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RN COMPREHENSIVE PREDICTOR
Questions 1 - 200
Advanced / Hard / Mixed Difficulty
Comprehensive Nursing Review Covering Medical-Surgical, Mental Health,
Maternity, Pediatrics, Pharmacology, Leadership, and Community Health
1. A nurse is caring for a client who is 2 hours postoperative following a total hip
arthroplasty. The client reports sudden shortness of breath and chest pain. The
nurse notes tachycardia and tachypnea. Which of the following actions should
the nurse take first?
A. Administer oxygen via non-rebreather mask
B. Notify the healthcare provider
C. Apply a pulse oximeter
D. Place the client in a high-Fowler's position
Valid answer: A
Explanation: The client's symptoms are consistent with a pulmonary embolism,
a life-threatening complication. The priority action is to administer oxygen to
maintain oxygenation and prevent further hypoxia. While notifying the provider,
applying a pulse oximeter, and positioning the client are important, they follow the
initial step of supporting oxygenation.
2. A nurse is providing discharge teaching to a client who has a new prescription
for enoxaparin. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I will massage the injection site after administering the medication."
B. "I will expel the air bubble from the syringe before injecting."
C. "I will inject the medication into my abdomen."
D. "I will aspirate for blood return before injecting."
Valid answer: C
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Explanation: Enoxaparin is a low-molecular-weight heparin administered
subcutaneously in the abdomen to reduce the risk of deep vein thrombosis. The air
bubble should not be expelled, as it ensures the full dose is delivered. Massaging
the site is contraindicated as it can cause bruising. Aspiration is not recommended
for subcutaneous injections of anticoagulants.
3. A nurse is assessing a client who has a history of heart failure. The client
reports a weight gain of 3 pounds in 2 days and swelling in the lower
extremities. Which of the following findings should the nurse anticipate?
A. Decreased heart rate
B. Increased blood pressure
C. Jugular vein distention
D. Decreased respiratory rate
Valid answer: C
Explanation: Weight gain and peripheral edema in a client with heart failure
indicate fluid volume overload. Jugular vein distention is a classic sign of increased
central venous pressure due to fluid overload. The nurse should expect
tachycardia, hypertension, and tachypnea as compensatory mechanisms, not
decreased heart rate or respiratory rate.
4. A nurse is caring for a client who has a nasogastric tube and is receiving
continuous enteral feedings. The nurse notes that the client has developed
diarrhea. Which of the following actions should the nurse take?
A. Decrease the feeding rate
B. Change the feeding formula
C. Administer an antidiarrheal medication
D. Check the client's gastric residual volume
Valid answer: B
Explanation: Diarrhea during enteral feedings is often caused by the formula
itself, such as a hyperosmolar formula, lactose intolerance, or bacterial
,3
contamination. Changing to a different formula may resolve the issue. Decreasing
the rate may help but does not address the underlying cause. Antidiarrheals
should not be the first intervention. Checking gastric residual volume is for
assessing gastric emptying, not diarrhea.
5. A nurse is providing teaching to a client who has a new prescription for an
ACE inhibitor. Which of the following adverse effects should the nurse instruct
the client to report immediately?
A. Dry cough
B. Dizziness
C. Angioedema
D. Hyperkalemia
Valid answer: C
Explanation: Angioedema is a serious, potentially life-threatening adverse effect
of ACE inhibitors characterized by swelling of the face, lips, tongue, and airway.
The client should report these symptoms immediately. Dry cough, dizziness, and
hyperkalemia are also side effects but are less emergent than angioedema.
6. A nurse is assessing a client who has a history of chronic kidney disease. The
client's laboratory results show a serum potassium level of 6.2 mEq/L. Which of
the following interventions should the nurse anticipate?
A. Administration of potassium supplements
B. Administration of sodium polystyrene sulfonate
C. Restriction of dietary sodium
D. Administration of IV fluids
Valid answer: B
Explanation: A serum potassium of 6.2 mEq/L is critically elevated
(hyperkalemia). Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange
resin that binds potassium in the gastrointestinal tract and promotes its excretion.
, 4
Potassium supplements would worsen the condition. Sodium restriction is not the
primary intervention for acute hyperkalemia.
7. A nurse is caring for a client who is receiving a blood transfusion. The client
develops chills, fever, and lower back pain. Which of the following actions
should the nurse take first?
A. Stop the blood transfusion
B. Notify the healthcare provider
C. Administer an antihistamine
D. Obtain a urine specimen
Valid answer: A
Explanation: The client's symptoms are consistent with an acute hemolytic
transfusion reaction, a life-threatening emergency. The priority action is to stop
the blood transfusion immediately to prevent further complications. After stopping
the transfusion, the nurse should notify the provider, maintain IV access with
normal saline, and monitor vital signs.
8. A nurse is providing teaching to a client who has a new prescription for
warfarin. Which of the following foods should the nurse instruct the client to
consume in consistent amounts?
A. Bananas and oranges
B. Green leafy vegetables
C. Dairy products
D. Whole grains
Valid answer: B
Explanation: Green leafy vegetables are high in vitamin K, which can interfere
with the effectiveness of warfarin. The client should maintain a consistent intake of
vitamin K-rich foods to avoid fluctuations in INR. Bananas, oranges, dairy
products, and whole grains do not significantly interact with warfarin.
