Acute Care Nurse Practitioner Acute Kidney Injury and Renal Replacement Therapy 3 — Questions and Answers
Question 1: Which diuretic is FIRST-LINE for managing volume overload in AKI patients who are not yet requiring RRT?
- Hydrochlorothiazide
- Spironolactone
- Furosemide (loop diuretic) (Correct answer)
- Acetazolamide
Correct answer: Furosemide (loop diuretic)
Furosemide is the first-line diuretic for volume overload in AKI; high doses may be needed in patients with reduced tubular function.
Question 2: A dialysis patient presents to the ICU with peaked T waves and widened QRS on ECG. Potassium is 7.2 mEq/L. What is the IMMEDIATE first step?
- Administer sodium polystyrene sulfonate (Kayexalate)
- Give IV calcium gluconate (Correct answer)
- Start emergent hemodialysis
- Administer insulin + dextrose
Correct answer: Give IV calcium gluconate
IV calcium gluconate immediately stabilizes the cardiac membrane without lowering potassium, buying time for definitive treatment.
Question 3: Which finding indicates successful AKI recovery and readiness to discontinue RRT?
- Urine output >500 mL/day spontaneously (Correct answer)
- Creatinine returning to baseline
- BUN <40 mg/dL
- Normal electrolytes on CRRT
Correct answer: Urine output >500 mL/day spontaneously
Spontaneous urine output >500 mL/day indicates recovering tubular function and is a key criterion for considering RRT discontinuation.
Question 4: Which medication dose adjustment is required in a critically ill patient with AKI (eGFR 15 mL/min)?
- Metoprolol — increase dose
- Vancomycin — reduce dose and extend dosing interval (Correct answer)
- Propofol — reduce infusion rate by 50%
- Norepinephrine — no adjustment needed
Correct answer: Vancomycin — reduce dose and extend dosing interval
Vancomycin is renally cleared; dose reduction and extended dosing intervals with TDM are required in AKI to avoid toxicity.
Question 5: Rhabdomyolysis-induced AKI is BEST prevented by which intervention?
- Alkalinizing urine with sodium bicarbonate infusion
- Aggressive IV fluid resuscitation with normal saline (Correct answer)
- Early hemodialysis initiation
- Administration of N-acetylcysteine
Correct answer: Aggressive IV fluid resuscitation with normal saline
Aggressive IV hydration with isotonic saline is the cornerstone of rhabdomyolysis management, diluting myoglobin and maintaining urine flow.
Question 6: An ACNP is initiating CRRT for a patient in septic shock with AKI. Which CRRT dose is recommended per KDIGO guidelines?
- 10–15 mL/kg/hr effluent
- 20–25 mL/kg/hr effluent (Correct answer)
- 35–40 mL/kg/hr effluent
- 50 mL/kg/hr effluent
Correct answer: 20–25 mL/kg/hr effluent
KDIGO guidelines recommend a delivered CRRT dose of 20–25 mL/kg/hr; higher doses do not improve outcomes.
Acute Care Nurse Practitioner Acute Kidney Injury and Renal Replacement Therapy 3
Which diuretic is FIRST-LINE for managing volume overload in AKI patients who are not yet requiring RRT?