and Correct Answers Review of the 2019 RN
Comprehensive Predictor/ RN Comprehensive
Predictor 2019 Review – Questions and Answers
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory acidosis. The nurse reviews the arterial blood gas (ABG) results: pH 7.25, PaCO2
65 mm Hg, HCO3- 26 mEq/L. Which intervention should the nurse implement first?
A. Administer intravenous sodium bicarbonate
B. Increase the oxygen flow rate to 6 L/min via nasal cannula
C. Position the patient in high Fowler's and encourage pursed-lip breathing
D. Prepare for noninvasive positive pressure ventilation (NIPPV)
Answer: D
Rationale: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2, normal HCO3-).
The priority is to improve ventilation. NIPPV (BiPAP) is the first-line intervention for acute hypercapnic
respiratory failure in COPD, as it reduces PaCO2 and work of breathing. Sodium bicarbonate is not
indicated because the acidosis is respiratory, not metabolic. High-flow oxygen can worsen hypercapnia
by blunting hypoxic drive. Positioning and breathing exercises are supportive but not the first priority in
severe acidosis.
2. A nurse is caring for a patient receiving a continuous infusion of heparin for treatment of deep
vein thrombosis. The patient's activated partial thromboplastin time (aPTT) is 90 seconds
(therapeutic range 60-80 seconds). Which action should the nurse take?
A. Increase the infusion rate by 2 units/kg/hr
B. Decrease the infusion rate by 2 units/kg/hr
C. Administer protamine sulfate 50 mg IV
D. Continue the current infusion rate and recheck aPTT in 6 hours
Answer: B
Rationale: The aPTT is above the therapeutic range (supratherapeutic), indicating increased bleeding
risk. The nurse should decrease the heparin infusion rate per protocol. Protamine sulfate is the reversal
agent for heparin but is reserved for life-threatening bleeding, not routine management. Continuing the
current rate would maintain the risk. Increasing the rate would worsen the situation.
3. A patient with schizophrenia has been taking haloperidol 10 mg twice daily for 3 weeks. The
nurse observes the patient exhibiting involuntary rhythmic movements of the face, tongue, and
jaw. Which intervention is most appropriate?
A. Administer benztropine 2 mg intramuscularly
B. Increase the haloperidol dose to 15 mg twice daily
C. Discontinue the haloperidol immediately and start clozapine
Page 1
,D. Obtain an electroencephalogram (EEG) to rule out seizure activity
Answer: A
Rationale: The symptoms describe tardive dyskinesia (TD), a potentially irreversible extrapyramidal side
effect of typical antipsychotics like haloperidol. First-line management includes anticholinergic agents
such as benztropine to reduce symptoms. Increasing the dose would likely worsen TD. Immediate
discontinuation and switching to clozapine is not first-line; gradual dose reduction or switching to a
second-generation antipsychotic is considered, but acute symptom management with benztropine is
appropriate. EEG is not indicated.
4. A patient with heart failure is receiving furosemide 40 mg IV push. The nurse notes that the
patient's urine output for the past hour was 30 mL. Which assessment finding is most important
for the nurse to monitor?
A. Serum potassium level
B. Blood pressure and heart rate
C. Serum creatinine level
D. Lung sounds and oxygen saturation
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium depletion. Low urine output despite
diuretic administration may indicate inadequate response or dehydration. However, the most critical
immediate risk is hypokalemia, which can lead to cardiac dysrhythmias. Monitoring serum potassium is
essential, especially with IV administration. While blood pressure, renal function, and respiratory status
are important, potassium imbalance is the most life-threatening in this context.
5. A nurse is teaching a patient about the use of a metered-dose inhaler (MDI) with a spacer. Which
patient statement indicates understanding of the correct technique?
