RN VATI Comprehensive Predictor 2026
180-Question Practice Exam with Answers and Rationales
QUESTION 1 | TOPIC: Pharmacology
A nurse is preparing to administer a blood transfusion to a client. Which of the following actions
should the nurse take first?
A. Check the client's vital signs
B. Verify the client's identity with two identifiers
C. Prime the blood administration tubing with normal saline
D. Obtain consent for the transfusion
Correct Answer: B
Rationale: The first action in any blood transfusion procedure is to verify the client's identity
using two identifiers (e.g., name and date of birth) to ensure the correct blood product is given
to the correct client. Vital signs are checked before and during, but identification is priority.
Priming tubing and consent are also important but occur after verification.
QUESTION 2 | TOPIC: Pharmacology
A client with type 2 diabetes is prescribed metformin. Which of the following adverse effects
should the nurse instruct the client to report immediately?
A. Gastrointestinal upset
B. Metallic taste in mouth
C. Muscle pain and weakness
D. Weight gain
Correct Answer: C
Rationale: Metformin can cause lactic acidosis, a rare but serious complication. Early signs
include muscle pain, weakness, lethargy, and hyperventilation. Gastrointestinal upset is
common and often transient. Metallic taste and weight gain are not typical adverse effects.
QUESTION 3 | TOPIC: Pharmacology
A nurse is administering morphine sulfate 2 mg IV to a client for postoperative pain. Which of
the following assessments is the priority?
A. Pain level on a 0–10 scale
B. Respiratory rate and depth
C. Blood pressure and heart rate
D. Level of sedation
Correct Answer: B
Rationale: Morphine is a potent opioid that can cause respiratory depression. The priority
,assessment is respiratory rate and depth because airway and breathing are the highest priority
in the ABC framework. Pain level, vital signs, and sedation are also important but secondary.
QUESTION 4 | TOPIC: Pharmacology
A nurse is reviewing a client's medication list and notes that the client is taking levothyroxine.
Which of the following findings indicates a therapeutic response to this medication?
A. Weight gain of 3 kg in 1 month
B. Heart rate of 52/min
C. Serum TSH level of 2.5 mIU/L
D. Serum T4 level of 1.0 mcg/dL
Correct Answer: C
Rationale: Levothyroxine replaces thyroid hormone in hypothyroidism. A normal TSH level
(typically 0.4–4.0 mIU/L) indicates adequate replacement. A TSH of 2.5 is within normal range.
Weight gain, bradycardia, and low T4 suggest inadequate dosing.
QUESTION 5 | TOPIC: Pharmacology
A nurse is caring for a client who is receiving heparin infusion for a deep vein thrombosis. Which
of the following laboratory values should the nurse monitor to evaluate the effectiveness of
therapy?
A. International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Prothrombin Time (PT)
D. Platelet count
Correct Answer: B
Rationale: Heparin is monitored using aPTT, with therapeutic goal typically 1.5–2.5 times the
normal control. INR and PT are used for warfarin monitoring. Platelet count monitors for
heparin-induced thrombocytopenia but not therapeutic effect.
QUESTION 6 | TOPIC: Pharmacology
A nurse is providing teaching to a client who has a new prescription for sertraline. Which of the
following statements by the client indicates an understanding of the teaching?
A. "I should take this medication with a full glass of milk"
B. "I can stop taking this medication once I feel better"
C. "I may experience improved mood in 1 to 2 weeks"
D. "This medication will increase my appetite"
Correct Answer: C
Rationale: Selective serotonin reuptake inhibitors (SSRIs) like sertraline typically take 1–4 weeks
to achieve therapeutic effect. Clients should not stop abruptly due to withdrawal. They may
cause GI upset and weight changes, not increased appetite universally.
,QUESTION 7 | TOPIC: Pharmacology
A nurse is preparing to administer lorazepam to a client who is experiencing status epilepticus.
Which of the following routes should the nurse anticipate using?
A. Oral
B. Intramuscular
C. Intravenous
D. Subcutaneous
Correct Answer: C
Rationale: In status epilepticus, rapid onset is critical; IV administration provides immediate
effect. Oral and subcutaneous are too slow. IM may be used if IV access is unavailable but IV is
preferred.
QUESTION 8 | TOPIC: Pharmacology
A client with heart failure is prescribed carvedilol. The nurse should monitor for which of the
following adverse effects?
A. Tachycardia
B. Hypertension
C. Bronchospasm
D. Hyperglycemia
Correct Answer: C
Rationale: Carvedilol is a nonselective beta-blocker that can cause bronchospasm, especially in
clients with reactive airway disease. It can cause bradycardia and hypotension, not tachycardia
or hyperglycemia.
QUESTION 9 | TOPIC: Pharmacology
A nurse is administering acyclovir to a client with herpes zoster. Which of the following is the
primary action of this medication?
