NR575 AGACNP Certification Review Renal and Genitourinary Questions
and Answers with Complete Solutions UPDATED!!!!.
Correct
Incorrect
Give this one a try later!
2. Acute tubular necrosis.
,Rationale: The patient presents with acute kidney injury (AKI) stage 2 caused by an increasing
serum creatinine 2 to 2.9 times greater than baseline and a urinary volume less than 0.5
mL/kg/hr over the last 12 hours. Chronic kidney disease (CKD) (answer 1) is kidney damage
for more than 3 months, as defined by structural and functional abnormality of the kidney
with or without decreased of glomerular filtration rate, according to The National Kidney
Foundation Kidney Disease Outcome Quality Initiative. The patient has muddy brown casts in
his urine, and his blood urea nitrogen (BUN)/serum creatinine ratio is between 10 and 15:1;
these are markers of acute tubular necrosis (answer 2). Postrenal AKI (answer 3) occurs in
patients with benign prostatic hyperplasia, some kinds of cancers, and in the presence of
nephrolithiasis. Prerenal azotemia occurs for patients with BUN/serum creatinine ratio
greater than 20:1 and there is no presence of visible casts (answer 4).
3. Cinacalcet is safe for patients with seizure disorders.
Rationale: Cinacalcet is a calcimimetic that attaches to the calcium receptor on the
parathyroid gland and increases the sensitivity of receptors to serum calcium concentration,
reducing parathyroid hormone (PTH). Cinacalcet is metabolized primarily by CYP3A4; thus
ketoconazole (CYP3A4 inhibitor) could increase the cinacalcet concentration by up to twofold
(answer 1). Cinacalcet could inhibit CYP2D6, inhibiting the metabolism of cytochrome CYP2D6
substrates such that dosage reduction in drugs with narrow therapeutic indices may be
required (e.g., tricyclic antidepressants) (answer 2). Cinacalcet can be used cautiously in
patients with seizure disorders (answer 3 is incorrect). Cinacalcet could cause hypocalcemia
as an exacerbation (answer 4).
1. Injury to kidney.
Rationale: To stratifying acute kidney injury (AKI) you can use the RIFLE (risk, injury,
failure, loss, and end-stage kidney disease) criteria. The patient presents with severe
community-acquired pneumonia and has an increasing serum creatinine two times the
baseline. According to RIFLE classification, increasing serum creatinine two times the
baseline is classified as an injury to the kidney (answer 1). When the serum creatinine
is increased more than 4 mg/dL or serum creatinine is increased to three times the
baseline, it is classified as failure of the kidney (answer 2). Loss of kidney function
occurs when there is a complete loss of kidney function for greater than 4 weeks
(answer 3). Endstage kidney disease (answer 4) happens when there is a complete loss
of kidney function for greater than 3 months.
4. Administer fluid bolus (500 mL of NaCl solution)
, Rationale: The patient presents with acute kidney injury (AKI) symptoms, and the initial
treatment of AKI is identifying and reversing the insult to the kidney if possible.
This patient has prerenal azotemia caused by hypotension and increased heart rate. Adding
sulfa antibiotics would not have any benefits for this patient because she does not have any
signs for urinary tract infections (answer 1). Administering diuretics such as furosemide
(answer 2) could worsen her volume depletion and probably further impair her kidney
function. Although the glucose level is elevated, adding insulin units is unnecessary at this
time (answer 3). Fluid management is critical to managing AKI; therefore administration of a
fluid bolus with normal saline would be the best choice for this patient.
Don't know?
2 of 52
Term
16. A 35-year-old patient presents to the emergency department with a 10-day
history of dysuria, abdominal pain, vomiting, and flank pain. He is diagnosed
with pyelonephritis and is prescribed a 14-day course of
trimethoprim/sulfamethazine tablet double strength. His medical history
includes hypertension, osteoarthritis, and hypothyroidism. His medications are
captopril 50 mg twice daily, acetaminophen 500 mg three times per day, and
levothyroxine 105 mcg/day. Which drug can cause pseudonephrotoxicity?
