ATI Custom NUR212 Midpoint Assessment Fall 2 2025
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Free ATI Custom NUR212 Midpoint Assessment Fall 2 2025 Questions
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.
- A. Earache
- B. Increased appetite
- C. Hand tremors
- D. Dizziness
- E. 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.
Nurse's Notes
Capillary blood glucose obtained: machine gives no value. Instead. an error message indicating hl displays on the machine. He A/O x 4, He complains of a stomachache' and reports he has nausea and experienced vomiting shortly before arrival. His skin is warm and dry, but his face is flushed. When asked about pain, he says he has a headache, and his vision is blurry. Noted fruity odor to his breath during vital signs.
History and Physical
Skyler Hansen is an 18-year-old male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his mother. The mother reports that he started acting "weird" after a wrestling tournament. He had not felt well on the bus ride with the team so his mother decided he should ride with her, His mother denies a history of chronic illness but did say he had like a cold but with a stomachache" about 3 months ago.
She also says that he has been very thirsty, and they had to stop several times for him to urinate. She is also worried because he almost missed his wrestling weight class parameters because he was significantly lighter this past weekend than he has been in the past, even with him eating more than usual.
The nurse is caring for a patient with diabetes.
Vital Signs
Time 1000
Temperature 98.6F
Heart rate 122
Respiratory rate 26
Blood pressure 90/54 mmHg
Oxygen saturation 98% RA
Pain 0/10 on scale of 1-10
The nurse has just completed the on-coming shift assessment for their client.
Select the "6" findings that require immediate follow-up
- A. Heart rate
- B. Nausea
- C. Blurry vision
- D. Oxygen saturation
- E. Blood glucose
- F. Blood pressure
- G. Pain level
- H. Fruity odor to breath
Explanation
The Correct Answers are:
A. Heart rate
B. Nausea
C. Blurry vision
E. Blood glucose
F. Blood pressure
H. Fruity odor to breath Explanation of Each Correct Option
A. Heart rate
The heart rate is 122/min, which indicates significant tachycardia. In diabetic ketoacidosis (DKA), dehydration from excessive urination and vomiting leads to hypovolemia, and the body compensates by increasing heart rate. Tachycardia is an early sign of fluid deficit and potential shock, requiring rapid IV fluid replacement.
B. Nausea
The client reports nausea and vomiting prior to arrival. This is concerning because vomiting contributes to severe dehydration, electrolyte imbalance, and worsening metabolic acidosis, all of which are markers of progressing DKA. Nausea also interferes with oral intake, making IV fluids and electrolyte replacement necessary.
C. Blurry vision
Blurry vision indicates effects of extreme hyperglycemia on the central nervous system. This may be caused by osmotic shifts and altered perfusion to the brain. It signals neurological changes that require immediate intervention to prevent further decline in mental status, including confusion and decreased responsiveness.
E. Blood glucose
The glucometer displayed “HI”, meaning the glucose level is too high to be read, often beyond 600 mg/dL. This is a medical emergency. Severe hyperglycemia impairs fluid balance, triggers osmotic diuresis, increases serum osmolality, and contributes to ketoacidosis. Immediate treatment with IV insulin and large-volume fluid resuscitation is required.
F. Blood pressure
The blood pressure is 90/54 mmHg, which indicates hypotension. This shows that the client is likely in hypovolemic shock, caused by fluid loss through vomiting and excessive urination. Hypotension impairs perfusion to vital organs such as the brain, kidneys, and heart. This requires urgent fluid therapy and hemodynamic monitoring.
H. Fruity odor to breath
A fruity odor is a classic sign of ketone accumulation in DKA. It indicates that the body is breaking down fat for energy because insulin is insufficient. This leads to metabolic acidosis, which may progress to coma if not treated quickly. This sign confirms the presence of ketosis, requiring immediate medical intervention.
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)
- A. Heart rate first, followed by Temperature
- B. Blood pressure first, followed by Pulse Ox
- C. Glucose first, followed by Leg ulcer
- D. 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 teaching a community education course about the physical complications related to substance use disorder. Which of the following findings should the nurse identify as the primary cause of liver cirrhosis?
- A. Caffeine
- B. Inhalants
- C. Cocaine
- D. Alcohol
Explanation
Explanation of Correct Answer (D):
Chronic alcohol use is the leading cause of liver cirrhosis due to repeated inflammation and scarring of liver tissue. Alcohol is metabolized by the liver, and excessive long-term use leads to fatty liver, alcoholic hepatitis, fibrosis, and ultimately cirrhosis. Cirrhosis impairs liver function and can lead to portal hypertension, jaundice, ascites, hepatic encephalopathy, and liver failure. Alcohol-related liver disease is one of the most preventable causes of mortality.
A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statements by the client should the nurse report to the provider?
- A. "The last time I voided it was painful and red-tinged."
- B. "I drink at least 2 quarts of fluid every day."
- C. "My period ended 2 days ago."
- D. "I don't eat shellfish because it gives me hives."
