‼️FINAL AKI‼️ Flashcards
(30 cards)
What is the most common initial manifestation of Acute Kidney Injury (AKI)?
A. Polyuria
B. Hematuria
C. Anuria
D. Oliguria
Answer: D. Oliguria
Rationale: Oliguria (urine output <400 mL/day) is the earliest and most common sign of AKI, indicating reduced filtration.
Which laboratory value is the most reliable indicator of AKI?
A. Blood urea nitrogen (BUN)
B. Hemoglobin
C. Serum creatinine
D. White blood cell count
Answer: C. Serum creatinine
Rationale: Serum creatinine is a reliable marker of kidney function and rises when kidney filtration is impaired.
What is the hallmark finding in the oliguric phase of AKI?
A. Urine output <400 mL/day
B. Polyuria
C. Hypokalemia
D. Decreased BUN
Answer: A. Urine output <400 mL/day
Rationale: The oliguric phase is defined by decreased urine output, often under 400 mL/day, indicating impaired renal function.
Which electrolyte imbalance is a major concern in AKI due to decreased excretion?
A. Hyponatremia
B. Hypocalcemia
C. Hypokalemia
D. Hyperkalemia
Answer: D. Hyperkalemia
Rationale: The kidneys excrete most of the body’s potassium. In AKI, excretion is impaired, leading to hyperkalemia.
What urine output defines oliguria in AKI?
A. More than 1,000 mL/day
B. Less than 400 mL/day
C. Less than 1,000 mL/day
D. Less than 100 mL/day
Answer: B. Less than 400 mL/day
Rationale: Oliguria is defined as urine output below 400 mL per day and often indicates early kidney injury.
Which phase of AKI is characterized by high urine output with poor concentration?
A. Oliguric phase
B. Recovery phase
C. Diuretic phase
D. End stage
Answer: C. Diuretic phase
Rationale: In the diuretic phase, urine output increases (1–3+ L/day), but tubules cannot concentrate urine effectively.
What type of AKI is caused by factors that reduce blood flow to the kidneys?
A. Prerenal
B. Intrarenal
C. Postrenal
D. Chronic
Answer: A. Prerenal
Rationale: Prerenal AKI results from decreased renal perfusion due to volume depletion or decreased cardiac output.
Which finding is expected in prerenal AKI but not in intrarenal AKI?
A. Elevated potassium
B. No parenchymal damage
C. Casts in urine
D. Fixed specific gravity
Answer: B. No parenchymal damage
Rationale: Prerenal AKI does not damage the kidney itself and is often reversible with proper perfusion.
What is the most common intrarenal cause of AKI in hospitalized patients?
A. Glomerulonephritis
B. Lupus nephritis
C. Interstitial nephritis
D. Acute tubular necrosis
Answer: D. Acute tubular necrosis
Rationale: ATN accounts for about 90% of intrarenal AKI cases in hospitals, often due to ischemia or nephrotoxins.
Which of the following is a common cause of postrenal AKI?
A. Dehydration
B. Sepsis
C. Benign prostatic hyperplasia
D. Lupus
Answer: C. Benign prostatic hyperplasia
Rationale: BPH causes urinary outflow obstruction, leading to postrenal AKI.
A fixed specific gravity around 1.010 in urinalysis indicates: (normal is 1.005-1.030)
A. Dehydration
B. Poor glucose control
C. Loss of concentrating ability
D. Severe infection
Answer: C. Loss of concentrating ability
Rationale: A fixed specific gravity around 1.010 suggests tubular damage and impaired urine concentration.
Which condition increases the risk of nephrotoxic AKI?
A. Use of NSAIDs
B. Vegetarian diet
C. High calcium levels
D. Low sodium intake
Answer: A. Use of NSAIDs
Rationale: NSAIDs can cause nephrotoxicity by reducing renal blood flow, especially in volume-depleted patients.
In the diuretic phase of AKI, the nurse should monitor for which complication?
