ATI RN COMPREHENSIVE PREDICTOR - SET 4 EXAM
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A provider asks the nurse which bedside findings would most strongly point toward ischemic stroke.
Which response is best?
A. fever, headache, neck stiffness, and altered mental status
B. sudden focal neurologic deficit
C. fatigable weakness including ocular/bulbar symptoms
D. ascending weakness and areflexia after infection
Correct Answer: B. sudden focal neurologic deficit
Rationale: sudden focal neurologic deficit is a characteristic presentation of ischemic stroke; recognizing this
pattern reduces delay in evaluation and management.
2. Which transmission-based precaution is most appropriate for a client with varicella with disseminated
lesions?
A. Airborne and contact precautions until lesions are crusted and transmission risk has passed
B. Droplet precautions only
C. Standard precautions only
D. Protective isolation only
Correct Answer: A. Airborne and contact precautions until lesions are crusted and transmission risk has passed
Rationale: Disseminated varicella requires both airborne and contact precautions because the virus can spread
through respiratory particles and lesion fluid.
3. A client arrives with suspected infection with organ dysfunction, consistent with sepsis. Which
intervention should the nurse take or anticipate first?
A. rapid cultures/lactate and early antibiotics and fluids according to condition
B. protect from bleeding/infection and treat cause
C. rapid analgesia, hydration as appropriate, and oxygen if hypoxemic
D. obtain cultures and give prompt broad-spectrum antipseudomonal antibiotics
Correct Answer: A. rapid cultures/lactate and early antibiotics and fluids according to condition
Rationale: The priority for sepsis is to rapid cultures/lactate and early antibiotics and fluids according to
condition. This addresses the immediate pathophysiology and reduces the risk of septic shock.
4. The nurse is caring for four clients after lunch. Which client should the nurse assess first?
A. a client with a new tracheostomy who has increasing restlessness and oxygen saturation of 86%
B. a client with cirrhosis who reports moderate pruritus
C. a client with osteoarthritis requesting a warm pack
D. a client with stable Crohn disease reporting two loose stools
Correct Answer: A. a client with a new tracheostomy who has increasing restlessness and oxygen saturation of
86%
Rationale: Hypoxemia and restlessness in a client with a new airway indicate an immediate airway/breathing
threat.
5. A client is experiencing nausea after surgery. Which finding is most consistent with this care need?
A. difficulty locating objects and navigating an unfamiliar room
B. difficulty repositioning with intact cognition and stable cardiopulmonary status
C. frequent loose stools with moist erythematous perineal skin
D. queasiness and reduced oral intake without abdominal rigidity or hemodynamic instability
Correct Answer: D. queasiness and reduced oral intake without abdominal rigidity or hemodynamic instability
Rationale: queasiness and reduced oral intake without abdominal rigidity or hemodynamic instability is a
common cue when caring for nausea after surgery.
6. Which nurse response is most therapeutic for a client experiencing moderate dementia?
A. Use simple choices and avoid quizzing the client about forgotten facts
B. Say, "You do not deserve to be hurt. Help is available, and you can decide what feels safest."
C. Ask permission before discussing trauma details and let the client control the pace
D. Say, "I will stay with you. Focus on one slow breath at a time."
Correct Answer: A. Use simple choices and avoid quizzing the client about forgotten facts
Rationale: Dementia care emphasizes function, predictability, dignity, and safety; confrontation can increase
distress.
,7. Which description best explains the therapeutic action of diltiazem?
A. increases uveoscleral outflow
B. slows AV nodal conduction
C. inhibits serotonin and norepinephrine reuptake
D. potentiates antithrombin with predominant factor Xa inhibition
Correct Answer: B. slows AV nodal conduction
Rationale: diltiazem is a non-dihydropyridine calcium channel blocker. Its relevant mechanism of action is slows
AV nodal conduction; safe nursing care requires connecting the medication class with its expected effects,
monitoring needs, and major risks.
