Nursing Clinical Skills questions

Nursing Clinical Skills questions Related

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The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of

  • A. dialyzer membrane incompatibility.
  • B. a shift in potassium levels.
  • C. dialysis disequilibrium syndrome.
  • D. hypothermia.
Correct Answer: C

Rationale: The correct answer is C: dialysis disequilibrium syndrome. This syndrome occurs when there is a rapid shift in electrolytes, especially in the brain, due to the removal of waste products during hemodialysis. The symptoms of headache, nausea, and confusion align with this syndrome as the brain struggles to adjust to the changes. Dialyzer membrane incompatibility (A) is unlikely as it typically presents with allergic reactions, not neurological symptoms. A shift in potassium levels (B) may cause symptoms like muscle weakness or irregular heartbeat, not headache and confusion. Hypothermia (D) would present with low body temperature, shivering, and confusion, but in this case, the symptoms are more indicative of dialysis disequilibrium syndrome.

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A patient presents to the emergency department with suspected thyroid storm. The nurse should be alert to which of the following cardiac rhythms while providing care to this patient?

  • A. Atrial fibrillation
  • B. Idioventricular rhythm
  • C. Junctional rhythm
  • D. Sinus bradycardia
Correct Answer: A

Rationale: The correct answer is A: Atrial fibrillation. In thyroid storm, excess thyroid hormone levels can lead to increased sympathetic activity, causing tachycardia and arrhythmias like atrial fibrillation. Atrial fibrillation is common in thyroid storm due to the hypermetabolic state and increased risk of atrial arrhythmias. Other choices are incorrect: B (Idioventricular rhythm) is not typically associated with thyroid storm, C (Junctional rhythm) is less likely since atrial arrhythmias are more common, and D (Sinus bradycardia) is unlikely due to the hypermetabolic state causing tachycardia.

Which of the following laboratory values would be found in a patient with syndrome of inappropriate secretion of antidiuretic hormone?

  • A. Fasting blood glucose 156 mg/dL
  • B. Serum potassium 5.8 mEq/L
  • C. Serum sodium 115 mEq/L
  • D. Serum sodium 152 mEq/L
Correct Answer: C

Rationale: The correct answer is C, Serum sodium 115 mEq/L. In syndrome of inappropriate secretion of antidiuretic hormone (SIADH), there is excess release of ADH leading to water retention and dilutional hyponatremia. Low serum sodium levels (hyponatremia) are characteristic of SIADH due to water retention without proportional sodium retention. Choices A and B are not indicative of SIADH. Choice D, high serum sodium, is more likely in conditions causing dehydration or excessive sodium intake.

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.

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.

Which of the following would be seen in a patient with myxedema coma?

  • A. Decreased reflexes
  • B. Hyperthermia
  • C. Hyperventilation
  • D. Tachycardia
Correct Answer: A

Rationale: The correct answer is A: Decreased reflexes. In myxedema coma, a severe form of hypothyroidism, patients often present with decreased mental status, hypothermia, and bradycardia. Decreased reflexes are a common neurological manifestation due to the slowing of metabolic processes and the central nervous system depression associated with this condition. Hyperthermia (B) is not typically seen in myxedema coma, as patients usually have low body temperature. Hyperventilation (C) is also unlikely, as respiratory depression is more common. Tachycardia (D) is incorrect because bradycardia is more characteristic of myxedema coma.

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