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Free ATI Predator Questions
A nurse is planning to obtain a 12-lead ECG for a client who has a history of cardiac dysrhythmias. Which of the following actions should the nurse plan to take?
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Instruct the client to remain as still as possible during the recording.
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Tell the client to expect a mild stinging sensation during the test.
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Assist the client to the orthopneic position.
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Attach a blood pressure cuff to the client's upper arm.
Explanation
During a 12-lead ECG, any movement by the client can create artifact on the tracing, leading to inaccurate readings. Instructing the client to lie still and breathe normally ensures a clear, accurate recording of the heart's electrical activity, which is essential for correct interpretation and diagnosis of dysrhythmias.
Correct Answer Is:
(A) Instruct the client to remain as still as possible during the recording
Why the other options are incorrect:
B. Tell the client to expect a mild stinging sensation during the test A 12-lead ECG is a non-invasive, painless procedure. There is no stinging sensation involved. Electrodes are simply placed on the skin with adhesive pads or gel.
C. Assist the client to the orthopneic position The orthopneic position (leaning forward over a table) is used for clients with breathing difficulty. For an ECG, the client should be in a supine or slightly elevated position to ensure proper electrode placement.
D. Attach a blood pressure cuff to the client's upper arm A blood pressure cuff is not part of a 12-lead ECG procedure. ECG electrodes are placed on the limbs and chest, not a blood pressure cuff.
A nurse is reviewing the laboratory results for a client who is receiving digoxin and notes a decreased potassium level. The nurse should monitor the client for which of the following adverse effects?
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Dysrhythmia
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Urinary retention
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Respiratory depression
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Tachycardia
Explanation
Correct Answer: (A) Dysrhythmia
Digoxin has a narrow therapeutic index and its toxicity is significantly potentiated by hypokalemia. Potassium and digoxin compete for the same binding sites on the sodium-potassium ATPase pump. When potassium levels are low, digoxin binds more readily, increasing its effect and the risk of digoxin toxicity, which most dangerously manifests as life-threatening dysrhythmias including heart block, ventricular fibrillation, and bradycardia.
Why the other options are incorrect:
B. Urinary retention — Urinary retention is not an adverse effect of digoxin toxicity. It is more commonly associated with anticholinergic medications or opioids.
C. Respiratory depression — Respiratory depression is not associated with digoxin toxicity. It is a known adverse effect of opioids and benzodiazepines.
D. Tachycardia — Digoxin toxicity typically causes bradycardia and heart block, not tachycardia. The drug works by slowing conduction through the AV node and increasing vagal tone.
A nurse is caring for a client who is receiving 0.45% sodium chloride at 45 mL/hr by continuous IV infusion. Which of the following tasks can the nurse delegate to the assistive personnel (AP)?
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Change the IV solution bag.
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Calculate IV intake.
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Regulate the IV flow rate.
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Report any IV infusion alarms.
Explanation
Assistive personnel can be delegated the task of reporting IV infusion alarms to the nurse. This is within the AP's scope as it requires only observation and communication, not clinical judgment or nursing assessment. The nurse retains responsibility for assessing and responding to the alarm.
Why the other options are incorrect:
A. Change the IV solution bag — Changing IV solution bags involves clinical knowledge and verification of the correct solution, concentration, and rate. This is a nursing responsibility and cannot be delegated to an AP.
B. Calculate IV intake — Calculating IV intake requires accurate mathematical computation and clinical documentation skills that are part of the nurse's responsibility for fluid balance monitoring. This cannot be delegated to an AP.
C. Regulate the IV flow rate — Adjusting or regulating the IV flow rate requires nursing judgment and knowledge of the prescribed infusion rate and the client's clinical status. This is outside the scope of an AP and cannot be delegated.
A nurse is reinforcing teaching with a client who has a neurogenic bladder and a prescription for intermittent urinary self-catheterizations. Which of the following statements by the client shows an understanding of the teaching?
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"I should wait to perform this procedure until my bladder is completely full."
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"I should perform this procedure without lubricating the catheter."
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"I should secure the catheter to my leg after the procedure."
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"I should wear gloves when performing this procedure."
Explanation
Correct Answer: (D) "I should wear gloves when performing this procedure."
Wearing clean gloves during intermittent self-catheterization is an important infection control measure that helps reduce the risk of introducing bacteria into the urinary tract. This demonstrates understanding of clean technique principles necessary for safe home catheterization.
Why Other Options are Incorrect:
A. "I should wait to perform this procedure until my bladder is completely full." Waiting until the bladder is completely full can cause overdistension, increase the risk of urinary tract infection, and lead to reflux. Catheterization should be performed on a scheduled basis, typically every 4 to 6 hours.
B. "I should perform this procedure without lubricating the catheter." The catheter must always be lubricated before insertion to reduce friction, prevent urethral trauma, and ease insertion. Inserting an unlubricated catheter can cause injury to the urethra.
C. "I should secure the catheter to my leg after the procedure." Intermittent catheterization involves inserting the catheter, draining the bladder, and then removing it. The catheter is not left in place and therefore does not need to be secured to the leg.
