Nursing Clinical Skills questions

Nursing Clinical Skills questions Related

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The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patient’s urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has:

  • A. acute kidney injury from a prerenal condition.
  • B. acute kidney injury from postrenal obstruction.
  • C. intrarenal disease, probably acute tubular necrosis.
  • D. a urinary tract infection.
Correct Answer: C

Rationale: The correct answer is C: intrarenal disease, probably acute tubular necrosis. The presence of coarse, muddy brown granular casts and hematuria in the urinalysis indicates damage to the renal tubules, which is characteristic of acute tubular necrosis. This condition is a type of intrarenal disease where there is direct damage to the kidney tubules, leading to decreased urinary output and symptoms like malaise and fatigue. Prerenal and postrenal conditions do not typically present with granular casts and hematuria, making choices A and B incorrect. Urinary tract infection is also unlikely to cause the specific findings seen in this case, ruling out choice D. Therefore, choice C is the most appropriate based on the urinalysis results and clinical presentation.

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The patient’s potassium level is 0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction?

  • A. Sodium polystyrene sulfonate
  • B. Sodium polystyrene sulfonate with sorbitol
  • C. Regular insulin
  • D. Calcium gluconate
Correct Answer: A

Rationale: The correct answer is A: Sodium polystyrene sulfonate. It works by exchanging sodium ions for potassium ions in the colon, leading to potassium excretion. A is the safest option without the risk of causing hypernatremia or intestinal necrosis like B. Regular insulin (C) may cause hypoglycemia and is not as effective as A in reducing potassium levels. Calcium gluconate (D) does not directly reduce potassium levels and is used for treating hyperkalemia-related cardiac toxicity.

The patient’s serum creatinine level is 7 mg/dL. The expected BUN level should be

  • A. 1 to 2 mg/dL.
  • B. 7 to 14 mg/dL.
  • C. 10 to 20 mg/dL.
  • D. 20 to 30 mg/dL.
Correct Answer: C

Rationale: The correct answer is C (10 to 20 mg/dL). In conditions where the serum creatinine level is elevated (7 mg/dL in this case), the BUN level is expected to also be elevated due to impaired kidney function. BUN levels are typically around 10-20 mg/dL, so this range is the most appropriate given the elevated creatinine level.

Choice A (1 to 2 mg/dL) is too low and would not be expected with a creatinine level of 7 mg/dL. Choice B (7 to 14 mg/dL) is a bit low for such a high creatinine level. Choice D (20 to 30 mg/dL) is too high as it exceeds the typical range for BUN levels. Therefore, choice C is the most appropriate range based on the given information.

In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started?

  • A. Never; normal saline is the only appropriate solution in diabetes management
  • B. When the blood sugar reaches 70 mg/dL
  • C. When the blood sugar reaches 150 mg/dL
  • D. When the blood glucose reaches 250 mg/dL
Correct Answer: D

Rationale: Correct Answer: D

Rationale: In diabetic emergencies, starting IV dextrose at 250 mg/dL prevents hypoglycemia while resolving ketoacidosis. Below 250 mg/dL, the body can use endogenous glucose, so IV dextrose is not necessary.

Summary:
A: Incorrect. Normal saline may be used for initial fluid resuscitation but does not address the need for glucose.
B: Incorrect. Starting dextrose at 70 mg/dL may lead to unnecessary hyperglycemia and complications.
C: Incorrect. Waiting until 150 mg/dL delays the provision of necessary glucose for metabolic functions.

Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.)

  • A. Hypotension
  • B. Dysrhythmias
  • C. Muscle cramps
  • D. Hemolysis
Correct Answer: A

Rationale: The correct answer is A: Hypotension. Hemodialysis can lead to hypotension due to rapid fluid removal, causing a drop in blood pressure. This occurs as the dialysis machine removes excess fluid, affecting plasma volume. Hypotension can result in complications like dizziness, nausea, and potential cardiac issues. Dysrhythmias (B) are less common during hemodialysis for acute kidney injury. Muscle cramps (C) may occur due to electrolyte imbalances but are not as common as hypotension. Hemolysis (D) is not a common complication of hemodialysis but can occur if there are issues with the dialysis machine or blood tubing.

The patient is admitted with acute kidney injury from a postrenal cause. Acceptable treatments for that diagnosis include: (Select all that apply.)

  • A. bladder catheterization.
  • B. increasing fluid volume intake.
  • C. ureteral stenting.
  • D. placement of nephrostomy tubes.
Correct Answer: A

Rationale: The correct answer is A. Bladder catheterization helps relieve urinary obstruction, a common postrenal cause of acute kidney injury. It allows urine to drain freely from the bladder.
- B: Increasing fluid volume intake may worsen the condition by increasing the pressure on the obstructed kidneys.
- C: Ureteral stenting is used for intrarenal causes, not postrenal causes.
- D: Placement of nephrostomy tubes bypasses the obstruction but is usually reserved for more severe cases.

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