NR341 / NR 341 Exam 1 2026/2027 Update | Complex Adult Health | Chamberlain University | Questions & Answers with Detailed Rationales | Grade A 100% Correct | Critical Care & Medical-Surgical Nursing | NCLEX-RN® Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive Exam 1 preparation guide for NR341 / NR 341 - Complex Adult Health (2026 Update) at Chamberlain University, featuring questions and answers with detailed rationales. Designed for nursing students in complex adult health and critical care courses, this resource consolidates the essential concepts required to master the NR341 Exam 1 and excel in complex adult health nursing. The guide is meticulously aligned with Chamberlain University curriculum, NCLEX-RN® test plan, and current evidence-based complex care standards. This verified resource provides comprehensive coverage of key NR341 Complex Adult Health Exam 1 topics, including: Hemodynamics (cardiac output (CO = HR × SV), stroke volume (preload, afterload, contractility), preload (volume returning to heart, CVP, PAOP), afterload (resistance left ventricle must overcome, SVR), contractility (inotropy, ejection fraction), Frank-Starling law, monitoring (arterial line (BP, waveform, dicrotic notch, zero at phlebostatic axis (4th ICS, mid-axillary line), square wave test for damping, complications (infection, bleeding, thrombosis, ischemia, pseudoaneurysm, nerve damage)), central venous pressure (CVP) (normal 2-6 mm Hg, reflects right ventricular preload, elevated in R heart failure, fluid overload, PE, cardiac tamponade, decreased in hypovolemia), pulmonary artery catheter (Swan-Ganz) (PAOP (wedge pressure) normal 4-12 mm Hg, reflects left ventricular preload, elevated in L heart failure, mitral stenosis/regurgitation, fluid overload, decreased in hypovolemia, cardiac output (thermodilution), mixed venous oxygen saturation (SvO2) normal 60-80%, decreased in decreased cardiac output, increased oxygen extraction (shock, hypoxia, anemia), increased in sepsis (decreased extraction), complications (arrhythmias, pulmonary artery rupture, infection, thrombus, pneumothorax, knotting), contraindications (tricuspid/pulmonic valve prosthesis, right heart mass, coagulopathy), waveforms (RA/CVP (a wave (atrial contraction), c wave (tricuspid bulging), v wave (atrial filling)), PA (systolic 15-25 mm Hg, diastolic 8-15 mm Hg, mean 10-20 mm Hg), PAOP (a wave (atrial contraction), v wave (atrial filling, large v wave in mitral regurgitation), interpretation), non-invasive hemodynamic monitoring (NICOM (bioreactance), Esophageal Doppler, ultrasound (IVC collapsibility (50% suggests hypovolemia), carotid flow, echocardiography (TTE, TEE)), shock classification (hypovolemic (hemorrhage, burns, vomiting, diarrhea, diuresis, third-spacing, S/S (tachycardia, hypotension, cool clammy skin, flat neck veins, oliguria, confusion), CVP low, PAOP low, CO low, SVR high, treatment (IV fluids (crystalloids (NS, LR), colloids (albumin)), blood products (PRBCs if Hgb 7-8, active bleeding), vasopressors (norepinephrine, dopamine if no response to fluids, temporary)), cardiogenic (MI, HF, cardiomyopathy, valvular disease, arrhythmias, S/S (tachycardia, hypotension, cool clammy skin, JVD, S3, crackles, oliguria, confusion), CVP high, PAOP high, CO low, SVR high, treatment (correct underlying cause (revascularization (PCI/CABG) for MI, rate control for arrhythmias), diuretics (furosemide, bumetanide, torsemide) for volume overload, vasodilators (nitroglycerin, nitroprusside, nesiritide) to reduce afterload/preload (monitor BP), inotropes (dobutamine (first-line, beta-1 agonist, vasodilator, increases CO, decreases SVR, monitor BP, arrhythmias), milrinone (PDE3 inhibitor, inotrope + vasodilator, long half-life, monitor hypotension, arrhythmias, thrombocytopenia), dopamine (low dose (1-5 mcg/kg/min) renal/ mesenteric vasodilation (controversial), moderate (5-10) beta-1 (inotropy, chronotropy), high (10-20) alpha-1 (vasoconstriction)), epinephrine (alpha, beta, inotrope, vasopressor, tachycardia, arrhythmias, increased myocardial oxygen demand, hyperglycemia, lactate elevation), levosimendan (calcium sensitizer, inotrope, vasodilator, not FDA-approved, limited availability)), mechanical circulatory support (IABP (intra-aortic balloon pump, inflates in diastole (augments coronary perfusion), deflates in systole (reduces afterload), indications (cardiogenic shock post-MI, refractory unstable angina, high-risk PCI, bridge to transplant/LVAD), contraindications (aortic regurgitation, aortic dissection, severe PVD, abdominal aortic aneurysm, uncontrolled sepsis), complications (limb ischemia, bleeding, infection, thrombocytopenia, balloon rupture, aortic dissection, embolism), nursing (monitor timing (ECG or pressure trigger), 1:1 augmentation (every beat), 1:2, 1:3 weaning, assess distal pulses, limb color/temp, sensation/motion, Hgb/Hct, platelets, position (HOB 30°, keep affected leg straight), remove sheath (if placed percutaneously, manual pressure or closure device), ECMO (veno-arterial (VA) for cardiogenic shock, veno-venous (VV) for respiratory failure)), distributive (septic (most common), anaphylactic, neurogenic, S/S (fever/hypothermia (septic), hypotension, warm/flushed skin (early septic), bounding pulses, JVD flat, oliguria, confusion), CVP low/normal, PAOP low/normal, CO high (early septic, increased with fluids, inotropes), SVR low, treatment (septic shock: IV fluids (30 mL/kg crystalloid within 3 hours of presentation), vasopressors (norepinephrine (first-line, titrate to MAP ≥65 mm Hg), vasopressin (0.03 units/min, second-line or add-on, does not titrate, do not use as monotherapy, avoid doses 0.04 units/min (cardiac ischemia, hyponatremia), epinephrine (second/third-line, add-on or replace norepinephrine), dopamine (not recommended except bradycardia), dobutamine (for persistent hypoperfusion despite adequate MAP, CO monitoring)), inotropes (dobutamine if CO low, signs hypoperfusion), antibiotics (broad-spectrum (pip/tazo, cefepime, meropenem, imipenem, ceftazidime, aztreonam + vancomycin + antifungal if risk factors) within 1 hour of recognition, de-escalate based on cultures, source control (remove infected devices, drain abscesses, debride necrotic tissue)), corticosteroids (hydrocortisone 200 mg/day IV (50 mg q6h or continuous infusion) if fluid and vasopressor refractory shock (unresponsive to norepinephrine ≥0.25-0.5 mcg/kg/min or equivalent), for 7 days or until vasopressor discontinuation, no taper needed), glycemic control (target glucose 140-180 mg/dL, avoid hypoglycemia), monitoring (lactate q2-4h until improving, ScvO2 (goal ≥70%), CVP (goal 8-12), MAP (≥65), urine output (0.5 mL/kg/h), sedation vacation, spontaneous breathing trial, DVT prophylaxis, stress ulcer prophylaxis), anaphylactic shock: epinephrine IM (0.3-0.5 mg of 1:1000 (1 mg/mL), repeat q5-15 min, IV infusion if refractory, antihistamines (diphenhydramine, famotidine), corticosteroids (methylprednisolone, hydrocortisone), IV fluids, airway management (intubation if stridor, angioedema, respiratory failure), remove trigger, neurogenic shock (spinal cord injury above T6, loss of sympathetic tone, unopposed vagal tone, S/S (hypotension, bradycardia, warm dry skin, flaccid paralysis, priapism), treatment (IV fluids (caution due to risk of pulmonary edema from neurogenic pulmonary edema), vasopressors (norepinephrine, phenylephrine (pure alpha, no beta, bradycardia may worsen), dopamine, vasopressin), atropine (if bradycardia symptomatic), methylprednisolone (30 mg/kg IV bolus, then 5.4 mg/kg/hour for 23 hours, controversial, limited evidence, risk of complications), supportive care, spinal immobilization, surgery (decompression, stabilization))), obstructive (PE, cardiac