Explanation
Explanation of Correct Answer (D):
An intravenous pyelogram (IVP) involves the use of iodine-based contrast dye, which carries a risk of allergic reactions. A client who develops hives after eating shellfish may have a hypersensitivity to iodine. This must be reported to the provider immediately because contrast dye could trigger a serious allergic reaction or anaphylaxis. Pre-medication or alternative imaging may be required.
A nurse is reviewing assessment data for four clients. Which of the following findings is MOST consistent with Graves’ disease?
- A. Heart rate is 54 bpm, with constipation and poor appetite
- B. Nonpitting edema noted in the extremities with thinning hair
- C. Patient has recently lost over 10 pounds in the last month and reports a fine tremor in the hands
- D. 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.
The nurse is caring for a patient with diabetes.
History & Physical
Skyler Hansen is an 18-year-old male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his mother. The mother reports that he started acting "weird" after a wrestling tournament. He had not felt well on the bus ride with the team so his mother decided he should ride with her. His mother denies a history of chronic illness but did say he had like a cold but with a stomachache about 3 months ago.
She also says that he has beer very thirsty. and they had to stop several times for him to urinate. She is also worried because he almost missed his wrestling weight class' parameters because he was significantly lighter this past weekend than he has been in the past, even with him eating more than usual.
Nurse's Noces
Capillary blood glucose obtained: machine gives no value. Instead, an error message indicating hi' displays on the machine. He A/O x 4. He complains of a "stomachache' and reports he has nausea and experienced vomiting shortly before arrival. His skin is warm and dry. but his face is flushed. When asked about pain, he says he has a headache, and his vision is blurry. Noted fruity odor to his breath during vital signs.
Vital Signs
Vital Signs
Time 1000
Temperature 98.6F
Heart rate 122
Respiratory rate 26
Blood pressure 90/54 mmHg
Oxygen saturation 98% RA
Pain 0/10 on scale of 1-10
Labs
Test
WBC
K+
Reference Range
5-10.000 cells/mct
3.5-5.0 mEq/L
Results
15.000
5.8
HgbA1C <5%
9%
Urea nitrogen (BUN) 8-20 mg/dl
21
Creatinine
Glucose
0.7-1.3 mg/dL
70-99 mg/dL fasting
0.77
420
Anion gap 3-10 meq/L
12
ABG 7.35-7.45
pH-7.25
22-28 mEq/L
HCOB- 15
38-42 mmHg
PaCO2-35
75-100 mmHg
PaO2-88
Urinalysis Positive for ketones and Negative
glucose
The nurse is preparing to speak with the provider regarding the client's condition, Which of the following orders should the nurse anticipate? Select all that apply.
(Select All that Apply,)
- A. Ambulate with assistance
- B. Regular insulin IV
- C. Calorie count
- D. Tylenol 650 mg PO every 6 hours PRN pain
- E. Repeat urinalysis in the morning
- F. Measure intake and output every shift
- G. Capillary blood glucose (CBG) before meals and at bedtime
- H. Oxygen at 2 L/min via nasal cannula
Explanation
Correct Answers:
B. Regular insulin IV
F. Measure intake and output every shift
G. Capillary blood glucose (CBG) before meals and at bedtime Explanation of Each Correct Answer
B. Regular insulin IV
The client is showing clear signs of Diabetic Ketoacidosis (DKA): glucose too high to read (“HI”), K+ 5.8, pH 7.25, HCO₃ 15, positive ketones, tachycardia, hypotension, weight loss, nausea, vomiting, and fruity breath. The primary treatment is IV regular insulin to correct hyperglycemia, reverse acidosis, and stop ketosis. Insulin IV is life-saving and must be initiated immediately with continuous monitoring.
F. Measure intake and output every shift
The client is significantly dehydrated due to osmotic diuresis and vomiting. Accurate I&O monitoring is essential to assess fluid status, evaluate kidney perfusion, and help guide electrolyte and IV fluid replacement. This is critical in DKA management to avoid renal failure and fluid overload.
G. Capillary blood glucose (CBG) before meals and at bedtime
Frequent blood glucose monitoring is essential during treatment. Rapid changes in glucose can occur during insulin therapy. Monitoring before meals and at bedtime allows safe titration of insulin and helps prevent hypoglycemia during correction of DKA.
A nurse is planning care for a client who has urolithiasis. Which of the following actions should the nurse take?
- A. Restrict protein intake to 2 servings per day.
- B. Apply cold compress to the client's flank area.
- C. Discourage ambulation.
- D. 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 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?
- A. Constipation
- B. Drowsiness
- C. Hypoactive deep-tendon reflexes
- D. 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.
A nurse is caring for a male client who has a urinary tract infection. Which of the following conditions is the client most likely to develop as a result of the UTI?
- A. Benign prostatic hypertrophy
- B. Erectile dysfunction
- C. Chlamydia
- D. Prostatitis
Explanation
Explanation of Correct Answer (D):
In males, urinary tract infections can spread to the prostate gland, resulting in prostatitis, which is inflammation or infection of the prostate. Bacteria from the urinary tract may ascend through the urethra and infect the prostate. Symptoms may include perineal pain, fever, dysuria, urinary retention, or pelvic discomfort. This is a common complication of UTIs specifically in male patients due to anatomical proximity.
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