VATI Green Ligth
Comprehensive Form
A,B,C Exam Final
Update
A nurse is admitting a client who has antisocial personality disorder. Which of the
following client behaviors should the nurse identify as consistent with this
disorder?
A. Compulsive attention to details
B. Avoids interacting with others
C. Uses others for personal gain
D. Socially awkward in group situations - ✔✔✔ANSWER-C. Uses others for
personal gain
,A nurse is interpreting the cardiac rhythm strip of a client who was admitted with
syncope. Which of the following images indicates that the client has atrial
fibrillation? - ✔✔✔ANSWER-
A client who has a diagnosis of complete placenta previa is admitted to the labor
and delivery suite at 36 weeks gestation with contractions 5 min in frequency and 1
min in duration. Which of the following actions should the nurse take?
A. Rupture the amniotic sac
B. Medicate the client for pain
C. Prepare the client for a cesarean section
D. Perform a vaginal exam - ✔✔✔ANSWER-C. Prepare the client for a cesarean
section
A charge nurse on a pediatric unit is making assignments for a float nurse from the
medical unit. Which of the following clients is appropriate to assign to the float
nurse?
A. A 10-year-old client who has pneumonia and is receiving respiratory treatments
B. A 4-year-old client who has a Wilms tumor and is receiving chemotherapy
C. An 8-month-old client who is scheduled for a surgical repair of a ventricular
septal defect tomorrow
D. A 14-year-old client who is scheduled for discharge today following placement of
a Harrington rod - ✔✔✔ANSWER-A. A 10-year-old client who has pneumonia and
is receiving respiratory treatments
A nurse notices smoke coming from a client's room and discovers a fire in the
wastebasket. After moving the client to safety, which of the following is the priority
action?
,A. Notify the facility operator.
B. Close the fire doors on the unit.
C. Turn off oxygen sources.
D. Put out the fire with the appropriate extinguisher. - ✔✔✔ANSWER-A. Notify the
facility operator.
A nurse is assessing an infant who has water intoxication. Which of the following
findings should the nurse expect?
A. Generalized edema
B. Elevated urine specific gravity
C. Thready pulse
D. Increased hematocrit - ✔✔✔ANSWER-A. Generalized edema
A nurse is discussing the z-track administration of hydroxyzine with a newly
licensed nurse. Which of the following statements indicates the newly licensed
nurse understands the purpose of the technique?
A. This technique prevents injury to the sciatic nerve
B. This technique decreases the risk of subcutaneous infiltration
C. This technique allows a larger amount of medication to be injected
D. This technique increases the absorption rate of the drug - ✔✔✔ANSWER-This
technique decreases the risk of subcutaneous infiltration
A nurse is creating a plan of care for a client who has anorexia nervosa. Which of
the following interventions should the nurse include in the plan?
A. Encourage the client to gain 2.3 kg per week
B. Weigh the client once per week throughout hospitalization
, C. Monitor the client for 1 hr after meals
D. Allow the client to choose mealtimes - ✔✔✔ANSWER-C. Monitor the client for 1
hr after meals
A nurse is planning care for a child who has increased intracranial pressure with a
decrease in level of consciousness. Which of the following interventions should the
nurse include in the plan of care?
A. Perform active range-of-motion exercises
B. Maintain the head at a midline position
C. Suction the airway frequently
D. Perform neurological checks every 4 hrs - ✔✔✔ANSWER-B. Maintain the head
at a midline position
10. A nurse is assessing a client who has delirium due to a febrile illness. Which of
the following findings should the nurse expect?
A. Hallucinations
B. Agnosia
C. Bradycardia
D. Aphasia - ✔✔✔ANSWER-A. Hallucinations
A nurse is assessing a client who is receiving enteral feedings via a gastrostomy
tube. The nurse should identify that which of the following findings indicates fluid
overload?
