NRNP 6566 WK 10 Knowledge Check
• Question 1
Needs Grading
A 57 year old female is admitted to the oncology unit for chemotherapy related to
her to acute leukemia. Her initial dose of chemo was 2 days ago. While
rounding today, the patients tells the NP that she feels so weak. The NP notes her
heart rate is 44 today (down from 68 2 days ago). She has had less than 100 cc
of urine out over the last 24 hours.
Labs from this morning include:
LAB DATA:
-Sodium 131
-Potassium 7.8
-Chloride 105
-Bicarbonate 17
-BUN 67
-Creatinine 5.8
-Glucose 83
-Calcium 7.6
-Phosphorus 6.8
-Uric acid 16.3
What is your working diagnosis for this patient? How would you treat her?
Correct
Answer: Diagnosis is hyperkalmeia probably from tumor lysis syndrome.
Chemotherapy has cause cells to die releasing potassium into the
circulation. The elevated uric acid, phsophorus, low calcium, and
acute renal failure all stem from tumor lysis.
Treatment
Check a 12 lead EKG
Give calcium gluconate to stabilize cardiac function
Begin insulin and dextrose to shift potassium into the intracellular
space.
Aggressively administer fluids to treat potential pre-renal azotemia
Consider Kayexalate to remove potassium.
Response [None Given]
Feedback:
• Question 2
Needs Grading
Using the Cockcroft and Gault formula, calculate the estimated GFR for the
following patient. 52 year old female weighting 177 pounds. Plasma creatinine is
3.3
Correct
Answer: The formula is:
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, For this patient
In women you would multiple the result by 0.85 to reflect the
lower muscle mass in women.
30 x .85 = 25 ml/min
Medication doses in this patient would need to be altered due to
the low GFR
Response [None Given]
Feedback:
• Question 3
Needs Grading
How would you calculate the fractional excretion of sodium? What does this
calculation tell you about the patient’s acute kidney injury?
Correct
Answer: Calculating the fractional excretion of sodium in patient’s with
oliguria is helpful in distinguishing prerenal from intrinsic renal
causes of acute kidney injury.
The formula is:
A result of less than 1% indicates a prerenal cause of acute kidney
injury. A vale greater than 2 percent indicates an intrinsic renal
cause. This formula is less reliable in patients on diuretic therapy.
Respons [None Given]
e
Feedbac
k:
• Question 4
Needs Grading
This study source was downloaded by 100000851646087 from CourseHero.com on 12-13-2022 08:22:13 GMT -06:00
https://www.coursehero.com/file/102766059/NRNP-6566-WK-10-Knowledge-Checkdocx/
• Question 1
Needs Grading
A 57 year old female is admitted to the oncology unit for chemotherapy related to
her to acute leukemia. Her initial dose of chemo was 2 days ago. While
rounding today, the patients tells the NP that she feels so weak. The NP notes her
heart rate is 44 today (down from 68 2 days ago). She has had less than 100 cc
of urine out over the last 24 hours.
Labs from this morning include:
LAB DATA:
-Sodium 131
-Potassium 7.8
-Chloride 105
-Bicarbonate 17
-BUN 67
-Creatinine 5.8
-Glucose 83
-Calcium 7.6
-Phosphorus 6.8
-Uric acid 16.3
What is your working diagnosis for this patient? How would you treat her?
Correct
Answer: Diagnosis is hyperkalmeia probably from tumor lysis syndrome.
Chemotherapy has cause cells to die releasing potassium into the
circulation. The elevated uric acid, phsophorus, low calcium, and
acute renal failure all stem from tumor lysis.
Treatment
Check a 12 lead EKG
Give calcium gluconate to stabilize cardiac function
Begin insulin and dextrose to shift potassium into the intracellular
space.
Aggressively administer fluids to treat potential pre-renal azotemia
Consider Kayexalate to remove potassium.
Response [None Given]
Feedback:
• Question 2
Needs Grading
Using the Cockcroft and Gault formula, calculate the estimated GFR for the
following patient. 52 year old female weighting 177 pounds. Plasma creatinine is
3.3
Correct
Answer: The formula is:
This study source was downloaded by 100000851646087 from CourseHero.com on 12-13-2022 08:22:13 GMT -06:00
https://www.coursehero.com/file/102766059/NRNP-6566-WK-10-Knowledge-Checkdocx/
, For this patient
In women you would multiple the result by 0.85 to reflect the
lower muscle mass in women.
30 x .85 = 25 ml/min
Medication doses in this patient would need to be altered due to
the low GFR
Response [None Given]
Feedback:
• Question 3
Needs Grading
How would you calculate the fractional excretion of sodium? What does this
calculation tell you about the patient’s acute kidney injury?
Correct
Answer: Calculating the fractional excretion of sodium in patient’s with
oliguria is helpful in distinguishing prerenal from intrinsic renal
causes of acute kidney injury.
The formula is:
A result of less than 1% indicates a prerenal cause of acute kidney
injury. A vale greater than 2 percent indicates an intrinsic renal
cause. This formula is less reliable in patients on diuretic therapy.
Respons [None Given]
e
Feedbac
k:
• Question 4
Needs Grading
This study source was downloaded by 100000851646087 from CourseHero.com on 12-13-2022 08:22:13 GMT -06:00
https://www.coursehero.com/file/102766059/NRNP-6566-WK-10-Knowledge-Checkdocx/
