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 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.
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.
You are caring for a patient with a positive TB skin test (15 mm), a productive cough for
two months, and unintentional weight loss. Which of the following orders will assist with
the diagnosis of active tuberculosis?
(Select ALL that apply)
-
Admit to a negative pressure room
-
Heart healthy diet
-
Collect specimen x3 mornings for acid-fast bacilli
-
Vital signs every shift
-
CBC, BMP, HIV viral load, VDRL
Explanation
A. Admit to a negative pressure room
Patients with suspected or confirmed active TB must be placed in airborne isolation using a
negative pressure room. This prevents the spread of Mycobacterium tuberculosis by keeping air
from escaping into the hallway and protecting others in the facility.
C. Collect specimen x3 mornings for acid-fast bacilli
The most definitive diagnostic test for active TB is sputum culture for acid-fast bacilli (AFB).
Three early-morning specimens are collected on separate days. This is essential for laboratory
confirmation and guides treatment.
E. CBC, BMP, HIV viral load, VDRL
Patients with active TB should be assessed for possible comorbidities and coinfections such as
HIV and syphilis. CBC and BMP also help evaluate overall health and organ function before
starting treatment, as TB therapy can be hepatotoxic.
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.
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 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.
A nurse is teaching a client who has tuberculosis and is to start medication therapy with
isoniazid, rifampin and pyrazinamide. Which of the following instructions should the nurse
include?
-
"Drink at least 8 ounces of water when you take the pyrazinamide tablet."
-
"Take isoniazid with an antacid."
-
"Provide a sputum specimen every 2 weeks to the clinic for testing."
-
"Expect your sputum cultures to be negative after 6 months of therapy."
Explanation
Explanation of Correct Answer (A):
Pyrazinamide can cause hyperuricemia and hepatotoxicity, so adequate fluid intake is essential
to help prevent gout and promote renal excretion of uric acid. Patients should take the medication
with a full glass of water and report any joint pain or swelling. Monitoring liver function is also
important during therapy.
Patient with admission diagnosis of sepsis
Provider Orders
Administer rapid infusion of IV fluid
Obtain lactate level
Administer vasopressors
Obtain blood cultures
Administer broad-spectrum antibiotics
How should the nurse prioritize the provider orders?
(Each category must have at least 1 response option selected)
-
1st Priority: Obtain lactate level and blood cultures, Administer rapid infusion of IV fluid,
Administer broad-spectrum antibiotics, Administer vasopressors
2nd Priority: Administer rapid infusion of IV fluid, Administer vasopressors, Obtain lactate level
and blood cultures, Administer broad-spectrum antibiotics
3rd Priority: Administer vasopressors, Administer rapid infusion of IV fluid, Obtain lactate level
and blood cultures
4th Priority: Administer broad-spectrum antibiotics, Administer rapid infusion of IV fluid,
Obtain lactate level and blood cultures, Administer vasopressors -
1st Priority: Administer rapid infusion of IV fluid, Administer vasopressors, Obtain lactate
level and blood cultures, Administer broad-spectrum antibiotics
2nd Priority: Obtain lactate level and blood cultures, Administer rapid infusion of IV fluid,
Administer broad-spectrum antibiotics, Administer vasopressors
3rd Priority: Administer vasopressors, Administer rapid infusion of IV fluid, Obtain lactate level
and blood cultures
4th Priority: Administer broad-spectrum antibiotics, Administer rapid infusion of IV fluid,
Obtain lactate level and blood cultures, Administer vasopressors -
1st Priority: Administer vasopressors, Administer rapid infusion of IV fluid, Obtain lactate
level and blood cultures
2nd Priority: Administer broad-spectrum antibiotics, Administer rapid infusion of IV fluid,
Obtain lactate level and blood cultures, Administer vasopressors
3rd Priority: Obtain lactate level and blood cultures, Administer rapid infusion of IV fluid,
Administer broad-spectrum antibiotics, Administer vasopressors
4th Priority: Administer rapid infusion of IV fluid, Administer vasopressors, Obtain lactate level
and blood cultures, Administer broad-spectrum antibiotics -
1st Priority: Administer broad-spectrum antibiotics, Administer rapid infusion of IV fluid,
Obtain lactate level and blood cultures, Administer vasopressors
2nd Priority: Administer rapid infusion of IV fluid, Administer vasopressors, Obtain lactate level
and blood cultures, Administer broad-spectrum antibiotics
3rd Priority: Administer vasopressors, Administer rapid infusion of IV fluid, Obtain lactate level
and blood cultures
4th Priority: Obtain lactate level and blood cultures, Administer rapid infusion of IV fluid,
Administer broad-spectrum antibiotics, Administer vasopressors
Explanation
The first priority in sepsis management is to obtain lactate level and blood cultures to evaluate
the severity of infection and identify the causative pathogen before starting antibiotics. The
second priority is to administer rapid infusion of IV fluid to restore circulating volume and
improve tissue perfusion. The third priority is administer vasopressors if hypotension persists
despite fluid resuscitation. Finally, broad-spectrum antibiotics are administered after cultures are
collected to treat the infection promptly.
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.
A nurse is interviewing a pre-operative patient scheduled for a total nephrolithotomy. Which
of the following findings would require the nurse to collaborate with the surgeon immediately
before sending the patient to the operating room?
-
The client took phenytoin 100 mg with a sip of water at 5 a.m.
-
The client took metoprolol 25 mg with a sip of water at 6 a.m.
-
The client took warfarin 2.5 mg with a sip of water at 6 a.m.
-
The client took half their morning dose of insulin at 6 a.m.
Explanation
Warfarin is a potent anticoagulant that significantly increases the risk of excessive bleeding
during surgery. Taking warfarin on the day of a surgical procedure, such as a nephrolithotomy,
can compromise hemostasis and lead to complications including intraoperative hemorrhage,
need for transfusion, or delayed wound healing. Immediate collaboration with the surgeon is
necessary to determine whether to delay the surgery, reverse the anticoagulation, or adjust
perioperative management. The nurse must communicate this finding promptly to prevent
life-threatening complications and ensure patient safety.
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