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VATI PN Comprehensive Predictor Form A, B, and C
1. What should a nurse instruct an adolescent to monitor when prescribed cefazolin?: Depression
2. What indicates a parent's understanding of proper car seat use for a new- born?: I can place a rolled towel on
each side of my newborn's head until he can hold his head up.
3. What action should a nurse take for a school-age child experiencing epis- taxis?: Apply pressure at the bridge
of the child's nose.
4. Which client's statement should a nurse attend to first?: My heartburn pain is going into my jaw now.
5. What indicates that a child with varicella is no longer contagious?: All vesicles have crusted over.
6. What statement should a nurse expect from a client with a hemoglobin level of 8.8 mg/dL?: I feel tired all the
time.
7. What action should a nurse take if a client reports mild cramping during a cleansing enema?: Slow the rate of
instillation.
8. Which client should a nurse first collect data about?: A client with a decreased level of consciousness and
vomiting.
9. What is the correct action when setting up a sterile field for a dressing change?: Open the outermost flap
of the wrapper toward the body.
10. What should a nurse frequently remind a client with bipolar disorder experiencing mania?:
Expectation for her behavior.
11. What action should a nurse take for a client with viral pneumonia?: Admin- ister Azithromycin.
12. What suggestion should a preceptor make to a nurse struggling with time management?: Try to complete a
task before moving on to the next.
13. What should a nurse use to secure a dressing for an older adult postoper- ative client?: Use paper tape for
securing the new dressing.
14. What should be included in the plan of care for a client with anorexia nervosa?: Maintain continuity of
staff members.
15. What alteration in perception is indicated by a client with schizophrenia hearing special messages?:
Hallucination.
16. What should a nurse teach a postpartum client about bathing her new- born?: Wash your newborn's head
under a stream of running water.
17. What challenge does a client with heart failure report regarding their diet?: Difficulty limiting sodium
in his diet.
18. What is the appropriate way to wash a newborn's head?: Under a stream of running water.
19. What dietary recommendation should a nurse provide to a client with heart failure to limit sodium intake?:
Replace bottled salad dressing with homemade vinegar and oil dressing.
20. What nonpharmacological pain relief instruction should a nurse give to a postpartum client with an
episiotomy?: Sit on soft pillows throughout the day.
21. How should a nurse respond to a client with a new colostomy who is reluctant to resume sexual relations?:
"I'm available if you'd like to talk about your concerns."
22. What transmission precaution should a nurse teach a client with hepatitis C?: Avoid sharing razors with other
34. What task is appropriate to delegate to assistive personnel on a med- ical-surgical unit?: Administer a
large-volume enema to a client.
35. What finding should a nurse expect in a client with a full-thickness burn in the emergent phase?:
Hypercalcemia.
36. What is the age of the child being assessed at a well-child visit?: 18 months old.
37. What condition is indicated by hypercalcemia?: Elevated calcium levels in the blood.
38. At what age should a toddler be able to say at least four words?: 18 months.
39. What should a nurse do first if an assistive personnel (AP) refuses an assigned task?: Perform the task
themselves.
40. What dietary restriction should be considered when providing food to a client following a kosher diet?:
Avoid providing ham and cheese sandwiches.
41. Which food has the highest vitamin C content?: 1 cup of raw broccoli.
42. What should occur during the orientation phase of the nurse-client rela- tionship?: Defining
responsibilities.
43. Where should the fetal heart monitor be placed to auscultate the fetal heart rate in a right occiput anterior
position?: Lower left side of the abdomen.
44. What action by a newly licensed nurse performing suctioning for a tra- cheostomy should be intervened
upon?: Suctioning for 30 seconds.
45. What interaction should a nurse monitor for a client taking atenolol and a nitroglycerin patch?:
Hypotension.
46. How should a nurse verify a client's identity before medication administra- tion?: Using a photograph of the
client.
47. What statement by a client with psoriasis should be reported to the provider?: "I try not to look at
the scales on my body."
48. What documentation should a nurse review to determine potential causes of falls in a long-term care
facility?: Medication record.
49. What task should a nurse assign to an assistive personnel (AP)?: Complete post mortem care for a deceased
client.
50. What manifestation should a client taking allopurinol monitor for Stevens-Johnsons
syndrome?: Skin rash with fever.
51. What indicates understanding of fall precautions by a nurse?: "I will instruct the client to sit when putting on a
pair of pants."
52. Which client should be recommended for discharge after a tornado disas- ter?: A client with a sodium level of
140 mEq/L after one episode of diarrhea.
