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NR574 FINAL EXAM NEWEST 2025 TEST BANK|
ACUTE CARE PRACTICUM FIN AL EXAM REVIEW|
COMPLETE 400 REAL EXAM QUESTIONS AND
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When is liver transplantation indicated in pt with tylenol OD? - ANSWER - hepatic failure signs (jaundice, coagulopathy, confusion) occur after N-acetylcysteine dose, live transplant may be the only option.
what does serum lactate tell us about the need for liver transplant? - ANSWER - is serum lactate is >3.5 - likely will require liver transplant to survive.
A 31-year-old woman has exposure to HIV after a condom broke while having vaginal sex with her partner who has HIV. She has follow-up HIV testing related to this exposure. Which one of the following best describes the window period? - ANSWER - The CDC recommends using 45 days as the window period for all laboratory-based IgM/IgG HIV-1/2 antibody immunoassays
A 51-year-old transgender woman (she/her/hers) with HIV has been stable for the last 3 years on an antiretroviral regimen of darunavir- cobicistat and tenofovir DF-emtricitabine. Despite changing to a
healthier diet and increas- ing her exercise, lipid values remain elevated :
total cholesterol 268 mg/dL, low-density lipoprotein (LDL) 198 mg/dL, 1 / 4
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pg. 2 high-density lipoprotein (HDL) 35 mg/dL, and triglycerides 220 mg/dL.She has a strong family history of car- diovascular disease, and her father had a myocardial infarction at age 52.She does not want to consider modifying the antiretroviral regimen but agrees to start lipid- lowering therapy. Which one of the following HMG-CoA reductase inhibitors ("statins") is contraindicated for use in this woman? - ANSWER - Simvastatin
What is a TIPS procedure? - ANSWER - The TIPS procedure bypasses a portion of the hepatic circulation by shunting blood flow from the portal vein to the hepatic vein-This reduces portal pressure and minimizes back pressure on the splanchnic organs. This also decreases the likelihood of bleeding from the esophageal varies and reduces the amount of ascites *Hemorrhage is a significant risk during TIPS
What is the treatment of choice for both type 1 and type 2 HRS? - ANSWER - Liver transplant
What medications are used to tx type 2 HRS? - ANSWER - vasoconstrictors (terlipressin, midodrine in combination with octriotide, norepinephrine) combined with albumin.
Bridge to transplant in Hepatorenal syndrome - ANSWER - The combination of octreotide, midodrine, and albumin (triple therapy) is used to treat hepatorenal syndrome (HRS) often as a bridge to liver transplantation (LT).
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pg. 3 Module ** Bridge to transplant** - ANSWER - In clients who do not respond to medical therapy, are not candidates for TIPS but are candidates for liver transplantation or recovery for their liver disease, continuous renal replacement therapy can be utilized as a bridge to recovery or transplantation. HRS clients typically do not tolerate hemodialysis well.
Joaquin is a 22-year-old male who presents to the emergency department (ED) with a 1-week history of headache, concentration difficulty, fatigue, nau- sea, and vague abdominal pain. He became concerned this morning whenhe noticed that the whites of his eyes appeared yellow.History is significant for epilepsy, which he has had since childhood but is well-controlled with antiepileptic medication. There is no known history of liver disease. Notable physical exam findings include scleral icterus, generalized abdominal tender- ness, and new-onset ascites.Urine alcohol and drug screen were negative. Labs reveal severe transaminitis, hyperbilirubinemia, hyperammonemia, and coagulopathy.The most likely diagnosis is - ANSWER - Acute liver failure
Chadwick presents to the ED following a suicide attempt. He reports swallowing approximately 10,000 milligrams (mg) of acetaminophen 4- hours ago. An hour ago, he began to develop generalized abdominal pain, nausea, and vomiting at which time he asked his brother to take him to the hospital. Shortly after arrival, he becomes confused and agitated. Labs reveal INR of 3.0, acute kidney injury (AKI) with creatinine 2.0, severe transaminitis, and lactic acidosis. Urine toxicology showed an acetaminophen level of 200 milligrams per kilogram. Serum alcohol was negative. The AGACNP knows that the best initial treatment
for Chadwick is: - ANSWER - Administer N-acetylcysteine (Mucomyst)
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pg. 4 Rhabdomyolysis - ANSWER - Rhabdomyolysis is a potentially life- threatening condition that occurs following skeletal muscle injury.- dissolution of striated muscle (caused by trauma, extreme exertion, or drug toxicity;in severe cases renal failure can result)
When the muscle injury occurs, what is released into the blood stream? - ANSWER - muscle fibers release large quantities of potassium, phosphate, creatinine kinase(CK), and myoglobin, a small protein that binds oxygen, into the circulation.-As an unbound protein, myoglobin is excreted by the kidneys but can precipitate and cause renal tubular obstruction.
What happens to myoglobin in Rhabdo? - ANSWER - myoglobin is release from skeletal muscle during injury. it binds to oxygenin excessive amount, as see with rhabdo, it is unbound. when unbound it has to be excreted through the kidneys which can cause renal tubular obstruction.
Risk factors of Rhabdomyolysis - ANSWER - Trauma, muscle compression, or ischemiaHeat-related causesInfection with bacteria or viruses that can directly attack the muscleMetabolic factorsGenetic factorsMedications that may cause direct myotoxicity Toxins which may cause indirect myotoxicity Exertional activity Nutritional supplements which contain substances that may induce muscle injury
Subjective findings of Rhabdo (patient) - ANSWER - muscle pain, dark urine and muscle weakness.Other symptoms commonly associated with rhabdomyolysis can be nonspecific such as fever, nausea, and vomiting, which developed over hours to days
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