NAPLEX - Acute kidney injury McGraw Hill
Questions and Answers
Hyperkalemia may result from acute kidney injury (AKI) and can lead to
which one of the following life-threatening complications?
A
Seizures
B
Arrhythmias
C
Hypertension
D
Acidosis - correct answers✅✅B
Hyperkalemia can lead to ECG changes such as peaked T waves, prolonged
QRS waves, and eventually ventricular fibrillation.
Answer a is incorrect. Patients with AKI may experience acid-base
abnormalities or other electrolyte abnormalities that increase risk for
seizures.
Answer c is incorrect. Hypertension is not indicative of acute hyperkalemia,
and patients with AKI may be normotensive, hypotensive, or hypertensive.
Answer d is incorrect. Metabolic acidosis can worsen hyperkalemia by
causing a shift of potassium from the intracellular to extracellular space.
Hyperkalemia, however, does not cause an acidosis.
Which of the following regimens would be the most appropriate prophylaxis
option for contrast-induced nephropathy in a high-risk patient?
A
Acetadote 150 mg/kg IV for 6 hours preprocedure.
B
Sodium chloride 0.9% IV infusion 6 hours before and 8 hours after.
,NAPLEX - Acute kidney injury McGraw Hill
Questions and Answers
C
Theophylline 200 mg po every 12 hours, two doses before, two doses after.
D
Dopamine 0.5 µg/kg/min IV infusion 6 hours before and 6 hours after. -
correct answers✅✅B
Adequate hydration is important to protect the tubules of the kidneys. The IV
solution of choice should be an isotonic crystalloid so that it remains in the
intravascular space.
Answer a is incorrect. The recommended practice is to hydrate the patient
prior to the administration of contrast media. While N-acetylcysteine
(Acetadote) is an agent that has shown some benefit and is relatively safe, it
would be used in conjunction with hydration, not alone. Additionally, this
dose is the loading dose for the indication of acetaminophen toxicity, not
prophylaxis of acute tubular necrosis (ATN).
Answer c is incorrect. There are conflicting data on the effectiveness of
theophylline in reducing the incidence of contrast-induced nephropathy and
its use is not supported by current guidelines. The primary prevention
strategy that is recommended is IV hydration.
Answer d is incorrect. The use of dopamine as well as fenoldopam has been
shown to be deleterious in patients with AKI and ineffective as a prophylactic
agent for ATN. The use of these agents is not recommended.
A patient with acute tubular necrosis with anuria has a serum potassium
concentration of 6.8 mEq/L with associated electrocardiogram (ECG) changes
of peaked T waves. Which intervention should be initiated first?
A
Regular insulin 10 units and 25 g of dextrose 50% IV push over 2 to 5
minutes
B
Sodium bicarbonate 8.4% 50 mEq IV push over 2 to 5 minutes
, NAPLEX - Acute kidney injury McGraw Hill
Questions and Answers
C
Calcium gluconate 1 g IV push over 2 to 5 minutes
D
Sodium polystyrene sulfonate 15 g po - correct answers✅✅C
This patient has signs of cardiotoxicity secondary to hyperkalemia. The most
important first step is to antagonize the effect of potassium on the
myocardial cells. One gram of calcium (either chloride or gluconate) should
be given immediately if any ECG abnormalities are noted.
Answer a is incorrect.Insulin stimulates the cellular uptake of potassium,
decreasing the extracellular concentration. This is an appropriate step to
manage hyperkalemia, though not the first step in this patient.
Answer b is incorrect. Administering sodium bicarbonate causes the efflux of
H+ from within in the cell in exchange for K+. While this might be an
appropriate strategy to manage hyperkalemia (especially if the patient had a
metabolic acidosis), it is not the first step in this patient.
Answer d is incorrect.Sodium polystyrene sulfonate is an appropriate
adjunctive agent to promote elimination of potassium from the body in the
feces. It acts to exchange sodium for potassium ions in the gastrointestinal
tract. It does not work immediately and would not be the first step.
Sodium bicarbonate is available as which of the following dosage forms?
Select all that apply.
