Acute Kidney Injury (AKI) is a sudden and serious decline in kidney function that requires prompt identification and management to prevent progression to chronic disease or death. Pharmacists play a critical role in both preventing and managing AKI, especially drug-induced kidney disease, a topic covered in detail in the Patient Care 4 curriculum. This quiz will test your ability to classify the types of AKI, identify causative agents, and understand the principles of management for this complex and urgent clinical condition.
1. Acute Kidney Injury (AKI) is best defined as:
- a. A slow, progressive loss of kidney function over months to years.
- b. An abrupt decline in kidney function occurring over hours to days.
- c. The presence of protein in the urine.
- d. A congenital defect of the kidneys.
Answer: b. An abrupt decline in kidney function occurring over hours to days.
2. According to the KDIGO guidelines, which of the following criteria can be used to diagnose AKI?
- a. An increase in serum creatinine (SCr) by ≥0.3 mg/dL within 48 hours.
- b. A decrease in urine output to <0.5 mL/kg/hr for 6 hours.
- c. An increase in SCr to ≥1.5 times baseline within the prior 7 days.
- d. All of the above.
Answer: d. All of the above.
3. An AKI caused by severe dehydration due to vomiting and diarrhea is classified as:
- a. Prerenal
- b. Intrinsic
- c. Postrenal
- d. Chronic
Answer: a. Prerenal
4. A patient with prerenal AKI would be expected to have what characteristic lab finding?
- a. A BUN:SCr ratio < 10:1
- b. A BUN:SCr ratio > 20:1
- c. Muddy brown casts in the urine.
- d. White blood cells in the urine.
Answer: b. A BUN:SCr ratio > 20:1
5. How do NSAIDs contribute to the development of prerenal AKI?
- a. They cause vasodilation of the efferent arteriole.
- b. They inhibit prostaglandins, leading to vasoconstriction of the afferent arteriole and reduced blood flow to the glomerulus.
- c. They cause direct damage to the tubules.
- d. They cause an allergic reaction in the interstitium.
Answer: b. They inhibit prostaglandins, leading to vasoconstriction of the afferent arteriole and reduced blood flow to the glomerulus.
6. The “Pathophysiology and Management of Acute Kidney Injury (AKI)” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. Acute Tubular Necrosis (ATN) is the most common cause of which type of AKI?
- a. Prerenal
- b. Intrinsic
- c. Postrenal
- d. Obstructive
Answer: b. Intrinsic
8. Which of the following drugs is a well-known cause of ATN due to direct tubular toxicity?
- a. Penicillin
- b. An aminoglycoside like gentamicin
- c. An ACE inhibitor
- d. A thiazide diuretic
Answer: b. An aminoglycoside like gentamicin
9. A patient develops a fever, rash, and an acute rise in SCr one week after starting a new beta-lactam antibiotic. The presence of eosinophils and WBC casts in the urine would suggest:
- a. Prerenal AKI
- b. Postrenal AKI
- c. Acute Tubular Necrosis (ATN)
- d. Acute Interstitial Nephritis (AIN)
Answer: d. Acute Interstitial Nephritis (AIN)
10. An enlarged prostate (BPH) causing urinary retention and a subsequent rise in SCr is an example of what type of AKI?
- a. Prerenal
- b. Intrinsic
- c. Postrenal
- d. Vasomotor
Answer: c. Postrenal
11. The “Management of Drug-Induced Kidney Disease” is an active learning session in the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. What is the cornerstone of management for prerenal AKI caused by hypovolemia?
- a. Initiating a diuretic.
- b. Administering IV fluids to restore renal perfusion.
- c. Starting an ACE inhibitor.
- d. Placing a urinary catheter.
Answer: b. Administering IV fluids to restore renal perfusion.
13. The presence of “muddy brown granular casts” in the urine is pathognomonic for:
- a. Prerenal AKI
- b. Postrenal AKI
- c. Acute Tubular Necrosis (ATN)
- d. Normal urinalysis
Answer: c. Acute Tubular Necrosis (ATN)
14. Why are the Cockcroft-Gault and MDRD equations unreliable for drug dosing during an active AKI?
- a. They are only validated for patients with liver disease.
- b. They assume a steady state of creatinine, which is not present when renal function is rapidly changing.
- c. They do not use serum creatinine as a variable.
- d. They are only accurate for pediatric patients.
Answer: b. They assume a steady state of creatinine, which is not present when renal function is rapidly changing.
15. A patient receiving IV contrast for a CT scan is at risk for developing:
- a. Prerenal AKI
- b. Contrast-induced nephropathy, a form of ATN.
