ATI Comprehensive Predictor Exam
1. A client with heart failure receives furosemide. Which finding best indicates
the medication is effective?
A. Increased urine output with decreased crackles
B. Weight gain of 1 kg in 24 hours
C. Increased peripheral edema
D. Serum potassium of 5.5 mEq/L
Correct Answer: A. Increased urine output with decreased crackles
Rationale: Effective diuresis increases urine output, reduces fluid overload (fewer
crackles, less edema) and lowers weight. Weight gain and increasing edema show
fluid retention.
2. Which finding in a client taking digoxin should the nurse report as a sign of
toxicity?
A. Dry nonproductive cough
B. Serum potassium of 4.2 mEq/L
C. Pulse of 88/min
D. Yellow-green halos around lights
Correct Answer: D. Yellow-green halos around lights
Rationale: Visual disturbances (yellow-green halos), nausea, anorexia and
dysrhythmias are classic signs of digoxin toxicity. A pulse of 88 and potassium of 4.2
are normal.
3. A client with atrial fibrillation is taking warfarin. Which INR value indicates
therapeutic anticoagulation?
A. 4.5
B. 1.0
C. 2.5
D. 1.5
Correct Answer: C. 2.5
Rationale: The therapeutic INR for most indications, including atrial fibrillation, is 2 to
3. Values of 1.0 to 1.5 are subtherapeutic and 4.5 increases bleeding risk.
,4. Which medication should the nurse have available for a client receiving a
continuous heparin infusion?
A. Vitamin K
B. Flumazenil
C. Protamine sulfate
D. Naloxone
Correct Answer: C. Protamine sulfate
Rationale: Protamine sulfate is the antidote for heparin. Vitamin K reverses warfarin,
naloxone reverses opioids and flumazenil reverses benzodiazepines.
5. A client reports crushing chest pain radiating to the left arm. Unless
contraindicated, which medication should the nurse anticipate giving
immediately?
A. Furosemide 40 mg IV
B. Chewed aspirin 160 to 325 mg
C. Acetaminophen 650 mg
D. Ibuprofen 400 mg
Correct Answer: B. Chewed aspirin 160 to 325 mg
Rationale: Chewed aspirin inhibits platelet aggregation and limits clot growth in
suspected acute coronary syndrome. NSAIDs can worsen cardiac outcomes.
6. Which finding would the nurse expect in a client with diabetic ketoacidosis?
A. Cool, clammy skin
B. Kussmaul respirations with fruity breath odor
C. Bradycardia
D. Slow, shallow respirations
Correct Answer: B. Kussmaul respirations with fruity breath odor
Rationale: Deep, rapid Kussmaul respirations blow off CO2 to compensate for
metabolic acidosis, and ketones cause a fruity odor. Dehydration also produces dry
skin and tachycardia.
,7. A conscious client who takes insulin has a blood glucose of 54 mg/dL and is
diaphoretic. What is the nurse's first action?
A. Give 15 g of fast-acting carbohydrate such as 4 oz of juice
B. Administer glucagon IM
C. Administer the next scheduled insulin dose
D. Recheck the glucose in 1 hour
Correct Answer: A. Give 15 g of fast-acting carbohydrate such as 4 oz of juice
Rationale: A conscious client with hypoglycemia receives 15 g of fast-acting
carbohydrate, then glucose is rechecked in 15 minutes. Glucagon is for unconscious
clients.
8. When mixing regular and NPH insulin in one syringe, which action is correct?
A. Use only the NPH vial and add saline
B. Draw up NPH first
C. Draw up regular insulin first, then NPH
D. Shake both vials vigorously
Correct Answer: C. Draw up regular insulin first, then NPH
Rationale: Draw up clear (regular) before cloudy (NPH): 'clear to cloudy' prevents
contaminating the regular insulin vial with NPH.
9. A client with COPD and chronic CO2 retention needs supplemental oxygen.
Which flow rate is most appropriate?
A. 6 L/min by simple mask
B. 10 L/min by nonrebreather mask
C. 15 L/min by face tent
D. 1 to 2 L/min by nasal cannula
Correct Answer: D. 1 to 2 L/min by nasal cannula
Rationale: Clients with chronic CO2 retention may depend on a hypoxic drive to
breathe, so low-flow oxygen (1 to 2 L/min) is used to avoid suppressing respirations.
, 10. Which medication is the priority for a client in an acute asthma
exacerbation?
A. Fluticasone inhaler
B. Montelukast
C. Albuterol
D. Cromolyn
Correct Answer: C. Albuterol
Rationale: Albuterol, a short-acting beta2 agonist, rapidly relaxes bronchial smooth
muscle. The others are for long-term control.
11. A client with a chest tube has continuous bubbling in the water-seal
chamber. What does the nurse suspect?
A. An air leak in the system
B. Normal lung re-expansion
C. The chest tube is clogged
D. Suction is set too low
Correct Answer: A. An air leak in the system
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
Intermittent bubbling with respirations can be normal early on. Tidaling that stops may
indicate re-expansion or obstruction.
12. Why is lactulose administered to a client with hepatic encephalopathy?
A. To increase appetite
B. To reduce ascites
C. To prevent esophageal bleeding
D. To decrease serum ammonia levels
Correct Answer: D. To decrease serum ammonia levels
Rationale: Lactulose acidifies the colon, traps ammonia as ammonium and promotes
its excretion in stool, lowering serum ammonia and improving mental status.
