A nurse is reviewing provider prescriptions for a client who has reduced kidney function. Which of the following prescribed diagnostics should the nurse question?

Rationale for Correct Answers

• How to check blood glucose at home: The client has hyperglycemia and may have undiagnosed diabetes. Teaching self-monitoring of blood glucose is essential for ongoing glycemic control, treatment adjustments, and early detection of dangerous fluctuations.
• Manifestations of hyperglycemia and hypoglycaemia: The client is already showing signs of hyperglycemia (polyuria, weight loss, fatigue). Understanding the symptoms of both high and low blood sugar helps prevent complications and allows timely self-intervention.
• Perform 100 min of physical activity per week: Moderate physical activity helps improve insulin sensitivity and blood glucose regulation. While 150 min/week is ideal, 100 min is a beneficial starting point for clients new to exercise or with complications like foot ulcers.
• Weight loss tips: The client has a BMI of 27, which falls into the overweight category. Weight loss is often beneficial for improving blood glucose control in individuals with type 2 diabetes and reducing overall health risks.

Rationale for Incorrect Answers

• Instructions on how to take metoprolol: There is no indication in the data that the client has hypertension, arrhythmia, or another condition that warrants beta-blocker therapy. Teaching this would be irrelevant unless metoprolol is newly prescribed.
• Check feet weekly on the same day each week: Clients with diabetes or suspected diabetes should be taught to inspect their feet daily, not weekly. Delayed detection of wounds or infection can lead to severe complications, including amputation.

A. Magnetic resonance imaging (MRI) of the abdomen: An MRI is a safe diagnostic procedure for clients with reduced kidney function, as it does not involve the use of nephrotoxic contrast material. This is typically safe for clients with kidney issues.

B. Kidney, ureter, bladder (KUB) radiograph: A KUB radiograph is a simple X-ray of the abdomen and does not involve contrast. It is safe for clients with reduced kidney function and can be used to assess the kidneys and urinary system.

C. Renal ultrasound: A renal ultrasound is a non-invasive imaging procedure that uses sound waves to assess kidney structure and function. It does not require contrast and is safe for clients with reduced kidney function.

D. CT scan with contrast: Contrast material can be nephrotoxic, especially in clients with reduced kidney function. This can lead to contrast-induced nephropathy, which should be avoided or carefully managed in patients with kidney impairment.