NR575 AGACNP Gastroenterology Certification Review 2025 |
Advanced Practice GI Topics, Evidence-Based Treatment, Flashcards
& Clinical Practice Prep | Chamberlain University Study Guide for
Nurse Practitioner Board Exam
1. The patient is a 64-year-old white woman (height 73 inches, weight 90 kg) who presents to the clinic
with abdominal pain and dizziness. She reports that she did not eat or drink for 24 hours because she has
a history of gastroenteritis. On exam, the blood pressure reading while sitting is 120/85 mmHg and drops
to 90/60 mmHg when standing. Her heart rate is 95 beats/min. The laboratory tests reveal sodium (Na) is
140 mEq/L, potassium 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. What is the best action for this patient?
1. Administer trimethoprim/sulfamethazine double strength orally for 3 days.
2. Administer furosemide 40 mg intravenously.
3. Administer Insulin lispro 5 units subcutaneously.
4. Administer fluid bolus (500 mL of NaCl solution).
4. Administer fluid bolus (500 mL of NaCl solution)
Rationale: The patient presents with acute kidney injury (AKI) symptoms, and the initial treatment of AKI is
identifying and reversing the insult to the kidney if possible. This patient has prerenal azotemia caused by
hypotension and increased heart rate. Adding sulfa antibiotics would not have any benefits for this patient
because she does not have any signs for urinary tract infections (answer 1). Administering diuretics such as
furosemide (answer 2) could worsen her volume depletion and probably further impair her kidney function.
Although the glucose level is elevated, adding insulin units is unnecessary at this time (answer 3). Fluid
management is critical to managing AKI; therefore administration of a fluid bolus with normal saline would be
the best choice for this patient.
2. A 63-year-old Asian man has diabetes, hypertension, and estimated glomerular filtration rate of 40
mL/min/1.73 m2. He takes simvastatin 40 mg daily, ramipril 10 mg daily, and metformin 1000 mg twice
daily. Laboratory values reveal hemoglobin is 12 mg/dL, parathyroid hormone is 200 pg/mL, sodium is
135 mEq/L, potassium is 3.9 mEq/L, 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. 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.
Rationale: There are many factors that can contribute to the development of chronic kidney disease-mineral and
bone disorders such as hypocalcemia, hyperparathyroidism, hyperphosphatemia, decrease of vitamin D, and
decreased production of 1.25-dihydroxyvitamin D. The patient's laboratory values reveal hyperparathyroidism,
which may be related to an increasing phosphorus concentration. The first approach is to administer a
phosphate binder. Knowing the corrected calcium concentration is necessary for this patient. The [measured Ca
,+ (0.8) (4 − serum albumin) = 8.9 + (0.8) (4 − 3.5) = 8.9 + 0.4 = 9.3 mEq/dL]; therefore this patient has
hypocalcemia. Cinacalcet (answer 1) is reserved for patients with hyperparathyroidism despite the
normalization of phosphate in patients with hypercalcemia. Ergocalciferol (answer 2) is unnecessary for this
patient because his 25-hydroxyvitamin D concentration is greater than 30 ng/mL. Calcium carbonate (answer
3) is the best phosphate binder for this case because the patient has hypocalcemia, and it is acceptable with a
corrected serum calcium concentration. An active vitamin D medication such as calcitriol (answer 4) could be
added if the parathyroid concentration remains elevated, despite normalization of serum phosphate.
3. The patient is a 35-year-old African American woman who is admitted to the hospital with a 2-day
history of nausea, vomiting, abdominal cramps, dysuria, and flank pain. She is diagnosed with
pyelonephritis and is prescribed a 5-day course of parenteral aminoglycosides. The patient develops acute
tubular necrosis. Antibiotic therapy is adjusted based on culture and sensitivity results. Which set of
laboratory data is consistent with this presentation?
1. Blood urea nitrogen (BUN)/serum creatinine ratio is 15:1, urinary sodium more than 40 mEq/L,
fractional excretion of sodium (FENa) more than 2%, specific gravity is less than 1.015, and muddy casts
are present.
