Renal Failure: Chapter 34, Care of Patients with Disorders of the Urinary System

Question 1 of 9

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Which patient’s urine output should the nurse immediately report to the health care provider?

• • The patient with renal calculi who has voided 800 mL in the past 3 hoursA patient with renal calculi is expected to produce high volumes of urine because fluids are being encouraged to flush the stones.
• Correct
  • The acutely ill patient who has urine output of 20 mL in the past hourThe nurse should notify the health care provider for a urine output of 20 mL/hour. A minimum urine output of 30 mL/hour indicates that the kidneys are receiving an adequate blood supply to prevent tissue destruction.
• • The patient with chronic renal failure who has voided 950 mL of urine in the past 24 hoursPatients with chronic renal failure will have decreasing amounts of urine as the disease progresses; 950 mL in 24 hours is within acceptable limits.
• • The older patient who is incontinent of 5 to 10 mL and seeks toileting every 15 minutesThe nurse should conduct an additional assessment on the older patient with incontinence for possible urinary tract infection or other urinary disorders.

Question 2 of 9

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Which rationale is the most important for postponing invasive procedures for 4 to 6 hours after a patient receives hemodialysis?

• • There is risk for infection after hemodialysis.Infection can occur but is a less urgent reason to delay an invasive procedure.
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  • Heparin is used during the hemodialysis treatment.Invasive procedures should be postponed for 4 to 6 hours after dialysis because prolonged bleeding could occur as a result of the extended clotting time from the heparin used during dialysis.
• • Hemodialysis is very tiring and takes a long time.Fatigue can occur but is a less urgent reason to delay an invasive procedure.
• • Disorientation occurs immediately after hemodialysis.Disorientation can occur but is a less urgent reason to delay an invasive procedure.

Question 3 of 9

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The nurse is taking care of a patient who has progressed from the oliguric to the diuretic stage of acute kidney injury (AKI). Which finding should the nurse expect?

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  • Diluted urineDuring the diuretic phase of AKI, the patient will be urinating large amounts of diluted urine because the kidneys are unable to concentrate the urine effectively.
• • Elevated creatinineCreatinine levels begin to normalize in the diuretic phase of AKI.
• • Decreased urine outputDecreased urine output is noted in the oliguric phase of AKI.
• • Symptoms of fluid overloadSymptoms of fluid overload are seen in the oliguric phase of AKI. In the diuretic phase, dehydration may occur.

Question 4 of 9

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The nurse is caring for a patient diagnosed with prerenal acute kidney injury (AKI). Which condition should the nurse suspect the patient has?

• • DiabetesDiabetes is a cause of intrarenal AKI.
• • Kidney stonesKidney stones cause postrenal AKI.
• Correct
  • Hypovolemic shockHypovolemia results in prerenal AKI because of decreased blood flow.
• • Enlarged prostate glandAn enlarged prostate gland can cause postrenal AKI.

Question 5 of 9

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The nurse is caring for a patient with chronic renal failure who has a glomerular filtration rate (GFR) of 40 mL/min/1.73 m². Which stage of chronic renal failure is the patient classified in?

• • Stage 1Stage 1 chronic renal failure is indicated by a GFR of greater than 90 mL/min/1.73 m².
• • Stage 2Stage 2 chronic renal failure is classified with a GFR of 60 to 89 mL/min/1.73 m².
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  • Stage 3A GFR of 40 mL/min/1.73 m² falls within the range for stage 3 chronic renal failure, which is between 30 and 59 mL/min/1.73 m².
• • Stage 4Stage 4 chronic renal failure is indicated with a GFR of 15 to 30 mL/min/1.73 m².

Question 6 of 9

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Which clinical manifestation will the nurse assess for in a patient with uremia? Select all that apply. One, some, or all responses may be correct.

• • HypotensionHypertension, not hypotension, is expected with uremia because of the presence of fluid overload.
• Correct
  • ParesthesiasParesthesias are a common clinical manifestation associated with uremia, usually because of electrolyte imbalances.
• Correct
  • EncephalopathyEncephalopathy is a common finding with uremia because of toxin buildup in the bloodstream.
• Correct
  • Sleep disturbancesSleep disturbances are commonly seen in patients with uremia.
• • HypoparathyroidismHyperparathyroidism is associated with uremia.

Question 7 of 9

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Which information should the nurse include in the teaching for a patient with renal failure being discharged with a prescription for calcitriol (Rocaltrol)?

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  • Report abnormal twitching immediately.Abnormal twitching may indicate hypocalcemia, which is a side effect of calcitriol, so this must be reported to the health care provider for immediate intervention.
• • Store the medication in a light-protected container.Folic acid and vitamin B12 should be stored in a dry, light-protected container.
• • Report any changes in hearing levels to your health care provider.Changes in hearing may occur with use of furosemide (Lasix) and should be reported to the health care provider right away because ototoxicity may occur.
• • Take laxatives as needed for the constipation associated with this drug.Constipation is a side effect of calcium carbonate, not calcitriol.

Question 8 of 9

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Which nursing intervention is appropriate when caring for a patient with renal failure who is taking iron (ferrous sulfate)?

• • Administer the iron with a glass of milk.Iron should be administered with water or juice, not milk products.
• • Report changes in stool color to the health care provider.It is normal for stool to turn black when taking iron supplements, so this does not need to be reported to the health care provider.
• • Monitor electrocardiogram (ECG) changes for dysrhythmias.ECG changes are not caused by iron administration. The ECG should be closely monitored for dysrhythmias in patients taking calcium acetate.
• Correct
  • Position the patient upright for 30 minutes after taking iron.The patient should remain upright for 30 minutes after taking iron.

Question 9 of 9

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Which nursing intervention is appropriate when caring for a patient undergoing hemodialysis with an arteriovenous (AV) graft?

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  • Check the capillary refill several times each shift.Capillary refill should be observed at least four times a day to ensure patency of the AV graft site.
• • Only check the blood pressure on the side with the graft.Checking blood pressure and performing venipuncture on the extremity with the AV graft should be avoided so that patency is maintained.
• • Monitor closely for hypertension after dialysis treatment.Hypotension, not hypertension, is a common finding after dialysis treatment.
• • Administer all medications as prescribed before hemodialysis.Some medications, such as antihypertensives, should not be given before dialysis.