Comprehensive Predictor

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Sample questions from Comprehensive Predictor

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client arrives in the emergency department with fever, confusion, and productive cough. Temperature is 39.1 C, heart rate is 124/min, respiratory rate is 30/min, blood pressure is 82/46 mm Hg, and lactate is 4.6 mmol/L. Oxygen has been applied. Which prescription should the nurse implement first?

   • A.Administer acetaminophen orally for fever.
   • B.Begin a rapid infusion of prescribed isotonic crystalloid.
   • C.Transport the client for a chest CT scan.
   • D.Collect a sputum specimen before beginning other treatment.

   Rationale: Hypotension and elevated lactate indicate impaired perfusion requiring immediate fluid resuscitation with frequent reassessment. Acetaminophen improves comfort but does not correct shock, and CT transport delays stabilization. Sputum collection should not delay resuscitation or timely antibiotics. The priority is supporting circulation while other sepsis interventions proceed.

2. 2.A 59-year-old client on a telemetry unit reports crushing chest pain rated 9/10. Blood pressure is 88/54 mm Hg, heart rate is 52/min, and oxygen saturation is 96% on room air. An ECG shows inferior ST-segment elevation. Which prescribed medication should the nurse question before administration?

   • A.Chewable aspirin
   • B.Intravenous unfractionated heparin
   • C.High-intensity atorvastatin
   • D.Sublingual nitroglycerin

   Rationale: Nitroglycerin can worsen hypotension, particularly when an inferior infarction involves the right ventricle and cardiac output is preload dependent. Aspirin and heparin address coronary thrombosis when not otherwise contraindicated. Atorvastatin is appropriate secondary prevention and is not contraindicated by this blood pressure. Check hemodynamic status before administering vasodilators.

3. 3.A 72-year-old client arrives at a stroke center 70 minutes after developing aphasia and right arm weakness. Blood pressure is 178/96 mm Hg, glucose is 112 mg/dL, and head CT shows no hemorrhage. The family reports no anticoagulant use or recent surgery. What should the nurse do next?

   • A.Activate the time-sensitive thrombolytic eligibility process.
   • B.Give aspirin before the thrombolytic decision is made.
   • C.Lower systolic blood pressure below 140 mm Hg immediately.
   • D.Provide oral fluids to assess swallowing ability.

   Rationale: The client is within a potential treatment window and needs immediate evaluation for intravenous thrombolysis. Aspirin should not precede the reperfusion decision, and rapid blood pressure reduction below 140 mm Hg is not indicated from these findings. Oral intake is unsafe until a validated swallowing screen is completed. Time-sensitive reperfusion assessment takes priority after hemorrhage and hypoglycemia are excluded.

4. 4.A 24-year-old client in the emergency department has diabetic ketoacidosis. Glucose is 548 mg/dL, pH is 7.16, potassium is 2.9 mEq/L, and blood pressure is 96/58 mm Hg. Isotonic fluid replacement is underway. Which action is most appropriate before starting the prescribed insulin infusion?

   • A.Administer intravenous sodium bicarbonate.
   • B.Change the fluids to a dextrose-containing solution.
   • C.Replace potassium according to protocol and delay insulin.
   • D.Give the insulin infusion at half the prescribed rate.

   Answer and rationale are in the full material.

5. 5.A 76-year-old client with small-cell lung cancer is admitted with headache and new confusion. Sodium is 118 mEq/L, serum osmolality is low, and the client has a generalized seizure. Which prescribed treatment should the nurse anticipate?

   • A.Rapid infusion of hypotonic saline
   • B.Carefully controlled administration of 3% saline
   • C.Encouragement of oral water intake
   • D.Administration of desmopressin as the sole initial treatment

   Answer and rationale are in the full material.