clinical skills exam questions

Correct Answer: A

Rationale: Rationale: A patient with head trauma may develop diabetes insipidus due to damage to the hypothalamus or pituitary gland, leading to decreased secretion of antidiuretic hormone (ADH). This results in excessive urine output and thirst. Other options are incorrect because: B: Diabetic ketoacidosis is associated with high blood sugar and ketones, not increased urine output. C: Hyperosmolar hyperglycemic syndrome is characterized by extreme hyperglycemia, not increased urine output. D: Syndrome of inappropriate secretion of antidiuretic hormone results in decreased urine output due to excess ADH.

Correct Answer: D

Rationale: Step-by-step rationale: 1. CRRT removes solutes and water slowly to avoid hemodynamic instability. 2. Slow removal better tolerates fluid and electrolyte shifts in critically ill patients. 3. Unlike intermittent hemodialysis, CRRT provides continuous, gentle therapy. 4. Choice A is incorrect as both CRRT and intermittent hemodialysis use a hemofilter. 5. Choice B is incorrect as CRRT does not provide faster solute and water removal. 6. Choice C is incorrect as CRRT allows for diffusion to occur, albeit at a slower rate. Summary: Continuous renal replacement therapy (CRRT) removes solutes and water slowly to prevent hemodynamic instability, making it a gentler and more continuous process compared to intermittent hemodialysis. The other choices are incorrect as CRRT does use a hemofilter, does not provide faster removal, and still allows for diffusion to occur.

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: fluid replacement with 0.45% saline. The patient's symptoms suggest dehydration and hypovolemia, indicated by low blood pressure, elevated heart rate, and lack of urine output. Fluid replacement with isotonic saline would help restore intravascular volume and improve blood pressure. Blood transfusion (A) is not indicated without evidence of significant blood loss. Inotropic agents (C) are used to improve cardiac function, which is not the primary issue in this case. Antiemetics (D) may help with nausea and vomiting but do not address the underlying cause of hypovolemia.

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.