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pg. 1 VATI RN Comprehensive Predictor

• A community health nurse is evaluating eligibility for home assistance for a

client who isquadriplegic. Which of the following actions should the nurse perform first?

• Determine the client's living situation.
• Problem solved with the client.
• Offer community resources to the client.
• Assist the client with decision-making.
• A nurse is discussing care with a newly licensed nurse for a client who practices

Orthodox Judaism. Which of the following meals suggestions by the newly licensed nurse indicates a needfor further teaching?

• Chicken breast and boiled potatoes.
• Carrot sticks and cottage cheese.
• Grilled cheese an

Apple sauce.d. Roast beef and ice cream.

• A nurse is preparing to auscultate a client apical pulse at the point of maximal

impulse (PMI). thenurse should place the diaphragm of the stethoscope at which of the following locations

• Within the angle of Louis.
• 5th intercostal space at the left midclavicular line.
• Second intercostal space to the right of the sternum.
• Over the xyphoid process.
• A nurse is caring for a client who is receiving a blood transfusion at 125 mL/hour

and develops ahemolytic reaction. Which of the following actions should the nurse perform?

• Infuse 0.9% sodium chloride IV.
• Administer an anti-pyretic.
• Decrease the infusion rate to 75 mL/hour.
• Place the client in a left lateral position
• A nurse is planning care for a client who is prescribed a cane for ambulation.

Which of thefollowing nursing actions should the nurse include in the plan of care?

• Remind the client to place the cane on the unaffected side.
• Adjust the length of the cane to equal the distance from the client's iliac

crest to the floor.

• Remove the rubber tip from the cane to enhance ambulation.
• Place the King safely in the closet during naps and at bedtime.
• Nurse is caring for a client who had a partial laryngectomy and is receiving

continuous enteralfeedings at 65 mL/hour through a gastrostomy tube.Which of the following findings requires immediate intervention by the nurse?

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pg. 2

• The gastric residual volume is 250 mL following two

hours of infusion.b. The client is lying in a supine position.

• The infusion pump for administering continuous feeding is turned off.
• Interior feeding bag and tubing are not dated.
• A nurse is caring for a group of clients which of the following tasks is

appropriate for the nurse todelegate to the assistive personnel (AP)? (Select all that apply.)

• change addressing for a client who has a stage three

decubitus ulcer.b. Measure I&O for a client who is receiving peritoneal dialysis.

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pg. 3

• Transfer client from bed to chair with mechanical lift.
• Provide postmortem care on a client who experienced cardiac arrest.
• Obtain a signed consent for a client for a screening colonoscopy.

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pg. 4

• A nurse is planning care for a newborn who has hyper bilirubinemia

and is to receivephototherapy. Which of the following interventions should the nurse include?

• Cloth the newborn in light cotton
• Check the newborns temperature every 8 hours.
• Administer 120 mL of water between feedings.
• Place the newborn 45 cm (18 in) from the light source.
• An assistive personnel tells the nurse that several client measurements

were obtained withmorning vital signs. Which of the following clients should the nurse plan to assess?

• A 4-year-old who has a closed head injury and a heart rate of 60/min
• A nurse is caring for a client following possible exposure to anthrax.

Which of the followingactions should the nurse take?

• Administer an antitoxin
• Quarantine the client.
• Monitor the client for a productive cough.
• Being prophylactic treatment with ciprofloxacin
• A nurse is providing teaching about car seat safety to the parent of a term

newborn. Which of thefollowing statements by the parent indicates an understanding of the teaching?

• I should place a rolled blanket along each side of my baby's head in the car

seat.

• I should place my baby's car seat rear facing until six months of age.
• I should put the car seat retainer clip at the end of my baby's belly button.
• I should position my baby's car seat at a 90-degree angle in the car.
• A nurse is assessing an infant who has water intoxication. Which of the following

findings shouldthe nurse expect?

• Generalized edema
• Elevated urine

specific gravityc.Thready pulse

• Increased hematocrit
• A nurse is assessing a client who has a chest tube following a thoracotomy.

Which of thefollowing findings requires intervention by the nurse?

• 1 cm of water present in the water seal chamber.
• Tidaling with spontaneous respirations.
• Suction chamber pressure of -20 cm H2O
• Drainage collection chamber is 1/3 full.
• A nurse is analyzing the laboratory data on a client who has dehydration.

Which finding shouldthe nurse anticipate in a client who has fluid volume deficit?

• Decreased serum osmolarity.
• Decreased hematocrit.
• Elevated blood urea nitrogen (BUN)
• lower urine specific gravity
• A nurse is performing a skin assessment on a client who has risk factors for