ACUTE KIDNEY INJURY NCLEX 2026 PRACTICE
TEST QUESTIONS AND DETAILED OLIGURIC
PHASE MANAGEMENT DIALYSIS INDICATIONS
AND COMPLICATIONS BREAKDOWN FULL
REVIEW
◉ A patient in the diuretic phase of AKI begins producing 400
mL/hr of urine. What is the nurse's priority concern?
A. Fluid overload
B. Electrolyte depletion
C. Rising creatinine
D. Metabolic acidosis
.. Answer: B. Electrolyte depletion
Rationale: Diuretic phase = high urine output. Risk shifts from fluid
overload to dehydration and electrolyte loss, especially potassium
◉ Which findings indicate a need for hemodialysis in a patient with
AKI? Select all that apply.
A. Potassium 6.8 mEq/L
,B. Severe metabolic acidosis
C. Urine output 35 mL/hr
D. Pulmonary edema unresponsive to diuretics
E. Uremic confusion. Answer: A. Potassium 6.8 mEq/L
B. Severe metabolic acidosis
D. Pulmonary edema unresponsive to diuretics
E. Uremic confusion
Rationale: Dialysis indications include severe hyperkalemia, severe
acidosis, fluid overload not responsive to treatment, and uremic
symptoms (confusion). Urine 35 mL/hr alone does not require
dialysis.
◉ A patient with AKI develops deep, rapid respirations. ABG shows
pH 7.28 and HCO₃ 18. What is occurring?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis with compensation
D. Respiratory acidosis. Answer: C. Metabolic acidosis with
compensation
,Rationale: Low pH + low HCO₃ = metabolic acidosis. Rapid
respirations (Kussmaul) indicate respiratory compensation.
◉ Which nursing action is most effective for early detection of acute
kidney injury in hospitalized patients?
A. Monitoring daily weights
B. Monitoring urine output hourly
C. Checking blood pressure once per shift
D. Monitoring respiratory rate. Answer: B. Monitoring urine output
hourly
Rationale: Decreased urine output is often the earliest indicator of
AKI. Creatinine rises later.
◉ A patient admitted with septic shock has a blood pressure of
84/40 despite receiving 2 liters of normal saline. Urine output is 12
mL/hr. Which intervention should the nurse anticipate next?
A. Administer furosemide
B. Start a vasopressor infusion
C. Restrict fluids
D. Prepare for dialysis. Answer: B. Start a vasopressor infusion
, Rationale: MAP = (84 + 80) ÷ 3 = 164 ÷ 3 ≈ 55. This is inadequate for
renal perfusion. After fluids fail, vasopressors are indicated to
maintain MAP ≥65. Dialysis is not first-line for perfusion-related
AKI.
◉ 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.
TEST QUESTIONS AND DETAILED OLIGURIC
PHASE MANAGEMENT DIALYSIS INDICATIONS
AND COMPLICATIONS BREAKDOWN FULL
REVIEW
◉ A patient in the diuretic phase of AKI begins producing 400
mL/hr of urine. What is the nurse's priority concern?
A. Fluid overload
B. Electrolyte depletion
C. Rising creatinine
D. Metabolic acidosis
.. Answer: B. Electrolyte depletion
Rationale: Diuretic phase = high urine output. Risk shifts from fluid
overload to dehydration and electrolyte loss, especially potassium
◉ Which findings indicate a need for hemodialysis in a patient with
AKI? Select all that apply.
A. Potassium 6.8 mEq/L
,B. Severe metabolic acidosis
C. Urine output 35 mL/hr
D. Pulmonary edema unresponsive to diuretics
E. Uremic confusion. Answer: A. Potassium 6.8 mEq/L
B. Severe metabolic acidosis
D. Pulmonary edema unresponsive to diuretics
E. Uremic confusion
Rationale: Dialysis indications include severe hyperkalemia, severe
acidosis, fluid overload not responsive to treatment, and uremic
symptoms (confusion). Urine 35 mL/hr alone does not require
dialysis.
◉ A patient with AKI develops deep, rapid respirations. ABG shows
pH 7.28 and HCO₃ 18. What is occurring?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis with compensation
D. Respiratory acidosis. Answer: C. Metabolic acidosis with
compensation
,Rationale: Low pH + low HCO₃ = metabolic acidosis. Rapid
respirations (Kussmaul) indicate respiratory compensation.
◉ Which nursing action is most effective for early detection of acute
kidney injury in hospitalized patients?
A. Monitoring daily weights
B. Monitoring urine output hourly
C. Checking blood pressure once per shift
D. Monitoring respiratory rate. Answer: B. Monitoring urine output
hourly
Rationale: Decreased urine output is often the earliest indicator of
AKI. Creatinine rises later.
◉ A patient admitted with septic shock has a blood pressure of
84/40 despite receiving 2 liters of normal saline. Urine output is 12
mL/hr. Which intervention should the nurse anticipate next?
A. Administer furosemide
B. Start a vasopressor infusion
C. Restrict fluids
D. Prepare for dialysis. Answer: B. Start a vasopressor infusion
, Rationale: MAP = (84 + 80) ÷ 3 = 164 ÷ 3 ≈ 55. This is inadequate for
renal perfusion. After fluids fail, vasopressors are indicated to
maintain MAP ≥65. Dialysis is not first-line for perfusion-related
AKI.
◉ 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.
