1
NR 574/ NR574 FINAL EXAM: ACUTE CARE
PRACTICUM I GUIDE| QUESTIONS & VERIFIED ANSWERS|
GRADE A| 100% CORRECT (LATEST 2026/ 2027 UPDATE)
(VERIFIED SOLUTIONS)- CHAMBERLAIN
1. What can happen if you only transfuse PRBCs during anacute
hemorrhage?: does not replace the plasma and otherclotting
factors the client is losing during hemorrhage. Thiscan lead to
coagulopathy and clotting problems as well asdifficulty with
volume status.
2. Risk factors for rhabdomyolysis: trauma, musclecompression,
or ischemia
Heat related causes (heat, stroke, malignant
hypothermia,neuroleptic malignant syndrome)
Infection with bacteria or viruses that can directly attack amuscle
(EBV, CMV, virus, HIV, Coxsackie, influenza, HSV, VZV,
E. coli, legionella, Rickettsia, GBS, etc.)
Metabolic factors (hypocalcemia, hypophosphatemia,hypokalemia,
hypo/hyponatremia, HHS, hypothyroid) Exertionalactivities
(marathons, high intensity interval training, intenserepetitive
,physical activity, especially in untrained peoplecausing dehydration
or performed and hot or humid conditions)
nutritional supplements containing substances that may
causemuscle injury (Ephedra, creatine, lg dose caffeine)
meds causing direct myotoxicity
(HMG CoA recuctase inhibitors, cyclosporin,
corticosteroids,colchicine, itraconazole)
Genetic factors (sickle cell)
3. Diagnostic criteria for rhabdomyolysis: • dark urine
OR
• an acute neuromuscular illness without other symptoms
PLUS
• an acute elevation in serum CK (at least 5x the upper limit ofnormal)
4. CK in rhabdomyolysis: • most reliable test for dxrhabdomyolysis
• will be marketing elevated, typically > 1000
• Begins to rise within 2 12 hours and continues to rise untilpeaks
around 24 72 hours following onset of injury
•half life 1.5 days, and level declines within 3 5 days of muscleinjury
cessation • CK > 5000 often results in AKI
, 3
5. Serum myoglobin in rhabdomyolysis: • Released fromcells
immediately when skeletal muscle is injured and risesrapidly in
serum
• Excreted rapidly so levels may return to normal within 6 8hours of
injury (half life 2 3 hrs)
• Normal serum myoglobin does not exclude rhabdomyolysisas dx
and is less reliable biomarker than elevated CK.
6. Normal CK range: 45 260 IU/L
7. Normal myoglobin level: 25 72 mg/mL (varies perlaboratory)
8. urine myoglobin: Appears in the urine when
serumconcentrations exceed 1.5 mg/dl
makes urine red brown, tea colored when you're in myoglobinlevels
exceed >3000 IU/L
9. Normal urine myoglobin levels: 0 5 IU/L
10. Urine myoglobin on dipstick: Detectable as "blood"
withconcentrations as low as 0.5 mg/dL, even long after urinehas
returned to its usual color
Therefore, urine color does not exclude rhabdomyolysis as a dx
11. AST in rhabdomyolysis: Often elevated due to skeletalmuscle
injury
Significant transaminitis may also be present withrhabdomyolysis
, 12. Electrolyte imbalances commonly seen
withrhabdomyolysis: • hyperkalemia
• hyperphosphatemia
• hyperuricemia
• hypocalcemia
13. Kidney function with rhabdomyolysis: BUN andcreatinine will
rise as renal function is impaired
14. PTT/APTT in rhabdomyolysis: Prolonged bleeding timesare
associated with rhabdomyolysis induced
disseminatedintervascular coagulation (DIC).
15. Treatment of rhabdomyolysis: • fluid resuscitation: isotonicIVF
@ 400 cc/hr
ASAP and then titrate to maintain UO of at least 200 cc/hr
~CK >15,000 6+ L are required
~ prevents and organ damage such as acute renal failure
• correcting electrolyte imbalances: treat hyperkalemia with
IVglucose, insulin, sodium bicarb, sodium polystyrene sulfonate.