tamponade, tension pneumothorax, S/S (tachycardia, hypotension, JVD, pulsus paradoxus, muffled heart sounds (tamponade), absent breath sounds (pneumothorax), CVP high, PAOP low/normal (PE, tamponade), CO low, SVR high, treatment (PE: anticoagulation (heparin, DOACs), thrombolytics (tPA) for massive PE (hemodynamic instability, RV dysfunction), embolectomy, ECMO; cardiac tamponade: pericardiocentesis (subxiphoid or apical approach, ECG monitoring, aspirate blood/fluid, volume resuscitation, vasopressors, surgical window if recurrent or hemopericardium), tension pneumothorax: needle decompression (2nd ICS, midclavicular line, 14-16g angiocatheter, rush of air, convert to chest tube (4th-5th ICS, anterior axillary line, 24-28 Fr for hemopneumothorax, 12-20 Fr for simple pneumothorax, water seal, suction if persistent air leak or large)), sepsis (SIRS criteria (≥2: temp 38.3 or 36, HR 90, RR 20 or PaCO2 32, WBC 12,000 or 4,000 or 10% bands), qSOFA (altered mental status, RR ≥22, SBP ≤100), SOFA score (respiratory (PaO2/FiO2), coagulation (platelets), liver (bilirubin), cardiovascular (MAP, vasopressors), CNS (GCS), renal (Cr, urine output)), sepsis-3 definition (life-threatening organ dysfunction caused by dysregulated host response to infection, suspected or confirmed infection + increase in SOFA ≥2, mortality 10%, septic shock (persistent hypotension requiring vasopressors to maintain MAP ≥65 and lactate 2 despite adequate volume resuscitation, mortality 40%+)), Surviving Sepsis Campaign Hour-1 Bundle (measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, start rapid IV fluids (30 mL/kg crystalloid), apply vasopressors if hypotensive during/after fluids (MAP 65), re-measure lactate (if initial 2, within 2-4 hours)), hemodynamic monitoring targets (MAP ≥65 mm Hg, urine output ≥0.5 mL/kg/h, ScvO2 ≥70% (or SvO2 ≥65%), lactate clearance (decrease by 20% within 2-4 hours), CVP 8-12 (not strong evidence), pulmonary artery catheter (PAC) not routinely recommended, use dynamic measures (passive leg raise, stroke volume variation (SVV), pulse pressure variation (PPV), end-expiratory occlusion test, mini-fluid challenge) if available), Acute Respiratory Distress Syndrome (ARDS) (Berlin definition: timing (within 1 week of known clinical insult or new/worsening respiratory symptoms), chest imaging (bilateral opacities not fully explained by effusions, lobar/lung collapse, or nodules), origin (respiratory failure not fully explained by heart failure or fluid overload, need objective assessment (echocardiography) to exclude hydrostatic edema if no risk factors), oxygenation (mild: PaO2/FiO2 201-300 with PEEP or CPAP ≥5 cm H2O, moderate: 101-200 with PEEP ≥5, severe: ≤100 with PEEP ≥5), direct (pulmonary) causes (pneumonia (bacterial, viral, fungal, PJP), aspiration of gastric contents, inhalation injury (smoke, toxic gas, chemical, drowning, near-drowning, re-expansion, reperfusion after lung transplant, pulmonary contusion), indirect (extrapulmonary) causes (sepsis (most common), severe trauma (multiple fractures, fat embolism, long bone fractures, burns, pancreatitis, massive transfusion (TRALI), cardiopulmonary bypass, drug overdose (opioids, salicylates, TCAs, cocaine, heroin, methadone, barbiturates, ethchlorvynol, propoxyphene, colchicine, tocolytics, nitrofurantoin, amiodarone, amphotericin B, bleomycin, cyclophosphamide, cytarabine, gemcitabine, methotrexate, mitomycin, rituximab), DIC, vasculitis (Goodpasture's, granulomatosis with polyangiitis (GPA), microscopic polyangiitis, IgA vasculitis), neurogenic (after head injury, stroke, seizure, subarachnoid hemorrhage, intracerebral hemorrhage, spinal cord injury, Guillain-Barré, myasthenia gravis, botulism, organophosphate poisoning), transfusion-related acute lung injury (TRALI) (within 6 hours of transfusion, exclude circulatory overload (TACO), incidence 0.1%, mortality 