[ Comprehensive atiiiii - March 18,
Predictor review ] 2022.
Comprehensive - Predictor review 03/18/22
1. A nurse is assessing a client who has left-sided heart failure. Which of the following symptoms should the nurse
identify as the highest priority?
Jugular distention
Frothy pink sputum
Hepatomegaly
Weight gain
2. A nurse in the emergency department is assisting with the suturing of a laceration to the client’s face. Which of
the following actions should the nurse take?
Pour the sterile cleansing solution holding the bottle 10 cm (4 in.) above the sterile field
Pull the top flap of the suture tray towards the body when opening.
Place the bottle of local anesthetic 5 cm (2 in) inside the sterile field border.
Drop the suture package on to the sterile field from a distance of 30 cm (12 in).
3. A nurse is assessing a client 1 hr following delivery and notes that her uterus is boggy and….to the umbilicus.
Which of the following actions should the nurse take first?
Massage the fundus.
Assess lochia
Take vital signs
Give oxytocin (Pitocin) IV bolus.
4. (missing)
5.. A nurse is caring for a client who is 1 day postoperative following a hypophysectomy for removal of a pituitary
tumor. Which of the following findings requires further assessment by the nurse?
Urinary output greater than fluid intake
Report of dry mouth
Glasgow Coma Scale score of 15
Bloody drainage on the nasal dressing measuring 3 cm
6. A nurse in an emergency department is caring for a client who has multiple wounds due to a crash. Which of the
following interventions are appropriate? (Select all that apply).
Apply direct pressure to bleeding wounds.
Clean lacerations and abrasions with hydrogen peroxide.
, [ Comprehensive atiiiii - March 18,
Predictor review ] 2022.
Administer 650 mg aspirin PO as needed for pain.
Cover wounds with a sterile dressing
Determine date of last tetanus toxoid vaccination.
7. A nurse is planning care for four clients. Which of the following clients is the highest priority?
, [ Comprehensive atiiiii - March 18,
Predictor review ] 2022.
A client who has frequent incontinence
A client who has dry, black eschar on the heel
A client who has a reddened skin area with blanching around the coccyx
A client who is wearing an arm cast and reports numb fingers
8. A nurse is assisting with mass casualty triage following an explosion at a local factory. Which of the clients
should the nurse identify as the priority?
A client who has massive head trauma
A client who has an open fracture of the lower extremity
A client who has full-thickness burns to the face and trunk
A client who has indication of hypovolemic shock
9. A nurse is planning care for a newly admitted adolescent client who has bacterial meningitis. Which of the
following instructions is appropriate for the nurse to include in the plan of care?
Assist the client to a supine position.
Recommend prophylactic acyclovir (Zovirax) for the client's family.
Initiate droplet precautions for the client.
Perform a Glasgow Coma Scale every 24 hr.
10. A nurse is caring for a client who is unconscious and has an advanced directive indicating no extraordinary
measures. The client's son wants everything possible done for his father. Which of the following is an
appropriate statement by the nurse?
"I will notify the health care provider of your wishes."
"Have you talked about this with your family?"
_X_ "We have to honor your father's wishes."
"Have you discussed this with your minister?"
11. A nurse is assessing a client brought to the hospital's psychiatric emergency services by a law enforcement
officer. The client has disorganized, incoherent speech with loose associations and religious content. The nurse
recognizes these signs and symptoms as being consistent with which of the following?
Alzheimer's disease
Depression
, [ Comprehensive atiiiii - March 18,
Predictor review ] 2022.
Substance intoxication
X Schizophrenia
12. A nurse is caring for a client who has a stool culture that is positive for Clostridium difficile (C. difficile) of the
following infection control precautions is appropriate?
Place the client in a negative pressure room.
Predictor review ] 2022.
Comprehensive - Predictor review 03/18/22
1. A nurse is assessing a client who has left-sided heart failure. Which of the following symptoms should the nurse
identify as the highest priority?
Jugular distention
Frothy pink sputum
Hepatomegaly
Weight gain
2. A nurse in the emergency department is assisting with the suturing of a laceration to the client’s face. Which of
the following actions should the nurse take?
Pour the sterile cleansing solution holding the bottle 10 cm (4 in.) above the sterile field
Pull the top flap of the suture tray towards the body when opening.
Place the bottle of local anesthetic 5 cm (2 in) inside the sterile field border.
Drop the suture package on to the sterile field from a distance of 30 cm (12 in).
3. A nurse is assessing a client 1 hr following delivery and notes that her uterus is boggy and….to the umbilicus.
Which of the following actions should the nurse take first?
Massage the fundus.
Assess lochia
Take vital signs
Give oxytocin (Pitocin) IV bolus.
4. (missing)
5.. A nurse is caring for a client who is 1 day postoperative following a hypophysectomy for removal of a pituitary
tumor. Which of the following findings requires further assessment by the nurse?
Urinary output greater than fluid intake
Report of dry mouth
Glasgow Coma Scale score of 15
Bloody drainage on the nasal dressing measuring 3 cm
6. A nurse in an emergency department is caring for a client who has multiple wounds due to a crash. Which of the
following interventions are appropriate? (Select all that apply).
Apply direct pressure to bleeding wounds.
Clean lacerations and abrasions with hydrogen peroxide.
, [ Comprehensive atiiiii - March 18,
Predictor review ] 2022.
Administer 650 mg aspirin PO as needed for pain.
Cover wounds with a sterile dressing
Determine date of last tetanus toxoid vaccination.
7. A nurse is planning care for four clients. Which of the following clients is the highest priority?
, [ Comprehensive atiiiii - March 18,
Predictor review ] 2022.
A client who has frequent incontinence
A client who has dry, black eschar on the heel
A client who has a reddened skin area with blanching around the coccyx
A client who is wearing an arm cast and reports numb fingers
8. A nurse is assisting with mass casualty triage following an explosion at a local factory. Which of the clients
should the nurse identify as the priority?
A client who has massive head trauma
A client who has an open fracture of the lower extremity
A client who has full-thickness burns to the face and trunk
A client who has indication of hypovolemic shock
9. A nurse is planning care for a newly admitted adolescent client who has bacterial meningitis. Which of the
following instructions is appropriate for the nurse to include in the plan of care?
Assist the client to a supine position.
Recommend prophylactic acyclovir (Zovirax) for the client's family.
Initiate droplet precautions for the client.
Perform a Glasgow Coma Scale every 24 hr.
10. A nurse is caring for a client who is unconscious and has an advanced directive indicating no extraordinary
measures. The client's son wants everything possible done for his father. Which of the following is an
appropriate statement by the nurse?
"I will notify the health care provider of your wishes."
"Have you talked about this with your family?"
_X_ "We have to honor your father's wishes."
"Have you discussed this with your minister?"
11. A nurse is assessing a client brought to the hospital's psychiatric emergency services by a law enforcement
officer. The client has disorganized, incoherent speech with loose associations and religious content. The nurse
recognizes these signs and symptoms as being consistent with which of the following?
Alzheimer's disease
Depression
, [ Comprehensive atiiiii - March 18,
Predictor review ] 2022.
Substance intoxication
X Schizophrenia
12. A nurse is caring for a client who has a stool culture that is positive for Clostridium difficile (C. difficile) of the
following infection control precautions is appropriate?
Place the client in a negative pressure room.