RN COMPREHENSIVE PREDICTOR
Questions 1 - 200
Advanced / Hard / Mixed Difficulty
Comprehensive Nursing Review Covering Medical-Surgical, Mental Health,
Maternity, Pediatrics, Pharmacology, Leadership, and Community Health
1. A nurse is caring for a client who is 2 hours postoperative following a total hip
arthroplasty. The client reports sudden shortness of breath and chest pain. The
nurse notes tachycardia and tachypnea. Which of the following actions should
the nurse take first?
A. Administer oxygen via non-rebreather mask
B. Notify the healthcare provider
C. Apply a pulse oximeter
D. Place the client in a high-Fowler's position
Valid answer: A
Explanation: The client's symptoms are consistent with a pulmonary embolism,
a life-threatening complication. The priority action is to administer oxygen to
maintain oxygenation and prevent further hypoxia. While notifying the provider,
applying a pulse oximeter, and positioning the client are important, they follow the
initial step of supporting oxygenation.
2. A nurse is providing discharge teaching to a client who has a new prescription
for enoxaparin. Which of the following statements by the client indicates an
understanding of the teaching?
A. "I will massage the injection site after administering the medication."
B. "I will expel the air bubble from the syringe before injecting."
C. "I will inject the medication into my abdomen."
D. "I will aspirate for blood return before injecting."
Valid answer: C
,2
Explanation: Enoxaparin is a low-molecular-weight heparin administered
subcutaneously in the abdomen to reduce the risk of deep vein thrombosis. The air
bubble should not be expelled, as it ensures the full dose is delivered. Massaging
the site is contraindicated as it can cause bruising. Aspiration is not recommended
for subcutaneous injections of anticoagulants.
3. A nurse is assessing a client who has a history of heart failure. The client
reports a weight gain of 3 pounds in 2 days and swelling in the lower
extremities. Which of the following findings should the nurse anticipate?
A. Decreased heart rate
B. Increased blood pressure
C. Jugular vein distention
D. Decreased respiratory rate
Valid answer: C
Explanation: Weight gain and peripheral edema in a client with heart failure
indicate fluid volume overload. Jugular vein distention is a classic sign of increased
central venous pressure due to fluid overload. The nurse should expect
tachycardia, hypertension, and tachypnea as compensatory mechanisms, not
decreased heart rate or respiratory rate.
4. A nurse is caring for a client who has a nasogastric tube and is receiving
continuous enteral feedings. The nurse notes that the client has developed
diarrhea. Which of the following actions should the nurse take?
A. Decrease the feeding rate
B. Change the feeding formula
C. Administer an antidiarrheal medication
D. Check the client's gastric residual volume
Valid answer: B
Explanation: Diarrhea during enteral feedings is often caused by the formula
itself, such as a hyperosmolar formula, lactose intolerance, or bacterial
,3
contamination. Changing to a different formula may resolve the issue. Decreasing
the rate may help but does not address the underlying cause. Antidiarrheals
should not be the first intervention. Checking gastric residual volume is for
assessing gastric emptying, not diarrhea.
5. A nurse is providing teaching to a client who has a new prescription for an
ACE inhibitor. Which of the following adverse effects should the nurse instruct
the client to report immediately?
A. Dry cough
B. Dizziness
C. Angioedema
D. Hyperkalemia
Valid answer: C
Explanation: Angioedema is a serious, potentially life-threatening adverse effect
of ACE inhibitors characterized by swelling of the face, lips, tongue, and airway.
The client should report these symptoms immediately. Dry cough, dizziness, and
hyperkalemia are also side effects but are less emergent than angioedema.
6. A nurse is assessing a client who has a history of chronic kidney disease. The
client's laboratory results show a serum potassium level of 6.2 mEq/L. Which of
the following interventions should the nurse anticipate?
A. Administration of potassium supplements
B. Administration of sodium polystyrene sulfonate
C. Restriction of dietary sodium
D. Administration of IV fluids
Valid answer: B
Explanation: A serum potassium of 6.2 mEq/L is critically elevated
(hyperkalemia). Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange
resin that binds potassium in the gastrointestinal tract and promotes its excretion.
, 4
Potassium supplements would worsen the condition. Sodium restriction is not the
primary intervention for acute hyperkalemia.
7. A nurse is caring for a client who is receiving a blood transfusion. The client
develops chills, fever, and lower back pain. Which of the following actions
should the nurse take first?
A. Stop the blood transfusion
B. Notify the healthcare provider
C. Administer an antihistamine
D. Obtain a urine specimen
Valid answer: A
Explanation: The client's symptoms are consistent with an acute hemolytic
transfusion reaction, a life-threatening emergency. The priority action is to stop
the blood transfusion immediately to prevent further complications. After stopping
the transfusion, the nurse should notify the provider, maintain IV access with
normal saline, and monitor vital signs.
8. A nurse is providing teaching to a client who has a new prescription for
warfarin. Which of the following foods should the nurse instruct the client to
consume in consistent amounts?
A. Bananas and oranges
B. Green leafy vegetables
C. Dairy products
D. Whole grains
Valid answer: B
Explanation: Green leafy vegetables are high in vitamin K, which can interfere
with the effectiveness of warfarin. The client should maintain a consistent intake of
vitamin K-rich foods to avoid fluctuations in INR. Bananas, oranges, dairy
products, and whole grains do not significantly interact with warfarin.