2. BUN/serum creatinine ratio is 15:1, urinary sodium is greater than 40 mEq/L, FENa greater than 2%,
specific gravity is less than 1.015, no casts visible.
3. BUN/serum creatinine ratio is greater than 20:1, urinary sodium is less than 20 mEq/L, FENa is les
1. Blood urea nitrogen (BUN)/serum creatinine ratio is 15:1, urinary sodium more than 40 mEq/L,
fractional excretion of sodium (FENa) more than 2%, specific gravity is less than 1.015, and muddy casts
are present.
Rationale: The patient develops acute tubular necrosis (ATN), so she has an intrinsic acute kidney injury (AKI).
Aminoglycosides can cause direct damage to the tubules. In ATN, the blood urea nitrogen/serum creatinine
ratio could be normal (between 10 and 15:1), but it is greater than 20:1, so it is reflecting hypovolemia, which
is common in prerenal azotemia. Urinary sodium less than 20 mEq/L is a marker of hypovolemia. The fractional
excretion of sodium (FENa) value could distinguish between prerenal and intrinsic AKI. A low FENa (less than
1%) in a patient with oliguria suggests that the tubular function is still intact, but a FENa greater than 2%
refers to intrinsic AKI. The specific gravity is normal in intrinsic AKI and is elevated (greater than 1.018) in
prerenal azotemia. Muddy casts are often present in intrinsic AKI because of the renal tubule cell damage.
Therefore answers 2, 3, and 4 are incorrect.
4. A 53-year-old Asian man presents to the emergency department with an 8-hour history of strong chest
pain, diaphoresis, and dyspnea. His medical history includes diabetes type 2, and he takes metformin
1000 mg twice daily. The nurse practitioner is concerned about a possible myocardial infarction and
recommends coronary angiography. The patient develops acute tubular necrosis after the procedure.
Which set of laboratory data is consistent with this presentation?
1. Blood urea nitrogen (BUN)/serum creatinine ratio is 20:1, urinary sodium is greater than 40 mEq/L,
fractional excretion of sodium (FENa) is less than 1%, specific gravity is 1.018, and no visible casts.
2. BUN/serum creatinine ratio is 15:1, urinary sodium is greater than 40 mEq/L, FENa is greater than
2%, specific gravity is 1.010, and no visible casts.
3. BUN/serum creatinine ratio is 10:1, urinary sodium is greater than 40 mEq/L, FENa is greater than
4. BUN/serum creatinine ratio 20:1, urinary sodium is less than 20 mEq/L, FENa is less than 1%, specific
gravity is 1.018, and muddy casts are present.
, Rationale: The patient develops acute tubular necrosis (ATN); therefore, he has an intrinsic acute kidney injury.
Coronary angiography can cause nephrotoxicity because of the use of intravenous contrast. Metformin should
be stopped about 24 hours before the coronary angiography procedure because the iodinated contrast dye can
increase the nephrotoxicity risk. Blood urea nitrogen/serum creatinine ratio could be normal (10 to 15:1) in
ATN, but it becomes greater than 20:1 in prerenal azotemia. Urinary sodium greater than 40 mEq/L is an
indication of ATN, but when it becomes less than 20 mEq/L, it reflects hypovolemia. A fraction excretion of
sodium (FENa) less than 1% is an indication of intact tubular function, but a FENa greater than 2% refers to
an intrinsic AKI. The specific gravity is normal in ATN, and it is greater than 1.018 in prerenal azotemia. The
presence of casts is a strong marker for ATN. Therefore, answers 1, 2, and 3 are incorrect.
5. A 67-year-old Asian man has an estimated glomerular filtration rate of 40 mL/min/1.73 m2. His
hemoglobin (Hgb) is 13.5 g/dL, with normal red blood cell indices without treatment. What is the
recommended minimum frequency of Hgb monitoring for this patient?
