ATI Custom NUR212 Midpoint Assessment Fall 2 2025
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Free ATI Custom NUR212 Midpoint Assessment Fall 2 2025 Questions
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
- Heart rate
- Nausea
- Blurry vision
- Oxygen saturation
- Blood glucose
- Blood pressure
- Pain level
- 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.
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.)
- Elevated BUN and creatinine
- Taut, dry skin
- Slow heart rate
- Elevated blood glucose
- 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.
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?
- "The last time I voided it was painful and red-tinged."
- "I drink at least 2 quarts of fluid every day."
- "My period ended 2 days ago."
- "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 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?
- Potassium
- Bicarbonate
- Ammonia
- 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 caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?
- Brudzinski's sign
- Kernig's sign
- Babinski's sign
- Chvostek's sign
Explanation
Explanation of Correct Answer (D):
Following a thyroidectomy, the client is at risk for hypocalcemia due to possible injury or removal of the parathyroid glands. Tingling around the mouth, hands, and feet is an early sign of low calcium levels. The nurse should assess Chvostek’s sign, which involves tapping the facial nerve and observing for twitching of the facial muscles. A positive sign confirms neuromuscular irritability secondary to hypocalcemia.
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.
- Earache
- Increased appetite
- Hand tremors
- Dizziness
- 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 reviewing assessment data for four clients. Which of the following findings is MOST consistent with Graves’ disease?
- Heart rate is 54 bpm, with constipation and poor appetite
- Nonpitting edema noted in the extremities with thinning hair
- Patient has recently lost over 10 pounds in the last month and reports a fine tremor in the hands
- 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.
Which nursing interventions should the RN implement when providing care for a patient with ascites related to cirrhosis of the liver? (Select All that Apply.)
- Administer furosemide as prescribed.
- Ambulate in hallway three times daily.
- Maintain strict intake and output.
- Prepare patient for a paracentesis.
- Encourage an increase in oral fluids.
Explanation
Explanation
A. Administer furosemide as prescribed
Ascites is caused by fluid accumulation in the peritoneal cavity due to portal hypertension and hypoalbuminemia. Diuretics such as furosemide help reduce excess fluid volume and promote excretion. Monitoring potassium levels and renal function is important.
C. Maintain strict intake and output
Precise monitoring of fluid balance is critical for patients with ascites. This helps assess the effectiveness of diuretic therapy, prevents fluid overload, and detects worsening renal function or electrolyte imbalance.
D. Prepare patient for a paracentesis
Paracentesis may be required to remove large amounts of fluid and relieve dyspnea, abdominal discomfort, or risk of respiratory compromise. The nurse should ensure consent is obtained, the bladder is emptied, and vital signs are monitored before and after the procedure.
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?
- Benign prostatic hypertrophy
- Erectile dysfunction
- Chlamydia
- 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.
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?
- Avoid foods high in fat.
- Avoid foods high in sodium.
- Include foods high in fiber.
- 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.
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