A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?

 

The correct answer is Choice A

Choice A rationale: Headache and restlessness can be signs of a seizure or neurological disturbance, which phenytoin is used to treat. Phenytoin is an anticonvulsant medication that helps control seizures by stabilizing neuronal membranes and reducing excitability.

Choice B rationale: Decreased blood pressure and rapid pulse are not indications for phenytoin administration. These symptoms may suggest hypotension or cardiovascular issues, which require different interventions such as fluid resuscitation or vasopressors.

Choice C rationale: Muscle cramps and chest heaviness are not treated with phenytoin. These symptoms could indicate electrolyte imbalances or cardiac issues, which need specific treatments like electrolyte replacement or cardiac monitoring.

Choice D rationale: Pain and tingling at the access site are not indications for phenytoin administration. These symptoms may suggest local irritation or infection at the dialysis access site, requiring appropriate wound care or antibiotics.

Choice A reason: In acute kidney injury (AKI), the blood urea nitrogen (BUN) level is expected to be elevated due to the kidneys' impaired ability to excrete urea, which is a waste product of protein metabolism. Normal BUN levels range from approximately 7 to 20 mg/dL.

Choice B reason: Hypercalcemia is not commonly associated with AKI. Instead, patients with AKI may experience hypocalcemia due to the kidneys' reduced ability to convert vitamin D to its active form, which is necessary for calcium absorption.

Choice C reason: Metabolic alkalosis is not a typical finding in AKI. More commonly, patients with AKI experience metabolic acidosis because the kidneys are unable to excrete acid effectively, leading to an accumulation of acid in the body.

Choice D reason: Hypokalemia is generally not expected in AKI. The condition is more often associated with hyperkalemia, as the impaired kidney function leads to a reduced excretion of potassium, which can accumulate to dangerous levels.