5-10%, treatment (supportive, avoid further implicated donor products, leukoreduction, washed RBCs)), management (low tidal volume ventilation (6 mL/kg predicted body weight (PBW), PBW (male) = 50 + 2.3 × (height in inches - 60), PBW (female) = 45.5 + 2.3 × (height in inches - 60), target plateau pressure (Pplat) ≤30 cm H2O, respiratory rate up to 35 to maintain pH ≥7.20-7.25, if pH 7.15 despite RR 35, consider permissive hypercapnia (if not contraindicated (increased ICP, severe metabolic acidosis, cardiac arrhythmias, pulmonary hypertension), increase TV by 1 mL/kg up to 8 mL/kg if Pplat 30, or bicarbonate infusion (controversial)), PEEP (high PEEP table (ARDSnet) based on FiO2, lower PEEP for mild ARDS, higher for moderate-severe, monitor for barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema), hemodynamics (decreased venous return, decreased CO, hypotension, use fluids, vasopressors), prone positioning (for severe ARDS (PaO2/FiO2 150), improves oxygenation (recruits dorsal lung units, improves V/Q matching, facilitates secretion drainage), duration ≥16 hours, complications (pressure injuries, facial edema, corneal abrasions, tube displacement (ETT, lines, drains), arrhythmias, hypotension, brachial plexus injury, blindness (rare), contraindications (unstable spine, pelvic/femur fractures, increased ICP, pregnancy, abdominal wounds, hemodynamic instability, massive hemoptysis, open abdomen, chest tube with air leak, tracheal surgery, recent sternotomy), neuromuscular blockade (cisatracurium, rocuronium, vecuronium) for early severe ARDS (PaO2/FiO2 120-150), for up to 48 hours, monitor train-of-four (TOF) (goal 1-2 twitches), sedation (propofol, midazolam, dexmedetomidine, fentanyl), complications (ICU-acquired weakness, critical illness myopathy/polyneuropathy, corneal abrasions, skin breakdown, DVT, corneal ulcers, corneal abrasions, corneal drying, eye care (tape, lubricating drops, ointment, eye patches, frequent assessment)), fluid conservative strategy (target CVP 4, PAOP 8, or negative fluid balance after hemodynamic stabilization, diuretics (furosemide, bumetanide, torsemide, metolazone), fluid restriction, monitor for hypotension, worsening renal function (Cr, BUN, urine output), ECMO (VV-ECMO for severe ARDS with refractory hypoxemia (PaO2/FiO2 80 for 6 hours despite optimal management, or 50 for 3 hours, or pH 7.15 with PaCO2 60, or severe air leak syndrome, or bridge to transplant), inclusion criteria (mechanical ventilation 7 days, no irreversible brain damage, no contraindications (intracranial hemorrhage, active bleeding, heparin-induced thrombocytopenia (HIT), limited vascular access, advanced age, irreversible organ failure)), inhaled vasodilators (epoprostenol (Flolan), iloprost, nitric oxide) for refractory hypoxemia (salvage, no mortality benefit, may improve oxygenation temporarily), corticosteroids (dexamethasone (for COVID-19 ARDS, 6 mg daily for up to 10 days, reduces mortality, methylprednisolone 1 mg/kg/day for 5-14 days in moderate-severe ARDS (controversial, no mortality benefit in non-COVID ARDS in meta-analyses, possible harm if late ARDS or high dose), consider if refractory shock, adrenal insufficiency, or eosinophilic pneumonia), nutrition (enteral nutrition preferred, start within 24-48 hours, avoid overfeeding (respiratory quotient 1 increases CO2 production, increases minute ventilation, prolongs weaning), protein 1.2-2.0 g/kg/day, calorie 20-30 kcal/kg/day, monitor gastric residual volume (GRV) (no need to check routinely, if 500 mL consider prokinetic (metoclopramide, erythromycin), post-pyloric feeding), glycemic control (insulin infusion target 140-180 mg/dL), DVT prophylaxis (heparin (UFH or LMWH) unless contraindicated (active bleeding, coagulopathy (INR 1.5, PTT 50, platelets 50), recent neurosurgery, hemorrhagic stroke, high risk falls, epidural/spinal catheter), mechanical