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)--Exertional-
NR 574
,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-
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)--Exertional-
NR 574
,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-
