CH 51: Acute Kidney Injury

Question 1

azotemia

Answer 1

Elevated levels of urea and other nitrogen compounds in the blood.

Question 2

What is the most common intrarenal cause of AKI in hospitalized patients?

Answer 2

acute tubular necrosis

Question 3

anuria

Answer 3

no urine output

Question 4

A 72-year-old male with a history of congestive heart failure is admitted to the ICU with sepsis. His blood pressure has remained at 82/52 mm Hg for the past 2 hours despite fluid resuscitation. His urine output over the last 6 hours has been 90 mL, and his serum creatinine has increased from 1.1 mg/dL to 2.4 mg/dL.
Which of the following best explains the patient’s clinical status?

A. Chronic kidney disease due to prolonged hypoperfusion
B. Acute kidney injury due to prolonged hypoperfusion
C. End-stage renal disease due to prolonged hypoperfusion
D. Urinary tract obstruction due to prolonged hypoperfusion

Answer 4

B. Acute kidney injury due to prolonged hypoperfusion

Rationale: The patient is exhibiting hallmark signs of AKI—rapid rise in creatinine and decreased urine output—following hypotension and sepsis. These are classic signs of AKI due to prolonged hypoperfusion, a common ICU scenario.

Question 5

Which laboratory value would the nurse expect to see in a patient with worsening acute kidney injury?

A. Decreased BUN and creatinine
B. Decreased serum potassium and sodium
C. Increased serum creatinine and potassium
D. Decreased specific gravity and magnesium

Answer 5

C. Increased serum creatinine and potassium

Rationale: AKI is characterized by an accumulation of nitrogenous waste and electrolytes. Creatinine and potassium rise due to impaired renal excretion.

Question 6

A patient in the emergency department presents with AKI. The nurse should first assess for a history of:

A. Hypertension or nephrotoxic drug exposure
B. Recent hypotensive episodes or nephrotoxic drug exposure
C. Urinary incontinence or nephrotoxic drug exposure
D. Weight gain over the past year or nephrotoxic drug exposure

Answer 6

B. Recent hypotensive episodes or nephrotoxic drug exposure

Rationale: AKI often follows hypotension, hypovolemia, or exposure to nephrotoxic agents. Identifying these causes helps guide immediate intervention.

Question 7

Which of the following are common clinical features or complications of acute kidney injury? (SATA)

A. Increased creatinine
B. Decreased potassium
C. Azotemia
D. Decreased BUN
E. Oliguria or decreased urine output

Answer 7

A. Increased creatinine
C. Azotemia
E. Oliguria or decreased urine output

Rationale: AKI involves a rapid decline in kidney function. It is associated with increased creatinine, azotemia, and often decreased urine output. Potassium usually increases, not decreases, and BUN rises as well.

Question 8

Which patient is at the highest risk for developing AKI?

A. A 45-year-old undergoing elective knee surgery
B. A 30-year-old taking acetaminophen for headaches
C. A 68-year-old septic patient on aminoglycoside antibiotics
D. A 19-year-old with a urinary tract infection

Answer 8

C. A 68-year-old septic patient on aminoglycoside antibiotics

Rationale: AKI often occurs in critically ill patients, especially in the presence of sepsis and nephrotoxic agents such as aminoglycosides.

Question 9

In the ICU, a nurse notes that a post-op trauma patient’s urine output has decreased to 12 mL/hr and his creatinine is now 3.1 mg/dL. What is the priority action?

A. Administer diuretics
B. Increase IV fluids
C. Monitor for another hour
D. Notify the provider immediately

Answer 9

D. Notify the provider immediately

Rationale: This patient is developing AKI, evidenced by critically low urine output and rising creatinine. Prompt intervention is crucial to prevent further kidney damage.

Question 10

A nurse is caring for a patient who developed AKI after being on vancomycin and receiving IV contrast. The patient asks if this condition is permanent. What is the nurse’s best response?

A. “Your kidney injury is likely reversible if caught early.”
B. “Unfortunately, your kidneys are unlikely to recover.”
C. “We will need to prepare for long-term dialysis.”
D. “This is now considered chronic kidney disease.”

Answer 10

A. “Your kidney injury is likely reversible if caught early.”

Rationale: AKI is potentially reversible, especially when caused by identifiable and correctable causes such as nephrotoxic agents and contrast media.

Question 11

Which statement made by a nursing student requires correction regarding AKI?

A. “AKI always causes complete loss of kidney function.”
B. “AKI can occur rapidly over hours or days.”
C. “Serum creatinine levels are used to monitor AKI.”
D. “AKI may be reversible with early treatment.”

Answer 11

A. “AKI always causes complete loss of kidney function.”

Rationale: AKI does not always cause complete loss of kidney function. It can range from mild dysfunction to severe, and is often reversible with early intervention.

Question 12

Which finding best indicates that a patient’s AKI is resolving?

A. Continued increase in potassium and decreasing creatinine
B. Rising creatinine and BUN and decreasing creatinine
C. Steady increase in urine output and decreasing creatinine
D. Onset of metabolic acidosis and decreasing creatinine

Answer 12

C. Steady increase in urine output and decreasing creatinine

Rationale: Improvement in kidney function is reflected by normalization of lab values and an increase in urine output, indicating recovery from AKI.

Question 13

A patient is admitted to the ED with vomiting and diarrhea for 3 days. Labs reveal BUN of 35 mg/dL, creatinine of 1.9 mg/dL, and urine sodium of 12 mEq/L. The patient’s urine output is 18 mL/hr. Which type of AKI is most likely occurring?

A. Postrenal AKI
B. Prerenal AKI
C. Intrarenal AKI
D. Chronic kidney disease

Answer 13

B. Prerenal AKI

Rationale: The patient shows signs of volume depletion, and the low urine sodium (<20 mEq/L) is a hallmark of prerenal azotemia. This is a functional problem due to decreased perfusion rather than intrinsic kidney damage.

Question 14

Which of the following best describes the pathophysiology of prerenal AKI?

A. Direct damage to kidney tissue caused by nephrotoxic agents
B. Urinary obstruction leading to increased intratubular pressure
C. Decreased renal perfusion causing reduced filtration without tissue damage
D. Inflammation and necrosis of renal glomeruli

Answer 14

C. Decreased renal perfusion causing reduced filtration without tissue damage

Rationale: Prerenal AKI occurs when there is reduced blood flow to the kidneys, leading to decreased filtration. It does not involve structural damage to the kidney tissue and is often reversible.

Question 15

A nurse is reviewing labs for a patient with suspected prerenal AKI. Which of the following findings would support the diagnosis?

A. Urine sodium of 8 mEq/L
B. Urine sodium of 45 mEq/L
C. Creatinine level of 0.9 mg/dL
D. Urine output of 60 mL/hr

Answer 15

A. Urine sodium of 8 mEq/L

Rationale: In prerenal AKI, sodium retention increases to preserve intravascular volume, resulting in low urine sodium levels (<20 mEq/L).

Question 16

Which of the following are common causes of prerenal acute kidney injury? (SATA)

A. Heart failure
B. Severe dehydration
C. Nephrotoxic antibiotics
D. Decreased cardiac output
E. Obstructed urinary outflow

Answer 16

A. Heart failure
B. Severe dehydration
D. Decreased cardiac output

Rationale: Prerenal AKI results from decreased blood flow to the kidneys, as seen in heart failure, dehydration, and low cardiac output. Nephrotoxic antibiotics and urinary obstructions are intrarenal and postrenal causes, respectively.

Question 17

A patient with heart failure is at risk for developing which type of kidney injury due to reduced cardiac output?

A. Intrarenal AKI
B. Chronic renal failure
C. Postrenal AKI
D. Prerenal AKI

Answer 17

D. Prerenal AKI

Rationale: Reduced cardiac output leads to decreased renal perfusion, which is a hallmark of prerenal AKI. Prompt management of heart failure can prevent permanent kidney injury.

Question 18

A critically ill patient in the ICU has had an MAP of 55 mm Hg for 4 hours. His urine output is 14 mL/hr, and he’s developing increasing BUN and creatinine levels. What is the priority action?

A. Administer a loop diuretic
B. Evaluate for urinary retention
C. Increase IV fluids
D. Discontinue nephrotoxic medications

Answer 18

C. Increase IV fluids

Rationale: The low MAP and urine output suggest prerenal AKI from poor perfusion. Fluid resuscitation is the first-line intervention to restore renal perfusion and prevent progression to intrarenal damage.

Question 19

Which statement made by a nurse demonstrates a correct understanding of prerenal oliguria?

A. “The kidneys are permanently damaged in prerenal oliguria.”
B. “It’s caused by obstruction in the lower urinary tract.”
C. “It results from decreased blood flow and can be reversed with early treatment.”
D. “It’s commonly caused by contrast-induced nephropathy.”

Answer 19

C. “It results from decreased blood flow and can be reversed with early treatment.”

Rationale: Prerenal oliguria is caused by inadequate renal perfusion and is typically reversible if corrected early. It does not involve intrinsic damage or obstruction.

Question 20

A patient with prerenal AKI from severe dehydration is receiving IV fluids. The nurse notes a gradual improvement in urine output and a drop in creatinine levels. What does this indicate?

A. The patient is transitioning to chronic kidney disease
B. The kidney tissue is becoming necrotic
C. The prerenal AKI is resolving with treatment
D. Intrarenal damage is occurring

Answer 20

C. The prerenal AKI is resolving with treatment

Rationale: Improved urine output and decreasing creatinine following fluid therapy suggest successful reversal of prerenal AKI, consistent with its reversible nature when perfusion is restored early.

Question 21

Which of the following best describes a hallmark feature of intrarenal acute kidney injury?

A. Decreased renal perfusion without tissue injury
B. Obstruction of urine flow distal to the kidney
C. Reversible damage from dehydration
D. Direct damage to kidney tissues impairing nephron function

Answer 21

D. Direct damage to kidney tissues impairing nephron function

Rationale: Intrarenal AKI is caused by direct injury to the kidney itself, such as from nephrotoxins, ischemia, or glomerular disease, resulting in loss of nephron function.

Question 22

A 65-year-old man receiving gentamicin for sepsis now has rising BUN and creatinine levels and urine output of 20 mL/hr. What is the most likely cause of his acute kidney injury?

A. Postrenal obstruction
B. Prerenal hypovolemia
C. Intrarenal nephrotoxic injury
D. Chronic renal failure

Answer 22

C. Intrarenal nephrotoxic injury

Rationale: Gentamicin is a known nephrotoxic aminoglycoside. Prolonged exposure can cause damage to tubular epithelial cells, leading to intrarenal AKI.

Question 23

A patient with a crush injury to the legs develops dark-colored urine, elevated creatinine, and decreased urine output. What substance is most likely contributing to the patient’s AKI?

A. Hemoglobin
B. Protein
C. Myoglobin
D. Uric acid

Answer 23

C. Myoglobin

Rationale: Muscle damage from trauma releases myoglobin into the bloodstream. Myoglobin can obstruct tubules and cause vasoconstriction, leading to intrarenal AKI.

Question 24

A patient develops AKI after undergoing prolonged surgery for bowel obstruction. Labs show elevated BUN and creatinine, and the urinalysis shows muddy brown granular casts. What is the likely diagnosis?

A. Prerenal AKI
B. Postrenal obstruction
C. Acute glomerulonephritis
D. Acute tubular necrosis

Answer 24

D. Acute tubular necrosis

Rationale: ATN is the most common form of intrarenal AKI in hospitalized patients. Muddy brown casts are classic findings, and prolonged surgery increases ischemia risk.

Question 25

Which of the following are known causes of intrarenal AKI? (SATA)

A. Severe hypotension
B. Systemic lupus erythematosus
C. Contrast media
D. Enlarged prostate
E. Hemoglobin release from hemolysis

Answer 25

A. Severe hypotension
B. Systemic lupus erythematosus
C. Contrast media
E. Hemoglobin release from hemolysis

Rationale: All options except the enlarged prostate are intrarenal causes. BPH is a postrenal cause. Intrarenal injury stems from ischemia, autoimmune disease, nephrotoxins, and obstruction by heme pigments.

Question 26

A patient is receiving IV contrast for a CT scan. Which intervention best reduces the risk of intrarenal AKI?

A. Administer a diuretic before the scan
B. Withhold all oral fluids before and after the scan
C. Ensure adequate hydration before and after the procedure
D. Administer nephrotoxic medications immediately post-scan

Answer 26

C. Ensure adequate hydration before and after the procedure

Rationale: Hydration helps dilute and flush contrast media, reducing nephrotoxic effects on renal tubules.

Question 27

A young adult is admitted after a severe burn injury with signs of rhabdomyolysis. What early intervention should the nurse anticipate to prevent intrarenal AKI?

A. Blood transfusion
B. Administration of nephrotoxic antibiotics
C. Dopamine infusion to increase blood pressure
D. Aggressive IV fluid resuscitation

Answer 27

D. Aggressive IV fluid resuscitation

Rationale: Rhabdomyolysis releases myoglobin, which can damage kidneys. Fluid resuscitation dilutes toxins and prevents tubular obstruction.

Question 28

Which mechanism leads to nephrotoxic acute tubular necrosis (ATN)?

A. Inflammation of glomeruli
B. Necrosis of tubular epithelial cells causing obstruction
C. Compression of renal arteries
D. Damage to ureters from stones

Answer 28

B. Necrosis of tubular epithelial cells causing obstruction

Rationale: Nephrotoxins cause necrosis of epithelial cells, which slough off and plug the tubules, disrupting kidney function and leading to ATN.

Question 29

A nurse is caring for a patient with lupus who presents with elevated creatinine and proteinuria. Which type of AKI is this most consistent with?

A. Intrarenal AKI
B. Prerenal AKI
C. Postrenal AKI
D. Functional AKI

Answer 29

A. Intrarenal AKI

Rationale: Lupus can cause glomerulonephritis and immune complex-mediated injury, leading to intrarenal damage and impaired nephron function.

Question 30

A post-op ICU patient with sepsis develops oliguria and increasing creatinine. Which factor is most likely contributing to acute tubular necrosis in this patient?

A. Prolonged hypoperfusion
B. Obstructive uropathy
C. Hypernatremia
D. Liver failure

Answer 30

A. Prolonged hypoperfusion

Rationale: Sepsis often leads to systemic hypotension, reducing renal perfusion. Prolonged ischemia contributes to acute tubular necrosis, a common cause of intrarenal AKI.

Question 31

What clinical conditions are associated with acute tubular necrosis (ATN)? (SATA)

A. Sepsis
B. Contrast-induced nephropathy
C. Ureteral obstruction
D. Blood transfusion reaction
E. Muscle injury from trauma

Answer 31

A. Sepsis
B. Contrast-induced nephropathy
D. Blood transfusion reaction
E. Muscle injury from trauma

Rationale: ATN is caused by ischemia or nephrotoxins, including sepsis, contrast agents, transfusion reactions (hemolysis), and muscle trauma (rhabdomyolysis). Ureteral obstruction is a postrenal issue.

Question 32

Which patient is most at risk for developing intrarenal AKI?

A. A patient with heart failure and hypotension
B. A patient with kidney stones causing bilateral obstruction
C. A patient receiving IV vancomycin and has elevated creatinine
D. A patient with dehydration from vomiting

Answer 32

C. A patient receiving IV vancomycin and has elevated creatinine

Rationale: Vancomycin is nephrotoxic, and rising creatinine suggests intrarenal injury. This is a classic case of nephrotoxic ATN due to direct damage to tubular epithelium.

Question 33

A nurse is assessing a patient with suspected postrenal AKI. Which finding would most strongly support this diagnosis?

A. History of chronic heart failure and low cardiac output
B. Use of nephrotoxic medications and dark, tea-colored urine
C. Recent severe dehydration and orthostatic hypotension
D. Bilateral flank pain and decreased urine output

Answer 33

D. Bilateral flank pain and decreased urine output

Rationale: Postrenal AKI results from mechanical obstruction of urine flow, often presenting with bilateral flank pain due to hydronephrosis and reduced urine output. These are hallmark signs of bilateral ureteral obstruction.

Question 34

An ICU patient with a history of prostate cancer has sudden-onset oliguria and a distended bladder. Which intervention should the nurse anticipate?

A. Increase IV fluid rate
B. Administer furosemide
C. Insert an indwelling urinary catheter
D. Prepare for emergent dialysis

Answer 34

C. Insert an indwelling urinary catheter

Rationale: A distended bladder in a patient with known prostate cancer suggests bladder outlet obstruction. Inserting a catheter relieves the obstruction and can reverse postrenal AKI if done early.

Question 35

Which of the following are known causes of postrenal AKI? (SATA)

A. Prostate cancer
B. Bilateral ureteral obstruction
C. Severe burns
D. Ureteral trauma
E. Kidney stones

Answer 35

A. Prostate cancer
B. Bilateral ureteral obstruction
D. Ureteral trauma
E. Kidney stones

Rationale: Postrenal AKI is caused by any obstruction in the urinary outflow tract, including tumors (like prostate cancer), trauma, bilateral obstruction, and calculi. Severe burns are typically a prerenal cause.

Question 36

Which mechanism leads to kidney dysfunction in postrenal AKI?

A. Glomerular inflammation and immune complex deposition
B. Ischemia from prolonged hypotension
C. Reflux of urine into the renal pelvis causing increased pressure
D. Damage to tubular epithelial cells by myoglobin

Answer 36

C. Reflux of urine into the renal pelvis causing increased pressure

Rationale: In postrenal AKI, obstruction causes urine to back up into the kidneys, increasing hydrostatic pressure, leading to impaired filtration and possible tubular atrophy.

Question 37

A 70-year-old male presents with urinary hesitancy, weak stream, and elevated creatinine. He is diagnosed with BPH. What is the most likely pathophysiological explanation for his AKI?