A. Inhibits viral DNA synthesis
B. Blocks neuraminidase
C. Prevents viral attachment to host cells
D. Destroys viral envelope
Correct Answer: A
Rationale: Acyclovir is an antiviral that inhibits viral DNA polymerase, thereby preventing viral
replication. Neuraminidase inhibitors are for influenza. Attachment blockers and envelope
disruptors are not acyclovir's mechanism.
QUESTION 10 | TOPIC: Pharmacology
A nurse is providing discharge teaching for a client who has a prescription for warfarin. Which of
the following over-the-counter products should the client avoid?
, A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
Correct Answer: B
Rationale: NSAIDs like ibuprofen increase bleeding risk when taken with warfarin.
Acetaminophen is safer but still monitor. Antihistamines are generally safe.
QUESTION 11 | TOPIC: Fundamentals & Safety
A nurse is caring for a client who is postoperative and has a patient-controlled analgesia (PCA)
pump. The client's family member expresses concern that the client is sleeping too much.
Which of the following responses by the nurse is appropriate?
A. "I will decrease the basal rate so the client will be more alert"
B. "The client is getting adequate pain relief and is resting comfortably"
C. "Excessive sedation can occur; I will assess the client's respiratory status"
D. "It is normal for clients to sleep a lot after surgery"
Correct Answer: C
Rationale: Excessive sedation may indicate opioid toxicity and respiratory depression. The nurse
should assess the client and possibly adjust the PCA settings. Sedation is not always normal; it
requires evaluation.
QUESTION 12 | TOPIC: Fundamentals & Safety
A nurse is preparing to perform a nasogastric (NG) tube insertion for a client with a bowel
obstruction. Which of the following is the correct method to measure the length of tube to be
inserted?
A. Measure from the tip of the nose to the earlobe to the xiphoid process
B. Measure from the corner of the mouth to the earlobe to the umbilicus
C. Measure from the tip of the nose to the earlobe to the sternum
D. Measure from the corner of the mouth to the earlobe to the xiphoid process
Correct Answer: A
Rationale: Standard measurement for NG tube insertion is from the tip of the nose to the
earlobe, then to the xiphoid process (NEX). This approximates the distance from the nares to
the stomach.
QUESTION 13 | TOPIC: Fundamentals & Safety
A nurse is assessing a client who has a urinary catheter and notes that the urine output has
decreased to 20 mL/hr over the past 2 hours. What is the nurse's priority action?
A. Check the catheter for kinks or obstruction
B. Increase the client's fluid intake
180-Question Practice Exam with Answers and Rationales
QUESTION 1 | TOPIC: Pharmacology
A nurse is preparing to administer a blood transfusion to a client. Which of the following actions
should the nurse take first?
A. Check the client's vital signs
B. Verify the client's identity with two identifiers
C. Prime the blood administration tubing with normal saline
D. Obtain consent for the transfusion
Correct Answer: B
Rationale: The first action in any blood transfusion procedure is to verify the client's identity
using two identifiers (e.g., name and date of birth) to ensure the correct blood product is given
to the correct client. Vital signs are checked before and during, but identification is priority.
Priming tubing and consent are also important but occur after verification.
QUESTION 2 | TOPIC: Pharmacology
A client with type 2 diabetes is prescribed metformin. Which of the following adverse effects
should the nurse instruct the client to report immediately?
A. Gastrointestinal upset
B. Metallic taste in mouth
C. Muscle pain and weakness
D. Weight gain
Correct Answer: C
Rationale: Metformin can cause lactic acidosis, a rare but serious complication. Early signs
include muscle pain, weakness, lethargy, and hyperventilation. Gastrointestinal upset is
common and often transient. Metallic taste and weight gain are not typical adverse effects.
QUESTION 3 | TOPIC: Pharmacology
A nurse is administering morphine sulfate 2 mg IV to a client for postoperative pain. Which of
the following assessments is the priority?
A. Pain level on a 0–10 scale
B. Respiratory rate and depth
C. Blood pressure and heart rate
D. Level of sedation
Correct Answer: B
Rationale: Morphine is a potent opioid that can cause respiratory depression. The priority
,assessment is respiratory rate and depth because airway and breathing are the highest priority
in the ABC framework. Pain level, vital signs, and sedation are also important but secondary.
QUESTION 4 | TOPIC: Pharmacology
A nurse is reviewing a client's medication list and notes that the client is taking levothyroxine.
Which of the following findings indicates a therapeutic response to this medication?
A. Weight gain of 3 kg in 1 month
B. Heart rate of 52/min
C. Serum TSH level of 2.5 mIU/L
D. Serum T4 level of 1.0 mcg/dL
Correct Answer: C
Rationale: Levothyroxine replaces thyroid hormone in hypothyroidism. A normal TSH level
(typically 0.4–4.0 mIU/L) indicates adequate replacement. A TSH of 2.5 is within normal range.