HD for severe refractory cases. ~ Hypocalcemia typicallypresent in
early course of rhabdomyolysis and is not clinicallysignificant unless
patient has evidence of seizure or cardiacdysrhythmia ~
hyperuricemia and hyperphosphatemia usually donot need
treatment
NR 574/ NR574 FINAL EXAM: ACUTE CARE
PRACTICUM I GUIDE| QUESTIONS & VERIFIED ANSWERS|
GRADE A| 100% CORRECT (LATEST 2026/ 2027 UPDATE)
(VERIFIED SOLUTIONS)- CHAMBERLAIN
1. What can happen if you only transfuse PRBCs during anacute
hemorrhage?: does not replace the plasma and otherclotting
factors the client is losing during hemorrhage. Thiscan lead to
coagulopathy and clotting problems as well asdifficulty with
volume status.
2. Risk factors for rhabdomyolysis: trauma, musclecompression,
or ischemia
Heat related causes (heat, stroke, malignant
hypothermia,neuroleptic malignant syndrome)
Infection with bacteria or viruses that can directly attack amuscle
(EBV, CMV, virus, HIV, Coxsackie, influenza, HSV, VZV,
E. coli, legionella, Rickettsia, GBS, etc.)
Metabolic factors (hypocalcemia, hypophosphatemia,hypokalemia,
hypo/hyponatremia, HHS, hypothyroid) Exertionalactivities
(marathons, high intensity interval training, intenserepetitive
,physical activity, especially in untrained peoplecausing dehydration
or performed and hot or humid conditions)
nutritional supplements containing substances that may
causemuscle injury (Ephedra, creatine, lg dose caffeine)
meds causing direct myotoxicity
(HMG CoA recuctase inhibitors, cyclosporin,
corticosteroids,colchicine, itraconazole)
Genetic factors (sickle cell)
3. Diagnostic criteria for rhabdomyolysis: • dark urine
OR
• an acute neuromuscular illness without other symptoms
PLUS
• an acute elevation in serum CK (at least 5x the upper limit ofnormal)
4. CK in rhabdomyolysis: • most reliable test for dxrhabdomyolysis
• will be marketing elevated, typically > 1000
• Begins to rise within 2 12 hours and continues to rise untilpeaks
around 24 72 hours following onset of injury
•half life 1.5 days, and level declines within 3 5 days of muscleinjury
cessation • CK > 5000 often results in AKI
, 3
5. Serum myoglobin in rhabdomyolysis: • Released fromcells
immediately when skeletal muscle is injured and risesrapidly in
serum
• Excreted rapidly so levels may return to normal within 6 8hours of
injury (half life 2 3 hrs)
• Normal serum myoglobin does not exclude rhabdomyolysisas dx
and is less reliable biomarker than elevated CK.
6. Normal CK range: 45 260 IU/L
7. Normal myoglobin level: 25 72 mg/mL (varies perlaboratory)
8. urine myoglobin: Appears in the urine when
serumconcentrations exceed 1.5 mg/dl
makes urine red brown, tea colored when you're in myoglobinlevels
exceed >3000 IU/L
9. Normal urine myoglobin levels: 0 5 IU/L
10. Urine myoglobin on dipstick: Detectable as "blood"
withconcentrations as low as 0.5 mg/dL, even long after urinehas
returned to its usual color
Therefore, urine color does not exclude rhabdomyolysis as a dx
11. AST in rhabdomyolysis: Often elevated due to skeletalmuscle
injury
Significant transaminitis may also be present withrhabdomyolysis
, 12. Electrolyte imbalances commonly seen
withrhabdomyolysis: • hyperkalemia
• hyperphosphatemia
• hyperuricemia
• hypocalcemia
13. Kidney function with rhabdomyolysis: BUN andcreatinine will
rise as renal function is impaired
14. PTT/APTT in rhabdomyolysis: Prolonged bleeding timesare
associated with rhabdomyolysis induced
disseminatedintervascular coagulation (DIC).
15. Treatment of rhabdomyolysis: • fluid resuscitation: isotonicIVF
@ 400 cc/hr
ASAP and then titrate to maintain UO of at least 200 cc/hr
~CK >15,000 6+ L are required
~ prevents and organ damage such as acute renal failure
• correcting electrolyte imbalances: treat hyperkalemia with
IVglucose, insulin, sodium bicarb, sodium polystyrene sulfonate.
HD for severe refractory cases. ~ Hypocalcemia typicallypresent in
early course of rhabdomyolysis and is not clinicallysignificant unless
patient has evidence of seizure or cardiacdysrhythmia ~
hyperuricemia and hyperphosphatemia usually donot need
treatment
