The nurse is assessing a client who is admitted to the renal unit with suspected decreased renal perfusion. The nurse should plan to carefully monitor which parameter?
Reference Range: Urine white blood cells (WBC) [0 to 4 WBC/low powered field (lpf)]

Choice A reason: Baked potato with skin is high in potassium (about 900 mg), unsuitable for CKD, where impaired renal excretion risks hyperkalemia, causing cardiac arrhythmias. White rice is low-potassium, aligning with dietary restrictions, demonstrating understanding of the need to limit potassium intake in renal disease.

Choice B reason: Orange juice contains high potassium (about 500 mg per cup), dangerous in CKD, as reduced glomerular filtration increases hyperkalemia risk, affecting cardiac conduction. White rice, with minimal potassium, complies with restrictions, indicating the client’s understanding of safe dietary choices for kidney function.

Choice C reason: White rice is low in potassium (about 50 mg per cup), appropriate for CKD, where the kidneys cannot excrete excess potassium, risking hyperkalemia and arrhythmias. Choosing white rice shows the client understands the low-potassium diet, supporting safe management of renal disease and electrolyte balance.

Choice D reason: Banana smoothie is high in potassium (about 400 mg per banana), contraindicated in CKD, where hyperkalemia risks cardiac instability due to poor renal clearance. White rice, low in potassium, reflects dietary compliance, demonstrating the client’s understanding of restrictions to prevent electrolyte imbalances.

Choice A reason: Going to the ER for glucose is unnecessary unless hypoglycemia or ketoacidosis is confirmed. Type 1 diabetes with nausea risks hyperglycemia from stress hormones like cortisol. Monitoring glucose and fluids manages the condition at home, preventing escalation unless severe symptoms arise, making this instruction premature.

Choice B reason: Drinking regular cola introduces high sugar, risking hyperglycemia in type 1 diabetes, where insulin deficiency impairs glucose uptake. Stress from illness elevates glucose via glucagon. Monitoring with non-sugar fluids prevents dehydration and ketoacidosis, making this advice dangerous and ineffective for diabetes management.

Choice C reason: Monitoring blood glucose and drinking fluids is critical in type 1 diabetes during illness. Nausea reduces intake, and stress hormones raise glucose, risking ketoacidosis. Frequent checks guide insulin adjustments, and fluids prevent dehydration, maintaining metabolic stability, addressing the physiological needs of insulin deficiency and infection.

Choice D reason: Avoiding insulin risks diabetic ketoacidosis, as type 1 diabetes requires basal insulin despite nausea. Illness increases glucose via stress hormones, even without food. Monitoring allows tailored dosing, preventing hyperglycemia, making this instruction harmful, as it ignores ongoing insulin needs for metabolic control.