**Title:** **Mastering the Multisystem Challenge: An
ATI & NCLEX-RN Next Gen Comprehensive Predictor
Exam**
---
### Question 1 of 87
A nurse on a medical-surgical unit is caring for a client who is postoperative day one following a right
total knee arthroplasty. The client reports sudden onset of shortness of breath and pleuritic chest pain.
Vital signs: BP 142/88, HR 118, RR 32, SpO2 88% on room air. Which action should the nurse take first?
A) Administer oxygen via nasal cannula at 4 L/min.
B) Prepare the client for a ventilation-perfusion scan.
C) Notify the rapid response team.
D) Place the client in a high-Fowler’s position.
💫RATIONALE✔️✔️: The client’s sudden dyspnea, tachypnea, tachycardia, and hypoxemia after surgery
are classic signs of a pulmonary embolism (PE). The immediate priority is to improve oxygenation, which
begins with administering high-flow oxygen. After oxygen, the nurse should position the client in high-
Fowler’s to maximize lung expansion, then notify the rapid response team or provider. While a V/Q scan
may confirm PE, it is not the first action.
💫ANSWER✔️✔️: A) Administer oxygen via nasal cannula at 4 L/min.
---
### Question 2 of 87
,A nurse is reviewing the laboratory results for a client who is receiving IV heparin for a deep vein
thrombosis. The client’s activated partial thromboplastin time (aPTT) is 98 seconds. The control value is
30 seconds. Which action should the nurse take?
A) Increase the heparin infusion rate by 2 units/kg/hr.
B) Administer protamine sulfate as prescribed.
C) Continue the heparin infusion at the current rate.
D) Hold the heparin infusion and notify the provider.
💫RATIONALE✔️✔️: The therapeutic aPTT range for a client on heparin is typically 1.5 to 2.5 times the
control value. Here, 30 x 2.5 = 75 seconds. The client’s aPTT of 98 seconds is supratherapeutic, indicating
a high bleeding risk. The nurse should hold the infusion and notify the provider for possible dose
reduction. Protamine sulfate is given for severe bleeding or overdose reversal, not as an automatic first
step.
💫ANSWER✔️✔️: D) Hold the heparin infusion and notify the provider.
---
### Question 3 of 87
A nurse is providing discharge teaching to a client with heart failure who has a new prescription for
furosemide (Lasix) 40 mg PO daily. Which of the following statements by the client indicates an
understanding of the teaching?
A) “I will take my medication at bedtime to prevent dizziness during the day.”
B) “I should eat foods like bananas, oranges, and potatoes every day.”
C) “I will weigh myself once a week at the same time each morning.”
D) “I can stop the medication if I feel like I am urinating too much.”
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes loss of potassium. To prevent hypokalemia,
the client should consume potassium-rich foods such as bananas, oranges, potatoes, and spinach.
Morning dosing is recommended to avoid nocturia. Daily, not weekly, weights are essential to monitor
, fluid status. Clients should never stop diuretics abruptly without provider guidance due to risk of fluid
overload.
💫ANSWER✔️✔️: B) “I should eat foods like bananas, oranges, and potatoes every day.”
---
### Question 4 of 87
**Select-All-That-Apply (SATA):** A nurse is assessing a client who is 2 hours post-cardiac
catheterization via the right femoral artery. Which of the following findings require immediate
intervention? (Select all that apply.)
A) Right pedal pulse +2 (palpable, normal)
B) Client reports back pain rated 3/10
C) Pulsatile mass with bruit at the insertion site
D) Right foot is pale and cool to the touch
E) Small amount of dried blood on the dressing
💫RATIONALE✔️✔️: A pulsatile mass with bruit (C) indicates a pseudoaneurysm or arteriovenous fistula,
requiring immediate intervention. Pale and cool extremity (D) suggests arterial occlusion. Both are
complications. A palpable +2 pedal pulse is normal. Mild back pain may be from lying flat. Small dried
blood is expected.
💫ANSWER✔️✔️: C, D
---
### Question 5 of 87
A nurse is caring for a client with diabetic ketoacidosis (DKA) who has an insulin infusion running at 0.1
unit/kg/hr. The client’s blood glucose has decreased from 650 mg/dL to 220 mg/dL over 4 hours. The
current serum potassium level is 3.8 mEq/L. Which action should the nurse anticipate?
