Acute Kidney Injury and Renal Replacement Therapy Flashcards
6 cards from real Acute Care Nurse Practitioner practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Acute Kidney Injury and Renal Replacement Therapy flashcards as text
Which indication for renal replacement therapy (RRT) is considered an EMERGENCY requiring immediate initiation?
Answer: Severe hyperkalemia with ECG changes
Severe hyperkalemia causing ECG changes (peaked T waves, wide QRS, sine wave pattern) is a life-threatening emergency requiring immediate RRT.
Which modality of RRT is preferred for hemodynamically unstable ICU patients?
Answer: Continuous renal replacement therapy (CRRT)
CRRT is preferred in hemodynamically unstable patients because it provides slow, continuous fluid and solute removal without causing rapid osmotic shifts.
Which anticoagulation is MOST commonly used in CRRT to prevent circuit clotting while minimizing systemic bleeding risk?
Answer: Citrate regional anticoagulation
Regional citrate anticoagulation confines anticoagulation to the extracorporeal circuit, minimizing systemic bleeding risk in high-risk patients.
A patient on CRRT receiving citrate anticoagulation develops rising total calcium with decreasing ionized calcium. What does this indicate?
Answer: Citrate toxicity/accumulation
Rising total calcium with low ionized calcium (high total/ionized ratio >2.5) indicates citrate accumulation, usually from hepatic failure impairing citrate metabolism.
Which condition is MOST likely to cause a false elevation in serum creatinine without true reduction in GFR?
Answer: Trimethoprim use
Trimethoprim (and cimetidine) blocks tubular secretion of creatinine, raising serum creatinine without changing GFR or true kidney function.
Recovery of renal function after AKI in the ICU is BEST predicted by which factor?
Answer: Underlying cause of AKI (reversibility)
The underlying etiology and its reversibility is the strongest predictor of renal recovery; pre-renal and ATN from reversible causes recover more reliably than CKD-related AKI.