Renal/Urology/GI and Sepsis/MODS

Question 1

What is the primary goal of urine production?

Answer 1

To maintain regulation of volume and composition of blood

Question 2

Glomerular filtration rate (GFR) is defined as the amount of ________ produced by the kidneys each minute.

Answer 2

filtrate

Question 3

T/F: Creatine is produced by the muscles and can be used as an indicator of renal insufficiency.

Answer 3

True

Question 4

T/F: You are treating a patient with renal failure. You would expect to see a decrease in their creatine level.

Answer 4

False, you would expect them to have an increased creatine

Question 5

T/F: BUN is a measurement of urea nitrogen in the blood and measures the metabolism of proteins in the liver and the removal by the kidneys.

Answer 5

True

Question 6

T/F: High BUN is often seen in patients with liver problems, malnutrition, or a history of alcoholism.

Answer 6

False, low BUN is often seen in patients with liver problems, malnutrition, or a history of alcoholism

Question 7

T/F: As ventilations increase, you would expect to see a resultant decrease in pH.

Answer 7

False, you would expect to see a resultant increase in pH

Question 8

T/F: Immediately after a kidney injury, the only sign may be decreased urinary output.

Answer 8

True

Question 9

Which of the following is NOT one of the three types of acute renal failure?

a) Prerenal
b) Postrenal
c) Intrinsic
d) Extrinsic

Answer 9

d) Extrinsic

Question 10

What type of acute renal failure results from decreased blood flow to the kidneys and is the most common form of kidney injury?

Answer 10

Prerenal

Question 11

Your patient has kidney stones. This patient is most at risk for what type of acute renal failure?

Answer 11

Postrenal

Question 12

For a patient with an acute kidney injury, would this patient be at an increased risk of hypokalemia or hyperkalemia?

Answer 12

hyperkalemia

Question 13

What is the most important concern for a patient with rhabdomyolysis?

Answer 13

blockage of the tubules and kidney failure

Question 14

T/F: Patients with renal failure may become hypoglycemic due to insulin being renally cleared.

Answer 14

True

Question 15

What electrolyte disturbance is most life-threatening in the hours following rhabdomyolysis?

Answer 15

hyperkalemia

Question 16

What is the primary treatment for rhabdomyolysis?

Answer 16

aggressive fluid rehydration

Question 17

Altered mental status from a urinary tract infection is most common in which age group?

Answer 17

elderly

Question 18

T/F: Pain management is one of the most important treatments for patients with kidney stones.

Answer 18

True

Question 19

The signs and symptoms of what mimic that of a kidney stone?

Answer 19

leaking aneurysm

Question 20

T/F: Urethral trauma is a contraindication to the insertion of a foley catheter.

Answer 20

True

Question 21

What is most often the cause of ischemic abdominal pain?

Answer 21

strangulated bowel

Question 22

In which of the following patients is extreme abdominal palpation contraindicated?

a) A patient with rebound tenderness
b) A patient with suspected gastritis
c) A patient with a suspected aortic aneurysm
d) A patient with a suspected ruptured appendix

Answer 22

c) A patient with a suspected aortic aneurysm

Question 23

You are treating a patient with an upper GI bleed with significant bleeding. After giving ___ liters of crystalloid, you should consider switching to fresh frozen plasma (FFP) or whole blood.

Answer 23

2

Question 24

_______________ sign is bruising around the flanks and can be indicative of pancreatitis.

Answer 24

Grey Turner’s

Question 25

____________ sign is bruising around the umbilicus and can be indicative of pancreatitis or an ectopic pregnancy.

Answer 25

Cullen’s

Question 26

What medication is the primary offender in drug-related hepatoxicity?

Answer 26

Acetaminophen

Question 27

Appendicitis pain will frequently migrate from the periumbilical area to which abdominal quadrant?

Answer 27

Right Lower Quadrant

Question 28

Which of the following is NOT typical treatment of a patient with an AAA?

a) Give a 2L crystalloid bolus in preparation for rupture
b) insert a foley catheter
c) insert a NG tube
d) establish two large bore IVs

Answer 28

a) Give a 2L crystalloid bolus in preparation for rupture

You should prepare a 2L crystalloid bolus, but only administer it in the event of an AAA rupture

Question 29

Which of the following is a contraindication of gastric lavage?

a) GI bleed
b) Ingestion of a strong alkali
c) Intentional drug overdose
d) Gastric distention

Answer 29

b) Ingestion of a strong alkali

Question 30

What are the two types of long-term feeding tubes?

Answer 30

PEG, PEJ

Question 31

You are treating an 8-year-old with a PEG tube. The PEG tube has come out. The tube must be reinstated within ______ hours or new surgery may be required.

Answer 31

24

Question 32

You are treating a patient with SIRS and you are reviewing the ABGs. Which of the following would you expect for the patient’s PCO2?

a) Typically the PCO2 is grossly elevated >55
b) Typically the PCO2 is <35
c) There is generally no change in the PCO2 from the standard range.
d) The PCO2 is dependent on whether a bacteria or a virus caused the sepsis

Answer 32

b) Typically the PCO2 is <35

Question 33

In patients with SIRS, _____glycemia is common and can significantly increase mortality if not tightly controlled.

Answer 33

hyper

Question 34

In patients with severe sepsis, you would expect them to have _____ platelet levels and a _________ clotting time.

Answer 34

low, prolonged

Question 35

T/F: Sepsis is the leading cause of non-coronary death in the ICU in the United States.

Answer 35

True

Question 36

Sepsis is defined as a systemic infection with one or more signs of organ dysfunction. Which of the following is one of the markers for organ dysfunction?

a) PaO2 of 85
b) Hypotension including oliguria
c) Tachycardia with fever
d) Chest pain with dyspnea

Answer 36

b) Hypotension including oliguria

Question 37

What is the most frequent cause of sepsis?

Answer 37

Respiratory infections (UTIs are the 2nd most common cause)

Question 38

T/F: Colloids are preferred for volume resuscitation in severe sepsis to correct hypoalbuminemia.

Answer 38

False

Question 39

T/F: Septic shock is defines are hypotension refractory to fluid resuscitation in the presence of sepsis.

Answer 39

True

Question 40

Which of the following heralds irreversible septic shock?

a) Respiratory alkalosis with increased CO2
b) Abnormally high white blood count
c) Metabolic acidosis with hypotension
d) A fall in cardiac output with accompanying tachycardia

Answer 40

c) Metabolic acidosis with hypotension

Question 41

You are transporting a patient with MODS. You have been elevating the patient’s blood pressure and MAP during transport. A MAP less than _____ mmHg indicates cardiovascular failure.

Answer 41

50