Final Exam: NR 574/ NR574 (New 2026/
2027 Update) Acute Care Practicum I
Guide| Questions & Answers| Grade
A| Correct (Verified Solutions)-
Chamberlain
What are common trauma-related risk factors for Rhabdomyolysis?
Trauma, muscle compression, or ischemia
What are examples of trauma-related causes of Rhabdomyolysis?
Compartment syndrome, crush injuries, lightning strike, near-drowning, significant
burns, blunt force trauma, high-voltage electrical injuries, prolonged immobilization
following a fall
What heat-related conditions can lead to Rhabdomyolysis?
Heatstroke, malignant hyperthermia, and neuroleptic malignant syndrome
What infections can directly attack muscle and cause Rhabdomyolysis?
Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus, human
immunodeficiency virus (HIV), coxsackievirus, influenza A/B, herpes simplex virus
(HSV), Varicella-zoster virus (VZV), E. Coli, C. perfringens, Legionella, Rickettsia,
Group B beta-hemolytic streptococci, S. pneumoniae, S. pyogenes
What metabolic factors can contribute to Rhabdomyolysis?
,Electrolyte imbalances (hypocalcemia, hypophosphatemia, hypokalemia, hypo-and
hypernatremia), hypothyroidism, hyperglycemic hyperosmolar nonketotic syndrome
Rhabdomylosis risk factors
Genetic factors Phosphofructokinase deficiency, myoadenylate deaminase deficiency
phosphoglycerate kinase deficiency, mitochondrial respiratory chain enzyme
deficiencies, sickle cell trait, etc.
Medications that may cause direct myotoxicity
HMG-CoA reductase inhibitors, cyclosporin, corticosteroids, zidovudine, colchicine,
itraconazole
Toxins which may cause indirect myotoxicity
CNS depressants, alcohol, heroin, cocaine, ethanol, ketamine, barbiturates,
amphetamines, caffeine, neuromuscular blocking agents, ecstasy, carbon monoxide,
snake, or spider venom, etc.
Exertional activity
Marathons, high-intensity interval training, intense repetitive physical activity especially
in untrained people, activities causing dehydration or performed in hot or humid
conditions
Nutritional supplements which contain substances that may induce muscle
injuryEphedra, creatine, or large doses of caffeine
Clinical presentation of Rhabdo (subjective)
Classic clinical findings characteristic of rhabdomyolysis includes dark urine, muscle
pain, and muscle weakness. However, myoglobin is rapidly excreted and metabolized to
bilirubin (half-life 2-3 hours) so visible changes in the urine may no longer be observable
by the time the client seeks care.
Physical exam finidings of Rhabdo
Physical exam findings in clients with rhabdomyolysis may also include:
muscle tenderness
soft tissue swelling
bruising
,skin changes consistent with pressure necrosis
muscle weakness
confusion, delirium, agitation
anuria
How do you diagnose Rhabdo
dark urine, acute neuromuscluar illness without other symptoms PLUS acute elevation
in serum creatinine kinase (typically 5x the upper limit of normal)
what is the most reliable lab for Rhabdo?
CK
it will be markely elevated >1000
normal level is 45-260
Ck levels in rhabdo?
it begins to rise within 2-12 hours , peaks around 24-72 hrs following the injury. then the
levels decline 3-5 days of muscle injury cessation.
SERUM CK > 5,000 results in AKI
what test assesses the extent of injury to the muscles?
MRI
Complications for RHabdo?
Compartment syndrome is suspected in when CK levels continue to rise or fail to
decline following the inciting event. compartment pressures should be measured.
TX of Rhabdo?
, Fluids at least 400ml/hr to prevent AKI to maintain a UOP of at least 200ml/hr
in patients who CK levels are greater than 15,000 6L of IVF is required
what electrolyte imbalance are rhabdo patients at risk for?
Hypocalcemia - - not clinically signifant unless in a dysrhythmia
Hyperkalemia - - Dextrose, sodium bicarb, sodium polystyrene sulfonate , sometimes
HD
Hyperurecemia & Hyperphosphate usually dont require tx
Tx of rhabdo (2)
monitor for DIC, renal failure, seizure, ekg changes, hyperkalemia
acute Intestinal obstruction risk factors
Adhesions from previous abdominal surgery
Internal or external hernias
Foreign bodies
Feces
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and
malrotation)
Trauma (hematoma formation)
Inflammation (inflammatory bowel disease, diverticulitis, radiation, and tuberculosis)
Neoplasms including carcinomatosis, colon cancer, primary small bowel cancer, and
extraintestinal malignancies such as ovarian cancer
Endometriosis
Volvulus
Ischemic injury
Intussusception
Intraperitoneal abscess
How will the patient present in acute intestinal obstruction?
