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: C

Rationale: The correct answer is C because the patient was recently discharged after a prolonged course of aminoglycoside therapy, which is a known risk factor for acute kidney injury due to its nephrotoxic effects. Choice A is incorrect because although aminoglycosides can cause kidney injury, the duration of therapy is shorter in this case. Choice B is incorrect because controlled hypertension is not a significant risk factor for acute kidney injury. Choice D is incorrect because fluid overload from heart failure may lead to other complications but is not directly associated with acute kidney injury.

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: 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: B

Rationale: The correct answer is B: Assess the patient's lungs. In rhabdomyolysis, muscle breakdown releases myoglobin which can cause kidney damage. Mannitol is given to prevent kidney damage by promoting diuresis. However, mannitol can also cause fluid overload and pulmonary edema. Therefore, assessing the patient's lungs is crucial to monitor for signs of fluid overload and prevent complications. A: Assessing the patient's hearing is not directly related to the management of rhabdomyolysis and mannitol administration. C: Decreasing IV fluids after administering a diuretic like mannitol can lead to inadequate fluid resuscitation and worsening kidney injury. D: Giving extra doses before radiological contrast agents is not necessary in the context of rhabdomyolysis and mannitol administration.