A client waiting to receive dialysis seems confused and presents with hypertension, edema, shortness of breath, and weight gain. Which action should the nurse implement?

A. Assess for signs of vertigo: Vertigo is associated with vestibular dysfunction affecting balance and spatial orientation. While the client is confused, the more concerning symptoms suggest fluid overload related to renal failure. Assessing vertigo would not address the immediate cardiopulmonary compromise that may occur from excess fluid accumulation. B. Determine serum potassium level: Clients with renal failure are at risk for hyperkalemia due to impaired potassium excretion. Although potassium monitoring is critical before dialysis, the client’s current symptoms are more indicative of fluid overload rather than an electrolyte imbalance. Immediate assessment should focus on oxygenation and respiratory status. C. Calculate the daily sodium intake: Evaluating sodium intake is helpful for long-term management of fluid retention and hypertension in clients with renal disease. However, dietary assessment does not address the client’s acute symptoms, particularly dyspnea and possible pulmonary congestion. Immediate physiological assessment is required before dietary factors. D. Obtain a pulse oximetry reading: The client’s confusion, dyspnea, hypertension, edema, and rapid weight gain strongly suggest fluid overload that may lead to pulmonary edema and impaired gas exchange. Pulse oximetry provides a rapid, noninvasive assessment of oxygen saturation and helps determine whether the client is experiencing hypoxemia.