clinical skills exam questions

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.

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.

Correct Answer: A

Rationale: The correct answer is A because renin activates the renin-angiotensin-aldosterone cascade. Renin is released by the kidneys in response to low blood pressure or low sodium levels. It acts on angiotensinogen to form angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme. Angiotensin II causes vasoconstriction, leading to increased blood pressure, and stimulates aldosterone release, promoting sodium and water retention. Choice B is incorrect because renin does not suppress angiotensin production; it actually initiates the process. Choice C is incorrect because renin's action leads to increased sodium reabsorption by stimulating aldosterone release. Choice D is incorrect because renin does not inhibit aldosterone release; it promotes it as part of the renin-angiotensin-aldosterone cascade.

Correct Answer: C

Rationale: The correct answer is C: notify the provider immediately. Lack of bruit, thrill, and distal pulse indicates potential complications like thrombosis or occlusion in the arteriovenous fistula. Prompt provider notification is crucial for timely intervention to prevent further complications such as ischemia or access failure. Reassessing the patient in an hour (A) may delay necessary intervention. Raising the arm above the level of the patient's heart (B) does not address the underlying issue. Applying warm packs (D) could worsen the situation if there is a clot present.

Correct Answer: B

Rationale: The correct answer is B: a decreased risk of peritonitis exists. Peritoneal dialysis involves using the peritoneum as a membrane for fluid exchange, reducing the risk of infections like peritonitis compared to hemodialysis. Option A is incorrect as peritoneal dialysis can be done at home and is less time-consuming than hemodialysis. Option C is incorrect as biochemical disturbances are corrected more gradually with peritoneal dialysis. Option D is incorrect as there is a risk of bleeding complications with peritoneal dialysis.