A nurse is caring for a 78-year-old client who was recently admitted from the emergency room and is reporting weakness.

Exhibits

Select words from the choices below to fill in each blank in the following sentence.

The nurse has reviewed the client's medical record.

The client is at risk for developing metabolic acidosis hypernatremia

dropdown

and

dropdown

A. Metolazone is a thiazide-like diuretic that works primarily in the distal convoluted tubule of the nephron. It can lead to hyponatremia due to its mechanism of increasing sodium and water excretion. However, it is not typically associated with hyperkalemia.
B. Furosemide is a loop diuretic that acts on the ascending loop of Henle. It primarily causes loss of sodium, potassium, and chloride ions. While it can lead to hypokalemia (low potassium levels) due to increased potassium excretion, it does not typically cause hyperkalemia or hyponatremia.
C. Hydrochlorothiazide is a thiazide diuretic that acts on the distal convoluted tubule. It can cause hyponatremia due to increased sodium and water excretion. It may also lead to hypokalemia but is not typically associated with hyperkalemia.
D. Spironolactone is a potassium-sparing diuretic that works by antagonizing aldosterone receptors in the distal nephron, leading to retention of potassium and excretion of sodium. It can cause hyperkalemia due to its potassium-sparing effects. Additionally, it may also lead to hyponatremia, although less commonly than thiazide diuretics.

A. Hypophosphatemia refers to low levels of phosphate in the blood. In prerenal AKI, phosphate levels are typically normal or even elevated due to reduced kidney function and impaired phosphate excretion. Therefore, hypophosphatemia is not expected in prerenal AKI.
B. Hypernatremia refers to high levels of sodium in the blood. In prerenal AKI, sodium levels can be elevated due to reduced kidney function and impaired ability to excrete sodium. This occurs because the kidneys play a crucial role in regulating sodium balance. Therefore, hypernatremia is a possible electrolyte imbalance in prerenal AKI.
C. Hypercalcemia refers to high levels of calcium in the blood. In prerenal AKI, calcium levels are usually normal or decreased due to various factors, including reduced renal excretion of calcium. Therefore, hypercalcemia is not typically seen in prerenal AKI.
D. Hyperkalemia refers to high levels of potassium in the blood. In prerenal AKI, hyperkalemia is a common electrolyte imbalance. Normally, the kidneys play a critical role in potassium excretion. Reduced kidney function in prerenal AKI can lead to impaired potassium excretion, resulting in elevated potassium levels in the blood.