8. A client with no contraindications asks how much sleep most adults need. Which response is reasonable?
A. Most adults benefit from about 7 or more hours of sleep per night on a regular basis
B. Two to three hours is adequate for adults
C. Adults should avoid regular sleep schedules
D. Sleep needs disappear after age 65
Correct Answer: A. Most adults benefit from about 7 or more hours of sleep per night on a regular basis
Rationale: Most adults need at least about 7 hours of regular sleep, though individual needs vary.
9. The emergency nurse recognizes severe pain out of proportion with pain on passive stretch as
compartment syndrome. Which treatment or nursing action has the highest priority?
A. control inflammation early with disease-modifying therapy
B. exercise, weight management, and analgesia as appropriate
C. control source and restore intravascular volume/blood as indicated
D. urgent surgical evaluation for fasciotomy
Correct Answer: D. urgent surgical evaluation for fasciotomy
Rationale: The priority for compartment syndrome is to urgent surgical evaluation for fasciotomy. This addresses
the immediate pathophysiology and reduces the risk of permanent nerve and muscle damage.
10. During assignment planning, which activity can the RN safely delegate for a stable client with heart
failure who requires the morning daily weight?
A. Interpret a 1.8-kg overnight weight gain and change the plan of care
B. Teach the client how sodium affects fluid retention
C. Evaluate the response to a newly started loop diuretic
D. Obtain and record the morning weight using the same scale
Correct Answer: D. Obtain and record the morning weight using the same scale
Rationale: Obtaining routine measurements is delegable; assessment, teaching, and evaluation remain RN
responsibilities.
11. A client with latex allergy is scheduled for a procedure. Which nursing action is appropriate?
A. Use latex gloves only for brief contact
B. Remove the allergy from the record after the procedure
C. Clearly identify the allergy and ensure latex-free supplies are used
D. Assume nonsterile latex products cannot cause a reaction
Correct Answer: C. Clearly identify the allergy and ensure latex-free supplies are used
Rationale: Latex-sensitive clients require avoidance of latex-containing products and clear communication across
the care team.
12. A client with acute myocardial infarction initially presented with persistent pressure-like chest
discomfort with ischemic ECG changes. Which assessment, laboratory value, or diagnostic trend is most
useful for monitoring the condition? acute myocardial infarction Condition persistent pressure-like chest
discomfort with ischemic ECG changes Initial cue Trend change and recognize risk early Nursing focus
A. ECG and anticoagulation risk assessment
B. echocardiography
C. serial ECGs and cardiac troponin
D. venous ultrasound
Correct Answer: C. serial ECGs and cardiac troponin
Rationale: For acute myocardial infarction, focused monitoring includes serial ECGs and cardiac troponin.
Trending the most relevant data helps identify deterioration or treatment complications before they become
irreversible.
, 13. A client using a PCA pump becomes very difficult to arouse with respirations of 7/min. Which action is
the priority?
A. Encourage the family to press the PCA button less often
B. Offer an oral opioid for breakthrough pain
C. Allow the client to sleep and reassess in 4 hours
D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Correct Answer: D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Rationale: Marked sedation with bradypnea indicates opioid toxicity and requires immediate airway/ventilation
support and reversal as indicated.
14. Which nursing action best addresses nausea after surgery?
A. pause feeding when aspiration or intolerance is suspected, assess the client, verify the plan, and resume only
when safe
B. cluster nighttime care when possible, reduce noise/light, control symptoms, and support the client's normal
sleep routine
C. administer prescribed antiemetic, minimize triggering odors, and advance oral intake as tolerated
D. use multimodal pain control, position for comfort, and reassess response after intervention
Correct Answer: C. administer prescribed antiemetic, minimize triggering odors, and advance oral intake as
tolerated
Rationale: Symptom control and gradual intake help prevent dehydration while the nurse remains alert for signs
of complications.