A. Decreased renal perfusion
B. Obstruction of urinary outflow from the prostate
C. Intrarenal damage from nephrotoxins
D. Immune-mediated glomerular inflammation

Answer 37

B. Obstruction of urinary outflow from the prostate

Rationale: BPH causes mechanical blockage at the bladder neck, which is a classic postrenal cause of AKI. This leads to backflow of urine and kidney dysfunction.

Question 38

A patient with postrenal AKI due to bilateral ureteral obstruction undergoes stent placement. Which outcome would indicate the intervention was effective?

A. Continued oliguria and increasing creatinine
B. Increased urine output and stabilized creatinine levels
C. Decreased urine sodium concentration
D. Weight gain and peripheral edema

Answer 38

B. Increased urine output and stabilized creatinine levels

Rationale: Relief of a postrenal obstruction should restore urine flow and improve kidney function. Rising output and stable creatinine reflect a positive response.

Question 39

Which statement about postrenal AKI is accurate?

A. It typically affects the glomeruli and is irreversible.
B. It results from prolonged hypotension and decreased renal perfusion.
C. It accounts for the majority of AKI cases in the hospital setting.
D. It is caused by mechanical blockage of urine and is potentially reversible if treated early.

Answer 39

D. It is caused by mechanical blockage of urine and is potentially reversible if treated early.

Rationale: Postrenal AKI results from mechanical obstruction and accounts for less than 10% of cases. If addressed within 48 hours, recovery is often complete.

Question 40

Which of the following patients is at highest risk for developing prerenal AKI?

A. A patient with spinal cord injury and urinary retention
B. A patient with sepsis and prolonged hypotension
C. A patient receiving gentamicin for a wound infection
D. A patient with a history of lupus nephritis

Answer 40

B. A patient with sepsis and prolonged hypotension

Rationale: Septic shock leads to decreased peripheral vascular resistance and renal hypoperfusion, making it a prerenal cause of AKI.

Question 41

A patient in the ICU develops AKI following cardiogenic shock. Which mechanism most likely contributed to the injury?

A. Immune complex deposition
B. Decreased renal perfusion
C. Tubular obstruction from hemoglobin
D. Urethral blockage

Answer 41

B. Decreased renal perfusion

Rationale: Cardiogenic shock leads to decreased cardiac output, a hallmark prerenal cause of AKI due to hypoperfusion of the kidneys.

Question 42

Which of the following are considered intrarenal causes of AKI? (SATA)

A. Prolonged prerenal ischemia
B. Acute glomerulonephritis
C. Benign prostatic hyperplasia
D. Exposure to ethylene glycol
E. Acute pyelonephritis

Answer 42

A. Prolonged prerenal ischemia
B. Acute glomerulonephritis
D. Exposure to ethylene glycol
E. Acute pyelonephritis

Rationale: Intrarenal AKI is due to direct kidney tissue damage. BPH is a postrenal cause.

Question 43

A 50-year-old patient presents with severe dehydration, dry mucous membranes, and orthostatic hypotension. Lab results show elevated BUN and creatinine. Which AKI classification does this scenario most likely represent?

A. Intrarenal
B. Postrenal
C. Prerenal
D. Chronic kidney disease

Answer 43

C. Prerenal

Rationale: Dehydration leads to reduced circulating volume, making this a classic example of prerenal AKI.

Question 44

A trauma patient with extensive pelvic fractures becomes oliguric with rising creatinine. Bladder scan reveals 900 mL of retained urine. What is the likely cause of AKI?

A. Postrenal from obstructed urine outflow
B. Prerenal from blood loss
C. Intrarenal from rhabdomyolysis
D. Intrarenal from nephrotoxic drug use

Answer 44

A. Postrenal from obstructed urine outflow

Rationale: Trauma to the pelvis can result in urinary tract obstruction, a postrenal cause of AKI.

Question 45

Which condition places a patient at risk for intrarenal AKI due to interstitial nephritis?

A. Use of NSAIDs and sulfonamides
B. Severe hemorrhage
C. Renal artery thrombosis
D. Prostate cancer and sulfonamides

Answer 45

A. Use of NSAIDs and sulfonamides

Rationale: These drugs are associated with allergic interstitial nephritis, a type of intrarenal AKI.

Question 46

Which of the following are prerenal causes of AKI? (SATA)

A. MI
B. Hypoalbuminemia
C. Anaphylaxis
D. BPH
E. GI losses

Answer 46

A. MI
B. Hypoalbuminemia
C. Anaphylaxis
E. GI losses

Rationale: All options except BPH (a postrenal cause) lead to decreased renal perfusion and are classified as prerenal.

Question 47

A patient has AKI after receiving IV contrast for a CT scan. Which mechanism likely caused this condition?

A. Mechanical obstruction
B. Vasodilation of renal arteries
C. Nephrotoxic injury
D. Immune-mediated injury

Answer 47

C. Nephrotoxic injury

Rationale: IV contrast is a known nephrotoxin and contributes to intrarenal AKI.

Question 48

A young adult is admitted after ingesting ethylene glycol. Which finding is most concerning for progression to AKI?

A. Increased urine output
B. Bilateral costovertebral angle tenderness
C. Elevated serum creatinine
D. Hypoactive bowel sounds

Answer 48

C. Elevated serum creatinine

Rationale: Ethylene glycol is a nephrotoxic chemical; rising creatinine indicates impaired renal function.

Question 49

Which of the following best describes a common postrenal cause of AKI in males?

A. Neurologic injury
B. Heart failure
C. Dehydration
D. BPH

Answer 49

D. BPH

Rationale: Benign prostatic hyperplasia causes obstruction of urine flow and is a leading postrenal cause of AKI in older males.

Question 50

Which of the following are nephrotoxic agents that may contribute to intrarenal AKI? (SATA)

A. Gentamicin
B. Amphotericin B
C. Lead
D. ACE inhibitors
E. Carbon tetrachloride

Answer 50

A. Gentamicin
B. Amphotericin B
C. Lead
E. Carbon tetrachloride

Rationale: These are nephrotoxic substances. ACE inhibitors are associated with interstitial nephritis.

Question 51

Which lab value would you expect to find in a patient with prerenal azotemia?

A. Sodium excretion >40 mEq/L
B. Low BUN/Creatinine ratio
C. Decreased urine output
D. Hypercalcemia

Answer 51

C. Decreased urine output

Rationale: Prerenal AKI leads to oliguria due to decreased renal perfusion. BUN often rises out of proportion to creatinine.

Question 52

Which condition places a patient at highest risk for renal artery thrombosis and prerenal AKI?

A. Atrial fibrillation
B. Severe asthma
C. Liver cirrhosis
D. Spinal cord injury

Answer 52

A. Atrial fibrillation

Rationale: Atrial fibrillation increases embolic risk, which may lead to renal artery thrombosis, a prerenal cause of AKI.

Question 53

What is the primary mechanism by which neuromuscular disorders contribute to postrenal AKI?

A. Reduced kidney perfusion
B. Immune complex formation
C. Impaired bladder emptying
D. Direct nephron damage

Answer 53

C. Impaired bladder emptying

Rationale: Neuromuscular disorders can cause bladder atony or dysfunction, resulting in urinary retention and postrenal obstruction.

Question 54

A patient in septic shock develops oliguria. Which phase of AKI is most likely occurring?

A. Prerenal from hypovolemia
B. Intrarenal from nephrotoxins
C. Postrenal from ureteral compression
D. Intrarenal from prolonged ischemia

Answer 54

D. Intrarenal from prolonged ischemia

Rationale: In septic shock, prolonged hypotension can cause ischemic injury to nephrons, progressing to intrarenal AKI.

Question 55

A patient with a history of systemic lupus erythematosus develops hematuria and elevated creatinine. What is the most likely cause of their AKI?

A. Prerenal due to hypovolemia
B. Intrarenal due to glomerular inflammation
C. Postrenal due to ureteral obstruction
D. Intrarenal due to contrast exposure

Answer 55

B. Intrarenal due to glomerular inflammation

Rationale: SLE can lead to glomerulonephritis, which damages the glomeruli and causes intrarenal AKI.

Question 56

Which of the following prerenal conditions reduce renovascular blood flow? (SATA)

A. Embolism
B. Renal artery thrombosis
C. Burns
D. Hepatorenal syndrome
E. Cardiogenic shock

Answer 56

A. Embolism
B. Renal artery thrombosis
D. Hepatorenal syndrome

Rationale: These conditions specifically affect blood flow to the kidneys. Burns and cardiogenic shock reduce overall perfusion, but not specifically renovascular flow.

Question 57

A nurse is reviewing medications for a patient with AKI. Which drug should raise concern due to its nephrotoxic potential?

A. Lisinopril
B. Acetaminophen
C. Loratadine
D. Amikacin

Answer 57

D. Amikacin

Rationale: Amikacin is an aminoglycoside and is nephrotoxic, making it a high-risk drug for intrarenal AKI.

Question 58

A patient presents with oliguria, bilateral flank pain, and a history of bladder cancer. Which type of AKI is most likely?

A. Prerenal
B. Intrarenal
C. Postrenal
D. Chronic renal failure

Answer 58

C. Postrenal

Rationale: Bladder cancer can obstruct urinary outflow, especially if bilateral, leading to postrenal AKI.

Question 59

Which patient is most likely experiencing interstitial nephritis as a cause of AKI?

A. A patient with flank trauma
B. A patient with recent Epstein-Barr virus infection and NSAID use
C. A patient with embolism in the renal artery
D. A patient with hydronephrosis and NSAID use

Answer 59

B. A patient with recent Epstein-Barr virus infection and NSAID use

Rationale: Viral infections and NSAIDs are known triggers for interstitial nephritis, an intrarenal cause of AKI.

Question 60

A patient is admitted with suspected AKI. The provider notes no intrarenal damage, and the patient improves rapidly with IV fluid resuscitation. Which type of AKI does this clinical course most likely represent?

A. Prerenal AKI
B. Intrarenal AKI
C. Chronic Kidney Disease
D. Postrenal AKI with bilateral obstruction

Answer 60

A. Prerenal AKI

Rationale: Prerenal AKI, when treated early and before any nephron damage occurs, typically resolves quickly with volume restoration. This reversible nature distinguishes it from intrarenal or prolonged postrenal causes.

Question 61

An ICU nurse is monitoring a patient with AKI that has progressed beyond the prerenal phase and now involves tubular damage. What clinical course should the nurse expect?

A. Progression through oliguric, diuretic, and recovery phases
B. Rapid return to baseline kidney function within hours
C. Brief anuria followed by immediate polyuria
D. Permanent kidney failure requiring lifelong dialysis

Answer 61

A. Progression through oliguric, diuretic, and recovery phases

Rationale: Once kidney tissue damage occurs, as with intrarenal AKI, the clinical course typically progresses through three distinct phases: oliguric (low urine output), diuretic (gradual increase in urine output), and recovery (stabilization and return of kidney function).

Question 62

A patient with longstanding BPH presents with AKI. Post-catheterization, urine output increases significantly, and renal labs improve within 24 hours. Which conclusion best fits this scenario?

A. The patient is entering the diuretic phase of AKI.
B. The AKI was postrenal and resolved before intrarenal damage occurred.
C. The patient has chronic kidney disease.
D. The AKI has reached the Failure stage of the RIFLE classification.

Answer 62

B. The AKI was postrenal and resolved before intrarenal damage occurred.

Rationale: Postrenal AKI from obstruction (such as BPH) that is treated early—before nephron damage—can resolve rapidly. A quick return of urine output and lab normalization supports this.

Question 63

Which RIFLE classification stage indicates the most severe level of acute kidney injury?

A. Risk
B. Injury
C. Failure
D. Loss
Correct Answer: C. Failure

Answer 63

C. Failure

Rationale: The RIFLE criteria progress from Risk (mildest) to Injury (moderate) to Failure (most severe of the three stages). “Loss” and “ESRD” are outcome classifications, not stages.

Question 64

A nurse is explaining the RIFLE classification to a new graduate. Which statement by the graduate indicates understanding of the outcome categories of AKI?

A. “Loss and End-stage renal disease refer to the potential outcomes of AKI.”
B. “The outcome categories include Injury and Failure.”
C. “Risk, Injury, and Failure describe the extent of tissue destruction.”
D. “The recovery phase falls under the RIFLE classification.”

Answer 64

A. “Loss and End-stage renal disease refer to the potential outcomes of AKI.”

Rationale: RIFLE includes three graded stages of AKI severity—Risk, Injury, Failure—and two outcome categories: Loss (complete loss of kidney function for >4 weeks) and End-stage renal disease (ESRD), which is complete loss for >3 months.

Question 65

A nurse is caring for a patient recently diagnosed with acute kidney injury (AKI) due to nephrotoxic medications. Which of the following urine patterns is the nurse most likely to observe during the initial phase of AKI in this patient?

A. Anuria occurring within 12 hours
B. Oliguria occurring within 24 hours
C. Oliguria occurring within 1 week
D. Polyuria occurring within 6 hours

Answer 65

C. Oliguria occurring within 1 week

Rationale: Nephrotoxic injury can delay the onset of oliguria for up to a week after the initial insult, whereas ischemic causes typically result in oliguria within 24 hours.

Question 66

A nurse is assessing a patient with suspected oliguric AKI. Which of the following findings would support this diagnosis? (SATA)

A. Urine output of 200 mL/day
B. Fixed urine specific gravity of 1.010
C. Serum creatinine of 0.8 mg/dL
D. Urinalysis with WBCs and RBCs
E. Urine osmolality of 1200 mOsm/kg

Answer 66

A. Urine output of 200 mL/day
B. Fixed urine specific gravity of 1.010
D. Urinalysis with WBCs and RBCs

Rationale: Oliguria is defined as urine output <400 mL/day. Fixed specific gravity around 1.010 and the presence of RBCs/WBCs on urinalysis are signs of tubular damage. Creatinine would typically be elevated in AKI, and urine osmolality would not be high due to loss of concentrating ability.

Question 67

A patient in the ICU with suspected AKI has a urine output of 50 mL in the past 24 hours. The nurse suspects which type of underlying cause?

A. Acute tubular necrosis
B. Urinary tract obstruction
C. Acute glomerulonephritis
D. Prerenal ischemia

Answer 67

B. Urinary tract obstruction

Rationale: Anuria (no urine output) is most commonly associated with urinary tract obstruction (postrenal AKI).

Question 68

A 72-year-old patient presents with dehydration and hypotension. Lab results reveal BUN/creatinine ratio is elevated, and urine output is 300 mL in 24 hours. What is the most likely classification of this patient’s AKI?

A. Intrarenal AKI
B. Postrenal AKI
C. Prerenal AKI
D. Nonoliguric AKI

Answer 68

C. Prerenal AKI

Rationale: Hypovolemia and hypotension point toward decreased renal perfusion, which is a prerenal cause. Oliguria is common in prerenal AKI.

Question 69

Which urinalysis finding would most strongly indicate tubular damage in a patient with AKI?

A. Urine specific gravity of 1.030
B. Presence of fatty casts
C. Absence of proteinuria
D. Fixed specific gravity of 1.010

Answer 69

D. Fixed specific gravity of 1.010

Rationale: A fixed specific gravity around 1.010 reflects an inability of the tubules to concentrate urine, indicating damage to the tubular epithelium.

Question 70

A patient with AKI has a urinalysis showing a large number of cellular casts. What does this finding most likely suggest?

A. Volume depletion
B. Intrarenal tubular damage
C. Obstruction of urinary flow
D. Glomerular hyperfiltration

Answer 70

B. Intrarenal tubular damage

Rationale: Casts are formed when necrotic tubular epithelial cells slough off and take the shape of the tubules, indicating tubular injury typical in ATN.

Question 71

Which of the following clinical presentations would be expected in the oliguric phase of AKI? (SATA)

A. Urine output of 100 mL/day
B. Occurrence of the phase within 1 day in ischemic injury
C. Increased urine specific gravity
D. Potential duration of 2 weeks or more
E. Full recovery of kidney function within 24 hours

Answer 71

A. Urine output of 100 mL/day
B. Occurrence of the phase within 1 day in ischemic injury
D. Potential duration of 2 weeks or more

Rationale: Oliguria is <400 mL/day, and ischemia causes it to occur rapidly, usually within 24 hours. This phase may last 10–14 days or even months. Specific gravity is usually fixed, not increased, and recovery is not rapid.

Question 72

A nurse is evaluating urine osmolality results in a patient with suspected AKI. The value is 300 mOsm/kg. How should the nurse interpret this?

A. Normal kidney concentrating ability
B. Early onset of prerenal AKI
C. Loss of kidney concentrating ability
D. Presence of postrenal obstruction

Answer 72

C. Loss of kidney concentrating ability

Rationale: A urine osmolality equal to plasma osmolality (~300 mOsm/kg) indicates that the kidney has lost its ability to concentrate urine, commonly due to tubular damage in intrarenal AKI.

Question 73

A patient is admitted with suspected nephrotoxic injury after receiving aminoglycosides. The patient has a urine output of 800 mL/day and a urinalysis that reveals proteinuria and epithelial cell casts. What type of AKI does this most likely represent?

A. Prerenal AKI
B. Intrarenal AKI
C. Postrenal AKI
D. Nonrenal cause

Answer 73

B. Intrarenal AKI

Rationale: The presence of proteinuria and epithelial cell casts in the setting of nephrotoxin exposure is consistent with tubular injury, an intrarenal cause.

Question 74

A nurse is monitoring a patient in the oliguric phase of AKI. Which of the following outcomes should concern the nurse most?

A. Urine output of 600 mL in 24 hours
B. Fixed urine specific gravity
C. BUN/creatinine ratio of 10:1
D. Prolonged oliguric phase beyond 3 weeks

Answer 74

D. Prolonged oliguric phase beyond 3 weeks

Rationale: The longer the oliguric phase lasts, the worse the prognosis for full recovery of renal function. Recovery is less likely if it extends beyond 2–3 weeks.

