NR574 ACUTE CARE PRACTUM
COMPREHENSIVE ASSESSMENT 2026 SOLVED
QUESTIONS VERIFIED
◉ A 22-year-old man presents for follow-up after a recent diagnosis
of HIV. He has an initial CD4 count of 390 cells/mm3 and his HIV
RNA level is46,120 copies/mL; a baseline genotype resistance assay
shows no evidence of antiretroviral resistance. He is motivated to
start antiretroviral therapy and states that he can take medications
without issue. According to the Adult and Adolescent Antiretroviral
(ARV) Guidelines, which one of the following best describes the
recommendations for starting antiretroviral therapy in treatment-
naïve persons with HIV? Answer: Antiretroviral therapy is
recommended for all persons with HIV
◉ A 51-year-old transgender woman (she/her/hers) with HIV has
been stable for the last 3 years on an antiretroviral regimen of
darunavir-cobicistat and tenofovir DF-emtricitabine. Despite
changing to a healthier diet and increas- ing her exercise, lipid
values remain elevated : total cholesterol 268 mg/dL, low-density
lipoprotein (LDL) 198 mg/dL, high-density lipoprotein (HDL) 35
mg/dL, and triglycerides 220 mg/dL. She has a strong family history
of car- diovascular disease, and her father had a myocardial
infarction at age 52.She does not want to consider modifying the
antiretroviral regimen but agrees to start lipid-lowering therapy.
,Which one of the following HMG-CoA reductase inhibitors ("statins")
is contraindicated for use in this woman? Answer: Simvastatin
◉ What is a TIPS procedure? Answer: The TIPS procedure bypasses
a portion of the hepatic circulation by shunting blood flow from the
portal vein to the hepatic vein-This reduces portal pressure and
minimizes back pressure on the splanchnic organs. This also
decreases the likelihood of bleeding from the esophageal varies and
reduces the amount of ascites
*Hemorrhage is a significant risk during TIPS
◉ What is the treatment of choice for both type 1 and type 2 HRS?
Answer: Liver transplant
◉ What medications are used to tx type 2 HRS? Answer:
vasoconstrictors (terlipressin, midodrine in combination with
octriotide, norepinephrine) combined with albumin.
◉ Bridge to transplant in Hepatorenal syndrome Answer: The
combination of octreotide, midodrine, and albumin (triple therapy)
is used to treat hepatorenal syndrome (HRS) often as a bridge to
liver transplantation (LT).
◉ Module ** Bridge to transplant** Answer: In clients who do not
respond to medical therapy, are not candidates for TIPS but are
,candidates for liver transplantation or recovery for their liver
disease, continuous renal replacement therapy can be utilized as a
bridge to recovery or transplantation. HRS clients typically do not
tolerate hemodialysis well.
◉ Joaquin is a 22-year-old male who presents to the emergency
department (ED) with a 1-week history of headache, concentration
difficulty, fatigue, nau- sea, and vague abdominal pain. He became
concerned this morning whenhe noticed that the whites of his eyes
appeared yellow. History is significant for epilepsy, which he has had
since childhood but is well-controlled with antiepileptic medication.
There is no known history of liver disease. Notable physical exam
findings include scleral icterus, generalized abdominal tender- ness,
and new-onset ascites. Urine alcohol and drug screen were negative.
Labs reveal severe transaminitis, hyperbilirubinemia,
hyperammonemia, and coagulopathy. The most likely diagnosis is
Answer: Acute liver failure
◉ Chadwick presents to the ED following a suicide attempt. He
reports swallowing approximately 10,000 milligrams (mg) of
acetaminophen 4-hours ago. An hour ago, he began to develop
generalized abdominal pain, nausea, and vomiting at which time he
asked his brother to take him to the hospital. Shortly after arrival, he
becomes confused and agitated. Labs reveal INR of 3.0, acute kidney
injury (AKI) with creatinine 2.0, severe transaminitis, and lactic
acidosis. Urine toxicology showed an acetaminophen level of 200
milligrams per kilogram. Serum alcohol was negative. The AGACNP
, knows that the best initial treatment for Chadwick is: Answer:
Administer N-acetylcysteine (Mucomyst)
◉ Rhabdomyolysis Answer: Rhabdomyolysis is a potentially life-
threatening condition that occurs following skeletal muscle injury.-
dissolution of striated muscle (caused by trauma, extreme exertion,
or drug toxicity;in severe cases renal failure can result)
◉ When the muscle injury occurs, what is released into the blood
stream? Answer: muscle fibers release large quantities of potassium,
phosphate, creatinine kinase(CK), and myoglobin, a small protein
that binds oxygen, into the circulation.-As an unbound protein,
myoglobin is excreted by the kidneys but can precipitate and cause
renal tubular obstruction.
◉ What happens to myoglobin in Rhabdo? Answer: myoglobin is
release from skeletal muscle during injury. it binds to oxygenin
excessive amount, as see with rhabdo, it is unbound. when unbound
it has to be excreted through the kidneys which can cause renal
tubular obstruction.