A nurse is verifying informed consent for a client who is preoperative for a vaginal hysterectomy. Which of the following statements should the nurse identify as an indication that the client has given informed consent?
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"I will no longer need a regular gynecological examination."
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"I should expect my periods to resume in 1 month."
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"I am thankful I am done having children."
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"I will have a large scar on my stomach after this procedure."
Explanation
Correct Answer: (C) "I am thankful I am done having children."
This statement demonstrates that the client understands a key outcome of a hysterectomy, which is the permanent loss of the ability to conceive children. Informed consent requires the client to understand the nature of the procedure, its risks, benefits, and consequences. Acknowledging that she will no longer be able to have children shows she has been informed about and accepted this permanent outcome.
Why Other Options are Incorrect:
A. "I will no longer need a regular gynecological examination." — This is incorrect. Even after a hysterectomy, clients still require regular gynecological examinations to monitor vaginal cuff health and screen for other conditions. This statement indicates a misconception and lack of informed understanding.
B. "I should expect my periods to resume in 1 month." — A hysterectomy results in the permanent cessation of menstruation. Expecting periods to resume indicates a serious misunderstanding of the procedure, meaning informed consent has not been achieved.
D. "I will have a large scar on my stomach after this procedure." — A vaginal hysterectomy is performed through the vagina and does not leave an abdominal scar. This statement indicates the client does not understand the nature of the specific procedure being performed.
A nurse is reviewing arterial blood gas results for a client who has metabolic acidosis. Which of the following values should the nurse expect?
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PaO2 64 mm Hg (80 to 100 mm Hg)
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HCO3- 20 mEq/L (22 to 26 mEq/L)
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PaCO2 32 mm Hg (35 to 45 mm Hg)
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pH 7.48 (7.35 to 7.45)
Explanation
Correct Answer: (B) HCO3- 20 mEq/L (22 to 26 mEq/L)
In metabolic acidosis, the primary disturbance is a decrease in bicarbonate (HCO3-). A bicarbonate level of 20 mEq/L is below the normal range of 22 to 26 mEq/L, which is the hallmark finding of metabolic acidosis. The kidneys are unable to retain sufficient bicarbonate to buffer the excess acid in the body, resulting in a decreased pH and low bicarbonate level.
Why the other options are incorrect:
A. PaO2 64 mm Hg — A PaO2 of 64 mm Hg indicates hypoxemia and is below the normal range of 80 to 100 mm Hg. While hypoxemia can contribute to acidosis, it is not the defining characteristic of metabolic acidosis specifically.
C. PaCO2 32 mm Hg — A PaCO2 of 32 mm Hg is below the normal range of 35 to 45 mm Hg, which indicates respiratory alkalosis or compensatory hyperventilation. In metabolic acidosis, the body compensates by blowing off CO2 through increased respirations, so this could be a compensatory finding, but it is not the primary expected value.
D. pH 7.48 — A pH of 7.48 is above the normal range of 7.35 to 7.45, indicating alkalosis, not acidosis. In metabolic acidosis the pH would be below 7.35.
Exhibit 1 – History and Physical: 1100: History of alcohol use disorder. Family history of mood disorders.
Exhibit 2 – Nurses' Notes: 1100: The client is brought to an inpatient mental health facility by their partner after slipping on the kitchen floor while cooking breakfast. Client reports hitting their arm on the counter and reports pain as 6 on a scale of 0 to 10. A 4-inch laceration is noted on client's left arm. Client is not making eye contact with nurse and alcohol is detected on client's breath when speaking. Client has a flat affect, their hygiene is poor, and clothes are dirty. Client states they lost their job 6 months ago and does not feel that life is worth living if they are not earning a daily living. 1400: The client reports feeling tired and is anxious. Left arm laceration sutured and pain medication administered. Client reports pain as 4 on a scale of 0 to 10.
Available choices: Actions to Take: Encourage client to eat slowly, Determine client's level of orientation, Remain in the room with the client, Assist the client to identify stressors, Speak with the client using simple words. Potential Conditions: Schizophrenia, Dementia, Dependent personality disorder, Major depressive disorder. Parameters to Monitor: Wandering at night, Sleep patterns, Suicidal ideation, Panic attacks, Hallucinations.
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Encourage client to eat slowly
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Determine client's level of orientation
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Remain in the room with the client
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Assist the client to identify stressors
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Speak with the client using simple words
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Schizophrenia
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Dementia
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Dependent personality disorder
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Major depressive disorder
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Wandering at night
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Sleep patterns
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Suicidal ideation
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Panic attacks
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Hallucinations
Explanation
Correct Answer: Potential Condition: Major depressive disorder Actions to Take: Remain in the room with the client and Assist the client to identify stressors Parameters to Monitor: Suicidal ideation and Sleep patterns
The client's presentation is consistent with major depressive disorder. Key supporting findings include flat affect, poor hygiene, loss of purposeful living ("does not feel that life is worth living"), job loss six months ago serving as a significant psychosocial stressor, social withdrawal evidenced by poor eye contact, fatigue, and anxiety. The history of alcohol use disorder and family history of mood disorders further support this diagnosis.
