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Ati rn vati comprehensive predictor proctored exam
Total Questions : 177
Showing 10 questions, Sign in for more6 Months Ago:
Client reports daytime fatigue for 3 to 4 months. Drinks 1 to 2 cups of coffee early in the morning.
Work schedule 0800 to 1600. Client exercises at the gym on the way home from work. Usual bedtime is 2330; awakens at 0630.
Today:
Client reports difficulty falling asleep at night, then awakening 1 to 2 hr after falling asleep. Has daytime fatigue. Recently changed work schedule. Works 1200 to 2000. Exercises at the gym on the way home from work and eats dinner after they shower. Usual bedtime is 2330; awakens at 0700
Client reports that they turn off phone at 2230 every night. Client drinks 2 to 3 cups of coffee early in the morning
8 Months Ago:
Ethinyl estradiol/desogestrel 1 tablet PC daily for contraception
6 Months Ago:
Ferrous sulfate 120 mg PO twice daily 1 hr before meals for iron supplementation
A nurse is caring for a client in an outpatient clinic
Select the 2 findings the nurse should identify as factors that may interfere with the client's sleep
A nurse is caring for a school-age child who has celiac disease. Which of the following food choices should the nurse incorporate into the child's diet?
A nurse is caring for a client who has lactose intolerance and eliminated dairy products from their diet. The nurse should instruct the client to increase consumption of which of the following foods?
2 years ago:
Client reports no dyspnea or chest pain. Reports that their primary care provider recently increased the dosages of their hypertension medication.
Today, 1200
Client reports they had dyspnea and felt fatigued after walking from parking lot to clinic.
Client reports occasional, sharp chest pain bilaterally on inspiration. Today, pain on inspiration is 4 on a scale of 0 to 10. Auscultation of the heart reveals S3, Crackles auscultated in the lungs bilaterally. Jugular veins nondistended.
Client reports appetite is good and reports voiding without difficulty.
2 years ago:
Temperature 36.7°C (98° F)
Heart rate 76/min
Respiratory rate 18/min
Blood pressure 144/84 mm Hg
Oxygen saturation 95% on room air
Today, 1200:
Temperature 36.6° C (97.9° F)
Heart rate 104/min
Respiratory rate 26/min
Blood pressure 160/98 mm Hg
Oxygen saturation 95% on room air
2 years ago:
12-lead ECG normal sinus rhythm rate 80/min
Today, 1330:
12-lead ECG sinus tachycardia rate 103/min
A nurse is caring for a dent in a cardiology clinic.
Complete the following sentence by using the lists of options.
Based on the client data, the nurse should identify the client is experiencing
Explanation
• Heart failure: The client’s new exertional dyspnea, fatigue, and bilateral crackles indicate fluid backing up into the lungs, which is typical in heart failure. The increase in heart rate and blood pressure suggests rising cardiac workload.. Pulmonary crackles especially point toward impaired left ventricular function leading to congestion.
• Heart and lung sounds: The presence of bilateral crackles is a key sign of pulmonary congestion associated with worsening heart function. Coupled with tachycardia and exertional dyspnea, these findings strongly support a cardiac cause rather than respiratory or infectious processes. These auscultatory findings of S3 directly link the symptoms to the underlying condition.
Rationale for incorrect choices
• Urinary tract infection: The client reports normal voiding, no burning, frequency, or urgency, and no systemic symptoms such as fever. Vital signs do not show abnormalities commonly associated with infection. The respiratory findings are entirely unrelated to urinary tract concerns, making this explanation unlikely. No urinary data indicate infection or inflammation.
• Fluid volume deficit: Typical signs of deficit—hypotension, tachycardia with weak pulse, dry mucous membranes, or decreased output—are not present. Instead, the client has hypertension and crackles, indicating volume overload rather than deficit. Fluid in the lungs suggests retention, not loss, ruling out this condition. The clinical picture supports congestion instead of dehydration.
• Atrial fibrillation: The ECG shows sinus tachycardia rather than an irregular rhythm, which is the hallmark of atrial fibrillation. P waves remain organized, indicating maintained electrical conduction through the atria. While tachycardia is present, it appears compensatory, not dysrhythmic. The clinical symptoms correlate more with heart failure than with atrial arrhythmia.
• 12-lead ECG findings: Although the client has sinus tachycardia, this finding is nonspecific and does not directly identify heart failure. The rhythm is regular and lacks features that point to arrhythmias or acute ischemia. Tachycardia can result from many conditions, making it insufficient evidence for diagnosis. The abnormal heart and lung sounds offer stronger, more specific clinical indicators.