- c. Postrenal AKI
- d. Allergic interstitial nephritis
Answer: b. Contrast-induced nephropathy, a form of ATN.
16. The renal system module in Patient Care 4 covers AKI.
- a. True
- b. False
Answer: a. True
17. What is the most important intervention in managing drug-induced kidney disease?
- a. Increasing the dose of the offending drug.
- b. Continuing the drug and monitoring closely.
- c. Discontinuing the offending agent, if possible.
- d. Starting a diuretic.
Answer: c. Discontinuing the offending agent, if possible.
18. A patient is on an ACE inhibitor and their SCr increases by 20% from baseline one week after initiation. The most appropriate action is to:
- a. Immediately discontinue the ACE inhibitor.
- b. Continue the ACE inhibitor, as a small, expected hemodynamic rise in SCr can occur.
- c. Double the dose of the ACE inhibitor.
- d. Add an ARB to the regimen.
Answer: b. Continue the ACE inhibitor, as a small, expected hemodynamic rise in SCr can occur.
19. The management of postrenal AKI focuses on:
- a. IV fluid resuscitation.
- b. Initiating an ESA.
- c. Removing the source of the urinary tract obstruction.
- d. Administering IV antibiotics.
Answer: c. Removing the source of the urinary tract obstruction.
20. An active learning session on AKI is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
21. A patient with rhabdomyolysis is at risk for AKI due to:
- a. Precipitation of myoglobin in the renal tubules, causing obstruction and direct toxicity.
- b. An allergic reaction to myoglobin.
- c. A decrease in muscle mass.
- d. Severe dehydration only.
Answer: a. Precipitation of myoglobin in the renal tubules, causing obstruction and direct toxicity.
22. Which of the following is NOT a risk factor for developing AKI in the hospital?
- a. Sepsis
- b. Advanced age
- c. Pre-existing Chronic Kidney Disease
- d. Young age with no comorbidities
Answer: d. Young age with no comorbidities
23. The pharmacist’s role in AKI management includes:
- a. Identifying and recommending discontinuation of nephrotoxic medications.
- b. Recommending appropriate fluid and electrolyte management.
- c. Adjusting doses of renally cleared medications.
- d. All of the above.
Answer: d. All of the above.
24. Which of the following is a common complication of severe AKI?
- a. Hypokalemia
- b. Hyperkalemia and fluid overload
- c. Hypophosphatemia
- d. Metabolic alkalosis
Answer: b. Hyperkalemia and fluid overload
25. A patient with severe AKI and life-threatening hyperkalemia may require what urgent intervention?
- a. A high-potassium diet.
- b. An oral potassium supplement.
- c. Renal Replacement Therapy (dialysis).
- d. A blood transfusion.
Answer: c. Renal Replacement Therapy (dialysis).
26. Which of the following is a preventative strategy for contrast-induced nephropathy?
- a. Restricting fluids before the procedure.
- b. Administering an NSAID before the procedure.
- c. IV hydration with isotonic saline before and after the procedure.
- d. Administering oral N-acetylcysteine has strong evidence of benefit.
Answer: c. IV hydration with isotonic saline before and after the procedure.
27. The principle of renal clearance and dosing in renal dysfunction is a major topic in the Drug Therapy Individualization course.
- a. True
- b. False
Answer: a. True
28. An active learning session on the renal system, including AKI, is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
29. The initial treatment of prerenal AKI is aimed at:
- a. Damaging the kidney tubules.
- b. Increasing urine output with a diuretic.
- c. Restoring adequate blood flow and pressure to the kidneys.
- d. Placing a catheter to relieve an obstruction.
Answer: c. Restoring adequate blood flow and pressure to the kidneys.
30. The “dosing in renal dysfunction” transcending concept is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
31. Which of the following is a key difference between prerenal AKI and intrinsic AKI (specifically ATN)?
- a. In prerenal AKI, the kidney’s structural integrity is initially preserved.
- b. In ATN, there is physical damage to the tubular cells of the kidney.
- c. The treatment for prerenal AKI is to restore perfusion, while ATN management is mainly supportive.
- d. All of the above are true.
Answer: d. All of the above are true.
32. The term “oliguria” refers to:
- a. The complete absence of urine output.
- b. A significantly reduced urine output.
- c. The presence of blood in the urine.
- d. Excessive urination.
Answer: b. A significantly reduced urine output.
33. Which of the following drug classes is a common cause of allergic Acute Interstitial Nephritis (AIN)?
- a. Proton Pump Inhibitors (PPIs)
- b. Beta-lactam antibiotics
- c. NSAIDs
- d. All of the above
Answer: d. All of the above
34. The recovery phase of ATN is often characterized by:
- a. A diuretic phase where urine output increases significantly.