Remaining in the room with the client is a priority safety intervention because the client has expressed feelings that life is not worth living, placing them at risk for self-harm or suicide. Constant presence reduces the opportunity for self-harm and communicates support.
Assisting the client to identify stressors is a therapeutic intervention that helps the client gain insight into the triggers contributing to their depressive episode, such as job loss, which is a necessary step toward developing healthy coping strategies and a recovery plan.
Suicidal ideation must be monitored because the client has already expressed passive suicidal thinking by stating life is not worth living. Ongoing assessment of suicidal ideation is essential to maintain client safety and adjust the level of care as needed.
Sleep patterns are an important parameter to monitor because sleep disturbances, including insomnia or hypersomnia, are hallmark symptoms of major depressive disorder. Changes in sleep patterns reflect the severity of depression and the client's response to treatment.
Why Other Options are Incorrect:
Schizophrenia is characterized by hallucinations, delusions, disorganized thinking, and psychosis. While the client has flat affect, there is no evidence of psychotic symptoms, making schizophrenia inconsistent with this presentation.
Dementia presents with progressive cognitive decline, memory impairment, and disorientation, typically in older adults. There is no evidence of cognitive impairment in this client's presentation.
Dependent personality disorder involves a pervasive need to be taken care of and fear of separation. The clinical findings here center on mood, affect, and expressed hopelessness, which are more consistent with major depressive disorder.
Encourage client to eat slowly is appropriate for clients with dementia or swallowing difficulties, not for a client presenting with depression and self-harm risk.
Determine client's level of orientation is appropriate for clients with dementia, delirium, or altered cognition, which is not the primary concern in this presentation.
Wandering at night is a parameter associated with dementia, not major depressive disorder.
Panic attacks are associated with anxiety disorders and are not a primary monitoring parameter for major depressive disorder in this clinical scenario.
Hallucinations are associated with schizophrenia or psychotic disorders and are not indicated by this client's presentation.
25 mg ÷ 1 mg/mL = 0.25 mL
The nurse should administer 0.25 mL of terbutaline subcutaneously.
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0.25 mL
Explanation
Answer: 0.25 mL
Using the formula: Dose desired ÷ Dose available = Volume to administer
0.25 mg ÷ 1 mg/mL = 0.25 mL
The nurse should administer 0.25 mL of terbutaline subcutaneously.
A nurse is caring for a client who has a prescription for warfarin. Which of the following laboratory tests should the nurse monitor?
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Prothrombin time
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Arterial blood gases
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Triiodothyronine
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Blood urea nitrogen
Explanation
Correct Answer: (A) Prothrombin time
Warfarin is an anticoagulant that works by inhibiting vitamin K-dependent clotting factors. The prothrombin time (PT) and its standardized ratio, the INR (International Normalized Ratio), are used to monitor the therapeutic effectiveness and safety of warfarin therapy. The goal INR range for most clients on warfarin is 2.0 to 3.0, and regular monitoring is essential to prevent bleeding or clotting complications.
Why Other Options are Incorrect:
B. Arterial blood gases Arterial blood gases measure oxygen, carbon dioxide, and pH levels in the blood and are used to assess respiratory and metabolic status. They are not relevant to monitoring warfarin therapy.
C. Triiodothyronine Triiodothyronine (T3) is a thyroid hormone level used to assess thyroid function. It has no direct relationship to anticoagulation monitoring with warfarin.
D. Blood urea nitrogen Blood urea nitrogen (BUN) is a marker of kidney function and hydration status. While renal function is important in overall client management, it is not the specific laboratory test used to monitor warfarin therapy.
A nurse is planning care for a client who recently attempted suicide. Which of the following actions should the nurse plan to take?
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Observe the client's behavior every 2 hours
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Keep the client's door shut when they are in the room
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Ensure the client swallows each dose of medication
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Limit the personal toiletries in the client's room to cologne
Explanation
Explanation:
Correct Answer: (C) Ensure the client swallows each dose of medication
For a client who has recently attempted suicide, the nurse must ensure that all medications are swallowed and not hoarded or stored for a potential overdose attempt. This is a critical safety measure known as medication check or mouth check, which is standard practice in psychiatric and mental health settings for clients at risk of self-harm.
Why Other Options are Incorrect:
A. Observe the client's behavior every 2 hours — A client who has recently attempted suicide requires continuous observation or checks every 15 minutes at minimum, not every 2 hours. Every 2 hours is insufficient to ensure client safety.
B. Keep the client's door shut when they are in the room — Keeping the door shut would prevent staff from being able to monitor the client and could provide opportunity for self-harm. The door should remain open or staff should have visual access at all times.
D. Limit the personal toiletries in the client's room to cologne — Cologne and other toiletries such as razors, glass bottles, and sharp objects should be removed or restricted. However, cologne itself contains alcohol and could be ingested or used for self-harm, making it an inappropriate item to keep in the room.
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