A
Oral tablet
B
Injectable solution
C
Oral powder
D
Questions and Answers
Hyperkalemia may result from acute kidney injury (AKI) and can lead to
which one of the following life-threatening complications?
A
Seizures
B
Arrhythmias
C
Hypertension
D
Acidosis - correct answers✅✅B
Hyperkalemia can lead to ECG changes such as peaked T waves, prolonged
QRS waves, and eventually ventricular fibrillation.
Answer a is incorrect. Patients with AKI may experience acid-base
abnormalities or other electrolyte abnormalities that increase risk for
seizures.
Answer c is incorrect. Hypertension is not indicative of acute hyperkalemia,
and patients with AKI may be normotensive, hypotensive, or hypertensive.
Answer d is incorrect. Metabolic acidosis can worsen hyperkalemia by
causing a shift of potassium from the intracellular to extracellular space.
Hyperkalemia, however, does not cause an acidosis.
Which of the following regimens would be the most appropriate prophylaxis
option for contrast-induced nephropathy in a high-risk patient?
A
Acetadote 150 mg/kg IV for 6 hours preprocedure.
B
Sodium chloride 0.9% IV infusion 6 hours before and 8 hours after.
,NAPLEX - Acute kidney injury McGraw Hill
Questions and Answers
C
Theophylline 200 mg po every 12 hours, two doses before, two doses after.
D
Dopamine 0.5 µg/kg/min IV infusion 6 hours before and 6 hours after. -
correct answers✅✅B
Adequate hydration is important to protect the tubules of the kidneys. The IV
solution of choice should be an isotonic crystalloid so that it remains in the
intravascular space.
Answer a is incorrect. The recommended practice is to hydrate the patient
prior to the administration of contrast media. While N-acetylcysteine
(Acetadote) is an agent that has shown some benefit and is relatively safe, it
would be used in conjunction with hydration, not alone. Additionally, this
dose is the loading dose for the indication of acetaminophen toxicity, not
prophylaxis of acute tubular necrosis (ATN).
Answer c is incorrect. There are conflicting data on the effectiveness of
theophylline in reducing the incidence of contrast-induced nephropathy and
its use is not supported by current guidelines. The primary prevention
strategy that is recommended is IV hydration.
Answer d is incorrect. The use of dopamine as well as fenoldopam has been
shown to be deleterious in patients with AKI and ineffective as a prophylactic
agent for ATN. The use of these agents is not recommended.
A patient with acute tubular necrosis with anuria has a serum potassium
concentration of 6.8 mEq/L with associated electrocardiogram (ECG) changes
of peaked T waves. Which intervention should be initiated first?
A
Regular insulin 10 units and 25 g of dextrose 50% IV push over 2 to 5
minutes
B
Sodium bicarbonate 8.4% 50 mEq IV push over 2 to 5 minutes
, NAPLEX - Acute kidney injury McGraw Hill
Questions and Answers
C
Calcium gluconate 1 g IV push over 2 to 5 minutes
D
Sodium polystyrene sulfonate 15 g po - correct answers✅✅C
This patient has signs of cardiotoxicity secondary to hyperkalemia. The most
important first step is to antagonize the effect of potassium on the
myocardial cells. One gram of calcium (either chloride or gluconate) should
be given immediately if any ECG abnormalities are noted.
Answer a is incorrect.Insulin stimulates the cellular uptake of potassium,
decreasing the extracellular concentration. This is an appropriate step to
manage hyperkalemia, though not the first step in this patient.
Answer b is incorrect. Administering sodium bicarbonate causes the efflux of
H+ from within in the cell in exchange for K+. While this might be an
appropriate strategy to manage hyperkalemia (especially if the patient had a
metabolic acidosis), it is not the first step in this patient.
Answer d is incorrect.Sodium polystyrene sulfonate is an appropriate
adjunctive agent to promote elimination of potassium from the body in the
feces. It acts to exchange sodium for potassium ions in the gastrointestinal
tract. It does not work immediately and would not be the first step.
Sodium bicarbonate is available as which of the following dosage forms?
Select all that apply.
A
Oral tablet
B
Injectable solution
C
Oral powder
D
