The nurse is caring for an acutely ill client. Which assessment finding should prompt the nurse to inform the healthcare provider that the client may be exhibiting signs of acute kidney injury (AKI)?

Choice A reason: Releasing the client when behavioral control is achieved aligns with autonomy and beneficence, not nonmaleficence. While it benefits the client, it does not directly address harm prevention, which is the core of nonmaleficence. The focus is on restoring freedom, not specifically ensuring no physical harm during restraint use.

Choice B reason: Explaining release requirements promotes understanding and autonomy but does not directly prevent harm, the focus of nonmaleficence. It supports therapeutic communication but does not address the physical safety risks of restraints, such as skin breakdown or circulation issues, making it less relevant to this principle.

Choice C reason: Applying restraints based on assessment, not attitude, ensures objectivity, aligning with justice and fairness. While this prevents inappropriate restraint use, it is less directly tied to nonmaleficence, which focuses on avoiding harm like injury during restraint application, making it a secondary consideration in this context.

Choice D reason: Assuring restraints do not cause injury directly upholds nonmaleficence, the ethical principle of avoiding harm. Regular checks for skin breakdown, circulation impairment, or nerve damage prevent physical harm, ensuring safety during restraint use, making this action the most aligned with nonmaleficence in a restrained client.

Choice A reason: Antihypertensives are routinely used in ESRD to manage hypertension caused by fluid overload and renin-angiotensin system dysregulation. Controlling blood pressure prevents cardiovascular complications like heart failure or stroke, which are common in ESRD due to chronic volume and pressure overload, making this medication appropriate.

Choice B reason: ADH is not used in ESRD, as it promotes water reabsorption, worsening fluid overload in anuric patients. ESRD patients rely on dialysis for fluid balance, and ADH could exacerbate hypertension or pulmonary edema. Its use is more relevant in conditions like diabetes insipidus, not renal failure.

Choice C reason: Erythrocyte-stimulating agents, like erythropoietin, are standard in ESRD to treat anemia caused by reduced erythropoietin production by failing kidneys. These agents stimulate red blood cell production, improving oxygen delivery and reducing fatigue, making them essential for managing ESRD-related anemia and improving quality of life.

Choice D reason: Phosphate binders are used in ESRD to manage hyperphosphatemia by binding dietary phosphate in the gut, preventing its absorption. This reduces the risk of vascular calcification and secondary hyperparathyroidism, common complications in ESRD due to impaired phosphate excretion, making these medications a standard part of therapy.