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Free ATI Predator Questions
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Bradycardia
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Hypotension
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Enlarged pupils
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Sedation
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Rhinorrhea
Explanation
Correct Answers: (A) Bradycardia, (B) Hypotension, and (D) Sedation
Opioid intoxication depresses the central nervous system and causes a characteristic triad of findings: decreased level of consciousness (sedation), respiratory depression, and miosis (pinpoint pupils). Additional manifestations include bradycardia and hypotension due to the depressant effect of opioids on the cardiovascular and autonomic nervous systems.
Why Other Options are Incorrect:
C. Enlarged pupils Opioid intoxication causes miosis, which is pinpoint or constricted pupils, not enlarged pupils. Enlarged or dilated pupils (mydriasis) are associated with stimulant use such as cocaine or amphetamines, or with opioid withdrawal.
E. Rhinorrhea Rhinorrhea (runny nose) is a classic manifestation of opioid withdrawal, not opioid intoxication. During withdrawal, the body experiences autonomic hyperactivity, which includes symptoms such as rhinorrhea, lacrimation, diaphoresis, and yawning.
Nurses' Notes: 0900: Client at 31 weeks gestation with severe headache unrelieved by acetaminophen, urinary frequency, decreased fetal movement. Gravida 3 para 2 with one preterm birth.
0930: Constant throbbing headache rated 6/10. Denies visual disturbances. +3 pitting edema in bilateral lower extremities. Patellar reflex 4+ without clonus. Occasional nighttime leg cramps. Reports 3 fetal movements in last 30 min. External fetal monitor: baseline FHR 140/min with occasional accelerations and moderate variability. No uterine contractions noted.
Vital Signs: 0900: BP 162/112 mm Hg, HR 72/min, RR 16/min, Temp 36.9°C, SaO2 97% 0930: BP 166/110 mm Hg, HR 84/min, RR 18/min, Temp 37.1°C, SaO2 99%
Diagnostic Results 0930: Hemoglobin 18.0 g/dL (12 to 16 g/dL) Hematocrit 35% (37 to 47%) Platelets 98,000/mm³ (150,000 to 400,000/mm³) Creatinine 0.8 mg/dL (0.5 to 1 mg/dL) WBC 8,000/mm³ (5,000 to 10,000/mm³)
- Platelet count → HELLP Syndrome
- Alanine aminotransferase (ALT) → HELLP Syndrome
- Blood pressure → Both Preeclampsia and HELLP Syndrome
- Hemoglobin → HELLP Syndrome
Explanation
Correct Answers: Platelet count → HELLP Syndrome, Alanine aminotransferase (ALT) → HELLP Syndrome, Blood pressure → Both Preeclampsia and HELLP Syndrome, Hemoglobin → HELLP Syndrome
Platelet count — HELLP Syndrome only
Platelets at 98,000/mm³ are critically below the normal range of 150,000 to 400,000/mm³, indicating thrombocytopenia. Low platelet count is a defining diagnostic feature of HELLP syndrome, where LP specifically stands for low platelets. The destruction of platelets occurs as red blood cells are damaged while passing through fibrin deposits in small blood vessels. Thrombocytopenia is not a primary diagnostic criterion for preeclampsia alone, making this finding specific to HELLP syndrome in this scenario.
Alanine aminotransferase (ALT) — HELLP Syndrome only
Elevated liver enzymes, particularly ALT, are the EL component of HELLP syndrome, standing for elevated liver enzymes. This elevation reflects hepatocellular damage caused by fibrin deposits accumulating in the hepatic sinusoids, leading to liver cell destruction and enzyme release into the bloodstream. Elevated liver enzymes are a hallmark diagnostic criterion of HELLP syndrome specifically and are not a primary defining feature of preeclampsia without HELLP.
Blood pressure — Both Preeclampsia and HELLP Syndrome
The blood pressure readings of 162/112 mm Hg at 0900 and 166/110 mm Hg at 0930 both exceed the threshold of 160/110 mm Hg that defines severe hypertension in pregnancy. Severe persistent hypertension is a core diagnostic criterion for preeclampsia with severe features. It is also consistently present in HELLP syndrome because HELLP syndrome most commonly develops as a severe complication of preeclampsia. Therefore blood pressure elevation is a shared finding in both conditions and applies to both disease processes in this client.
