THE ULTIMATE ATI COMPREHENSIVE
PREDICTOR FORM A EXAM PREP:
HIGH-YIELD NCLEX-STYLE
QUESTIONS WITH DETAILED
RATIONALES COVERING MEDICAL-
SURGICAL, PHARMACOLOGY,
MATERNAL-NEWBORN, PEDIATRICS,
MENTAL HEALTH, AND LEADERSHIP
Medical-Surgical Nursing
1. A nurse is planning care for a client who is postoperative following
creation of an arteriovenous fistula in the left arm. Which action
should the nurse include in the plan?
A. Compare blood pressure in both arms every 2 hours
B. Auscultate the client's left arm for a bruit every 4 hours
C. Instruct the client to keep the left arm in a dependent position
D. Encourage the client to restrict movement of the left arm
Answer: B. Auscultate the client's left arm for a bruit every 4 hours
,Rationale: A patent AV fistula will have a bruit (whooshing sound) and thrill
(vibration) upon palpation. The nurse should avoid taking blood pressure or
drawing blood from the arm with the fistula to prevent damage. The arm
should not be kept in a dependent position as this can compromise
circulation .
2. A nurse is caring for a client who has a chest tube following a
thoracotomy. Which finding requires immediate intervention?
A. 1 cm of water present in the water seal chamber
B. Tidaling with spontaneous respirations
C. Suction chamber pressure of -20 cm H₂O
D. Drainage collection chamber is one-third full
Answer: A. 1 cm of water present in the water seal chamber
Rationale: The water seal chamber should contain 2 cm of water. Tidaling is
expected with spontaneous respirations, and -20 cm H₂O is an appropriate
suction level. One-third full drainage collection is acceptable .
3. A nurse is reinforcing teaching with an older adult client who has
severe left-sided heart failure. Which statement should the nurse
make?
A. "Limit all physical activity to prevent fatigue"
B. "Rest for 15 minutes between activities"
C. "Exercise vigorously to strengthen your heart"
D. "Avoid drinking fluids with meals"
,Answer: B. "Rest for 15 minutes between activities"
Rationale: Clients with heart failure need to balance activity with rest to
reduce cardiac workload. Gradual activity with rest periods of 15 minutes
when tired is recommended .
4. A nurse is caring for a client who is receiving a blood transfusion
and develops a hemolytic reaction. Which action should the nurse take
first?
A. Administer an antipyretic
B. Decrease the infusion rate to 75 mL/hr
C. Infuse 0.9% sodium chloride IV
D. Place the client in a left lateral position
Answer: C. Infuse 0.9% sodium chloride IV
Rationale: For a suspected hemolytic transfusion reaction, the nurse should
stop the transfusion immediately and infuse 0.9% sodium chloride to
maintain IV access and dilute the transfused blood .
5. A nurse is reviewing laboratory results of a toddler who has
hemophilia A. Which aPTT value should the nurse expect? (Normal: 30-
40 seconds)
A. 25 seconds
B. 32 seconds
, C. 45 seconds
D. 60 seconds
Answer: C. 45 seconds
Rationale: Hemophilia A results from Factor VIII deficiency affecting the
intrinsic coagulation pathway, causing a prolonged aPTT. A value of 45
seconds indicates prolonged clotting time consistent with hemophilia .
6. A nurse is assessing a client who is taking propranolol. Which
finding indicates an adverse reaction to the medication?
A. Bradycardia
B. Wheezing
C. Dry mouth
D. Insomnia
Answer: B. Wheezing
Rationale: Propranolol is a non-selective beta-blocker that can cause
bronchospasm and wheezing by blocking beta-2 receptors in the lungs.
This is a serious adverse reaction requiring immediate intervention .
7. A nurse is providing teaching to a client who has COPD about
strategies to promote eating. Which instruction should the nurse
include?
PREDICTOR FORM A EXAM PREP:
HIGH-YIELD NCLEX-STYLE
QUESTIONS WITH DETAILED
RATIONALES COVERING MEDICAL-
SURGICAL, PHARMACOLOGY,
MATERNAL-NEWBORN, PEDIATRICS,
MENTAL HEALTH, AND LEADERSHIP
Medical-Surgical Nursing
1. A nurse is planning care for a client who is postoperative following
creation of an arteriovenous fistula in the left arm. Which action
should the nurse include in the plan?
A. Compare blood pressure in both arms every 2 hours
B. Auscultate the client's left arm for a bruit every 4 hours
C. Instruct the client to keep the left arm in a dependent position
D. Encourage the client to restrict movement of the left arm
Answer: B. Auscultate the client's left arm for a bruit every 4 hours
,Rationale: A patent AV fistula will have a bruit (whooshing sound) and thrill
(vibration) upon palpation. The nurse should avoid taking blood pressure or
drawing blood from the arm with the fistula to prevent damage. The arm
should not be kept in a dependent position as this can compromise
circulation .
2. A nurse is caring for a client who has a chest tube following a
thoracotomy. Which finding requires immediate intervention?
A. 1 cm of water present in the water seal chamber
B. Tidaling with spontaneous respirations
C. Suction chamber pressure of -20 cm H₂O
D. Drainage collection chamber is one-third full
Answer: A. 1 cm of water present in the water seal chamber
Rationale: The water seal chamber should contain 2 cm of water. Tidaling is
expected with spontaneous respirations, and -20 cm H₂O is an appropriate
suction level. One-third full drainage collection is acceptable .
3. A nurse is reinforcing teaching with an older adult client who has
severe left-sided heart failure. Which statement should the nurse
make?
A. "Limit all physical activity to prevent fatigue"
B. "Rest for 15 minutes between activities"
C. "Exercise vigorously to strengthen your heart"
D. "Avoid drinking fluids with meals"
,Answer: B. "Rest for 15 minutes between activities"
Rationale: Clients with heart failure need to balance activity with rest to
reduce cardiac workload. Gradual activity with rest periods of 15 minutes
when tired is recommended .
4. A nurse is caring for a client who is receiving a blood transfusion
and develops a hemolytic reaction. Which action should the nurse take
first?
A. Administer an antipyretic
B. Decrease the infusion rate to 75 mL/hr
C. Infuse 0.9% sodium chloride IV
D. Place the client in a left lateral position
Answer: C. Infuse 0.9% sodium chloride IV
Rationale: For a suspected hemolytic transfusion reaction, the nurse should
stop the transfusion immediately and infuse 0.9% sodium chloride to
maintain IV access and dilute the transfused blood .
5. A nurse is reviewing laboratory results of a toddler who has
hemophilia A. Which aPTT value should the nurse expect? (Normal: 30-
40 seconds)
A. 25 seconds
B. 32 seconds
, C. 45 seconds
D. 60 seconds
Answer: C. 45 seconds
Rationale: Hemophilia A results from Factor VIII deficiency affecting the
intrinsic coagulation pathway, causing a prolonged aPTT. A value of 45
seconds indicates prolonged clotting time consistent with hemophilia .
6. A nurse is assessing a client who is taking propranolol. Which
finding indicates an adverse reaction to the medication?
A. Bradycardia
B. Wheezing
C. Dry mouth
D. Insomnia
Answer: B. Wheezing
Rationale: Propranolol is a non-selective beta-blocker that can cause
bronchospasm and wheezing by blocking beta-2 receptors in the lungs.
This is a serious adverse reaction requiring immediate intervention .
7. A nurse is providing teaching to a client who has COPD about
strategies to promote eating. Which instruction should the nurse
include?
