A patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first?

Choice A rationale
Monitoring calcium levels is important after administering calcium gluconate IV, but it is not the primary indicator of the medication's effectiveness in treating hyperkalemia. Calcium gluconate is used in hyperkalemia to stabilize the heart muscle, not to correct calcium levels.

Choice B rationale
Neurologic status may be affected by hyperkalemia, but changes in neurologic status are not the most direct measure of calcium gluconate's effectiveness. The medication's primary role is to address cardiac risks associated with high potassium levels.

Choice C rationale
Cardiac rhythm is the most critical aspect to monitor after administering calcium gluconate for hyperkalemia. Hyperkalemia can cause life-threatening cardiac dysrhythmias, and calcium gluconate works by stabilizing the cardiac membrane, thus the effectiveness of the treatment is directly reflected in the stabilization of the cardiac rhythm.

Choice D rationale
While urine volume can indicate kidney function and might indirectly reflect changes in potassium levels, it is not the direct measure of calcium gluconate's effectiveness in the emergency treatment of hyperkalemia.

Choice A rationale
The red blood cell (RBC) count is not typically affected by hemodialysis. Hemodialysis is a process that primarily targets the removal of waste products and excess fluid from the blood, not red blood cells.

Choice B rationale
Potassium levels are often elevated in clients with renal failure due to the kidneys' inability to excrete potassium. Hemodialysis helps to remove excess potassium from the bloodstream, thereby decreasing its levels.

Choice C rationale
Calcium levels can be affected by hemodialysis; however, they are more often managed with medication and diet rather than being directly targeted by the dialysis process itself.

Choice D rationale
Protein levels should not decrease significantly as a result of hemodialysis. The dialysis membrane is designed to allow small waste products to pass through while retaining larger molecules like proteins.