Acute Care Nurse Practitioner Acute Kidney Injury and Renal Replacement Therapy 2

Question 1

Which indication for renal replacement therapy (RRT) is considered an EMERGENCY requiring immediate initiation?

Accepted Answer

Severe hyperkalemia with ECG changes

Answer

Severe hyperkalemia causing ECG changes (peaked T waves, wide QRS, sine wave pattern) is a life-threatening emergency requiring immediate RRT.

Question 2

Which modality of RRT is preferred for hemodynamically unstable ICU patients?

Accepted Answer

Continuous renal replacement therapy (CRRT)

Answer

CRRT is preferred in hemodynamically unstable patients because it provides slow, continuous fluid and solute removal without causing rapid osmotic shifts.

Question 3

Which anticoagulation is MOST commonly used in CRRT to prevent circuit clotting while minimizing systemic bleeding risk?

Accepted Answer

Citrate regional anticoagulation

Answer

Regional citrate anticoagulation confines anticoagulation to the extracorporeal circuit, minimizing systemic bleeding risk in high-risk patients.

Question 4

A patient on CRRT receiving citrate anticoagulation develops rising total calcium with decreasing ionized calcium. What does this indicate?

Accepted Answer

Citrate toxicity/accumulation

Answer

Rising total calcium with low ionized calcium (high total/ionized ratio >2.5) indicates citrate accumulation, usually from hepatic failure impairing citrate metabolism.

Question 5

Which condition is MOST likely to cause a false elevation in serum creatinine without true reduction in GFR?

Accepted Answer

Trimethoprim use

Answer

Trimethoprim (and cimetidine) blocks tubular secretion of creatinine, raising serum creatinine without changing GFR or true kidney function.

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Acute Kidney Injury and Renal Replacement Therapy 2