Weight gain, bradycardia, and low T4 suggest inadequate dosing.
QUESTION 5 | TOPIC: Pharmacology
A nurse is caring for a client who is receiving heparin infusion for a deep vein thrombosis. Which
of the following laboratory values should the nurse monitor to evaluate the effectiveness of
therapy?
A. International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Prothrombin Time (PT)
D. Platelet count
Correct Answer: B
Rationale: Heparin is monitored using aPTT, with therapeutic goal typically 1.5–2.5 times the
normal control. INR and PT are used for warfarin monitoring. Platelet count monitors for
heparin-induced thrombocytopenia but not therapeutic effect.
QUESTION 6 | TOPIC: Pharmacology
A nurse is providing teaching to a client who has a new prescription for sertraline. Which of the
following statements by the client indicates an understanding of the teaching?
A. "I should take this medication with a full glass of milk"
B. "I can stop taking this medication once I feel better"
C. "I may experience improved mood in 1 to 2 weeks"
D. "This medication will increase my appetite"
Correct Answer: C
Rationale: Selective serotonin reuptake inhibitors (SSRIs) like sertraline typically take 1–4 weeks
to achieve therapeutic effect. Clients should not stop abruptly due to withdrawal. They may
cause GI upset and weight changes, not increased appetite universally.
,QUESTION 7 | TOPIC: Pharmacology
A nurse is preparing to administer lorazepam to a client who is experiencing status epilepticus.
Which of the following routes should the nurse anticipate using?
A. Oral
B. Intramuscular
C. Intravenous
D. Subcutaneous
Correct Answer: C
Rationale: In status epilepticus, rapid onset is critical; IV administration provides immediate
effect. Oral and subcutaneous are too slow. IM may be used if IV access is unavailable but IV is
preferred.
QUESTION 8 | TOPIC: Pharmacology
A client with heart failure is prescribed carvedilol. The nurse should monitor for which of the
following adverse effects?
A. Tachycardia
B. Hypertension
C. Bronchospasm
D. Hyperglycemia
Correct Answer: C
Rationale: Carvedilol is a nonselective beta-blocker that can cause bronchospasm, especially in
clients with reactive airway disease. It can cause bradycardia and hypotension, not tachycardia
or hyperglycemia.
QUESTION 9 | TOPIC: Pharmacology
A nurse is administering acyclovir to a client with herpes zoster. Which of the following is the
primary action of this medication?
A. Inhibits viral DNA synthesis
B. Blocks neuraminidase
C. Prevents viral attachment to host cells
D. Destroys viral envelope
Correct Answer: A
Rationale: Acyclovir is an antiviral that inhibits viral DNA polymerase, thereby preventing viral
replication. Neuraminidase inhibitors are for influenza. Attachment blockers and envelope
disruptors are not acyclovir's mechanism.
QUESTION 10 | TOPIC: Pharmacology
A nurse is providing discharge teaching for a client who has a prescription for warfarin. Which of
the following over-the-counter products should the client avoid?
, A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
Correct Answer: B
Rationale: NSAIDs like ibuprofen increase bleeding risk when taken with warfarin.
Acetaminophen is safer but still monitor. Antihistamines are generally safe.
QUESTION 11 | TOPIC: Fundamentals & Safety
A nurse is caring for a client who is postoperative and has a patient-controlled analgesia (PCA)
pump. The client's family member expresses concern that the client is sleeping too much.
Which of the following responses by the nurse is appropriate?
A. "I will decrease the basal rate so the client will be more alert"
B. "The client is getting adequate pain relief and is resting comfortably"
C. "Excessive sedation can occur; I will assess the client's respiratory status"
D. "It is normal for clients to sleep a lot after surgery"
Correct Answer: C
Rationale: Excessive sedation may indicate opioid toxicity and respiratory depression. The nurse
should assess the client and possibly adjust the PCA settings. Sedation is not always normal; it
requires evaluation.
QUESTION 12 | TOPIC: Fundamentals & Safety
A nurse is preparing to perform a nasogastric (NG) tube insertion for a client with a bowel
obstruction. Which of the following is the correct method to measure the length of tube to be
inserted?
A. Measure from the tip of the nose to the earlobe to the xiphoid process
B. Measure from the corner of the mouth to the earlobe to the umbilicus
C. Measure from the tip of the nose to the earlobe to the sternum
D. Measure from the corner of the mouth to the earlobe to the xiphoid process
Correct Answer: A
Rationale: Standard measurement for NG tube insertion is from the tip of the nose to the
earlobe, then to the xiphoid process (NEX). This approximates the distance from the nares to
the stomach.
QUESTION 13 | TOPIC: Fundamentals & Safety
A nurse is assessing a client who has a urinary catheter and notes that the urine output has
decreased to 20 mL/hr over the past 2 hours. What is the nurse's priority action?
A. Check the catheter for kinks or obstruction
B. Increase the client's fluid intake
