Acute Renal Failure Nclex Questions

Acute Renal Failure: Mastering the NCLECX Questions

Acute kidney injury (AKI), formerly known as acute renal failure (ARF), is a sudden decline in kidney function, resulting in the buildup of waste products in the blood and an imbalance of fluids and electrolytes. Understanding AKI is crucial for nursing students preparing for the NCLEX-RN exam. This article provides a comprehensive overview of AKI, focusing on common NCLEX-style questions and the underlying pathophysiology, clinical manifestations, nursing interventions, and potential complications. We'll explore various scenarios and delve into the reasoning behind correct answers, empowering you to confidently tackle AKI-related questions on the exam.

Understanding Acute Kidney Injury (AKI)

Before diving into specific NCLEX questions, let's establish a solid foundation in AKI pathophysiology. AKI is characterized by a rapid decrease in glomerular filtration rate (GFR), leading to impaired kidney function. This can be caused by a variety of factors, broadly categorized into:

• Prerenal AKI: This is the most common cause, resulting from decreased blood flow to the kidneys. Conditions like hypovolemia (dehydration), hypotension (low blood pressure), heart failure, and sepsis can all lead to prerenal AKI. The kidneys themselves are not damaged, but their function is compromised due to inadequate perfusion.

• Intrarenal AKI: This type of AKI involves direct damage to the kidney structures themselves. Common causes include:

  • Acute Tubular Necrosis (ATN): Damage to the renal tubules, often caused by nephrotoxic medications (e.g., aminoglycosides, NSAIDs), ischemia, or contrast dye used during imaging procedures.
  • Glomerulonephritis: Inflammation of the glomeruli, the filtering units of the kidneys. This can be caused by infections or autoimmune diseases.
  • Interstitial Nephritis: Inflammation of the kidney's interstitial tissue, often due to allergic reactions to medications.

• Postrenal AKI: This occurs when there is an obstruction of urine flow from the kidneys. Causes include kidney stones, tumors, benign prostatic hyperplasia (BPH), and bladder outlet obstruction.

Clinical Manifestations of AKI

Recognizing the signs and symptoms of AKI is essential for early intervention. These can vary depending on the severity and cause of the AKI, but common manifestations include:

• Oliguria: Decreased urine output (less than 400 mL/day). Anuria refers to the absence of urine output.
• Changes in mental status: Confusion, lethargy, and even coma can occur due to fluid and electrolyte imbalances.
• Fluid overload: Edema (swelling), hypertension, and shortness of breath due to impaired fluid excretion.
• Electrolyte imbalances: Hyperkalemia (high potassium), hyperphosphatemia (high phosphate), hypocalcemia (low calcium), and metabolic acidosis (low blood pH).
• Nausea and vomiting: Gastrointestinal symptoms are common.
• Uremic symptoms: These include fatigue, muscle cramps, itching, and metallic taste in the mouth. These are related to the buildup of waste products in the blood.

NCLEX-Style Questions and Rationales

Here are some sample NCLEX-style questions focusing on AKI, followed by detailed rationales:

Question 1: A patient with AKI is experiencing hyperkalemia. Which of the following nursing interventions is the PRIORITY?

A. Administer calcium gluconate. B. Restrict potassium intake. C. Administer sodium polystyrene sulfonate (Kayexalate). D. Monitor cardiac rhythm.

Correct Answer: A. Administer calcium gluconate.

Rationale: Hyperkalemia is a life-threatening complication of AKI, as it can lead to fatal cardiac arrhythmias. Calcium gluconate protects the heart against the effects of hyperkalemia by stabilizing the myocardium. While the other options are important, administering calcium gluconate is the immediate priority to prevent cardiac arrest. Sodium polystyrene sulfonate (Kayexalate) helps remove potassium from the body but takes longer to work.

Question 2: A patient with AKI is on fluid restriction. Which of the following nursing interventions is MOST important?

A. Weigh the patient daily. B. Monitor intake and output (I&O) meticulously. C. Educate the patient about fluid restriction. D. Administer diuretics as ordered.

Correct Answer: B. Monitor intake and output (I&O) meticulously.

