AKI Types & Labs
A patient presents with:
Severe dehydration
Hypotension
BUN:Cr ratio 22:1
Which type of acute kidney injury is most likely?
Prerenal AKI
Rationale:
Prerenal AKI results from decreased renal perfusion (ex. dehydration, hemorrhage, shock) and is associated with BUN:Cr >20:1.
A patient with suspected prerenal AKI presents with:
BP 82/48
HR 118
Urine output 15 mL/hr
BUN:Cr ratio 24:1
What is the priority nursing intervention?
Administer IV isotonic fluids (NS or LR).
Rationale
Prerenal AKI results from kidney hypoperfusion, so the priority intervention is restoring circulating volume and perfusion to the kidneys.
A patient with acute kidney injury has:
Potassium 6.9 mEq/L
Peaked T waves on ECG
Which medication should the nurse administer first?
Calcium gluconate
Rationale
Calcium gluconate stabilizes the cardiac membrane and prevents lethal arrhythmias but does NOT lower potassium levels.
A patient with an AV fistula for hemodialysis arrives for assessment.
What two findings indicate that the fistula is patent and functioning properly?
Thrill and bruit
Rationale
Thrill = vibration felt when palpating
Bruit = swishing sound heard with auscultation
Both indicate blood flow through the fistula.
A patient with chronic kidney disease is prescribed sevelamer carbonate.
When should the nurse instruct the patient to take this medication?
With meals
Rationale
Sevelamer is a phosphate binder that works in the GI tract, so it must be taken with meals to bind dietary phosphorus and reduce serum phosphate levels.
A patient develops AKI two days after receiving IV contrast dye for a CT scan.
Which type of AKI is most likely?
Intrarenal (intrinsic) AKI
Rationale:
Contrast dye causes direct nephron damage, making it a classic cause of intrarenal AKI.
A
patient with AKI has the following findings:
Crackles in lungs
JVD
Edema
Weight gain of 2 kg in 24 hours
What is the priority nursing action?
Restrict fluids and prepare for diuretics or dialysis if ordered.
Rationale
These findings indicate fluid volume excess, a major complication during the oliguric phase of AKI.
The priority is preventing pulmonary edema and respiratory compromise.
After calcium gluconate is administered for severe hyperkalemia, the provider orders:
10 units regular insulin IV
Dextrose 50%
What is the primary purpose of this therapy?
Shift potassium from the bloodstream into the cells.
Rationale
Insulin drives potassium intracellularly, temporarily lowering serum potassium levels. D50 prevents hypoglycemia.
A nurse is caring for a patient with a left arm AV fistula.
Which nursing action is contraindicated?
Taking blood pressure on the fistula arm
Rationale
Actions to avoid on a fistula arm:
No blood pressure
No IV insertion
No blood draws
No tight clothing
These actions can damage the access.
A patient with CKD receives epoetin alfa therapy.
Which laboratory value should the nurse monitor to evaluate the effectiveness of this treatment?
Hemoglobin (Hgb)
Rationale
Epoetin stimulates red blood cell production to treat CKD-related anemia caused by decreased erythropoietin production by the kidneys.
A patient suddenly develops anuria after prostate surgery. The nurse notes bladder distention.
What type of AKI should the nurse suspect?
Postrenal AKI
Rationale:
Postrenal AKI results from urinary outflow obstruction such as BPH, stones, or tumors.
A patient with AKI develops:
Potassium 6.8 mEq/L
Peaked T waves on ECG
Which medication should the nurse anticipate administering FIRST?
Calcium gluconate
Rationale
Calcium gluconate is given first to stabilize the cardiac membrane and prevent lethal arrhythmias before lowering potassium levels.
A patient with hyperkalemia receives nebulized albuterol.
What is the therapeutic effect of this medication in hyperkalemia?
Shifts potassium into cells via beta-adrenergic stimulation.
Rationale
Albuterol activates β2 receptors, promoting intracellular potassium movement and lowering serum potassium temporarily.
