A nurse is assessing a child who has an acute kidney injury. Which of the following clinical manifestations should the nurse expect?

Choice A rationale Acute kidney injury leads to a buildup of metabolic waste products, including hydrogen ions, resulting in metabolic acidosis. The body compensates for this acidosis by increasing the respiratory rate and depth to blow off carbon dioxide, a form of carbonic acid. Therefore, a decreased respiratory rate is an unexpected finding. Choice B rationale Acute kidney injury is characterized by the inability of the kidneys to filter waste and regulate fluid balance. The most common manifestation in the initial phase is oliguria, which is a significant decrease in urine output, not polyuria (excessive urination). Polyuria may occur during the recovery phase, but not acutely. Choice C rationale An acute kidney injury can lead to the retention of nitrogenous wastes like urea and creatinine, a condition known as uremia. This can cause neurological symptoms such as lethargy, seizures, and altered mental status. Hyperactivity is not a typical manifestation and would be an unusual finding. Choice D rationale Edema is a hallmark sign of acute kidney injury. The kidneys fail to excrete excess sodium and water, leading to fluid retention. This fluid accumulates in the interstitial spaces, causing generalized swelling, especially in the face, hands, and feet. This is a direct consequence of the kidney's impaired regulatory function.