ATI NUR 250 Summer 1 2025 Midpoint Assessment
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Free ATI NUR 250 Summer 1 2025 Midpoint Assessment Questions
A nurse is planning care for a client who has a tracheostomy. Which of the following interprofessional team members should the nurse anticipate a provider's prescription for a referral to manage the client's tracheostomy?
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Occupational therapist
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Respiratory therapist
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Social worker
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Registered dietitian
Explanation
Correct Answer: B. Respiratory therapist
Explanation:
A respiratory therapist specializes in airway management and will assist with the care and maintenance of a tracheostomy. This includes suctioning, changing inner cannulas, managing oxygen delivery systems, and providing education on tracheostomy care. Collaboration with a respiratory therapist ensures proper airway clearance, optimal oxygenation, and prevention of complications such as obstruction or infection, making them the appropriate referral for tracheostomy management.
Which of the following clients should the nurse see first when performing triage in the emergency department
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A client who has a new onset of atrial fibrillation and a heart rate of 152/min.
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A client who has heart failure and peripheral edema.
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A client who has cirrhosis of the liver and bruising on their arms.
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A client who reports urinary burning and a temperature of 39.2° C (102.5° F).
Explanation
Correct Answer A: A client who has a new onset of atrial fibrillation and a heart rate of 152/min.
Explanation:
A new onset of atrial fibrillation with a rapid ventricular rate (heart rate of 152/min) indicates a potentially unstable cardiac condition that can compromise perfusion and lead to serious complications such as stroke, heart failure, or hypotension. This is a high-priority situation requiring immediate assessment and intervention to stabilize the heart rhythm and rate.
Why the Other Options Are Incorrect:
B. A client who has heart failure and peripheral edema
Peripheral edema is a chronic symptom of heart failure and not immediately life-threatening. This client should be evaluated, but not before someone with a possibly unstable arrhythmia.
C. A client who has cirrhosis of the liver and bruising on their arms
Bruising is a common manifestation of cirrhosis-related coagulopathy, but it is not an acute emergency and does not require immediate attention over a cardiac instability.
D. A client who reports urinary burning and a temperature of 39.2° C (102.5° F)
This client may have pyelonephritis or another form of infection and needs prompt treatment, but does not take priority over a client with unstable cardiac status, which can deteriorate more rapidly.
Which of the following information should be included in the situation component of the I-SBAR-R handoff report
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Client admitted with ruptured disc at L5
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Request prescription for opioid medication for pain relief
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Provider notified of client's back pain
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Client is grimacing due to pain
Explanation
Correct Answer D: Client is grimacing due to pain
Explanation:
The situation component of the I-SBAR-R report focuses on the immediate issue or concern that prompted the communication. It provides a brief summary of the client’s current condition or what is happening right now. “Client is grimacing due to pain” describes the client’s current observable problem, making it the appropriate information for the situation section.
Why the Other Options Are Incorrect:
A. Client admitted with ruptured disc at L5
This belongs in the background section, which includes relevant medical history and the reason for admission.
B. Request prescription for opioid medication for pain relief
This is part of the recommendation, where the nurse suggests a course of action or what is needed from the provider.
C. Provider notified of client's back pain
This fits into the assessment or possibly the readback component, as it communicates what has been done in response to the client’s condition, not the current situation itself.
A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?
- Monitor plasma drug levels
- Administer this medication intravenously
- Administer the drug at intervals longer than the drug half-life
- Teach the patient that maximum drug effects will occur within a short period
Explanation
Drugs with a narrow therapeutic range have a small margin between therapeutic and toxic doses. Because of this, the nurse must monitor plasma drug levels closely to ensure the drug concentration stays within the safe and effective range. This helps prevent toxicity or subtherapeutic effects.
Why the other options are incorrect:
B) Administer this medication intravenously:
Route of administration depends on the drug, not its therapeutic range. Narrow-range drugs can be oral, IV, or other forms.
C) Administer the drug at intervals longer than the drug half-life:
This could lead to subtherapeutic levels. Dosing is usually more frequent to maintain steady levels.
D) Teach the patient that maximum drug effects will occur within a short period:
The timing of effects varies with each drug and is not directly related to the therapeutic range.
A nurse is assessing a client who has iron deficiency. Which of the following findings should the nurse expect?
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Tooth decay
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Goiter
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Fatigue
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Tetany
Explanation
Correct Answer: C. Fatigue
Explanation:
Fatigue is a classic sign of iron deficiency because low iron levels result in decreased hemoglobin production, leading to reduced oxygen delivery to tissues. This causes the client to feel weak and tired even with minimal activity. Other symptoms may include pallor, shortness of breath, and dizziness. Addressing iron deficiency through diet or supplements is essential to restore oxygen-carrying capacity and relieve symptoms.