• Urinary report: There are no urinary abnormalities or complaints to suggest changes in renal status. The client is voiding normally and without discomfort, making urinary data irrelevant to the current condition. Nothing in the urinary report supports a cardiovascular diagnosis. Therefore, it does not provide evidence of heart failure.
• Blood pressure: Although the blood pressure is elevated, hypertension alone does not confirm heart failure because it can result from multiple factors. Blood pressure changes provide supporting context but not primary evidence of fluid overload. The presence of crackles gives more direct information about pulmonary congestion.
During the immediate postoperative period following thoracic surgery, a nurse medicates a client for pain on a schedule. The rationale for this nursing action is which of the following?
A nurse is caring for a client who has fractured ribs, has developed thrombophlebitis, and is being treated with a heparin drip. The client develops hematuria and has an activated partial thromboplastin time (aPTT) of 100 seconds (60 to 80 seconds). Which of the following actions should the nurse take first?
No history of chronic illness.
Last documented acute illness: Group Aáşž haemolytic streptococcus pharyngitis 8 months ago. Treated with a 10-day course of amoxicillin.
Immunizations up to date.
Caregivers report child has been very irritable and had a fever for the past week. They report that giving acetaminophen or ibuprofen did not lower the fever. Child has been receiving amoxicillin for the past 2 days but "isn't getting any better." Caregivers report the child woke up with a rash and they are concerned the child has "pink eye" due to the reddened eyes.
Child is irritable and uncooperative. Eyes are reddened with absent exudate. Oral mucosa and tongue inflamed. Lips red, dry, and cracked. Respirations unlabored. Lungs clear to auscultation. Apical pulse strong and regular. No extra heart sounds noted. Maculopapular rash noted on trunk and extremities. Hands and feet edematous with peeling skin noted.
Temperature 39° C (102.2° F)
Heart rate 128/min (apical)
Respiration rate 36/min
Blood pressure 94/50 mm Hg
C-reactive protein 9 mg/dL (less than 1.0 mg/dL)
Erythrocyte sedimentation rate 38 mm/hr (up to 10 mm/hr)
WBC 29,000/mm3 (5,000 to 10,000/mm3)
Hemoglobin 8.9 g/dL (9.5 to 14 g/dL)
Platelet count 515,000/mm3 (150,000 to 400,000/mm3)
A nurse is caring for a 6-year-old child in an emergency department.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Explanation
Rationale for correct choices
• Kawasaki disease: The child presents with prolonged fever, conjunctival injection without exudate, inflamed oral mucosa, cracked lips, maculopapular rash, and edema with peeling of hands and feet. Laboratory findings include elevated WBC, CRP, ESR, and platelets, consistent with systemic inflammation. These clinical and lab features strongly indicate Kawasaki disease, a medium-vessel vasculitis primarily affecting children under 5–6 years of age.
• Assess for neurological changes: Neurological assessment is important because Kawasaki disease can involve the central nervous system, leading to irritability, lethargy, or aseptic meningitis. Continuous monitoring of neurological status helps identify complications early and guides supportive interventions.
• Plan to administer high dose of aspirin: High-dose aspirin is a standard treatment in the acute phase of Kawasaki disease to reduce inflammation and prevent coronary artery complications. It helps mitigate fever and vascular inflammation. This intervention is central to managing the inflammatory process and reducing the risk of long-term cardiac sequelae.
• Reports of chest pain or pressure: Monitoring for chest pain or pressure is essential because Kawasaki disease can lead to coronary artery aneurysms or myocardial ischemia. These symptoms may indicate cardiac involvement requiring immediate attention. Ongoing assessment helps detect early signs of cardiovascular complications, which are the most serious consequences of the disease.
• Daily weights: Daily weights help monitor fluid balance and detect edema, which may develop as part of systemic inflammation or as a response to treatment. Tracking weight changes assists in identifying fluid retention or loss, guiding interventions such as fluid management. Weight monitoring provides an objective measure of the child’s overall clinical status.
Rationale for incorrect choices
• Reyes syndrome: Reye’s syndrome is associated with post-viral illness and aspirin use, presenting with hepatic dysfunction and encephalopathy. The child’s symptoms of conjunctivitis, rash, and extremity changes do not align with Reye’s syndrome. Liver function tests and neurological deterioration would be more prominent, making this diagnosis unlikely.
