Acute Kidney Injury and Chronic Kidney Disease
1. What are intrarenal causes of acute kidney injury (AKI) (select all that
apply)?
a. Anaphylaxis
b. Renal stones
c. Bladder cancer
d. Nephrotoxic drugs
e. Acute glomerulonephritis
f. Tubular obstruction by myoglobin
2. An 83-year-old female patient was found lying on the bathroom floor. She
said she fell 2 days ago and has not been able to take her heart medicine or
eat or drink anything since then. What conditions could contribute to
prerenal AKI in this patient (select all that apply)?
a. Anaphylaxis
b. Renal stones
c. Hypovolemia
d. Nephrotoxic drugs
e. Decreased cardiac output
3. Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI.
Which patient is most likely to develop ATN?
a. Patient with diabetes
b. Patient with hypertensive crisis
c. Patient who tried to overdose on acetaminophen
d. Patient with major surgery who required a blood transfusion
4. Priority Decision: A dehydrated patient is in the Injury stage of the RIFLE
staging of AKI. What would the nurse first anticipate in the treatment of this
patient?
a. Assessment of daily weight
b. IV administration of fluid and furosemide (Lasix)
c. IV administration of insulin and sodium bicarbonate
d. Urinalysis to check for sediment, osmolality, sodium, and specific gravity
5. What indicates to the nurse that a patient with oliguria has prerenal
oliguria?
a. Urine testing reveals a low specific gravity.
b. Causative factor is malignant hypertension.
,c. Urine testing reveals a high sodium concentration.
d. Reversal of oliguria occurs with fluid replacement.
6. In a patient with AKI, which laboratory urinalysis result indicates tubular
damage?
a. Hematuria
b. Specific gravity fixed at 1.010
c. Urine sodium of 12 mEq/L (12 mmol/L)
d. Osmolality of 1000 mOsm/kg (1000 mmol/kg)
7. Metabolic acidosis occurs in the oliguric phase of AKI as a result of
impairment of
a. excretion of sodium.
b. excretion of bicarbonate.
c. conservation of potassium.
d. excretion of hydrogen ions.
8. What indicates to the nurse that a patient with AKI is in the recovery
phase?
a. A return to normal weight
b. A urine output of 3700 mL/day
c. Decreasing sodium and potassium levels
d. Decreasing blood urea nitrogen (BUN) and creatinine levels
9. Patient-Centered Care: While caring for the patient in the oliguric phase of
AKI, the nurse monitors the patient for associated collaborative problems.
When should the nurse notify the health care provider (HCP)?
a. Urine output is 300 mL/day.
b. Edema occurs in the feet, legs, and sacral area.
c. Cardiac monitor reveals a depressed T wave and elevated ST segment.
d. The patient develops increasing muscle weakness and abdominal
cramping.
10. In caring for the patient with AKI, of what should the nurse be aware?
a. The most common cause of death in AKI is irreversible metabolic acidosis.
b. During the oliguric phase of AKI, daily fluid intake is limited to 1000 mL
plus the prior day’s measured fluid loss.
c. Dietary sodium and potassium during the oliguric phase of AKI are
managed according to the patient’s urinary output.
d. One of the most important nursing measures in managing fluid balance in
, the patient with AKI is taking accurate daily weights.
11. Patient-Centered Care: A 68-year-old man with a history of heart failure
resulting from hypertension has AKI resulting from the effects of nephrotoxic
diuretics. Currently, his serum potassium is 6.2 mEq/L (6.2 mmol/L) with
cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is
4.1 mg/dL (362 mmol/L), and his serum bicarbonate (HCO3−) is 14 mEq/L
(14 mmol/L). He is somnolent and disoriented. Which treatment should the
nurse expect to be used for him?
a. Loop diuretics
b. Renal replacement therapy
c. Insulin and sodium bicarbonate
d. Sodium polystyrene sulfonate (Kayexalate)
12. Prevention of AKI is important because of the high mortality rate. Which
patients are at increased risk for AKI (select all that apply)?
a. An 86-year-old woman scheduled for a cardiac catheterization
b. A 48-year-old man with multiple injuries from a motor vehicle accident
c. A 32-year-old woman following a C-section delivery for abruptio placentae
d. A 64-year-old woman with chronic heart failure admitted with bloody
stools
e. A 58-year-old man with prostate cancer undergoing preoperative workup
for prostatectomy
13. Priority Decision: A patient on a medical unit has a potassium level of 6.8
mEq/L. What is the priority action that the nurse should take?
a. Place the patient on a cardiac monitor.
b. Check the patient’s BP.
c. Teach the patient to avoid high-potassium foods.
d. Call the laboratory and request a redraw of the laboratory to verify results.
14. A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L)
and the following arterial blood gas results: pH 7.28, partial pressure of
carbon dioxide in arterial blood (PaCO2) 30 mm Hg, partial pressure of
oxygen in arterial blood (PaO2) 86 mm Hg, HCO3− 18 mEq/L (18 mmol/L).
