The nurse is receiving the morning report on four clients on a medical-surgical unit. Based on the information provided, which clients are at greatest risk for developing end-stage renal disease (ESRD)? (Select all that apply)

Choice A reason: Legislation changing civil commitment procedures occurred later, notably in the 1960s–1970s, with deinstitutionalization movements. In the 1950s, institutional care was still prevalent, and legislative reforms were not the primary change in mental health treatment, making this option incorrect for that decade.

Choice B reason: Community support services expanded significantly during the 1960s with deinstitutionalization, not the 1950s. While some early community efforts existed, they were not the hallmark change of the 1950s, when institutional care dominated, and psychotropic drugs revolutionized treatment approaches for mental illness.

Choice C reason: The Patient’s Bill of Rights was formalized in the 1970s, not the 1950s. While patient advocacy began to emerge later, the 1950s focused primarily on medical advancements like psychotropic drugs, not legal frameworks for patient rights, making this option incorrect.

Choice D reason: In the 1950s, psychotropic drugs like chlorpromazine were introduced, revolutionizing mental health treatment. These medications effectively managed psychosis, reducing symptoms and enabling outpatient care, decreasing reliance on long-term institutionalization. This marked a significant shift in psychiatric care, making it the key change of the decade.

Choice A reason: In the oliguric phase of AKI, kidney function is severely impaired, reducing potassium excretion. This leads to hyperkalemia, which disrupts cardiac electrical activity, potentially causing life-threatening arrhythmias or cardiac arrest. Elevated potassium levels are a hallmark of this phase due to decreased glomerular filtration rate and impaired tubular secretion.

Choice B reason: Urine output of 2000 mL in 24 hours indicates polyuria, characteristic of the recovery phase of AKI, not the oliguric phase, where output is typically less than 400 mL/day. High urine output suggests restored renal function, which is not expected in the oliguric phase, where kidneys fail to filter adequately.

Choice C reason: Tachycardia may occur in AKI due to fluid overload causing increased cardiac workload or electrolyte imbalances like hyperkalemia affecting heart rhythm. However, it is a secondary symptom and less specific than hyperkalemia, which directly results from impaired renal excretion and poses a more immediate risk to cardiac function.

Choice D reason: Tenting of the skin indicates dehydration, which may precede AKI but is not typical in the oliguric phase, where fluid retention is more common due to reduced urine output. Fluid overload leads to edema, not dehydration, making skin tenting an unlikely finding in this phase of AKI.