A. I will shake the inhaler for 5 seconds before each use
B. I will hold my breath for 5 seconds after inhaling the medication
C. I will exhale fully before placing the mouthpiece in my mouth
D. I will inhale the medication as quickly as possible
Answer: C
Rationale: Correct MDI technique includes exhaling fully (to residual volume) before actuation to allow
maximal inhalation of the medication. Shaking for 5 seconds is not necessary; 5-10 seconds is
recommended. Breath-hold should be 10 seconds, not 5. Inhalation should be slow and deep, not quick.
Therefore, option C is the only correct statement.
6. A patient with cirrhosis and ascites is receiving spironolactone 100 mg daily. The nurse reviews
the laboratory results: sodium 132 mEq/L, potassium 5.6 mEq/L, chloride 98 mEq/L. Which action
should the nurse take?
A. Administer the spironolactone as prescribed
B. Hold the spironolactone and notify the provider
C. Administer furosemide 20 mg IV push
D. Give potassium chloride 20 mEq orally
Page 2
,Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. The patient has hyperkalemia (potassium 5.6
mEq/L), which is a contraindication to spironolactone. The nurse should hold the medication and notify
the provider. Administering it could worsen hyperkalemia, leading to cardiac arrest. Furosemide is not
indicated without an order. Potassium supplementation is dangerous in hyperkalemia.
7. A nurse is assessing a patient who has just undergone a thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which complication should the nurse suspect?
A. Thyroid storm
B. Hypocalcemia due to parathyroid injury
C. Laryngeal nerve damage
D. Hemorrhage at the surgical site
Answer: B
Rationale: Tingling (paresthesias) in the fingers and perioral area is a classic sign of hypocalcemia,
which can occur after thyroidectomy if the parathyroid glands are inadvertently damaged or removed.
This leads to decreased parathyroid hormone and subsequent hypocalcemia. Thyroid storm presents
with hyperthermia, tachycardia, and agitation. Laryngeal nerve damage causes hoarseness or voice
changes. Hemorrhage would present with neck swelling and respiratory distress.
8. A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
initiates an insulin infusion at 0.1 units/kg/hr. Which laboratory value requires the most immediate
intervention?
A. Serum glucose 450 mg/dL
B. Serum potassium 3.0 mEq/L
C. Serum bicarbonate 12 mEq/L
D. Arterial pH 7.20
Answer: B
Rationale: In DKA, total body potassium is depleted despite initial hyperkalemia. As insulin therapy
drives potassium into cells, hypokalemia can develop rapidly, leading to life-threatening cardiac
dysrhythmias. A potassium level of 3.0 mEq/L is critical and requires immediate replacement.
Hyperglycemia and acidosis are expected in DKA and will improve with insulin and fluids. Bicarbonate
is rarely needed unless pH <7.0.
9. A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse take?
A. Clamp the chest tube near the insertion site
B. Increase the suction pressure
C. Assess the chest tube system for an air leak
D. Reposition the patient to the affected side
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system. The nurse
should assess the chest tube system for leaks, including connections, tubing, and the insertion site.
Clamping the chest tube is dangerous and can cause tension pneumothorax. Increasing suction does not
address the leak. Repositioning may help if the leak is at the insertion site, but systematic assessment is
Page 3
, the priority.
10. A patient with acute pancreatitis has a nasogastric tube to low intermittent suction. The nurse
evaluates the patient's pain as 8 on a 0-10 scale. Which intervention should the nurse implement?
A. Administer morphine 4 mg IV push
B. Reposition the patient to a supine position
C. Irrigate the nasogastric tube with normal saline
D. Offer clear liquids to promote gastric emptying
Answer: A
Rationale: Pain management in acute pancreatitis is essential. Morphine is the analgesic of choice
(previously controversial but now accepted) because it does not cause sphincter of Oddi spasm as much
as other opioids. The patient is NPO with NG suction; offering clear liquids is contraindicated.
Repositioning may help but is insufficient for severe pain. Irrigating the NG tube is not indicated unless
it is blocked.
