ATI Custom NUR212 Midpoint Assessment Fall 2 2025
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Free ATI Custom NUR212 Midpoint Assessment Fall 2 2025 Questions
A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan?
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Avoid foods high in fat.
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Avoid foods high in sodium.
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Include foods high in fiber.
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Include foods high in starch and proteins.
Explanation
Explanation of Correct Answer (A):
Chronic cholecystitis and biliary colic are often triggered by the consumption of fatty foods, because fat digestion stimulates the gallbladder to contract and release bile. This can cause pain, inflammation, and worsening symptoms. Therefore, clients should avoid fatty foods such as fried foods, full-fat dairy, processed meats, and high-fat sauces. A low-fat diet reduces gallbladder stimulation and decreases discomfort during cholecystitis flare-ups.
A nurse is planning care for a client who has urolithiasis. Which of the following actions should the nurse take?
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Restrict protein intake to 2 servings per day.
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Apply cold compress to the client's flank area.
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Discourage ambulation.
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Encourage intake of at least 3 L of fluids per day.
Explanation
Explanation of Correct Answer (D):
Adequate fluid intake is a primary intervention for urolithiasis (kidney stones). Encouraging the client to drink at least 3 liters of fluids daily helps dilute urine, promotes stone passage, and reduces the concentration of minerals that contribute to stone formation. Increased hydration is essential to prevent further stone development and support renal function. This intervention is both preventive and therapeutic.
A patient with Type 2 Diabetes has been diagnosed with Hyperglycemic Hyperosmolar Syndrome (HHS). The patient's spouse asks the RN which symptoms characterize this disorder. Which are the most appropriate responses by the RN? Select all that apply. (Select All that Apply.)
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Elevated BUN and creatinine
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Taut, dry skin
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Slow heart rate
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Elevated blood glucose
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Decreased osmolality
Explanation
Explanation
A. Elevated BUN and creatinine
In HHS, severe dehydration causes reduced renal perfusion, leading to elevated BUN and creatinine levels. These lab findings are markers of dehydration and impaired kidney function, which are commonly seen in HHS due to extreme fluid loss from osmotic diuresis.
B. Taut, dry skin
HHS causes profound dehydration resulting in very dry, tented, or taut skin. The osmotic diuresis caused by extremely high blood glucose levels leads to excessive urination, loss of fluids, and marked skin dryness, a key physical assessment finding.
D. Elevated blood glucose
HHS is characterized by very high blood glucose levels—usually above 600 mg/dL, without significant ketoacidosis. This elevated glucose level increases serum osmolality and draws fluid out of tissues, contributing to dehydration and neurologic changes.
Admission Note
68-year-old male. report consuming 2 alcoholic beverages per day. A history of hypertension and has gained 10 pounds in the last 4 months. There is a family history of diabetes mellitus. Patient reports having been extremely thirsty and hungry with frequent urination along with numbness and tingling in lower extremities. The patient has a right lower extremity ulcer. The patient tested positive for COVID three weeks ago and has had a decrease in activity since. The patient reports nausea and vomiting over the past 3 days. Spouse is at the bedside.
Nurse's Note
0900: The patient is alert and oriented with periods of confusion. speech is clear, and lungs are clear upon auscultation. Skin is dry and appropriate for ethnicity. Bowels sounds present in all quadrants and urine is light yellow.
Vital Signs
Time 0900
Temperature 101.2F (38.4C)
Heart rate 104/min
Respiratory rate 22/min
Blood pressure 140/84 mmHg
Oxygen saturation 95% RA
Pain 6/10 on scale= of 1-10
Labs
Time Test Results
Reference Range
0900
WBC
12.432uL
5.000 - 10.000 uL
Potassium 4.3 3.5 - 5.1 mEq/L
Sodium 148 133 -147 mEQ/L
BUN 28 7-26 mg/dL
Creatinine 1.2 0.7 - 1.21 mg/dL
Glucose 450 70-99 mg/dL
Complete the following sentence by choosing from the list of options.
The nurse should first address the patient's —------------(Glucose/ Heart rate/ Temperature/ Blood pressure) followed by the client's—-------------(Pulse Ox/ Leg ulcer/ Temperature/ Glucose)
The nurse should first address the patient's:
(Glucose / Heart rate / Temperature / Blood pressure)
followed by the client’s:
(Pulse Ox / Leg ulcer / Temperature / Glucose)
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Heart rate first, followed by Temperature
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Blood pressure first, followed by Pulse Ox
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Glucose first, followed by Leg ulcer
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Temperature first, followed by Glucose
Explanation
Explanation of Correct Answer (C):
The client’s glucose is 450 mg/dL, which indicates possible Hyperglycemic Hyperosmolar Syndrome (HHS)—a medical emergency characterized by severe dehydration, confusion, nausea, vomiting, and possible coma. This must be treated before wound care or other secondary assessments. After stabilizing glucose, the right leg ulcer becomes the next priority because the patient is likely diabetic, immunocompromised, and at high risk for infection and poor circulation.
