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 caring for a client who has hypovolemic shock. Which of the following should
the nurse recognize as an expected finding?
- Bradypnea
- Oliguria
- Hypertension
- Flushing of the skin
Explanation
Explanation of Correct Answer (B):
Hypovolemic shock causes a severe reduction in circulating blood volume, leading to decreased
perfusion of vital organs. The kidneys receive less blood flow, which results in oliguria (low
urine output). This is an early and critical sign indicating impaired renal perfusion and
progressing shock. Monitoring urine output is essential because it reflects the effectiveness of
circulation and tissue perfusion.
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.
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 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 is caring for a client who is experiencing anaphylactic shock in response to the
administration of penicillin. Which of the following medications should the nurse administer
first?
- Dobutamine
- Methylprednisolone
- Furosemide
- Epinephrine
Explanation
Epinephrine is the first-line treatment for anaphylactic shock because it rapidly reverses the
life-threatening effects of severe allergic reactions. It works by vasoconstriction to increase
blood pressure, bronchodilation to improve airway patency, and inhibition of further mediator
release from mast cells and basophils. Administering epinephrine immediately is critical to
prevent airway obstruction, hypotension, and cardiovascular collapse, which are the most
urgent threats to the client’s life during anaphylaxis.
Complete the sentence using the drop down selections
When caring for a HIV+ patient the nurse is aware that —-------- (white plaque in te mourn/
diarrhea/ sore throat/ erectile dysfunction) indicates an opportunistic infection. It is caused by
—------ (herpes simplex/ candidiasis/ amoebiasis/ Bacterial infection) and treated with
—----(Trimetoprim-sulfamethoxarpie/ Amphotericin/ Peniciilin/ Fluconazole)
- White plaque in the mouth … Candidiasis … Fluconazole
- Diarrhea … Amoebiasis … Trimethoprim-sulfamethoxazole
- Sore throat … Herpes simplex … Penicillin
- Erectile dysfunction … Bacterial infection … Amphotericin
Explanation
White plaque in the mouth is a common sign of oral candidiasis, an opportunistic infection
often seen in HIV+ patients with low CD4 counts. The infection is caused by the fungus
Candida albicans and is treated effectively with fluconazole, an antifungal medication. Early
recognition and treatment help prevent systemic spread and improve the patient’s ability to eat
and maintain nutrition.
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 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 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 is caring for a client in septic shock due to a wound infection. Despite aggressive
fluid resuscitation, the client has a blood pressure of 78/50 mmHg and a heart rate of 136 beats
per minute. The nurse contacts the provider. Which of the following orders should the nurse
expect to receive from the provider?
- Start infusion of Dobutamine 500 mg/250 mL D5W
- Start infusion of Norepinephrine 1 mg/250 mL D5W
- Start infusion of Nitroprusside 100 mg/250 mL D5W
- Start infusion of Nitroglycerin 50 mg/250 mL 0.9% NS
Explanation
Norepinephrine is the first-line vasopressor for septic shock when a patient remains
hypotensive despite adequate fluid resuscitation. It works by potent vasoconstriction, increasing
systemic vascular resistance and raising blood pressure while maintaining perfusion to vital
organs. Dobutamine may be used if there is myocardial dysfunction, but the priority in this case
is to stabilize blood pressure. Nitroprusside and nitroglycerin are vasodilators, which would
lower blood pressure further and are contraindicated in hypotensive septic shock.
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