Hemoglobin — HELLP Syndrome only
A hemoglobin of 18.0 g/dL is elevated above the normal range of 12 to 16 g/dL. When interpreted alongside a hematocrit of 35% that is below the normal range of 37 to 47%, this combination is consistent with hemoconcentration from plasma loss and microangiopathic hemolytic anemia, which is the H component of HELLP syndrome standing for hemolysis. As red blood cells are destroyed while passing through damaged blood vessels, hemoglobin is released, leading to elevated serum hemoglobin levels with a paradoxically decreased hematocrit. Hemolysis is not a primary feature of preeclampsia without HELLP syndrome, making this finding specific to HELLP syndrome.
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"Expect the client's urine to contain clots for the first 24 hours."
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"Expect the stoma to appear pale until healing is complete."
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"We need to check the client's urine output every hour."
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"We will keep the client's fluid intake restricted until he is free of pain."
Explanation
Correct Answer: (C) "We need to check the client's urine output every hour."
In the immediate postoperative period following urostomy creation, hourly urine output monitoring is essential to assess kidney function, stoma patency, and adequate fluid balance. A urine output of at least 30 mL/hour is the expected minimum, and any decrease could indicate obstruction, dehydration, or renal complications requiring prompt intervention.
Why Other Options are Incorrect:
A. "Expect the client's urine to contain clots for the first 24 hours." Blood clots in urine are not a normal or expected finding following urostomy surgery. While some mucus may be present due to the bowel segment used to create the conduit, clots in the urine would indicate abnormal bleeding and should be reported to the provider.
B. "Expect the stoma to appear pale until healing is complete." A healthy stoma should appear beefy red and moist, similar to the color of oral mucous membranes. A pale stoma indicates inadequate blood flow or ischemia and is an abnormal finding that requires immediate assessment and notification of the provider.
D. "We will keep the client's fluid intake restricted until he is free of pain." Fluid restriction is not appropriate following urostomy surgery. Adequate hydration is essential to maintain urine flow through the conduit, prevent urinary tract infection, and support healing. Restricting fluids postoperatively could lead to dehydration and urinary complications.
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Support the extremity above and below each joint during the exercises.
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Position the bed at mid-thigh level.
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Move each joint just past the point of resistance.
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Repeat each exercise movement 10 times.
Explanation
When performing passive range-of-motion exercises, it is essential to support the extremity both above and below the joint being exercised. This technique protects the joint from injury, ensures proper alignment, and allows for safe and effective movement without causing strain or discomfort to the client.
Why the other options are incorrect:
B. Position the bed at mid-thigh level The bed should be raised to a comfortable working height for the caregiver, typically at waist level, to prevent back strain. Mid-thigh level is too low and could cause injury to the caregiver.
C. Move each joint just past the point of resistance Passive range-of-motion exercises should only be performed to the point of resistance, never beyond it. Moving past resistance can cause pain, injury, or muscle tears.
D. Repeat each exercise movement 10 times The standard recommendation is to repeat each movement 3 to 5 times, not 10. Repeating 10 times may cause fatigue or injury, especially in stroke patients with compromised muscle tone.
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Fundus is located 2 cm (0.4 in) below the level of the umbilicus
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Scant lochia rubra on the perineal pad
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Non-pitting bilateral peripheral edema
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Oral temperature of 38.8°C (101.8°F)
Explanation
Correct Answer: (D) Oral temperature of 38.8°C (101.8°F)
An oral temperature of 38.8°C (101.8°F) at 24 hours postpartum is an abnormal finding that must be reported to the RN immediately. While a slight temperature elevation up to 38°C (100.4°F) within the first 24 hours postpartum can be a normal physiological response to the exertion of labor, a temperature of 38.8°C is above this threshold and may indicate a postpartum infection such as endometritis, urinary tract infection, or wound infection requiring prompt assessment and intervention.
Why Other Options are Incorrect:
A. Fundus is located 2 cm below the level of the umbilicus — At 24 hours postpartum, the fundus is expected to be approximately 1 cm below the umbilicus and descends approximately 1 cm per day. A fundus located 2 cm below the umbilicus at 24 hours is a slightly early but acceptable finding within the normal range of uterine involution and does not require reporting.