A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of the following values?
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Magnesium
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Amylase
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RBC count
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Calcium
Explanation
Explanation of Correct Answer (B):
In acute pancreatitis, pancreatic enzymes such as amylase and lipase leak into the bloodstream due to inflammation and autodigestion of the pancreas. Amylase levels typically rise within hours of onset and are a key diagnostic indicator of pancreatitis. Elevated amylase confirms pancreatic injury and is commonly used to assess severity and treatment response.
A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to decrease levels of which of the following components in the bloodstream?
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Potassium
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Bicarbonate
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Ammonia
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Glucose
Explanation
Explanation of Correct Answer (C):
In clients with cirrhosis, the liver is unable to adequately convert ammonia into urea for excretion. Elevated ammonia levels can lead to hepatic encephalopathy, causing confusion, altered mental status, and even coma. Lactulose works by trapping ammonia in the gut and promoting its excretion through the stool. It also acidifies the colon, which reduces ammonia absorption. Therefore, lactulose is used primarily to lower ammonia levels, not just to relieve constipation.
A nurse is reviewing assessment data for four clients. Which of the following findings is MOST consistent with Graves’ disease?
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Heart rate is 54 bpm, with constipation and poor appetite
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Nonpitting edema noted in the extremities with thinning hair
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Patient has recently lost over 10 pounds in the last month and reports a fine tremor in the hands
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Patient is anxious and irritable with skin moist and warm
Explanation
Explanation of Correct Answer (C): Graves’ disease is a form of hyperthyroidism characterized by excessive thyroid hormone production. A rapid and unexplained weight loss combined with a fine tremor in the hands strongly indicates increased metabolic activity, which is typical of hyperthyroidism. These symptoms reflect heightened sympathetic nervous system activity, increased caloric expenditure, and neuromuscular excitability—all classic findings in Graves’ disease. The weight loss is unintentional and unexplained, making it more concerning for an endocrine disorder rather than lifestyle change.
A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?
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Constipation
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Drowsiness
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Hypoactive deep-tendon reflexes
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Insomnia
Explanation
Explanation of Correct Answer (D):
Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism. An overdose leads to symptoms of hyperthyroidism, because the body has excess thyroid hormone. Classic manifestations include insomnia, anxiety, tremors, weight loss, heat intolerance, diaphoresis, and tachycardia. Insomnia reflects an overstimulation of the nervous system and is a key indicator that the dose may be too high.
Which symptoms reported by the patient immediately following the surgical removal of the thyroid and parathyroid gland requires intervention by the RN? Select the "2" findings that require immediate follow-up.
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Earache
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Increased appetite
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Hand tremors
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Dizziness
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Foot cramps
Explanation
Explanation of Correct Answers
C. Hand tremors
Hand tremors indicate neuromuscular irritability, which is a classic sign of hypocalcemia after removal of the thyroid and parathyroid glands. The parathyroid glands regulate calcium levels; damage or removal leads to decreased calcium and possible tetany. Hypocalcemia is life-threatening if untreated and may progress to laryngospasm or seizures. Immediate assessment and possible IV calcium replacement are required.
E. Foot cramps
Foot cramps also signal hypocalcemia, another sign of increased neuromuscular excitability. Muscle cramping or spasms—especially in feet, hands, or face—require immediate intervention to prevent worsening tetany or respiratory compromise. These symptoms are early indicators and must be treated promptly.
A nurse is providing teaching to a client who has hypothyroidism and has been prescribed levothyroxine. Which of the following medication instructions would the nurse include in the teaching?
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"Take this medication with high-protein foods."
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"Take this medication with a full glass of water or fruit juice."
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"Take this medication before a meal or several hours after a meal."
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"Take this medication during your morning meal."
Explanation
Explanation of Correct Answer (C): Levothyroxine must be taken on an empty stomach for best absorption. The medication should be taken first thing in the morning, ideally 30 to 60 minutes before breakfast, or at least 3–4 hours after eating. Food—especially high-fiber, calcium, iron, soy, and protein-rich foods—can interfere with absorption and reduce effectiveness. Taking it correctly improves hormone regulation and therapeutic stability.
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