11. A 55-year-old patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (K+
6.8 mEq/L) and ECG changes (peaked T waves). The provider prescribes intravenous calcium
gluconate, regular insulin with dextrose 50%, and albuterol nebulization. Which mechanism best
explains the synergistic effect of these three interventions?
A. Calcium stabilizes cardiac membranes, insulin shifts potassium intracellularly, and albuterol enhances beta-2
receptor-mediated potassium uptake in skeletal muscle.
B. Calcium binds to potassium in the serum, insulin promotes renal excretion of potassium, and albuterol
inhibits potassium release from cells.
C. Calcium directly lowers serum potassium, insulin increases potassium reabsorption in the distal tubule, and
albuterol blocks potassium channels in the myocardium.
D. Calcium chelates potassium ions, insulin activates sodium-potassium ATPase in liver cells, and albuterol
increases potassium loss through sweat glands.
Answer: A
Rationale: Calcium gluconate antagonizes the cardiac effects of hyperkalemia by stabilizing the
myocardial cell membrane. Insulin and dextrose facilitate cellular uptake of potassium via activation of
Na+/K+ ATPase. Albuterol, a beta-2 agonist, stimulates potassium uptake into skeletal muscle cells. The
other options incorrectly describe the mechanisms of action.
12. A patient with a history of opioid use disorder is admitted for management of acute pain
following a traumatic injury. The nurse is concerned about the risk of respiratory depression.
Which pharmacologic approach is most appropriate to balance effective analgesia with minimizing
respiratory risk?
A. Administer a full mu-opioid agonist at a low dose and titrate to effect while monitoring respiratory rate and
oxygen saturation.
B. Use a nonsteroidal anti-inflammatory drug (NSAID) alone to avoid opioids entirely.
C. Prescribe a partial mu-opioid agonist such as buprenorphine, but avoid naloxone co-administration.
D. Administer a long-acting opioid like methadone to provide sustained analgesia with less respiratory
depression.
Page 4
Comprehensive Predictor/ RN Comprehensive
Predictor 2019 Review – Questions and Answers
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory acidosis. The nurse reviews the arterial blood gas (ABG) results: pH 7.25, PaCO2
65 mm Hg, HCO3- 26 mEq/L. Which intervention should the nurse implement first?
A. Administer intravenous sodium bicarbonate
B. Increase the oxygen flow rate to 6 L/min via nasal cannula
C. Position the patient in high Fowler's and encourage pursed-lip breathing
D. Prepare for noninvasive positive pressure ventilation (NIPPV)
Answer: D
Rationale: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2, normal HCO3-).
The priority is to improve ventilation. NIPPV (BiPAP) is the first-line intervention for acute hypercapnic
respiratory failure in COPD, as it reduces PaCO2 and work of breathing. Sodium bicarbonate is not
indicated because the acidosis is respiratory, not metabolic. High-flow oxygen can worsen hypercapnia
by blunting hypoxic drive. Positioning and breathing exercises are supportive but not the first priority in
severe acidosis.
2. A nurse is caring for a patient receiving a continuous infusion of heparin for treatment of deep
vein thrombosis. The patient's activated partial thromboplastin time (aPTT) is 90 seconds
(therapeutic range 60-80 seconds). Which action should the nurse take?
A. Increase the infusion rate by 2 units/kg/hr
B. Decrease the infusion rate by 2 units/kg/hr
C. Administer protamine sulfate 50 mg IV
D. Continue the current infusion rate and recheck aPTT in 6 hours
Answer: B
Rationale: The aPTT is above the therapeutic range (supratherapeutic), indicating increased bleeding
risk. The nurse should decrease the heparin infusion rate per protocol. Protamine sulfate is the reversal
agent for heparin but is reserved for life-threatening bleeding, not routine management. Continuing the
current rate would maintain the risk. Increasing the rate would worsen the situation.