B. Scant lochia rubra on the perineal pad — Scant lochia rubra is a normal and expected finding in the first 24 hours following vaginal delivery. Lochia rubra consists of blood, decidua, and trophoblastic debris and is expected to be present in the early postpartum period. Scant amounts indicate normal blood loss and do not require reporting.
C. Non-pitting bilateral peripheral edema — Non-pitting bilateral peripheral edema is a common and expected finding in the early postpartum period due to the physiological fluid shifts and redistribution that occur after delivery. This is a normal postpartum finding that resolves spontaneously over several days and does not require reporting.
Exhibit 1 – History and Physical Gravida 3 Para 2 Abortion 1 Asthma (managed with levalbuterol inhaler as needed) Pelvic inflammatory disease (PID) Spontaneous vaginal delivery x 2 (hypertension with first pregnancy at 20 years of age) Voluntary termination of pregnancy (third pregnancy)
Exhibit 2 – Nurses' Notes 1000: Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period 6 weeks ago. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented and dressed appropriately, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at rate of 90/min. Respirations even and nonlabored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting.
Exhibit 3 – Graphic Record 1000: Temperature 37.3°C (99.1°F), Heart rate 90/min, Respiratory rate 16/min, Blood pressure 120/74 mm Hg, Oxygen saturation 97% on room air
Exhibit 4 – Diagnostic Results 1015: Urine human chorionic gonadotropin (hCG): positive (negative)
Drag 1 condition and 1 client finding to fill in each blank in the following sentence.
After collecting data from the client, the nurse should identify that the client is experiencing ______ (Condition) as evidenced by the client's ______ (Finding).
Conditions: ectopic pregnancy, abruptio placentae, pyelonephritis, placenta previa, acute asthma attack
Findings: respiratory rate, history of regular menstrual period, right lower quadrant abdominal tenderness, hyperactive bowel sounds, temperature
- ectopic pregnancy
- abruptio placentae
- pyelonephritis
- placenta previa
- acute asthma attack
- respiratory rate
- history of regular menstrual period
- right lower quadrant abdominal tenderness
- hyperactive bowel sounds
- temperature
Explanation
Condition — Ectopic pregnancy: The combination of a positive urine hCG (confirming pregnancy), a missed menstrual period with last menstrual period 6 weeks ago, scant dark red vaginal spotting, right lower quadrant abdominal tenderness, and a significant history of pelvic inflammatory disease all point directly to ectopic pregnancy. PID causes scarring and damage to the fallopian tubes, which is the leading risk factor for ectopic implantation. An ectopic pregnancy is a life-threatening emergency if the fallopian tube ruptures.
Finding — Right lower quadrant abdominal tenderness: This is the classic clinical finding associated with a right-sided ectopic pregnancy. The localized tenderness in the right lower quadrant, combined with a positive pregnancy test and vaginal spotting, is the hallmark physical finding that supports this diagnosis.
Why the other options are incorrect:
Abruptio placentae — This condition involves premature separation of the placenta and occurs in the second or third trimester of an established intrauterine pregnancy. There is no evidence of an advanced pregnancy in this client.
Pyelonephritis — Pyelonephritis typically presents with flank pain, fever, dysuria, and urinary symptoms. The client's temperature is normal and there are no urinary complaints documented.
Placenta previa — Placenta previa involves painless bright red vaginal bleeding in the second or third trimester. This client has dark red spotting with abdominal pain and a very early suspected pregnancy.
Acute asthma attack — While the client has a history of asthma and slight inspiratory wheezes, respirations are even and nonlabored with an oxygen saturation of 97%, which does not support an acute asthma attack as the primary condition.
Respiratory rate — The respiratory rate is 16/min, which is within normal limits and does not serve as a clinical finding that supports any of the listed conditions as the primary diagnosis.
History of regular menstrual period — A regular menstrual history is background information. The significant finding is the current missed period and positive hCG, not the history of regularity itself.
Hyperactive bowel sounds — While hyperactive bowel sounds are noted, they are a nonspecific finding and are not the most clinically relevant evidence supporting ectopic pregnancy compared to the localized right lower quadrant tenderness.