ATI & NCLEX-RN Next Gen Comprehensive Predictor
Exam**
---
### Question 1 of 87
A nurse on a medical-surgical unit is caring for a client who is postoperative day one following a right
total knee arthroplasty. The client reports sudden onset of shortness of breath and pleuritic chest pain.
Vital signs: BP 142/88, HR 118, RR 32, SpO2 88% on room air. Which action should the nurse take first?
A) Administer oxygen via nasal cannula at 4 L/min.
B) Prepare the client for a ventilation-perfusion scan.
C) Notify the rapid response team.
D) Place the client in a high-Fowler’s position.
💫RATIONALE✔️✔️: The client’s sudden dyspnea, tachypnea, tachycardia, and hypoxemia after surgery
are classic signs of a pulmonary embolism (PE). The immediate priority is to improve oxygenation, which
begins with administering high-flow oxygen. After oxygen, the nurse should position the client in high-
Fowler’s to maximize lung expansion, then notify the rapid response team or provider. While a V/Q scan
may confirm PE, it is not the first action.
💫ANSWER✔️✔️: A) Administer oxygen via nasal cannula at 4 L/min.
---
### Question 2 of 87
,A nurse is reviewing the laboratory results for a client who is receiving IV heparin for a deep vein
thrombosis. The client’s activated partial thromboplastin time (aPTT) is 98 seconds. The control value is
30 seconds. Which action should the nurse take?
A) Increase the heparin infusion rate by 2 units/kg/hr.
B) Administer protamine sulfate as prescribed.
C) Continue the heparin infusion at the current rate.
D) Hold the heparin infusion and notify the provider.
💫RATIONALE✔️✔️: The therapeutic aPTT range for a client on heparin is typically 1.5 to 2.5 times the
control value. Here, 30 x 2.5 = 75 seconds. The client’s aPTT of 98 seconds is supratherapeutic, indicating
a high bleeding risk. The nurse should hold the infusion and notify the provider for possible dose
reduction. Protamine sulfate is given for severe bleeding or overdose reversal, not as an automatic first
step.
💫ANSWER✔️✔️: D) Hold the heparin infusion and notify the provider.
---
### Question 3 of 87
A nurse is providing discharge teaching to a client with heart failure who has a new prescription for
furosemide (Lasix) 40 mg PO daily. Which of the following statements by the client indicates an
understanding of the teaching?
A) “I will take my medication at bedtime to prevent dizziness during the day.”
B) “I should eat foods like bananas, oranges, and potatoes every day.”
C) “I will weigh myself once a week at the same time each morning.”
D) “I can stop the medication if I feel like I am urinating too much.”
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes loss of potassium. To prevent hypokalemia,
the client should consume potassium-rich foods such as bananas, oranges, potatoes, and spinach.
Morning dosing is recommended to avoid nocturia. Daily, not weekly, weights are essential to monitor
, fluid status. Clients should never stop diuretics abruptly without provider guidance due to risk of fluid
overload.
💫ANSWER✔️✔️: B) “I should eat foods like bananas, oranges, and potatoes every day.”
---
### Question 4 of 87
**Select-All-That-Apply (SATA):** A nurse is assessing a client who is 2 hours post-cardiac
catheterization via the right femoral artery. Which of the following findings require immediate
intervention? (Select all that apply.)
A) Right pedal pulse +2 (palpable, normal)
B) Client reports back pain rated 3/10
C) Pulsatile mass with bruit at the insertion site
D) Right foot is pale and cool to the touch
E) Small amount of dried blood on the dressing
💫RATIONALE✔️✔️: A pulsatile mass with bruit (C) indicates a pseudoaneurysm or arteriovenous fistula,
requiring immediate intervention. Pale and cool extremity (D) suggests arterial occlusion. Both are
complications. A palpable +2 pedal pulse is normal. Mild back pain may be from lying flat. Small dried
blood is expected.
💫ANSWER✔️✔️: C, D
---
### Question 5 of 87
A nurse is caring for a client with diabetic ketoacidosis (DKA) who has an insulin infusion running at 0.1
unit/kg/hr. The client’s blood glucose has decreased from 650 mg/dL to 220 mg/dL over 4 hours. The
current serum potassium level is 3.8 mEq/L. Which action should the nurse anticipate?