A. Diminished bowel sounds
B. Bradycardia
C. Hypotension
Comprehensive Form
A,B,C Exam Final
Update
A nurse is admitting a client who has antisocial personality disorder. Which of the
following client behaviors should the nurse identify as consistent with this
disorder?
A. Compulsive attention to details
B. Avoids interacting with others
C. Uses others for personal gain
D. Socially awkward in group situations - ✔✔✔ANSWER-C. Uses others for
personal gain
,A nurse is interpreting the cardiac rhythm strip of a client who was admitted with
syncope. Which of the following images indicates that the client has atrial
fibrillation? - ✔✔✔ANSWER-
A client who has a diagnosis of complete placenta previa is admitted to the labor
and delivery suite at 36 weeks gestation with contractions 5 min in frequency and 1
min in duration. Which of the following actions should the nurse take?
A. Rupture the amniotic sac
B. Medicate the client for pain
C. Prepare the client for a cesarean section
D. Perform a vaginal exam - ✔✔✔ANSWER-C. Prepare the client for a cesarean
section
A charge nurse on a pediatric unit is making assignments for a float nurse from the
medical unit. Which of the following clients is appropriate to assign to the float
nurse?
A. A 10-year-old client who has pneumonia and is receiving respiratory treatments
B. A 4-year-old client who has a Wilms tumor and is receiving chemotherapy
C. An 8-month-old client who is scheduled for a surgical repair of a ventricular
septal defect tomorrow
D. A 14-year-old client who is scheduled for discharge today following placement of
a Harrington rod - ✔✔✔ANSWER-A. A 10-year-old client who has pneumonia and
is receiving respiratory treatments
A nurse notices smoke coming from a client's room and discovers a fire in the
wastebasket. After moving the client to safety, which of the following is the priority
action?
,A. Notify the facility operator.
B. Close the fire doors on the unit.
C. Turn off oxygen sources.
D. Put out the fire with the appropriate extinguisher. - ✔✔✔ANSWER-A. Notify the
facility operator.
A nurse is assessing an infant who has water intoxication. Which of the following
findings should the nurse expect?
A. Generalized edema
B. Elevated urine specific gravity
C. Thready pulse
D. Increased hematocrit - ✔✔✔ANSWER-A. Generalized edema
A nurse is discussing the z-track administration of hydroxyzine with a newly
licensed nurse. Which of the following statements indicates the newly licensed
nurse understands the purpose of the technique?
A. This technique prevents injury to the sciatic nerve
B. This technique decreases the risk of subcutaneous infiltration
C. This technique allows a larger amount of medication to be injected
D. This technique increases the absorption rate of the drug - ✔✔✔ANSWER-This
technique decreases the risk of subcutaneous infiltration
A nurse is creating a plan of care for a client who has anorexia nervosa. Which of
the following interventions should the nurse include in the plan?
A. Encourage the client to gain 2.3 kg per week
B. Weigh the client once per week throughout hospitalization
, C. Monitor the client for 1 hr after meals
D. Allow the client to choose mealtimes - ✔✔✔ANSWER-C. Monitor the client for 1
hr after meals
A nurse is planning care for a child who has increased intracranial pressure with a
decrease in level of consciousness. Which of the following interventions should the
nurse include in the plan of care?
A. Perform active range-of-motion exercises
B. Maintain the head at a midline position
C. Suction the airway frequently
D. Perform neurological checks every 4 hrs - ✔✔✔ANSWER-B. Maintain the head
at a midline position
10. A nurse is assessing a client who has delirium due to a febrile illness. Which of
the following findings should the nurse expect?
A. Hallucinations
B. Agnosia
C. Bradycardia
D. Aphasia - ✔✔✔ANSWER-A. Hallucinations
A nurse is assessing a client who is receiving enteral feedings via a gastrostomy
tube. The nurse should identify that which of the following findings indicates fluid
overload?
A. Diminished bowel sounds
B. Bradycardia
C. Hypotension