Question 75

A client presents with AKI and proteinuria. Which associated pathology would the nurse suspect based on this urinalysis?

A. Prerenal hypoperfusion
B. Glomerular membrane dysfunction
C. Urinary tract obstruction
D. Interstitial inflammation

Answer 75

B. Glomerular membrane dysfunction

Rationale: Proteinuria is typically a sign of glomerular membrane damage, commonly seen in conditions like glomerulonephritis.

Question 76

A 60-year-old male presents with muscle pain after a crush injury. Labs show elevated creatinine and BUN. Urine is dark and contains myoglobin. Output is 500 mL/day. What form of AKI is most likely present?

A. Prerenal AKI due to hypotension
B. Postrenal AKI due to obstruction
C. Nonoliguric AKI due to aging
D. Intrarenal AKI due to myoglobin-induced nephropathy

Answer 76

D. Intrarenal AKI due to myoglobin-induced nephropathy

Rationale: Myoglobin from necrotic muscle causes tubular obstruction and vasoconstriction, resulting in intrarenal AKI (acute tubular necrosis).

Question 77

A patient is being treated for prerenal AKI. Which of the following interventions is the most important to prevent worsening of the condition?

A. Fluid replacement to correct hypovolemia
B. Administration of diuretics to promote urine output
C. Administration of antihypertensive medications
D. Restricting fluid intake to prevent fluid overload

Answer 77

A. Fluid replacement to correct hypovolemia

Rationale: Fluid replacement is crucial in prerenal AKI, especially when hypovolemia is the cause. Rehydration helps restore kidney perfusion and prevent further damage.

Question 78

A nurse is assessing a patient with AKI who has a decrease in urine output and is developing fluid retention. Which of the following findings would most likely be seen in this patient?

A. Decreased neck vein distention
B. Bounding pulse and distended neck veins
C. Hypotension and dry mucous membranes
D. Decreased heart rate and hypotension

Answer 78

B. Bounding pulse and distended neck veins

Rationale: Fluid retention causes vascular congestion, leading to distended neck veins and a bounding pulse due to the increased fluid volume.

Question 79

A 72-year-old patient with AKI is exhibiting symptoms of fluid overload, including peripheral edema, hypertension, and dyspnea. What is the most likely complication associated with these findings?

A. Pulmonary embolism
B. Congestive heart failure
C. Hypovolemic shock
D. Gastrointestinal bleeding

Answer 79

B. Congestive heart failure

Rationale: Fluid overload in AKI can lead to heart failure as the excess fluid burden causes the heart to work harder, potentially leading to CHF and pulmonary edema.

Question 80

A nurse is caring for a patient with AKI and oliguria. The patient’s neck veins are distended, and they have a bounding pulse. What is the most appropriate intervention at this time?

A. Administer a loop diuretic to reduce edema
B. Restrict all fluids and electrolytes
C. Administer fluids cautiously to avoid further overload
D. Provide a sodium bicarbonate infusion

Answer 80

C. Administer fluids cautiously to avoid further overload

Rationale: Fluid management must be cautious, as the patient may already be experiencing fluid overload. Overzealous fluid administration can worsen the situation and lead to complications like pulmonary edema or heart failure.

Question 81

Which of the following are potential consequences of severe fluid overload in a patient with AKI? (SATA)

A. Hypertension
B. Pulmonary edema
C. Decreased urine output
D. Hyperkalemia
E. Pericardial effusion

Answer 81

A. Hypertension
B. Pulmonary edema
D. Hyperkalemia
E. Pericardial effusion

Rationale: Severe fluid overload can lead to hypertension, pulmonary edema, and pericardial effusion due to increased fluid retention. Hyperkalemia may also occur as a result of kidney dysfunction and inability to excrete potassium. Decreased urine output is a hallmark of AKI, but it is a primary manifestation, not a consequence of fluid overload.

Question 82

A patient with AKI is showing signs of metabolic acidosis. Which of the following laboratory findings would most likely be expected?

A. Elevated bicarbonate (HCO3−) levels
B. Decreased hydrogen ion (H+) concentration
C. Increased respiratory rate with deep respirations
D. Decreased pH

Answer 82

D. Decreased pH

Rationale: In metabolic acidosis, the body’s inability to excrete hydrogen ions and the depletion of bicarbonate lead to a decrease in pH, resulting in acidosis. The increased respiratory rate and deep respirations are compensatory mechanisms to expel CO2 and try to normalize pH.

Question 83

A patient with AKI develops metabolic acidosis. Which of the following compensatory mechanisms would the nurse expect the body to employ to try to balance the pH?

A. Increased excretion of bicarbonate ions by the kidneys
B. Rapid, deep respirations to expel CO2
C. Decreased respiratory rate to retain CO2
D. Increased production of hydrogen ions by the kidneys

Answer 83

B. Rapid, deep respirations to expel CO2

Rationale: The body compensates for metabolic acidosis by increasing respiratory rate and depth (Kussmaul respirations) to expel CO2, which helps raise the pH by decreasing carbonic acid levels.

Question 84

A nurse is caring for a patient with severe metabolic acidosis. The patient’s blood gas results show a pH of 7.28 and a bicarbonate (HCO3−) level of 18 mEq/L. Which of the following actions is most important for the nurse to take?

A. Monitor the patient’s respiratory rate and depth closely to assess for compensation
B. Administer sodium bicarbonate to correct the acidosis
C. Prepare to administer a respiratory stimulant to increase the patient’s breathing rate
D. Restrict fluid intake to prevent further acid buildup

Answer 84

A. Monitor the patient’s respiratory rate and depth closely to assess for compensation

Rationale: In metabolic acidosis, the body compensates by increasing respiratory rate and depth to expel CO2. Monitoring the patient’s breathing pattern will help assess the effectiveness of this compensatory mechanism.

Question 85

A patient with AKI and metabolic acidosis is experiencing Kussmaul respirations. The nurse understands that these respirations are a compensatory response to:

A. Retention of CO2
B. Increased excretion of hydrogen ions
C. Increased bicarbonate levels
D. Increased CO2 exhalation

Answer 85

D. Increased CO2 exhalation

Rationale: Kussmaul respirations are deep, rapid breaths that occur as a compensatory mechanism to expel CO2, which helps to reduce carbonic acid levels and increase pH, counteracting the effects of metabolic acidosis.

Question 86

A patient with AKI is experiencing metabolic acidosis due to an inability to excrete hydrogen ions. Which of the following is the most likely outcome of this condition?

A. Decreased pH and impaired buffering of acids
B. Increased serum bicarbonate production
C. Increased kidney reabsorption of bicarbonate
D. Normal acid-base balance despite kidney dysfunction

Answer 86

A. Decreased pH and impaired buffering of acids

Rationale: Impaired kidney function in metabolic acidosis results in an inability to excrete hydrogen ions or regenerate bicarbonate, leading to a decreased pH and impaired acid buffering capacity, which worsens acidosis.

Question 87

A patient with AKI is unable to conserve sodium due to tubular damage. The nurse knows that an increase in urinary sodium excretion may lead to which of the following serum sodium levels?

A. Increased serum sodium

B. Normal or below-normal serum sodium

C. Elevated serum sodium

D. Fluctuating serum sodium levels

Answer 87

B. Normal or below-normal serum sodium

Rationale: Damaged tubules in AKI cannot effectively conserve sodium, leading to increased urinary sodium excretion. This typically results in normal or below-normal serum sodium levels, as the kidneys are unable to retain sodium properly.

Question 88

A nurse is caring for a patient with AKI and notices signs of volume expansion, including edema and hypertension. The nurse is aware that excessive sodium intake can contribute to which of the following complications?

A. Hypovolemia

B. Cerebral edema

C. Heart failure

D. Hyperkalemia

Answer 88

C. Heart failure

Rationale: Excessive sodium intake in AKI can lead to volume expansion, increasing blood volume and contributing to hypertension and heart failure due to the increased fluid burden on the heart.

Question 89

A patient with AKI develops uncontrolled hyponatremia. What is the most likely serious complication that can result from this electrolyte imbalance?

A. Hyperkalemia

B. Cerebral edema

C. Metabolic acidosis

D. Pulmonary embolis

Answer 89

B. Cerebral edema

Rationale: Uncontrolled hyponatremia or water excess can cause cerebral edema, a dangerous complication that can lead to altered mental status and increased intracranial pressure.

Question 90

A patient with AKI has impaired kidney function and is at risk for hyperkalemia. What is the most common cause of hyperkalemia in patients with AKI?

A. Increased sodium retention
B. Impaired potassium excretion
C. Increased potassium intake
D. Excessive insulin secretion

Answer 90

B. Impaired potassium excretion

Rationale: The kidneys are responsible for excreting 80-90% of the body’s potassium. In AKI, this ability is impaired, leading to the accumulation of potassium in the bloodstream and increasing the risk of hyperkalemia.

Question 91

A nurse is assessing a patient with AKI who has experienced massive tissue trauma. What is the most likely cause of hyperkalemia in this patient?

A. Release of potassium from damaged cells
B. Impaired kidney filtration
C. Excessive intake of potassium-rich foods
D. Increased secretion of aldosterone

Answer 91

A. Release of potassium from damaged cells

Rationale: Massive tissue trauma causes cellular destruction, which releases potassium into the extracellular fluid, increasing the risk of hyperkalemia in patients with AKI.

Question 92

In a patient with AKI and metabolic acidosis, which mechanism contributes most to the development of hyperkalemia?

A. Increased excretion of hydrogen ions, pushing potassium into the extracellular fluid
B. Decreased excretion of potassium, pushing potassium into the extracellular fluid
C. Hydrogen ions entering the cells, pushing potassium into the extracellular fluid
D. Decreased potassium intake from food, pushing potassium into the extracellular fluid

Answer 92

C. Hydrogen ions entering the cells, pushing potassium into the extracellular fluid

Rationale: In metabolic acidosis, hydrogen ions enter the cells, displacing potassium into the extracellular fluid, which exacerbates hyperkalemia.

Question 93

A nurse is reviewing the electrocardiogram (ECG) of a patient with severe hyperkalemia. What ECG finding would the nurse expect to see in this patient?

A. Peaked T waves, widening of the QRS complex, and ST segment depression
B. Flat T waves, prolonged QT interval, and ST segment elevation
C. U waves, normal QRS complex, and no change in ST segment
D. Inverted T waves, shortening of the QT interval, and no change in QRS complex

Answer 93

A. Peaked T waves, widening of the QRS complex, and ST segment depression

Rationale: In patients with severe hyperkalemia, the ECG typically shows peaked T waves, widening of the QRS complex, and ST segment depression. These changes indicate the acute effect of elevated potassium on cardiac conduction.

Question 94

A nurse is caring for a patient with AKI who is asymptomatic despite an elevated potassium level. What is the most important intervention for this patient?

A. Monitor for ECG changes
B. Restrict potassium intake
C. Administer potassium-sparing diuretics
D. Prepare the patient for dialysis

Answer 94

A. Monitor for ECG changes

Rationale: While the patient may be asymptomatic, the nurse must monitor for ECG changes, such as peaked T waves or widened QRS complex, as these are signs of severe hyperkalemia that may lead to life-threatening arrhythmias.

Question 95

A patient with AKI and hyperkalemia is at risk for life-threatening arrhythmias. What is the most urgent intervention to reduce potassium levels?

A. Administer sodium bicarbonate to correct acidosis
B. Administer potassium-rich foods to promote potassium excretion
C. Start a potassium-sparing diuretic to increase potassium excretion
D. Give intravenous calcium to stabilize the cardiac membrane

Answer 95

D. Give intravenous calcium to stabilize the cardiac membrane

Rationale: Intravenous calcium helps stabilize the cardiac membrane and protect against life-threatening arrhythmias caused by hyperkalemia, which is the most urgent intervention.

Question 96

A patient with AKI has a potassium level of 7.0 mEq/L and is showing ECG changes. What should the nurse prepare to administer next to help manage the hyperkalemia?

A. Sodium bicarbonate
B. Furosemide
C. Insulin and glucose
D. Sodium chloride

Answer 96

C. Insulin and glucose

Rationale: Insulin and glucose are used to shift potassium into the cells, lowering serum potassium levels in hyperkalemic patients. This is an essential treatment in the acute management of hyperkalemia.

Question 97

Which of the following conditions increases the risk of hyperkalemia in a patient with AKI?

A. Hypoglycemia
B. Excessive potassium excretion
C. Decreased excretion of hydrogen ions
D. Release of potassium from damaged red blood cells

Answer 97

D. Release of potassium from damaged red blood cells

Rationale: Hemolysis of red blood cells, such as from bleeding or blood transfusions, can release potassium into the extracellular fluid, exacerbating hyperkalemia in patients with AKI.

Question 98

A patient with AKI has developed hospital-acquired infection. What is the most common site of infection in patients with AKI?

A. Gastrointestinal tract

B. Urinary system

C. Skin and soft tissues

D. Central nervous system

Answer 98

B. Urinary system

Rationale: In patients with AKI, the most common sites of infection are the urinary and respiratory systems, with the urinary system being particularly prone to infection due to decreased renal function and possible urinary stasis.

Question 99

A patient with AKI is showing signs of leukocytosis. What is the most likely cause of the elevated white blood cell count in this patient?

A. Hemorrhage

B. Infection

C. Anemia

D. Electrolyte imbalance

Answer 99

B. Infection

Rationale: Leukocytosis, an elevated white blood cell count, is commonly seen in patients with AKI, especially when they have infections. Infection is the most common cause of death in AKI patients, and it often presents with leukocytosis.

Question 100

A nurse is caring for a patient with AKI and a history of multiorgan failure. What is the most important consideration regarding the patient’s hematologic status?

A. Risk for bleeding due to low platelet count

B. Risk for infection due to leukocytosis

C. Risk for anemia due to decreased erythropoiesis

D. Risk for hypercoagulability due to increased clotting factors

Answer 100

B. Risk for infection due to leukocytosis

Rationale: In patients with AKI and multiorgan failure, infection is the most common cause of death. Leukocytosis often occurs as a response to infection, so monitoring and managing infection risk is a priority in these patients.

Question 101

A patient with acute kidney injury (AKI) has elevated levels of both blood urea nitrogen (BUN) and serum creatinine. Which of the following statements is true regarding BUN and creatinine levels in kidney disease?

A) BUN is the best serum indicator of AKI.
B) Serum creatinine levels are unaffected by factors like dehydration or corticosteroid use.
C) BUN levels can be influenced by dehydration, corticosteroids, and catabolism, but creatinine levels are more reliable for diagnosing AKI.
D) Both BUN and creatinine levels are equally reliable indicators of AKI.

Answer 101

C) BUN levels can be influenced by dehydration, corticosteroids, and catabolism, but creatinine levels are more reliable for diagnosing AKI.

Rationale: Serum creatinine is considered the best serum indicator of AKI because it is not influenced by factors such as dehydration, corticosteroid use, or catabolism, whereas BUN levels can be affected by these conditions.

Question 102

A patient with suspected acute kidney injury (AKI) presents with an elevated BUN and serum creatinine. The nurse understands that which of the following factors would most likely contribute to an increase in BUN levels?

A) Recent corticosteroid therapy
B) Elevated serum creatinine due to nephrotoxic drugs
C) Reduced serum sodium levels
D) Normal hydration status and electrolyte balance

Answer 102

A) Recent corticosteroid therapy

Rationale: An increase in BUN levels can be caused by dehydration, corticosteroid therapy, or catabolic states such as infections or fever, all of which increase protein metabolism.

Question 103

A 65-year-old male patient with a history of heart failure and diabetes presents to the emergency department with confusion and lethargy. Laboratory results reveal a BUN of 45 mg/dL and a serum creatinine of 3.5 mg/dL. The nurse recognizes that the elevated creatinine level is the best indicator of which condition?

A) Dehydration
B) Acute kidney injury
C) Chronic kidney disease
D) Infection

Answer 103

B) Acute kidney injury

Rationale: The elevated serum creatinine level is a more reliable indicator of acute kidney injury (AKI) than BUN because creatinine is not influenced by factors such as dehydration, corticosteroid use, or infection, making it the best marker for kidney function.

Question 104

Which of the following is the most reliable serum indicator of acute kidney injury (AKI)?

A) Blood urea nitrogen (BUN)
B) Glomerular filtration rate (GFR)
C) Urine output
D) Serum creatinine

Answer 104

D) Serum creatinine

Rationale: Serum creatinine is considered the best serum indicator of AKI because it reflects kidney function more reliably than BUN, which can be influenced by factors like hydration status, corticosteroid use, and catabolic states.

Question 105

A patient with acute kidney injury (AKI) is experiencing an accumulation of nitrogenous waste products in the brain. The nurse recognizes that which of the following neurologic manifestations is most likely to occur as a result?

A) Memory loss

B) Fatigue and difficulty concentrating

C) Increased motor coordination

D) Muscle spasms and rigidity

Answer 105

B) Fatigue and difficulty concentrating

Rationale: Accumulation of nitrogenous waste products, such as urea, in the brain can lead to neurologic symptoms ranging from mild fatigue and difficulty concentrating to more severe manifestations like seizures, stupor, and coma.

Question 106

A 72-year-old male patient with acute kidney injury (AKI) is exhibiting confusion, fatigue, and difficulty concentrating. The nurse understands that these symptoms are likely caused by which of the following?

A) Increased creatinine levels leading to kidney damage

B) Accumulation of nitrogenous waste products in the brain

C) Dehydration resulting in electrolyte imbalances

D) The side effects of medications used to treat AKI

Answer 106

B) Accumulation of nitrogenous waste products in the brain

Rationale: Neurologic symptoms, such as fatigue and difficulty concentrating, can occur due to the accumulation of nitrogenous waste products in the brain and other nervous tissues during acute kidney injury (AKI).

