Excelsior NUR 250 Fall 1 2026 Midpoint

Nursing Process:

1. A nurse is receiving change-of-shift report for a group of assigned clients. Which activity is anticipated first in delivering client care using the nursing process?

• A. Determine effectiveness of interventions.
• B. Collect baseline client assessment data.
• C. Critically analyze client data to determine priorities.
• D. Develop a plan of care for each client.

Answer: B. The nursing process always begins with Assessment. Before analyzing data or prioritizing interventions, the nurse must first collect accurate client status data.

Hypoglycemia Management:

2. A client with type 1 diabetes mellitus reports feeling shaky and having palpitations. The nurse finds the client's blood glucose to be 48 mg/dL. What should the nurse give the client?

• A. 15 to 20 g of fast-acting simple carbohydrate (e.g., 4 oz fruit juice or 3-4 glucose tablets).
• B. A full meal with protein and complex carbohydrates.
• C. A dose of glucagon by injection.
• D. Nothing by mouth until the provider is notified.

Answer: A. For conscious hypoglycemia (<70 mg/dL), the nurse follows the "Rule of 15": give 15 g of simple carbohydrate and recheck glucose in 15 minutes.

Dosage Calculation:

3. A nurse is preparing to administer a continuous heparin infusion at 1,600 units/hr. Available is heparin 25,000 units in D5W 500 mL. The nurse should set the IV pump to deliver how many mL/hr?

• A. 16 mL/hr
• B. 32 mL/hr
• C. 50 mL/hr
• D. 64 mL/hr

Answer: B. (1,600 units/hr ÷ 25,000 units) × 500 mL = 32 mL/hr.

DKA Management:

4. An adolescent presents with severe diabetic ketoacidosis (DKA). Which provider prescriptions should the nurse anticipate?

Complete the sentence: The nurse should anticipate the provider's prescriptions to include [Target 1] and [Target 2].

• Word choices: administer oxygen via nasal cannula · infuse bolus of 1,400 mL of IV fluid 0.9% NaCl over 1 hr · add 5% dextrose to IV fluid when glucose is below 300 mg/dL · change IV fluid to 0.9% NaCl with 20 mEq/L of KCl

Answer: infuse bolus of 1,400 mL of IV fluid 0.9% NaCl over 1 hr (Target 1) and add 5% dextrose to IV fluid when glucose is below 300 mg/dL (Target 2). DKA requires immediate fluid resuscitation with 0.9% NaCl; dextrose is added once glucose drops to 250–300 mg/dL to prevent rapid hypoglycemia and cerebral edema.

Cultural Competence:

5. A nurse manager is preparing a presentation on cultural competence. Which definition should the manager provide for the concept of cultural humility?

• A. Knowledge of one's own thoughts and feelings about diversity.
• B. A self-reflection and critique of power imbalances that allow health inequities.
• C. The recognition of differences in race, color, ethnicity, or nationality that exist among individuals.
• D. Knowledge that allows one to appreciate other cultures.

Answer: B. Cultural humility is a lifelong process of self-reflection, personal critique, and addressing power differentials between healthcare providers and clients.

Insulin Teaching — Evaluation:

6. A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new diagnosis of diabetes mellitus. Which statement by the parent indicates a need for further teaching?

• A. "The insulin should be injected at a 90-degree angle."
• B. "I will be sure my child rotates sites after 5 injections in one area."
• C. "I will be sure my child aspirates before injecting the insulin."
• D. "The insulin can be injected anywhere there is adipose tissue."

Answer: C. Aspiration before a subcutaneous insulin injection is obsolete and contraindicated — it increases tissue trauma and bruising without any benefit.

Postoperative Priorities:

7. A nurse is caring for a client who is 3 hr postoperative following abdominal surgery. Which of the following assessment data should the nurse report to the provider?

• A. The client's pain level has decreased since the administration of morphine.
• B. The client's urine output has been 50 mL since surgery.
• C. Postoperative laboratory results are Hgb 15% and Hct 40%.
• D. Serosanguineous drainage noted on the abdominal dressing.

Answer: B. Oliguria (<30 mL/hr) — here, only 50 mL total over 3 hours — indicates acute renal hypoperfusion, hypovolemia, or acute kidney injury and requires immediate provider notification.