ATI NUR 213 Midpoint Assessment FA II 2025 Assessment I
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Free ATI NUR 213 Midpoint Assessment FA II 2025 Assessment I Questions
A nurse is planning care for a client who is to receive a competitive neuromuscular blocking
agent. Which of the following items should the nurse plan to have at the client's bedside?
- Urinary catheter insertion tray
- Temporary pacemaker
- Bag-valve-mask device
- Central venous catheterization tray
Explanation
Competitive neuromuscular blocking agents (NMBA) are used to induce paralysis by blocking
acetylcholine at the neuromuscular junction. This causes muscle paralysis, including the
respiratory muscles, which may require mechanical ventilation. A bag-valve-mask (BVM)
device should be readily available at the bedside to ensure immediate airway management and
respiratory support if the client experiences respiratory failure or difficulty breathing due to the
effects of the neuromuscular blocker.
A nurse is caring for a client who has burns to approximately 50% of their body. Which of the
following physiological changes related to the burns should the nurse anticipate? Select all that
apply.
- Hypermagnesemia
- Loss of protein
- Diuresis
- Decreased plasma volume
- Capillary leak
Explanation
B. Loss of protein
Burns, especially when covering a significant portion of the body, cause extensive damage to the
skin and underlying tissues. This damage leads to the loss of proteins such as albumin and
globulins, which normally help maintain the balance of fluids within the blood vessels. As
protein is lost through the burn wounds, this can result in hypoalbuminemia, which contributes
to edema and worsens fluid shifts between the intracellular, intravascular, and interstitial spaces.
The body’s inability to retain enough protein increases the risk of hypovolemic shock and
delayed wound healing.
C. Diuresis
Following the initial phase of burn injury, the body undergoes a hypermetabolic state and
experiences fluid shifts. The kidneys respond to these fluid shifts by increasing urine output,
known as diuresis, as part of the body’s compensatory mechanisms. This process is essential for
eliminating excess fluid that accumulates during the acute phase of burns. Diuresis is also
influenced by fluid resuscitation therapy (e.g., using fluids like lactated Ringer's solution),
which temporarily expands the extracellular volume. However, excessive diuresis can lead to
electrolyte imbalances and dehydration if not carefully monitored.
D. Decreased plasma volume
In the initial stage of a severe burn injury, there is a dramatic decrease in plasma volume due to
the capillary leak syndrome. Burn-induced injury to the endothelial cells of blood vessels causes
them to become more permeable, allowing fluid, proteins, and electrolytes to leak from the
vascular system into the interstitial and intracellular spaces. This causes a reduction in the
circulating blood volume, contributing to hypovolemia. This reduction in plasma volume can
result in shock and requires immediate and aggressive fluid resuscitation to restore normal blood
volume and blood pressure.
E. Capillary leak
One of the most significant consequences of severe burns is the capillary leak syndrome, where
the permeability of blood vessels increases significantly due to the inflammatory response
triggered by the burn injury. The affected blood vessels lose their ability to maintain a selective
barrier, allowing fluid and proteins (including albumin) to leak out of the vessels and
accumulate in the interstitial spaces. This leads to edema, and in some cases, shock if the fluid
A nurse assessing a client determines that he is in the compensatory stage of shock.
Which of the following findings support this conclusion?
- Anuria
- Petechiae
- Confusion
- Blood pressure 84/50 mm Hg
Explanation
Explanation of Correct Answer (C):
In the compensatory stage of shock, the body activates mechanisms to maintain perfusion to
vital organs. One key sign is altered mental status, including confusion, restlessness, or anxiety,
caused by decreased cerebral perfusion. The blood pressure often remains within normal or
A nurse is monitoring a client who was admitted with a severe burn injury and is receiving IV
fluid resuscitation therapy. The nurse should identify a decrease in which of the following
findings as an indication of adequate fluid replacement?
- Heart rate
- Urine output
- BP
- Weight
Explanation
In the early phase of burn injury, fluid loss and hypovolemia cause an increase in heart rate as
the body compensates for the decreased circulating blood volume. As adequate fluid
replacement occurs, the heart rate should decrease, indicating that the body is no longer in a
compensatory state of shock. This decrease in heart rate is a positive sign of improved
circulatory volume and the effectiveness of fluid resuscitation.
A nurse is caring for a patient who has suffered a major burn. Of the lab values listed,
which would be concerning as it is a strong indicator of massive cell destruction?
- Calcium 8.0 mg/dL
- Glucose 180 mg/dL
- Potassium 6.0 mg/dL
- Sodium 180 mEq/L
Explanation
Explanation of Correct Answer (C):
When major burns occur, massive cell destruction leads to the release of large amounts of
intracellular potassium into the bloodstream. A potassium level of 6.0 mg/dL indicates
hyperkalemia, which is a dangerous sign of cellular breakdown and can lead to life-threatening
cardiac arrhythmias. This value requires immediate intervention to prevent cardiac
complications.
A patient tests positive for HIV,
Discharge Orders
Dolutegravir 50mg PO in the morning
Lamivudine 150mg PO every 12 hours
CBC. CD4+T. and viral load levels every 3 months until stable.
Which statements should the nurse include in the patient’s education? (Select 3 responses)
- If you miss a dose of medication, take two of that pill as soon as you think of it.
- These medications should keep the viral load suppressed.
- There are no side effects of ART.
- ART medications will cause wasting syndrome.
- Headache, nausea, vomiting, and anorexia are known side effects of these medications.
- ART causes insomnia, so it should be taken at night.
- Take ART with antacids to ensure they do not upset the stomach.