Question 107

A patient is in the diuretic phase of acute kidney injury (AKI). Which of the following would the nurse be most concerned about due to the increased urine output?

A) Hyponatremia
B) Hyperkalemia
C) Hypercalcemia
D) Hypervolemia

Answer 107

A) Hyponatremia

Rationale: During the diuretic phase of AKI, large volumes of urine are excreted, which increases the risk of electrolyte imbalances like hyponatremia, hypokalemia, and dehydration due to the loss of sodium and potassium.

Question 108

A nurse is caring for a patient in the diuretic phase of AKI who has developed hypotension. What is the most likely cause of the hypotension?

A) Inadequate fluid intake
B) Loss of renal function
C) Increased blood volume from kidney recovery
D) Osmotic diuresis from high urea concentrations

Answer 108

D) Osmotic diuresis from high urea concentrations

Rationale: Osmotic diuresis from high urea concentrations in the glomerular filtrate causes increased urine output during the diuretic phase of AKI, leading to fluid and electrolyte imbalances, including hypotension.

Question 109

A nurse is monitoring a patient in the diuretic phase of AKI. Which lab finding would the nurse expect to be present due to excessive fluid loss?

A) Hypernatremia
B) Hyperkalemia
C) Hypocalcemia
D) Hyponatremia

Answer 109

D) Hyponatremia

Rationale: Excessive fluid and electrolyte losses during the diuretic phase of AKI can result in hyponatremia, hypokalemia, and dehydration due to the inability of the kidneys to concentrate urine effectively.

Question 110

During the diuretic phase of AKI, the kidneys begin to recover their ability to excrete waste products but not to concentrate urine. What would the nurse expect the patient’s urine output to be in this phase?

A) Less than 100 mL/day
B) 1 to 3 L/day
C) 5 to 10 L/day
D) No urine output

Answer 110

B) 1 to 3 L/day

Rationale: During the diuretic phase of AKI, urine output typically increases to 1 to 3 L/day, and it may reach up to 5 L or more, though the kidneys still have difficulty concentrating the urine.

Question 111

A 60-year-old male patient in the diuretic phase of AKI is losing large amounts of fluid through urine output. What electrolyte imbalance should the nurse monitor for due to these excessive fluid losses?

A) Hyperkalemia
B) Hypercalcemia
C) Hyponatremia
D) Hypermagnesemia

Answer 111

C) Hyponatremia

Rationale: During the diuretic phase of AKI, large fluid losses increase the risk for electrolyte imbalances, such as hyponatremia, hypokalemia, and dehydration, due to the increased urine output and inability of the kidneys to concentrate urine.

Question 112

Which of the following assessments should the nurse prioritize for a patient in the diuretic phase of AKI?

A) Monitoring for signs of infection
B) Measuring fluid intake and output
C) Assessing for signs of hypercalcemia
D) Administering potassium supplements

Answer 112

B) Measuring fluid intake and output

Rationale: Monitoring fluid intake and output is essential during the diuretic phase of AKI to manage fluid balance, monitor for dehydration, and detect electrolyte imbalances such as hyponatremia and hypokalemia.

Question 113

A nurse is caring for a patient in the diuretic phase of AKI. The patient’s BUN and creatinine levels are beginning to stabilize. What would the nurse interpret as an indication that the patient is nearing the end of the diuretic phase?

A) Stabilization of acid-base and electrolyte levels
B) Significant decrease in urine output
C) Development of oliguria
D) Decrease in urine specific gravity

Answer 113

A) Stabilization of acid-base and electrolyte levels

Rationale: Near the end of the diuretic phase of AKI, the patient’s acid-base, electrolyte, and waste product levels (BUN, creatinine) stabilize, indicating recovery and improvement in kidney function.

Question 114

A nurse is caring for a patient who is entering the recovery phase of AKI. Which of the following laboratory findings is most likely to be observed during this phase?

A) Increased BUN and creatinine

B) Decreased GFR

C) Increased GFR with decreased BUN and creatinine

D) Stable BUN and creatinine with stable GFR

Answer 114

C) Increased GFR with decreased BUN and creatinine

Rationale: During the recovery phase of AKI, the glomerular filtration rate (GFR) increases, leading to a decrease in BUN and serum creatinine levels, reflecting improved kidney function.

Question 115

A patient is in the recovery phase of AKI, and the nurse notices that the patient’s kidney function is improving. Which of the following would indicate that the patient’s kidney function is stabilizing?

A) Continued high urine output without electrolyte imbalances

B) A steady decrease in BUN and creatinine levels

C) Persistent oliguria despite increasing GFR

D) Presence of proteinuria and hematuria in the urine

Answer 115

B) A steady decrease in BUN and creatinine levels

Rationale: A steady decrease in BUN and creatinine levels, along with an increase in GFR, indicates that kidney function is stabilizing and improving during the recovery phase of AKI.

Question 116

Which of the following factors would most likely contribute to a poor recovery outcome in a patient with AKI during the recovery phase?

A) Early initiation of dialysis

B) Presence of multiple complications and comorbidities

C) Younger age

D) Short duration of the oliguria phase

Answer 116

B) Presence of multiple complications and comorbidities

Rationale: The presence of multiple complications and comorbidities, such as cardiovascular disease, diabetes, or infection, can hinder recovery and increase the likelihood of progressing to end-stage renal disease (ESRD).

Question 117

A 70-year-old patient is recovering from AKI. The nurse understands that the patient may have a slower recovery due to which of the following factors?

A) Older age

B) Decreased urine output

C) Increased fluid intake

D) Elevated creatinine levels

Answer 117

A) Older age

Rationale: Older adults are less likely to experience a complete recovery of kidney function due to age-related changes in renal function, comorbidities, and overall health, which can affect the recovery phase of AKI.

Question 118

Which of the following outcomes is expected in a patient who recovers from AKI but remains in the early stage of chronic kidney disease (CKD)?

A) Complete return to normal kidney function

B) Stable kidney function with no further deterioration

C) Progressive kidney damage and worsening of kidney function

D) No need for dialysis or long-term management

Answer 118

B) Stable kidney function with no further deterioration

Rationale: Patients who recover from AKI may achieve clinically normal kidney function but still remain in the early stages of CKD, where kidney function is stable but potentially susceptible to further deterioration in the future.

Question 119

A nurse is assessing a patient with AKI who has a history of dehydration and hypotension. Which of the following is the most likely cause of this patient’s AKI?

A) Prerenal cause
B) Intrarenal cause
C) Postrenal cause
D) Chronic kidney disease (CKD)

Answer 119

A) Prerenal cause

Rationale: Prerenal causes of AKI are often due to decreased blood flow to the kidneys, which can result from dehydration, hypotension, or blood loss. These factors cause the kidneys to be deprived of adequate perfusion.

Question 120

A patient is admitted with suspected intrarenal AKI. The nurse is aware that which of the following diagnostic tests is most definitive in confirming intrarenal causes of AKI?

A) Kidney ultrasound
B) CT scan
C) Renal biopsy
D) Urinalysis

Answer 120

C) Renal biopsy

Rationale: A renal biopsy is the best way to confirm intrarenal causes of AKI. It provides direct information about the kidney tissue, which is essential for diagnosing the underlying pathology.

Question 121

A patient’s urinalysis shows hematuria, pyuria, and casts. Which of the following is the most likely cause of AKI in this patient?

A) Prerenal cause
B) Postrenal cause
C) Chronic kidney disease
D) Intrarenal cause

Answer 121

D) Intrarenal cause

Rationale: The presence of hematuria, pyuria, and casts in the urine suggests an intrarenal disorder, which is a common cause of AKI. These findings reflect damage to the renal tubules and glomeruli.

Question 122

A 65-year-old patient presents with difficulty urinating, a history of prostate cancer, and increasing serum creatinine levels. The nurse suspects a postrenal cause of AKI. Which of the following diagnostic tests is most appropriate to confirm this diagnosis?

A) Renal biopsy
B) Kidney ultrasound
C) Urinalysis
D) CT scan

Answer 122

B) Kidney ultrasound

Rationale: A kidney ultrasound is often the first test performed in suspected postrenal AKI, as it helps evaluate urinary tract obstruction, such as from bladder or prostate cancer, without exposing the patient to nephrotoxic contrast agents.

Question 123

Which of the following findings in a patient with AKI suggests a prerenal cause of the condition?

A) Decreased urine output and high specific gravity
B) Increased urine sodium and low urine osmolality
C) Presence of casts and hematuria in the urine
D) Increased serum creatinine with a rapid onset of oliguria

Answer 123

A) Decreased urine output and high specific gravity

Rationale: In prerenal AKI, decreased urine output is often seen along with high specific gravity, reflecting the kidneys’ attempt to concentrate urine due to decreased perfusion. The urine sodium level is typically low in prerenal causes.

Question 124

A nurse is caring for a patient with AKI and is preparing to perform a renal scan. Which of the following is the primary purpose of a renal scan in this patient?

A) To assess kidney blood flow and tubular function
B) To detect urinary tract obstruction
C) To visualize lesions, masses, and obstructions
D) To evaluate kidney size and anatomy

Answer 124

A) To assess kidney blood flow and tubular function

Rationale: A renal scan is used to assess abnormalities in kidney blood flow, tubular function, and the collecting system, which can help determine the cause of AKI and evaluate kidney function.

Question 125

Which of the following diagnostic tests should be avoided in patients with AKI and suspected kidney failure due to the risk of a potentially fatal reaction?

A) Kidney ultrasound
B) Renal biopsy
C) MRI or MRA with gadolinium contrast
D) Urinalysis

Answer 125

C) MRI or MRA

Rationale: MRI or MRA with gadolinium contrast should be avoided in patients with kidney failure because gadolinium contrast can be potentially fatal in these patients, particularly due to the risk of nephrogenic systemic fibrosis.

Question 126

A patient with AKI is being evaluated, and a history of nephrotoxic drug exposure is noted. What diagnostic test would the nurse most likely expect to be ordered to help determine the cause of this patient’s AKI?

A) Renal biopsy
B) Urinalysis showing casts and proteins
C) Kidney ultrasound
D) Serum creatinine and BUN levels

Answer 126

B) Urinalysis showing casts and proteins

Rationale: In cases of intrarenal AKI caused by nephrotoxic drugs, a urinalysis showing casts, proteins, and possibly other cellular debris would help confirm the diagnosis of kidney damage from the toxic exposure.

Question 127

A nurse is reviewing a patient’s diagnostic test results for AKI. The patient’s BUN is elevated, but the serum creatinine level has not yet increased significantly. The nurse understands that an increase in serum creatinine will occur after which of the following?

A) Loss of more than 50% of kidney function
B) Initial damage to the renal tubules
C) Decreased urine output due to fluid retention
D) Onset of the diuretic phase

Answer 127

A) Loss of more than 50% of kidney function

Rationale: An increase in serum creatinine typically does not occur until more than 50% of kidney function has been lost. The BUN may rise earlier due to other factors such as dehydration, infection, or corticosteroid use.

Question 128

A patient presents with a suspected postrenal cause of AKI, and the nurse is preparing for diagnostic testing. Which of the following would the nurse expect to be done first?

A) CT scan
B) Kidney biopsy
C) Renal ultrasound
D) Urinalysis

Answer 128

C) Renal ultrasound

Rationale: A renal ultrasound is typically the first diagnostic test performed to evaluate postrenal causes of AKI. It helps detect urinary tract obstructions without the use of nephrotoxic contrast agents.

Question 129

Which of the following urine findings would suggest an intrarenal cause of AKI?

A) Presence of casts and RBCs in the urine
B) Fixed specific gravity of 1.010 with normal sodium content
C) Low urine osmolality with normal urine sodium levels
D) Increased urine output with normal urine sediment

Answer 129

A) Presence of casts and RBCs in the urine

Rationale: The presence of casts and RBCs in the urine suggests an intrarenal cause of AKI, which is indicative of damage to the renal tubules or glomeruli, often caused by conditions like glomerulonephritis or acute tubular necrosis.

Question 130

A nurse is teaching a patient about diagnostic studies for AKI. The nurse explains that which of the following tests is primarily used to detect kidney disease or urinary tract obstruction without the use of nephrotoxic contrast?

A) CT scan
B) Renal biopsy
C) MRI
D) Kidney ultrasound

Answer 130

D) Kidney ultrasound

Rationale: A kidney ultrasound is commonly used to evaluate kidney disease or urinary tract obstruction without exposing the patient to nephrotoxic contrast agents, making it a safer option for those with kidney issues.

Question 131

A 68-year-old patient with type 2 diabetes, hypertension, coronary artery disease (CAD), and chronic kidney disease (CKD) is scheduled for emergency coronary artery bypass graft surgery. The nurse is assessing the patient’s risk for acute kidney injury (AKI) based on the RIFLE classification. Which of the following would indicate the patient is at risk for AKI?

A) Serum creatinine increased × 1.5 and urine output <0.5 mL/kg/hr for 6 hours

B) Serum creatinine increased × 2 and urine output <0.5 mL/kg/hr for 12 hours

C) Serum creatinine increased × 3 and urine output <0.3 mL/kg/hr for 24 hours

D) Serum creatinine >4 mg/dL with acute rise ≥0.5 mg/dL and urine output <0.3 mL/kg/hr for 24 hours

Answer 131

A) Serum creatinine increased × 1.5 and urine output <0.5 mL/kg/hr for 6 hours

Rationale: According to the RIFLE classification, the “Risk” stage is defined by a serum creatinine increase of 1.5 times the baseline, a GFR decrease of 25%, and urine output less than 0.5 mL/kg/hr for 6 hours. This patient’s serum creatinine is increased, and they are at risk for AKI.

Question 132

A patient develops acute tubular necrosis (ATN) after surgery, with a serum creatinine increase to 3.6 mg/dL and a urine output of 28 mL/hr. According to the RIFLE classification, which stage of AKI does this patient meet?

A) Risk
B) Injury
C) Failure
D) Loss

Answer 132

B) Injury

Rationale: The “Injury” stage of AKI is characterized by a serum creatinine increase of 2 times the baseline and a GFR decrease of 50%. The patient also has urine output of less than 0.5 mL/kg/hr for 12 hours, fitting the criteria for the “Injury” stage.

Question 133

A patient in the ICU develops a serum creatinine level of 5.2 mg/dL and a urine output of 10 mL/hr 72 hours after surgery. The nurse recognizes this as a sign of which stage of acute kidney injury (AKI) based on the RIFLE classification?

A) Risk
B) Injury
C) Loss
D) Failure

Answer 133

D) Failure

Rationale: The “Failure” stage of AKI is defined by a serum creatinine increase of 3 times the baseline or a serum creatinine level greater than 4 mg/dL with an acute rise of at least 0.5 mg/dL. The patient’s serum creatinine and urine output meet the criteria for “Failure.”

Question 134

A patient with AKI develops complete loss of kidney function after continuous venovenous hemodialysis for 3 weeks. The nurse recognizes that this patient is in which stage of AKI according to the RIFLE classification?

A) Risk
B) Injury
C) Failure
D) Loss

Answer 134

D) Loss

Rationale: The “Loss” stage in the RIFLE classification refers to persistent acute kidney failure, with complete loss of kidney function lasting more than 4 weeks. This patient’s condition indicates progression to this stage.

Question 135

A patient is diagnosed with end-stage renal disease (ESRD) following complete loss of kidney function for more than 3 months. The nurse understands that the patient’s condition is classified as which stage in the RIFLE classification?

A) Risk
B) Injury
C) Failure
D) End-stage renal disease

Answer 135

D) End-stage renal disease

Rationale: “End-stage renal disease” in the RIFLE classification refers to complete loss of kidney function for more than 3 months. This patient’s condition aligns with this classification.

Question 136

A nurse is reviewing the diagnostic criteria for the “Risk” stage of AKI in the RIFLE classification. Which of the following is a required finding for this stage?

A) Serum creatinine increased × 1.5
B) Serum creatinine increased × 2
C) Urine output <0.3 mL/kg/hr for 24 hours
D) Urine output <0.5 mL/kg/hr for 12 hours

Answer 136

A) Serum creatinine increased × 1.5

Rationale: The “Risk” stage in the RIFLE classification is defined by a serum creatinine increase of 1.5 times the baseline and a decrease in GFR by 25%. The urine output must be less than 0.5 mL/kg/hr for 6 hours.

Question 137

A 72-year-old patient with acute kidney injury (AKI) has a serum creatinine of 5.2 mg/dL and a urine output of 10 mL/hr after 72 hours of surgery. This patient’s condition is consistent with which stage of AKI based on the RIFLE classification?

A) Risk
B) Injury
C) Failure
D) End-stage renal disease

Answer 137

C) Failure

Rationale: The “Failure” stage in the RIFLE classification is indicated by a serum creatinine increase of 3 times the baseline or a serum creatinine level greater than 4 mg/dL, with an acute rise of at least 0.5 mg/dL, and a urine output of less than 0.3 mL/kg/hr for 24 hours.

Question 138

A nurse is assessing a patient who has been on continuous venovenous hemodialysis for 3 weeks due to acute kidney injury. The patient has no improvement in kidney function and is in a critical condition. The nurse recognizes the patient is likely in which stage of AKI based on the RIFLE classification?

A) Risk
B) Injury
C) Failure
D) Loss

Answer 138

D) Loss

Rationale: The “Loss” stage in the RIFLE classification is marked by persistent kidney failure and complete loss of kidney function lasting more than 4 weeks. This patient has been on dialysis for 3 weeks without improvement, indicating the “Loss” stage.