prophylaxis (SCDs, compression stockings) if pharmacologic contraindicated or high bleeding risk, stress ulcer prophylaxis (PPI (pantoprazole, omeprazole) or H2RA (famotidine) for high-risk patients (mechanical ventilation 48 hours, coagulopathy (INR 1.5, PTT 2x normal, platelets 50), traumatic brain injury, spinal cord injury, burns 30%, sepsis, ICU stay 7 days, history of GI bleed, renal/liver failure, high-dose corticosteroids), risk of C. difficile infection, pneumonia, monitor for GI bleed (Hgb drop, melena, hematemesis, coffee-ground NG aspirate), weaning from mechanical ventilation (daily spontaneous awakening trial (SAT) (interrupt sedative infusions (propofol, midazolam, dexmedetomidine) daily if stable, monitor for agitation, pain, delirium, respiratory distress) + spontaneous breathing trial (SBT) (low pressure support (5-8 cm H2O) or T-piece for 30-120 minutes, assess (respiratory rate 35, RR/VT 105, SpO2 88-90%, HR 140 or change 20%, SBP 90-180, no signs of distress, no diaphoresis, no accessory muscle use, no paradoxical breathing, no altered mental status), weaning predictors (rapid shallow breathing index (RSBI = RR/VT) 105, negative inspiratory force (NIF) -20 to -30 cm H2O, minute ventilation 10-15 L/min, vital capacity 10-15 mL/kg, PaO2/FiO2 150-200, PEEP ≤5-8 cm H2O, FiO2 ≤0.4-0.5, hemodynamic stability, no vasopressors or low dose (norepinephrine 0.1 mcg/kg/min, dopamine 5, dobutamine 5), no sedation or light (RASS 0 to -1, SAS 3-4), cough strength (strong), secretions (minimal), extubation criteria (pass SBT, stable hemodynamics, minimal secretions, intact airway reflexes, ability to protect airway (cough, gag, swallow), no impending laryngeal edema (cuff leak test (deflate cuff, assess leak around ETT, if no leak 110-130 mL or 10-15% of TV, risk post-extubation stridor, administer corticosteroids (methylprednisolone 40 mg IV q6h for 4 doses starting at least 4 hours before extubation), anticipate reintubation (obesity, sleep apnea, COPD, CHF, advanced age, upper airway surgery, difficult airway, high-risk surgery), equipment at bedside (face mask, non-rebreather, BiPAP, suction, reintubation supplies, emergency airway cart, video laryngoscope, bougie, cricothyrotomy kit)), complications of mechanical ventilation (VAP (ventilator-associated pneumonia, diagnosis (new or progressive infiltrate on CXR + ≥2 of: fever 38, leukocytosis or leukopenia, purulent secretions), prevention (HOB 30-45°, oral care with chlorhexidine (controversial, may increase mortality in some studies, not recommended routinely, use toothbrushing with non-antimicrobial paste, oropharyngeal suction, ETT with subglottic suctioning, continuous aspiration of subglottic secretions (CASS), selective digestive decontamination (SDD) (not standard in US, reduces VAP but not mortality, risk of antibiotic resistance), stress ulcer prophylaxis, wean sedation daily, avoid unnecessary antibiotics, use closed suction system, change circuit only when soiled or malfunctioning, use heat-moisture exchanger (HME) or heated humidifier, use silver-coated ETT? not widely available), treatment (empiric antibiotics (pip/tazo, cefepime, meropenem, imipenem, ceftazidime, levofloxacin, ciprofloxacin, gentamicin, tobramycin, amikacin + vancomycin or linezolid for MRSA coverage if risk factors (prior MRSA, hospitalization 5 days, IV drug use, immunosuppression, high prevalence unit), de-escalate based on cultures (ETA (endotracheal aspirate) or BAL (bronchoalveolar lavage) quantitative cultures 10^4 CFU/mL for BAL, 10^5-10^6 for ETA), duration 7 days (longer if immunocompromised, necrotizing, empyema, cavitary, persistent symptoms, MRSA, Pseudomonas), barotrauma (pneumothorax (sudden hypoxia, hypotension, tachycardia, absent breath sounds, hyperresonance to percussion, hypotension, JVD, pulsus paradoxus, tension physiology, needle decompression (2nd ICS, midclavicular line) then chest tube (4th-5th ICS, anterior axillary line, 20-28 Fr, water seal, suction if large or persistent air leak, monitor for re-expansion pulmonary edema), pneumomediastinum (subcutaneous emphysema, mediastinal crunch (Hamman sign), chest pain, usually self-limited, treat underlying, reduce pressures, pneumopericardium (rare, may cause tamponade, pericardiocentesis if symptomatic)), diaphragmatic injury, oxygen toxicity (FiO2 0.60 for 24-48 hours, absorption atelectasis, pulmonary fibrosis, monitor PaO2/FiO2, use lowest FiO2 to maintain SpO2 88-95% (for ARDS, permissive hypoxemia acceptable if no signs of organ ischemia, mixed venous O2 60-65%, lactate normal)), ventilator-induced lung injury (VILI) (volutrauma (overdistension, plateau pressure 30), atelectrauma (cyclic opening and closing, use PEEP to recruit), biotrauma (inflammatory response, cytokines, multi-organ failure, use lung protective ventilation (low tidal volume, high PEEP, prone positioning, neuromuscular blockade, conservative fluids, ECMO if severe))), Acute Kidney Injury (AKI) (RIFLE criteria (Risk (Cr increase 1.5x baseline or GFR decrease 25%, urine output 0.5 mL/kg/h for 6 hours), Injury (Cr 2x baseline or GFR decrease 50%, UOP 0.5 for 12 hours), Failure (Cr 3x baseline or Cr 4 mg/dL or GFR decrease 75%, UOP 0.3 for 24 hours or anuria for 12 hours), Loss (persistent AKI 4 weeks), ESRD (3 months)), KDIGO staging (Stage 1: Cr increase ≥0.3 mg/dL within 48 hours or 1.5-1.9x baseline, UOP 0.5 mL/kg/h for 6-12 hours, Stage 2: Cr 2-2.9x baseline, UOP 0.5 for ≥12 hours, Stage 3: Cr 3x baseline or ≥4 mg/dL or initiation of RRT or eGFR 35, UOP 0.3 for ≥24 hours or anuria for ≥12 hours), causes (prerenal (hypovolemia, decreased effective circulating volume (HF, cirrhosis, sepsis, anaphylaxis), renal artery stenosis, medications (ACEi, ARB, NSAIDs, calcineurin inhibitors), S/S (BUN:Cr 20, FeNa 1%, urine osmolality 500, urine specific gravity 1.020, bland sediment, response to fluids), treatment (correct underlying cause (fluids (isotonic crystalloids), avoid nephrotoxins, discontinue ACEi/ARB/NSAIDs, if diuretic-induced, stop diuretic, if hepatorenal syndrome (cirrhosis, ascites, renal failure without other cause), treat with albumin + vasoconstrictors (midodrine, octreotide, terlipressin (not US), norepinephrine)), intrinsic (acute tubular necrosis (ATN) (ischemic (shock, sepsis, prolonged prerenal), nephrotoxic (contrast, aminoglycosides, amphotericin B, cisplatin, methotrexate, calcineurin inhibitors, vancomycin, IVIG, mannitol, hydroxyethyl starch, myoglobin (rhabdomyolysis), hemoglobin (hemolysis), uric acid (tumor lysis), ethylene glycol), S/S (muddy brown granular casts, FeNa 2%, urine osmolality 350, specific gravity 1.015, may have oliguric or non-oliguric phase, treatment (supportive, maintain euvolemia, avoid further insults, treat underlying, no role for dopamine, fenoldopam, furosemide to convert oliguric to non-oliguric (no mortality benefit, may delay RRT, use for fluid management only), renal replacement therapy (RRT) indications (AEIOU: Acidosis (severe metabolic acidosis pH 7.1-7.2, HCO3 12-15, refractory to medical therapy), Electrolytes (hyperkalemia 6.5 with ECG changes or refractory to medical therapy), Intoxications (lithium, methanol, ethylene glycol, salicylates, theophylline, metformin, valproate, phenytoin, barbiturates, toxic alcohols), Overload (volume overload with pulmonary edema refractory to diuretics), Uremia (pericarditis, encephalopathy, bleeding, platelet dysfunction, nausea/vomiting, anorexia, pruritus, seizures, coma, asterixis, myoclonus)), modalities (intermittent hemodialysis (IHD) (hemodynamically stable, rapid solute/fluid removal, requires anticoagulation (heparin), vascular access (tunneled or non-tunneled dialysis catheter (IJ, femoral)), complications (hypotension (especially with