When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

Choice B reason: Vancomycin is an antibiotic that can treat serious bacterial infections that are resistant to other antibiotics. However, vancomycin can also cause nephrotoxicity, or damage to the kidneys, especially when given in high doses or for prolonged periods. Nephrotoxicity can lead to AKI, which is a sudden and severe decrease in kidney function that can cause fluid and electrolyte imbalances, acid-base disorders, uremia, and death. Therefore, the nurse should closely monitor the client who is receiving vancomycin for development of AKI by checking their serum creatinine and blood urea nitrogen (BUN) levels, urine output and specific gravity, and signs and symptoms of fluid overload or dehydration.

Choice A reason: Sucralfate is an anti-ulcer drug that forms a protective coating over the stomach lining and prevents further damage from acid or pepsin. Sucralfate does not cause nephrotoxicity or AKI and has minimal systemic absorption or side effects. Therefore, the nurse does not need to closely monitor the client who is taking sucralfate for development of AKI.

Choice C reason: Lorazepam is a benzodiazepine that can treat anxiety, insomnia, seizures, or alcohol withdrawal. Lorazepam does not cause nephrotoxicity or AKI and has low renal clearance or elimination. Therefore, the nurse does not need to closely monitor the client who is taking lorazepam for development of AKI.

Choice D reason: Digoxin is a cardiac glycoside that can treat heart failure or atrial fibrillation by increasing the force and efficiency of heart contractions and slowing down the heart rate. Digoxin does not cause nephrotoxicity

Choice A reason: Encouraging an increase in oral intake is not necessary in this situation, as dark urine is not a sign of dehydration or fluid imbalance. Dark urine may be caused by certain foods, medications, or medical conditions, but it does not indicate a need for more fluids.

Choice B reason: Measuring the client's urinary output is not relevant to this situation, as dark urine is not a sign of urinary retention or obstruction. Urinary output may vary depending on fluid intake, activity level, or other factors, but it does not reflect urine color.

Choice C reason: Explaining that color change is normal is the appropriate action to take, as dark urine is a common and harmless side effect of carbidopa/levodopa, which is a combination drug used to treat Parkinson's disease by increasing dopamine levels in the brain. Carbidopa/levodopa can cause urine to turn brown, black, or red, but this does not affect the function or health of the kidneys or bladder.

Choice D reason: Obtaining a specimen for a urine culture is not necessary in this situation, as dark urine is not a sign of infection or inflammation. A urine culture may be indicated if the client has symptoms such as fever, pain, burning, frequency, or urgency, but it does not diagnose urine color