RN VATI Predictor Advanced Prep: Master
NCLEX-RN Concepts, Clinical Judgement &
Practice Questions
Subject: Registered Nurse (RN) Virtual ATI (VATI) – Medical-Surgical,
Pharmacology, and Maternal-Newborn Synthesis
Question 1: A nurse is caring for a client who is postoperative following a thyroidectomy. The
client suddenly develops laryngeal stridor and hypocalcemia. Which of the following is the
priority nursing action?
A) Administer intravenous calcium gluconate as prescribed.
B) Prepare for immediate endotracheal intubation.
C) Notify the provider regarding the change in respiratory status.
D) Check the client's Chvostek's sign.
Correct Answer: B) Prepare for immediate endotracheal intubation.
Explanation: The priority in airway management is patency. Laryngeal stridor indicates airway
obstruction, likely due to edema or tetany. While calcium gluconate (A) is the treatment for
hypocalcemia, the immediate threat to life is the loss of the airway. B addresses the ABCs
(Airway, Breathing, Circulation) hierarchy.
Question 2: A nurse is reviewing the laboratory results of a client receiving total parenteral
nutrition (TPN). Which finding requires immediate intervention?
A) Serum glucose 145 mg/dL.
B) Serum potassium 3.2 mEq/L.
C) Serum albumin 3.8 g/dL.
D) Urine specific gravity 1.015.
Correct Answer: B) Serum potassium 3.2 mEq/L.
Explanation: TPN therapy promotes rapid cellular uptake of glucose and potassium, which often
leads to hypokalemia. A potassium level of 3.2 mEq/L is below the normal range (3.5–5.0) and
poses a risk for cardiac arrhythmias. While glucose (A) is slightly elevated, it is common during
TPN and requires monitoring rather than immediate intervention.
,Question 3: A client with chronic obstructive pulmonary disease (COPD) presents with arterial
blood gas (ABG) values: pH 7.25, $PaCO_2$ 65 mmHg, $HCO_3^-$ 28 mEq/L. Which
compensatory mechanism is occurring?
A) Metabolic alkalosis.
B) Respiratory acidosis with partial renal compensation.
C) Uncompensated respiratory acidosis.
D) Fully compensated respiratory acidosis.
Correct Answer: B) Respiratory acidosis with partial renal compensation.
Explanation: The pH is acidic (<7.35), the $PaCO_2$ is elevated (>45), and the bicarbonate is
elevated (>26). Because the pH remains outside the normal range, compensation is partial. The
elevated bicarbonate indicates the kidneys are attempting to compensate for the primary
respiratory acidosis.
Question 4: A nurse is preparing to administer digoxin to a client with heart failure. The client's
apical pulse is 58/min. Which action should the nurse take?
A) Administer the medication as ordered.
B) Withhold the dose and notify the provider.
C) Administer half the dose.
D) Instruct the client to increase dietary potassium.
Correct Answer: B) Withhold the dose and notify the provider.
Explanation: Digoxin has a negative chronotropic effect. The standard clinical protocol for adult
clients is to withhold digoxin if the apical pulse is less than 60/min to prevent symptomatic
bradycardia and digoxin toxicity.
Question 5: A nurse is caring for a client who is in the active phase of labor. The fetal heart rate
(FHR) monitor shows variable decelerations. Which of the following is the first nursing
intervention?
A) Discontinue the oxytocin infusion.
B) Change the client’s position.
C) Administer oxygen via a non-rebreather mask.
,D) Notify the provider.
Correct Answer: B) Change the client’s position.
Explanation: Variable decelerations are caused by cord compression. Repositioning the client is
the first intervention to relieve pressure on the umbilical cord. If the pattern persists, the nurse
would then discontinue oxytocin (A) and apply oxygen (C).
Question 6: A client with a new diagnosis of diabetes mellitus is prescribed NPH and regular
insulin. Which instruction should the nurse provide regarding mixing these insulins?
A) Draw the NPH insulin into the syringe first.
B) Draw the regular insulin into the syringe first.
C) Mix the insulins in a separate container.
D) Inject the regular insulin into the NPH vial first.
Correct Answer: B) Draw the regular insulin into the syringe first.
Explanation: The mnemonic "clear before cloudy" is essential to prevent the contamination of
the shorter-acting (clear) regular insulin with the longer-acting (cloudy) NPH protein, which
would alter its absorption profile.
Question 7: A nurse is caring for a client who is experiencing a manic episode. Which
intervention is the highest priority?