rapid ultrafiltration, high sodium dialysate, cool temperature, midodrine, albumin, sodium modeling), arrhythmias, electrolyte shifts, dialysis disequilibrium syndrome (cerebral edema, headache, nausea, vomiting, confusion, seizures, coma, treat with slow low-efficiency dialysis, mannitol, hypertonic saline), bleeding (anticoagulation), air embolism, infection (exit site, tunnel, bacteremia, endocarditis, epidural abscess, discitis, osteomyelitis)), continuous renal replacement therapy (CRRT) (hemodynamically unstable, slow continuous fluid/ solute removal, less hypotension, requires anticoagulation (citrate (regional, preferred), heparin, no anticoagulation if high bleeding risk), continuous veno-venous hemofiltration (CVVH) (convection), hemodiafiltration (CVVHDF) (diffusion + convection), complications (hypothermia, electrolyte disturbances (hypophosphatemia, hypokalemia, hypomagnesemia), bleeding, filter clotting, air embolism, infection), sustained low-efficiency dialysis (SLED) (hybrid, 8-12 hours, more stable than IHD, less continuous than CRRT)), postrenal (obstruction (BPH, stones, tumor, retroperitoneal fibrosis, neurogenic bladder, blocked urinary catheter), S/S (hydronephrosis on ultrasound, anuria (sudden, alternating with polyuria), FeNa variable, treatment (relieve obstruction (Foley catheter, suprapubic catheter, nephrostomy tube, ureteral stent, treat underlying cause), monitor post-obstructive diuresis (after relief, may have massive diuresis (up to 1 L/h), replace urine output with 0.45% NS or 0.9% NS at 75% of output (to avoid volume overload while preventing hypovolemia, monitor electrolytes (K+, Na+, Mg++, PO4, Ca++), replace as needed))), renal replacement therapy anticoagulation (citrate (regional, preferred for CRRT, chelates calcium, anticoagulates circuit, calcium infused separately, monitor ionized calcium (post-filter 0.4, systemic 1.0-1.2), metabolic alkalosis, hypocalcemia, citrate accumulation (total Ca:ionized Ca 2.5, metabolic acidosis, high anion gap, monitor LFTs, treat with low citrate solution, calcium replacement, hemodialysis if severe)), heparin (systemic, monitor aPTT 40-60 (or 1.5-2x baseline), PTT q6h, risk of bleeding (HIT (heparin-induced thrombocytopenia) (type II: platelets drop 50% or 150, 5-10 days after exposure, thrombosis risk 50%, treatment (stop all heparin (flushes, locks, lines, catheters), start direct thrombin inhibitor (argatroban (monitor PTT, aPTT 1.5-3x baseline, hepatic metabolism, adjust in liver disease), bivalirudin (monitor PTT, 1.5-2.5x baseline, renal clearance, adjust in renal impairment), fondaparinux (factor Xa inhibitor, no cross-reactivity, but not FDA-approved for HIT, used off-label, monitor anti-Xa, risk of HIT antibody formation but lower than heparin, no routine monitoring), danaparoid (not US), transition to warfarin (after platelets recover 150, overlap with direct thrombin inhibitor for 5 days, INR goal 2-3, avoid warfarin without non-heparin anticoagulant overlap (risk of venous limb gangrene, skin necrosis, warfarin-induced microthrombosis, protein C depletion), vitamin K if needed (but may delay warfarin resumption, use other anticoagulants), treat thrombosis (surgical or catheter embolectomy, thrombolytics, vena cava filter if contraindication to anticoagulation, or anticoagulation alone if stable)), no anticoagulation if high bleeding risk (platelets 20, recent surgery, active bleeding, coagulopathy (INR 2, PTT 60), intracranial hemorrhage, trauma, massive transfusion, hemodialysis without anticoagulation (saline flushes q30min, heparin-coated circuit, modified circuit), monitor filter clotting (increased transmembrane pressure, decreased filter life, clotted circuit, blood loss, decreased dialysis dose, replace circuit)), contrast-induced acute kidney injury (CI-AKI) (increase Cr ≥0.5 mg/dL or 25% within 48-72 hours of IV