1. Monthly.
2. Every 3 months.
3. Every 6 months.
4. Every 12 months.
4. Every 12 months
Rationale: This patient has stage 3 chronic kidney disease (CKD) because his estimated glomerular filtration
rate is less than 60 mL/min/1.73 m2. His hemoglobin (Hgb) concentration is greater than 13 g/dL, so he does
not have anemia. Hgb concentration should be monitored according to the CKD stage. Monthly monitoring is
never recommended for a patient who does not have anemia (answer 1). Monitoring Hgb every 3 months should
occur for patients with stage 5 CKD and receiving dialysis (answer 2). Monitoring of Hgb concentration is
recommended every 6 months for patients with stages 4 and 5 CKD who have not received dialysis treatment
(answer 3). Monitoring Hgb every 12 months should be recommended for patients with stage 3 CKD (answer
4).
6. The patient is a 59-year-old white woman who comes to the clinic for a follow-up. The patient's
estimated glomerular filtration rate is 25 mL/min/1.73 m2. Her hemoglobin (Hgb) is 10.5 g/dL, and the
nurse practitioner recommends iron tablets once daily. The patient does not receive dialysis treatment.
What is the recommended minimum frequently of Hgb monitoring for this patient?
1. Not needed.
2. Four times every year.
3. Two times every year.
4. Every 12 months.
3. Two times every year.
Rationale: The patient has stage 4 chronic kidney disease (CKD) because her estimated glomerular filtration
rate (eGFR) is less than 30 mL/min/1.73 m2 and greater than 15 mL/min/1.73 m2. Her hemoglobin (Hgb) is less
than 13 g/dL; therefore she is diagnosed with anemia and the nurse practitioner recommends iron tablets. The
patient has anemia and should monitor her Hgb according to her eGFR; therefore answer 1 is incorrect.
Monitoring of hemoglobin concentration four times per year should be recommended for patients with stage 5
CKD who are receiving dialysis (answer 2). The Hgb should be monitored at least two times per year for
patients with stage 4 CKD or stage 5 CKD and who do not receive dialysis treatment (answer 3). Monitoring
hemoglobin concentration once yearly should be recommended for patients with stage 3 CKD (answer 4).
Advanced Practice GI Topics, Evidence-Based Treatment, Flashcards
& Clinical Practice Prep | Chamberlain University Study Guide for
Nurse Practitioner Board Exam
1. The patient is a 64-year-old white woman (height 73 inches, weight 90 kg) who presents to the clinic
with abdominal pain and dizziness. She reports that she did not eat or drink for 24 hours because she has
a history of gastroenteritis. On exam, the blood pressure reading while sitting is 120/85 mmHg and drops
to 90/60 mmHg when standing. Her heart rate is 95 beats/min. The laboratory tests reveal sodium (Na) is
140 mEq/L, potassium 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. What is the best action for this patient?
1. Administer trimethoprim/sulfamethazine double strength orally for 3 days.
2. Administer furosemide 40 mg intravenously.
3. Administer Insulin lispro 5 units subcutaneously.
4. Administer fluid bolus (500 mL of NaCl solution).
4. Administer fluid bolus (500 mL of NaCl solution)
Rationale: The patient presents with acute kidney injury (AKI) symptoms, and the initial treatment of AKI is
identifying and reversing the insult to the kidney if possible. This patient has prerenal azotemia caused by
hypotension and increased heart rate. Adding sulfa antibiotics would not have any benefits for this patient
because she does not have any signs for urinary tract infections (answer 1). Administering diuretics such as
furosemide (answer 2) could worsen her volume depletion and probably further impair her kidney function.
Although the glucose level is elevated, adding insulin units is unnecessary at this time (answer 3). Fluid
management is critical to managing AKI; therefore administration of a fluid bolus with normal saline would be
the best choice for this patient.
2. A 63-year-old Asian man has diabetes, hypertension, and estimated glomerular filtration rate of 40
mL/min/1.73 m2. He takes simvastatin 40 mg daily, ramipril 10 mg daily, and metformin 1000 mg twice
daily. Laboratory values reveal hemoglobin is 12 mg/dL, parathyroid hormone is 200 pg/mL, sodium is
135 mEq/L, potassium is 3.9 mEq/L, 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. 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.