Shifts potassium into cells via beta-adrenergic stimulation.
Rationale
Albuterol activates β2 receptors, promoting intracellular potassium movement and lowering serum potassium temporarily.
During hemodialysis a patient suddenly develops:
dizziness
nausea
weakness
BP 84/50
What complication is most likely occurring?
Hypotension
Rationale
Hypotension is the most common complication of hemodialysis due to rapid fluid removal.
A patient with CKD is prescribed ferrous sulfate along with epoetin therapy.
What is the primary purpose of administering iron with epoetin?
To support red blood cell production
Rationale
Iron is required for hemoglobin synthesis, and epoetin therapy is ineffective without adequate iron stores.
A patient with AKI has the following findings:
Urine sodium high
Urine osmolality similar to serum
Presence of urinary casts
Which type of AKI is most consistent with these findings?
Intrarenal AKI
Rationale:
Intrarenal damage causes impaired tubular function, leading to high urine sodium and abnormal casts.
A patient in the diuretic phase of AKI produces 3500 mL of urine in 24 hours.
Which complication should the nurse monitor for most closely?
Fluid volume deficit and hypokalemia
Rationale
During the diuretic phase, the kidneys produce large volumes of dilute urine, placing the patient at risk for dehydration and electrolyte loss.
A patient with severe hyperkalemia is prescribed sodium polystyrene sulfonate (Kayexalate).
What is the expected outcome indicating the medication is working?
Increased stooling and decreasing potassium levels
Rationale
Kayexalate exchanges sodium for potassium in the intestines, removing potassium from the body via the GI tract.
A patient receiving peritoneal dialysis has drainage that appears cloudy.
What is the priority nursing action?
Notify the provider and obtain a culture of the dialysate.
Rationale
Cloudy dialysate indicates peritonitis, a life-threatening infection requiring immediate treatment with antibiotics.
A patient with advanced CKD has the following laboratory results:
Potassium 6.2 mEq/L
Phosphorus 6.0 mg/dL
Calcium 7.8 mg/dL
Which electrolyte abnormality is most immediately life-threatening?
Hyperkalemia
Rationale
Hyperkalemia can cause fatal cardiac dysrhythmias, making it the most dangerous electrolyte imbalance in kidney failure.
A patient with AKI suddenly develops anuria with a urinary catheter in place.
What is the nurse’s first action?
Check the catheter for obstruction
Rationale:
Postrenal AKI from obstruction is reversible, and the first step is assessing the catheter for kinks or blockage.
A patient with AKI has the following findings:
K⁺ = 6.5
Severe metabolic acidosis
Pulmonary edema
Confusion
Despite medical treatment, symptoms persist.
What is the priority intervention?
Initiate dialysis.
Rationale
Dialysis is indicated when kidney failure causes life-threatening complications such as:
Hyperkalemia
Fluid overload
Metabolic acidosis
Uremic symptoms
These are classic indications for renal replacement therapy.
A patient with kidney failure has:
Potassium 7.2 mEq/L
Ventricular dysrhythmias
Pulmonary edema
Severe metabolic acidosis
Despite medication treatment, potassium remains elevated.
What is the definitive treatment?
Emergency dialysis
Rationale
Dialysis removes potassium directly from the bloodstream and is required when hyperkalemia is refractory or life-threatening.
A patient undergoing hemodialysis develops:
headache
nausea
confusion
seizures
What complication should the nurse suspect?
Dialysis disequilibrium syndrome
Rationale
This occurs when urea is removed too quickly, causing cerebral edema and neurologic symptoms.
A patient with CKD develops:
Severe pulmonary edema
Potassium 7.0 mEq/L
Metabolic acidosis
Confusion
Which treatment should the nurse anticipate next?
Initiation of dialysis
Rationale
Dialysis is indicated when kidney failure causes life-threatening complications such as:
Hyperkalemia
Fluid overload
Severe metabolic acidosis
Uremic symptoms
These indicate the kidneys can no longer maintain homeostasis.