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RN Comprehensive Predictor 2023
Total Questions : 151
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58-year-old client reporting chest pain is admitted to the emergency department. Client states chest pain began this morning after breakfast and chest pain radiates to left arm. Client rates chest pain as 4 on a scale of 0 to 10. Client has medical history of hypertension, type 2 diabetes mellitus, and hyperlipidemia.
Social history: denies alcohol use, has smoked a pack of cigarettes per day for 35 years
Current medications:
Lisinopril 20 mg PO daily
Glucophage 500 mg PO BID Simvastatin 40 mg PO daily
1230:
Nurse called to bedside. Client reports sudden onset of chest pain and shortness of breath. Client rates chest pain as 7 on a scale of 0 to 10.
1200:
- Temperature 37Oc (98.6 oF)
- Heart rate 90/min
- Respiratory rate 20/min
- BP 152/80 mmHg
- Oxygen Saturation 97% on room air
1245:
- Temperature 37.1 Oc (98.8 oF)
- Heart rate 116/min
- Respiratory rate 24/min
- BP 172/94 mmHg
- Oxygen Saturation 92% on room air
1215:
ECG: Sinus tachycardia
1300:
Cardiac troponin T less than 0.1 ng/mL (less than 0.1 ng/mL)
LDL 110 mg/dL (less than 130 mg/dL)
Total cholesterol 230 mg/dL (Less than 200 mg/dL)
A nurse is caring for a client.
Complete the following sentence by using the list of options.
After notifying the provider, the nurse should first administer
Explanation
After notifying the provider, the nurse should first administer oxygen at 2L/min via nasal cannula and then administer sublingual nitroglycerin.
Rationale:
Step 1: Administer Oxygen at 2L/min via Nasal Cannula
The client's oxygen saturation has dropped from 97% to 92% on room air, which indicates potential myocardial oxygen demand exceeding supply. Oxygen therapy helps improve myocardial oxygenation, which is crucial for clients with suspected acute coronary syndrome (ACS).
Step 2: Administer Sublingual Nitroglycerin
The client’s chest pain has worsened (increased from 4/10 to 7/10) and is associated with shortness of breath, which suggests possible myocardial ischemia. Nitroglycerin causes vasodilation, reducing myocardial oxygen demand and improving coronary perfusion.
It is a first-line treatment for suspected angina or acute coronary syndrome (ACS).
Incorrect Options
Step 1:
Prepare the client for cardiac catheterization: While a catheterization may be necessary, immediate interventions (oxygen, nitroglycerin) take priority before an invasive procedure.
Request a prescription for an increase in statin medication: Adjusting statins is a long-term strategy; it does not address the acute issue of chest pain and shortness of breath.
Step 2:
Request a prescription for a beta-blocker: Beta-blockers reduce heart rate and myocardial oxygen demand, but nitroglycerin provides more immediate relief for chest pain.
Check a STAT cardiac troponin: A repeat troponin may be necessary, but the initial focus is on stabilizing the client’s oxygenation and relieving chest pain.
0640:
- Temperature 36.7° C (98.1° F) axillary
- Heart rate 154/min
- Respiratory rate 68/min
- BP 72/48 mm Hg
0650:
- Heart rate 156/min
- Respiratory rate 72/min
0700:
- Temperature 37° C (98.6° F) axillary
- Heart rate 156/min
- Respiratory rate 76/min
0630:
Newborn delivered via cesarean birth under spinal anesthesia at 0630. Amniotic fluid clear.
0631:
1-min Apgar score 7
0636:
5-min Apgar score 9
Newborn transferred to nursery.
0640:
Weight 4200 gm (9 lb 4 oz), head circumference 35.5 cm (14 in) Respiratory rate 68/min, with mild grunting.
0650:
Respiratory rate 72/min, with mild grunting
0700:
Respiratory rate 76/min, with moderate grunting and mild intercostal retractions.
A nurse is caring for a newborn.
Drag words from the choices below to fill in each blank in the following sentence.
The client is at risk for developing
Explanation
The client is at risk for developing transient tachypnea of the newbornand hypoglycemia.