A) Provide a quiet, low-stimulation environment.
B) Set firm limits on the client’s behavior.
C) Ensure adequate hydration and nutritional intake.
D) Administer mood stabilizers as prescribed.
Correct Answer: C) Ensure adequate hydration and nutritional intake.
Explanation: During a manic episode, clients are often too active to eat or drink, risking
dehydration and exhaustion. While a low-stimulation environment (A) and limit-setting (B) are
important, physiological stability (C) is the primary safety concern.
Question 8: A nurse is assessing a client for signs of acute appendicitis. Which assessment
finding is consistent with this diagnosis?
A) Pain in the left lower quadrant.
, B) Rebound tenderness at McBurney's point.
C) Pain relieved by movement.
D) Hyperactive bowel sounds in all quadrants.
Correct Answer: B) Rebound tenderness at McBurney's point.
Explanation: Appendicitis typically presents with pain in the right lower quadrant at McBurney’s
point. Rebound tenderness (Blumberg's sign) is a classic indicator of peritoneal irritation
associated with appendicitis.
Question 9: A client is prescribed phenytoin for seizure control. Which instruction is essential for
the nurse to emphasize?
A) "Stop the medication if you develop a rash."
B) "Maintain good oral hygiene to prevent gingival hyperplasia."
C) "Take the medication with an antacid to prevent gastric irritatio n."
D) "This medication is safe to take during pregnancy."
Correct Answer: B) "Maintain good oral hygiene to prevent gingival hyperplasia."
Explanation: Gingival hyperplasia (overgrowth of gum tissue) is a common side effect of
phenytoin. Thorough oral care and regular dental visits are necessary. Phenytoin is teratogenic,
and rashes should be reported, but gingival care is a standard daily intervention for all clients.
Question 10: A nurse is caring for a client with a fractured hip. Which assessment finding
indicates a potential complication?
A) External rotation of the affected extremity.
B) Muscle spasms in the affected extremity.
C) Pain managed by analgesics.
D) Ecchymosis around the fracture site.
Correct Answer: A) External rotation of the affected extremity.
Explanation: A shortened, externally rotated leg is a classic clinical indicator of a hip fracture. If
this occurs after initial stabilization, it suggests displacement of the fracture.
NCLEX-RN Concepts, Clinical Judgement &
Practice Questions
Subject: Registered Nurse (RN) Virtual ATI (VATI) – Medical-Surgical,
Pharmacology, and Maternal-Newborn Synthesis
Question 1: A nurse is caring for a client who is postoperative following a thyroidectomy. The
client suddenly develops laryngeal stridor and hypocalcemia. Which of the following is the
priority nursing action?
A) Administer intravenous calcium gluconate as prescribed.
B) Prepare for immediate endotracheal intubation.
C) Notify the provider regarding the change in respiratory status.
D) Check the client's Chvostek's sign.
Correct Answer: B) Prepare for immediate endotracheal intubation.
Explanation: The priority in airway management is patency. Laryngeal stridor indicates airway
obstruction, likely due to edema or tetany. While calcium gluconate (A) is the treatment for
hypocalcemia, the immediate threat to life is the loss of the airway. B addresses the ABCs
(Airway, Breathing, Circulation) hierarchy.
Question 2: A nurse is reviewing the laboratory results of a client receiving total parenteral
nutrition (TPN). Which finding requires immediate intervention?
A) Serum glucose 145 mg/dL.
B) Serum potassium 3.2 mEq/L.
C) Serum albumin 3.8 g/dL.
D) Urine specific gravity 1.015.
Correct Answer: B) Serum potassium 3.2 mEq/L.
Explanation: TPN therapy promotes rapid cellular uptake of glucose and potassium, which often
leads to hypokalemia. A potassium level of 3.2 mEq/L is below the normal range (3.5–5.0) and
poses a risk for cardiac arrhythmias. While glucose (A) is slightly elevated, it is common during
TPN and requires monitoring rather than immediate intervention.
,Question 3: A client with chronic obstructive pulmonary disease (COPD) presents with arterial
blood gas (ABG) values: pH 7.25, $PaCO_2$ 65 mmHg, $HCO_3^-$ 28 mEq/L. Which
compensatory mechanism is occurring?
A) Metabolic alkalosis.
B) Respiratory acidosis with partial renal compensation.
C) Uncompensated respiratory acidosis.
D) Fully compensated respiratory acidosis.
