ATI Capstone Comprehensive Exam V3 |
2026 Q&A with Rationale (ATI Capstone
Comprehensive Exam 2026)
1. A nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which of
the following findings should the nurse report to the provider immediately?
A. Clubbing of the fingers
B. Oxygen saturation of 89% on room air
C. Productive cough with clear sputum
D. Increased use of accessory muscles and paradoxical chest movement
Correct Answer: D
Rationale: Paradoxical chest movement and increased use of accessory muscles indicate
acute respiratory distress or potential respiratory failure. While clubbing and low oxygen
saturation are common in COPD, they are typically expected chronic findings rather than
acute emergencies. The nurse must prioritize signs of immediate airway or breathing
compromise to ensure client safety.
2. A nurse is caring for a client who is in the active phase of labor and reports severe back
pain. Which of the following non-pharmacological interventions should the nurse perform?
(Select All That Apply)
A. Apply counterpressure to the sacral area
,B. Administer an IV opioid analgesic
C. Assist the client into a hands-and-knees position
D. Encourage the client to maintain a supine position
E. Perform Effleurage on the abdomen
F. Apply cold compresses to the lower back
Correct Answer: A,C,E,F
Rationale: Counterpressure and hands-and-knees positioning help alleviate back pain,
especially if the fetus is in an occiput posterior position. Effleurage and cold/heat therapy
are also effective non-pharmacological comfort measures for laboring clients. Opioid
analgesics are pharmacological, and the supine position should be avoided to prevent vena
cava compression.
3. A nurse is preparing to administer digoxin 0.25 mg PO to a client with heart failure. Which
of the following findings should lead the nurse to withhold the medication?
A. Blood pressure of 110/70 mmHg
B. Potassium level of 4.8 mEq/L
C. Digoxin level of 1.2 ng/mL
D. Apical pulse of 52/min
Correct Answer: D
,Rationale: Digoxin is an inotropic agent that slows the heart rate; therefore, it should be
withheld if the apical pulse is less than 60/min in adults. The potassium level and digoxin
level provided are within the reference ranges. Monitoring the heart rate is the most
critical assessment before administering this medication to prevent bradycardia.
4. Extended Multiple Response (Matrix): A nurse is assessing a client with suspected
hyperthyroidism. Which of the following sets of clinical manifestations and lab values should
the nurse expect?
A. Weight loss, Tachycardia, Increased T4
B. Weight gain, Bradycardia, Decreased T4
C. Heat intolerance, Constipation, Decreased TSH
D. Cold intolerance, Tremors, Increased TSH
Correct Answer: A
Rationale: Hyperthyroidism is characterized by an overactive metabolism, leading to
weight loss, tachycardia, and elevated T4 levels. Patients often experience heat intolerance
and diarrhea rather than constipation. Understanding the metabolic impact of thyroid
hormones is essential for differentiating between hyper and hypo states.
5. A nurse is teaching a client who has a new prescription for lithium carbonate to treat
bipolar disorder. Which of the following instructions should the nurse include?
A. Limit sodium intake to 1,500 mg per day
B. Take the medication on an empty stomach
, C. Maintain a consistent fluid intake of 2 to 3 liters per day
D. Discontinue the medication if hand tremors occur
Correct Answer: C
Rationale: Lithium has a narrow therapeutic index, and maintaining consistent fluid and
sodium intake is vital to prevent toxicity. Decreased sodium or dehydration can cause the
kidneys to retain lithium, leading to dangerously high levels. Clients should be taught to
recognize signs of toxicity but should not stop the medication without consulting a
provider unless it is an emergency.
6. A nurse is reviewing the laboratory results for a client receiving heparin by continuous IV
infusion. Which of the following results indicates the infusion rate should be adjusted?
A. aPTT of 30 seconds
B. aPTT of 70 seconds
C. PT of 12 seconds
D. INR of 1.1
Correct Answer: A
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5
times the control value (usually 60-80 seconds). An aPTT of 30 seconds is too low,
indicating the client is not adequately anticoagulated and the rate needs to be increased. PT
and INR are used to monitor warfarin therapy, not heparin.