Rationale:
Target 1: Transient Tachypnea of the Newborn (TTN): The newborn has progressively increasing respiratory rates (68 → 72 → 76 breaths/min) along with grunting and mild intercostal retractions. Cesarean birth is a major risk factor for TTN because the absence of labor contractions delays the clearance of fetal lung fluid. TTN typically presents within the first few hours of life with tachypnea and mild respiratory distress, resolving within 24–72 hours.
Target 2: Hypoglycemia: The newborn weighs 4200 g (9 lb 4 oz), indicating macrosomia.
Large-for-gestational-age (LGA) infants are at higher risk for hypoglycemia due to increased insulin production in response to maternal hyperglycemia. Tachypnea can also be a sign of hypoglycemia in neonates.
Incorrect Options:
Tachycardia: The newborn’s heart rate is elevated (154–156 bpm), but mild tachycardia is expected in newborns and is not the primary concern compared to respiratory distress and hypoglycemia risk.
Bronchopulmonary Dysplasia (BPD): BPD is a chronic lung condition primarily seen in preterm infants who require prolonged mechanical ventilation and oxygen therapy. This newborn was term, had clear amniotic fluid, and no intubation, making BPD unlikely.
A nurse is teaching a client who has atrial fibrillation and is to start taking dabigatran. Which of the following statements by the client indicates an understanding of the teaching?
0900:
A 16-year-old client reports to the clinic with their caregiver. The client's caregiver informs the nurse that the client has "not been themselves lately." The client's parents and a sibling passed away from injuries sustained when a tornado moved through their town 1 month ago. They were the only survivor and witnessed their family's deaths.
0910:
Client appears anxious but answers questions appropriately for age. They report experiencing nightmares that awaken them at night and startle easily during thunderstorm, but the client admits that they have always been afraid of thunderstorms. Client admits smoking marijuana for about 1 month because it helps clear their mind. They also admit that they have no desire to leave the house. They do attend school regularly and are on the honor roll.
0915:
- Temperature 36.7° C (98° F)
- BP 122/80 mm Hg
- Respiratory rate 20/min
- Heart rate 99/min
A nurse is caring for a client in a clinic.
Based on the information in the client's medical record, which of the following findings require immediate follow-up? Select the 4 findings that require follow-up.
A nurse is preparing to insert an IV catheter for a client. Which of the following actions should the nurse plan to take?
1900:
750 mL intake over 12 hr
0500:
Client admitted from emergency department with heart failure. Crackles auscultated bilaterally throughout lung fields. Lower extremities cool and dry with 1+ pedal pulses and 3+ pitting edema bilaterally.
Capillary refill 2 seconds.
0800:
Client incontinent of urine.
0500:
- Temperature 36.6° C (97.9° F)
- Heart rate 100/min
- Respiratory rate 22/min
- BP 160/98 mm Hg
- Pulse oximetry 96% on oxygen 2 L/min via nasal cannula
1400:
- Temperature 36.8° C (98.2° F)
- Heart rate 90/min
- Respiratory rate 18/min
- BP 138/88 mm Hg
- Pulse oximetry 97% on oxygen 2 L/min via nasal cannula
0500:
Administer oxygen 2 L/min via nasal cannula.
Monitor intake and output.
Fluid restriction of 1000 mL daily
1000:
insert indwelling urinary catheter.
0600:
Calcium 9.3 mg/dL (9.0 to 10.5 mg/dL) Chloride 105 mEq/L (98 to 106 mEq/L) Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L) Phosphate 4.1 mg/dL (3 to 4.5 mg/dL) Potassium 4.5 mEq/L (3.5 to 5.0 mEq/L) Sodium 149 mEq/L (136 to 145 mEq/L)
A nurse is caring for a client in the medical-surgical unit.
Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client? Select all that apply.
1330:
- Temperature 36.8° C (98.2° F)
- Heart rate 88/min
- Respiratory rate 16/min
- BP 110/64 mm Hg
- Oxygen saturation 96% on oxygen 3 L/min via simple face mask
1345:
- Temperature 37° C (98.6° F)
- Heart rate 112/min
- Respiratory rate 20/min
- BP 108/60 mm Hg
- Oxygen saturation 94% on oxygen 3 L/min via simple face mask
1400:
- Temperature 38.3° C (101° F)
A nurse is caring for a client who is postoperative following a right hip arthroplasty.