Rationale: Accurate monitoring of I&O is crucial for patients with AKI who are on fluid restriction. This allows for close monitoring of fluid balance and early detection of any imbalances. Daily weight is helpful, but I&O provides more precise information. While patient education is important, meticulous I&O monitoring is the most critical nursing intervention. Diuretics may be used, but careful I&O monitoring is essential to guide their use and prevent fluid overload or dehydration.

Question 3: A patient with prerenal AKI is experiencing hypotension. What is the MOST likely initial nursing intervention?

A. Administer IV fluids. B. Administer diuretics. C. Restrict fluids. D. Monitor urine output.

Correct Answer: A. Administer IV fluids.

Rationale: Prerenal AKI is caused by decreased blood flow to the kidneys. Hypotension further reduces renal perfusion. The priority is to restore adequate blood volume and improve renal perfusion by administering intravenous fluids. Diuretics would worsen the situation by increasing fluid loss. Fluid restriction is not appropriate in this context. Monitoring urine output is important, but restoring perfusion is the immediate priority.

Question 4: Which of the following laboratory values is MOST indicative of AKI?

A. Increased BUN and creatinine. B. Decreased BUN and creatinine. C. Increased potassium and decreased calcium. D. Decreased potassium and increased calcium.

Correct Answer: A. Increased BUN and creatinine.

Rationale: Blood urea nitrogen (BUN) and creatinine are waste products normally filtered by the kidneys. Elevated levels indicate impaired kidney function, a hallmark of AKI. While electrolyte imbalances (option C) are common in AKI, the elevated BUN and creatinine are the most direct indicators of kidney dysfunction.

Question 5: A patient with AKI is receiving hemodialysis. Which of the following nursing assessments is MOST important during the dialysis treatment?

A. Monitoring blood pressure. B. Assessing for bleeding at the access site. C. Monitoring weight. D. Assessing for nausea and vomiting.

Correct Answer: B. Assessing for bleeding at the access site.

Rationale: The arteriovenous (AV) fistula or graft used for hemodialysis is at risk for bleeding during and after dialysis. Close monitoring of the access site for bleeding is paramount. While the other options are important, preventing and detecting bleeding is the highest priority to prevent serious complications.

Nursing Management of AKI

Nursing care for patients with AKI is multifaceted and focuses on:

• Fluid and electrolyte balance: Closely monitor I&O, daily weight, electrolyte levels, and administer fluids and medications as ordered to correct imbalances.
• Nutritional support: Provide a diet that restricts potassium, phosphorus, and sodium, and consider nutritional supplements as needed.
• Medication management: Administer medications as prescribed, carefully monitoring for adverse effects. This might include medications to control hyperkalemia, hypertension, or anemia.
• Monitoring for complications: Closely observe for signs and symptoms of infection, fluid overload, and other complications.
• Patient and family education: Educate the patient and family about AKI, its treatment, and potential complications.

Dialysis and AKI

Dialysis (hemodialysis or peritoneal dialysis) is often necessary to remove waste products and excess fluid from the body when kidney function is severely impaired. Nurses play a crucial role in patient care during dialysis, including monitoring vital signs, assessing access sites, and managing potential complications. NCLEX questions may focus on dialysis access sites (fistulas, grafts), complications of dialysis (hypotension, muscle cramps), and patient education related to dialysis.

Prognosis and Prevention

The prognosis for AKI depends on several factors, including the underlying cause, the severity of the kidney injury, and the patient's overall health. Early diagnosis and prompt treatment are crucial for improving outcomes. Prevention strategies include:

• Managing underlying conditions: Controlling hypertension, diabetes, and heart failure.
• Avoiding nephrotoxic medications: Using caution with medications known to be harmful to the kidneys.
• Staying adequately hydrated: Preventing dehydration.

Conclusion

Acute kidney injury is a serious condition requiring vigilant nursing care. Mastering the pathophysiology, clinical manifestations, and nursing interventions related to AKI is vital for success on the NCLEX-RN exam. By understanding the rationale behind each answer, you can confidently approach AKI-related questions and provide safe and effective care for your patients. Remember to focus on the prioritization of interventions based on the urgency and severity of the patient's condition. This article has provided a strong foundation, but further study and practice using NCLEX review materials is highly recommended.