Nursing Clinical Skills questions

Nursing Clinical Skills questions Related

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A patient with a history of type 1 diabetes and an eating disorder is found unconscious. In the emergency department, the following lab values are obtained: Glucose: 648 mg/dL pH: 88 P CO : 20 mm Hg a 2 P O : 95 mm Hg a 2 HCO ¯: undetectable Anion gap: >31 Na+: 127 mEq/L K+: 5 mEq/L Creatinine: 8 mg/dL After the patient’s airway and ventilation have been established, the next priority for this patient is:

  • A. administration of a 1-L normal saline fluid bolus.
  • B. administration of 0.1 unit of regular insulin IV push followed by an insulin infusion.
  • C. administration of 20 mEq KCl in 100 mL.
  • D. IV push administration of 1 amp of sodium bicarbonate.
Correct Answer: A

Rationale: The correct answer is A: administration of a 1-L normal saline fluid bolus. In this scenario, the patient is likely experiencing diabetic ketoacidosis (DKA) due to the extremely high glucose levels, low bicarbonate, and anion gap metabolic acidosis. The priority is to correct the dehydration and electrolyte imbalances through fluid resuscitation with normal saline to improve perfusion and reverse the metabolic derangements. Options B, C, and D do not address the immediate need for volume resuscitation and correction of dehydration. Administering insulin or potassium without first addressing the fluid deficit could lead to further complications. Sodium bicarbonate is not recommended in DKA as it can worsen acidosis and has not been shown to improve outcomes.

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The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is

  • A. oliguria.
  • B. azotemia.
  • C. acute kidney injury.
  • D. prerenal disease.
Correct Answer: B

Rationale: The correct answer is B: azotemia. Azotemia refers to elevated levels of nitrogenous waste products like BUN and creatinine in the blood. This occurs when the kidneys are not functioning properly, leading to decreased filtration and excretion of waste products. Oliguria (A) is reduced urine output, not specific to elevated BUN and creatinine levels. Acute kidney injury (C) is a broader term for sudden loss of kidney function. Prerenal disease (D) typically refers to conditions affecting blood flow to the kidneys, leading to decreased kidney function, but it does not specifically describe the increase in BUN and creatinine levels.

Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?

  • A. Blood glucose >1000 mg/dL
  • B. Negative ketones in the urine
  • C. Normal anion gap
  • D. pH 7.24
Correct Answer: A

Rationale: The correct answer is A (Blood glucose >1000 mg/dL) because diabetic ketoacidosis is characterized by severe hyperglycemia. High blood glucose levels (>1000 mg/dL) are common due to insulin deficiency leading to increased glucose production.

B: Negative ketones in the urine would be incorrect as DKA results in ketone production, leading to ketonuria.

C: Normal anion gap would be incorrect as DKA typically presents with an elevated anion gap metabolic acidosis due to ketone accumulation.

D: pH 7.24 would be incorrect as DKA would present with a lower pH due to metabolic acidosis.

Mechanisms for development of diabetes insipidus include which of the following? (Select all that apply.)

  • A. ADH deficiency
  • B. ADH excess
  • C. ADH insensitivity
  • D. ADH replacement therapy
Correct Answer: A

Rationale: The correct answer is A: ADH deficiency. Diabetes insipidus is caused by a deficiency of antidiuretic hormone (ADH), leading to excessive urine production and thirst. ADH is responsible for regulating water reabsorption in the kidneys. When ADH levels are low or absent, the kidneys cannot concentrate urine effectively, resulting in excessive urine output.

Explanation for why other choices are incorrect:
B: ADH excess would not lead to diabetes insipidus, as it would result in increased water reabsorption and concentrated urine.
C: ADH insensitivity refers to a condition where the body does not respond to ADH, but it does not cause diabetes insipidus.
D: ADH replacement therapy is actually a treatment for diabetes insipidus, not a mechanism for its development.

The critical care nurse knows that in critically ill patients, renal dysfunction

  • A. is a very rare problem.
  • B. affects nearly two thirds of patients.
  • C. has a low mortality rate once renal replacement therapy has been initiated.
  • D. has little effect on morbidity, mortality, or quality of life.
Correct Answer: B

Rationale: The correct answer is B because renal dysfunction is a common issue in critically ill patients due to factors like sepsis or hypoperfusion. This affects nearly two thirds of patients, leading to potential complications. Choice A is incorrect as renal dysfunction is common, not rare. Choice C is incorrect as mortality rates can still be high even with renal replacement therapy. Choice D is incorrect as renal dysfunction can significantly impact morbidity, mortality, and quality of life in critically ill patients.

The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the following would be the best response?

  • A. “Unfortunately, kidney injury is not reversible; it is permanent.”
  • B. “Kidney function usually returns within 2 weeks.”
  • C. “You will know for sure if you start urinating a lot all at once.”
  • D. “Recovery is possible, but it may take several months.”
Correct Answer: D

Rationale: The correct answer is D: “Recovery is possible, but it may take several months.” This response is the best because acute kidney injury can be reversible with appropriate management, and recovery may take time. It is important to provide hope and encouragement to the patient.

A: “Unfortunately, kidney injury is not reversible; it is permanent.” - This is incorrect as acute kidney injury can be reversible with timely intervention and proper treatment.

B: “Kidney function usually returns within 2 weeks.” - This is incorrect because the recovery timeline varies for each individual and can take longer than 2 weeks.

C: “You will know for sure if you start urinating a lot all at once.” - This is incorrect as increased urine output may not always indicate complete recovery from acute kidney injury.

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