Question 139

A patient with a serum creatinine of 4.5 mg/dL and urine output of 12 mL/hr for 18 hours is in which stage of acute kidney injury based on the RIFLE classification?

A) Risk
B) Injury
C) Failure
D) Loss

Answer 139

C) Failure

Rationale: The “Failure” stage in the RIFLE classification requires a serum creatinine increase of 3 times the baseline or a serum creatinine level greater than 4 mg/dL with an acute rise of at least 0.5 mg/dL. The patient’s serum creatinine and urine output meet the criteria for “Failure.”

Question 140

A 68-year-old patient with a history of CKD develops AKI after surgery. The nurse calculates the patient’s GFR as 35 mL/min/1.73 m2. According to the RIFLE classification, this patient is in which stage of AKI?

A) Risk
B) Injury
C) Failure
D) Loss

Answer 140

A) Risk

Rationale: The “Risk” stage of AKI in the RIFLE classification is characterized by a serum creatinine increase of 1.5 times the baseline and a GFR decrease of 25%. A GFR of 35 mL/min/1.73 m2 is indicative of the “Risk” stage.

Question 141

A patient in the ICU has been diagnosed with AKI and is receiving dopamine therapy for hypotension. Despite treatment, the patient’s urine output drops to 10 mL/hr, and their serum creatinine rises to 5.2 mg/dL. Based on these findings, which stage of AKI is the patient in according to the RIFLE classification?

A) Risk
B) Failure
C) Injury
D) End-stage renal disease

Answer 141

B) Failure

Rationale: The patient meets the criteria for “Failure” in the RIFLE classification with a serum creatinine increase of 3 times the baseline and a urine output of less than 0.3 mL/kg/hr for 24 hours.

Question 142

Which of the following criteria defines the “Failure” stage of AKI in the RIFLE classification?

A) Serum creatinine increased × 2 and urine output <0.5 mL/kg/hr for 12 hours

B) Serum creatinine >4 mg/dL with acute rise ≥0.5 mg/dL and urine output <0.3 mL/kg/hr for 24 hours

C) Serum creatinine increased × 1.5 and urine output <0.5 mL/kg/hr for 6 hours

D) Serum creatinine increased × 3 and urine output <0.3 mL/kg/hr for 24 hours

Answer 142

B) Serum creatinine >4 mg/dL with acute rise ≥0.5 mg/dL and urine output <0.3 mL/kg/hr for 24 hours

Rationale: The “Failure” stage of AKI is defined by a serum creatinine increase of 3 times the baseline, a serum creatinine greater than 4 mg/dL with an acute rise of at least 0.5 mg/dL, and urine output of less than 0.3 mL/kg/hr for 24 hours.

Question 143

A nurse is caring for a patient who is recovering from AKI. The patient’s serum creatinine has stabilized and is no longer rising, and the patient is no longer requiring dialysis. The nurse recognizes that the patient is in which stage of AKI according to the RIFLE classification?

A) Risk
B) Injury
C) Loss
D) Recovery

Answer 143

D) Recovery
Rationale: The “Recovery” phase is marked by stabilization of kidney function, including a stable or decreasing serum creatinine level. This phase may take several months for full recovery of kidney function.

Question 144

A 75-year-old patient presents with persistent kidney failure for over 4 weeks despite treatment. The nurse recognizes that the patient is likely in which stage of AKI according to the RIFLE classification?

A) Risk
B) Injury
C) Failure
D) Loss

Answer 144

D) Loss

Rationale: The “Loss” stage of AKI in the RIFLE classification refers to persistent kidney failure with complete loss of kidney function lasting more than 4 weeks. This patient’s condition suggests they are in the “Loss” stage.

Question 145

A patient develops ventilator-associated pneumonia and sepsis in the ICU, and their serum creatinine rises to 5.2 mg/dL. Their urine output drops to 10 mL/hr. Based on these findings, which stage of AKI would the nurse classify this patient in according to the RIFLE criteria?

A) Risk
B) Injury
C) Failure
D) End-stage renal disease

Answer 145

C) Failure

Rationale: The patient’s serum creatinine has risen to 5.2 mg/dL, which is a 3-fold increase from baseline, and their urine output has decreased to less than 0.3 mL/kg/hr for 24 hours, indicating the “Failure” stage of AKI in the RIFLE classification.

Question 146

A nurse is educating a patient on the stages of acute kidney injury (AKI) based on the RIFLE classification. Which of the following statements by the patient indicates a correct understanding of the “Risk” stage?

A) “I am at risk of kidney failure, and my kidney function may be permanently damaged.”

B) “If I am in the Risk stage, my kidney function will decrease by 50%, and I will require dialysis.”

C) “In the Risk stage, my serum creatinine will increase by 1.5 times my baseline, and my urine output will be reduced.”

D) “The Risk stage means I will need a kidney transplant.”

Answer 146

C) “In the Risk stage, my serum creatinine will increase by 1.5 times my baseline, and my urine output will be reduced.”

Rationale: The “Risk” stage in the RIFLE classification is defined by a 1.5-fold increase in serum creatinine, a 25% decrease in GFR, and a urine output of less than 0.5 mL/kg/hr for 6 hours. This patient’s statement reflects the criteria for the “Risk” stage.

Question 147

A nurse is preparing a patient for diagnostic tests to evaluate acute kidney injury (AKI). Which diagnostic test is most commonly used to assess kidney function and identify the cause of AKI?

A) Urinalysis
B) CT scan
C) Renal ultrasound
D) Serum creatinine and BUN levels

Answer 147

D) Serum creatinine and BUN levels

Rationale: Serum creatinine and BUN levels are the primary diagnostic indicators for evaluating kidney function and identifying the cause of AKI. These tests provide crucial information about kidney function.

Question 148

A patient with AKI is prescribed fluid restriction of 600 mL plus the previous 24-hour fluid loss. Which of the following interventions should the nurse implement to ensure appropriate fluid management?

A) Provide fluids based on the patient’s thirst level.
B) Calculate the patient’s daily fluid balance and adjust intake accordingly.
C) Encourage the patient to drink water frequently to maintain hydration.
D) Administer intravenous fluids as needed to prevent dehydration.

Answer 148

B) Calculate the patient’s daily fluid balance and adjust intake accordingly.

Rationale: Fluid restriction should be based on the patient’s total fluid balance, including the 24-hour fluid loss. This ensures that the patient does not experience fluid overload or dehydration.

Question 149

A nurse is educating a patient with AKI on nutrition therapy. The patient is prescribed an adequate protein intake of 0.8-1.0 g/kg/day. Which of the following factors determines the specific protein intake for the patient?

A) The degree of catabolism
B) Serum creatinine levels
C) The patient’s BMI
D) The patient’s age

Answer 149

A) The degree of catabolism

Rationale: The degree of catabolism (breakdown of body tissue) determines the patient’s protein needs. Higher protein intake may be necessary if there is significant catabolism, which is common in AKI.

Question 150

Which of the following nutrition therapy interventions is appropriate for a patient with AKI who is unable to consume food orally?

A) Total parenteral nutrition (TPN)
B) Enteral nutrition
C) High-calorie, low-protein diet
D) Low-calorie, high-protein diet

Answer 150

B) Enteral nutrition

Rationale: Enteral nutrition is appropriate for patients unable to consume food orally. It helps maintain adequate nutrition and supports the gut’s normal function.

Question 151

A patient with AKI is prescribed dialysis. The nurse is educating the patient about dialysis options. Which of the following should be included in the discussion?

A) Dialysis is used to treat all forms of AKI.
B) Dialysis is required for all patients with AKI, regardless of the cause.
C) Dialysis is only necessary when kidney function is permanently lost.
D) Continuous renal replacement therapy (CRRT) may be used if dialysis is not effective.

Answer 151

D) Continuous renal replacement therapy (CRRT) may be used if dialysis is not effective.

Rationale: Continuous renal replacement therapy (CRRT) is a form of dialysis that is often used in critically ill patients with AKI. It is typically used when traditional dialysis methods are not suitable.

Question 152

The nurse is planning dietary restrictions for a patient with AKI. Which of the following restrictions is most important for the patient to adhere to in order to manage electrolyte imbalances?

A) Potassium
B) Protein
C) Carbohydrates
D) Calcium

Answer 152

A) Potassium

Rationale: Potassium restrictions are critical in managing AKI because the kidneys may have difficulty excreting potassium, leading to the risk of hyperkalemia. Other electrolyte restrictions may also be necessary, but potassium is a priority.

Question 153

A nurse is preparing to administer calcium supplements to a patient with AKI. Which of the following interventions is most important to monitor in the patient receiving calcium supplements?

A) Serum calcium levels
B) Blood glucose levels
C) Serum potassium levels
D) Serum phosphate levels

Answer 153

A) Serum calcium levels

Rationale: Calcium supplements should be administered cautiously, and serum calcium levels should be closely monitored to avoid hypercalcemia, which can occur if calcium is over-supplemented.

Question 154

A nurse is caring for a patient with AKI and a potassium level of 6.2 mEq/L. Which of the following interventions is the priority for managing hyperkalemia in this patient?

A) Administer sodium bicarbonate to shift potassium into cells.
B) Restrict potassium in the diet.
C) Increase fluid intake to promote renal clearance of potassium.
D) Monitor the patient for signs of hypokalemia.

Answer 154

A) Administer sodium bicarbonate to shift potassium into cells.

Rationale: Administering sodium bicarbonate helps to shift potassium from the extracellular space into cells, effectively lowering the potassium level. This intervention is necessary to prevent life-threatening arrhythmias associated with hyperkalemia.

Question 155

A patient with AKI is prescribed a low-sodium diet. Which of the following foods should the nurse instruct the patient to avoid?

A) Fresh fruits
B) Fresh vegetables
C) Canned soups
D) Grilled chicken

Answer 155

C) Canned soups

Rationale: Canned soups are typically high in sodium and should be avoided by patients on a low-sodium diet. Fresh fruits, vegetables, and grilled chicken are generally low in sodium.

Question 156

A nurse is monitoring a patient with AKI for signs of fluid overload. Which of the following assessments should the nurse prioritize?

A) Serum creatinine level
B) Respiratory rate and effort
C) Weight and urine output
D) Blood pressure and pulse

Answer 156

C) Weight and urine output

Rationale: Monitoring weight and urine output is critical for detecting fluid overload. A sudden increase in weight or a decrease in urine output can indicate that the patient is retaining fluid, which may lead to complications such as pulmonary edema.

Question 157

Which of the following diagnostic tests is most commonly used to evaluate kidney disease and urinary tract obstruction in a patient with AKI?

A) Renal ultrasound
B) CT scan
C) Kidney biopsy
D) Serum electrolytes

Answer 157

A) Renal ultrasound

Rationale: Renal ultrasound is commonly used to evaluate kidney disease and detect any urinary tract obstructions, making it a standard diagnostic test in the management of AKI.

Question 158

A patient with acute kidney injury (AKI) is experiencing hyperkalemia. The nurse is preparing to administer treatment. Which intervention should the nurse prioritize to stabilize the patient’s heart and reduce the risk of life-threatening dysrhythmias?

A. Administer sodium bicarbonate
B. Administer calcium gluconate
C. Administer sodium polystyrene sulfonate (Kayexalate)
D. Administer insulin with glucose

Answer 158

B. Administer calcium gluconate

Rationale: Calcium gluconate temporarily stabilizes the myocardium and raises the threshold for dysrhythmias in patients with hyperkalemia. This intervention is critical in reducing the risk of life-threatening cardiac arrhythmias before other measures like potassium removal are considered.

Question 159

Which of the following is a primary goal of treatment in patients with acute kidney injury (AKI)?

A. Prevent progression to end-stage renal disease (ESRD)
B. Manage the underlying cause and prevent complications
C. Initiate renal replacement therapy immediately
D. Administer large volumes of intravenous fluids

Answer 159

B. Manage the underlying cause and prevent complications

Rationale: The main goals in treating AKI are to eliminate the cause, manage symptoms, and prevent complications while the kidneys recover. Immediate renal replacement therapy (RRT) is not always necessary unless the clinical condition requires it.

Question 160

A 72-year-old male with a history of heart failure, diabetes, and chronic kidney disease (CKD) is diagnosed with acute kidney injury (AKI) after undergoing coronary artery bypass graft (CABG) surgery. His current serum creatinine is 3.6 mg/dL, and his urine output is reduced to 28 mL/hr. What is the most appropriate initial intervention for this patient?

A. Administer furosemide (Lasix) to improve urine output
B. Increase fluid intake to improve kidney perfusion
C. Monitor closely for complications while initiating conservative therapy
D. Start renal replacement therapy (RRT) immediately

Answer 160

C. Monitor closely for complications while initiating conservative therapy

Rationale: Conservative therapy is often sufficient for managing AKI unless it is refractory to treatment. Monitoring and supporting the patient with fluid management, electrolytes, and other therapies are appropriate in this phase. Immediate initiation of RRT is not indicated unless certain critical factors are met.

Question 161

Which of the following is an indication for initiating renal replacement therapy (RRT) in a patient with acute kidney injury (AKI)?

A. BUN level of 80 mg/dL
B. Serum potassium level of 4.2 mEq/L
C. Serum bicarbonate level of 18 mEq/L
D. Pericarditis, pericardial effusion, or cardiac tamponade

Answer 161

D. Pericarditis, pericardial effusion, or cardiac tamponade

Rationale: Indications for initiating RRT in AKI include volume overload, high serum potassium, metabolic acidosis (serum HCO3 <15 mEq/L), BUN >120 mg/dL, changes in mental status, and pericarditis, pericardial effusion, or cardiac tamponade.

Question 162

Which of the following is the most appropriate formula for calculating the fluid restriction in a patient with AKI during the oliguric phase?

A. 500 mL plus the previous 24-hour fluid loss
B. 600 mL plus the previous 24-hour fluid loss
C. 700 mL plus the previous 24-hour fluid loss
D. 800 mL plus the previous 24-hour fluid loss

Answer 162

B. 600 mL plus the previous 24-hour fluid loss

Rationale: The fluid restriction during the oliguric phase is calculated by adding all losses from the previous 24 hours (urine, diarrhea, emesis, blood) plus 600 mL for insensible losses, such as respiration and diaphoresis.

Question 163

A patient with AKI is undergoing intermittent hemodialysis (HD) for acute management. The nurse should be most concerned if the patient experiences which of the following during HD treatment?

A. Hypotension
B. Increased urine output
C. Increased serum creatinine
D. Decreased BUN levels

Answer 163

A. Hypotension

Rationale: Rapid fluid shifts during HD can cause hypotension, which is a common complication. Hypotension during dialysis needs prompt attention to prevent further complications.

Question 164

Which of the following diuretics would be most appropriate for managing AKI if the patient has adequate intravascular volume and cardiac output?

A. Furosemide
B. Hydrochlorothiazide
C. Mannitol
D. Spironolactone

Answer 164

A. Furosemide

Rationale: Furosemide (Lasix) is a loop diuretic commonly used to manage fluid overload in AKI when the patient has adequate intravascular volume and cardiac output. Mannitol is used for osmotic diuresis but is not typically used in all AKI cases.

Question 165

A 60-year-old patient with AKI is receiving peritoneal dialysis (PD) for renal replacement therapy. The nurse should be aware that which of the following is a primary complication of peritoneal dialysis?

A. Hypokalemia
B. Hypotension
C. Peritonitis
D. Fluid overload

Answer 165

C. Peritonitis

Rationale: Peritonitis is a serious complication of peritoneal dialysis (PD) and can occur when the catheter or peritoneal cavity becomes infected. Proper aseptic technique is essential to prevent this complication.

Question 166

Which of the following laboratory values is the best indicator of kidney function in a patient with AKI?

A. Blood urea nitrogen (BUN)
B. Urine osmolality
C. Serum potassium
D. Serum creatinine

Answer 166

D. Serum creatinine
Rationale: Serum creatinine is the best indicator of kidney function in AKI because it is not affected by factors such as hydration status or protein intake, unlike BUN.

Question 167

A nurse is caring for a patient in the ICU with AKI and requires renal replacement therapy (RRT). The nurse should understand that which of the following is a characteristic of continuous renal replacement therapy (CRRT)?

A. It is administered over 24 hours
B. It requires rapid fluid shifts to be effective
C. It is typically used for short-term management
D. It requires anticoagulation therapy during treatment

Answer 167

A. It is administered over 24 hours

Rationale: CRRT is administered continuously over 24 hours and has slower blood flow rates compared to intermittent hemodialysis (HD). It does not involve rapid fluid shifts and is typically used for long-term management in critically ill patients.

Question 168

A nurse is reviewing a patient’s lab results during the oliguric phase of acute kidney injury (AKI). The nurse should prioritize which of the following actions to prevent complications related to fluid imbalance?

A. Administer a diuretic to increase urine output
B. Restrict fluids based on previous losses plus 600 mL
C. Increase intravenous fluids to promote kidney perfusion
D. Administer potassium supplements to correct electrolyte imbalances

Answer 168

B. Restrict fluids based on previous losses plus 600 mL

Rationale: Fluid restriction during the oliguric phase is essential to prevent fluid overload, which can worsen the condition. The correct formula for fluid restriction is to add all losses from the previous 24 hours plus 600 mL for insensible losses.

Question 169

A 65-year-old patient with a history of hypertension and chronic kidney disease (CKD) is admitted with acute kidney injury (AKI) following a myocardial infarction. The patient’s potassium level is 6.0 mEq/L. Which action should the nurse take first?

A. Administer sodium bicarbonate
B. Initiate hemodialysis
C. Administer calcium gluconate
D. Administer sodium polystyrene sulfonate (Kayexalate)

Answer 169

C. Administer calcium gluconate

Rationale: Calcium gluconate is used first to stabilize the myocardium in the presence of hyperkalemia, reducing the risk of life-threatening dysrhythmias. Other treatments such as sodium bicarbonate or Kayexalate may follow.

