ATI RN DETAILED PREDICTOR QUESTION AND ANSWER
Question 1: A nurse is caring for a client with a history of chronic obstructive pulmonary
disease (COPD) who presents with increased dyspnea and a respiratory rate of 30 breaths per
minute. Which action should the nurse take first?
1. Administer oxygen therapy.
2. Assist the client to a sitting position.
3. Perform pursed-lip breathing with the client.
4. Assess the client's oxygen saturation.
Answer: 4. Assess the client's oxygen saturation.
Explanation: Assessing the client's oxygen saturation is the first action the nurse should take to
determine the severity of hypoxia and guide subsequent interventions. Options 1, 2, and 3 are
important interventions for managing COPD exacerbations, but assessing oxygen saturation
provides immediate information about the client's respiratory status.
Question 2: A nurse is caring for a client who has just been admitted with acute pancreatitis. The
client reports severe abdominal pain. Which action should the nurse take first?
1. Administer prescribed pain medication.
2. Assess the client's vital signs.
3. Place the client in a supine position.
4. Offer the client clear liquids to drink.
Answer: 2. Assess the client's vital signs.
Explanation: Assessing the client's vital signs is the priority to determine the severity of the
client's condition and to guide appropriate interventions, including pain management. Option 1
should be done after vital signs are assessed. Options 3 and 4 are not the priority at this time.
Question 3: A nurse is caring for a client with heart failure who is receiving intravenous
furosemide (Lasix). The client's serum potassium level is 3.0 mEq/L. Which action should the
nurse take first?
1. Administer potassium supplements as prescribed.
2. Decrease the furosemide infusion rate.
3. Assess the client's cardiac rhythm.
4. Encourage the client to increase dietary potassium intake.
, Answer: 3. Assess the client's cardiac rhythm.
Explanation: A serum potassium level of 3.0 mEq/L is below the normal range (3.5-5.0 mEq/L)
and places the client at risk for cardiac dysrhythmias, which is the nurse's priority concern.
Options 1 and 4 are appropriate interventions but are secondary to assessing cardiac rhythm.
Option 2 may be considered after assessing the cardiac rhythm and consulting with the
healthcare provider.
Question 4: A nurse is caring for a client receiving total parenteral nutrition (TPN) via central
line. The client develops sudden onset of chest pain, dyspnea, and hypotension. What action
should the nurse take first?
1. Stop the TPN infusion.
2. Assess the central line insertion site.
3. Administer oxygen via face mask.
4. Perform a bedside chest X-ray.
Answer: 3. Administer oxygen via face mask.
Explanation: The client's symptoms suggest a potential pulmonary embolism, and administering
oxygen is the priority to support oxygenation. Options 1 and 2 may be necessary subsequently,
but oxygenation takes precedence. Option 4 may be considered after stabilizing the client's
respiratory status.
Question 5: A nurse is preparing to administer a medication via a nasogastric tube to a client
who is unable to swallow. Which action should the nurse take first?
1. Check for tube placement by auscultating over the stomach.
2. Flush the tube with 30 mL of water before administration.
3. Crush the medication and dissolve it in water.
4. Elevate the head of the client's bed to a semi-Fowler's position.
Answer:
1. Check for tube placement by auscultating over the stomach.
Explanation: Before administering any medication via a nasogastric tube, the nurse must
confirm correct tube placement by auscultating over the stomach to ensure the tube is in the
gastric area. Options 2 and 3 are appropriate after confirming tube placement. Option 4 facilitates
safe administration but is not the first action.
Question 1: A nurse is caring for a client with a history of chronic obstructive pulmonary
disease (COPD) who presents with increased dyspnea and a respiratory rate of 30 breaths per
minute. Which action should the nurse take first?
1. Administer oxygen therapy.
2. Assist the client to a sitting position.
3. Perform pursed-lip breathing with the client.
4. Assess the client's oxygen saturation.
Answer: 4. Assess the client's oxygen saturation.
Explanation: Assessing the client's oxygen saturation is the first action the nurse should take to
determine the severity of hypoxia and guide subsequent interventions. Options 1, 2, and 3 are
important interventions for managing COPD exacerbations, but assessing oxygen saturation
provides immediate information about the client's respiratory status.
Question 2: A nurse is caring for a client who has just been admitted with acute pancreatitis. The
client reports severe abdominal pain. Which action should the nurse take first?
1. Administer prescribed pain medication.
2. Assess the client's vital signs.
3. Place the client in a supine position.
4. Offer the client clear liquids to drink.
Answer: 2. Assess the client's vital signs.
Explanation: Assessing the client's vital signs is the priority to determine the severity of the
client's condition and to guide appropriate interventions, including pain management. Option 1
should be done after vital signs are assessed. Options 3 and 4 are not the priority at this time.
Question 3: A nurse is caring for a client with heart failure who is receiving intravenous
furosemide (Lasix). The client's serum potassium level is 3.0 mEq/L. Which action should the
nurse take first?
1. Administer potassium supplements as prescribed.
2. Decrease the furosemide infusion rate.
3. Assess the client's cardiac rhythm.
4. Encourage the client to increase dietary potassium intake.
, Answer: 3. Assess the client's cardiac rhythm.
Explanation: A serum potassium level of 3.0 mEq/L is below the normal range (3.5-5.0 mEq/L)
and places the client at risk for cardiac dysrhythmias, which is the nurse's priority concern.
Options 1 and 4 are appropriate interventions but are secondary to assessing cardiac rhythm.
Option 2 may be considered after assessing the cardiac rhythm and consulting with the
healthcare provider.
Question 4: A nurse is caring for a client receiving total parenteral nutrition (TPN) via central
line. The client develops sudden onset of chest pain, dyspnea, and hypotension. What action
should the nurse take first?
1. Stop the TPN infusion.
2. Assess the central line insertion site.
3. Administer oxygen via face mask.
4. Perform a bedside chest X-ray.
Answer: 3. Administer oxygen via face mask.
Explanation: The client's symptoms suggest a potential pulmonary embolism, and administering
oxygen is the priority to support oxygenation. Options 1 and 2 may be necessary subsequently,
but oxygenation takes precedence. Option 4 may be considered after stabilizing the client's
respiratory status.
Question 5: A nurse is preparing to administer a medication via a nasogastric tube to a client
who is unable to swallow. Which action should the nurse take first?
1. Check for tube placement by auscultating over the stomach.
2. Flush the tube with 30 mL of water before administration.
3. Crush the medication and dissolve it in water.
4. Elevate the head of the client's bed to a semi-Fowler's position.
Answer:
1. Check for tube placement by auscultating over the stomach.
Explanation: Before administering any medication via a nasogastric tube, the nurse must
confirm correct tube placement by auscultating over the stomach to ensure the tube is in the
gastric area. Options 2 and 3 are appropriate after confirming tube placement. Option 4 facilitates
safe administration but is not the first action.