A. Hyperkalemia
B. Hypervolemia
C. Hypovolemia
D. Metabolic alkalosis
Answer: C. Hypovolemia
Rationale: The diuretic phase involves excessive urine output, risking dehydration and electrolyte imbalances.
What is the appropriate treatment for life-threatening hyperkalemia in AKI?
A. Furosemide
B. IV insulin with glucose
C. Sodium bicarbonate PO
D. Lasix and fluids
Answer: B. IV insulin with glucose
Rationale: Insulin drives potassium into cells; glucose prevents hypoglycemia. It’s a rapid treatment for hyperkalemia.
What causes metabolic acidosis in AKI?
A. Increased bicarbonate
B. Excess glucose
C. Decreased protein intake
D. Inability to excrete hydrogen ions
Answer: D. Inability to excrete hydrogen ions
Rationale: In AKI, the kidneys can’t excrete hydrogen ions or regenerate bicarbonate, leading to acidosis.
Which intervention is appropriate during the oliguric phase of AKI?
A. Increase fluid intake
B. Administer potassium supplements
C. Liberalize protein intake
D. Fluid restriction
Answer: D. Fluid restriction
Rationale: Fluid is restricted in the oliguric phase to prevent volume overload and complications like pulmonary edema.
What nursing assessment is most important to determine fluid balance in AKI?
A. Lung auscultation
B. Blood pressure readings
C. Daily weights
D. Abdominal girth
Answer: C. Daily weights
Rationale: Daily weights are the most accurate and sensitive indicator of fluid status in AKI.
What is the most common cause of death in patients with AKI?
A. Electrolyte imbalances
B. Bleeding
C. Cardiovascular collapse
D. Infection
Answer: D. Infection
Rationale: Infection, particularly respiratory and urinary tract infections, is the leading cause of death in AKI patients.
A patient with AKI presents with peaked T waves on ECG. What is the likely cause?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hyperphosphatemia
Answer: B. Hyperkalemia
Rationale: Hyperkalemia can cause ECG changes such as peaked T waves and is common in AKI due to decreased excretion.
Which medication removes potassium through the gastrointestinal tract?
A. Calcium gluconate
B. Sodium bicarbonate
C. Sodium polystyrene sulfonate (Kayexalate)
D. Patiromer
Answer: C. Sodium polystyrene sulfonate (Kayexalate)
Rationale: Kayexalate binds potassium in the bowel and eliminates it through osmotic diarrhea.
Which is a primary indication for initiating dialysis in a patient with AKI?
A. Elevated creatinine kinase
B. Urine output over 3 L/day
C. Metabolic acidosis
D. Low white blood cell count
Answer: C. Metabolic acidosis
Rationale: Severe metabolic acidosis unresponsive to medical therapy is a key indication for dialysis.
What should be avoided in a patient with AKI receiving contrast media?
A. Oral acetaminophen
B. IV normal saline
C. Gadolinium contrast
D. Renal ultrasound
Answer: C. Gadolinium contrast
Rationale: Gadolinium can cause nephrogenic systemic fibrosis in patients with impaired renal function.
Which dietary component is restricted during the acute phase of AKI?
A. Carbohydrates
B. Potassium
C. Fats
D. Water-soluble vitamins
Answer: B. Potassium
Rationale: Potassium is restricted to prevent hyperkalemia, which can result in cardiac complications.
What defines the ‘Injury’ stage of AKI based on the RIFLE criteria?
A. Serum creatinine increased ×1.5 and urine output <0.5 mL/kg/hr for 6 hrs
B. GFR decreased by 25%
C. Serum creatinine increased ×2 and urine output <0.5 mL/kg/hr for 12 hrs
D. Serum creatinine >4 mg/dL with anuria for 6 hrs
Answer: C. Serum creatinine increased ×2 and urine output <0.5 mL/kg/hr for 12 hrs
Rationale: This matches the RIFLE ‘Injury’ criteria, representing moderate kidney impairment.
