ATI RN
Nursing Clinical Skills questions Questions
Question 1 of 9
The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of
Correct Answer: C
Rationale: The correct answer is C: dialysis disequilibrium syndrome. This syndrome occurs when there is a rapid shift in electrolytes, especially in the brain, due to the removal of waste products during hemodialysis. The symptoms of headache, nausea, and confusion align with this syndrome as the brain struggles to adjust to the changes. Dialyzer membrane incompatibility (A) is unlikely as it typically presents with allergic reactions, not neurological symptoms. A shift in potassium levels (B) may cause symptoms like muscle weakness or irregular heartbeat, not headache and confusion. Hypothermia (D) would present with low body temperature, shivering, and confusion, but in this case, the symptoms are more indicative of dialysis disequilibrium syndrome.
Question 2 of 9
Daily weights are being recorded for the patient with a urine output that has been less than the intravenous and oral intake. The weight yesterday was 5 kg. This morning it is 99 kg. The nurse understands that this corresponds to a(n)
Correct Answer: A
Rationale: The correct answer is A: fluid retention of 1.5 liters. The weight gain from 5 kg to 99 kg indicates an increase of 94 kg. Since 1 kg of weight gain is approximately equal to 1 liter of fluid retention, the patient has retained 94 liters of fluid. Therefore, the correct choice is fluid retention of 1.5 liters. Choice B is incorrect because the weight gain indicates fluid retention, not loss. Choice C is incorrect as it mentions equal intake and output, which does not match the weight gain observed. Choice D is incorrect as it suggests fluid loss, which contradicts the weight gain.
Question 3 of 9
Acute kidney injury from postrenal etiology is caused by
Correct Answer: A
Rationale: The correct answer is A because acute kidney injury from postrenal etiology is caused by obstruction of the flow of urine, leading to back pressure and damage to the kidneys. Choices B and C relate to prerenal causes, affecting renal perfusion and volume status. Choice D refers to intrinsic renal causes, directly affecting kidney tissue function, not postrenal obstruction. Therefore, A is correct due to the nature of postrenal etiology.
Question 4 of 9
The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the following would be the best response?
Correct Answer: D
Rationale: The correct answer is D: “Recovery is possible, but it may take several months.” This response is the best because acute kidney injury can be reversible with appropriate management, and recovery may take time. It is important to provide hope and encouragement to the patient. A: “Unfortunately, kidney injury is not reversible; it is permanent.” - This is incorrect as acute kidney injury can be reversible with timely intervention and proper treatment. B: “Kidney function usually returns within 2 weeks.” - This is incorrect because the recovery timeline varies for each individual and can take longer than 2 weeks. C: “You will know for sure if you start urinating a lot all at once.” - This is incorrect as increased urine output may not always indicate complete recovery from acute kidney injury.
Question 5 of 9
Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis
Correct Answer: B
Rationale: The correct answer is B because peritoneal dialysis uses the patient's own semipermeable membrane, the peritoneal membrane, to filter waste and excess fluid from the blood. This membrane allows for the exchange of fluids and solutes, making it an effective method for dialysis. A is incorrect because peritoneal dialysis can be used for acute kidney injury. C is incorrect as peritoneal dialysis can address drug overdose and electrolyte imbalance by removing toxins and balancing electrolytes. D is incorrect as peritoneal dialysis can be used in cases of water intoxication by helping to remove excess fluid from the body.
Question 6 of 9
The patient’s potassium level is 0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction?
Correct Answer: A
Rationale: The correct answer is A: Sodium polystyrene sulfonate. It works by exchanging sodium ions for potassium ions in the colon, leading to potassium excretion. A is the safest option without the risk of causing hypernatremia or intestinal necrosis like B. Regular insulin (C) may cause hypoglycemia and is not as effective as A in reducing potassium levels. Calcium gluconate (D) does not directly reduce potassium levels and is used for treating hyperkalemia-related cardiac toxicity.
Question 7 of 9
A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient?
Correct Answer: A
Rationale: The correct answer is A: He will go into adrenal crisis. Rationale: 1. Glucocorticoids suppress the body's natural production of cortisol. 2. Abruptly stopping high-dose glucocorticoid therapy can lead to adrenal insufficiency. 3. Adrenal crisis can result in symptoms like weakness, fatigue, hypotension, and potentially life-threatening consequences. 4. This patient, being on high-dose glucocorticoid therapy, is at risk for adrenal crisis if he abruptly stops the medication. Summary: B: Thyroid storm is not related to abruptly stopping glucocorticoid therapy. C: Autoimmune disease remission is unlikely to occur within 3 days of stopping medication. D: It is not appropriate to stop high-dose glucocorticoid therapy abruptly, as it can lead to adverse effects like adrenal crisis.
Question 8 of 9
A patient with a history of type 1 diabetes and an eating disorder is found unconscious. In the emergency department, the following lab values are obtained: Glucose: 648 mg/dL pH: 88 P CO : 20 mm Hg a 2 P O : 95 mm Hg a 2 HCO ¯: undetectable Anion gap: >31 Na+: 127 mEq/L K+: 5 mEq/L Creatinine: 8 mg/dL After the patient’s airway and ventilation have been established, the next priority for this patient is:
Correct Answer: A
Rationale: The correct answer is A: administration of a 1-L normal saline fluid bolus. In this scenario, the patient is likely experiencing diabetic ketoacidosis (DKA) due to the extremely high glucose levels, low bicarbonate, and anion gap metabolic acidosis. The priority is to correct the dehydration and electrolyte imbalances through fluid resuscitation with normal saline to improve perfusion and reverse the metabolic derangements. Options B, C, and D do not address the immediate need for volume resuscitation and correction of dehydration. Administering insulin or potassium without first addressing the fluid deficit could lead to further complications. Sodium bicarbonate is not recommended in DKA as it can worsen acidosis and has not been shown to improve outcomes.
Question 9 of 9
The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of
Correct Answer: C
Rationale: The correct answer is C: dialysis disequilibrium syndrome. This syndrome occurs when there is a rapid shift in electrolytes, especially in the brain, due to the removal of waste products during hemodialysis. The symptoms of headache, nausea, and confusion align with this syndrome as the brain struggles to adjust to the changes. Dialyzer membrane incompatibility (A) is unlikely as it typically presents with allergic reactions, not neurological symptoms. A shift in potassium levels (B) may cause symptoms like muscle weakness or irregular heartbeat, not headache and confusion. Hypothermia (D) would present with low body temperature, shivering, and confusion, but in this case, the symptoms are more indicative of dialysis disequilibrium syndrome.