AKI Basics
During the diuretic phase, urine output is 4,500 mL/day.
What is the priority electrolyte to monitor?
Answer: What is potassium?
Why: High output → potassium loss → dysrhythmia risk.
The most common cause of CKD in the United States.
Answer: What is diabetes mellitus?
A patient with kidney failure has pH 7.30, HCO₃⁻ 18. This is what acid-base imbalance?
Answer: What is metabolic acidosis?
A nurse palpates an AV fistula and feels no thrill.
What is the priority action?
Answer: What is notify the provider immediately?
Why: Access may be clotted.
Crackles and shortness of breath in kidney failure indicate this complication.
Answer: What is fluid overload / pulmonary edema?
This phase of AKI is characterized by very low urine output and risk for hyperkalemia.
Answer: What is the oliguric phase?
Which medication order should the nurse question in a CKD patient?
Lisinopril
Spironolactone
Furosemide
Sevelamer
Answer: What is spironolactone?
Potassium-sparing diuretic → worsens hyperkalemia.
A CKD patient’s phosphate is elevated.
What will happen to calcium levels?
Answer: What is they will decrease?
Which arm precaution is required for a patient with an AV fistula?
Answer: What is no blood pressure or venipuncture in that arm?
A patient with AKI has:
pH 7.25
HCO₃ 15
K 6.0
Peaked T waves
Which order should the nurse anticipate FIRST?
Answer: What is IV calcium gluconate?
Calcium stabilizes cardiac membrane before shifting potassium.
BUN and creatinine _____________in this condition, but the damage may be reversible.
Answer: what is rise rapidly
Two patients present:
Patient A:
Sudden rise in creatinine
Normal-sized kidneys
History of sepsis
Patient B:
Gradual rise in creatinine
Small shrunken kidneys
Long-standing diabetes
Which patient has irreversible kidney damage?
Answer: What is Patient B?
Shrunken kidneys = chronic scarring = CKD.
A GFR less than this number indicates kidney failure.
Answer: What is 15 mL/min?
This type of dialysis uses the peritoneum as a semipermeable membrane.
Answer: What is peritoneal dialysis?
A CKD patient is weak, confused, and has ammonia-like breath. This condition is called:
Answer: What is uremia?
During the diuretic phase of AKI, the patient is most at risk for this electrolyte imbalance.
Answer: What is hypokalemia?
Which client should the nurse assess first?
A. CKD client with pruritus
B. CKD client with Hgb 8.5
C. CKD client with potassium 6.4
D. CKD client with phosphorus 5.7
What is C, CKD client with potassium 6.4
Rationale:
Hyperkalemia is immediately life-threatening.
This hormone decreases in CKD, leading to anemia.
Answer: What is erythropoietin?
A hemodialysis patient’s BP is 82/50 during treatment.
Which intervention is most appropriate?
Answer: What is decrease ultrafiltration rate and give normal saline?
Why: Hypotension from fluid removal.
A patient with AKI has the following assessment findings:
Potassium 6.2
Crackles in lungs
BP 168/94
Urine output 20 mL/hr
Which finding requires immediate intervention?
Answer: What is potassium 6.2?
Hyperkalemia can cause lethal arrhythmias.
Airway and cardiac rhythm always take priority over fluid overload or hypertension.
This type of AKI is caused by decreased renal perfusion such as hypovolemia or heart failure.
The patient’s urine sodium is very low and BUN/Cr ratio is high.
What type of AKI is this?
Answer: What is prerenal AKI?
Kidneys conserving sodium → perfusion problem.
A CKD patient develops confusion, asterixis, and ammonia-like breath.
What syndrome is developing?
Answer: What is uremic encephalopathy?
Then nurse is caring for a patient with AKI secondary to dehydration
Which finding indicates improvement?
A. urine output 120 mL in 8 hours
B. Rising BUN level
C. K+ 6.5
D. Decreasing serum creatinine
What is D, Decreasing serum creatinine
Improvement in prerenal AKI (from dehydration) occurs when:
Renal perfusion improves
Kidney filtration improves
Waste products decrease
A decreasing serum creatinine indicates improved glomerular filtration rate (GFR) and recovery of kidney function.
A patient on hemodialysis gained 3.5 kg between sessions.
What does this indicate?
Answer: What is excess fluid retention?
1 kg ≈ 1 liter of fluid
3.5 kg = 3.5 liters → high risk for pulmonary edema.
A hemodialysis patient reports:
Chest pain
Dyspnea
Pericardial friction rub
What complication should the nurse suspect?
Answer: What is uremic pericarditis?
This is a dialysis emergency and may require urgent dialysis.