NRNP 6566 Week 10 Knowledge Check

1. Question: A 57 year old female is admitted to the oncology unit for chemotherapy related to her to acute leukemia. Her initial dose of chemo was 2 days ago. While rounding today, the patients tells the NP that she feels so weak. The NP notes her heart rate is 44 today (down from 68 2 days ago). She has had less than 100 cc of urine out over the last 24 hours……. What is your working diagnosis for this patient? How would you treat her? 2. Question: Using the Cockcroft and Gault formula, calculate the estimated GFR for the following patient. 52 year old female weighting 177 pounds. Plasma creatinine is 3.3 3. Question: How would you calculate the fractional excretion of sodium? What does this calculation tell you about the patient’s acute kidney injury? 4. Question: A 44 year old female is NPO following surgery for a bowel obstruction. She weighs 166 pounds. How would you calculate her daily maintenance IV fluid need while she is NPO? 5. Question: A 65 year old man is admitted with left lobar pneumonia. His symptoms on admission included productive cough, fever, dyspnea, confusion, nausea vomiting, constipation, and weakness. He has a 45 pack year history of smoking. He admits to losing 35 pounds over the past 4 months but his wife says he thought that was because of his poor appetite, feeling bad, and no energy……. What is the most likely diagnosis and how would you treat it? 6. Question: A 70 year old man is 4 hours post right heme-colectomy for a tumor. The NP is called due to falling urine output since surgery.Past medical history - hypertension, type 2 diabetes, gout Medications - lisinopril, allopurinol, and spironolactone (all last given this morning).Physical exam - BP 100/60. HR 110 regular weight 60 kg. Lungs are clear, abdominal wound is clean with no drainage, No JVD…….How would you classify his renal status? How would you treat it? 7. Question: An 87 year male is brought to the emergency department from a nursing home by his family with concerns about his functional status. They state that over the past week he is very somnolent and not participating in his own care very much. The family is worried that he has had a stroke or is overmedicated by the nursing homestaff.Medicalrecordfromthenursinghomeshowsthatheisdisruptiveand has daily wrist restraintsordered.The patient is arousable but somnolent when no one is speaking with him. His past medical history is unremarkable. He was placed in the nursing home due to his age and inability to care for himself at home. His family states that he is usually quite alert and interactive. The patient is widowed and has been at the nursing home for about 2 months.He has no routine medications but several PRN mediations includinghaloperidol, valium, and milk ofmagnesia. BP 100/53 T 98.3 HR 88 RR14. Mucous membranes are dry. Pulmonary, cardiovascular, abdominal, and extremity examinations are normal. Chest x-ray shows no infiltrate and voided urine shows no evidenced of UTI…….What is your working diagnosis for this patient? How would you treat it? 8. Question: A 65 year old woman is brought to the ED by her family for increasing confusion and lethargy over the past week. She was recently diagnosed with small cell cancer of the lung. She has not had any fever or recent illness. She takes no medications at this time.PE - BP 136/82 HR 84 RR 14 T 98.2 Elderly appearing women who is difficult to arouse and reacts only to painful stimuli. She moves her extremities without apparent motor deficit. Her reflexesare normal. No JVD or extremity edema is present.Na 108 K 3.8 Bicarb 24 BUN 5 Cr 0.5 Serum osmolality 220 urine osmolality 400 CT Scan of the head shows no brain masses or hydrocephalus…….What is your working diagnosis? What is the next step in her treatment? 9. Question:TheNPreceivedaurgentconsultrequestfora52yearoldwomenwithendstage renal disease. The patient is in the endoscopy area undergoing a colonoscopy for renal transplant evaluation. While awaiting the colonoscopy to being, the patient is noted to have weakness, irritability and is obtunded. She does not arouse to her name but responds appropriate to painful stimuli. Her breathing appears labored and her muscles are very flaccid. The patient’s son indicated that thereis nothing new or different with the patient over the last day except two bottles of Citromag (magnesium citrate) as part of the bowel prep for thecolonscopy. Past medical history - end stage renal disease, hypertension, anemia. No drug clergies Current medications include metoprolol, lisinopril, sevelamer, cinacalcet, and Aranesp given at dialysis. Physical exam - patient is essentially unresponsive. BP 91/35 HR 44 RR 6 Rest of the exam is essentially 10. Question:52 year old female with history of chronic kidney disease and acute onset of lower extremity weakness. Historically has been non complaint with her dietary restrictions BP = 166/94, HR = 105, no fever, bilateral lower extremity weakness…….What is your working diagnosis for this patient? What are the critical interventions? What is your working diagnosis? How would you treat this patient?