ATI RN
clinical skills exam questions Questions
Question 1 of 5
The patient is complaining of severe flank pain when he tries to urinate. His urinalysis shows sediment and crystals along with a few bacteria. Using this information along with the clinical picture, the nurse realizes that the patient’s condition is
Correct Answer: C
Rationale: The correct answer is C: intrarenal. The presence of sediment, crystals, and bacteria in the urinalysis indicates an issue within the kidneys themselves. The flank pain suggests renal involvement. Prerenal would involve issues before the kidneys, such as inadequate blood flow. Postrenal would involve issues after the kidneys, such as urinary tract obstruction. Not renal related is incorrect as the symptoms and urinalysis findings clearly point to a renal issue.
Question 2 of 5
The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas shows that the patient’s pH is 19, with a PCO of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to
Correct Answer: B
Rationale: The correct answer is B: prepare for intubation and mechanical ventilation. The patient's arterial blood gas results indicate metabolic acidosis (low pH, low bicarbonate) with respiratory compensation (low PCO). In this scenario, the patient is likely experiencing respiratory fatigue due to tachypnea from metabolic acidosis. Intubation and mechanical ventilation are needed to support the patient's respiratory effort and correct the acid-base imbalance. Administering morphine (choice A) can further depress the respiratory drive. Administering intravenous sodium bicarbonate (choice C) can temporarily correct the pH but does not address the underlying respiratory distress. Canceling dialysis (choice D) is not indicated as it does not address the acute respiratory compromise.
Question 3 of 5
The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. The nurse should
Correct Answer: B
Rationale: The correct answer is B: evaluate the patient for signs and symptoms of infection. After 5 days, infection risk increases. Signs of infection include fever, redness, swelling, and tenderness at the catheter site. Monitoring for these signs is crucial to prevent complications. A: Routine dialysis catheter change is not indicated after 5 days. C: Teaching long-term use is incorrect as temporary catheters are not meant for extended use. D: Using lumens for fluid administration can increase infection risk and is not recommended.
Question 4 of 5
The nurse is assessing a patient with a new arteriovenous fistula, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should
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.
Question 5 of 5
Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that
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.