2026 Q&A with Rationale (ATI Capstone
Comprehensive Exam 2026)
1. A nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which of
the following findings should the nurse report to the provider immediately?
A. Clubbing of the fingers
B. Oxygen saturation of 89% on room air
C. Productive cough with clear sputum
D. Increased use of accessory muscles and paradoxical chest movement
Correct Answer: D
Rationale: Paradoxical chest movement and increased use of accessory muscles indicate
acute respiratory distress or potential respiratory failure. While clubbing and low oxygen
saturation are common in COPD, they are typically expected chronic findings rather than
acute emergencies. The nurse must prioritize signs of immediate airway or breathing
compromise to ensure client safety.
2. A nurse is caring for a client who is in the active phase of labor and reports severe back
pain. Which of the following non-pharmacological interventions should the nurse perform?
(Select All That Apply)
A. Apply counterpressure to the sacral area
,B. Administer an IV opioid analgesic
C. Assist the client into a hands-and-knees position
D. Encourage the client to maintain a supine position
E. Perform Effleurage on the abdomen
F. Apply cold compresses to the lower back
Correct Answer: A,C,E,F
Rationale: Counterpressure and hands-and-knees positioning help alleviate back pain,
especially if the fetus is in an occiput posterior position. Effleurage and cold/heat therapy
are also effective non-pharmacological comfort measures for laboring clients. Opioid
analgesics are pharmacological, and the supine position should be avoided to prevent vena
cava compression.
3. A nurse is preparing to administer digoxin 0.25 mg PO to a client with heart failure. Which
of the following findings should lead the nurse to withhold the medication?
A. Blood pressure of 110/70 mmHg
B. Potassium level of 4.8 mEq/L
C. Digoxin level of 1.2 ng/mL
D. Apical pulse of 52/min
Correct Answer: D
,Rationale: Digoxin is an inotropic agent that slows the heart rate; therefore, it should be
withheld if the apical pulse is less than 60/min in adults. The potassium level and digoxin
level provided are within the reference ranges. Monitoring the heart rate is the most
critical assessment before administering this medication to prevent bradycardia.
4. Extended Multiple Response (Matrix): A nurse is assessing a client with suspected
hyperthyroidism. Which of the following sets of clinical manifestations and lab values should
the nurse expect?
A. Weight loss, Tachycardia, Increased T4
B. Weight gain, Bradycardia, Decreased T4
C. Heat intolerance, Constipation, Decreased TSH
D. Cold intolerance, Tremors, Increased TSH
Correct Answer: A
Rationale: Hyperthyroidism is characterized by an overactive metabolism, leading to
weight loss, tachycardia, and elevated T4 levels. Patients often experience heat intolerance
and diarrhea rather than constipation. Understanding the metabolic impact of thyroid
hormones is essential for differentiating between hyper and hypo states.
5. A nurse is teaching a client who has a new prescription for lithium carbonate to treat
bipolar disorder. Which of the following instructions should the nurse include?
A. Limit sodium intake to 1,500 mg per day
B. Take the medication on an empty stomach
, C. Maintain a consistent fluid intake of 2 to 3 liters per day
D. Discontinue the medication if hand tremors occur
Correct Answer: C
Rationale: Lithium has a narrow therapeutic index, and maintaining consistent fluid and
sodium intake is vital to prevent toxicity. Decreased sodium or dehydration can cause the
kidneys to retain lithium, leading to dangerously high levels. Clients should be taught to
recognize signs of toxicity but should not stop the medication without consulting a
provider unless it is an emergency.
6. A nurse is reviewing the laboratory results for a client receiving heparin by continuous IV
infusion. Which of the following results indicates the infusion rate should be adjusted?
A. aPTT of 30 seconds
B. aPTT of 70 seconds
C. PT of 12 seconds
D. INR of 1.1
Correct Answer: A
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5
times the control value (usually 60-80 seconds). An aPTT of 30 seconds is too low,
indicating the client is not adequately anticoagulated and the rate needs to be increased. PT
and INR are used to monitor warfarin therapy, not heparin.
