NR574 FINAL EXAM
Hepatorenal syndrome (HRS)
functional form of renal failure that occurs primarily in pt with cirrhosis and ascites.
Type 1 hepatorenal syndrome is characterized by...
-rapidly progressive renal impairment
-doubling of initial serum Cr to greater than 2.5mg/dL over a period less than 2 weeks
-without liver transplant prognosis is very poor
Type 2 hepatorenal syndrome is characterized by...
-moderate form of renal failure
-serum Cr levels between 1.5 to 2.5 mg/dL
reduction in GFR with elevation in serum creatinine
-associated with a more indolent course and improved survival compared to type 1
Risk Factors of hepatorenal syndrome
Dilutional hyponatremia
Previous episodes of ascites
Presence of esophageal varices
Poor nutritional status
Infections such as spontaneous bacterial peritonitis
Severe urinary sodium retention (urine sodium < 5 milliequivalents/liter [mEq/L])
Large-volume paracentesis without albumin replacement
Acute alcoholic hepatitis
Low mean arterial blood pressure (map <80 mm Hg)
subjective clinical presentation of hepatorenal syndrome
, Most clients with HRS have a known diagnosis of acute or chronic liver disease and present with
nonspecific symptoms including:
-dysgeusia (altered taste perception)
-malaise
-fatigue
-decreased urine output.
objective clinical presentation of hepatorenal syndrome
HRS has no characteristic physical exam findings.
It is important to assess the client for stigmata of chronic liver disease including:
-spider nevi
-scleral icterus
-lower extremity edema
-asterixis
-abdominal distention
-fluid wave
-paraumbilical hernia
-bruits.
A 28-year-old woman is seen in a sexually transmitted disease clinic and is diagnosed with Chlamydia
trachomatis. An HIV antibody test is ordered. Which one of the following statements is TRUE
regarding laboratory-based HIV antibody tests that are approved for use by the United States Food
and Drug Administration?
a. The IgG-sensitive antibody tests detect HIV sooner after infection than the IgM/IgG-sensitive
antibody tests
b. Recent inoculation with the influenza vaccine is a known cause of a false-positive result
c. The most common cause of a false-negative test is coinfection with hepatitis C virus
d. The IgM/IgG-sensitive antibody tests detect HIV sooner after infection than HIV p24 antigen tests
e. None of the IgM/IgG-sensitive antibody tests can detect HIV-2
Recent inoculation with the influenza vaccine is a known cause of a false-positive result (Correct
answer)
Rationale: The IgM/IgG-sensitive assays detect HIV sooner after infection than the IgG-sensitive
assays. The laboratory-based IgG-sensitive assays detect HIV later after initial HIV acquisition than the
IgM/IgG-sensitive assays. The most notable causes of a false-positive HIV antibody test are pregnancy,
recent inoculation with influenza vaccine, autoimmune disorders, immunization with an
investigational HIV-1 vaccine, hypergammaglobulinemia, receipt of gamma globulin, prior blood
transfusions, HTLV-1/2 infection, and collagen vascular diseases. With HIV antibody tests, the most
common cause of a false-negative test is acute HIV infection.
A 31-year-old woman has exposure to HIV after a condom broke while having vaginal sex with her
partner who has HIV. She has follow-up HIV testing related to this exposure. Which one of the
following best describes the window period?
Hepatorenal syndrome (HRS)
functional form of renal failure that occurs primarily in pt with cirrhosis and ascites.
Type 1 hepatorenal syndrome is characterized by...
-rapidly progressive renal impairment
-doubling of initial serum Cr to greater than 2.5mg/dL over a period less than 2 weeks
-without liver transplant prognosis is very poor
Type 2 hepatorenal syndrome is characterized by...
-moderate form of renal failure
-serum Cr levels between 1.5 to 2.5 mg/dL
reduction in GFR with elevation in serum creatinine
-associated with a more indolent course and improved survival compared to type 1
Risk Factors of hepatorenal syndrome
Dilutional hyponatremia
Previous episodes of ascites
Presence of esophageal varices
Poor nutritional status
Infections such as spontaneous bacterial peritonitis
Severe urinary sodium retention (urine sodium < 5 milliequivalents/liter [mEq/L])
Large-volume paracentesis without albumin replacement
Acute alcoholic hepatitis
Low mean arterial blood pressure (map <80 mm Hg)
subjective clinical presentation of hepatorenal syndrome
, Most clients with HRS have a known diagnosis of acute or chronic liver disease and present with
nonspecific symptoms including:
-dysgeusia (altered taste perception)
-malaise
-fatigue
-decreased urine output.
objective clinical presentation of hepatorenal syndrome
HRS has no characteristic physical exam findings.
It is important to assess the client for stigmata of chronic liver disease including:
-spider nevi
-scleral icterus
-lower extremity edema
-asterixis
-abdominal distention
-fluid wave
-paraumbilical hernia
-bruits.
A 28-year-old woman is seen in a sexually transmitted disease clinic and is diagnosed with Chlamydia
trachomatis. An HIV antibody test is ordered. Which one of the following statements is TRUE
regarding laboratory-based HIV antibody tests that are approved for use by the United States Food
and Drug Administration?
a. The IgG-sensitive antibody tests detect HIV sooner after infection than the IgM/IgG-sensitive
antibody tests
b. Recent inoculation with the influenza vaccine is a known cause of a false-positive result
c. The most common cause of a false-negative test is coinfection with hepatitis C virus
d. The IgM/IgG-sensitive antibody tests detect HIV sooner after infection than HIV p24 antigen tests
e. None of the IgM/IgG-sensitive antibody tests can detect HIV-2
Recent inoculation with the influenza vaccine is a known cause of a false-positive result (Correct
answer)
Rationale: The IgM/IgG-sensitive assays detect HIV sooner after infection than the IgG-sensitive
assays. The laboratory-based IgG-sensitive assays detect HIV later after initial HIV acquisition than the
IgM/IgG-sensitive assays. The most notable causes of a false-positive HIV antibody test are pregnancy,
recent inoculation with influenza vaccine, autoimmune disorders, immunization with an
investigational HIV-1 vaccine, hypergammaglobulinemia, receipt of gamma globulin, prior blood
transfusions, HTLV-1/2 infection, and collagen vascular diseases. With HIV antibody tests, the most
common cause of a false-negative test is acute HIV infection.
A 31-year-old woman has exposure to HIV after a condom broke while having vaginal sex with her
partner who has HIV. She has follow-up HIV testing related to this exposure. Which one of the
following best describes the window period?
