ACUTE KIDNEY INJURY NCLEX 2026 STUDY
GUIDE COMPLETE RENAL PATHOPHYSIOLOGY
STAGES CAUSES AND PRACTICE QUESTIONS
◉ A patient with AKI has the following labs: K⁺ 6.3 mEq/L,
creatinine 3.2 mg/dL, phosphorus 5.6 mg/dL, calcium 7.9 mg/dL.
Which finding requires immediate intervention?
A. Creatinine 3.2
B. Phosphorus 5.6
C. Calcium 7.9
D. Potassium 6.3. Answer: D. Potassium 6.3
Rationale: Hyperkalemia above 6.0 is life-threatening and can cause
fatal arrhythmias. Elevated creatinine indicates kidney injury but is
not immediately lethal. Calcium is low due to inverse relationship
with phosphorus but not most urgent.
◉ A patient's blood pressure is 88/42. What is the MAP, and does
this support adequate renal perfusion?
A. MAP 57, inadequate perfusion
B. MAP 64, adequate perfusion
,C. MAP 70, adequate perfusion
D. MAP 58, adequate perfusion. Answer: A. MAP 57, inadequate
perfusion
Rationale: MAP = (SBP + 2×DBP) ÷ 3 = (88 + 84) ÷ 3 = 172 ÷ 3 ≈ 57
MAP must be ≥65 for kidney perfusion. This patient is at risk for
prerenal AKI.
◉ A patient receives IV contrast for a CT scan and develops rising
creatinine over 48 hours. Which type of AKI is most likely?
A. Prerenal
B. Intrarenal
C. Postrenal
D. Obstructive. Answer: B. Intrarenal
Rationale: Contrast dye is nephrotoxic and causes acute tubular
necrosis (ATN), which is intrinsic kidney damage.
◉ A patient with benign prostatic hyperplasia presents with bladder
distention and minimal urine output. Creatinine is rising. What is the
priority intervention?
,A. Administer IV fluids
B. Start vasopressors
C. Insert Foley catheter
D. Give furosemide. Answer: C. Insert Foley catheter
Rationale: Postrenal AKI is caused by obstruction. The priority is
relieving obstruction immediately. Fluids or diuretics will not fix the
underlying issue.
◉ 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
GUIDE COMPLETE RENAL PATHOPHYSIOLOGY
STAGES CAUSES AND PRACTICE QUESTIONS
◉ A patient with AKI has the following labs: K⁺ 6.3 mEq/L,
creatinine 3.2 mg/dL, phosphorus 5.6 mg/dL, calcium 7.9 mg/dL.
Which finding requires immediate intervention?
A. Creatinine 3.2
B. Phosphorus 5.6
C. Calcium 7.9
D. Potassium 6.3. Answer: D. Potassium 6.3
Rationale: Hyperkalemia above 6.0 is life-threatening and can cause
fatal arrhythmias. Elevated creatinine indicates kidney injury but is
not immediately lethal. Calcium is low due to inverse relationship
with phosphorus but not most urgent.
◉ A patient's blood pressure is 88/42. What is the MAP, and does
this support adequate renal perfusion?
A. MAP 57, inadequate perfusion
B. MAP 64, adequate perfusion
,C. MAP 70, adequate perfusion
D. MAP 58, adequate perfusion. Answer: A. MAP 57, inadequate
perfusion
Rationale: MAP = (SBP + 2×DBP) ÷ 3 = (88 + 84) ÷ 3 = 172 ÷ 3 ≈ 57
MAP must be ≥65 for kidney perfusion. This patient is at risk for
prerenal AKI.
◉ A patient receives IV contrast for a CT scan and develops rising
creatinine over 48 hours. Which type of AKI is most likely?
A. Prerenal
B. Intrarenal
C. Postrenal
D. Obstructive. Answer: B. Intrarenal
Rationale: Contrast dye is nephrotoxic and causes acute tubular
necrosis (ATN), which is intrinsic kidney damage.
◉ A patient with benign prostatic hyperplasia presents with bladder
distention and minimal urine output. Creatinine is rising. What is the
priority intervention?
,A. Administer IV fluids
B. Start vasopressors
C. Insert Foley catheter
D. Give furosemide. Answer: C. Insert Foley catheter
Rationale: Postrenal AKI is caused by obstruction. The priority is
relieving obstruction immediately. Fluids or diuretics will not fix the
underlying issue.
◉ 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
