A client is admitted with hyponatremia.
Which of the following interventions should the nurse prioritize for this client?

Choice A reason: This hypotonic saline solution is often used after initial resuscitation, especially when the patient’s serum sodium is normal or elevated. It helps replace intracellular fluid losses and provides ongoing hydration without excessively increasing sodium levels. It is typically administered once the initial intravascular volume is restored with isotonic fluids.

Choice B reason: This isotonic saline solution is the first-line intravenous fluid used in DKA. It helps expand intravascular volume quickly, restore tissue perfusion, and correct hypovolemia caused by osmotic diuresis. It is given initially as a bolus, followed by continuous infusion until the patient is stabilized.

Choice C reason: This dextrose-containing solution is introduced once blood glucose falls to approximately 200–250 mg/dL. At this point, insulin therapy must continue to clear ketones and correct acidosis, but dextrose is added to prevent hypoglycemia. It is usually combined with saline (e.g., D5 0.45% NS) to balance hydration and glucose support.

Choice D reason: This balanced electrolyte solution is not typically the preferred fluid in DKA management because the lactate component may complicate interpretation of acid–base status. Although it can expand volume, it is generally avoided in favor of saline solutions that more directly address dehydration and electrolyte imbalance in DKA.

Choice E reason: This form of insulin is the only type used intravenously in DKA. A continuous infusion of regular insulin is essential to reduce blood glucose, suppress ketone production, and correct metabolic acidosis. It is carefully titrated with close monitoring of electrolytes, especially potassium, since insulin drives potassium into cells and can cause hypokalemia.

This is a priority nursing intervention for a client with acute kidney injury (AKI) because it helps to assess the renal function and fluid status of the client. Urine output is also an indicator of the response to treatment and the need for further interventions.

Choice A is wrong because pain medication is not a priority intervention for AKI unless the client has other conditions that cause pain.

Pain medication may also have adverse effects on the kidney function and should be used with caution.

Choice C is wrong because ambulation is not a priority intervention for AKI and may not be appropriate for a client who is fluid overloaded or hypotensive.

Ambulation may also increase the risk of falls and injury in a client who is confused or fatigued.

Choice D is wrong because assisting with meals is not a priority intervention for AKI and may not be necessary for a client who has adequate oral intake.

A client with AKI may also have dietary restrictions such as low protein, low potassium, low sodium, and low phosphorus, which should be considered when providing meals.