The client has an IV of dextrose 5% in 0.45% normal saline. The physician has ordered a transfusion of one unit of packed red blood cells (PRBCs).
Before hanging the blood, the nurse will prime the blood tubing with which of the following solutions?

Monitoring the client’s electrolyte levels before and after the treatment. This is because acute kidney injury (AKI) can cause electrolyte imbalances such as hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis. Hemodialysis can help correct these imbalances by removing excess fluid and waste products from the blood. However, hemodialysis can also cause electrolyte shifts and complications such as hypotension, muscle cramps, and arrhythmias. Therefore, it is important to monitor the client’s electrolyte levels before and after the treatment to assess the effectiveness and safety of hemodialysis.

Choice A is wrong because monitoring the client’s blood pressure every 4 hours is not frequent enough during hemodialysis.

Hemodialysis can cause rapid changes in blood pressure due to fluid removal and vascular access.

Therefore, blood pressure should be monitored more often, such as every 15 to 30 minutes during hemodialysis.

Choice B is wrong because administering a loop diuretic before the treatment is not indicated for AKI patients receiving hemodialysis.

Loop diuretics are used to increase urine output and reduce fluid overload in AKI patients who have some residual kidney function.

However, hemodialysis can achieve the same goal by removing excess fluid from the blood.

Moreover, loop diuretics can cause electrolyte depletion and ototoxicity, which can worsen the condition of AKI patients.

Choice C is wrong because assessing the client’s respiratory status every 2 hours is not specific enough for hemodialysis treatment.

Hemodialysis can affect respiratory mechanics by altering fluid balance, acid- base status, and oxygen delivery.

Therefore, respiratory status should be assessed more frequently and comprehensively during hemodialysis, such as by measuring respiratory rate, oxygen saturation, arterial blood gas, and chest auscultation.

The correct answer is A. 42 mL/h.

Choice A: 42 mL/h

Reason: To calculate the IV rate, we use the formula: IV rate (mL/h) = Total volume (mL) ÷ Total time (hours). For this problem, the total volume is 1000 mL and the total time is 24 hours. Therefore, the calculation is 1000 mL ÷ 24 hours = 41.6667 mL/h. When rounded to the nearest whole number, the IV rate is 42 mL/h. This makes 42 mL/h the correct answer.

Choice B: 44 mL/h

Reason: This choice is incorrect because it does not match the calculated IV rate. The calculation of 1000 mL ÷ 24 hours results in 41.6667 mL/h, which rounds to 42 mL/h, not 44 mL/h. Therefore, 44 mL/h is not a valid option based on the given data.

Choice C: 46 mL/h

Reason: This choice is also incorrect. The calculated IV rate of 41.6667 mL/h, when rounded to the nearest whole number, is 42 mL/h. There is no mathematical basis for rounding up to 46 mL/h from 41.6667 mL/h, making this choice invalid.

Choice D: 48 mL/h

Reason: This choice is incorrect as well. The correct calculation yields 41.6667 mL/h, which rounds to 42 mL/h. There is no justification for rounding up to 48 mL/h. This choice does not align with the calculated and rounded IV rate.