Acute Kidney Injury Nclex Questions

Acute Kidney Injury (AKI) NCLECX Questions: Mastering the Concepts for Success

Acute kidney injury (AKI), formerly known as acute renal failure (ARF), is a sudden decline in kidney function, resulting in the impaired ability to filter waste products from the blood. Understanding AKI is crucial for nursing students preparing for the NCLEX-RN exam. This comprehensive article will delve into the key concepts surrounding AKI, providing a detailed overview and addressing common NCLEX-style questions. We'll explore the pathophysiology, risk factors, clinical manifestations, diagnostic tests, nursing management, and potential complications, equipping you with the knowledge to confidently tackle AKI questions on the exam.

Understanding Acute Kidney Injury: A Comprehensive Overview

Introduction to AKI: AKI is characterized by a rapid decrease in glomerular filtration rate (GFR), leading to an accumulation of nitrogenous waste products (like creatinine and urea) in the blood, along with fluid and electrolyte imbalances. This condition can range from mild and reversible to severe and life-threatening. The severity can be classified using RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) or KDIGO (Kidney Disease: Improving Global Outcomes) criteria, which assess changes in serum creatinine, urine output, and GFR.

Pathophysiology of AKI: AKI can develop through three primary mechanisms:

• Prerenal AKI: This is the most common cause, resulting from reduced blood flow to the kidneys. Conditions such as hypovolemia (dehydration), hypotension (low blood pressure), heart failure, and sepsis can impair renal perfusion, leading to decreased GFR.

• Intrarenal AKI: This involves direct damage to the kidney structures themselves. Causes include:

  • Acute Tubular Necrosis (ATN): Damage to the renal tubules, often caused by nephrotoxic drugs (e.g., aminoglycosides, contrast dye), ischemia, or toxins.
  • Glomerulonephritis: Inflammation of the glomeruli, the filtering units of the kidneys.
  • Interstitial Nephritis: Inflammation of the renal interstitium (tissue surrounding the nephrons).

• Postrenal AKI: This occurs due to obstruction of urine flow from the kidneys. Causes include:

  • Kidney stones
  • Benign prostatic hyperplasia (BPH)
  • Tumors
  • Ureteral strictures

Risk Factors for AKI: Several factors increase the risk of developing AKI, including:

• Advanced age: Older adults are more susceptible due to decreased renal reserve.
• Pre-existing kidney disease: Individuals with chronic kidney disease (CKD) are at higher risk of developing AKI.
• Diabetes mellitus: Diabetes can damage blood vessels in the kidneys.
• Hypertension: High blood pressure can damage the renal vasculature.
• Heart failure: Reduced cardiac output can impair renal perfusion.
• Sepsis: Systemic infection can cause decreased blood flow to the kidneys.
• Nephrotoxic medications: Certain drugs can directly damage the kidneys.
• Contrast media: Used during imaging procedures, contrast agents can be nephrotoxic.
• Surgery: Major surgical procedures can increase the risk of AKI.

Clinical Manifestations of AKI: Recognizing the Signs and Symptoms

The clinical presentation of AKI varies depending on the severity and underlying cause. However, some common symptoms include:

• Oliguria: Decreased urine output (less than 400 mL/day). Anuria refers to the absence of urine output.
• Changes in urine color: Urine may be dark, tea-colored, or bloody.
• Edema: Fluid retention can lead to swelling in the legs, ankles, and face.
• Hypertension: Fluid overload can cause increased blood pressure.
• Fatigue and weakness: Due to waste product accumulation and electrolyte imbalances.
• Nausea and vomiting: Gastrointestinal symptoms are common.
• Shortness of breath: Fluid overload can lead to pulmonary edema.
• Mental status changes: Electrolyte imbalances can affect brain function.

Diagnostic Tests for AKI: Confirming the Diagnosis

Several tests are used to diagnose and assess the severity of AKI:

• Serum creatinine: An elevated creatinine level indicates impaired kidney function.
• Blood urea nitrogen (BUN): A high BUN level reflects impaired waste removal.
• Glomerular filtration rate (GFR): GFR is a measure of kidney function and is estimated using serum creatinine and other factors.
• Urinalysis: Examines urine for abnormalities such as proteinuria, hematuria, and casts.
• Urine culture: To identify the presence of infection.
• Ultrasound: Used to assess kidney size, structure, and presence of obstruction.