15. Which finding most strongly supports moderate dementia?
A. progressive memory impairment and functional decline without the acute fluctuating course of delirium
B. intrusive memories, avoidance, hyperarousal, and exaggerated startle after trauma
C. tremor, autonomic hyperactivity, insomnia, agitation, hallucinations, or seizures after reducing heavy alcohol
use
D. a report that voices are telling the client to harm someone
Correct Answer: A. progressive memory impairment and functional decline without the acute fluctuating course
of delirium
Rationale: progressive memory impairment and functional decline without the acute fluctuating course of
delirium is characteristic of moderate dementia.
16. Which description best explains the therapeutic action of heparin?
A. enhances antithrombin activity
B. relaxes bronchial smooth muscle via beta2 stimulation
C. stabilizes inactivated sodium channels
D. promotes cellular glucose uptake
Correct Answer: A. enhances antithrombin activity
Rationale: heparin is a unfractionated anticoagulant. Its relevant mechanism of action is enhances antithrombin
activity; safe nursing care requires connecting the medication class with its expected effects, monitoring needs,
and major risks.
17. A pregnant client at 10 weeks asks which symptom should be reported urgently. Which finding requires
prompt evaluation?
A. Mild nausea in the morning
B. Breast tenderness
C. Heavy vaginal bleeding with severe abdominal pain
D. Increased urinary frequency without dysuria
Correct Answer: C. Heavy vaginal bleeding with severe abdominal pain
Rationale: Heavy bleeding with severe pain may indicate pregnancy loss or ectopic pregnancy and requires
urgent assessment.
18. During rapid assessment, the nurse identifies refractory hypoxemia with bilateral opacities not fully
explained by heart failure in a client with ARDS. What is the priority response?
A. lung-protective ventilation and treat underlying cause
B. early airway evaluation and intubation before edema progresses when indicated
C. give rapid bronchodilation and assess response
D. immediate decompression followed by chest tube
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A provider asks the nurse which bedside findings would most strongly point toward ischemic stroke.
Which response is best?
A. fever, headache, neck stiffness, and altered mental status
B. sudden focal neurologic deficit
C. fatigable weakness including ocular/bulbar symptoms
D. ascending weakness and areflexia after infection
Correct Answer: B. sudden focal neurologic deficit
Rationale: sudden focal neurologic deficit is a characteristic presentation of ischemic stroke; recognizing this
pattern reduces delay in evaluation and management.
2. Which transmission-based precaution is most appropriate for a client with varicella with disseminated
lesions?
A. Airborne and contact precautions until lesions are crusted and transmission risk has passed
B. Droplet precautions only
C. Standard precautions only
D. Protective isolation only
Correct Answer: A. Airborne and contact precautions until lesions are crusted and transmission risk has passed
Rationale: Disseminated varicella requires both airborne and contact precautions because the virus can spread
through respiratory particles and lesion fluid.
3. A client arrives with suspected infection with organ dysfunction, consistent with sepsis. Which
intervention should the nurse take or anticipate first?
A. rapid cultures/lactate and early antibiotics and fluids according to condition
B. protect from bleeding/infection and treat cause
C. rapid analgesia, hydration as appropriate, and oxygen if hypoxemic
D. obtain cultures and give prompt broad-spectrum antipseudomonal antibiotics
Correct Answer: A. rapid cultures/lactate and early antibiotics and fluids according to condition
Rationale: The priority for sepsis is to rapid cultures/lactate and early antibiotics and fluids according to
condition. This addresses the immediate pathophysiology and reduces the risk of septic shock.
4. The nurse is caring for four clients after lunch. Which client should the nurse assess first?
A. a client with a new tracheostomy who has increasing restlessness and oxygen saturation of 86%
B. a client with cirrhosis who reports moderate pruritus
C. a client with osteoarthritis requesting a warm pack
D. a client with stable Crohn disease reporting two loose stools
Correct Answer: A. a client with a new tracheostomy who has increasing restlessness and oxygen saturation of
86%
Rationale: Hypoxemia and restlessness in a client with a new airway indicate an immediate airway/breathing
threat.
