ACUTE KIDNEY INJURY NCLEX 2026 EXAM
PREPARATION PACK KEY FLUID AND
ELECTROLYTE IMBALANCES LAB VALUES AND
NURSING INTERVENTIONS WITH SAMPLE
QUESTIONS
◉ A patient in the oliguric phase of AKI has gained 4 pounds in 24
hours. Which findings would the nurse expect? Select all that apply.
A. Bounding pulses
B. Crackles in lung bases
C. Hypertension
D. Hypotension
E. Peripheral edema
F. Decreased BUN. Answer: B. Crackles in lung bases
C. Hypertension
E. Peripheral edema
Rationale: Rapid weight gain = fluid overload. Expect crackles,
hypertension, and edema. BUN rises in AKI. Hypotension would
suggest hypovolemia, not overload.
,◉ A patient with prolonged dehydration develops AKI. Two days
later, creatinine continues to rise despite fluid resuscitation. What
does the nurse suspect?
A. Postrenal obstruction
B. Transition from prerenal to intrarenal AKI
C. Chronic kidney disease
D. Laboratory error. Answer: B. Transition from prerenal to
intrarenal AKI
Rationale: Prolonged ischemia from prerenal AKI can cause acute
tubular necrosis, which is intrinsic damage.
◉ Which electrolyte imbalance most directly contributes to muscle
weakness and life-threatening arrhythmias in AKI?
A. Hyperphosphatemia
B. Hypermagnesemia
C. Hyperkalemia
D. Hyponatremia. Answer: C. Hyperkalemia
Rationale: Potassium directly affects cardiac conduction and skeletal
muscle function.
, ◉ A patient with AKI has the following ABG: pH 7.30, CO₂ 32, HCO₃
18. What is the nurse's interpretation?
A. Uncompensated metabolic acidosis
B. Partially compensated metabolic acidosis
C. Fully compensated metabolic acidosis
D. Respiratory alkalosis
.. Answer: B. Partially compensated metabolic acidosis
Rationale: Low pH and low HCO₃ = metabolic acidosis. Low CO₂
indicates respiratory compensation. pH not normal yet → partial
compensation
◉ A patient in the diuretic phase produces 5 liters of urine in 24
hours. Which lab trend is most concerning?
A. Potassium 5.2
B. Potassium 3.1
C. Creatinine 2.5
D. Phosphorus 4.8. Answer: B. Potassium 3.1
PREPARATION PACK KEY FLUID AND
ELECTROLYTE IMBALANCES LAB VALUES AND
NURSING INTERVENTIONS WITH SAMPLE
QUESTIONS
◉ A patient in the oliguric phase of AKI has gained 4 pounds in 24
hours. Which findings would the nurse expect? Select all that apply.
A. Bounding pulses
B. Crackles in lung bases
C. Hypertension
D. Hypotension
E. Peripheral edema
F. Decreased BUN. Answer: B. Crackles in lung bases
C. Hypertension
E. Peripheral edema
Rationale: Rapid weight gain = fluid overload. Expect crackles,
hypertension, and edema. BUN rises in AKI. Hypotension would
suggest hypovolemia, not overload.
,◉ A patient with prolonged dehydration develops AKI. Two days
later, creatinine continues to rise despite fluid resuscitation. What
does the nurse suspect?
A. Postrenal obstruction
B. Transition from prerenal to intrarenal AKI
C. Chronic kidney disease
D. Laboratory error. Answer: B. Transition from prerenal to
intrarenal AKI
Rationale: Prolonged ischemia from prerenal AKI can cause acute
tubular necrosis, which is intrinsic damage.
◉ Which electrolyte imbalance most directly contributes to muscle
weakness and life-threatening arrhythmias in AKI?
A. Hyperphosphatemia
B. Hypermagnesemia
C. Hyperkalemia
D. Hyponatremia. Answer: C. Hyperkalemia
Rationale: Potassium directly affects cardiac conduction and skeletal
muscle function.
, ◉ A patient with AKI has the following ABG: pH 7.30, CO₂ 32, HCO₃
18. What is the nurse's interpretation?
A. Uncompensated metabolic acidosis
B. Partially compensated metabolic acidosis
C. Fully compensated metabolic acidosis
D. Respiratory alkalosis
.. Answer: B. Partially compensated metabolic acidosis
Rationale: Low pH and low HCO₃ = metabolic acidosis. Low CO₂
indicates respiratory compensation. pH not normal yet → partial
compensation
◉ A patient in the diuretic phase produces 5 liters of urine in 24
hours. Which lab trend is most concerning?
A. Potassium 5.2
B. Potassium 3.1
C. Creatinine 2.5
D. Phosphorus 4.8. Answer: B. Potassium 3.1
