The client has been diagnosed with chronic kidney disease (CKD).
Which of the following lab values should the nurse monitor to assess for renal function?

Choice A reason: This hypotonic saline solution is often used after initial resuscitation, especially when the patient’s serum sodium is normal or elevated. It helps replace intracellular fluid losses and provides ongoing hydration without excessively increasing sodium levels. It is typically administered once the initial intravascular volume is restored with isotonic fluids.

Choice B reason: This isotonic saline solution is the first-line intravenous fluid used in DKA. It helps expand intravascular volume quickly, restore tissue perfusion, and correct hypovolemia caused by osmotic diuresis. It is given initially as a bolus, followed by continuous infusion until the patient is stabilized.

Choice C reason: This dextrose-containing solution is introduced once blood glucose falls to approximately 200–250 mg/dL. At this point, insulin therapy must continue to clear ketones and correct acidosis, but dextrose is added to prevent hypoglycemia. It is usually combined with saline (e.g., D5 0.45% NS) to balance hydration and glucose support.

Choice D reason: This balanced electrolyte solution is not typically the preferred fluid in DKA management because the lactate component may complicate interpretation of acid–base status. Although it can expand volume, it is generally avoided in favor of saline solutions that more directly address dehydration and electrolyte imbalance in DKA.

Choice E reason: This form of insulin is the only type used intravenously in DKA. A continuous infusion of regular insulin is essential to reduce blood glucose, suppress ketone production, and correct metabolic acidosis. It is carefully titrated with close monitoring of electrolytes, especially potassium, since insulin drives potassium into cells and can cause hypokalemia.

Metabolic acidosis is a condition in which there is excess acid in the body fluids.

It causes rapid breathing, confusion, tiredness, headache, and increased heart rate.

Rapid breathing is a compensatory mechanism that helps to lower the carbon dioxide levels and increase the pH of the blood.

Choice B is wrong because decreased respiratory rate would worsen the acidosis by retaining more carbon dioxide and lowering the pH of the blood.

Choice C is wrong because normal respiratory rate would not be adequate to compensate for the metabolic acidosis and would result in acidemia (low blood pH).

Choice D is wrong because irregular respiratory rate is not a typical response to metabolic acidosis and could indicate other problems such as brain injury or drug overdose.