3. A patient with schizophrenia has been taking haloperidol 10 mg twice daily for 3 weeks. The
nurse observes the patient exhibiting involuntary rhythmic movements of the face, tongue, and
jaw. Which intervention is most appropriate?
A. Administer benztropine 2 mg intramuscularly
B. Increase the haloperidol dose to 15 mg twice daily
C. Discontinue the haloperidol immediately and start clozapine
Page 1
,D. Obtain an electroencephalogram (EEG) to rule out seizure activity
Answer: A
Rationale: The symptoms describe tardive dyskinesia (TD), a potentially irreversible extrapyramidal side
effect of typical antipsychotics like haloperidol. First-line management includes anticholinergic agents
such as benztropine to reduce symptoms. Increasing the dose would likely worsen TD. Immediate
discontinuation and switching to clozapine is not first-line; gradual dose reduction or switching to a
second-generation antipsychotic is considered, but acute symptom management with benztropine is
appropriate. EEG is not indicated.
4. A patient with heart failure is receiving furosemide 40 mg IV push. The nurse notes that the
patient's urine output for the past hour was 30 mL. Which assessment finding is most important
for the nurse to monitor?
A. Serum potassium level
B. Blood pressure and heart rate
C. Serum creatinine level
D. Lung sounds and oxygen saturation
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium depletion. Low urine output despite
diuretic administration may indicate inadequate response or dehydration. However, the most critical
immediate risk is hypokalemia, which can lead to cardiac dysrhythmias. Monitoring serum potassium is
essential, especially with IV administration. While blood pressure, renal function, and respiratory status
are important, potassium imbalance is the most life-threatening in this context.
5. A nurse is teaching a patient about the use of a metered-dose inhaler (MDI) with a spacer. Which
patient statement indicates understanding of the correct technique?
A. I will shake the inhaler for 5 seconds before each use
B. I will hold my breath for 5 seconds after inhaling the medication
C. I will exhale fully before placing the mouthpiece in my mouth
D. I will inhale the medication as quickly as possible
Answer: C
Rationale: Correct MDI technique includes exhaling fully (to residual volume) before actuation to allow
maximal inhalation of the medication. Shaking for 5 seconds is not necessary; 5-10 seconds is
recommended. Breath-hold should be 10 seconds, not 5. Inhalation should be slow and deep, not quick.
Therefore, option C is the only correct statement.
6. A patient with cirrhosis and ascites is receiving spironolactone 100 mg daily. The nurse reviews
the laboratory results: sodium 132 mEq/L, potassium 5.6 mEq/L, chloride 98 mEq/L. Which action
should the nurse take?
A. Administer the spironolactone as prescribed
B. Hold the spironolactone and notify the provider
C. Administer furosemide 20 mg IV push
D. Give potassium chloride 20 mEq orally
Page 2
,Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. The patient has hyperkalemia (potassium 5.6
mEq/L), which is a contraindication to spironolactone. The nurse should hold the medication and notify
the provider. Administering it could worsen hyperkalemia, leading to cardiac arrest. Furosemide is not
indicated without an order. Potassium supplementation is dangerous in hyperkalemia.
7. A nurse is assessing a patient who has just undergone a thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which complication should the nurse suspect?
A. Thyroid storm
B. Hypocalcemia due to parathyroid injury
C. Laryngeal nerve damage
D. Hemorrhage at the surgical site
Answer: B
Rationale: Tingling (paresthesias) in the fingers and perioral area is a classic sign of hypocalcemia,
which can occur after thyroidectomy if the parathyroid glands are inadvertently damaged or removed.
This leads to decreased parathyroid hormone and subsequent hypocalcemia. Thyroid storm presents
with hyperthermia, tachycardia, and agitation. Laryngeal nerve damage causes hoarseness or voice
changes. Hemorrhage would present with neck swelling and respiratory distress.