For each assessment finding, click to specify if the finding is consistent with malignant hyperthermia, latex allergy, or hypovolemic shock. Each finding may support more than 1 disease process.
Explanation
Hypercapnia: Malignant Hyperthermia
Malignant hyperthermia (MH) is a life-threatening reaction to anesthesia, causing uncontrolled muscle metabolism and COâ‚‚ buildup.
Wheezes: Latex Allergy
A latex allergy can trigger anaphylaxis, leading to airway swelling and bronchospasm, which cause wheezing.
Tachycardia: Malignant Hyperthermia, Latex Allergy, Hypovolemic Shock
Tachycardia is a common response to stress, hypoxia, allergic reactions, or shock.
MH: Increased metabolism causes hyperthermia and tachycardia.
Latex Allergy: Anaphylaxis can cause vasodilation and compensatory tachycardia.
Hypovolemic Shock: The body compensates for low blood volume by increasing heart rate.
Muscle Rigidity: Malignant Hyperthermia
A hallmark sign of MH is generalized muscle rigidity, especially in the jaw and chest, due to sustained muscle contractions.
Urticaria: Latex Allergy
Latex allergy causes histamine release, leading to itching, rash, and hives (urticaria).
Today
0700:
Received change of shift report. Client is 2 days postoperative following a hysterectomy and they have not yet ambulated with physical therapy due to significant postoperative pain. Per change of shift report, pain medications have been adjusted and pain has improved. Client currently reports pain level as 2 on a scale of 0 to 10.
0900:
Ambulating in hallway with the assistance of physical therapy.
1000:
Return to bed with siderails up x 2, but not wearing sequential compression devices because they "hurt too much." Applied antiembolism stockings.
1400:
Client notified nurse that right leg is warm and painful. Assessment reveals unilateral right lower extremity swelling and warmth below the knee. Provider notified.
A nurse is caring for a 75-year-old client who is admitted to the medical- surgical unit.
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
Potential Condition: Deep Venous Thrombosis (DVT)
Actions to Take:
Request a prescription for a lower extremity Doppler flow study
Check for pedal pulses and signs of ischemia
Parameters to Monitor:
PT/INR and platelet count
Signs of bleeding after anticoagulation initiation
Rationale:
DVT: The client presents with classic signs of DVT, including: unilateral leg swelling, pain and warmth in the affected limb, recent immobility (limited ambulation after surgery). DVT is a serious complication that can lead to pulmonary embolism (PE) if the clot dislodges.
Actions to Take:
Request a prescription for a lower extremity Doppler flow study: A Doppler ultrasound is the gold standard for diagnosing DVT by assessing blood flow and detecting clots.
Check for pedal pulses and signs of ischemia: Ensuring adequate circulation is crucial to monitor for complications like arterial occlusion.
Parameters to Monitor:
PT/INR and platelet count: If anticoagulation therapy is initiated, monitoring PT/INR (for warfarin) or platelet count (for heparin-induced thrombocytopenia) is essential.
Signs of bleeding after anticoagulation initiation: Anticoagulants increase the risk of bleeding, so assessing for bruising, hematuria, or GI bleeding is critical.
A nurse is providing teaching about immunizations to a client who is pregnant. Which of the following statements should the nurse include in the teaching?
A nurse at a community health clinic is planning care for an adolescent who recently learned that she is pregnant and is concerned about her ability to afford and care for her baby. Which of the following actions should the nurse take?
A nurse in a PACU is transferring care of a client to a nurse on the medical-surgical unit. Which of the following statements should the nurse include in the hand-off report?
Day 1,0900:
Client reports lower back pain and pinkish vaginal discharge. Uterine contractions every 8 minutes, palpate strong, duration
30 seconds.
FHR baseline 145, minimal variability.
Cervical exam indicates 2 cm, 50% effaced, 0 station.
Membranes intact.
CBC and urinalysis collected and sent to lab.
Day 1, 0900:
30-year-old client at 33 weeks gestation, Gravida 4 Para 3
Maternal blood type: Rh+
Last pregnancy resulted in a preterm spontaneous vaginal birth at 30 weeks gestation.
NKA
Day 1, 0900:
Admission:
Temperature 38.4° C (101.1° F) Heart rate 92/min
Respiratory rate 18/min
Blood pressure 130/78 mm Hg
Pre-pregnancy BMI 27.6 Current BMI 29.9
A nurse is caring for a client who has been admitted to the antepartum unit.
