ACUTE KIDNEY INJURY NCLEX 2026 REVISION
NOTES AND STRUCTURED RENAL FAILURE
NURSING CARE OVERVIEW GUIDE
◉ Which nursing interventions are appropriate for a patient with
intrarenal AKI? Select all that apply.
A. Discontinue nephrotoxic medications
B. Monitor ECG continuously
C. Encourage high-protein diet
D. Strict intake and output
E. Administer contrast dye as ordered. Answer: A. Discontinue
nephrotoxic medications
B. Monitor ECG continuously
D. Strict intake and output
Rationale: Stop nephrotoxins, monitor potassium effects on heart,
track fluid balance. Protein is needed but not high-protein
unrestricted. Contrast worsens injury.
◉ Which assessment finding most strongly indicates postrenal AKI
rather than prerenal or intrarenal?
,A. History of severe burns
B. Recent contrast exposure
C. Distended bladder and inability to void
D. Hypotension. Answer: C. Distended bladder and inability to void
Rationale: Obstruction = postrenal. Burns and hypotension =
prerenal. Contrast = intrarenal.
◉ A patient with AKI has crackles, edema, and potassium 6.5 despite
receiving insulin and bicarbonate. Urine output is 10 mL/hr. What is
the priority next action?
A. Increase IV fluids
B. Administer another dose of insulin
C. Prepare for emergent dialysis
D. Restrict potassium intake. Answer: C. Prepare for emergent
dialysis
Rationale: Severe hyperkalemia + fluid overload + minimal urine
output = dialysis indication.
, ◉ The nurse is assigned four patients. Which patient should be
assessed first?
A. A patient in the diuretic phase producing 350 mL/hr
B. A patient with AKI and potassium 5.6 mEq/L
C. A patient with AKI whose MAP is 58 mmHg
D. A patient with AKI complaining of fatigue. Answer: C. A patient
with AKI whose MAP is 58 mmHg
Rationale: Perfusion is priority. MAP must be ≥65 to maintain kidney
and organ perfusion. 58 indicates active ischemia. Potassium 5.6 is
elevated but not yet critical. Diuretic phase high output is expected.
◉ Which task is appropriate to delegate to the unlicensed assistive
personnel (UAP) for a patient with AKI?
A. Interpret lab trends
B. Monitor hourly urine output
C. Educate patient on fluid restriction
D. Assess for pulmonary crackles. Answer: B. Monitor hourly urine
output
Rationale: UAP can measure and report output but cannot interpret
labs, teach, or assess lung sounds.
NOTES AND STRUCTURED RENAL FAILURE
NURSING CARE OVERVIEW GUIDE
◉ Which nursing interventions are appropriate for a patient with
intrarenal AKI? Select all that apply.
A. Discontinue nephrotoxic medications
B. Monitor ECG continuously
C. Encourage high-protein diet
D. Strict intake and output
E. Administer contrast dye as ordered. Answer: A. Discontinue
nephrotoxic medications
B. Monitor ECG continuously
D. Strict intake and output
Rationale: Stop nephrotoxins, monitor potassium effects on heart,
track fluid balance. Protein is needed but not high-protein
unrestricted. Contrast worsens injury.
◉ Which assessment finding most strongly indicates postrenal AKI
rather than prerenal or intrarenal?
,A. History of severe burns
B. Recent contrast exposure
C. Distended bladder and inability to void
D. Hypotension. Answer: C. Distended bladder and inability to void
Rationale: Obstruction = postrenal. Burns and hypotension =
prerenal. Contrast = intrarenal.
◉ A patient with AKI has crackles, edema, and potassium 6.5 despite
receiving insulin and bicarbonate. Urine output is 10 mL/hr. What is
the priority next action?
A. Increase IV fluids
B. Administer another dose of insulin
C. Prepare for emergent dialysis
D. Restrict potassium intake. Answer: C. Prepare for emergent
dialysis
Rationale: Severe hyperkalemia + fluid overload + minimal urine
output = dialysis indication.
, ◉ The nurse is assigned four patients. Which patient should be
assessed first?
A. A patient in the diuretic phase producing 350 mL/hr
B. A patient with AKI and potassium 5.6 mEq/L
C. A patient with AKI whose MAP is 58 mmHg
D. A patient with AKI complaining of fatigue. Answer: C. A patient
with AKI whose MAP is 58 mmHg
Rationale: Perfusion is priority. MAP must be ≥65 to maintain kidney
and organ perfusion. 58 indicates active ischemia. Potassium 5.6 is
elevated but not yet critical. Diuretic phase high output is expected.
◉ Which task is appropriate to delegate to the unlicensed assistive
personnel (UAP) for a patient with AKI?
A. Interpret lab trends
B. Monitor hourly urine output
C. Educate patient on fluid restriction
D. Assess for pulmonary crackles. Answer: B. Monitor hourly urine
output
Rationale: UAP can measure and report output but cannot interpret
labs, teach, or assess lung sounds.
