A nurse is caring for a client undergoing hemodialysis who has a history of acute kidney injury due to nephrotoxic antibiotic use. Which nursing intervention should the nurse prioritize to ensure effective hemodialysis and client safety?

Choice A rationale High dietary potassium is contraindicated because hemodialysis is utilized to remove excess potassium from the blood when the kidneys fail. The normal serum potassium range is 3.5 to 5.0 mEq/L. Increasing intake would lead to hyperkalemia, causing life threatening cardiac arrhythmias and muscle weakness. Dialysis removes potassium efficiently, but patients must still adhere to a restricted diet to prevent dangerous spikes between treatments that could cause cardiac arrest. Choice B rationale Unrestricted fluid intake is dangerous for hemodialysis patients because the kidneys cannot process excess volume. This leads to fluid overload, hypertension, and pulmonary edema. Most patients are placed on a strict fluid restriction, often 500 to 1000 mL plus the previous day's urine output. Excess fluid weight gain between sessions, known as interdialytic weight gain, increases the risk of hypotension and cramping during the ultrafiltration process performed by the dialysis machine. Choice C rationale Assessing the access site, such as an arteriovenous fistula or graft, is the highest priority for ensuring patient safety and treatment efficacy. The nurse must check for a palpable thrill and an audible bruit to confirm patency. Signs of infection like redness, warmth, or drainage can lead to systemic sepsis. Since nephrotoxic antibiotics previously damaged the kidneys, maintaining a functional, infection free access is vital for the delivery of life sustaining renal replacement therapy. Choice D rationale Routine insulin administration is not a standard intervention for reducing fluid retention in hemodialysis. Insulin is primarily used to manage blood glucose levels or to acutely treat hyperkalemia by shifting potassium into the intracellular space. It does not directly affect fluid volume or the mechanical removal of water during dialysis. Administering insulin without clear indications like hyperglycemia could cause dangerous hypoglycemia, characterized by diaphoresis, confusion, and potential loss of consciousness.