A patient with acute renal failure (ARF) is admitted due to uncontrolled type 1 diabetes mellitus and hyperkalemia. The nurse administers an IV dose of regular insulin per sliding scale.
What is the most important intervention for the nurse to include in this patient’s plan of care?
Monitor the patient’s cardiac activity via telemetry.
Assess glucose via fingerstick every 4 to 6 hours.
Evaluate hourly urine output for return of normal renal function.
Maintain venous access with an infusion of normal saline.
The Correct Answer is A
Choice A rationale
Monitoring the patient’s cardiac activity via telemetry is the most important intervention for a patient with acute renal failure (ARF), uncontrolled type 1 diabetes mellitus, and hyperkalemia who is receiving an IV dose of regular insulin. Hyperkalemia can cause cardiac arrhythmias and other cardiac complications. Therefore, continuous cardiac monitoring is crucial to detect any changes in heart rhythm or rate that could indicate worsening hyperkalemia.
Choice B rationale
While assessing glucose via fingerstick every 4 to 6 hours is important for a patient with uncontrolled type 1 diabetes mellitus, it is not the most important intervention in this scenario. The patient’s hyperkalemia and ARF pose more immediate risks.
Choice C rationale
Evaluating hourly urine output for return of normal renal function is an important part of monitoring a patient with ARF34. However, in the context of hyperkalemia and the administration of insulin, cardiac monitoring is more critical.
Choice D rationale
Maintaining venous access with an infusion of normal saline is a standard nursing intervention for most hospitalized patients, but it is not the most important intervention in this scenario.
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Correct Answer is D
Explanation
Choice D rationale
Scheduling frequent rest periods can help manage the fatigue and concentration problems reported by the client. These symptoms are common in clients with CKD and elevated BUN and serum creatinine levels.
Choice A rationale
Administering PRN oxygen may not be necessary unless the client is showing signs of respiratory distress or hypoxia. There is no indication of this in the question.
Choice B rationale
Providing high protein snacks is not recommended for clients with CKD. High protein diets can increase the workload on the kidneys and worsen kidney function.
Choice C rationale
Monitoring glucose levels every 4 hours is not directly related to the client’s reported symptoms or the elevated BUN and serum creatinine levels.
Correct Answer is A
Explanation
Choice A rationale
Nadolol is a beta-blocker that can decrease heart rate and contractility, which can potentially exacerbate heart failure and lead to cardiogenic shock.
Choice B rationale
Captopril is an angiotensin-converting enzyme (ACE) inhibitor that is often used in the treatment of heart failure. It works by relaxing blood vessels and reducing the workload of the heart.
Choice C rationale
Digoxin is a cardiac glycoside that is used to treat heart failure and certain heart arrhythmias. It works by increasing the force of the heart’s contractions, which can improve heart function.
Choice D rationale
Hydrochlorothiazide is a diuretic that is often used in the treatment of heart failure. It works by helping the body get rid of excess fluid, which can reduce the workload of the heart.
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