Nursing Management of AKI: Providing Holistic Care

Nursing management of AKI focuses on supporting kidney function, managing complications, and providing patient education. Key interventions include:

• Fluid and electrolyte monitoring: Closely monitor intake and output (I&O), serum electrolytes, and acid-base balance. Fluid restriction may be necessary to manage fluid overload.
• Medication management: Administer prescribed medications, including diuretics (to increase urine output), antihypertensives (to manage hypertension), and medications to treat underlying causes.
• Nutritional management: Provide a diet that restricts protein, potassium, and phosphorus, as needed.
• Monitoring for complications: Watch for signs of infection, hyperkalemia (high potassium levels), metabolic acidosis, and pericarditis.
• Dialysis: Patients with severe AKI may require dialysis (hemodialysis or peritoneal dialysis) to remove waste products and excess fluid.
• Patient education: Educate the patient and family about AKI, its management, and potential complications.

Complications of AKI: Addressing Potential Risks

Several serious complications can arise from AKI:

• Hyperkalemia: Elevated potassium levels can lead to cardiac arrhythmias and even cardiac arrest.
• Metabolic acidosis: Impaired acid-base balance can cause various symptoms, including lethargy and confusion.
• Pericarditis: Inflammation of the pericardium (sac surrounding the heart) can lead to chest pain and potentially cardiac tamponade.
• Anemia: Reduced production of erythropoietin can result in decreased red blood cell production.
• Infection: Immunocompromised patients are at increased risk of infection.
• Chronic Kidney Disease (CKD): Some cases of AKI can progress to chronic kidney disease.

Acute Kidney Injury NCLECX Questions: Practice and Review

Here are some example NCLEX-style questions related to AKI, followed by explanations:

Question 1: A patient with AKI is experiencing oliguria. Which of the following nursing interventions is MOST important?

a) Restrict fluids to 500 mL/day. b) Monitor intake and output (I&O) closely. c) Administer potassium-sparing diuretics. d) Encourage increased protein intake.

Answer: b) Monitor intake and output (I&O) closely. Accurate I&O monitoring is crucial in managing fluid balance in patients with AKI. Fluid restriction may be necessary, but the priority is to monitor the patient's fluid status. Potassium-sparing diuretics are contraindicated in oliguria, and protein restriction is often necessary to reduce the workload on the kidneys.

Question 2: Which of the following laboratory findings is MOST indicative of AKI?

a) Decreased serum creatinine. b) Increased glomerular filtration rate (GFR). c) Increased serum creatinine. d) Decreased blood urea nitrogen (BUN).

Answer: c) Increased serum creatinine. Serum creatinine is a marker of kidney function, and an elevated level indicates impaired kidney function, a hallmark of AKI.

Question 3: A patient with AKI is receiving hemodialysis. Which nursing intervention is essential during the dialysis treatment?

a) Monitor blood pressure every 15 minutes. b) Administer supplemental oxygen as needed. c) Monitor the patient's weight before and after dialysis. d) All of the above.

Answer: d) All of the above. All three interventions are essential during hemodialysis. Blood pressure monitoring helps identify hypotension, a common complication. Oxygen may be needed if the patient becomes hypoxic. Weight monitoring assesses fluid removal during dialysis.

Question 4: A patient with AKI is at risk for hyperkalemia. Which of the following foods should be restricted in the patient's diet?

a) Apples b) Bananas c) Lettuce d) White rice

Answer: b) Bananas. Bananas are a high-potassium food and should be restricted in patients at risk for hyperkalemia.

Question 5: Which of the following is a common cause of prerenal AKI?

a) Acute tubular necrosis b) Kidney stones c) Hypovolemia d) Glomerulonephritis

Answer: c) Hypovolemia. Hypovolemia (decreased blood volume) reduces renal perfusion, leading to prerenal AKI. The other options are causes of intrarenal or postrenal AKI.

Conclusion: Preparing for Success on the NCLEX-RN

Mastering the concepts related to AKI is essential for success on the NCLEX-RN exam. This article provided a comprehensive overview of AKI, encompassing pathophysiology, risk factors, clinical manifestations, diagnostic tests, nursing management, and potential complications. By understanding these key aspects, you'll be well-prepared to answer a wide range of AKI-related questions effectively and confidently. Remember to review this information thoroughly, practice with NCLEX-style questions, and utilize available resources to reinforce your learning. Good luck with your exam preparations!