53. What intervention should be included in the care plan for a client with anorexia nervosa?: Administer
liquid supplements.
54. What should a newly licensed nurse document when floating to a different unit?: The support nurse who
assists with planning care.
55. What should a nurse document regarding the support nurse in care plan- ning?: The nurse should document
the support nurse who assists with planning care for clients.
67. What indicates a client's understanding of teaching regarding ferrous sulfate elixir?: The client states
they will mix the medication with water.
68. What finding should a nurse expect after administering oxytocin for exces- sive vaginal bleeding?: A boggy
fundus 3 fingerbreadths above the umbilicus.
69. What action indicates a nurse's understanding of client confidentiality?: -
Changing her personal login password at random intervals.
70. Which client should a nurse recommend for a home health referral?: An older adult client who has heart
failure and lives alone.
71. What instruction should a nurse provide to a female client taking pheny- toin?: You might experience
swollen gums while taking this medication.
72. How many mL of paroxetine should a nurse administer for a 15 mg dose if available is 10 mg/5 mL?: 7.5 mL.
73. What is the purpose of a contraction stress test for a client at 38 weeks of gestation?: To assess fetal response
to contractions.
74. What indicates a client understands the reason for a nonstress test?: I am having this test because my baby was
not reactive during a nonstress test.
75. What statement indicates a mother practices cupping?: I sometimes place a bottle containing steam against my
child's skin.
76. What should a client with primary open-angle glaucoma do while taking timolol eye drops?: I should check
my heart rate while taking this medication.
77. What weight loss percentage indicates severe dehydration in a preschool- er?: Weight loss of 10%.
78. What physiological change should be considered when administering medication to older adults?:
Decreased kidney function.
79. To whom should a nurse refer a client asking about medication interac- tions?: Advanced practice nurse.
80. What finding indicates an allergic reaction to sulfasalazine?: Dyspnea.
81. For which client should a nurse recommend an interprofessional care conference with a dietician?: A
client who has a body mass index of 32.
82. What indicates a newly licensed nurse understands infection control mea- sures?: Soiled dressings should be
placed in a biohazard trash receptacle.
83. What is the purpose of a vitamin K injection for a newborn?: This medication will decrease the risk of
hemorrhage in your newborn.
84. What finding in a client with diabetic ketoacidosis should be reported to the provider?: Fruity breath odor.
85. What action should a nurse take when caring for a client with a vacu- um-assisted closure system?: Use an
adhesive remover to remove tape before reapplying a dressing.
86. What indicates a client has given informed consent for a vaginal hysterec- tomy?: I am thankful I am done
having children.
87. What should a nurse do when a client is experiencing a tonic-clonic seizure?: Measure the duration of
the seizure.
88. What should a nurse say to a client expressing ambivalence about preg- nancy?: Many women experience
feelings of ambivalence during pregnancy.
89. What situation requires a signed consent form?: Administering an iron injec- tion Z-track method.
90. Which client should a nurse assess first after receiving report?: A preschooler who has epiglottis
101. What finding should a nurse expect 15 minutes after a client undergoes electroconvulsive therapy?:
Disorientation.
102. What should a nurse do first when caring for an adolescent client with bulimia nervosa?: Observe the
client during and after meals.
103. What action should a nurse take when monitoring a postoperative client's respirations?: Observe the
movements of the client's chest wall.
104. What information should a nurse include in a change-of-shift report for a client who is 2 days
postoperative from a total knee arthroplasty?: Time of last pain medication.
105. What statement indicates a client understands discharge teaching re- garding carbamazepine?: I will
plan to avoid grapefruit juice while taking this medication.
106. What action should a nurse take to resolve conflict with an assistive personnel who feels overwhelmed?:
Ask the AP to discuss the issue in a private area.
107. What instruction should a nurse include when teaching a client with arthritis?: Engage in low-impact
aerobic exercises.
108. What action should a nurse take for a female client with an indwelling catheter?: Secure the tubing with
adhesive tape to the lower abdomen.
109. What statement indicates the greatest risk for violence from a client in a support group for intimate
partner violence?: I have decided to tell my husband I am leaving him.
110. What findings should a nurse expect when collecting data from a client receiving magnesium sulfate for
preterm labor?: Expected findings include signs of magnesium sulfate effects such as decreased deep tendon reflexes and respira- tory depression.
111. What is the medical term for low blood pressure?: Hypotension.
112. What action should a charge nurse take if overhearing two APs dis- cussing a client?: Tell the APs to
stop the conversation.