◉ Risk factors of Rhabdomyolysis Answer: Trauma, muscle
compression, or ischemiaHeat-related causesInfection with bacteria
or viruses that can directly attack the muscleMetabolic
factorsGenetic factorsMedications that may cause direct myotoxicity
Toxins which may cause indirect myotoxicity Exertional activity
COMPREHENSIVE ASSESSMENT 2026 SOLVED
QUESTIONS VERIFIED
◉ A 22-year-old man presents for follow-up after a recent diagnosis
of HIV. He has an initial CD4 count of 390 cells/mm3 and his HIV
RNA level is46,120 copies/mL; a baseline genotype resistance assay
shows no evidence of antiretroviral resistance. He is motivated to
start antiretroviral therapy and states that he can take medications
without issue. According to the Adult and Adolescent Antiretroviral
(ARV) Guidelines, which one of the following best describes the
recommendations for starting antiretroviral therapy in treatment-
naïve persons with HIV? Answer: Antiretroviral therapy is
recommended for all persons with HIV
◉ A 51-year-old transgender woman (she/her/hers) with HIV has
been stable for the last 3 years on an antiretroviral regimen of
darunavir-cobicistat and tenofovir DF-emtricitabine. Despite
changing to a healthier diet and increas- ing her exercise, lipid
values remain elevated : total cholesterol 268 mg/dL, low-density
lipoprotein (LDL) 198 mg/dL, high-density lipoprotein (HDL) 35
mg/dL, and triglycerides 220 mg/dL. She has a strong family history
of car- diovascular disease, and her father had a myocardial
infarction at age 52.She does not want to consider modifying the
antiretroviral regimen but agrees to start lipid-lowering therapy.
,Which one of the following HMG-CoA reductase inhibitors ("statins")
is contraindicated for use in this woman? Answer: Simvastatin
◉ What is a TIPS procedure? Answer: The TIPS procedure bypasses
a portion of the hepatic circulation by shunting blood flow from the
portal vein to the hepatic vein-This reduces portal pressure and
minimizes back pressure on the splanchnic organs. This also
decreases the likelihood of bleeding from the esophageal varies and
reduces the amount of ascites
*Hemorrhage is a significant risk during TIPS
◉ What is the treatment of choice for both type 1 and type 2 HRS?
Answer: Liver transplant
◉ What medications are used to tx type 2 HRS? Answer:
vasoconstrictors (terlipressin, midodrine in combination with
octriotide, norepinephrine) combined with albumin.
◉ Bridge to transplant in Hepatorenal syndrome Answer: The
combination of octreotide, midodrine, and albumin (triple therapy)
is used to treat hepatorenal syndrome (HRS) often as a bridge to
liver transplantation (LT).
◉ Module ** Bridge to transplant** Answer: In clients who do not
respond to medical therapy, are not candidates for TIPS but are
,candidates for liver transplantation or recovery for their liver
disease, continuous renal replacement therapy can be utilized as a
bridge to recovery or transplantation. HRS clients typically do not
tolerate hemodialysis well.
◉ Joaquin is a 22-year-old male who presents to the emergency
department (ED) with a 1-week history of headache, concentration
difficulty, fatigue, nau- sea, and vague abdominal pain. He became
concerned this morning whenhe noticed that the whites of his eyes
appeared yellow. History is significant for epilepsy, which he has had
since childhood but is well-controlled with antiepileptic medication.
There is no known history of liver disease. Notable physical exam
findings include scleral icterus, generalized abdominal tender- ness,
and new-onset ascites. Urine alcohol and drug screen were negative.
Labs reveal severe transaminitis, hyperbilirubinemia,
hyperammonemia, and coagulopathy. The most likely diagnosis is
Answer: Acute liver failure
◉ Chadwick presents to the ED following a suicide attempt. He
reports swallowing approximately 10,000 milligrams (mg) of
acetaminophen 4-hours ago. An hour ago, he began to develop
generalized abdominal pain, nausea, and vomiting at which time he
asked his brother to take him to the hospital. Shortly after arrival, he
becomes confused and agitated. Labs reveal INR of 3.0, acute kidney
injury (AKI) with creatinine 2.0, severe transaminitis, and lactic
acidosis. Urine toxicology showed an acetaminophen level of 200
milligrams per kilogram. Serum alcohol was negative. The AGACNP
, knows that the best initial treatment for Chadwick is: Answer:
Administer N-acetylcysteine (Mucomyst)
◉ Rhabdomyolysis Answer: Rhabdomyolysis is a potentially life-
threatening condition that occurs following skeletal muscle injury.-
dissolution of striated muscle (caused by trauma, extreme exertion,
or drug toxicity;in severe cases renal failure can result)
◉ When the muscle injury occurs, what is released into the blood
stream? Answer: muscle fibers release large quantities of potassium,
phosphate, creatinine kinase(CK), and myoglobin, a small protein
that binds oxygen, into the circulation.-As an unbound protein,
myoglobin is excreted by the kidneys but can precipitate and cause
renal tubular obstruction.
◉ What happens to myoglobin in Rhabdo? Answer: myoglobin is
release from skeletal muscle during injury. it binds to oxygenin
excessive amount, as see with rhabdo, it is unbound. when unbound
it has to be excreted through the kidneys which can cause renal
tubular obstruction.
◉ Risk factors of Rhabdomyolysis Answer: Trauma, muscle
compression, or ischemiaHeat-related causesInfection with bacteria
or viruses that can directly attack the muscleMetabolic
factorsGenetic factorsMedications that may cause direct myotoxicity
Toxins which may cause indirect myotoxicity Exertional activity
