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 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.
- A. Hypermagnesemia
- B. Loss of protein
- C. Diuresis
- D. Decreased plasma volume
- E. 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
The nurse is caring for a patient with an acute ulcerative colitis flare-up. The provider
wants to start the patient on medication. Which medications are appropriate for use in
ulcerative colitis?
(Select ALL that apply)
- A. Aspirin
- B. Ciprofloxacin
- C. Sumatriptan
- D. Ibuprofen
- E. Golimumab
- F. Methylprednisolone
Explanation
B. Ciprofloxacin
Antibiotics such as ciprofloxacin may be prescribed during severe flare-ups of ulcerative colitis
when there is concern for secondary infection. Although not used routinely, it may be used when
complications such as abscess or infection are suspected.
E. Golimumab
Golimumab is a biologic (TNF inhibitor) approved for use in moderate to severe ulcerative
colitis. It reduces inflammation by suppressing immune responses and is often used when other
medications fail to control symptoms effectively.
F. Methylprednisolone
Corticosteroids like methylprednisolone are used during acute flare-ups to rapidly decrease
inflammation. They are not used long-term but are appropriate for induction therapy to control
severe symptoms and promote remission.
A client is admitted with the diagnosis of Pneumocystis carinii pneumonia. Which
nursing diagnosis has the highest priority?
- A. Activity intolerance
- B. Impaired oral mucous membranes
- C. Impaired gas exchange
- D. Imbalanced nutrition, less than body requirements
Explanation
Explanation of Correct Answer (C):
Pneumocystis carinii pneumonia affects the lungs and significantly compromises oxygenation.
According to the ABC priority framework (Airway, Breathing, Circulation), impaired gas
exchange is the most urgent concern because it directly affects breathing. Without adequate
oxygenation, the client is at risk for respiratory failure, hypoxia, and even death. Therefore, this
diagnosis is the highest priority.
A post-operative patient is receiving opioid analgesics for pain management. Which
assessment would alert the nurse to contact the provider?
- A. BP of 120/80, pulse of 100, respiratory rate of 18
- B. BP of 110/60, pulse of 70, respiratory rate of 14
- C. BP of 104/72, pulse of 80, respiratory rate of 20
- D. BP of 96/50, pulse of 120, respiratory rate of 10
Explanation
Explanation of Correct Answer (D):
A respiratory rate of 10 breaths per minute indicates significant respiratory depression, a
dangerous opioid complication. Opioids slow the central nervous system, and a rate below 12
breaths per minute is an urgent warning sign. The low blood pressure and elevated pulse
further indicate possible hemodynamic compromise. This assessment requires immediate
notification of the provider and preparation to administer naloxone if ordered.
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?
- A. Heart rate
- B. Urine output
- C. BP
- D. 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 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.
-
A. 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 -
B. 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 -
C. 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 -
D. 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 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?
- A. The client took phenytoin 100 mg with a sip of water at 5 a.m.
- B. The client took metoprolol 25 mg with a sip of water at 6 a.m.
- C. The client took warfarin 2.5 mg with a sip of water at 6 a.m.
- D. 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.
You are caring for a patient post-op after bariatric surgery. Complete the sentence using the
drop-down choices. The nurse knows that the patient needs to ambulate post-op for several
reasons.
This can help the patient —-------as well as help prevent —-------and —--------.
- A. Heal … Jaundice … Drowsiness
- B. Expel gas … Constipation … Incontinence
- C. Improve mood … Jaundice … Constipation
- D. Increase weight … Drowsiness … Incontinence
Explanation
Postoperative ambulation after bariatric surgery helps expel gas from the gastrointestinal tract,
which relieves discomfort and promotes normal bowel function. Ambulation also stimulates
bowel motility, helping prevent constipation, a common post-op complication. Additionally,
early mobilization reduces the risk of urinary incontinence and other complications associated
with prolonged immobility, supporting overall recovery and improving circulation.
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)
- A. 8 mL
- B. 10 mL
- C. 12 mL
- D. 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 hypovolemic shock. Which of the following should
the nurse recognize as an expected finding?
- A. Bradypnea
- B. Oliguria
- C. Hypertension
- D. 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.
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