113. What indicates a client's understanding of an intravenous pyelogram procedure?: I will feel a warming
sensation after the injection of the dye.
114. What should a nurse verify for a client with end-stage amyotrophic lateral sclerosis who has pneumonia?:
Verify the status of the client's advance directive.
115. What indicates a new mother understands facility security measures for her baby?: I will have an
identification band that matches the one my baby wears.
116. What should a nurse prioritize for a client who is 2 days postoperative from a total bilateral mastectomy
and is tearful?: Identifying the client's percep- tion of the changes in her physical appearance.
117. What risk reduction strategy should a nurse teach a client at risk for hypertension?: Walk for 30
minutes, 5 days per week.
118. What manifestation should a nurse expect in a client with dependent personality disorder?:
Submissive behavior.
119. What precautions should a nurse implement for a client with varicella zoster?: Initiate contact
precautions.
120. What should a nurse do when administering medications via a gastros- tomy tube?: Allow separate
medications to flow through the tube by gravity.
121. What supplies should a nurse use for a client with pneumonia on droplet precautions?: Surgical mask.
122. What dietary choice indicates a client understands teaching about car- diovascular disease risk?: I have
unsalted pretzels for a snack.
134. What statement by a client with a new mastectomy indicates coping with body image changes?: I am afraid
to discuss my concerns with my husband.
135. What recommendation should a nurse make to an adult client having trouble sleeping at night?:
Establish a daily exercise routine.
136. What defense mechanism is an adolescent using by joining the track team to avoid arguing with siblings?:
Sublimation.
137. What indicates a client understands the use of transdermal nitroglycerin patches?: I will place the patch on
a hairless area of skin.
138. What sign indicates hopelessness in a client with a terminal illness?: The client has a decreased energy level.
139. What behaviors indicate a preschooler is ready to cooperate during data collection?: Allows the nurse to
touch him on the arm, answers questions asked by the nurse, makes eye contact with the nurse.
140. Which client should a nurse prioritize seeing first on a mental health unit?: A client who has
schizophrenia and is having command hallucinations.
141. What response should a nurse give to a new mother struggling with her crying newborn?: Let me show you
how to swaddle and cuddle him, then you try.
142. What action should a nurse take when using a glucometer to measure a client's blood glucose level?: Keep
the finger in a dependent position.
143. Which over-the-counter medication should a nurse instruct a client taking clopidogrel to avoid?: Naproxen.
144. What is the first action a nurse should take when a client with a long leg cast shows signs of pale foot and
weak pedal pulse?: Check for pain with passive movement of the affected extremity.
145. What adverse effect of cigarette smoking should a nurse include in teach- ing?: Somnolence.
146. In what situation can nursing staff medicate a client against his will without a court hearing?: (Context
needed for a specific answer; generally involves emergency situations or risk of harm.)
147. What should a nurse monitor for a client prescribed digoxin?: Monitor for muscle weakness while taking the
medication.
148. Who is an appropriate individual to share client information with?: A social worker who is assigned to an
involuntary committed school-age client.
149. What laboratory finding should a nurse report for a client at 34 weeks of gestation?: Urine protein 3 plus.
150. What is the priority finding for a nurse to address in a postoperative client?: Oxygen saturation 89%.
151. What finding during an annual physical examination should a nurse report immediately?: Blurred
vision.
152. What is the first action a nurse should take for a client with sudden chest pain and dyspnea?: Elevate the
head of the client's bed.
153. Which laboratory test is most accurate for assessing blood glucose management in a diabetic client?:
Glycosylated hemoglobin.
154. What action by a newly licensed nurse should a supervising nurse inter- vene on?: Telling a client he will
lose his phone privileges if he does not take his medication.
155. What materials should an assistive personnel obtain for a client on seizure precautions?: Oral
suction equipment.
156. What instruction should a nurse give to a client with dependent person- ality disorder?: Encourage the
client to be assertive.
163. What response should a nurse make to a client with paranoid schizophre- nia who believes they are being
followed?: The psychiatric staff is not FBI. They are here to help you.
164. What action should a nurse take for a client in Buck's traction with a fractured femur?: Ensure
proper alignment and traction is maintained.
165. What should be ensured about the weights during monitoring?: Weights should be hanging freely.
166. Which condition can affect the validity of oxygen saturation readings?: -
Peripheral vascular disease.