Question 170

Which of the following factors most influences the decision to initiate renal replacement therapy (RRT) in a patient with acute kidney injury (AKI)?

A. Serum creatinine level
B. BUN level
C. Clinical status of the patient
D. Duration of oliguria

Answer 170

C. Clinical status of the patient

Rationale: The decision to initiate RRT is based on the clinical status of the patient, including volume overload, high potassium, acidosis, or changes in mental status, rather than just lab values like serum creatinine or BUN.

Question 171

A patient with AKI is receiving intermittent hemodialysis (HD). The nurse should be aware that which of the following is a potential complication of this treatment?

A. Hyperkalemia
B. Hypotension
C. Hypertension
D. Hyperglycemia

Answer 171

B. Hypotension

Rationale: Rapid fluid shifts during HD can lead to hypotension. It is important to monitor for signs of hypotension during and after treatment and manage it appropriately to prevent further complications.

Question 172

A patient with acute kidney injury (AKI) is undergoing continuous renal replacement therapy (CRRT). The nurse recognizes that which of the following is a characteristic of CRRT compared to intermittent hemodialysis (HD)?

A. CRRT can be used for patients who are hemodynamically unstable
B. CRRT is more likely to cause hypotension due to rapid fluid shifts
C. CRRT requires less specialized equipment than HD
D. CRRT is performed over a shorter period of time than HD

Answer 172

A. CRRT can be used for patients who are hemodynamically unstable

Rationale: CRRT is used in hemodynamically unstable patients because it provides slow, continuous fluid and solute removal, which is less likely to cause hypotension compared to HD. It requires specialized equipment and is performed continuously over 24 hours.

Question 173

The nurse is caring for a patient with AKI who is receiving nutritional therapy. Which of the following is the appropriate protein intake recommendation for this patient?

A. 0.6–0.8 g/kg/day
B. 0.8–1.0 g/kg/day
C. 1.2–1.5 g/kg/day
D. 1.5–2.0 g/kg/day

Answer 173

B. 0.8–1.0 g/kg/day

Rationale: The appropriate protein intake for patients with AKI is 0.8–1.0 g/kg/day, depending on the degree of catabolism. Higher protein intake may be required for patients with increased metabolic needs.

Question 174

A nurse is caring for a patient with AKI who is receiving treatment with sodium polystyrene sulfonate (Kayexalate) to lower potassium levels. The nurse should monitor the patient for which of the following complications?

A. Hyperkalemia
B. Hypertension
C. Constipation
D. Hypoglycemia

Answer 174

C. Constipation

Rationale: Sodium polystyrene sulfonate (Kayexalate) can cause constipation as a side effect, and the nurse should monitor the patient for bowel movement changes.

Question 175

A nurse is caring for a patient with AKI who has been prescribed a loop diuretic. The nurse should assess the patient for which of the following complications?

A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypocalcemia

Answer 175

B. Hyponatremia

Rationale: Loop diuretics, such as furosemide, can cause electrolyte imbalances, including hyponatremia. The nurse should monitor sodium levels closely when administering these medications.

Question 176

A nurse is preparing to administer continuous renal replacement therapy (CRRT) to a patient with acute kidney injury (AKI). The nurse should anticipate that which of the following is required for CRRT?

A. Hemodialysis catheter and anticoagulation therapy
B. Dialysis machine and vascular access
C. Catheter placement and close monitoring of fluid shifts
D. A dialysate solution and frequent electrolyte monitoring

Answer 176

A. Hemodialysis catheter and anticoagulation therapy

Rationale: CRRT requires a hemodialysis catheter and anticoagulation therapy to prevent clotting of the dialysis circuit due to the slower blood flow rates compared to intermittent hemodialysis.

Question 177

A nurse is caring for a patient in the intensive care unit who has been diagnosed with acute kidney injury (AKI). The patient’s urine output is 50 mL over the last 4 hours. The nurse knows that a hallmark sign of the oliguric phase of AKI is:

A. Hyperkalemia
B. Increased urine output
C. Hypoglycemia
D. Decreased urine output

Answer 177

D. Decreased urine output

Rationale: The oliguric phase of AKI is characterized by a significant decrease in urine output, typically less than 400 mL per day. This phase often occurs in the first 1-7 days following the insult.

Question 178

A patient with AKI is being treated with diuretics for fluid overload. Which laboratory result should the nurse monitor closely while the patient is receiving this medication?

A. Blood urea nitrogen (BUN)
B. Serum calcium
C. Serum sodium
D. Serum potassium

Answer 178

D. Serum potassium

Rationale: Diuretics can cause potassium depletion, which can lead to hypokalemia. The nurse should closely monitor potassium levels to prevent complications such as cardiac arrhythmias.

Question 179

A patient with acute kidney injury (AKI) is receiving hemodialysis. The nurse should be aware that a potential complication of hemodialysis is:

A. Hypotension
B. Hyperglycemia
C. Hypokalemia
D. Hypocalcemia

Answer 179

A. Hypotension

Rationale: Hemodialysis can cause hypotension due to the rapid removal of fluid and solutes. This drop in blood pressure can lead to dizziness, fainting, or shock if not managed properly.

Question 180

A 70-year-old male patient with a history of diabetes and hypertension is admitted with acute kidney injury (AKI). The physician orders a renal biopsy to determine the underlying cause of the AKI. What action should the nurse take before the procedure?

A. Administer an anticoagulant to prevent bleeding
B. Ensure the patient is well hydrated before the procedure
C. Withhold any medications that affect renal function
D. Monitor the patient for signs of infection

Answer 180

B. Ensure the patient is well hydrated before the procedure

Rationale: Renal biopsy requires the patient to be well hydrated before the procedure to prevent complications such as hypotension or reduced perfusion. The nurse should also ensure that the patient has no active bleeding risk.

Question 181

Which of the following is an indication for initiating renal replacement therapy (RRT) in a patient with acute kidney injury (AKI)?

A. Serum creatinine level greater than 2.0 mg/dL
B. Refractory hyperkalemia
C. Mild oliguria
D. Decreased glomerular filtration rate (GFR)

Answer 181

B. Refractory hyperkalemia

Rationale: Renal replacement therapy is indicated in cases of severe and refractory hyperkalemia, when medications and other measures are insufficient to control the potassium levels.

Question 182

A patient with acute kidney injury (AKI) is undergoing continuous renal replacement therapy (CRRT). The nurse notes that the patient’s weight has increased by 2 kg since the last shift. Which of the following should the nurse do?

A. Document the weight gain and notify the physician
B. Increase the fluid intake
C. Decrease the CRRT flow rate
D. Administer a dose of diuretic

Answer 182

A. Document the weight gain and notify the physician

Rationale: A 2 kg weight gain could indicate fluid retention, which is common in AKI. The nurse should notify the physician to evaluate the patient’s condition and adjust treatment as needed.

Question 183

A patient with AKI has a potassium level of 6.5 mEq/L. The nurse should anticipate which of the following interventions?

A. Administer potassium-sparing diuretics
B. Increase the patient’s potassium intake
C. Prepare to administer sodium polystyrene sulfonate
D. Encourage the patient to drink more fluids

Answer 183

C. Prepare to administer sodium polystyrene sulfonate

Rationale: Sodium polystyrene sulfonate (Kayexalate) is a medication used to treat hyperkalemia by exchanging sodium for potassium in the gastrointestinal tract. The nurse should anticipate this intervention for a potassium level of 6.5 mEq/L.

Question 184

A nurse is caring for a patient who has been diagnosed with AKI due to dehydration. The patient’s urine output has increased significantly after receiving intravenous fluids. Which of the following would be the most appropriate next step?

A. Discontinue the fluids to prevent fluid overload
B. Continue to monitor the patient’s vital signs and urine output
C. Administer a loop diuretic to enhance urine output
D. Switch the patient to continuous renal replacement therapy (CRRT)

Answer 184

B. Continue to monitor the patient’s vital signs and urine output

Rationale: After the administration of fluids, the nurse should continue to monitor the patient’s urine output and vital signs closely. Increased urine output is a positive sign, and fluid overload should be prevented.

Question 185

A nurse is educating a patient with AKI about diet modifications. Which of the following dietary restrictions is most important for a patient with AKI?

A. Low-potassium diet
B. High-protein diet
C. High-sodium diet
D. Low-calcium diet

Answer 185

A. Low-potassium diet

Rationale: A low-potassium diet is crucial for patients with AKI to prevent hyperkalemia, which can lead to life-threatening arrhythmias. Potassium-rich foods should be avoided.

Question 186

A nurse is caring for a patient in the recovery phase of acute kidney injury (AKI). The nurse should anticipate which of the following findings during this phase?

A. Urine output remains low and consistent
B. Blood urea nitrogen (BUN) and creatinine levels continue to rise
C. The patient’s renal function returns to baseline
D. The patient requires renal replacement therapy

Answer 186

C. The patient’s renal function returns to baseline

Rationale: In the recovery phase of AKI, the patient’s renal function begins to return to baseline, with normalization of urine output and improvement in laboratory values such as BUN and creatinine.

Question 187

Which of the following is a priority assessment for a nurse caring for a patient with acute kidney injury (AKI) receiving renal replacement therapy (RRT)?

A. Monitoring for signs of hyperglycemia
B. Assessing the site of dialysis catheter placement
C. Checking for signs of electrolyte imbalance
D. Monitoring for signs of dehydration

Answer 187

C. Checking for signs of electrolyte imbalance

Rationale: A priority assessment for a patient receiving renal replacement therapy (RRT) is monitoring for signs of electrolyte imbalance, as RRT can alter electrolyte levels, including potassium, sodium, and calcium.

Question 188

A nurse is caring for a patient with acute kidney injury (AKI) who is receiving continuous renal replacement therapy (CRRT). The patient’s urine output has decreased despite the therapy. Which action should the nurse take next?

A. Increase the CRRT flow rate
B. Discontinue the therapy and reassess the patient
C. Notify the healthcare provider about the decrease in urine output
D. Administer a diuretic to promote urine output

Answer 188

C. Notify the healthcare provider about the decrease in urine output

Rationale: The nurse should notify the healthcare provider about the decrease in urine output, as this could indicate a need for adjustment in the CRRT or further intervention. Increasing the flow rate or administering diuretics without guidance could worsen the situation.

Question 189

A patient with acute kidney injury (AKI) is being treated for hyperkalemia. Which of the following medications should the nurse anticipate administering to promote potassium shift into the cells?

A. Sodium polystyrene sulfonate (Kayexalate)
B. Calcium gluconate
C. Insulin and glucose
D. Furosemide

Answer 189

C. Insulin and glucose

Rationale: Insulin and glucose are used together to promote the transient shift of potassium into cells, which can temporarily lower serum potassium levels in cases of hyperkalemia.

Question 190

A patient with AKI is being treated with diuretics. The nurse notes a potassium level of 2.8 mEq/L. What action should the nurse take first?

A. Administer a potassium supplement
B. Assess for signs of hypokalemia
C. Discontinue the diuretic therapy
D. Notify the healthcare provider

Answer 190

B. Assess for signs of hypokalemia

Rationale: The nurse should first assess for signs and symptoms of hypokalemia (e.g., weakness, muscle cramps, cardiac arrhythmias) before taking further action. Hypokalemia can be life-threatening and may require immediate intervention.

Question 191

A nurse is preparing to administer sodium bicarbonate to a patient with AKI and hyperkalemia. The purpose of sodium bicarbonate administration is to:

A. Promote potassium excretion through the kidneys
B. Shift potassium into cells temporarily
C. Lower serum potassium levels by increasing renal perfusion
D. Increase renal blood flow to enhance diuresis

Answer 191

B. Shift potassium into cells temporarily

Rationale: Sodium bicarbonate temporarily shifts potassium into cells, which helps lower serum potassium levels. This intervention is used in the management of hyperkalemia, especially when it is severe.

Question 192

A nurse is caring for a patient in the recovery phase of AKI. Which laboratory finding should the nurse expect to return to baseline during this phase?

A. Blood urea nitrogen (BUN)
B. Serum potassium
C. Hemoglobin
D. Creatinine

Answer 192

D. Creatinine

Rationale: During the recovery phase of AKI, creatinine levels are expected to return to baseline as kidney function improves and the kidneys begin to excrete waste products more effectively.

Question 193

A nurse is caring for a patient with acute kidney injury (AKI) who is receiving sodium polystyrene sulfonate (Kayexalate) for hyperkalemia. The nurse should monitor for which of the following complications?

A. Hypokalemia
B. Hyperkalemia
C. Constipation
D. Hypertension

Answer 193

C. Constipation

Rationale: Sodium polystyrene sulfonate (Kayexalate) works by exchanging sodium for potassium in the gastrointestinal tract, which can cause constipation as a side effect. The nurse should monitor for this and intervene as necessary.

Question 194

A patient with acute kidney injury (AKI) has a serum creatinine level of 5.4 mg/dL and is experiencing oliguria. Which of the following should the nurse anticipate as the next step in management?

A. Administer loop diuretics
B. Initiate continuous renal replacement therapy
C. Administer potassium-sparing diuretics
D. Increase fluid intake

Answer 194

B. Initiate continuous renal replacement therapy

Rationale: For a patient with severe AKI (serum creatinine >4 mg/dL and oliguria), continuous renal replacement therapy (CRRT) is often initiated to manage fluid overload, electrolyte imbalances, and metabolic acidosis.

Question 195

A nurse is caring for a patient who is undergoing continuous renal replacement therapy (CRRT). The nurse notices that the patient’s blood pressure is 88/50 mm Hg, and the heart rate is 110 bpm. What is the nurse’s priority action?

A. Decrease the CRRT flow rate
B. Increase the infusion of IV fluids
C. Administer an antihypertensive medication
D. Notify the healthcare provider about the changes in vital signs

Answer 195

A. Decrease the CRRT flow rate

Rationale: The nurse should decrease the CRRT flow rate to prevent further hypotension. Rapid fluid and solute removal during CRRT can cause hypotension, which can lead to inadequate perfusion and other complications.

Question 196

A patient with acute kidney injury (AKI) is receiving nutrition therapy. The nurse should prioritize providing calories from which of the following sources to prevent ketosis and muscle protein breakdown?

A. Protein
B. Simple sugars
C. High-sodium foods
D. Carbohydrates and fats

Answer 196

D. Carbohydrates and fats

Rationale: Carbohydrates and fats are the primary sources of energy in AKI nutrition therapy to prevent ketosis from fat breakdown and gluconeogenesis from muscle protein breakdown. This helps avoid catabolism and ensures adequate energy for recovery.

Question 197

A nurse is caring for a patient with acute kidney injury (AKI) who is on enteral nutrition. The nurse should monitor which of the following to ensure that the patient’s nutritional needs are met?

A. Serum glucose levels
B. Serum potassium levels
C. Urine output
D. Serum sodium levels

Answer 197

B. Serum potassium levels

Rationale: For patients with AKI, it is important to monitor serum potassium levels because dietary potassium intake needs to be carefully managed to prevent hyperkalemia.

Question 198

A patient with AKI is being provided parenteral nutrition (PN). The nurse is concerned about the patient’s fluid balance. Which intervention should the nurse anticipate?

A. Administration of loop diuretics
B. Restriction of all oral fluids
C. Daily dialysis to remove excess fluid
D. Decreasing the protein intake

Answer 198

C. Daily dialysis to remove excess fluid

Rationale: Parenteral nutrition (PN) may result in fluid overload, and the patient may need daily dialysis (such as hemodialysis or CRRT) to remove the excess fluid and maintain fluid balance.

Question 199

Which of the following is the primary goal of nutrition therapy in a patient with acute kidney injury (AKI)?

A. To eliminate azotemia
B. To provide adequate calories and prevent catabolism
C. To promote renal recovery through high-protein intake
D. To regulate serum sodium levels only

Answer 199

B. To provide adequate calories and prevent catabolism

Rationale: The primary goal of nutrition therapy in AKI is to provide adequate calories (30 to 35 kcal/kg) and protein (0.8–1.0 g/kg) to prevent catabolism and support the body’s recovery while managing fluid and electrolyte imbalances.

Question 200

A nurse is caring for a patient with AKI who is receiving parenteral nutrition (PN). The nurse notices that the patient’s sodium levels are elevated. Which intervention is appropriate to address this issue?

A. Restrict the patient’s sodium intake
B. Increase the sodium intake in the PN formula
C. Initiate IV fluids with sodium bicarbonate
D. Administer loop diuretics to eliminate excess sodium

Answer 200

A. Restrict the patient’s sodium intake

Rationale: When sodium levels are elevated in patients receiving PN, restricting sodium intake is appropriate to prevent further complications such as edema, hypertension, and fluid retention.

Question 201

In patients with acute kidney injury (AKI) who are receiving enteral nutrition, the nurse should prioritize which of the following to prevent fluid overload and electrolyte imbalance?

A. Administering a high-sodium diet
B. Monitoring serum potassium and sodium levels regularly
C. Increasing the protein intake to prevent muscle wasting
D. Providing only low-calorie food sources

Answer 201

B. Monitoring serum potassium and sodium levels regularly

Rationale: Monitoring serum potassium and sodium levels is essential for preventing electrolyte imbalances in patients with AKI, as these patients are at risk for both hyperkalemia and hyponatremia.

Question 202

A nurse is caring for a patient with acute kidney injury (AKI) who is on a prescribed low-protein diet with adequate calories primarily from fats and carbohydrates. The nurse should educate the patient that the goal of this dietary restriction is to:

A. Prevent the breakdown of muscle protein and promote recovery
B. Increase the intake of potassium and sodium for electrolyte balance
C. Minimize the risk of protein metabolism leading to increased urea
D. Promote faster kidney recovery by reducing serum creatinine

Answer 202

A. Prevent the breakdown of muscle protein and promote recovery

Rationale: The goal of providing adequate calories from fats and carbohydrates while restricting protein in AKI is to prevent muscle protein breakdown, thus minimizing catabolism and promoting recovery without overwhelming the kidneys.