Temperature — The temperature is 37.3°C, which is normal, and does not serve as a supporting finding for ectopic pregnancy.
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Medications for a cardiac anomaly
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Two diarrhea stools in the last day
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Clear rhinorrhea
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Chemotherapy treatments
Explanation
Varicella is a live attenuated vaccine and is contraindicated in immunocompromised individuals. Chemotherapy severely suppresses the immune system, making it unsafe to administer a live vaccine as it could cause serious infection.
Why the other options are incorrect:
A. Medications for a cardiac anomaly Cardiac medications alone are not a contraindication for varicella vaccination unless they cause significant immunosuppression.
B. Two diarrhea stools in the last day Mild illness such as diarrhea is not a contraindication for vaccination. The child can still receive the vaccine.
C. Clear rhinorrhea A mild upper respiratory symptom like clear rhinorrhea is not a contraindication for vaccination and does not pose a significant risk.
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Ask the client's family about cultural or religious practices regarding postmortem care.
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Remove the client's dentures from their mouth before rigor mortis begins.
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Turn on all the lights in the room before the family views the client's body.
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Position the client's bed flat without a pillow under their head.
Explanation
Correct Answer: (A) Ask the client's family about cultural or religious practices regarding postmortem care.
Culturally sensitive and respectful postmortem care requires the nurse to ask the family about their cultural, spiritual, and religious practices. Different cultures have specific rituals and preferences regarding the handling of the body after death, and honoring these practices is an essential component of compassionate end-of-life nursing care.
Why the other options are incorrect:
B. Remove the client's dentures from their mouth before rigor mortis begins — Dentures should actually be left in place or reinserted before rigor mortis sets in to maintain the client's facial appearance and dignity for family viewing.
C. Turn on all the lights in the room before the family views the client's body — A calm, softly lit environment is more appropriate for family viewing. Bright lighting can feel harsh and clinical during an emotionally sensitive time.
D. Position the client's bed flat without a pillow under their head — The head of the bed should be slightly elevated and a pillow placed under the head to prevent discoloration of the face and maintain a natural, dignified appearance for the family.
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Hypoglycemia
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Hypokalemia
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Hyperchloremia
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Hypernatremia
Explanation
Correct Answer: (B) Hypokalemia
Furosemide is a loop diuretic that promotes the excretion of water, sodium, and potassium through the kidneys. Because potassium is lost along with fluid, hypokalemia (low potassium) is a well-known and common adverse effect. The nurse should monitor potassium levels closely and watch for signs such as muscle weakness, cramping, and cardiac dysrhythmias.
Why the other options are incorrect:
A. Hypoglycemia — Furosemide does not lower blood glucose. Hypoglycemia is associated with insulin or oral hypoglycemic agents, not loop diuretics.
C. Hyperchloremia — Furosemide actually promotes chloride excretion, which can lead to hypochloremia, not hyperchloremia.
D. Hypernatremia — While furosemide causes sodium excretion, it tends to cause hyponatremia rather than hypernatremia due to the loss of sodium in the urine.
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Puncture the side of the client's finger.
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Position the client's finger above their heart.
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Milk the finger site.
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Apply sterile gloves prior to performing the test.
Explanation
Correct Answer: (A) Puncture the side of the client's finger.
The correct technique for blood glucose monitoring is to puncture the lateral (side) aspect of the fingertip, which has fewer nerve endings than the pad, causing less pain while still providing an adequate blood sample. This is the standard evidence-based practice for capillary blood glucose testing.
Why the other options are incorrect:
B. Position the client's finger above their heart — The finger should be positioned below or at the level of the heart to promote blood flow to the fingertip and obtain an adequate blood sample. Raising the finger above the heart reduces blood flow and makes it harder to obtain a sample.
C. Milk the finger site — Milking or squeezing the finger is contraindicated because it can dilute the blood sample with tissue fluid, leading to inaccurate glucose readings. The finger should be gently warmed if needed to promote blood flow instead.
D. Apply sterile gloves prior to performing the test — Clean (nonsterile) gloves are appropriate for blood glucose monitoring. Sterile gloves are reserved for invasive procedures that require a sterile field, such as wound care or catheter insertion. Blood glucose monitoring is a clean procedure, not a sterile one.
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