clinical skills exam questions

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A college student was admitted to the emergency department after being found unconscious by a roommate. The roommate informs emergency medical personnel that the student has diabetes and has been experiencing flulike symptoms, including vomiting, since yesterday. The patient had been up all night studying for exams. The patient used the last diabetes testing supplies 3 days ago and has not had time to go to the pharmacy to refill prescription supplies. Based upon the history, which laboratory findings would be anticipated in this client? (Select all that apply.)

  • A. Blood glucose: 43 mg/dL
  • B. Blood glucose: 524 mg/dL
  • C. HCO —: 10 mEq/L
  • D. PaCO : 37 mm Hg
Correct Answer: B

Rationale: The correct answer is B: Blood glucose: 524 mg/dL. The patient likely has diabetic ketoacidosis (DKA) due to missed insulin doses, stress, and illness leading to high blood glucose levels. DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis. A low blood glucose level (Choice A) is not consistent with DKA. HCO3- of 10 mEq/L (Choice C) indicates metabolic acidosis, but it's not specific to DKA. A PaCO2 of 37 mm Hg (Choice D) is within the normal range and not directly related to DKA.

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The most common cause of acute kidney injury in critically ill patients is

  • A. sepsis.
  • B. fluid overload.
  • C. medications.
  • D. hemodynamic instability.
Correct Answer: A

Rationale: The correct answer is A: sepsis. Sepsis is a leading cause of acute kidney injury in critically ill patients due to the systemic inflammatory response leading to kidney damage. Fluid overload (B) can contribute but is not the primary cause. Medications (C) and hemodynamic instability (D) can also lead to acute kidney injury but are not as common as sepsis in critically ill patients.

The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. The nurse should

  • A. prepare to assist with a routine dialysis catheter change.
  • B. evaluate the patient for signs and symptoms of infection.
  • C. teach the patient that the catheter is designed for long-term use.
  • D. use one of the three lumens for fluid administration.
Correct Answer: B

Rationale: The correct answer is B: evaluate the patient for signs and symptoms of infection. After 5 days, infection risk increases. Signs of infection include fever, redness, swelling, and tenderness at the catheter site. Monitoring for these signs is crucial to prevent complications. A: Routine dialysis catheter change is not indicated after 5 days. C: Teaching long-term use is incorrect as temporary catheters are not meant for extended use. D: Using lumens for fluid administration can increase infection risk and is not recommended.

Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. The most common intrarenal condition is

  • A. prolonged ischemia.
  • B. exposure to nephrotoxic substances.
  • C. acute tubular necrosis (ATN).
  • D. hypotension for several hours.
Correct Answer: C

Rationale: Rationale: Acute tubular necrosis (ATN) is the most common intrarenal condition causing acute kidney injury. ATN is characterized by damage to the renal tubules due to ischemia or nephrotoxic substances. Prolonged ischemia (choice A) and exposure to nephrotoxic substances (choice B) can lead to ATN. Hypotension for several hours (choice D) can result in ischemic injury, which may lead to ATN but is not the direct cause. Therefore, choice C is correct as it directly relates to the primary intrarenal condition of ATN.

In determining the glomerular filtration rate (GFR) or creatinine clearance, a 24-hour urine is obtained. If a reliable 24-hour urine collection is not possible,

  • A. it is not possible to determine the GFR.
  • B. the BUN may be used to determine renal function.
  • C. an elevated BUN/creatinine ratio can be used.
  • D. a standardized formula may be used to calculate GFR.
Correct Answer: D

Rationale: The correct answer is D because if a reliable 24-hour urine collection is not possible, a standardized formula can be used to estimate the GFR. This is typically done using the patient's serum creatinine level, age, sex, and race. It is a validated method when direct measurement is not feasible.

A: Incorrect. It is still possible to estimate GFR using formulas when 24-hour urine collection is not possible.
B: Incorrect. BUN alone is not sufficient to accurately determine renal function.
C: Incorrect. BUN/Creatinine ratio is not a direct measure of GFR and may be influenced by other factors.

The nurse is caring for a patient who underwent pituitary surgery 12 hours ago. The nurse will give priority to monitoring the patient carefully for which of the following?

  • A. Congestive heart failure
  • B. Hypovolemic shock
  • C. Infection
  • D. Volume overload
Correct Answer: B

Rationale: The correct answer is B: Hypovolemic shock. After pituitary surgery, patients are at risk for hypovolemic shock due to potential intraoperative blood loss and fluid shifts. Monitoring for signs of shock, such as hypotension and tachycardia, is crucial for early intervention. A: Congestive heart failure is less likely immediately post-surgery. C: Infection is a concern but not the highest priority in the immediate postoperative period. D: Volume overload is not a common immediate complication of pituitary surgery.

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