Question 203

When assessing a patient with acute kidney injury (AKI), the nurse notices that the patient has edema, neck vein distention, and crackles in the lungs. Which of the following interventions should the nurse prioritize?

A. Administer diuretics as ordered
B. Increase the patient’s fluid intake
C. Encourage deep breathing exercises
D. Prepare the patient for dialysis

Answer 203

A. Administer diuretics as ordered

Rationale: The presence of edema, neck vein distention, and crackles in the lungs suggests fluid overload. The nurse should prioritize administering diuretics as ordered to help manage fluid retention before considering other interventions.

Question 204

A nurse is assessing the urine output of a patient with acute kidney injury (AKI). The nurse notes that the urine is dark and has a specific gravity of 1.030. What is the most likely implication of these findings?

A. The patient is experiencing hyperkalemia
B. The patient is in the oliguric phase of AKI
C. The patient has normal kidney function
D. The patient is experiencing dehydration

Answer 204

B. The patient is in the oliguric phase of AKI

Rationale: Dark urine and a high specific gravity (greater than 1.020) are common findings in the oliguric phase of AKI, indicating concentrated urine due to decreased urine output.

Question 205

When assessing a patient with acute kidney injury (AKI), the nurse observes that the patient’s oral mucosa is dry and inflamed. Which of the following interventions is most appropriate for this patient?

A. Encourage the patient to drink large amounts of water
B. Administer oral antibiotics as prescribed
C. Provide oral care and offer sips of water frequently
D. Apply a topical corticosteroid to the oral mucosa

Answer 205

C. Provide oral care and offer sips of water frequently

Rationale: Dry and inflamed oral mucosa is a common finding in AKI due to fluid imbalances. The nurse should provide frequent oral care and offer sips of water to help alleviate dryness and prevent further irritation.

Question 206

A nurse is assessing a patient with acute kidney injury (AKI) and notices an S3 gallop on auscultation of the heart. What is the significance of this finding?

A. It indicates dehydration
B. It is a normal finding in elderly patients
C. It suggests electrolyte imbalance and arrhythmia
D. It suggests fluid overload and heart failure

Answer 206

D. It suggests fluid overload and heart failure

Rationale: An S3 gallop is often associated with fluid overload and heart failure, which can occur in AKI due to the kidneys’ inability to manage fluid balance effectively.

Question 207

When assessing a patient with acute kidney injury (AKI), the nurse observes that the patient has developed bruises and signs of poor circulation. What should the nurse do next?

A. Immediately administer vitamin K
B. Encourage increased physical activity
C. Document the findings and continue monitoring
D. Assess for signs of coagulation abnormalities or bleeding

Answer 207

D. Assess for signs of coagulation abnormalities or bleeding

Rationale: The development of bruises and poor circulation may suggest coagulation abnormalities, which are common in AKI. The nurse should assess the patient for signs of bleeding and notify the healthcare provider if necessary.

Question 208

A nurse is assessing a patient’s ECG readings and notices frequent premature ventricular contractions (PVCs). What action should the nurse take first?

A. Administer antiarrhythmic medications as prescribed
B. Monitor the patient’s potassium levels
C. Prepare for immediate defibrillation
D. Assess the patient’s blood pressure

Answer 208

B. Monitor the patient’s potassium levels

Rationale: PVCs can be caused by electrolyte imbalances, particularly low potassium levels. The nurse should first assess the patient’s potassium levels and correct any deficiencies before taking further action.

Question 209

A nurse is assessing a patient with acute kidney injury (AKI) who is undergoing dialysis. The nurse notices inflammation and exudate at the dialysis access site. What should the nurse do next?

A. Continue monitoring the site without intervention
B. Apply a warm compress to the site and assess for changes
C. Remove the catheter and notify the healthcare provider
D. Clean the site with alcohol and administer antibiotics

Answer 209

C. Remove the catheter and notify the healthcare provider

Rationale: Inflammation and exudate at the dialysis access site could indicate an infection or complication. The nurse should notify the healthcare provider immediately for further evaluation and possible intervention.

Question 210

A nurse is reviewing the laboratory values of a patient with acute kidney injury (AKI). The nurse is particularly concerned about the patient’s BUN level, which is elevated. What should the nurse consider when interpreting this finding?

A. The BUN level is elevated due to dehydration
B. The BUN level is a normal finding in AKI
C. The BUN level should not be used to assess kidney function
D. The BUN level may indicate kidney dysfunction or azotemia

Answer 210

D. The BUN level may indicate kidney dysfunction or azotemia

Rationale: Elevated BUN levels are a common sign of kidney dysfunction and azotemia, which are key concerns in AKI. The nurse should monitor BUN levels as part of assessing the patient’s kidney function and overall condition.

Question 211

A nurse is caring for a patient with acute kidney injury (AKI) who is at risk for electrolyte imbalance. Which of the following interventions should the nurse prioritize to prevent complications related to this risk?

A. Administer prescribed potassium-sparing diuretics

B. Monitor serum electrolyte levels frequently

C. Restrict all fluid intake to prevent dilution

D. Encourage a high-protein, low-carbohydrate diet

Answer 211

B. Monitor serum electrolyte levels frequently

Rationale: Monitoring serum electrolyte levels frequently is essential for managing electrolyte imbalances in AKI. Frequent monitoring allows the nurse to detect changes in electrolyte levels early and intervene to prevent complications such as arrhythmias or other life-threatening issues.

Question 212

A nurse is caring for a patient with acute kidney injury (AKI) who is experiencing anxiety. Which of the following interventions is most appropriate to help reduce the patient’s anxiety?

A. Encourage the patient to rest in a quiet environment

B. Administer prescribed sedatives to induce sleep

C. Offer relaxation techniques and provide information about the condition

D. Restrict visitors to minimize stimulation

Answer 212

C. Offer relaxation techniques and provide information about the condition

Rationale: Offering relaxation techniques and providing information about the patient’s condition can help alleviate anxiety. Education and reassurance are key components in managing anxiety, especially when the patient understands what is happening and what to expect in terms of treatment and recovery.

Question 213

A nurse is developing a plan of care for a patient with acute kidney injury (AKI). Which of the following outcomes is the nurse’s priority in the planning process?

A. The patient will maintain normal blood pressure.

B. The patient will completely recover without any loss of kidney function.

C. The patient will experience a decrease in pain and discomfort.

D. The patient will demonstrate an understanding of the need for follow-up care.

Answer 213

B. The patient will completely recover without any loss of kidney function.

Rationale: The priority goal for a patient with AKI is to completely recover without any loss of kidney function. This goal ensures the restoration of kidney health and the prevention of long-term complications.

Question 214

Which of the following is the most appropriate goal for a nurse to set when caring for a patient with acute kidney injury (AKI) who is at risk for electrolyte imbalances?

A. The patient will have normal electrolyte levels within 24 hours.

B. The patient will maintain normal fluid and electrolyte balance during hospitalization.

C. The patient will demonstrate understanding of the effects of electrolytes on kidney function.

D. The patient will not require any dialysis during hospitalization.

Answer 214

B. The patient will maintain normal fluid and electrolyte balance during hospitalization.

Rationale: The goal of maintaining normal fluid and electrolyte balance is essential to preventing complications in AKI. This goal is realistic and focuses on the patient’s immediate needs during hospitalization.

Question 215

When planning care for a patient with acute kidney injury (AKI), which of the following goals would be appropriate to reduce the patient’s anxiety?

A. The patient will demonstrate effective coping strategies.

B. The patient will receive a sedative every 4 hours.

C. The patient will express fewer concerns about their diagnosis.

D. The patient will verbalize understanding of the need for follow-up care.

Answer 215

A. The patient will demonstrate effective coping strategies.

Rationale: The goal of demonstrating effective coping strategies is appropriate for addressing anxiety in a patient with AKI. This outcome focuses on equipping the patient with tools to manage their emotions and stress during hospitalization.

Question 216

Which of the following is the most important strategy in preventing acute kidney injury (AKI) in high-risk populations?

A. Prevention and early recognition of AKI
B. Early administration of nephrotoxic drugs
C. Restricting fluid intake in high-risk patients
D. Immediate use of dialysis for at-risk patients

Answer 216

A. Prevention and early recognition of AKI

Rationale: Prevention and early recognition are the most important aspects of care in preventing AKI. Identifying high-risk populations and monitoring them closely helps in preventing the onset of AKI.

Question 217

Which patient would be most at risk for developing acute kidney injury (AKI)?

A. A 30-year-old with no significant health issues
B. A 45-year-old with controlled diabetes and hypertension
C. A 65-year-old with chronic kidney disease (CKD) and heart failure
D. A 50-year-old who underwent a minor outpatient procedure

Answer 217

C. A 65-year-old with chronic kidney disease (CKD) and heart failure

Rationale: A patient with preexisting CKD, older age, heart failure, and other risk factors is at a significantly higher risk for developing AKI, particularly when they undergo stressors like surgery or trauma.

Question 218

What is the most effective strategy for preventing contrast-induced nephropathy (CIN) in a patient with diabetes receiving contrast media?

A. Administer a high dose of contrast media to reduce toxicity
B. Use an increased dose of insulin prior to the procedure
C. Hold metformin for 48 hours before and after the contrast procedure
D. Monitor renal function more frequently post-procedure

Answer 218

C. Hold metformin for 48 hours before and after the contrast procedure

Rationale: Holding metformin for 48 hours before and after the use of contrast media is recommended to decrease the risk for lactic acidosis, a common complication in diabetic patients receiving contrast.

Question 219

Which of the following is a common risk factor for the development of acute kidney injury (AKI) in hospitalized patients?

A. Preexisting chronic kidney disease
B. Short-term use of diuretics
C. Surgical procedures involving small incisions
D. Non-invasive diagnostic tests

Answer 219

A. Preexisting chronic kidney disease

Rationale: Preexisting chronic kidney disease (CKD) is a significant risk factor for AKI in hospitalized patients, especially if they are exposed to nephrotoxic drugs or undergo major surgery or trauma.

Question 220

What should be monitored in a patient at high risk for developing acute kidney injury (AKI) due to nephrotoxic drug use?

A. Only serum creatinine levels
B. Weight, intake and output, and fluid balance
C. Blood pressure and heart rate
D. Glucose and hemoglobin A1c

Answer 220

B. Weight, intake and output, and fluid balance

Rationale: Monitoring weight, intake and output, and fluid balance helps assess kidney function and fluid volume status, which are critical in preventing and managing AKI.

Question 221

Which medication can potentially worsen kidney function in a patient with mild chronic kidney disease (CKD)?

A. Angiotensin-converting enzyme inhibitors
B. Beta-blockers
C. Calcium channel blockers
D. Nonsteroidal anti-inflammatory drugs

Answer 221

D. Nonsteroidal anti-inflammatory drugs

Rationale: NSAIDs can worsen kidney function, particularly in patients with CKD, by decreasing renal blood flow and increasing the risk of AKI.

Question 222

What is the recommended action when ACE inhibitors are used in a patient with acute kidney injury (AKI) and hyperkalemia?

A. Increase the dose of the ACE inhibitor
B. Discontinue the ACE inhibitor if hyperkalemia is not controlled by other means
C. Switch to a calcium channel blocker
D. Administer sodium bicarbonate to balance potassium levels

Answer 222

B. Discontinue the ACE inhibitor if hyperkalemia is not controlled by other means

Rationale: If hyperkalemia is not controlled by diet changes or diuretics, ACE inhibitors may need to be reduced or stopped because they can exacerbate hyperkalemia.

Question 223

Which of the following is an important nursing intervention when administering nephrotoxic drugs to a high-risk patient?

A. Ensure hydration and monitor renal function closely
B. Increase the dose of nephrotoxic drugs for quicker action
C. Administer analgesics to prevent discomfort from nephrotoxic effects
D. Discontinue all medications after the first dose

Answer 223

A. Ensure hydration and monitor renal function closely

Rationale: Ensuring adequate hydration and closely monitoring renal function is crucial when administering nephrotoxic drugs to prevent or minimize kidney damage.

Question 224

How can the nurse help prevent contrast-induced nephropathy (CIN) when contrast media is required for a high-risk patient?

A. Use a high osmolality contrast agent
B. Ensure adequate hydration before, during, and after the procedure
C. Withhold all fluid intake 12 hours before the procedure
D. Increase the dose of contrast media for faster results

Answer 224

B. Ensure adequate hydration before, during, and after the procedure

Rationale: Ensuring adequate hydration before, during, and after the procedure helps reduce the risk of CIN in high-risk patients by promoting renal perfusion and minimizing nephrotoxic effects.

Question 225

What is the most important aspect of care for a patient with acute kidney injury (AKI) undergoing aggressive diuretic therapy?

A. Ensure the patient is on a low-sodium diet
B. Monitor for signs of decreased renal blood flow
C. Administer potassium supplements to prevent hypokalemia
D. Monitor for signs of hypotension and fluid imbalance

Answer 225

D. Monitor for signs of hypotension and fluid imbalance

Rationale: Aggressive diuretic therapy can lead to hypotension and fluid imbalance, so it is essential to monitor for these complications to prevent further kidney damage.

Question 226

In a patient with acute kidney injury (AKI), which of the following is the most appropriate response if the patient has significant fluid loss from vomiting and diarrhea?

A. Increase fluid intake with hypotonic solutions
B. Promptly replace the fluid losses to prevent ischemic damage
C. Withhold fluids to prevent kidney overload
D. Administer diuretics to decrease the workload on the kidneys

Answer 226

B. Promptly replace the fluid losses to prevent ischemic damage

Rationale: Prompt replacement of significant fluid losses helps prevent ischemic tubular damage, especially in cases of trauma, burns, or extensive surgery, all of which increase the risk of AKI.

Question 227

Which of the following interventions would be appropriate for a patient at high risk of acute kidney injury (AKI) due to extensive burns?

A. Encourage a high-protein diet to prevent further kidney damage
B. Limit fluid intake to reduce kidney workload
C. Administer nephrotoxic drugs to prevent infection
D. Closely monitor fluid and electrolyte balance

Answer 227

D. Closely monitor fluid and electrolyte balance

Rationale: Patients with extensive burns are at high risk for AKI due to fluid and electrolyte imbalances. Close monitoring of fluid and electrolyte balance is essential to prevent kidney damage.

Question 228

When planning care for a patient with acute kidney injury (AKI) who is receiving diuretic therapy, the nurse should prioritize which of the following?

A. Monitoring for signs of hypotension and electrolyte imbalances
B. Ensuring the patient has adequate caloric intake
C. Administering pain relief medication
D. Limiting fluid intake to 1 liter per day

Answer 228

A. Monitoring for signs of hypotension and electrolyte imbalances

Rationale: Monitoring for hypotension and electrolyte imbalances is crucial when a patient is receiving diuretic therapy, as these can lead to further complications such as dehydration and renal damage.

Question 229

What is the most important action to take when caring for a patient with AKI receiving nephrotoxic medications?

A. Monitor kidney function and fluid status regularly
B. Increase the dose of the medication for better efficacy
C. Discontinue nephrotoxic medications immediately
D. Administer fluids only if the patient has edema

Answer 229

A. Monitor kidney function and fluid status regularly

Rationale: Regular monitoring of kidney function and fluid status is crucial to detecting any signs of kidney damage early and preventing further injury when nephrotoxic medications are used.

Question 230

Which of the following is an essential part of preventing contrast-induced nephropathy (CIN) in a high-risk patient undergoing imaging studies?

A. Withhold fluids for 24 hours before the procedure
B. Administer a low osmolality contrast agent
C. Increase the contrast media dosage to minimize exposure
D. Ensure that the patient is sedated during the procedure

Answer 230

B. Administer a low osmolality contrast agent

Rationale: Using a low osmolality contrast agent reduces the nephrotoxic effect of contrast media and helps minimize the risk of CIN in high-risk patients.

Question 231

A patient with acute kidney injury (AKI) is in the oliguric phase. Which of the following assessments is most critical in managing this phase?

A. Monitoring daily weight and intake and output
B. Measuring blood glucose levels regularly
C. Administering diuretics to enhance urine output
D. Monitoring for signs of hyperkalemia only

Answer 231

A. Monitoring daily weight and intake and output

Rationale: Monitoring daily weight and intake and output is critical during the oliguric phase to detect fluid retention or imbalance, which can lead to complications such as hypervolemia.

Question 232

A patient with AKI and diabetes is being treated in the critical care unit. Which of the following should the nurse prioritize in this patient’s care plan?

A. Monitoring blood glucose levels closely
B. Initiating fluid restriction to prevent hypovolemia
C. Administering antibiotics to treat potential infections
D. Starting ACE inhibitors to control blood pressure

Answer 232

A. Monitoring blood glucose levels closely

Rationale: In patients with AKI and comorbid conditions like diabetes, closely monitoring blood glucose is crucial to prevent further kidney damage, as poorly controlled glucose can exacerbate kidney injury.

Question 233

Which of the following is a key consideration when managing fluid and electrolyte balance in a patient during the diuretic phase of AKI?

A. Monitoring for signs of hypervolemia
B. Monitoring for signs of hypovolemia
C. Restricting potassium intake
D. Administering large fluid boluses to promote urine output

Answer 233

B. Monitoring for signs of hypovolemia

Rationale: In the diuretic phase of AKI, the patient may lose significant amounts of fluid, making it crucial to monitor for signs of hypovolemia, such as hypotension and dehydration.

Question 234

A patient with AKI develops an infection. The nurse should be aware that the patient may not exhibit which of the following common symptoms?

