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Question

Difficulty: MediumEstablishing Priorities

A nurse on a urology and renal medical-surgical unit is reviewing the electronic health records of four newly assigned clients. Which client should the nurse assess first?

  1. A client with acute kidney injury who has a new-onset peaked T-wave on the electrocardiogram.Answer
  2. B
    A client with nephrolithiasis who is reporting sudden, severe flank pain radiating to the groin.
  3. C
    A client with end-stage renal disease who missed their last dialysis session and reports severe pruritus.
  4. D
    A client who is 12 hours post-transurethral resection of the prostate (TURP) and has light pink drainage in the continuous bladder irrigation system.

Answer

The client with acute kidney injury who has a new-onset peaked T-wave on the electrocardiogram.
The client with a peaked T-wave is exhibiting a classic sign of hyperkalemia, a highly dangerous electrolyte imbalance common in acute kidney injury. This can rapidly progress to ventricular fibrillation or asystole. This circulatory threat takes highest priority.

Step-by-Step Solution

1
Analyze the clinical implications of a peaked T-wave in a client with acute kidney injury.
Identified as a classic, acute sign of severe hyperkalemia.
To recognize immediate life-threatening conditions related to circulation and cardiac function.
2
Evaluate the severity of the remaining clients' symptoms.
The other clients exhibit expected findings (pink urine post-TURP, pruritus in ESRD) or non-life-threatening conditions (kidney stone pain).
To compare acuity levels using acute versus chronic and expected versus unexpected frameworks.
3
Apply prioritization frameworks to select the client needing immediate intervention.
The client with the acute cardiac threat (hyperkalemia) is prioritized above those with expected pain or expected post-operative findings.
Cardiac dysrhythmias pose an immediate threat to life (Circulation in the ABCs framework).

Key Concept

Prioritizing acute, life-threatening complications (e.g., hyperkalemia causing cardiac changes) over expected disease manifestations or localized pain.
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Topics

Establishing Priorities

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