Rationale: There are many factors that can contribute to the development of chronic kidney disease-mineral and
bone disorders such as hypocalcemia, hyperparathyroidism, hyperphosphatemia, decrease of vitamin D, and
decreased production of 1.25-dihydroxyvitamin D. The patient's laboratory values reveal hyperparathyroidism,
which may be related to an increasing phosphorus concentration. The first approach is to administer a
phosphate binder. Knowing the corrected calcium concentration is necessary for this patient. The [measured Ca
,+ (0.8) (4 − serum albumin) = 8.9 + (0.8) (4 − 3.5) = 8.9 + 0.4 = 9.3 mEq/dL]; therefore this patient has
hypocalcemia. Cinacalcet (answer 1) is reserved for patients with hyperparathyroidism despite the
normalization of phosphate in patients with hypercalcemia. Ergocalciferol (answer 2) is unnecessary for this
patient because his 25-hydroxyvitamin D concentration is greater than 30 ng/mL. Calcium carbonate (answer
3) is the best phosphate binder for this case because the patient has hypocalcemia, and it is acceptable with a
corrected serum calcium concentration. An active vitamin D medication such as calcitriol (answer 4) could be
added if the parathyroid concentration remains elevated, despite normalization of serum phosphate.
3. The patient is a 35-year-old African American woman who is admitted to the hospital with a 2-day
history of nausea, vomiting, abdominal cramps, dysuria, and flank pain. She is diagnosed with
pyelonephritis and is prescribed a 5-day course of parenteral aminoglycosides. The patient develops acute
tubular necrosis. Antibiotic therapy is adjusted based on culture and sensitivity results. Which set of
laboratory data is consistent with this presentation?
1. Blood urea nitrogen (BUN)/serum creatinine ratio is 15:1, urinary sodium more than 40 mEq/L,
fractional excretion of sodium (FENa) more than 2%, specific gravity is less than 1.015, and muddy casts
are present.
2. BUN/serum creatinine ratio is 15:1, urinary sodium is greater than 40 mEq/L, FENa greater than 2%,
specific gravity is less than 1.015, no casts visible.
3. BUN/serum creatinine ratio is greater than 20:1, urinary sodium is less than 20 mEq/L, FENa is les
1. Blood urea nitrogen (BUN)/serum creatinine ratio is 15:1, urinary sodium more than 40 mEq/L,
fractional excretion of sodium (FENa) more than 2%, specific gravity is less than 1.015, and muddy casts
are present.
Rationale: The patient develops acute tubular necrosis (ATN), so she has an intrinsic acute kidney injury (AKI).
Aminoglycosides can cause direct damage to the tubules. In ATN, the blood urea nitrogen/serum creatinine
ratio could be normal (between 10 and 15:1), but it is greater than 20:1, so it is reflecting hypovolemia, which
is common in prerenal azotemia. Urinary sodium less than 20 mEq/L is a marker of hypovolemia. The fractional
excretion of sodium (FENa) value could distinguish between prerenal and intrinsic AKI. A low FENa (less than
1%) in a patient with oliguria suggests that the tubular function is still intact, but a FENa greater than 2%
refers to intrinsic AKI. The specific gravity is normal in intrinsic AKI and is elevated (greater than 1.018) in
prerenal azotemia. Muddy casts are often present in intrinsic AKI because of the renal tubule cell damage.
Therefore answers 2, 3, and 4 are incorrect.
4. A 53-year-old Asian man presents to the emergency department with an 8-hour history of strong chest
pain, diaphoresis, and dyspnea. His medical history includes diabetes type 2, and he takes metformin
1000 mg twice daily. The nurse practitioner is concerned about a possible myocardial infarction and
recommends coronary angiography. The patient develops acute tubular necrosis after the procedure.
Which set of laboratory data is consistent with this presentation?
1. Blood urea nitrogen (BUN)/serum creatinine ratio is 20:1, urinary sodium is greater than 40 mEq/L,
fractional excretion of sodium (FENa) is less than 1%, specific gravity is 1.018, and no visible casts.
