clinical skills questions

Correct Answer: C

Rationale: The correct answer is C: a decrease of 35 to 90 mg/dL compared with admitting values. In diabetic ketoacidosis, there is severe hyperglycemia which needs to be corrected gradually to prevent complications like cerebral edema. A rapid decrease in glucose levels can lead to osmotic shifts and neurological issues. The targeted decrease of 35 to 90 mg/dL is considered safe and effective in managing hyperglycemia in these patients. This range ensures a controlled reduction in blood glucose levels without causing harm. Choice A (70 to 120 mg/dL) is too broad and may lead to overly aggressive treatment. Choice B (a decrease of 25 to 50 mg/dL) is too conservative and may not adequately address the high glucose levels seen in diabetic ketoacidosis. Choice D (less than 200 mg/dL) does not provide a specific target range for glucose reduction, which is essential in managing diabetic ketoacidosis effectively.

Correct Answer: B

Rationale: Correct Answer: B Rationale: 1. Contrast dyes can cause kidney injury due to their nephrotoxic effects. 2. Serum creatinine levels are a reliable indicator of kidney function. 3. Evaluating serum creatinine for up to 72 hours after the procedure allows detection of any contrast-induced kidney injury. 4. Monitoring serum creatinine helps in early identification and intervention for renal complications. Summary: A: Incorrect. Urine output alone is not a definitive indicator of kidney injury. C: Incorrect. Renal ultrasound is not typically used for detecting contrast-induced kidney injury. D: Incorrect. Postvoid residual volume is not specific for contrast-induced kidney injury.

Correct Answer: A

Rationale: Rationale: 1. Urine output < 20 mL/hour indicates potential hypoperfusion. 2. Decreased urine output with hypotension and tachycardia suggests inadequate fluid resuscitation. 3. Administering a normal saline bolus can help improve perfusion and stabilize blood pressure. 4. Contacting the provider promptly for orders is crucial in managing this acute situation. Summary of Incorrect Choices: B. Delaying reporting to the provider risks worsening the patient's condition. C. Continuing to evaluate urine output without intervention can lead to further deterioration. D. Ignoring the urine output due to potential postrenal causes overlooks the urgent need for fluid resuscitation.

Correct Answer: B

Rationale: The elevated BUN and serum creatinine levels with a normal BUN/creatinine ratio suggest kidney dysfunction. This pattern is commonly seen in acute kidney injury, like acute tubular necrosis (ATN), where the kidneys are unable to properly filter waste products. Other choices (A) increased nitrogen intake and (C) hypovolemia would not cause the specific pattern of elevated BUN and creatinine levels with a normal ratio. (D) Fluid resuscitation would actually aim to correct hypovolemia and would not directly affect the BUN and creatinine levels.

Correct Answer: C

Rationale: Correct Answer: C - Increased ability to excrete drugs. Rationale: 1. Renal insufficiency impairs kidney function, leading to decreased excretion of drugs. 2. In elderly patients with renal insufficiency, there may be compensatory mechanisms to enhance drug excretion. 3. This increased ability to excrete drugs helps prevent drug accumulation and potential toxicity. Summary: A: Increased GFR is not expected in renal insufficiency; it typically decreases. B: Serum creatinine level would likely be elevated in renal insufficiency, not normal. D: Hypokalemia is not a typical lab finding in renal insufficiency; hyperkalemia is more common.