ATI RN VATI Comprehensive Predictor
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A nurse is caring for a client on the medical-surgical unit. Exhibit 1 Provider Prescriptions Day 1, 1600: Insert nasogastric feeding tube. Chest x-ray to confirm placement of feeding tube. Day 1, 1800: Administer enteral formula 120 mL every 6 hr while awake via nasogastric feeding tube. Correction insulin: Administer regular insulin SUBQ PRN 4 times daily: 151 to 180 mg/dL - administer 2 units regular insulin SUBQ 181 to 200 mg/dL - administer 4 units regular insulin SUBQ If glucose greater than 200 mg/dL, notify provider. Exhibit 2 Laboratory Results Day 2, 0600: Blood glucose 138 mg/dL (70 to 110 mg/dL) Day 2, 0630: Potassium 3.7 mEq/L (3.5 to 5 mEq/L) Sodium 137 mEq/L (136 to 145 mEq/L) Day 2, 1200: Blood glucose 152 mg/dL (70 to 110 mg/dL) Exhibit 3 Nurses' Notes Day 1, 1800: Before administration of enteral feeding, pH of aspirate is 4.8. Day 1, 2040: Client had formed stool. Day 2, 0830: Abdomen distended, firm, and tense. Before administration of enteral feeding via nasogastric feeding tube, gastric residual is 90 mL. pH of aspirate is 6.4. Exhibit 4 Vital Signs Day 2, 1200: Temperature 36.5° C (97.7° F) Heart rate 88/min Respiratory rate 20/min Blood pressure 144/90 mm Hg Oxygen saturation 96% on room air Which of the following client findings suggest that the nurse should hold the tube feeding and notify the provider? Select all that apply.
- A. Gastric content pH
- B. Abdominal findings
- C. Oxygen saturation
- D. Gastric residual
- E. Blood glucose
- F. Laboratory electrolyte results
Explanation
A. Gastric content pH:
The client’s gastric aspirate pH increased from 4.8 on Day 1 to 6.4 on Day 2. A rising pH
suggests possible tube displacement into the respiratory tract or small intestine. A pH >5 for
nasogastric tube aspirate is concerning and indicates the need to hold feeding until placement is
reverified and the provider is notified.
B. Abdominal findings:
The abdomen is distended, firm, and tense, which indicates decreased tolerance to enteral
feeding and possible gastric retention, obstruction, or delayed gastric emptying. These findings
increase the risk for aspiration and feeding intolerance. Feeding should be held, and the provider
must be notified for further evaluation.
D. Gastric residual:
The gastric residual is 90 mL prior to feeding. For intermittent feedings every 6 hours, a residual
nearing 100 mL is abnormal and suggests delayed gastric emptying or poor tolerance. Combined
with abdominal distension and rising pH, this finding warrants holding the feeding and notifying
the provider.
A nurse is planning the discharge of an infant who has tetralogy of Fallot. The nurse anticipates the need for which of the following equipment?
- A. Portable suction
- B. Cervical collar
- C. Hemodialyzer
- D. Pulse oximeter
Explanation
D. Pulse oximeter: Infants with tetralogy of Fallot require continuous monitoring of
oxygen saturation levels at home. These infants are prone to "tet spells" - sudden
episode of cyanosis and hypoxia triggered by crying, feeding, or dehydration. A pulse
oximeter allows parents to monitor the infant's oxygen saturation and recognize early
signs of deterioration, enabling prompt intervention. The other equipment is not
indicated: portable suction is for airway secretions management (not typically needed),
cervical collars are for spinal immobilization, and hemodialyzers are for renal failure
treatment.
A nurse in an emergency department is assessing a client who has a nasal fracture. Which of the following findings should cause the nurse to suspect a skull fracture?
- A. Clear fluid drainage from the nares
- B. Report of pain around the eyes
- C. Dried blood in the mouth
- D. Mandibular asymmetry
Explanation
Clear, watery drainage from the nose (rhinorrhea) following head trauma suggests
cerebrospinal fluid (CSF) leakage, which indicates a skull fracture with disruption
of the dura mater. This finding requires immediate medical attention due to the
risk of meningitis and other serious complications. The other findings are more
consistent with isolated facial trauma: periorbital pain is common with nasal
fractures, dried blood in the mouth may result from nasal bleeding, and
mandibular asymmetry suggests jaw injury rather than skull fracture.
A nurse is preparing to discharge a newborn who has an atrial septal defect. The nurse should expect the provider to refer the client to which of the following interprofessional team members?