1. A client with heart failure receives furosemide. Which finding best indicates
the medication is effective?
A. Increased urine output with decreased crackles
B. Weight gain of 1 kg in 24 hours
C. Increased peripheral edema
D. Serum potassium of 5.5 mEq/L
Correct Answer: A. Increased urine output with decreased crackles
Rationale: Effective diuresis increases urine output, reduces fluid overload (fewer
crackles, less edema) and lowers weight. Weight gain and increasing edema show
fluid retention.
2. Which finding in a client taking digoxin should the nurse report as a sign of
toxicity?
A. Dry nonproductive cough
B. Serum potassium of 4.2 mEq/L
C. Pulse of 88/min
D. Yellow-green halos around lights
Correct Answer: D. Yellow-green halos around lights
Rationale: Visual disturbances (yellow-green halos), nausea, anorexia and
dysrhythmias are classic signs of digoxin toxicity. A pulse of 88 and potassium of 4.2
are normal.
3. A client with atrial fibrillation is taking warfarin. Which INR value indicates
therapeutic anticoagulation?
A. 4.5
B. 1.0
C. 2.5
D. 1.5
Correct Answer: C. 2.5
Rationale: The therapeutic INR for most indications, including atrial fibrillation, is 2 to
3. Values of 1.0 to 1.5 are subtherapeutic and 4.5 increases bleeding risk.
,4. Which medication should the nurse have available for a client receiving a
continuous heparin infusion?
A. Vitamin K
B. Flumazenil
C. Protamine sulfate
D. Naloxone
Correct Answer: C. Protamine sulfate
Rationale: Protamine sulfate is the antidote for heparin. Vitamin K reverses warfarin,
naloxone reverses opioids and flumazenil reverses benzodiazepines.
5. A client reports crushing chest pain radiating to the left arm. Unless
contraindicated, which medication should the nurse anticipate giving
immediately?
A. Furosemide 40 mg IV
B. Chewed aspirin 160 to 325 mg
C. Acetaminophen 650 mg
D. Ibuprofen 400 mg
Correct Answer: B. Chewed aspirin 160 to 325 mg
Rationale: Chewed aspirin inhibits platelet aggregation and limits clot growth in
suspected acute coronary syndrome. NSAIDs can worsen cardiac outcomes.
6. Which finding would the nurse expect in a client with diabetic ketoacidosis?
A. Cool, clammy skin
B. Kussmaul respirations with fruity breath odor
C. Bradycardia
D. Slow, shallow respirations
Correct Answer: B. Kussmaul respirations with fruity breath odor
Rationale: Deep, rapid Kussmaul respirations blow off CO2 to compensate for
metabolic acidosis, and ketones cause a fruity odor. Dehydration also produces dry
skin and tachycardia.
,7. A conscious client who takes insulin has a blood glucose of 54 mg/dL and is
diaphoretic. What is the nurse's first action?
A. Give 15 g of fast-acting carbohydrate such as 4 oz of juice
B. Administer glucagon IM
C. Administer the next scheduled insulin dose
D. Recheck the glucose in 1 hour
Correct Answer: A. Give 15 g of fast-acting carbohydrate such as 4 oz of juice
Rationale: A conscious client with hypoglycemia receives 15 g of fast-acting
carbohydrate, then glucose is rechecked in 15 minutes. Glucagon is for unconscious
clients.
8. When mixing regular and NPH insulin in one syringe, which action is correct?
A. Use only the NPH vial and add saline
B. Draw up NPH first
C. Draw up regular insulin first, then NPH
D. Shake both vials vigorously
Correct Answer: C. Draw up regular insulin first, then NPH
Rationale: Draw up clear (regular) before cloudy (NPH): 'clear to cloudy' prevents
contaminating the regular insulin vial with NPH.
9. A client with COPD and chronic CO2 retention needs supplemental oxygen.
Which flow rate is most appropriate?
A. 6 L/min by simple mask
B. 10 L/min by nonrebreather mask
C. 15 L/min by face tent
D. 1 to 2 L/min by nasal cannula
Correct Answer: D. 1 to 2 L/min by nasal cannula
Rationale: Clients with chronic CO2 retention may depend on a hypoxic drive to
breathe, so low-flow oxygen (1 to 2 L/min) is used to avoid suppressing respirations.
, 10. Which medication is the priority for a client in an acute asthma
exacerbation?
A. Fluticasone inhaler
B. Montelukast
C. Albuterol
D. Cromolyn
Correct Answer: C. Albuterol
Rationale: Albuterol, a short-acting beta2 agonist, rapidly relaxes bronchial smooth
muscle. The others are for long-term control.
11. A client with a chest tube has continuous bubbling in the water-seal
chamber. What does the nurse suspect?
A. An air leak in the system
B. Normal lung re-expansion
C. The chest tube is clogged
D. Suction is set too low
Correct Answer: A. An air leak in the system
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
Intermittent bubbling with respirations can be normal early on. Tidaling that stops may
indicate re-expansion or obstruction.
12. Why is lactulose administered to a client with hepatic encephalopathy?
A. To increase appetite
B. To reduce ascites
C. To prevent esophageal bleeding
D. To decrease serum ammonia levels
Correct Answer: D. To decrease serum ammonia levels
Rationale: Lactulose acidifies the colon, traps ammonia as ammonium and promotes
its excretion in stool, lowering serum ammonia and improving mental status.
