clinical skills exam questions

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: 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.

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: D

Rationale: The correct answer is D because continuous venovenous hemodiafiltration (CVVHDF) combines ultrafiltration, convection, and dialysis to maximize fluid and solute removal. Ultrafiltration removes plasma water, convection removes fluids and solutes, and dialysis facilitates solute removal through diffusion. Choice A is incorrect because convection alone does not remove solutes, but CVVHDF combines convection with other methods. Choice B is incorrect because CVVHDF is not specifically used for volume overload, although it does remove fluids. Choice C is incorrect because CVVHDF does not involve adding dialysate to remove solutes; instead, it relies on diffusion for solute removal. In summary, the correct answer D is the best choice as it encompasses all the components needed for comprehensive fluid and solute removal in CVVHDF.

Correct Answer: B

Rationale: The correct answer is B: deficiency of corticosteroids. Acute adrenal crisis is caused by a sudden and severe deficiency of cortisol and aldosterone, which are essential corticosteroids produced by the adrenal glands. Without these hormones, the body cannot regulate blood pressure, electrolyte balance, and respond to stress adequately. Acute renal failure (choice A) does not directly lead to adrenal crisis. High doses of corticosteroids (choice C) can suppress the adrenal glands but do not cause acute adrenal crisis. Overdose of testosterone (choice D) does not impact the production of cortisol and aldosterone, thus not causing acute adrenal crisis.