ATI PN Comprehensive Predictor 2020 / 2021_Questions &

Answers with Rationale

1. A nurse in a provider's office is reviewing the medical record of a client who

requests aprescription for an oral contraceptive. Which of the following findings

should the nurseidentify as a contraindication for oral contraceptive use?

ANS: Coronary artery disease

RATIONALE: Coronary artery disease is a contraindication to oral contraceptive

use because it increases the client's risk for myocardial infarction. Other

contraindications forreceiving oral contraceptives include gallbladder disease,

breast cancer, and hypertension

2. A nurse is assisting with the care of a school-age child immediately following

surgery.The child weights 21.8 kg (48 lb) and has a chest tube applied to suction.

Which of thefollowing findings should the nurse report to the provider?

ANS: 250 mL of sanguineous drainage over the last 3 hr

RATIONALE: The nurse should recognize that if more than 3 mL/kg/her of

sanguineousdrainage occurs for more than 3 consecutive hours following

surgery, it can indicate active hemorrhaging. Therefore, 250 mL of sanguineous

drainage from the child's chest tube is excessive and the nurse should report this

finding to the provider immediately

3. A nurse is collecting data from a client who is at 30 weeks of gestation and

has gestational diabetes. Which of the following findings should the nurse

report to theprovider as an indication of hyperglycemia?

ANS: Polyuria

RATIONALE: The nurse should identify polyuria as an expected

finding ofhyperglycemia and report this finding to the provider

4. A nurse is discussing home safety with a group of clients who have type 1

diabetes mellitus. Which of the following client statements indicates an

understanding of theteaching?

ANS: "I will dispose of my needles in a plastic laundry detergent

container."

RATIONALE: The nurse should instruct the client to dispose of needles in a

puncture-proof container, such as a plastic laundry detergent container.

5. A nurse is caring for a client who has Alzheimer's disease. Which of the

followingactions should the nurse take?

ANS: Encourage the client to reminisce about the past

RATIONALE: The client who has Alzheimer's disease has progressive loss of

short-termmemory and might not be able to recall recent happenings and events.

This can lead to increased frustration. However, remote memory remains in

place for a longer period of time and can elicit feelings of happiness

6. A nurse is monitoring a client who is receiving telemetry. Which of the

following ECGfindings should the nurse report to the provider?

ANS: PR interval 0.24 seconds

RATIONALE: An expected PR interval is 0.12 to 0.20 seconds. A prolonged PR

intervalcan indicate a heart block; therefore, the nurse should report this finding

provider

7. A nurse on a medical unit is reviewing a client's medical record. Which of the

followingprocedures should the nurse identify requires the client to sign a

separate informed consent form?

ANS: Lumbar puncture

RATIONALE: The nurse should identify that a client needs to provide consent

for general treatment as well as a separate written informed consent for any

treatment thathas an element of risk, such as a lumbar puncture

8. A nurse is reviewing the techniques for transferring a client from a bed to a chair

with agroup of assistive personnel (AP). Which of the following instructions

should the nurseinclude?

ANS: Use lower-body strength

RATIONALE: The nurse should instruct the AP to use lower-body strength when

liftinga client to reduce stress on the back