A nurse is caring for a patient in acute renal failure who develops muscle weakness and an irregular heart rhythm. The provider prescribes an IV infusion of hypertonic glucose, regular insulin, and sodium bicarbonate. The nurse recognizes that these treatments are intended to manage which of the following complications?

Choice A reason: Increased potassium intake is dangerous in ESRD, as impaired kidneys cannot excrete potassium, leading to hyperkalemia. This can disrupt cardiac membrane potentials, causing arrhythmias or cardiac arrest. ESRD diets require strict potassium restriction to prevent life-threatening electrolyte imbalances, making this modification inappropriate.

Choice B reason: Increased protein intake is often recommended in ESRD patients on hemodialysis to replace protein lost during dialysis and prevent malnutrition. However, it must be balanced to avoid excess urea production, which can worsen uremia. This is not the primary focus compared to phosphorus management in this context.

Choice C reason: Decreased phosphorus intake is critical in ESRD, as kidneys cannot excrete phosphate, leading to hyperphosphatemia. This causes vascular calcification and secondary hyperparathyroidism, increasing cardiovascular risk. Dietary phosphorus restriction, often with phosphate binders, prevents these complications, making it a key dietary modification for hemodialysis patients.

Choice D reason: Decreased calcium intake is not recommended in ESRD, as patients often have hypocalcemia due to impaired vitamin D activation and phosphate retention. Calcium supplementation or adequate intake is needed to prevent bone disease and secondary hyperparathyroidism, making this modification incorrect for ESRD management.

Choice A reason: Assault involves threatening harm, not applicable here, as the issue is failure to document assessments, not intentional threats by staff. The client’s self-harm resulted from inadequate monitoring, not a staff-initiated threat, making assault an incorrect legal issue in this scenario.

Choice B reason: Battery involves unauthorized physical contact, not relevant to failure to document assessments. The client’s self-harm stemmed from inadequate observation, not staff-inflicted harm, making battery an inappropriate legal claim compared to negligence in monitoring and documentation.

Choice C reason: Suicide risk is a clinical concern, not a legal issue to defend against. While the client’s self-harm indicates risk, the hospital’s liability arises from failure to follow monitoring protocols, not the risk itself, making this option incorrect for the legal defense context.

Choice D reason: Malpractice involves negligence, such as failing to document hourly assessments for a high-risk client, leading to harm. This breach of standard care (1:1 observation) allowed self-harm, making the hospital liable for not adhering to protocols, requiring defense against malpractice for inadequate monitoring and documentation.