The client is at risk for developing which of the following 2 complications? Select 2 complications the client is at risk for developing.
Day 1,0900:
Client reports lower back pain and pinkish vaginal discharge. Uterine contractions every 8 minutes, palpate strong, duration 30 seconds.
FHR baseline 145, minimal variability.
Cervical exam indicates 2 cm, 50% effaced, 0 station. Membranes intact.
CBC and urinalysis collected and sent to lab.
Day 1, 0900:
30-year-old client at 33 weeks gestation, Gravida 4 Para 3
Maternal blood type: Rh+
Last pregnancy resulted in a preterm spontaneous vaginal birth at 30 weeks gestation.
NKA
Day 1, 0900:
Admission:
Temperature 38.4° C (101.1° F) Heart rate 92/min
Respiratory rate 18/min
Blood pressure 130/78 mm Hg
Pre-pregnancy BMI 27.6 Current BMI 29.9
A nurse is caring for a client who has been admitted to the antepartum unit.
For each potential provider's prescription, click to specify if the potential prescription is anticipated or unanticipated for the client.
Explanation
|
Provider Prescriptions |
Anticipated |
Unanticipated |
|
Administer betamethasone |
✅ |
|
|
Administer oxytocin |
✅ |
|
|
Administer terbutaline |
✅ |
|
|
Place client in supine position |
✅ |
|
|
Maintain bed rest with bathroom privileges |
✅ |
|
|
Limit fluid intake to 1000 mL/day |
✅ |
Rationale:
Anticipated:
Administer betamethasone: The client is 33 weeks gestation with signs of preterm labor (back pain, contractions, cervical dilation). Betamethasone is given to enhance fetal lung maturity and reduce complications if preterm birth occurs.
Administer terbutaline: Terbutaline is a tocolytic (uterine relaxant) used to delay preterm labor and allow time for betamethasone to take effect. Since the client is not yet in active labor, terbutaline may be used to temporarily suppress contractions.
Maintain bed rest with bathroom privileges: Activity restrictions are recommended to reduce uterine stimulation and preterm labor progression. However, strict bed rest is not typically recommended due to risks (e.g., venous thromboembolism).
Unanticipated:
Administer oxytocin: Oxytocin stimulates labor contractions, which is contraindicated since the goal is to delay preterm birth. Instead, tocolytics (e.g., terbutaline) should be used to suppress contractions.
Place client in supine position: The supine position can cause supine hypotensive syndrome by compressing the vena cava, reducing blood flow to the fetus. The left lateral position is preferred to optimize placental perfusion.
Limit fluid intake to 1000 mL/day: Hydration is important for preventing contractions, as dehydration can trigger uterine irritability. Unless there is a specific medical reason (e.g., preeclampsia, heart failure), fluid restriction is unnecessary.
Day 1, 0900:
Client reports lower back pain and pinkish vaginal discharge. Uterine contractions every 8 minutes, palpate strong, duration 30 seconds.
FHR baseline 145, minimal variability.
Cervical exam indicates 2 cm, 50% effaced, 0 station.
Membranes intact.
CBC and urinalysis collected and sent to lab.
Day 1, 0930:
Peripheral IV initiated. Provider prescriptions received and implemented.
Day 1, 1000:
Client voided and reports pain and discomfort upon urination.
Day 1, 0900:
30-year-old client at 33 weeks gestation, Gravida 4 Para 3
Maternal blood type: Rh+
Last pregnancy resulted in a preterm spontaneous vaginal birth at 30 weeks gestation.
NKA
Day 1, 0900:
Admission:
Temperature 38.4° C (101.1° F) Heart rate 92/min Respiratory rate 18/min
Blood pressure 130/78 mm Hg
Pre-pregnancy BMI 27.6 Current BMI 29.9
Day 1, 1000:
WBC 16,000/mm3 (5,000 to 10,000/mm3)
RBC count 5.1 million/mm3 (4.2 to 5.4 per million/mm3) Hgb 11.5 g/dL (>11 g/dL) Hct 34% (>33%)
Platelet count 175,000/mm3 (150,000 to 400,000/mm3) Urinalysis appearance cloudy, color is amber yellow, pH 6. Protein, leukocyte esterase: positive. WBC casts, glucose: negative, Ketones: negative.