1. Captopril.
2. Acetaminophen.
3. Levothyroxine.
4. Trimethoprim/sulfamethazine.
Give this one a try later!
4. Trimethoprim/sulfamethazine.
Rationale: Captopril (answer 1) is an angiotensin-converting enzyme inhibitor (ACEi)
that can cause vasodilatation of efferent arterioles and lead to decrease of glomerular
hydrostatic pressure; thus an ACEi can cause functional acute kidney injury (AKI).
Acetaminophen (answer 2) is metabolized by N-acetyl-p-benzoquinone, which is
, produced by liver. Levothyroxine (answer 3) has not been shown to have any
nephrotoxicity symptoms. Trimethoprim/sulfamethazine (answer 4) could inhibit the
tubular secretion of creatinine and leads to pseudonephrotoxicity.
4. 3 mg/mL.
Rationale: The fraction of drug excreted in the urine can determine the proper dose of a drug
when specific dosing guidelines are not available. The Rowland–Tozer equation can determine
the percentage of the usual dosage to give a patient with known kidney disease (Q),
considering the ratio of the patient's renal function to normal.
If the usual dose of drug X is 400 mg/day, so the adjusted dose will be 300 mg/day
(400 × 0.75) = 300. Thus the patient should receive 3 mL of the 100 mg/mL preparation (300
mg/100 mg/mL). Therefore answers 1, 2, and 3 are incorrect.
3. Metformin.
Rationale: The patient has chronic kidney disease history with an elevated serum creatinine.
Metformin should be interrupted for two reasons. One reason is that metformin is historically
contraindicated for patient with serum creatinine is greater than 1.5 mg/dL in men and 1.4
mg/dL in women because it would increase the risk of lactic acidosis. Metformin also should
be interrupted if the patient is to undergo procedures using iodinated contrast dye in 24
hours because of the risk of nephrotoxicity. It should then reinitiated after 48 hours.
Therefore answers 1, 2, and 4 are incorrect.
and Answers with Complete Solutions UPDATED!!!!.
Correct
Incorrect
Give this one a try later!
2. Acute tubular necrosis.
,Rationale: The patient presents with acute kidney injury (AKI) stage 2 caused by an increasing
serum creatinine 2 to 2.9 times greater than baseline and a urinary volume less than 0.5
mL/kg/hr over the last 12 hours. Chronic kidney disease (CKD) (answer 1) is kidney damage
for more than 3 months, as defined by structural and functional abnormality of the kidney
with or without decreased of glomerular filtration rate, according to The National Kidney
Foundation Kidney Disease Outcome Quality Initiative. The patient has muddy brown casts in
his urine, and his blood urea nitrogen (BUN)/serum creatinine ratio is between 10 and 15:1;
these are markers of acute tubular necrosis (answer 2). Postrenal AKI (answer 3) occurs in
patients with benign prostatic hyperplasia, some kinds of cancers, and in the presence of
nephrolithiasis. Prerenal azotemia occurs for patients with BUN/serum creatinine ratio
greater than 20:1 and there is no presence of visible casts (answer 4).
3. Cinacalcet is safe for patients with seizure disorders.
Rationale: Cinacalcet is a calcimimetic that attaches to the calcium receptor on the
parathyroid gland and increases the sensitivity of receptors to serum calcium concentration,
reducing parathyroid hormone (PTH). Cinacalcet is metabolized primarily by CYP3A4; thus
ketoconazole (CYP3A4 inhibitor) could increase the cinacalcet concentration by up to twofold
(answer 1). Cinacalcet could inhibit CYP2D6, inhibiting the metabolism of cytochrome CYP2D6
substrates such that dosage reduction in drugs with narrow therapeutic indices may be
required (e.g., tricyclic antidepressants) (answer 2). Cinacalcet can be used cautiously in
patients with seizure disorders (answer 3 is incorrect). Cinacalcet could cause hypocalcemia
as an exacerbation (answer 4).