A. Fever
B. Leukocytosis
C. Malaise
D. Swelling and redness at the infection site

Answer 234

A. Fever

Rationale: Patients with AKI may have a blunted febrile response to infection, which means they may not exhibit the typical fever associated with infections such as pneumonia.

Question 235

Which of the following interventions should the nurse implement to reduce the risk of infection in a patient with AKI?

A. Administer antibiotics without checking renal function
B. Implement strict aseptic techniques during invasive procedures
C. Ensure the patient is isolated from all other patients
D. Withhold all vaccinations to prevent potential reactions

Answer 235

B. Implement strict aseptic techniques during invasive procedures

Rationale: Strict aseptic techniques are essential in preventing infection in patients with AKI, as infection is a leading cause of death, and these patients may be at a higher risk of infection due to compromised immunity.

Question 236

When administering antibiotics to a patient with AKI, the nurse should be aware that:

A. All antibiotics are safe for patients with renal failure
B. Antibiotics should only be given via the oral route
C. Antibiotic dosages should be decreased based on the patient’s level of kidney function
D. The kidneys are not involved in the elimination of antibiotics

Answer 236

C. Antibiotic dosages should be decreased based on the patient’s level of kidney function

Rationale: Antibiotics are often eliminated by the kidneys, so in patients with AKI, dosages may need to be adjusted based on the patient’s renal function to prevent toxicity and adverse effects.

Question 237

A nurse is caring for a patient with AKI who is at high risk for pressure injuries due to limited mobility. Which of the following interventions is most important in preventing pressure injuries?

A. Encourage frequent repositioning of the patient
B. Provide high-protein, high-calorie snacks
C. Keep the patient’s skin moist to prevent dryness
D. Limit fluid intake to reduce skin moisture

Answer 237

A. Encourage frequent repositioning of the patient

Rationale: Repositioning the patient frequently helps prevent pressure injuries, especially in patients with limited mobility. This reduces the risk of pressure ulcers, which are common in critically ill patients.

Question 238

Which of the following is the best nursing action to prevent stomatitis in a patient with AKI?

A. Administering an oral analgesic before meals
B. Avoiding all fluids to prevent oral irritation
C. Applying topical corticosteroids to the mouth
D. Maintaining good oral hygiene and mouth care

Answer 238

D. Maintaining good oral hygiene and mouth care

Rationale: Maintaining good oral hygiene and mouth care is essential in preventing stomatitis in patients with AKI, as ammonia in saliva can irritate the mucous membranes.

Question 239

In a patient with AKI, how should the nurse respond to a weight gain of 1 kg in one day?

A. Administer a diuretic immediately
B. Report the weight gain as it indicates potential fluid retention
C. Increase the patient’s fluid intake to improve kidney function
D. Decrease the patient’s intake to prevent further weight gain

Answer 239

B. Report the weight gain as it indicates potential fluid retention

Rationale: A weight gain of 1 kg in one day is equivalent to 1000 mL of fluid and may indicate fluid retention, which should be reported to the healthcare provider to adjust the patient’s treatment plan accordingly.

Question 240

A nurse is caring for a patient with AKI and is monitoring for electrolyte imbalances. Which of the following is most likely to occur in the oliguric phase?

A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia

Answer 240

A. Hyperkalemia

Rationale: Hyperkalemia is most likely to occur during the oliguric phase of AKI due to decreased renal excretion of potassium, which can lead to dangerous cardiac arrhythmias.

Question 241

In the management of AKI, which of the following is most important to consider when planning care for a critically ill patient with multiple comorbidities such as cardiovascular disease (CVD)?

A. Administering nephrotoxic medications carefully to avoid further kidney injury
B. Strictly limiting all fluid intake to avoid fluid overload
C. Increasing protein intake to compensate for kidney damage
D. Monitoring blood pressure frequently to prevent exacerbating kidney injury

Answer 241

B. Strictly limiting all fluid intake to avoid fluid overload

Rationale: Monitoring blood pressure frequently is critical in preventing further kidney injury, especially in patients with comorbid conditions such as CVD, as hypertension can exacerbate AKI.

Question 242

Which of the following is the most critical assessment for a nurse to perform on a patient with AKI during the diuretic phase?

A. Monitoring for signs of hypervolemia
B. Assessing the patient’s renal output and urinary output trends
C. Providing frequent oral care to prevent stomatitis
D. Monitoring the patient’s potassium levels

Answer 242

B. Assessing the patient’s renal output and urinary output trends

Rationale: During the diuretic phase, it is important to assess the patient’s renal and urinary output trends, as this can help in determining whether the kidneys are recovering or if further interventions are needed.

Question 243

Which of the following is an appropriate nursing intervention for a patient with AKI who is at risk for infection?

A. Use standard precautions for all procedures
B. Place the patient in reverse isolation
C. Perform all tasks for the patient without using gloves
D. Ensure the patient is continuously in a high-traffic area for monitoring

Answer 243

A. Use standard precautions for all procedures

Rationale: Standard precautions should be used for all patients to reduce the risk of infection. Patients with AKI may have a blunted immune response, increasing their susceptibility to infections.

Question 244

When caring for a patient with AKI, which of the following actions would be most appropriate to prevent electrolyte imbalances?

A. Encourage the patient to eat potassium-rich foods
B. Monitor the patient’s serum electrolytes regularly
C. Restrict sodium intake to prevent fluid retention
D. Discontinue all medications that may affect electrolyte balance

Answer 244

B. Monitor the patient’s serum electrolytes regularly

Rationale: Monitoring the patient’s serum electrolytes regularly is essential to identify and manage any imbalances that may occur during the course of AKI, such as hyperkalemia or hyponatremia.

Question 245

A patient recovering from acute kidney injury (AKI) is being discharged. The nurse teaches the patient about the signs and symptoms of recurrent kidney disease. Which of the following should be included in the teaching plan?

A. “Monitor your urine output and report any decrease in the amount.”

B. “Increase your potassium and protein intake to promote kidney recovery.”

C. “Avoid all medications unless prescribed by your nephrologist.”

D. “Perform regular strenuous exercise to strengthen your kidneys.”

Answer 245

A. “Monitor your urine output and report any decrease in the amount.”

Rationale: Monitoring urine output and reporting any decrease is crucial in identifying recurrent kidney issues. Decreased urine output could indicate a recurrence of kidney damage or worsening of renal function.

Question 246

A patient with AKI is recovering and experiencing psychosocial and financial hardships. What should the nurse prioritize in the care plan?

A. Provide referrals for financial assistance and counseling

B. Encourage the patient to avoid social interactions to minimize stress

C. Focus primarily on physical rehabilitation and discourage emotional expression

D. Suggest the patient reduces all social activities to save energy

Answer 246

A. Provide referrals for financial assistance and counseling

Rationale: Referrals for financial assistance and counseling are crucial for patients dealing with the psychosocial and financial challenges of recovery. Addressing emotional well-being can aid in the overall recovery process.

Question 247

A nurse is teaching a patient about the long-term convalescence following acute kidney injury (AKI). Which of the following is an appropriate teaching point regarding recovery?

A. “You should expect complete recovery within the first month.”

B. “The recovery period may last anywhere from 3 to 12 months.”

C. “Your kidney function will return to normal immediately after the oliguric phase.”

D. “Most patients recover from AKI in less than 6 weeks.”

Answer 247

B. “The recovery period may last anywhere from 3 to 12 months.”

Rationale: Recovery from AKI can take 3 to 12 months, depending on the severity of the kidney injury and the patient’s overall health, including any comorbid conditions. It is important to set realistic expectations for recovery.

Question 248

A patient is recovering from AKI and is advised to regulate protein and potassium intake based on kidney function. What is the nurse’s role in managing this?

A. Instruct the patient to eat large amounts of protein to support healing

B. Encourage the patient to consume potassium-rich foods to improve renal function

C. Monitor kidney function and adjust dietary recommendations accordingly

D. Allow the patient to freely choose their diet as kidney function improves

Answer 248

C. Monitor kidney function and adjust dietary recommendations accordingly

Rationale: Kidney function directly affects protein and potassium requirements. The nurse should monitor kidney function and adjust the patient’s dietary recommendations to ensure they are not consuming excess protein or potassium that could worsen kidney function.

Question 249

A patient with AKI has not experienced full recovery and may require a transition to chronic dialysis. What should the nurse include in the discharge teaching for this patient?

A. “You should not prepare for dialysis until kidney function completely fails.”

B. “The possibility of kidney transplant may be an option if dialysis becomes necessary.”

C. “Dialysis is a temporary solution and will not be necessary for long.”

D. “Focus on maintaining a low-protein, low-potassium diet, even if dialysis is required.”

Answer 249

B. “The possibility of kidney transplant may be an option if dialysis becomes necessary.”

Rationale: If kidneys do not recover, chronic dialysis or a kidney transplant may be necessary. Discussing the potential for a transplant is part of preparing the patient for ongoing renal management.

Question 250

A nurse is evaluating the progress of a patient with acute kidney injury (AKI). Which of the following is the most important indicator that the patient has achieved the expected outcome of maintaining normal fluid and electrolyte balance?

A. The patient demonstrates adherence to the prescribed treatment regimen

B. The patient’s daily weights show no significant fluid gain or loss

C. The patient reports no complications during the treatment phase

D. The patient’s electrolyte levels are within normal range

Answer 250

D. The patient’s electrolyte levels are within normal range

Rationale: Maintaining normal electrolyte levels is a critical component of achieving normal fluid and electrolyte balance in patients with AKI. Monitoring electrolyte levels helps to evaluate the success of therapy and management of AKI.

Question 251

When evaluating the success of the treatment plan for a patient with acute kidney injury (AKI), which of the following outcomes indicates the best chance for a complete recovery?

A. The patient has no signs of complications and adheres to the treatment regimen

B. The patient maintains normal fluid balance but still requires dialysis

C. The patient demonstrates improved kidney function, but electrolyte imbalances persist

D. The patient experiences minimal discomfort but has continued fluctuations in urine output

Answer 251

A. The patient has no signs of complications and adheres to the treatment regimen

Rationale: A complete recovery from AKI is most likely when the patient adheres to the treatment plan, experiences no complications, and regains normal kidney function. The absence of complications indicates that the patient’s condition is improving without further deterioration.

Question 252

A nurse is caring for an older adult patient at risk for acute kidney injury (AKI). Which of the following factors is most likely to contribute to the development of AKI in this patient?

A. Increased glomerular filtration rate (GFR) with aging

B. Dehydration due to polypharmacy and immobility

C. Improved renal compensation for changes in fluid volume

D. Decreased risk for hypotension and infection

Answer 252

B. Dehydration due to polypharmacy and immobility

Rationale: Older adults are at increased risk for AKI due to factors such as polypharmacy (e.g., diuretics and laxatives) and immobility, which can lead to dehydration. This combination of factors is a significant risk for kidney injury.

Question 253

Which of the following best explains why older adults are at higher risk for acute kidney injury (AKI)?

A. Increased renal compensation due to aging kidneys

B. Reduced renal reserve and less ability to compensate for changes in fluid volume

C. Higher glomerular filtration rate (GFR) in older adults

D. Enhanced ability to manage hypotension and dehydration

Answer 253

B. Reduced renal reserve and less ability to compensate for changes in fluid volume

Rationale: Aging kidneys have reduced renal reserve and are less able to compensate for changes in fluid volume, solute load, and cardiac output, which makes older adults more susceptible to AKI.

Question 254

A nurse is caring for an elderly patient who has a history of cardiovascular disease (CVD) and diabetes. Which of the following conditions is most likely to increase the patient’s risk for acute kidney injury (AKI)?

A. Normal blood pressure and fluid balance

B. Adequate renal perfusion and no recent illness

C. Impaired function of other organ systems, such as CVD and diabetes

D. Low serum creatinine and normal urinary output

Answer 254

C. Impaired function of other organ systems, such as CVD and diabetes

Rationale: Impaired function of other organ systems, such as CVD and diabetes, increases the risk of AKI in older adults. These conditions contribute to decreased renal perfusion and kidney function.

Question 255

Which of the following interventions is most important to prevent acute kidney injury (AKI) in an older adult patient who is at risk?

A. Monitor for and prevent dehydration due to polypharmacy

B. Limit the use of diuretics and other nephrotoxic medications

C. Encourage increased fluid intake regardless of renal status

D. Administer contrast media only in emergency situations

Answer 255

A. Monitor for and prevent dehydration due to polypharmacy

Rationale: Preventing dehydration due to polypharmacy (e.g., diuretics and laxatives) is crucial in older adults to reduce the risk of AKI. Dehydration is a significant predisposing factor in the development of kidney injury.

Question 256

Which of the following statements about acute kidney injury (AKI) in older adults is correct?

A. Older adults have a higher glomerular filtration rate (GFR), which protects against AKI.

B. The mortality rate from AKI is lower in older adults compared to younger adults.

C. Patients over 65 years of age are less likely to recover from AKI.

D. Surgery and infection have a negligible impact on kidney function in older adults.

Answer 256

C. Patients over 65 years of age are less likely to recover from AKI.

Rationale: Older adults are less likely to recover from AKI compared to younger adults. While mortality rates are similar, age and other comorbidities increase the likelihood of poor recovery.

Question 257

A nurse is caring for an elderly patient who has recently undergone surgery and is receiving aminoglycosides. The nurse is aware that the patient is at risk for acute kidney injury (AKI). Which of the following factors contributes to this increased risk?

A. The patient’s age, which reduces renal reserve

B. Aminoglycosides, which are nephrotoxic medications

C. The patient’s mobility, which is impaired after surgery

D. All of the above

Answer 257

D. All of the above

Rationale: All of these factors contribute to the increased risk of AKI in older adults. Reduced renal reserve due to aging, nephrotoxic effects of aminoglycosides, and reduced mobility after surgery all increase the likelihood of kidney injury.

Question 258

The nurse using RIFLE to determine the early stage of AKI evaluates the patient’s

a. blood pressure and urine osmolality.
b. fractional excretion of urinary sodium.
c. estimation of GFR with the MDRD equation.
d. serum creatinine or urine output from baseline.

Answer 258

d. serum creatinine or urine output from baseline.

Question 259

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply)

a. hypotension.
b. ECG changes.
c. hypernatremia.
d. pulmonary edema.
e. urine with high specific gravity.

Answer 259

b. ECG changes.
d. pulmonary edema.

Question 260

When a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances?

a. Hyperkalemia and hyponatremia
b. Hyperkalemia and hypernatremia
c. Hypokalemia and hyponatremia
d. Hypokalemia and hypernatremia

Answer 260

c. Hypokalemia and hyponatremia

Question 261

Which assessment finding would the nurse expect when a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30?

a. Persistent skin tenting

b. Rapid, deep respirations

c. Hot, flushed face and neck

d. Bounding peripheral pulses

Answer 261

b. Rapid, deep respirations

Rationale: Patients with metabolic acidosis caused by AKI may have Kussmaul respirations to eliminate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.

Question 262

The nurse is planning care for a patient with severe heart failure who has developed increased blood urea nitrogen (BUN) and creatinine levels. Which aim will be the primary treatment goal?

a. Augmenting fluid volume

b. Maintaining cardiac output

c. Diluting nephrotoxic substances

d. Preventing systemic hypertension

Answer 262

c. Diluting nephrotoxic substances

Rationale: The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient‘s heart failure is causing AKI, the care will be directed toward treatment of the heart failure. Renal failure caused by hypertension, hypovolemia, or nephrotoxins would be managed by interventions specific to those problems.

Question 263

A patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?

a. Urine volume

b. Creatinine level

c. Glomerular filtration rate (GFR)

d. Blood urea nitrogen (BUN) level

Answer 263

c. Glomerular filtration rate (GFR)

Rationale: Calculated GFR is a more accurate indicator of kidney function than BUN or creatinine. BUN levels can fluctuate based on factors such as fluid volume status and protein intake. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.

Question 264

Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?

a. Limit movement of the left leg.

b. Start continuous pulse oximetry.

c. Restrict the patient‘s protein intake.

d. Discontinue the urethral retention catheter.

Answer 264

a. Limit movement of the left leg.

Rationale: Temporary vascular catheters have high rates of infection, dislodgment, and malfunction; the patient with a left femoral vein catheter must avoid flexion of the left leg. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.

Question 265

A patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy would the nurse implement first?

a. Insert urethral catheter.

b. Obtain renal ultrasound.

c. Draw a complete blood count.

d. Infuse normal saline at 50 mL/hr.

Answer 265

a. Insert urethral catheter.

Rationale: The patient‘s elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of an indwelling catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions are appropriate but would be implemented after the catheter.

Question 266

A patient has been hospitalized for 4 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider?

a. The creatinine level is 3.0 mg/dL.

b. Urine output over an 8-hour period is 2500 mL.

c. The blood urea nitrogen (BUN) level is 67 mg/dL.

d. The glomerular filtration rate is less than 30 mL/min/1.73 m 2.

Answer 266

b. Urine output over an 8-hour period is 2500 mL.

Rationale: The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.

Question 267

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action would the nurse take first?

a. Notify the patient‘s health care provider.

b. Document the QRS interval measurement.

c. Check the patient‘s most recent potassium level.

d. Review the chart for the patient‘s current creatinine level.

Answer 267

c. Check the patient‘s most recent potassium level.

Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse would check the most recent potassium and then notify the patient‘s health care provider. The BUN and creatinine will be increased in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening dysrhythmias.

Question 268

A patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action would the nurse take first?

a. Insert a urinary retention catheter.

b. Administer epoetin alfa (Epogen).

c. Place the patient on a cardiac monitor.

d. Give sodium polystyrene sulfonate (Kayexalate).

Answer 268

c. Place the patient on a cardiac monitor.

Rationale: Because hyperkalemia can cause fatal dysrhythmias, the initial action would be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.