167. What is xanthelasma and how can it be identified?: Xanthelasma can be identified as nodules on the eyelid.
168. What type of precautions should be implemented for a client with Van- comycin resistant
enterococcus?: Contact precautions.
169. When developing a brochure about hypertension, what should the nurse do regarding medical
terminology?: Explain medical terminology using basic, one-syllable words.
170. What is the priority statement from an adolescent during a physical examination?: "I would rather
be alone than with my friends."
171. What type of dressing should be used for a stage 1 pressure ulcer?: -
Transparent film.
172. What action should a nurse take for a client prescribed ketorolac with a blood pressure of 114/55 mm
Hg?: Administer the medication to the client.
173. What actions should a charge nurse take when developing a performance improvement plan for an AP?: Set
a specific time frame for meeting performance goals, ask the nurse supervisor to review the plan, and include the performance standard that the AP should meet.
174. What instruction should be included for a client undergoing radiation therapy to the neck?: Avoid
exposing the neck to the cold.
175. What fall precaution should be implemented for an older adult client with impaired mobility?: Determine
the client's ability to use the call light.
176. What should a nurse teach a client about intermittent catheterization?: -
You will need to urinate before the procedure.
177. What should the charge nurse do when a nurse attempts to convince a client with terminal cancer to
reconsider treatment?: Talk with the nurse about the need to support the client's decision.
178. What breastfeeding frequency should be recommended for a newborn?-
: Feed the newborn 8 to 12 times every 24 hours.
179. What action should a nurse take when admitting a school-aged child?: -
Initiate contact precautions for the child
180. What intervention should be included in the care plan for a client with ascites due to cirrhosis?:
Measure the client's abdominal girth daily.
181. What food choice should be recommended to a client who experiences diarrhea from antibiotics?:
Yogurt.
182. What action should a nurse take for a client with increased intracranial pressure following a closed head
injury?: The specific action is not provided in the notes.
195. What instruction should a nurse expect from a provider for a client taking warfarin with an INR of 5.5?:
Obtain an aPTT level.
196. What indicates fluid volume excess in a client receiving a continuous IV infusion?: Distended neck veins.
197. What should a nurse teach the parents of an infant with a Pavlik harness?-
: The harness can promote hip joint development.
198. Where should a nurse document an error of administering 2 tablets instead of 1 for a pain
medication?: Incident report.
199. What action should a nurse take when preparing a sterile field for a dressing change?: Place sterile objects
at least 2.5 cm (1 in) from the edge of the sterile field.
200. What does the nurse's action of interrupting a bath to obtain a meal for a client demonstrate?:
Countertransference.
201. What intervention should a nurse consider for a client who has herpes simplex?: Contribute to the plan of
care.
202. What type of isolation precautions should a nurse initiate when caring for a client with a contagious
condition?: Contact precautions.
203. What should a nurse do if they notice a blank space in the nurses' notes?: Draw a horizontal line through
the space and sign at the end of the line.
204. Which solution should a nurse use to disinfect a client's overhead table after a blood spill?: Bleach.
205. What safety risk should a nurse identify when caring for an older adult client with rheumatoid arthritis?:
The client's electrical wires are run under car- peting.
206. What should a nurse include in teaching about informed consent before surgery?: The client can sign the
informed consent form after the provider explains the pros and cons of the procedure.
207. What should a nurse instruct a client with a trichomoniasis vaginalis infection regarding metronidazole?:
You should expect your urine to turn brown.
208. What action should a nurse take if a client does not understand the necessity of an invasive procedure?:
Notify the charge nurse about the situation.
209. What indicates a client's understanding of advance directives?: Advance directives include a living will.
210. What intervention should a nurse recommend for a caregiver of a client with Alzheimer's who has
difficulty sleeping?: Encourage the client to take frequent walks during the day.
211. What action should a nurse take for a client who is 8 hours postpartum with uterine atony and increased
bleeding?: Assist the client to empty her blad- der.
212. What instruction should a nurse give regarding effleurage during the first stage of labor?: Gently stroke her
abdomen during contractions.
213. What action should a nurse take to prevent skin breakdown in a postop- erative client who is incontinent?:
Use a moisture barrier on the client's skin.
214. How can a nurse promote autonomy for a client with terminal cancer?: -
Allow the client to choose treatment times.
215. What finding indicates an obstetric complication in a client at 40 weeks of gestation with a sudden gush of
vaginal fluids?: The fluid appears green- ish-brown in color.
216. What should a nurse inform an adolescent client about after a lumbar puncture?: He might experience
