RN Comprehensive Predictor 2019 Form C
A nurse is caring for a client who has bipolar disorder and is
experiencing acute mania. The nurse obtained a verbal prescription for
restraints. Which of the following should the actions the nurse take?
A. Request a renewal of the prescription every 8 hr.
B. Check the client’s peripheral pulse rate every 30 min
C. Obtain a prescription for restraint within 4 hr.
D. Document the client’s condition every 15 minutes
1. A nursing planning care for a school-age child who is 4 hr
postoperative following perforated appendicitis. Which of the
following actions should the nurse include in the plan of care?
a. Offer small amounts of clear liquids 6 hr following surgery
(assess for gag reflex first)
b. Give cromolyn nebulizer solution every 6 hr (for asthma)
c. Apply a warm compress to the operative site every 4 hr
d. Administer analgesics on a scheduled basis for the first 24 hr
2. A nurse is receiving change-of-shift report for a group of
clients. Which of the following clients should the nurse plan to
assess first?
a. A client who has sinus arrhythmia and is receiving cardiac monitoring
b. A client who has diabetes mellitus and a hemoglobin A1C of 6.8%
c. A client who has epidural analgesia and weakness in the
, lower extremities
d. A client who has a hip fracture and a new onset of tachypnea
3. A nurse is preparing to apply a transdermal nicotine patch
for a client. Which of the following actions should the nurse tak
e?
a. Shave hairy areas of skin prior to application (apply to hairless,
clean & dry areas to promote absorption; avoid oily or broken skin)
b. Wear gloves to apply the patch to the client’s skin
,c. Apply the patch within 1 hr of removing it from the protective
pouch (apply immediately)
d. Remove the previous patch and place it in a tissue (fold
patch in half with sticky sides pressed together)
4. A nurse has just received change-of-shift report for four clients. Which of the followin
clients should the nurse assess first?
a. A client who was just given a glass of orange juice for a low blood glucose level
b. A client who is scheduled for a procedure in 1 hr (can wait)
c. A client who has 100 mL fluid remaining in his IV bag (can wait)
d. A client who received a pain medication 30 min ago for postoperative pain
5. A nurse is caring for a client who is receiving intermittent enteral tube feedings. Whic
of the following places the client at risk for aspiration?
a. A history of gastroesophageal reflux disease
b. Receiving a high osmolarity formula
c. Sitting in a high-Fowler’s position during the feeding
d. A residual of 65 mL 1 hr postprandial
6. A nurse is reviewing the laboratory results for a client who has Cushing’s disease. The
nurse should expect the client to have an increase in which of the following laboratory
values?
, a. Serum glucose level - increased
b. Serum calcium level - decreased
c. Lymphocyte count - decreased (immune system)
d. Serum potassium level - decreased
8. A nurse is caring for a client who has severe preeclampsia and is receiving magnesium
sulfate intravenously. The nurse discontinues the magnesium sulfate after the client
displays toxicity. Which of the following actions should the nurse take?
a. Position the client supine
b. Prepare an IV bolus of dextrose 5% in water
c. Administer methylergonovine IM
d. Administer calcium gluconate IV
Calcium gluconate is given for magnesium sulfate toxicity. Always have an injectable form of
calcium gluconate available when administering magnesium sulfate by IV.
9. A charge nurse is teaching new staff members about factors that increase a client’s ris
to become violent. Which of the following risk factors should the nurse include as the bes
predictor of future violence?
a. Experiencing delusions
b. Male gender
c. Previous violent behavior
d. A history of being in prison
Risk factors also include: past history of aggression, poor impulse control, and violence.
Comorbidity that leads to acts of violence (psychotic delusions, command hallucinations,
violent angry reactions with cognitive disorders).
A nurse is caring for a client who has bipolar disorder and is
experiencing acute mania. The nurse obtained a verbal prescription for
restraints. Which of the following should the actions the nurse take?
A. Request a renewal of the prescription every 8 hr.
B. Check the client’s peripheral pulse rate every 30 min
C. Obtain a prescription for restraint within 4 hr.
D. Document the client’s condition every 15 minutes
1. A nursing planning care for a school-age child who is 4 hr
postoperative following perforated appendicitis. Which of the
following actions should the nurse include in the plan of care?
a. Offer small amounts of clear liquids 6 hr following surgery
(assess for gag reflex first)
b. Give cromolyn nebulizer solution every 6 hr (for asthma)
c. Apply a warm compress to the operative site every 4 hr
d. Administer analgesics on a scheduled basis for the first 24 hr
2. A nurse is receiving change-of-shift report for a group of
clients. Which of the following clients should the nurse plan to
assess first?
a. A client who has sinus arrhythmia and is receiving cardiac monitoring
b. A client who has diabetes mellitus and a hemoglobin A1C of 6.8%
c. A client who has epidural analgesia and weakness in the
, lower extremities
d. A client who has a hip fracture and a new onset of tachypnea
3. A nurse is preparing to apply a transdermal nicotine patch
for a client. Which of the following actions should the nurse tak
e?
a. Shave hairy areas of skin prior to application (apply to hairless,
clean & dry areas to promote absorption; avoid oily or broken skin)
b. Wear gloves to apply the patch to the client’s skin
,c. Apply the patch within 1 hr of removing it from the protective
pouch (apply immediately)
d. Remove the previous patch and place it in a tissue (fold
patch in half with sticky sides pressed together)
4. A nurse has just received change-of-shift report for four clients. Which of the followin
clients should the nurse assess first?
a. A client who was just given a glass of orange juice for a low blood glucose level
b. A client who is scheduled for a procedure in 1 hr (can wait)
c. A client who has 100 mL fluid remaining in his IV bag (can wait)
d. A client who received a pain medication 30 min ago for postoperative pain
5. A nurse is caring for a client who is receiving intermittent enteral tube feedings. Whic
of the following places the client at risk for aspiration?
a. A history of gastroesophageal reflux disease
b. Receiving a high osmolarity formula
c. Sitting in a high-Fowler’s position during the feeding
d. A residual of 65 mL 1 hr postprandial
6. A nurse is reviewing the laboratory results for a client who has Cushing’s disease. The
nurse should expect the client to have an increase in which of the following laboratory
values?
, a. Serum glucose level - increased
b. Serum calcium level - decreased
c. Lymphocyte count - decreased (immune system)
d. Serum potassium level - decreased
8. A nurse is caring for a client who has severe preeclampsia and is receiving magnesium
sulfate intravenously. The nurse discontinues the magnesium sulfate after the client
displays toxicity. Which of the following actions should the nurse take?
a. Position the client supine
b. Prepare an IV bolus of dextrose 5% in water
c. Administer methylergonovine IM
d. Administer calcium gluconate IV
Calcium gluconate is given for magnesium sulfate toxicity. Always have an injectable form of
calcium gluconate available when administering magnesium sulfate by IV.
9. A charge nurse is teaching new staff members about factors that increase a client’s ris
to become violent. Which of the following risk factors should the nurse include as the bes
predictor of future violence?
a. Experiencing delusions
b. Male gender
c. Previous violent behavior
d. A history of being in prison
Risk factors also include: past history of aggression, poor impulse control, and violence.
Comorbidity that leads to acts of violence (psychotic delusions, command hallucinations,
violent angry reactions with cognitive disorders).