The nurse recognizes that treatment of the acid–base problem with sodium
bicarbonate would cause a decrease in which value?
a. pH
1. What are intrarenal causes of acute kidney injury (AKI) (select all that
apply)?
a. Anaphylaxis
b. Renal stones
c. Bladder cancer
d. Nephrotoxic drugs
e. Acute glomerulonephritis
f. Tubular obstruction by myoglobin
2. An 83-year-old female patient was found lying on the bathroom floor. She
said she fell 2 days ago and has not been able to take her heart medicine or
eat or drink anything since then. What conditions could contribute to
prerenal AKI in this patient (select all that apply)?
a. Anaphylaxis
b. Renal stones
c. Hypovolemia
d. Nephrotoxic drugs
e. Decreased cardiac output
3. Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI.
Which patient is most likely to develop ATN?
a. Patient with diabetes
b. Patient with hypertensive crisis
c. Patient who tried to overdose on acetaminophen
d. Patient with major surgery who required a blood transfusion
4. Priority Decision: A dehydrated patient is in the Injury stage of the RIFLE
staging of AKI. What would the nurse first anticipate in the treatment of this
patient?
a. Assessment of daily weight
b. IV administration of fluid and furosemide (Lasix)
c. IV administration of insulin and sodium bicarbonate
d. Urinalysis to check for sediment, osmolality, sodium, and specific gravity
5. What indicates to the nurse that a patient with oliguria has prerenal
oliguria?
a. Urine testing reveals a low specific gravity.
b. Causative factor is malignant hypertension.
,c. Urine testing reveals a high sodium concentration.
d. Reversal of oliguria occurs with fluid replacement.
6. In a patient with AKI, which laboratory urinalysis result indicates tubular
damage?
a. Hematuria
b. Specific gravity fixed at 1.010
c. Urine sodium of 12 mEq/L (12 mmol/L)
d. Osmolality of 1000 mOsm/kg (1000 mmol/kg)
7. Metabolic acidosis occurs in the oliguric phase of AKI as a result of
impairment of
a. excretion of sodium.
b. excretion of bicarbonate.
c. conservation of potassium.
d. excretion of hydrogen ions.
8. What indicates to the nurse that a patient with AKI is in the recovery
phase?
a. A return to normal weight
b. A urine output of 3700 mL/day
c. Decreasing sodium and potassium levels
d. Decreasing blood urea nitrogen (BUN) and creatinine levels
9. Patient-Centered Care: While caring for the patient in the oliguric phase of
AKI, the nurse monitors the patient for associated collaborative problems.
When should the nurse notify the health care provider (HCP)?
a. Urine output is 300 mL/day.
b. Edema occurs in the feet, legs, and sacral area.
c. Cardiac monitor reveals a depressed T wave and elevated ST segment.
d. The patient develops increasing muscle weakness and abdominal
cramping.
10. In caring for the patient with AKI, of what should the nurse be aware?
a. The most common cause of death in AKI is irreversible metabolic acidosis.
b. During the oliguric phase of AKI, daily fluid intake is limited to 1000 mL
plus the prior day’s measured fluid loss.
c. Dietary sodium and potassium during the oliguric phase of AKI are
managed according to the patient’s urinary output.
d. One of the most important nursing measures in managing fluid balance in
, the patient with AKI is taking accurate daily weights.
11. Patient-Centered Care: A 68-year-old man with a history of heart failure
resulting from hypertension has AKI resulting from the effects of nephrotoxic
diuretics. Currently, his serum potassium is 6.2 mEq/L (6.2 mmol/L) with
cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is
4.1 mg/dL (362 mmol/L), and his serum bicarbonate (HCO3−) is 14 mEq/L
(14 mmol/L). He is somnolent and disoriented. Which treatment should the
nurse expect to be used for him?
a. Loop diuretics
b. Renal replacement therapy
c. Insulin and sodium bicarbonate
d. Sodium polystyrene sulfonate (Kayexalate)
12. Prevention of AKI is important because of the high mortality rate. Which
patients are at increased risk for AKI (select all that apply)?
a. An 86-year-old woman scheduled for a cardiac catheterization
b. A 48-year-old man with multiple injuries from a motor vehicle accident
c. A 32-year-old woman following a C-section delivery for abruptio placentae
d. A 64-year-old woman with chronic heart failure admitted with bloody
stools
e. A 58-year-old man with prostate cancer undergoing preoperative workup
for prostatectomy
13. Priority Decision: A patient on a medical unit has a potassium level of 6.8
mEq/L. What is the priority action that the nurse should take?
a. Place the patient on a cardiac monitor.
b. Check the patient’s BP.
c. Teach the patient to avoid high-potassium foods.
d. Call the laboratory and request a redraw of the laboratory to verify results.
14. A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L)
and the following arterial blood gas results: pH 7.28, partial pressure of
carbon dioxide in arterial blood (PaCO2) 30 mm Hg, partial pressure of
oxygen in arterial blood (PaO2) 86 mm Hg, HCO3− 18 mEq/L (18 mmol/L).
The nurse recognizes that treatment of the acid–base problem with sodium
bicarbonate would cause a decrease in which value?
a. pH