- We will measure the effectiveness of ART by measuring CD4+ T-cell counts.
Explanation
B. These medications should keep the viral load suppressed
The purpose of antiretroviral therapy (ART) is to control viral replication and bring the viral
load to undetectable levels. Maintaining viral suppression prevents disease progression and
reduces the risk of HIV transmission. Consistent adherence is essential.
E. Headache, nausea, vomiting, and anorexia are known side effects of these medications
Patients must be informed about possible side effects so they can monitor their symptoms and
report persistent issues. Educating the patient promotes adherence, prevents abrupt
discontinuation, and helps the nurse manage side effects appropriately.
H. We will measure the effectiveness of ART by measuring CD4+ T-cell counts
Evaluation of treatment success involves monitoring CD4+ T-cell counts and viral load levels.
An increasing CD4 count and a decreasing viral load indicate effective therapy. These labs help
guide adjustments in treatment and ensure immune recovery.
Pressure injuries can occur to the skin and underlying tissues due to pressure, shear or
friction. Which of the following can reduce the incidence of pressure injuries in hospitalized
clients?
(Select All that Apply)
- Inspect the sacrum for blanching
- Maintaining the head of the bed at a 45-degree angle
- Optimizing nutrition
- Frequent turning and positioning
- Frequent skin assessments
Explanation
A. Inspect the sacrum for blanching
Early assessment helps detect tissue damage before breakdown occurs. Checking for blanching
identifies impaired circulation and allows interventions before a pressure injury develops.
C. Optimizing nutrition
Proper nutrition, especially protein, vitamins, and hydration, promotes tissue repair and skin
integrity. Malnutrition increases the risk of pressure ulcers and delays healing.
D. Frequent turning and positioning
Repositioning at regular intervals reduces prolonged pressure on bony prominences. Turning
every 2 hours is a standard intervention to prevent pressure injuries.
E. Frequent skin assessments
Ongoing inspection allows early identification of redness, moisture, or irritation. Monitoring
high-risk areas ensures timely care and prevents skin breakdown.
A nurse in a community health clinic is caring for a client who has a history of HIV.
Diagnostic Results
January
Laboratory:
CD4 cell count 200 cells/mm2 (600 - 1500 celis/mm3)
June
Laboratory
CD4 cell count 90 celis/mm" (600-1500 cells/mm3)
Chest x-ray:
Bilateral white infiltrates consistent with pneumonia
Physical Examination
January
Reports flu-like manifestations: headache body aches, sore throat low grade fever.
Swollen lymph nodes.
Dry skin with rash.
Weight loss of 15 lb over last 3 months with report of diarrhea and anorexia.
June
Client appears emaciated. Weight loss of 20 lb over last 6 months with report of chronic diarrhea.
inability to eat due to oral ulcers
Extreme weakness and fatigue.
Based on the assessment findings, which of the following are consistent with HIV Stage I or HIV
Stage III (AIDS)? Each finding may support more than one stage.
-
Chest x-ray: Bilateral white infiltrates; Latest CD4 count: 90 cells/mm³; Skin condition: Dry
skin with rash; Weight changes: 20 lb weight loss over 6 months -
Chest x-ray: Clear; Latest CD4 count: 200 cells/mm³; Skin condition: Dry skin with rash;
Weight changes: 15 lb weight loss over 3 months -
Chest x-ray: Bilateral white infiltrates; Latest CD4 count: 200 cells/mm³; Skin condition:
Clear skin; Weight changes: 15 lb weight loss over 3 months -
Chest x-ray: Clear; Latest CD4 count: 90 cells/mm³; Skin condition: Dry skin with rash;
Weight changes: 20 lb weight loss over 6 months
Explanation
The client’s chest x-ray showing bilateral infiltrates and CD4 count of 90 cells/mm³ are
consistent with HIV Stage III (AIDS) due to opportunistic infections and severe
immunosuppression. Dry skin with rash is an early manifestation consistent with HIV Stage I.
Weight loss occurs in both stages, but is more severe in AIDS due to chronic diarrhea, inability
to eat, and emaciation. This combination of findings demonstrates progression from early HIV to
advanced AIDS.
The provider has ordered Golimumab 2 mg/kg IV over 30 minutes for a patient weighing 140
pounds. The pharmacy provided a vial of Golimumab 50 mg/4 mL. The nurse will administer
how many mL of Golimumab? (Round to the nearest whole number)
- 8 mL
- 10 mL
- 12 mL
- 15 mL
Explanation
Step 1 – Convert pounds to kilograms
140 lb ÷ 2.2 = 63.6 kg
Step 2 – Calculate the required dose
2 mg × 63.6 kg = 127.2 mg needed
Step 3 – Use concentration provided
50 mg in 4 mL → 12.5 mg per mL
Step 4 – Calculate total mL to give
127.2 mg ÷ 12.5 mg/mL = 10.176 mL
Step 5 – Round to nearest whole number
10 mL
A provider tells the nurse that a patient with a peptic ulcer is being placed on a proton pump
inhibitor. Which medication would the nurse anticipate the provider ordering?
- Famotidine
- Ranitidine
- Pantoprazole
- Cimetidine
Explanation
Pantoprazole is a proton pump inhibitor (PPI) that works by irreversibly blocking the
hydrogen-potassium ATPase enzyme system in the stomach lining, reducing gastric acid
secretion. PPIs are commonly prescribed for peptic ulcers to promote healing and prevent
complications. Famotidine, ranitidine, and cimetidine are H2 receptor antagonists, which also
reduce acid but work through a different mechanism and are not classified as proton pump
inhibitors.
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