1. Injury to kidney.
Rationale: To stratifying acute kidney injury (AKI) you can use the RIFLE (risk, injury,
failure, loss, and end-stage kidney disease) criteria. The patient presents with severe
community-acquired pneumonia and has an increasing serum creatinine two times the
baseline. According to RIFLE classification, increasing serum creatinine two times the
baseline is classified as an injury to the kidney (answer 1). When the serum creatinine
is increased more than 4 mg/dL or serum creatinine is increased to three times the
baseline, it is classified as failure of the kidney (answer 2). Loss of kidney function
occurs when there is a complete loss of kidney function for greater than 4 weeks
(answer 3). Endstage kidney disease (answer 4) happens when there is a complete loss
of kidney function for greater than 3 months.
4. Administer fluid bolus (500 mL of NaCl solution)
, Rationale: The patient presents with acute kidney injury (AKI) symptoms, and the initial
treatment of AKI is identifying and reversing the insult to the kidney if possible.
This patient has prerenal azotemia caused by hypotension and increased heart rate. Adding
sulfa antibiotics would not have any benefits for this patient because she does not have any
signs for urinary tract infections (answer 1). Administering diuretics such as furosemide
(answer 2) could worsen her volume depletion and probably further impair her kidney
function. Although the glucose level is elevated, adding insulin units is unnecessary at this
time (answer 3). Fluid management is critical to managing AKI; therefore administration of a
fluid bolus with normal saline would be the best choice for this patient.
Don't know?
2 of 52
Term
16. A 35-year-old patient presents to the emergency department with a 10-day
history of dysuria, abdominal pain, vomiting, and flank pain. He is diagnosed
with pyelonephritis and is prescribed a 14-day course of
trimethoprim/sulfamethazine tablet double strength. His medical history
includes hypertension, osteoarthritis, and hypothyroidism. His medications are
captopril 50 mg twice daily, acetaminophen 500 mg three times per day, and
levothyroxine 105 mcg/day. Which drug can cause pseudonephrotoxicity?
1. Captopril.
2. Acetaminophen.
3. Levothyroxine.
4. Trimethoprim/sulfamethazine.
Give this one a try later!
4. Trimethoprim/sulfamethazine.
Rationale: Captopril (answer 1) is an angiotensin-converting enzyme inhibitor (ACEi)
that can cause vasodilatation of efferent arterioles and lead to decrease of glomerular
hydrostatic pressure; thus an ACEi can cause functional acute kidney injury (AKI).
Acetaminophen (answer 2) is metabolized by N-acetyl-p-benzoquinone, which is
, produced by liver. Levothyroxine (answer 3) has not been shown to have any
nephrotoxicity symptoms. Trimethoprim/sulfamethazine (answer 4) could inhibit the
tubular secretion of creatinine and leads to pseudonephrotoxicity.
4. 3 mg/mL.
Rationale: The fraction of drug excreted in the urine can determine the proper dose of a drug
when specific dosing guidelines are not available. The Rowland–Tozer equation can determine
the percentage of the usual dosage to give a patient with known kidney disease (Q),
considering the ratio of the patient's renal function to normal.
If the usual dose of drug X is 400 mg/day, so the adjusted dose will be 300 mg/day
(400 × 0.75) = 300. Thus the patient should receive 3 mL of the 100 mg/mL preparation (300
mg/100 mg/mL). Therefore answers 1, 2, and 3 are incorrect.
3. Metformin.
Rationale: The patient has chronic kidney disease history with an elevated serum creatinine.
Metformin should be interrupted for two reasons. One reason is that metformin is historically
contraindicated for patient with serum creatinine is greater than 1.5 mg/dL in men and 1.4
mg/dL in women because it would increase the risk of lactic acidosis. Metformin also should
be interrupted if the patient is to undergo procedures using iodinated contrast dye in 24
hours because of the risk of nephrotoxicity. It should then reinitiated after 48 hours.
Therefore answers 1, 2, and 4 are incorrect.