8. A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
initiates an insulin infusion at 0.1 units/kg/hr. Which laboratory value requires the most immediate
intervention?
A. Serum glucose 450 mg/dL
B. Serum potassium 3.0 mEq/L
C. Serum bicarbonate 12 mEq/L
D. Arterial pH 7.20
Answer: B
Rationale: In DKA, total body potassium is depleted despite initial hyperkalemia. As insulin therapy
drives potassium into cells, hypokalemia can develop rapidly, leading to life-threatening cardiac
dysrhythmias. A potassium level of 3.0 mEq/L is critical and requires immediate replacement.
Hyperglycemia and acidosis are expected in DKA and will improve with insulin and fluids. Bicarbonate
is rarely needed unless pH <7.0.
9. A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse take?
A. Clamp the chest tube near the insertion site
B. Increase the suction pressure
C. Assess the chest tube system for an air leak
D. Reposition the patient to the affected side
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system. The nurse
should assess the chest tube system for leaks, including connections, tubing, and the insertion site.
Clamping the chest tube is dangerous and can cause tension pneumothorax. Increasing suction does not
address the leak. Repositioning may help if the leak is at the insertion site, but systematic assessment is
Page 3
, the priority.
10. A patient with acute pancreatitis has a nasogastric tube to low intermittent suction. The nurse
evaluates the patient's pain as 8 on a 0-10 scale. Which intervention should the nurse implement?
A. Administer morphine 4 mg IV push
B. Reposition the patient to a supine position
C. Irrigate the nasogastric tube with normal saline
D. Offer clear liquids to promote gastric emptying
Answer: A
Rationale: Pain management in acute pancreatitis is essential. Morphine is the analgesic of choice
(previously controversial but now accepted) because it does not cause sphincter of Oddi spasm as much
as other opioids. The patient is NPO with NG suction; offering clear liquids is contraindicated.
Repositioning may help but is insufficient for severe pain. Irrigating the NG tube is not indicated unless
it is blocked.
11. A 55-year-old patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (K+
6.8 mEq/L) and ECG changes (peaked T waves). The provider prescribes intravenous calcium
gluconate, regular insulin with dextrose 50%, and albuterol nebulization. Which mechanism best
explains the synergistic effect of these three interventions?
A. Calcium stabilizes cardiac membranes, insulin shifts potassium intracellularly, and albuterol enhances beta-2
receptor-mediated potassium uptake in skeletal muscle.
B. Calcium binds to potassium in the serum, insulin promotes renal excretion of potassium, and albuterol
inhibits potassium release from cells.
C. Calcium directly lowers serum potassium, insulin increases potassium reabsorption in the distal tubule, and
albuterol blocks potassium channels in the myocardium.
D. Calcium chelates potassium ions, insulin activates sodium-potassium ATPase in liver cells, and albuterol
increases potassium loss through sweat glands.
Answer: A
Rationale: Calcium gluconate antagonizes the cardiac effects of hyperkalemia by stabilizing the
myocardial cell membrane. Insulin and dextrose facilitate cellular uptake of potassium via activation of
Na+/K+ ATPase. Albuterol, a beta-2 agonist, stimulates potassium uptake into skeletal muscle cells. The
other options incorrectly describe the mechanisms of action.
12. A patient with a history of opioid use disorder is admitted for management of acute pain
following a traumatic injury. The nurse is concerned about the risk of respiratory depression.
Which pharmacologic approach is most appropriate to balance effective analgesia with minimizing
respiratory risk?
A. Administer a full mu-opioid agonist at a low dose and titrate to effect while monitoring respiratory rate and
oxygen saturation.
B. Use a nonsteroidal anti-inflammatory drug (NSAID) alone to avoid opioids entirely.
C. Prescribe a partial mu-opioid agonist such as buprenorphine, but avoid naloxone co-administration.
D. Administer a long-acting opioid like methadone to provide sustained analgesia with less respiratory
depression.
Page 4