The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. What is this patient most likely experiencing?
- An allergic reaction
- An idiosyncratic drug effect on the bone marrow
- Iatrogenic disease of the skin
- Drug toxicity of the liver
Explanation
The symptoms described—jaundice, dark urine, light-colored stools, nausea, vomiting, and malaise—are classic signs of liver dysfunction, often due to hepatotoxicity or drug-induced liver injury. Many medications can damage liver cells, leading to impaired bile excretion and systemic symptoms.
Why the other options are incorrect:
A) An allergic reaction:
Usually presents with rash, itching, hives, swelling, or respiratory issues—not liver-related symptoms like jaundice.
B) An idiosyncratic drug effect on the bone marrow:
Would more likely cause blood-related issues such as anemia, infection, or bleeding—not liver-specific signs.
C) Iatrogenic disease of the skin:
Refers to a skin condition caused by medical treatment, not systemic liver symptoms like jaundice or digestive distress.
A nurse is caring for an adolescent.
Medical History
This adolescent was diagnosed 2 years ago with type I diabetes mellitus.
Glucose control has been maintained (HgA1C range from 5.6 to 7%) with diet and an insulin pump. Two days ago, they developed a fever, vomiting and diarrhea and were managed by the provider. However, the glucoses continued to be high and per guardian, the child got sicker. The provider instructed them to be seen in the emergency department.
Adolescent was examined, bloodwork was prescribed, 2 peripheral IVs were placed, and IV fluids were initiated. Adolescent is being admitted to the pediatric intensive care unit (PICU). Adolescent is severely dehydrated.
Nurses' Notes
Emergency Department
0830:
14-year-old adolescent who has a history of type I diabetes mellitus
accompanied by guardian. Adolescent is confused and lethargic. Skin is
hot and dry. Mucus membranes are dried and cracked. Skin turgor is
tenting, capillary refill is greater than 4 seconds, peripheral pulses are
rapid and weak. Guardian reports it has been over 12 hr since adolescent
last voided and for the past 6 hr has not been able to retain any oral
fluids. Respirations are deep and rapid. Breath has an acetone odor to it.
Adolescent does ask for a drink and cries out that they are thirsty.
Bedside Glucose monitor shows glucose is above 500 mg/dL. Provider
notified immediately.
0900:
2 peripheral IVs were started in the antecubital space. Bloodwork drawn
via left antecubital IV and sent STAT to laboratory. IV of 0.9% sodium
chloride infusing in the right antecubital IV at 200 mL/hr. No edema or
drainage and IV site. Placed on cardiac monitor and is transported to the
PICU.
PICU
0915:
14-year-old received from the emergency department for treatment of
diabetic ketoacidosis (DKA). Guardian is present. Adolescent is placed on
cardiac monitor. IV fluid of 0.9% NaCI is infusing at 200 mL/hr in right
antecubital IV. No edema or drainage at IV site. Child is yelling for a drink
of water. Explained that they are not able to have anything by mouth at
this time. Kussmaul respirations and fruity smelling breath are noted.
Sinus tachycardia is noted on monitor. Laboratory called with results
from the bloodwork. Provider is notified.
Diagnostic Results
0930:
Basic Metabolic Profile (BMP)
Sodium 139 mEq/L (136 to 145 mEq/L)
Potassium 5.1 mEq/L (3.5 to 5 mEq/L)
Glucose 650 mg/dL (74 to 106 mg/dL)
BUN 32 mg/dL (10 to 20 mg/dL)
Creatinine 1.2 mg/dL (0.5 to 1 mg/dL)
Vital Signs
PICU Admission
Temperature 38.5° C (97.6° F)
Heart rate 132/min
Respiratory rate 40/min
Blood pressure 102/60 mm Hg
Pulse oximeter 92% on room air
Drag words from the choices below to fill in each blank in the following
sentence.
When planning care for this client, the nurse should anticipate a provider's
prescription for which of the following?