The nurse continues to care for the client.
Which of the following actions should the nurse take? Select all that apply.
Day 1, 0900:
Client reports lower back pain and pinkish vaginal discharge. Uterine contractions every 8 minutes, palpate strong, duration 30 seconds.
FHR baseline 145, minimal variability.
Cervical exam indicates 2 cm, 50% effaced, 0 station. Membranes intact.
CBC and urinalysis collected and sent to lab.
Day 1, 0930:
Peripheral IV initiated. Provider prescriptions received and implemented.
Day 1, 1000:
Client voided and reports pain and discomfort upon urination. Client states, "I've noticed burning when I urinate for the past 2
Day 1, 0900:
30-year-old client at 33 weeks gestation, Gravida 4 Para 3
Maternal blood type: Rh+
Last pregnancy resulted in a preterm spontaneous vaginal birth at 30 weeks gestation.
NKA
Day 1,0900:
Admission:
- Temperature 38.4° C (101.1° F)
- Heart rate 92/min
- Respiratory rate 18/min
- Blood pressure 130/78 mm Hg
- Pre-pregnancy BMI 27.6 Current BMI 29.9
Day 2, 0800:
- Temperature 37.1° C (98.7° F)
- Heart rate 85/min
- Respiratory rate 16/min
- Blood pressure 120/78 mm Hg
Day 1, 1000:
WBC 16,000/mm3 (5,000 to 10,000/mm3)
RBC count 5.1 million/mm3 (4.2 to 5.4 per million/mm3) Hgb 11.5 g/dL (>11 g/dL)
Hct 34% (>3396)
Platelet count 175,000/mm3 (150,000 to 400,000/mm3) Urinalysis appearance cloudy, color is amber yellow, pH 6. Protein, leukocyte esterase: positive. WBC casts, glucose: negative. Ketones: negative.
Day 2, 0800:
pe here to search
WBC 12,000/mm3 (5,000 to 10,000/mm3)
RBC count 4.9 million/mm3 (4.2 to 5.4 per million/mm3)
Hgb 11 g/dL (>11 g/dL)
Hct 35% (>33%)
Platelet count 188,000/mm3 (150,000 to 400,000/mm3)
Urine culture pending
The nurse continues to care for the client.
Click to highlight the findings that indicate improvement in the client's condition. To deselect a finding, click on the finding again.
|
Assessment |
Findings |
|
Nurses' Notes
|
Client rates lower back pain a 0 on a scale from 0 to 10. No reports of vaginal discharge. Membranes intact No uterine contractions noted. FHR baseline 138, minimal variability. No further reports of burning with urination. |
|
Laboratory Results |
WBC 12, 000/mm3 (5000 to 10000/mm3) Platelet count 188000/mm3 (150000 to 400000/mm3) |
|
Vital Signs |
Temperature 37.1°C (98.7°F) Blood pressure 120/78 mmHg |
Explanation
Nurses' Notes:
Client rates lower back pain a 0 on a scale from 0 to 10: Indicates pain resolution, suggesting improvement.
No reports of vaginal discharge: Suggests stabilization and no signs of labor progression.
No uterine contractions noted: Indicates that preterm labor is resolving.
No further reports of burning with urination: Suggests that the urinary tract infection (UTI) is improving.
Vital Signs:
Temperature 37.1°C (98.7°F): Fever has resolved, indicating response to antibiotics.
Blood pressure 120/78 mmHg: Remains stable within normal limits.
Laboratory Results:
WBC 12,000/mm³ (previously 16,000/mm³): Decreasing WBC count suggests resolution of infection.
A nurse has just received change-of-shift report for four clients. Which of the following clients should the nurse assess first?
A nurse is caring for a child who is postoperative following a tonsillectomy. Which of the following findings indicates that the child may be experiencing hemorrhage?
A nurse is providing teaching to a client who has a depressive disorder and a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching?
A public health nurse working in a rural area is developing a program to improve health for the local population. Which of the following actions should the nurse plan to take?
A nurse is planning care for a school-age child who is 4 hr postoperative following appendicitis. Which of the following actions should the nurse include in the plan of care?
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