2027 Update) Acute Care Practicum I
Guide| Questions & Answers| Grade
A| Correct (Verified Solutions)-
Chamberlain
What are common trauma-related risk factors for Rhabdomyolysis?
Trauma, muscle compression, or ischemia
What are examples of trauma-related causes of Rhabdomyolysis?
Compartment syndrome, crush injuries, lightning strike, near-drowning, significant
burns, blunt force trauma, high-voltage electrical injuries, prolonged immobilization
following a fall
What heat-related conditions can lead to Rhabdomyolysis?
Heatstroke, malignant hyperthermia, and neuroleptic malignant syndrome
What infections can directly attack muscle and cause Rhabdomyolysis?
Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus, human
immunodeficiency virus (HIV), coxsackievirus, influenza A/B, herpes simplex virus
(HSV), Varicella-zoster virus (VZV), E. Coli, C. perfringens, Legionella, Rickettsia,
Group B beta-hemolytic streptococci, S. pneumoniae, S. pyogenes
What metabolic factors can contribute to Rhabdomyolysis?
,Electrolyte imbalances (hypocalcemia, hypophosphatemia, hypokalemia, hypo-and
hypernatremia), hypothyroidism, hyperglycemic hyperosmolar nonketotic syndrome
Rhabdomylosis risk factors
Genetic factors Phosphofructokinase deficiency, myoadenylate deaminase deficiency
phosphoglycerate kinase deficiency, mitochondrial respiratory chain enzyme
deficiencies, sickle cell trait, etc.
Medications that may cause direct myotoxicity
HMG-CoA reductase inhibitors, cyclosporin, corticosteroids, zidovudine, colchicine,
itraconazole
Toxins which may cause indirect myotoxicity
CNS depressants, alcohol, heroin, cocaine, ethanol, ketamine, barbiturates,
amphetamines, caffeine, neuromuscular blocking agents, ecstasy, carbon monoxide,
snake, or spider venom, etc.
Exertional activity
Marathons, high-intensity interval training, intense repetitive physical activity especially
in untrained people, activities causing dehydration or performed in hot or humid
conditions
Nutritional supplements which contain substances that may induce muscle
injuryEphedra, creatine, or large doses of caffeine
Clinical presentation of Rhabdo (subjective)
Classic clinical findings characteristic of rhabdomyolysis includes dark urine, muscle
pain, and muscle weakness. However, myoglobin is rapidly excreted and metabolized to
bilirubin (half-life 2-3 hours) so visible changes in the urine may no longer be observable
by the time the client seeks care.
Physical exam finidings of Rhabdo
Physical exam findings in clients with rhabdomyolysis may also include:
muscle tenderness
soft tissue swelling
bruising
,skin changes consistent with pressure necrosis
muscle weakness
confusion, delirium, agitation
anuria
How do you diagnose Rhabdo
dark urine, acute neuromuscluar illness without other symptoms PLUS acute elevation
in serum creatinine kinase (typically 5x the upper limit of normal)
what is the most reliable lab for Rhabdo?
CK
it will be markely elevated >1000
normal level is 45-260
Ck levels in rhabdo?
it begins to rise within 2-12 hours , peaks around 24-72 hrs following the injury. then the
levels decline 3-5 days of muscle injury cessation.
SERUM CK > 5,000 results in AKI
what test assesses the extent of injury to the muscles?
MRI
Complications for RHabdo?
Compartment syndrome is suspected in when CK levels continue to rise or fail to
decline following the inciting event. compartment pressures should be measured.
TX of Rhabdo?
, Fluids at least 400ml/hr to prevent AKI to maintain a UOP of at least 200ml/hr
in patients who CK levels are greater than 15,000 6L of IVF is required
what electrolyte imbalance are rhabdo patients at risk for?
Hypocalcemia - - not clinically signifant unless in a dysrhythmia
Hyperkalemia - - Dextrose, sodium bicarb, sodium polystyrene sulfonate , sometimes
HD
Hyperurecemia & Hyperphosphate usually dont require tx
Tx of rhabdo (2)
monitor for DIC, renal failure, seizure, ekg changes, hyperkalemia
acute Intestinal obstruction risk factors
Adhesions from previous abdominal surgery
Internal or external hernias
Foreign bodies
Feces
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and
malrotation)
Trauma (hematoma formation)
Inflammation (inflammatory bowel disease, diverticulitis, radiation, and tuberculosis)
Neoplasms including carcinomatosis, colon cancer, primary small bowel cancer, and
extraintestinal malignancies such as ovarian cancer
Endometriosis
Volvulus
Ischemic injury
Intussusception
Intraperitoneal abscess
How will the patient present in acute intestinal obstruction?