• Varicella: Varicella (chickenpox) typically presents with vesicular lesions in different stages of healing, starting on the trunk and face. This child has maculopapular rash, not vesicular lesions, and systemic signs such as conjunctival injection and oral mucosa changes are not typical of varicella. The lab findings further support an inflammatory rather than viral etiology.
• Rheumatic fever: Rheumatic fever usually develops after untreated streptococcal pharyngitis and affects joints, heart valves, skin, and CNS (Sydenham chorea). This child’s current symptoms of rash, edema, conjunctivitis, and mucous membrane involvement do not fit the classic Jones criteria for rheumatic fever. Cardiac murmurs or migratory polyarthritis are absent, making this unlikely.
• Restrict fluid and salt intake: Fluid restriction is not a standard intervention in Kawasaki disease unless cardiac complications arise. Restricting fluids prematurely could risk dehydration and worsen systemic inflammation. Immediate priority is anti-inflammatory therapy and monitoring for cardiovascular involvement.
• Provide soft food: Providing soft food addresses oral discomfort but does not treat the underlying inflammatory vasculitis. While it may improve comfort, it does not impact disease progression or prevent cardiac complications, making it a lower-priority intervention.
• Implement airborne precautions: Airborne precautions are indicated for infections such as measles, varicella, or tuberculosis. Kawasaki disease is not contagious, so airborne precautions are unnecessary. Standard precautions suffice, allowing focus on managing inflammation and monitoring cardiac status.
• Prolonged bleeding time: Bleeding time is not a primary concern in Kawasaki disease and does not guide treatment or monitoring. The child’s labs indicate thrombocytosis rather than coagulopathy. This parameter is more relevant for platelet disorders or anticoagulant therapy.
• Lesion bruising: Bruising is not a feature of Kawasaki disease; the child’s rash is maculopapular, not hemorrhagic. Lesion bruising would suggest a hematologic or coagulation disorder, which is not indicated in this case.
• Chorea: Chorea is a hallmark of Sydenham chorea, a manifestation of rheumatic fever. The child exhibits irritability but not involuntary movements. Absence of chorea helps differentiate Kawasaki disease from post-streptococcal neurological complications.
Day 1, 1800:
Before administration of enteral feeding, pH of aspirate is 4.8
Day 1, 2040:
Client had formed stool.
Day 2,08.30:
Abdomen distended, firm, and tense. Before administration of enteral feeding via nasogastric feeding tube, gastric residual is 90 mL pH of aspirate is 6.4.
Day 2, 1200:
Temperature 36.5°C (97. 7° F).
Heart rate 88/min
Respiratory rate 20/min
Blood pressure 144/90 mm Hg
Oxygen saturation 96% on room air
Day 2,0600:
Blood glucose 138 mg/dL (70 to 110 mg/dL)
Day 2,0630:
Potassium 3.7 mEq/L (3.5 to 5 mEq/L)
Sodium 137 mEq/L (136 to 145 mEq/L)
Day 2, 1200:
Blood glucose 152 mg/dL (70 to 110 mg/dL)
Day 1, 1600:
Insert nasogastric feeding tube.
Chest x-ray to confirm placement of feeding tube.
Day 1, 1800:
Administer enteral formula 120 mL every 6 hr while awake via nasogastric feeding tube.
Correction insulin: Administer regular insulin SUBQ PRN 4 time daily.
151 to 180 mg/dL - administer 2 units regular insulin SUBQ
181 to 200 mg/dL - administer 4 units regular insulin SUBQ
If glucose greater than 200 mg/dL, notify provider.
A nurse is caring for a client on the medical surgical unit
Which of the following client findings suggest that the nurse should hold the tube feeding and notify the provider?
A nurse is preparing to administer lactulose 30 g PO four times daily to a client who has portal-systemic encephalopathy. The amount available is lactulose al solution 10 g/15 ml. How many ml. should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero)
Explanation
Identify the ordered dose and the available concentration
Ordered Dose: 30 g
Available Concentration: 10 g per 15 mL
Calculate the volume to administer per dose using the Dose/Have method
Amount to administer = (Ordered Dose ÷ Dose on Hand) × Quantity
Quantity corresponding to the Dose on Hand = 15 mL
Volume = (30 ÷ 10) × 15
= 3 × 15
= 45 mL
A nurse delegates tasks to a licensed practical nurse (LPN) and an assistive personnel (AP). When admitting a client who is experiencing acute liver failure and who has ascites and an NG tube, which of the following tasks is most appropriate for the nurse to delegate to the LPN?
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