Acute Kidney Injury Nclex Questions

Acute Kidney Injury (AKI) NCLECX Questions: A Comprehensive Guide

Acute kidney injury (AKI), previously known as acute renal failure (ARF), is a sudden decline in kidney function resulting in the inability to remove waste products and excess fluid from the blood. Understanding AKI is crucial for nursing students preparing for the NCLEX-RN exam. This comprehensive guide will delve into key aspects of AKI, providing explanations and examples relevant to potential NCLEX questions. We'll cover risk factors, pathophysiology, clinical manifestations, diagnostic tests, nursing management, and common complications, all framed within the context of typical NCLEX-style questions.

Understanding AKI: Pre-Renal, Intra-Renal, and Post-Renal Causes

AKI is broadly classified into three categories based on the underlying cause:

1. Pre-renal AKI: This type results from factors that reduce blood flow to the kidneys, impairing their perfusion. Think of it as a problem before the kidneys themselves.

• Causes: Hypovolemia (dehydration, hemorrhage), hypotension (shock, sepsis), heart failure, renal artery stenosis, and use of nephrotoxic drugs.

Example NCLEX Question: A patient presents with hypotension, decreased urine output, and elevated BUN and creatinine levels. Which type of AKI is most likely? * a) Intra-renal AKI * b) Post-renal AKI * c) Pre-renal AKI * d) Chronic Kidney Disease (CKD)

Correct Answer: c) Pre-renal AKI. The clinical picture points towards reduced renal perfusion.

2. Intra-renal AKI: This involves direct damage to the kidney parenchyma (the functional tissue of the kidney).

• Causes: Nephrotoxic drugs (aminoglycosides, NSAIDs, contrast media), acute glomerulonephritis, acute tubular necrosis (ATN), and ischemic injury.

Example NCLEX Question: A patient receiving intravenous aminoglycoside antibiotics develops oliguria and elevated serum creatinine. What type of AKI is suspected? * a) Pre-renal AKI * b) Post-renal AKI * c) Intra-renal AKI * d) Chronic kidney disease

Correct Answer: c) Intra-renal AKI. Aminoglycosides are known nephrotoxins, directly damaging the renal tubules.

3. Post-renal AKI: This is caused by obstruction of urine flow from the kidneys.

• Causes: Kidney stones, benign prostatic hyperplasia (BPH), tumors, bladder stones, and urethral strictures.

Example NCLEX Question: A patient with a history of BPH presents with sudden onset of oliguria and flank pain. Which type of AKI is most likely? * a) Pre-renal AKI * b) Intra-renal AKI * c) Post-renal AKI * d) Chronic kidney disease

Correct Answer: c) Post-renal AKI. BPH can obstruct urine outflow, leading to post-renal AKI.

Clinical Manifestations of AKI: Recognizing the Signs and Symptoms

The clinical presentation of AKI can vary depending on the severity and stage of the injury. However, some common signs and symptoms include:

• Changes in urine output: Oliguria (decreased urine output) is a hallmark sign, but it's not always present. Anuria (absence of urine) is a severe manifestation. Polyuria (increased urine output) can occur during the recovery phase.
• Fluid and electrolyte imbalances: Hyperkalemia (high potassium levels), hyponatremia (low sodium levels), hyperphosphatemia (high phosphate levels), and hypocalcemia (low calcium levels) are common.
• Metabolic acidosis: The kidneys play a crucial role in acid-base balance; impaired kidney function can lead to acidosis.
• Uremia: This is a build-up of waste products in the blood, causing symptoms like nausea, vomiting, lethargy, and altered mental status.
• Elevated BUN and creatinine levels: These are key laboratory indicators of impaired kidney function.

Example NCLEX Question: Which of the following is NOT a common clinical manifestation of AKI? * a) Elevated BUN and creatinine * b) Hyperkalemia * c) Polyuria during the recovery phase * d) Increased urine output in the oliguric phase

Correct Answer: d) Increased urine output in the oliguric phase. The oliguric phase is characterized by decreased urine output.

Diagnostic Tests for AKI: Confirming the Diagnosis

Several diagnostic tests are used to confirm the diagnosis of AKI and assess its severity:

• Serum creatinine and BUN levels: These are the primary indicators of kidney function. Elevated levels suggest impaired kidney function.
• Urine analysis: This helps identify the cause of AKI by looking for proteinuria, hematuria, casts, and other abnormalities.
• Blood urea nitrogen (BUN): Measures the amount of urea nitrogen in the blood, reflecting kidney function and protein metabolism.
• Glomerular filtration rate (GFR): Estimates the rate at which the kidneys filter blood, providing a more precise measure of kidney function than creatinine alone.
• Imaging studies: Ultrasound, CT scan, or intravenous pyelography (IVP) can identify anatomical abnormalities, such as kidney stones or tumors, causing post-renal AKI.