The nurse should anticipate the provider's prescriptions for this client to
include Target 1 and Target 2
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Administer 7 units of regular insulin subcutaneously every 2 hr until blood glucose is controlled
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Infuse bolus of 1,400 mL of IV fluid 0.9% NaCl over 1 hr
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Add 5% dextrose to IV fluid when glucose is below 300 mg/dL
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Change IV fluid to 0.9% NaCl with 20 mEq/L of KCl
Explanation
Correct Answers
B: Infuse bolus of 1,400 mL of IV fluid 0.9% NaCl over 1 hr,
C. Add 5% dextrose to IV fluid when glucose is below 300 mg/dL
Explanation:
B. Infuse bolus of 1,400 mL of IV fluid 0.9% NaCl over 1 hr
The client is showing signs of severe dehydration, including tenting skin, dry mucous membranes, weak pulses, and no urine output for over 12 hours. The DKA protocol begins with aggressive fluid resuscitation using isotonic saline (0.9% NaCl). A bolus of 10–20 mL/kg is appropriate. For a 50 kg adolescent, 1,400 mL over 1 hour is within standard recommendations.
C. Add 5% dextrose to IV fluid when glucose is below 300 mg/dL
As insulin is administered to reduce glucose and clear ketones, blood glucose levels can drop rapidly. Dextrose is added to IV fluids once glucose falls below 300 mg/dL to prevent hypoglycemia while allowing continued insulin therapy for ketone clearance.
Why the Other Options Are Incorrect:
A. Administer 7 units of regular insulin subcutaneously every 2 hr until blood glucose is controlled
In DKA management, insulin is given via continuous IV infusion, not subcutaneously. This allows for tight control of glucose and ketone levels and rapid adjustment based on frequent lab monitoring.
D. Change IV fluid to 0.9% NaCl with 20 mEq/L of KCl
Although potassium replacement is part of DKA treatment, it is only added once urine output is adequate and serum potassium is under 5.3 mEq/L. This client has not voided in over 12 hours and has a potassium level of 5.1 mEq/L, so potassium should not be added yet.
A nurse is preparing to administer diphenhydramine 30 mg IM stat to a client who is having an allergic reaction. Available is diphenhydramine 50 mg/1 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
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0.3 mL
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0.5 mL
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0.6 mL
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0.8 mL
Explanation
Correct Answer: C. 0.6 mL
Explanation:
To find the correct dose, use the formula:
(Desired dose ÷ Available dose) × Volume = Amount to administer
(30 mg ÷ 50 mg) × 1 mL = 0.6 mL
The nurse should administer 0.6 mL of diphenhydramine. This ensures accurate dosing for an immediate (stat) intramuscular injection to treat the allergic reaction safely and effectively.
Which of the following statements by a school-age child with a new diagnosis of type 1 diabetes mellitus indicates an understanding of the teaching
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I can store unopened bottles of insulin in the freezer.
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I should not take my regular insulin when I am sick.
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I should eat a snack half an hour before playing soccer.
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My morning blood glucose should be between 90 and 130
Explanation
Correct Answer C: I should eat a snack half an hour before playing soccer.
Explanation:
This statement shows correct understanding. Physical activity like soccer can lower blood glucose levels, increasing the risk of hypoglycemia. Eating a carbohydrate-containing snack before exercise helps maintain stable glucose levels and prevents hypoglycemia during or after physical activity. Children with type 1 diabetes are often taught to plan snacks around exercise to manage their energy and insulin needs.
Why the Other Options Are Incorrect:
A. I can store unopened bottles of insulin in the freezer.
This is incorrect. Insulin should never be frozen. Unopened insulin should be stored in the refrigerator, not the freezer, as freezing can damage its effectiveness.
B. I should not take my regular insulin when I am sick.
This is incorrect. Children with type 1 diabetes should usually continue taking insulin even when they are sick because illness can raise blood glucose levels. They may even need more frequent monitoring and insulin adjustments during illness.
D. My morning blood glucose should be between 90 and 130.
This range is more appropriate for adults. The target fasting blood glucose for school-age children with type 1 diabetes is typically 90 to 180 mg/dL, depending on their individual care plan. This response reflects a misunderstanding of the appropriate target range.
A patient with a history of hypertension is admitted for a procedure. If the patient's blood pressure decreases, which clinical manifestation would the nurse expect to see?
- Decreased heart rate
- Erythema
- Increased temperature
- Increased heart rate
Explanation
When blood pressure drops, the body compensates by activating the sympathetic nervous system, which causes the heart to beat faster to maintain adequate perfusion to vital organs. This results in increased heart rate (tachycardia), a common physiological response to hypotension.
Why the other options are incorrect:
A) Decreased heart rate:
Bradycardia would not be expected in response to hypotension; it would worsen perfusion.
B) Erythema:
This refers to skin redness, often due to inflammation or infection, not related to changes in blood pressure.
C) Increased temperature:
Temperature changes are usually linked to infection or inflammation, not directly to blood pressure changes.
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