clinical skills exam questions

Correct Answer: D

Rationale: The correct answer is D: Discontinue the IV infusion and administer the Lantus insulin at bedtime. This is the correct approach because insulin glargine (Lantus) is a long-acting basal insulin that provides a steady level of insulin throughout the day and night. By administering it at bedtime, it mimics the basal insulin secretion in a person without diabetes. This helps maintain stable blood sugar levels overnight. Choice A is incorrect because continuing the IV insulin infusion for 24 hours alongside insulin glargine is unnecessary and may lead to insulin overdose. Choice B is incorrect because discontinuing the IV infusion in several hours without administering the long-acting insulin can lead to inadequate insulin coverage. Choice C is incorrect because insulin aspart is a rapid-acting insulin that should be given with meals, not as a basal insulin replacement at bedtime.

Correct Answer: D

Rationale: The correct answer is D because the presence of red blood cells and albumin in the urine indicates kidney damage, as these are not normally found in urine. A: Creatinine levels should be similar in blood and urine for proper kidney function. B: Sodium and chloride are normal components of urine. C: Uric acid levels can vary in urine and serum. Therefore, D is the correct answer as it signals potential kidney injury.

Correct Answer: A

Rationale: The correct answer is A: Kidney, ureter, bladder (KUB) x-ray. KUB x-ray is a noninvasive diagnostic procedure that provides information about the size, shape, and position of the kidneys, ureters, and bladder. It can help detect abnormalities such as kidney stones or structural issues. Rationale: 1. KUB x-ray is noninvasive, meaning it does not require any incisions or insertion of instruments into the body. 2. It is commonly used as an initial screening tool to assess kidney function. 3. Renal ultrasound (Choice B) is also noninvasive but primarily used for imaging the kidneys and not the entire urinary system. 4. MRI (Choice C) and IVP (Choice D) are more invasive procedures that involve injecting contrast agents and may not be routinely used for initial kidney function assessment. In summary, the KUB x-ray is the correct choice as it is a noninvasive procedure specifically designed to evaluate kidney

Correct Answer: C

Rationale: Step 1: Syndrome of inappropriate antidiuretic hormone (SIADH) leads to excess water retention, diluting sodium levels in the blood. Step 2: Fluid restriction is the mainstay of treatment to prevent further dilution of sodium. Step 3: Administering 3% normal saline (choice A) can worsen the condition by further increasing sodium levels. Step 4: Exogenous vasopressin (choice B) would exacerbate the problem by increasing water retention. Step 5: Low sodium diet (choice D) may be beneficial in the long term but is not the immediate priority.

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.