Example NCLEX Question: Which laboratory test is the MOST sensitive indicator of early AKI? * a) Serum creatinine * b) BUN * c) GFR * d) Urine analysis

Correct Answer: c) GFR. While serum creatinine is commonly used, GFR provides a more accurate and earlier assessment of kidney function decline.

Nursing Management of AKI: Providing Comprehensive Care

Nursing care for patients with AKI focuses on supporting kidney function, managing complications, and providing patient education. Key aspects of nursing management include:

• Fluid and electrolyte management: Strict intake and output monitoring is crucial. Fluid restriction may be necessary, especially in patients with fluid overload. Electrolyte imbalances require careful monitoring and correction.
• Nutritional support: Dietary modifications may be needed to restrict potassium, phosphorus, and protein intake. Nutritional consultation is often beneficial.
• Medication administration: Drugs may be used to manage hypertension, hyperkalemia, and acidosis. Careful medication reconciliation is essential to avoid nephrotoxic agents.
• Monitoring for complications: Close monitoring for signs and symptoms of hyperkalemia, hypervolemia, and metabolic acidosis is crucial. Early detection and intervention are vital.
• Patient education: Educating patients about their condition, treatment plan, dietary restrictions, and potential complications is essential for optimal outcomes. Emphasize the importance of follow-up care.

Example NCLEX Question: A patient with AKI is experiencing hyperkalemia. Which of the following nursing interventions is PRIORITY? * a) Administer calcium gluconate. * b) Restrict potassium intake. * c) Monitor for cardiac arrhythmias. * d) All of the above.

Correct Answer: d) All of the above. While calcium gluconate addresses the immediate danger of hyperkalemia-induced cardiac arrhythmias, dietary restrictions and continuous monitoring are crucial for long-term management.

Complications of AKI: Potential Risks and Their Management

Several complications can arise in patients with AKI, including:

• Hyperkalemia: High potassium levels can lead to life-threatening cardiac arrhythmias.
• Hypervolemia: Fluid overload can cause pulmonary edema and heart failure.
• Metabolic acidosis: This can affect various organ systems.
• Anemia: The kidneys produce erythropoietin, a hormone essential for red blood cell production. AKI can lead to anemia.
• Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, is a potential complication.
• Gastrointestinal issues: Nausea, vomiting, and anorexia are common.
• Infection: Immunosuppression associated with AKI increases the risk of infection.

Example NCLEX Question: A patient with AKI is at increased risk for which of the following complications? Select all that apply. * a) Hyperkalemia * b) Hypervolemia * c) Anemia * d) Hypocalcemia

Correct Answer: a, b, and c. AKI predisposes patients to hyperkalemia, hypervolemia, and anemia. Hypocalcemia is often a secondary effect, but not directly caused by AKI itself, and while it can present in conjunction with chronic kidney failure, it isn't a common direct result of the acute phase.

AKI and Dialysis: When Renal Replacement Therapy is Necessary

In severe cases of AKI, dialysis may be necessary to remove waste products and excess fluid from the blood. Two main types of dialysis are:

• Hemodialysis: This involves filtering the blood through an artificial kidney machine.
• Peritoneal dialysis: This uses the patient's own peritoneal membrane to filter waste products.

The decision to initiate dialysis depends on the severity of AKI and the patient's clinical status. Nursing care related to dialysis includes:

• Vascular access care: For hemodialysis, appropriate vascular access is crucial.
• Monitoring during dialysis: Close monitoring of vital signs, fluid balance, and electrolyte levels is necessary.
• Patient education: Educating patients and their families about the dialysis procedure and potential complications is essential.

Example NCLEX Question: Which type of dialysis uses the patient's own peritoneal membrane? * a) Hemodialysis * b) Peritoneal dialysis * c) Continuous renal replacement therapy (CRRT) * d) Ultrafiltration

Correct Answer: b) Peritoneal dialysis.

Recovery from AKI: The Road to Renal Function Restoration

Recovery from AKI can take weeks to months, depending on the underlying cause and the severity of the injury. The recovery phase is often marked by gradual improvement in kidney function, normalization of laboratory values, and resolution of clinical symptoms. Nursing care focuses on continued monitoring, supportive measures, and patient education.

Example NCLEX Question: What indicates a good prognosis for AKI recovery? * a) Early recognition and treatment. * b) Effective management of complications. * c) Adequate fluid and electrolyte balance. * d) All of the above.

Correct Answer: d) All of the above. These are all important factors contributing to successful recovery from AKI.

Conclusion: Mastering AKI for NCLEX Success

Mastering the concepts of AKI is crucial for success on the NCLEX-RN exam. By understanding the different types of AKI, their clinical manifestations, diagnostic tests, nursing management, complications, and dialysis options, you will be well-prepared to answer related questions effectively. Remember to focus on applying your knowledge to real-life scenarios, and practice answering NCLEX-style questions to strengthen your understanding. Good luck with your studies!