1
NR
NR 574/ NR574 FINAL EXAM: ACUTE CARE
PRACTICUM I GUIDE| QUESTIONS & ANSWERS| GRADE
A| 100% CORRECT (NEW 2025/ 2026 UPDATE)
(VERIFIED SOLUTIONS)- CHAMBERLAIN
1. What can happen if you only transfuse PRBCs during an
acute hemorrhage?: does not replace the plasma and other
clotting factors the client is losing during hemorrhage. This can
lead to coagulopathy and clotting problems as well as difficulty
with volume status.
2. Risk factors for rhabdomyolysis: -trauma, muscle
compression, or ischemia
-Heat-related causes (heat, stroke, malignant hypothermia,
neuroleptic malignant syndrome)
-Infection with bacteria or viruses that can directly attack a muscle
(EBV, CMV, virus, HIV, Coxsackie, influenza, HSV, VZV, E. coli,
legionella, Rickettsia, GBS, etc.)
-Metabolic factors (hypocalcemia, hypophosphatemia,
hypokalemia, hypo/hyponatremia, HHS, hypothyroid)
NR 574
,-Exertional activities (marathons, high intensity interval training,
intense repetitive physical activity, especially in untrained people
causing dehydration or performed and hot or humid conditions)
-nutritional supplements containing substances that may cause
muscle 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 of
normal)
4. CK in rhabdomyolysis: • most reliable test for dx
rhabdomyolysis
• will be marketing elevated, typically > 1000
• Begins to rise within 2-12 hours and continues to rise until peaks
around 24-72 hours following onset of injury
, 3
NR
•half-life 1.5 days, and level declines within 3-5 days of muscle
injury cessation • CK > 5000 often results in AKI
5. Serum myoglobin in rhabdomyolysis: • Released from cells
immediately when skeletal muscle is injured and rises rapidly in
serum
• Excreted rapidly so levels may return to normal within 6-8
hours of injury (half-life 2-3 hrs)
• Normal serum myoglobin does not exclude rhabdomyolysis
as 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 per
laboratory)
8. urine myoglobin: -Appears in the urine when serum
concentrations exceed 1.5 mg/dl
-makes urine red-brown, tea-colored when you're in myoglobin
levels exceed >3000 IU/L
9. Normal urine myoglobin levels: 0-5 IU/L
10. Urine myoglobin on dipstick: Detectable as "blood" with
concentrations as low as 0.5 mg/dL, even long after urine has
returned to its usual color
Therefore, urine color does not exclude rhabdomyolysis as a dx
NR 574
, 11. AST in rhabdomyolysis: Often elevated due to skeletal
muscle injury
Significant transaminitis may also be present with rhabdomyolysis
12. Electrolyte imbalances commonly seen with
rhabdomyolysis: • hyperkalemia
• hyperphosphatemia
• hyperuricemia
• hypocalcemia
13. Kidney function with rhabdomyolysis: BUN and creatinine
will rise as renal function is impaired
14. PTT/APTT in rhabdomyolysis: Prolonged bleeding times are
associated with rhabdomyolysis induced disseminated
intervascular coagulation (DIC).
15. Treatment of rhabdomyolysis: • fluid resuscitation: isotonic
IVF @ 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 IV
glucose, insulin, sodium bicarb, sodium polystyrene sulfonate.
HD for severe refractory cases. ~ Hypocalcemia typically present
NR
NR 574/ NR574 FINAL EXAM: ACUTE CARE
PRACTICUM I GUIDE| QUESTIONS & ANSWERS| GRADE
A| 100% CORRECT (NEW 2025/ 2026 UPDATE)
(VERIFIED SOLUTIONS)- CHAMBERLAIN
1. What can happen if you only transfuse PRBCs during an
acute hemorrhage?: does not replace the plasma and other
clotting factors the client is losing during hemorrhage. This can
lead to coagulopathy and clotting problems as well as difficulty
with volume status.
2. Risk factors for rhabdomyolysis: -trauma, muscle
compression, or ischemia
-Heat-related causes (heat, stroke, malignant hypothermia,
neuroleptic malignant syndrome)
-Infection with bacteria or viruses that can directly attack a muscle
(EBV, CMV, virus, HIV, Coxsackie, influenza, HSV, VZV, E. coli,
legionella, Rickettsia, GBS, etc.)
-Metabolic factors (hypocalcemia, hypophosphatemia,
hypokalemia, hypo/hyponatremia, HHS, hypothyroid)
NR 574
,-Exertional activities (marathons, high intensity interval training,
intense repetitive physical activity, especially in untrained people
causing dehydration or performed and hot or humid conditions)
-nutritional supplements containing substances that may cause
muscle 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 of
normal)
4. CK in rhabdomyolysis: • most reliable test for dx
rhabdomyolysis
• will be marketing elevated, typically > 1000
• Begins to rise within 2-12 hours and continues to rise until peaks
around 24-72 hours following onset of injury
, 3
NR
•half-life 1.5 days, and level declines within 3-5 days of muscle
injury cessation • CK > 5000 often results in AKI
5. Serum myoglobin in rhabdomyolysis: • Released from cells
immediately when skeletal muscle is injured and rises rapidly in
serum
• Excreted rapidly so levels may return to normal within 6-8
hours of injury (half-life 2-3 hrs)
• Normal serum myoglobin does not exclude rhabdomyolysis
as 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 per
laboratory)
8. urine myoglobin: -Appears in the urine when serum
concentrations exceed 1.5 mg/dl
-makes urine red-brown, tea-colored when you're in myoglobin
levels exceed >3000 IU/L
9. Normal urine myoglobin levels: 0-5 IU/L
10. Urine myoglobin on dipstick: Detectable as "blood" with
concentrations as low as 0.5 mg/dL, even long after urine has
returned to its usual color
Therefore, urine color does not exclude rhabdomyolysis as a dx
NR 574
, 11. AST in rhabdomyolysis: Often elevated due to skeletal
muscle injury
Significant transaminitis may also be present with rhabdomyolysis
12. Electrolyte imbalances commonly seen with
rhabdomyolysis: • hyperkalemia
• hyperphosphatemia
• hyperuricemia
• hypocalcemia
13. Kidney function with rhabdomyolysis: BUN and creatinine
will rise as renal function is impaired
14. PTT/APTT in rhabdomyolysis: Prolonged bleeding times are
associated with rhabdomyolysis induced disseminated
intervascular coagulation (DIC).
15. Treatment of rhabdomyolysis: • fluid resuscitation: isotonic
IVF @ 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 IV
glucose, insulin, sodium bicarb, sodium polystyrene sulfonate.
HD for severe refractory cases. ~ Hypocalcemia typically present