5. A client is experiencing nausea after surgery. Which finding is most consistent with this care need?
A. difficulty locating objects and navigating an unfamiliar room
B. difficulty repositioning with intact cognition and stable cardiopulmonary status
C. frequent loose stools with moist erythematous perineal skin
D. queasiness and reduced oral intake without abdominal rigidity or hemodynamic instability
Correct Answer: D. queasiness and reduced oral intake without abdominal rigidity or hemodynamic instability
Rationale: queasiness and reduced oral intake without abdominal rigidity or hemodynamic instability is a
common cue when caring for nausea after surgery.
6. Which nurse response is most therapeutic for a client experiencing moderate dementia?
A. Use simple choices and avoid quizzing the client about forgotten facts
B. Say, "You do not deserve to be hurt. Help is available, and you can decide what feels safest."
C. Ask permission before discussing trauma details and let the client control the pace
D. Say, "I will stay with you. Focus on one slow breath at a time."
Correct Answer: A. Use simple choices and avoid quizzing the client about forgotten facts
Rationale: Dementia care emphasizes function, predictability, dignity, and safety; confrontation can increase
distress.
,7. Which description best explains the therapeutic action of diltiazem?
A. increases uveoscleral outflow
B. slows AV nodal conduction
C. inhibits serotonin and norepinephrine reuptake
D. potentiates antithrombin with predominant factor Xa inhibition
Correct Answer: B. slows AV nodal conduction
Rationale: diltiazem is a non-dihydropyridine calcium channel blocker. Its relevant mechanism of action is slows
AV nodal conduction; safe nursing care requires connecting the medication class with its expected effects,
monitoring needs, and major risks.
8. A client with no contraindications asks how much sleep most adults need. Which response is reasonable?
A. Most adults benefit from about 7 or more hours of sleep per night on a regular basis
B. Two to three hours is adequate for adults
C. Adults should avoid regular sleep schedules
D. Sleep needs disappear after age 65
Correct Answer: A. Most adults benefit from about 7 or more hours of sleep per night on a regular basis
Rationale: Most adults need at least about 7 hours of regular sleep, though individual needs vary.
9. The emergency nurse recognizes severe pain out of proportion with pain on passive stretch as
compartment syndrome. Which treatment or nursing action has the highest priority?
A. control inflammation early with disease-modifying therapy
B. exercise, weight management, and analgesia as appropriate
C. control source and restore intravascular volume/blood as indicated
D. urgent surgical evaluation for fasciotomy
Correct Answer: D. urgent surgical evaluation for fasciotomy
Rationale: The priority for compartment syndrome is to urgent surgical evaluation for fasciotomy. This addresses
the immediate pathophysiology and reduces the risk of permanent nerve and muscle damage.
10. During assignment planning, which activity can the RN safely delegate for a stable client with heart
failure who requires the morning daily weight?
A. Interpret a 1.8-kg overnight weight gain and change the plan of care
B. Teach the client how sodium affects fluid retention
C. Evaluate the response to a newly started loop diuretic
D. Obtain and record the morning weight using the same scale
Correct Answer: D. Obtain and record the morning weight using the same scale
Rationale: Obtaining routine measurements is delegable; assessment, teaching, and evaluation remain RN
responsibilities.
11. A client with latex allergy is scheduled for a procedure. Which nursing action is appropriate?
A. Use latex gloves only for brief contact
B. Remove the allergy from the record after the procedure
C. Clearly identify the allergy and ensure latex-free supplies are used
D. Assume nonsterile latex products cannot cause a reaction
Correct Answer: C. Clearly identify the allergy and ensure latex-free supplies are used
Rationale: Latex-sensitive clients require avoidance of latex-containing products and clear communication across
the care team.