contrast, risk factors (pre-existing CKD (eGFR 30-45), diabetes, multiple myeloma, dehydration, heart failure, hypotension, sepsis, older age, high contrast volume, intra-arterial administration (cardiac cath higher risk than IV), nephrotoxic medications (NSAIDs, aminoglycosides, amphotericin, cisplatin, calcineurin inhibitors, vancomycin), prevention (IV fluids (0.9% NS or isotonic sodium bicarbonate (154 mEq/L) at 1-3 mL/kg/hour for 3-12 hours before and after contrast), hold metformin (48 hours before and after, restart when renal function stable), use low- or iso-osmolar contrast (iodixanol, iopamidol, ioversol, iopromide, iohexol, ioxaglate, iobitridol), minimize contrast volume, N-acetylcysteine (NAC) 600-1200 mg PO BID day before and day of contrast (controversial, may reduce risk, cheap, safe, consider in high-risk patients), withhold nephrotoxins (NSAIDs, diuretics (except for heart failure), ACEi/ARB (controversial, may continue if BP stable), statins (atorvastatin, rosuvastatin may reduce risk, pleiotropic effects), hemodialysis/CRRT (not effective for prevention, may remove contrast but also causes hypotension, infection, vascular access complications, increased mortality, not recommended))), Electrolyte Emergencies (hyperkalemia (pseudo-hyperkalemia (tourniquet use, fist pumping, hemolysis, thrombocytosis (1 million), leukocytosis (100,000), familial pseudohyperkalemia, blood sample left at room temperature, delay in processing), ECG changes (peaked T waves (tenting) earliest, PR prolongation, QRS widening, loss of P wave, ST depression, sine wave, V-fib, asystole, progression correlates with potassium level (peaked T 5.5-6.0, QRS widening 6.5, sine wave 7.0, asystole 8.0-9.0), not all patients follow sequence, immediate management for severe (6.5 with ECG changes, any ECG changes, or rapidly rising), stabilize myocardium (calcium gluconate (1g = 10 mL of 10% solution) IV over 2-5 minutes, onset 1-3 minutes, duration 30-60 minutes, repeat once if no improvement or ECG worsening, calcium chloride (1g = 10 mL of 10% solution) has 3x more elemental calcium, more irritating to veins (use central line if possible), give through central line or large peripheral vein, monitor for bradycardia, hypotension, tissue necrosis if extravasation, may potentiate digoxin toxicity (give slow, avoid if possible in digoxin toxic patient, but life-threatening hyperkalemia overrides, use digoxin immune fab before calcium if digoxin toxicity suspected)), shift potassium intracellularly (insulin (regular 10 units IV push, always give with D50 25-50g (1-2 amps) unless hyperglycemic (250 mg/dL, check glucose, may give insulin alone, monitor glucose q30-60 min, may need dextrose infusion), onset 15-30 minutes, peak 30-60 minutes, duration 4-6 hours, monitor for hypoglycemia for 6 hours), albuterol (nebulized 10-20 mg (2.5 mg in mild, 10-20 mg in severe) over 10 minutes, onset 30-90 minutes, peak 90-120 minutes, duration 2-4 hours, side effects (tachycardia, tremor, palpitations, hypokalemia, hyperglycemia, lactic acidosis)), sodium bicarbonate (50 mEq (1 amp) IV push over 5 minutes, for metabolic acidosis (pH 7.2), onset 15-30 minutes, duration 2-4 hours, may cause hypernatremia, volume overload, worsening hypocalcemia (increased binding to albumin), left shift of oxyhemoglobin dissociation curve (decreased oxygen delivery), contraindicated in respiratory acidosis (worsens intracellular acidosis, CO2 crosses BBB, worsens CNS acidosis, coma, death), do not give concurrently with calcium (precipitates, calcium carbonate formation)), remove potassium from body (loop diuretics (furosemide 40-80 mg IV, onset 15-30 minutes, duration 2-4 hours, monitor urine output, electrolytes (hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia), ototoxicity), potassium-binding resins (patiromer (Veltassa) 8.4-25.2 g daily, onset hours, duration 24 hours,