NR575 AGACNP Certification Review
Renal and Genitourinary
1. The white woman, 64 years old, weighs 90 kilograms, and she presents to the clinic with
abdominal pain and drowsiness. She says that due to her history of gastroenteritis, she
didn't eat or drink for 24 hours. During the examination, the patient's sitting blood pressure is
120/85 mmHg, while their standing blood pressure is 90/60 mmHg. 95 beats per minute is
her heart rate. Sodium (Na) is 140 mEq/L, potassium (K) is 4 mEq/L, chloride (Cl) is 105
mEq/L, blood urea nitrogen is 42 mg/dL, serum creatinine is 1.3 mg/dL, and glucose is 190
mg/dL, according to the tests performed in the laboratory. What is this patient's best course
of action? 1. Take trimethoprim and sulfamethazine in double doses orally for three days. 2.
Furosemide 40 mg should be given intravenously. 3. Administer Insulin lispro 5 units
subcutaneously.
4. Apply a bolus of fluid (500 milliliters of NaCl solution). 4. Administer fluid bolus (500 mL
of NaCl solution)
The patient presents with acute kidney injury (AKI) symptoms, and the first step in treating
AKI is to identify and, if possible, reverse the kidney injury. Due to increased heart rate and
hypotension, this patient has prerenal azotemia. This patient would not benefit from taking
sulfa antibiotics because she does not show any signs of urinary tract infections (answer 1).
Diuretics like furosemide (answer 2) could make her volume depletion worse and probably
hurt her kidneys even more. Although the glucose level is elevated, adding insulin units is
unnecessary at this time (answer 3). Since fluid management is essential to AKI
management, the best course of action for this patient would be to administer a fluid bolus
containing normal saline. 2. Diabetes, hypertension, and an estimated glomerular filtration
rate of 40 mL/min/1.73 m2 characterize a 63-year-old Asian man. He takes metformin 1000
mg twice daily, ramipril 10 mg daily, and simvastatin 40 mg daily. Hemoglobin is 12 mg/dL,
parathyroid hormone is 200 pg/mL, calcium is 8.9 mEq/dL, albumin is 3.5 g/dL, phosphorus
is 5.9 mg/dL, and 25-hydroxyvitamin D is 50 ng/mL, according to laboratory results. Which
therapy is the best to prevent chronic kidney disease-mineral and bone disorders?
1. Cinacalcet.
2. Ergocalciferol.
3. Calcium carbonate.
4. Calcitriol.
3. Calcium carbonate.
Justification: Mineral and bone disorders like hypocalcemia, hyperparathyroidism,
hyperphosphatemia, a lack of vitamin D, and a decrease in the production of
1.25-dihydroxyvitamin D are just a few of the many things that can make chronic kidney
disease more likely. The patient's lab results show hyperparathyroidism, which could be
caused by an increase in phosphorus levels. Utilizing a phosphate binder is the first strategy.
Knowing the corrected calcium concentration is necessary for this patient. This patient has
hypocalcemia because [measured Ca + (0.8) (4 serum albumin) = 8.9 + (0.8) (4 3.5) = 8.9
+ 0.4 = 9.3 mEq/dL] Despite the fact that hypercalcemia patients' phosphate levels return to
normal, Cinacalcet (answer 1) is only prescribed to those with hyperparathyroidism. Because
Renal and Genitourinary
1. The white woman, 64 years old, weighs 90 kilograms, and she presents to the clinic with
abdominal pain and drowsiness. She says that due to her history of gastroenteritis, she
didn't eat or drink for 24 hours. During the examination, the patient's sitting blood pressure is
120/85 mmHg, while their standing blood pressure is 90/60 mmHg. 95 beats per minute is
her heart rate. Sodium (Na) is 140 mEq/L, potassium (K) is 4 mEq/L, chloride (Cl) is 105
mEq/L, blood urea nitrogen is 42 mg/dL, serum creatinine is 1.3 mg/dL, and glucose is 190
mg/dL, according to the tests performed in the laboratory. What is this patient's best course
of action? 1. Take trimethoprim and sulfamethazine in double doses orally for three days. 2.
Furosemide 40 mg should be given intravenously. 3. Administer Insulin lispro 5 units
subcutaneously.
4. Apply a bolus of fluid (500 milliliters of NaCl solution). 4. Administer fluid bolus (500 mL
of NaCl solution)
The patient presents with acute kidney injury (AKI) symptoms, and the first step in treating
AKI is to identify and, if possible, reverse the kidney injury. Due to increased heart rate and
hypotension, this patient has prerenal azotemia. This patient would not benefit from taking
sulfa antibiotics because she does not show any signs of urinary tract infections (answer 1).
Diuretics like furosemide (answer 2) could make her volume depletion worse and probably
hurt her kidneys even more. Although the glucose level is elevated, adding insulin units is
unnecessary at this time (answer 3). Since fluid management is essential to AKI
management, the best course of action for this patient would be to administer a fluid bolus
containing normal saline. 2. Diabetes, hypertension, and an estimated glomerular filtration
rate of 40 mL/min/1.73 m2 characterize a 63-year-old Asian man. He takes metformin 1000
mg twice daily, ramipril 10 mg daily, and simvastatin 40 mg daily. Hemoglobin is 12 mg/dL,
parathyroid hormone is 200 pg/mL, calcium is 8.9 mEq/dL, albumin is 3.5 g/dL, phosphorus
is 5.9 mg/dL, and 25-hydroxyvitamin D is 50 ng/mL, according to laboratory results. Which
therapy is the best to prevent chronic kidney disease-mineral and bone disorders?
1. Cinacalcet.
2. Ergocalciferol.
3. Calcium carbonate.
4. Calcitriol.
3. Calcium carbonate.
Justification: Mineral and bone disorders like hypocalcemia, hyperparathyroidism,
hyperphosphatemia, a lack of vitamin D, and a decrease in the production of
1.25-dihydroxyvitamin D are just a few of the many things that can make chronic kidney
disease more likely. The patient's lab results show hyperparathyroidism, which could be
caused by an increase in phosphorus levels. Utilizing a phosphate binder is the first strategy.
Knowing the corrected calcium concentration is necessary for this patient. This patient has
hypocalcemia because [measured Ca + (0.8) (4 serum albumin) = 8.9 + (0.8) (4 3.5) = 8.9
+ 0.4 = 9.3 mEq/dL] Despite the fact that hypercalcemia patients' phosphate levels return to
normal, Cinacalcet (answer 1) is only prescribed to those with hyperparathyroidism. Because