12. A client with acute myocardial infarction initially presented with persistent pressure-like chest
discomfort with ischemic ECG changes. Which assessment, laboratory value, or diagnostic trend is most
useful for monitoring the condition? acute myocardial infarction Condition persistent pressure-like chest
discomfort with ischemic ECG changes Initial cue Trend change and recognize risk early Nursing focus
A. ECG and anticoagulation risk assessment
B. echocardiography
C. serial ECGs and cardiac troponin
D. venous ultrasound
Correct Answer: C. serial ECGs and cardiac troponin
Rationale: For acute myocardial infarction, focused monitoring includes serial ECGs and cardiac troponin.
Trending the most relevant data helps identify deterioration or treatment complications before they become
irreversible.
, 13. A client using a PCA pump becomes very difficult to arouse with respirations of 7/min. Which action is
the priority?
A. Encourage the family to press the PCA button less often
B. Offer an oral opioid for breakthrough pain
C. Allow the client to sleep and reassess in 4 hours
D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Correct Answer: D. Stop opioid delivery, support ventilation, and prepare to give naloxone according to protocol
Rationale: Marked sedation with bradypnea indicates opioid toxicity and requires immediate airway/ventilation
support and reversal as indicated.
14. Which nursing action best addresses nausea after surgery?
A. pause feeding when aspiration or intolerance is suspected, assess the client, verify the plan, and resume only
when safe
B. cluster nighttime care when possible, reduce noise/light, control symptoms, and support the client's normal
sleep routine
C. administer prescribed antiemetic, minimize triggering odors, and advance oral intake as tolerated
D. use multimodal pain control, position for comfort, and reassess response after intervention
Correct Answer: C. administer prescribed antiemetic, minimize triggering odors, and advance oral intake as
tolerated
Rationale: Symptom control and gradual intake help prevent dehydration while the nurse remains alert for signs
of complications.
15. Which finding most strongly supports moderate dementia?
A. progressive memory impairment and functional decline without the acute fluctuating course of delirium
B. intrusive memories, avoidance, hyperarousal, and exaggerated startle after trauma
C. tremor, autonomic hyperactivity, insomnia, agitation, hallucinations, or seizures after reducing heavy alcohol
use
D. a report that voices are telling the client to harm someone
Correct Answer: A. progressive memory impairment and functional decline without the acute fluctuating course
of delirium
Rationale: progressive memory impairment and functional decline without the acute fluctuating course of
delirium is characteristic of moderate dementia.
16. Which description best explains the therapeutic action of heparin?
A. enhances antithrombin activity
B. relaxes bronchial smooth muscle via beta2 stimulation
C. stabilizes inactivated sodium channels
D. promotes cellular glucose uptake
Correct Answer: A. enhances antithrombin activity
Rationale: heparin is a unfractionated anticoagulant. Its relevant mechanism of action is enhances antithrombin
activity; safe nursing care requires connecting the medication class with its expected effects, monitoring needs,
and major risks.
17. A pregnant client at 10 weeks asks which symptom should be reported urgently. Which finding requires
prompt evaluation?
A. Mild nausea in the morning
B. Breast tenderness
C. Heavy vaginal bleeding with severe abdominal pain
D. Increased urinary frequency without dysuria
Correct Answer: C. Heavy vaginal bleeding with severe abdominal pain
Rationale: Heavy bleeding with severe pain may indicate pregnancy loss or ectopic pregnancy and requires
urgent assessment.
18. During rapid assessment, the nurse identifies refractory hypoxemia with bilateral opacities not fully
explained by heart failure in a client with ARDS. What is the priority response?
A. lung-protective ventilation and treat underlying cause
B. early airway evaluation and intubation before edema progresses when indicated
C. give rapid bronchodilation and assess response
D. immediate decompression followed by chest tube
