and are less acute in presentation.
3. An adult is found unconscious at home with a blood glucose of 28 mg/dL. IV access is
not available. What is the safest and most effective intervention to rapidly raise blood
glucose?
A. Oral glucose gel
B. Dextrose 50% IV
C. Regular insulin
D. Glucagon IM
,Rationale: Unconscious patients cannot safely receive oral glucose due to aspiration risk.
Without IV access, intramuscular glucagon stimulates hepatic glycogenolysis to raise blood
glucose levels quickly. Insulin would worsen hypoglycemia. Rapid intervention prevents
neurological injury and life-threatening complications.
4. A patient is found unresponsive with pulseless ventricular fibrillation on telemetry.
Immediate intervention is necessary. What should be done first?
A. Administer amiodarone
B. Insert an airway
C. Defibrillate immediately
D. Check blood pressure
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation.
CPR should continue until defibrillation. Medications like amiodarone are secondary
interventions. Immediate action prevents sudden cardiac death and restores perfusion.
5. A 55-year-old presents with severe headache, nuchal rigidity, photophobia, and
fever. Before performing lumbar puncture, which assessment is essential to prevent
life-threatening complications?
A. Hypoglycemia
B. Sepsis
C. Increased intracranial pressure
D. Dehydration
Rationale: Performing lumbar puncture in the presence of elevated ICP can precipitate brain
herniation. Neurological assessment and imaging, such as CT scan, should precede LP. Early
identification ensures safe diagnostic procedures and prevents catastrophic neurological
outcomes.
6. Twenty minutes after vaginal delivery, a patient experiences heavy uterine bleeding
and a soft, boggy uterus. Vital signs show hypotension and tachycardia. What is the
immediate intervention?
A. Administer antibiotics
B. Insert urinary catheter
C. Prepare for blood transfusion
D. Massage the fundus
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. Fundal massage
stimulates uterine contraction and rapidly reduces bleeding. Early intervention prevents
hypovolemic shock and ensures maternal safety. Preparatory steps such as transfusions are
secondary to immediate mechanical stimulation.
,7. Laboratory results show potassium 6.8 mEq/L with peaked T waves on ECG. Which
intervention protects the myocardium immediately?
A. Insulin with dextrose
B. Sodium polystyrene sulfonate
C. Furosemide
D. Calcium gluconate
Rationale: Hyperkalemia with ECG changes increases risk for fatal arrhythmias. Calcium
gluconate stabilizes cardiac membranes instantly. Insulin lowers potassium gradually but
does not provide immediate protection. Prompt recognition reduces cardiac morbidity and
mortality.
8. After thyroidectomy, a patient develops stridor, drooling, and difficulty swallowing.
Oxygen saturation is 88%, respiratory rate is 28/min. What complication should be
managed immediately?
A. Hypocalcemia
B. Thyroid storm
C. Airway obstruction
D. Laryngeal paralysis
Rationale: Postoperative stridor indicates airway compromise, possibly from swelling or
hematoma. Immediate airway assessment and intervention prevent complete obstruction.
Delayed management can be fatal. Hypocalcemia or thyroid storm may co-occur but do not
pose immediate airway threat.
9. A child presents sitting upright, leaning forward, drooling, and refusing to speak.
Vital signs reveal fever and tachypnea. Which action should be avoided to prevent
airway collapse?
A. Prepare for intubation
B. Provide humidified oxygen
C. Administer IV antibiotics
D. Inspect throat with tongue depressor
Rationale: These findings suggest epiglottitis. Throat inspection may trigger complete
airway obstruction. Airway stabilization and oxygen support are priority. Rapid IV
antibiotics reduce infection progression. Safe management prevents respiratory failure.
10. After major trauma, a patient presents with hypotension (BP 70/40 mmHg),
tachycardia (HR 132/min), and cool, clammy skin. Which type of shock is most likely
occurring?
, A. Cardiogenic
B. Neurogenic
C. Septic
D. Hypovolemic
Rationale: Trauma with hypotension, tachycardia, and signs of hypoperfusion indicates
hypovolemic shock from blood loss. Rapid fluid resuscitation and blood transfusion restore
circulating volume and perfusion. Other types of shock present differently and would require
alternative interventions.
11. A patient suddenly develops right-sided facial droop, slurred speech, and right arm
weakness. Symptoms began 20 minutes ago. Which intervention is the immediate
priority?
A. Administer aspirin
B. Lower blood pressure immediately
C. Prepare for urgent CT scan
D. Provide oral fluids
Rationale: Early neuroimaging is required to differentiate ischemic from hemorrhagic
stroke. Thrombolytic therapy depends on stroke type. Administering medications before
diagnosis may be harmful. Rapid imaging maximizes neurological recovery.
12. During insulin infusion for diabetic ketoacidosis, which electrolyte imbalance is
most likely to develop?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
Rationale: Insulin shifts potassium into cells, decreasing serum potassium. Hypokalemia can
cause life-threatening arrhythmias. Frequent monitoring and replacement prevent cardiac
complications during DKA management.
13. A patient receiving magnesium sulfate for preeclampsia exhibits absent deep tendon
reflexes and respiratory rate of 7/min. Which intervention is required immediately?
A. Epinephrine
B. Naloxone
C. Atropine
D. Calcium gluconate
