Reproductive System Disorders Q 4

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A male client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client’s 24-hour urine output totals 240 ml, Nurse Billy suspects that the client is at risk for:

  

    A. Cardiac arrhythmia.

    B. Paresthesia.

    C. Dehydration.

    D. Pruritus.

    

    

Correct Answer: A. Cardiac arrhythmia.

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As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Although the serum K+concentration can usually be controlled by the administration of calcium, glucose and insulin, sodium bicarbonate, diuretics, and/or the use of K+ exchange resins, dialysis may be necessary. Hyperkalemia complicating acute or chronic renal failure is an important, common problem requiring the use of peritoneal dialysis or hemodialysis.

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Option B: Hyperkalemia doesn’t cause paresthesia (sensations of numbness and tingling). Physical exam findings may include hypertension and edema in the setting or renal disease. There may also be signs of hypoperfusion. Muscle tenderness may be present in patients with rhabdomyolysis. Jaundice may be seen in patients with hemolytic conditions. Patients may have muscle weakness, flaccid paralysis, or depressed deep tendon reflexes.

Option C: Dehydration doesn’t occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. Potassium is usually an intracellular cation. The sodium-potassium pump is responsible for maintaining potassium within the cells. Most potassium is excreted in urine through the kidneys with about 10% in sweat and stool. Inside the kidney, the excretion of potassium takes place in the distal convoluted and cortical collecting ducts.

Option D: In a client with ARF, pruritus results from increased phosphates and isn’t associated with hyperkalemia. Kidneys remove wastes from the bloodstream. When the kidneys fail, the build-up of waste in the blood can cause severe itching. Patients also accumulate excessive phosphorus which contributes to itching.

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