- A. Case manager
- B. Physical therapist
- C. Occupational therapist
- D. Nurse manager
Explanation
A case manager is essential for coordinating the complex care needs of an infant with a
congenital heart defect like atrial septal defect. This professional helps arrange
follow-up cardiology appointments, coordinates home care services, assists with
insurance authorization for potential future procedures, and ensures continuity of care
between hospital and home. The other team members serve different purposes:
physical and occupational therapists focus on developmental and motor skills (not
typically primary needs for uncomplicated atrial septal defect), and the nurse manager
oversees unit operations rather than direct discharge planning.
A home health nurse is admitting a client who is prescribed peritoneal dialysis. Which of the following actions should the nurse take first?
- A. Confirm schedule for delivery of supplies.
- B. Coordinate interdisciplinary health care services.
- C. Demonstrate how to perform the procedure.
- D. Clarify the client's actual and perceived health needs.
Explanation
D. Clarify the client's actual and perceived health needs:
During an admission visit, the first nursing action is to perform a comprehensive assessment.
This includes understanding the client’s medical needs, home environment, learning needs,
readiness to learn, concerns, and support system. Before teaching, arranging services, or
planning care, the nurse must determine what the client actually needs and perceives as a need.
This forms the foundation for the entire home health care plan.
A nurse is teaching a client who has osteoporosis about how to increase calcium in their diet. The nurse should instruct the client that which of the following foods is the best source of calcium?
- A. 1/2 cup raw carrots
- B. 3 oz canned tuna
- C. 6 oz low-fat yogurt
- D. 1 slice whole-wheat bread
Explanation
Low-fat yogurt is one of the richest dietary sources of calcium, providing approximately 300 mg
per 6-oz serving. For clients with osteoporosis, adequate daily calcium intake is essential for
slowing bone loss and maintaining bone density. Dairy products, especially yogurt, milk, and
cheese, contain highly absorbable calcium, making them superior to plant or grain sources for
meeting recommended intake levels.
A nurse is providing teaching to a client who is at 8 weeks of gestation and experiencing episode of nausea and vomiting. Which of the following instructions should the nurse include?
- A. Brush teeth immediately after eating.
- B. Lay down for 30 min after meals.
- C. Drink 12 oz of water with each meal.
- D. Eat a dry carbohydrate before getting out of bed.
Explanation
D. Eat a dry carbohydrate before getting out of bed:
During early pregnancy, nausea and vomiting (morning sickness) are frequently worsened by an
empty stomach and sudden changes in position. Eating a dry carbohydrate—such as crackers or
toast—before getting out of bed stabilizes blood sugar, provides a gentle start to digestion, and
reduces queasiness. This is a well-established, first-line recommendation for managing morning
sickness.
A nurse is caring for a client who has schizophrenia. The client states, "Run cats spin the rain throwing procedure mechanical paper lake." The nurse should document that the client is demonstrating which of the following speech alterations?
- A. Echolalia
- B. Word salad
- C. Neologisms
- D. Clang association
Explanation
B. Word salad:
“Word salad” is a severe form of disorganized speech in which words are combined in a
completely incoherent, nonsensical order without logical connection. The client’s statement
contains unrelated words and phrases strung together, demonstrating a classic example of word
salad, which is common in schizophrenia.
A nurse at a public health clinic is caring for a group of clients. Which of the following should the nurse identify as a reportable diagnosis to the CDC?
- A. Herpes simplex virus (HSV) type 1
- B. Hepatitis A
- C. Human papillomavirus (HPV)
- D. Pediculosis capitis
Explanation
B. Hepatitis A: Hepatitis A is a nationally notifiable disease that must be reported to the
Centers for Disease Control and Prevention (CDC). This reporting allows for public
health monitoring, outbreak identification, and implementation of control measures. The
other conditions are not typically reportable to the CDC: HSV-1 and HPV are common
viral infections with no national reporting requirement, and pediculosis capitis (head
lice) is managed at the local level but not reported to national authorities.
A nurse is planning to provide community education about viral hepatitis. Which of the following should the nurse plan to include in the teaching?
- A. A series of four hepatitis vaccines is recommended to prevent viral hepatitis.
- B. Hepatitis B is transmitted by contaminated food.
- C. Chronic hepatitis can lead to renal cell cancer.
- D. Clients who have a history of viral hepatitis are unable to donate blood.
Explanation
D. Clients who have a history of viral hepatitis are unable to donate
blood: Individuals with a history of viral hepatitis are permanently deferred from blood donation according to FDA
guidelines. This precaution helps prevent transmission of hepatitis viruses through blood
products, protecting transfusion recipients. The other options contain inaccuracies: hepatitis B
vaccine typically requires 3 doses, not 4; hepatitis B is transmitted through blood and body
fluids, not contaminated food (that's hepatitis A); and chronic hepatitis primarily increases risk
for liver cancer, not renal cell cancer.
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