- b. A continued decline in urine output.
- c. The need to start dialysis.
- d. The development of chronic hypertension.
Answer: a. A diuretic phase where urine output increases significantly.
35. A pharmacist receives a prescription for a high dose of a renally-cleared antibiotic for a patient with a baseline SCr of 1.0 mg/dL, but whose SCr today is 3.5 mg/dL. The pharmacist should:
- a. Dispense the prescription as written.
- b. Recognize that the patient has AKI and that the dose needs to be adjusted based on their current, poor renal function.
- c. Calculate the CrCl using the SCr of 1.0 mg/dL.
- d. Calculate the CrCl using the SCr of 3.5 mg/dL, but understand it’s just an estimate.
Answer: d. Calculate the CrCl using the SCr of 3.5 mg/dL, but understand it’s just an estimate.
36. A patient with heart failure and a low ejection fraction is at high risk for what type of AKI?
- a. Prerenal AKI due to poor cardiac output and renal perfusion.
- b. Postrenal AKI.
- c. Intrinsic AKI from AIN.
- d. They are not at risk for AKI.
Answer: a. Prerenal AKI due to poor cardiac output and renal perfusion.
37. The most important preventative measure for AKI in the hospital is:
- a. Avoiding all potentially nephrotoxic drugs.
- b. Ensuring adequate patient hydration and blood pressure.
- c. Performing daily renal ultrasounds.
- d. Placing a Foley catheter in every patient.
Answer: b. Ensuring adequate patient hydration and blood pressure.
38. An active learning session on AKI and CKD is part of which course module?
- a. Module 7: Renal System
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 7: Renal System
39. Which of the following is NOT a typical sign of AKI?
- a. A rise in serum creatinine.
- b. A decrease in urine output.
- c. Edema and fluid overload.
- d. A decrease in serum potassium.
Answer: d. A decrease in serum potassium.
40. A patient’s medication list is the first place a pharmacist should look when investigating a potential cause of:
- a. Drug-induced kidney disease.
- b. A prerenal state (e.g., from diuretics).
- c. An electrolyte abnormality.
- d. All of the above.
Answer: d. All of the above.
41. What is the role of loop diuretics in the management of established AKI?
- a. They help to restore kidney function.
- b. They can convert an anuric/oliguric AKI to a non-oliguric AKI, which helps with fluid management.
- c. They are used to prevent AKI.
- d. They have no role in AKI.
Answer: b. They can convert an anuric/oliguric AKI to a non-oliguric AKI, which helps with fluid management.
42. The term “nephron” refers to the functional unit of the kidney.
- a. True
- b. False
Answer: a. True
43. A patient with severe AKI and metabolic acidosis may require:
- a. IV sodium bicarbonate therapy or dialysis.
- b. An increased protein diet.
- c. A potassium supplement.
- d. A fluid restriction.
Answer: a. IV sodium bicarbonate therapy or dialysis.
44. What is the difference between AKI and CKD?
- a. AKI is always less severe than CKD.
- b. AKI is an acute process that is often reversible, whereas CKD is a chronic, progressive process.
- c. Only CKD requires dose adjustments.
- d. There is no difference.
Answer: b. AKI is an acute process that is often reversible, whereas CKD is a chronic, progressive process.
45. Which of the following is a risk factor for aminoglycoside-induced nephrotoxicity?
- a. Prolonged duration of therapy.
- b. High trough concentrations.
- c. Pre-existing renal dysfunction.
- d. All of the above.
Answer: d. All of the above.
46. A patient’s renal function should be monitored when starting any new medication that is:
- a. Known to be nephrotoxic.
- b. Primarily cleared by the kidneys.
- c. Both a and b.
- d. Monitoring is not necessary.
Answer: c. Both a and b.
47. The “Management of AKI” is a lecture in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
48. An active learning session on AKI is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. The overall goal of AKI management is:
- a. To start every patient on dialysis.
- b. To identify and treat the underlying cause to allow for kidney function to recover.
- c. To use as many nephrotoxic drugs as possible.
- d. To restrict all fluids in every patient.
Answer: b. To identify and treat the underlying cause to allow for kidney function to recover.
50. The ultimate reason for a pharmacist to master the topic of AKI is to:
- a. Prevent drug-induced kidney injury and ensure safe and effective medication use in patients with impaired renal function.
- b. Be able to order all the necessary lab tests.
- c. Be able to perform a renal biopsy.
- d. Pass the renal module exam.
Answer: a. To prevent drug-induced kidney injury and ensure safe and effective medication use in patients with impaired renal function.