2. BUN/serum creatinine ratio is 15:1, urinary sodium is greater than 40 mEq/L, FENa is greater than
2%, specific gravity is 1.010, and no visible casts.
3. BUN/serum creatinine ratio is 10:1, urinary sodium is greater than 40 mEq/L, FENa is greater than
4. BUN/serum creatinine ratio 20:1, urinary sodium is less than 20 mEq/L, FENa is less than 1%, specific
gravity is 1.018, and muddy casts are present.
, Rationale: The patient develops acute tubular necrosis (ATN); therefore, he has an intrinsic acute kidney injury.
Coronary angiography can cause nephrotoxicity because of the use of intravenous contrast. Metformin should
be stopped about 24 hours before the coronary angiography procedure because the iodinated contrast dye can
increase the nephrotoxicity risk. Blood urea nitrogen/serum creatinine ratio could be normal (10 to 15:1) in
ATN, but it becomes greater than 20:1 in prerenal azotemia. Urinary sodium greater than 40 mEq/L is an
indication of ATN, but when it becomes less than 20 mEq/L, it reflects hypovolemia. A fraction excretion of
sodium (FENa) less than 1% is an indication of intact tubular function, but a FENa greater than 2% refers to
an intrinsic AKI. The specific gravity is normal in ATN, and it is greater than 1.018 in prerenal azotemia. The
presence of casts is a strong marker for ATN. Therefore, answers 1, 2, and 3 are incorrect.
5. A 67-year-old Asian man has an estimated glomerular filtration rate of 40 mL/min/1.73 m2. His
hemoglobin (Hgb) is 13.5 g/dL, with normal red blood cell indices without treatment. What is the
recommended minimum frequency of Hgb monitoring for this patient?
1. Monthly.
2. Every 3 months.
3. Every 6 months.
4. Every 12 months.
4. Every 12 months
Rationale: This patient has stage 3 chronic kidney disease (CKD) because his estimated glomerular filtration
rate is less than 60 mL/min/1.73 m2. His hemoglobin (Hgb) concentration is greater than 13 g/dL, so he does
not have anemia. Hgb concentration should be monitored according to the CKD stage. Monthly monitoring is
never recommended for a patient who does not have anemia (answer 1). Monitoring Hgb every 3 months should
occur for patients with stage 5 CKD and receiving dialysis (answer 2). Monitoring of Hgb concentration is
recommended every 6 months for patients with stages 4 and 5 CKD who have not received dialysis treatment
(answer 3). Monitoring Hgb every 12 months should be recommended for patients with stage 3 CKD (answer
4).
6. The patient is a 59-year-old white woman who comes to the clinic for a follow-up. The patient's
estimated glomerular filtration rate is 25 mL/min/1.73 m2. Her hemoglobin (Hgb) is 10.5 g/dL, and the
nurse practitioner recommends iron tablets once daily. The patient does not receive dialysis treatment.
What is the recommended minimum frequently of Hgb monitoring for this patient?
1. Not needed.
2. Four times every year.
3. Two times every year.
4. Every 12 months.
3. Two times every year.
Rationale: The patient has stage 4 chronic kidney disease (CKD) because her estimated glomerular filtration
rate (eGFR) is less than 30 mL/min/1.73 m2 and greater than 15 mL/min/1.73 m2. Her hemoglobin (Hgb) is less
than 13 g/dL; therefore she is diagnosed with anemia and the nurse practitioner recommends iron tablets. The
patient has anemia and should monitor her Hgb according to her eGFR; therefore answer 1 is incorrect.
Monitoring of hemoglobin concentration four times per year should be recommended for patients with stage 5
CKD who are receiving dialysis (answer 2). The Hgb should be monitored at least two times per year for
patients with stage 4 CKD or stage 5 CKD and who do not receive dialysis treatment (answer 3). Monitoring
hemoglobin concentration once yearly should be recommended for patients with stage 3 CKD (answer 4).