Correct Answer: B) Respiratory acidosis with partial renal compensation.
Explanation: The pH is acidic (<7.35), the $PaCO_2$ is elevated (>45), and the bicarbonate is
elevated (>26). Because the pH remains outside the normal range, compensation is partial. The
elevated bicarbonate indicates the kidneys are attempting to compensate for the primary
respiratory acidosis.
Question 4: A nurse is preparing to administer digoxin to a client with heart failure. The client's
apical pulse is 58/min. Which action should the nurse take?
A) Administer the medication as ordered.
B) Withhold the dose and notify the provider.
C) Administer half the dose.
D) Instruct the client to increase dietary potassium.
Correct Answer: B) Withhold the dose and notify the provider.
Explanation: Digoxin has a negative chronotropic effect. The standard clinical protocol for adult
clients is to withhold digoxin if the apical pulse is less than 60/min to prevent symptomatic
bradycardia and digoxin toxicity.
Question 5: A nurse is caring for a client who is in the active phase of labor. The fetal heart rate
(FHR) monitor shows variable decelerations. Which of the following is the first nursing
intervention?
A) Discontinue the oxytocin infusion.
B) Change the client’s position.
C) Administer oxygen via a non-rebreather mask.
,D) Notify the provider.
Correct Answer: B) Change the client’s position.
Explanation: Variable decelerations are caused by cord compression. Repositioning the client is
the first intervention to relieve pressure on the umbilical cord. If the pattern persists, the nurse
would then discontinue oxytocin (A) and apply oxygen (C).
Question 6: A client with a new diagnosis of diabetes mellitus is prescribed NPH and regular
insulin. Which instruction should the nurse provide regarding mixing these insulins?
A) Draw the NPH insulin into the syringe first.
B) Draw the regular insulin into the syringe first.
C) Mix the insulins in a separate container.
D) Inject the regular insulin into the NPH vial first.
Correct Answer: B) Draw the regular insulin into the syringe first.
Explanation: The mnemonic "clear before cloudy" is essential to prevent the contamination of
the shorter-acting (clear) regular insulin with the longer-acting (cloudy) NPH protein, which
would alter its absorption profile.
Question 7: A nurse is caring for a client who is experiencing a manic episode. Which
intervention is the highest priority?
A) Provide a quiet, low-stimulation environment.
B) Set firm limits on the client’s behavior.
C) Ensure adequate hydration and nutritional intake.
D) Administer mood stabilizers as prescribed.
Correct Answer: C) Ensure adequate hydration and nutritional intake.
Explanation: During a manic episode, clients are often too active to eat or drink, risking
dehydration and exhaustion. While a low-stimulation environment (A) and limit-setting (B) are
important, physiological stability (C) is the primary safety concern.
Question 8: A nurse is assessing a client for signs of acute appendicitis. Which assessment
finding is consistent with this diagnosis?
A) Pain in the left lower quadrant.
, B) Rebound tenderness at McBurney's point.
C) Pain relieved by movement.
D) Hyperactive bowel sounds in all quadrants.
Correct Answer: B) Rebound tenderness at McBurney's point.
Explanation: Appendicitis typically presents with pain in the right lower quadrant at McBurney’s
point. Rebound tenderness (Blumberg's sign) is a classic indicator of peritoneal irritation
associated with appendicitis.
Question 9: A client is prescribed phenytoin for seizure control. Which instruction is essential for
the nurse to emphasize?
A) "Stop the medication if you develop a rash."
B) "Maintain good oral hygiene to prevent gingival hyperplasia."
C) "Take the medication with an antacid to prevent gastric irritatio n."
D) "This medication is safe to take during pregnancy."
Correct Answer: B) "Maintain good oral hygiene to prevent gingival hyperplasia."
Explanation: Gingival hyperplasia (overgrowth of gum tissue) is a common side effect of
phenytoin. Thorough oral care and regular dental visits are necessary. Phenytoin is teratogenic,
and rashes should be reported, but gingival care is a standard daily intervention for all clients.
Question 10: A nurse is caring for a client with a fractured hip. Which assessment finding
indicates a potential complication?
A) External rotation of the affected extremity.
B) Muscle spasms in the affected extremity.
C) Pain managed by analgesics.
D) Ecchymosis around the fracture site.
Correct Answer: A) External rotation of the affected extremity.
Explanation: A shortened, externally rotated leg is a classic clinical indicator of a hip fracture. If
this occurs after initial stabilization, it suggests displacement of the fracture.
