NORCET 2 - 2021 (shift-1)
Medical & Surgical Nursing
Easy
A patient is diagnosed with acute renal failure. Which is the most common acid-base imbalance that occurs in this patient?
Appeared in: NORCET 2 - 2021 (shift-1)
Explanation
- In acute renal failure, the kidneys cannot effectively excrete metabolic acids (like hydrogen ions, sulfates, and phosphates) produced by the body.
- Simultaneously, the damaged kidneys are unable to reabsorb and regenerate bicarbonate (HCO3−), which is the primary buffer for acids in the blood.
- This combination of acid retention and bicarbonate loss leads to a net increase in the body's acid load, resulting in metabolic acidosis.
- The body attempts to compensate for metabolic acidosis through the respiratory system by increasing the rate and depth of breathing (Kussmaul respirations) to exhale more carbon dioxide (CO2), an acid.
Why Other Options Were Wrong
- Option B: Metabolic alkalosis is characterized by an excess of bicarbonate or a loss of acid. This is the opposite of what occurs in renal failure, where acid is retained.
- Option C: Respiratory acidosis is caused by the lungs' inability to remove carbon dioxide effectively (hypoventilation), leading to an increase in carbonic acid. The primary problem in renal failure is metabolic, not respiratory.
- Option D: Respiratory alkalosis results from excessive exhalation of carbon dioxide (hyperventilation). While the body uses hyperventilation to compensate for metabolic acidosis, the primary disorder in renal failure is not respiratory.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to The most common acid-base imbalance associated with acute renal failure to guide bedside assessment, documentation, and the next nursing action.
- Nurses must closely monitor patients with acute renal failure for signs of metabolic acidosis, such as confusion, lethargy, and Kussmaul respirations (deep, rapid breathing).
- Monitoring arterial blood gases (ABGs) and serum electrolytes, especially potassium, is critical. Acidosis can cause a shift of potassium out of cells, leading to life-threatening hyperkalemia and cardiac arrhythmias.
- What if? If a patient with renal failure also has severe diarrhea, the metabolic acidosis can be exacerbated. Diarrhea causes a direct loss of bicarbonate from the gastrointestinal tract, worsening the acid-base imbalance.
How to Approach the Question
- First, identify the key condition in the question stem: 'acute renal failure'.
- Recall the primary functions of the kidneys. They are vital for metabolic processes, including filtering waste products and regulating the body's acid-base balance.
- Since the kidneys are the primary organ involved, the imbalance will be 'metabolic', not 'respiratory'. This allows you to eliminate 'respiratory acidosis' and 'respiratory alkalosis' as likely answers.
- Next, consider the effect of organ 'failure'. When an organ fails, it can no longer perform its job. In this case, the kidneys fail to get rid of waste products, which are primarily acidic.
- The accumulation of acid due to kidney failure points directly to 'acidosis', not 'alkalosis'.
- Combining these steps leads to the correct answer: Metabolic acidosis.
Concept Tested & Keywords
- Concept Tested: The most common acid-base imbalance associated with acute renal failure.
- Stem keywords: acute renal failure, acid-base imbalance
- Lead-in keywords: most common
Question ID
QCTIwFfG9Pj4ApSeODTxrY
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 55-57
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 559-561
Practise the full NORCET 2 - 2021 (shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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