The nurse plans care for a client in the diuretic phase of acute kidney injury who has developed abdominal distention, hypoactive bowel sounds. and hypotension. Which action should the nurse include in the plan of care?

Rationale: A. Administering sodium bicarbonate is used to treat metabolic acidosis and hyperkalemia, but the question indicates signs of hypokalemia (common in the diuretic phase of AKI due to excessive potassium loss). Administering sodium bicarbonate in this context could worsen electrolyte imbalances. B. Dialysis is typically indicated for severe hyperkalemia or fluid overload, but the client in the diuretic phase of AKI is more likely experiencing potassium loss rather than hyperkalemia. Dialysis would be unnecessary at this stage. C. Hypokalemia can cause abnormal cardiac rhythms even before severe symptoms appear. Obtaining an ECG allows the nurse to assess for arrhythmias such as U waves, flattened T waves, or ventricular ectopy and report findings promptly to the provider. This is a safe and priority intervention for the client’s hypotension and electrolyte imbalance. D. Administering an IV bolus of potassium without assessment is unsafe because rapid potassium administration can cause cardiac arrest. Potassium replacement must be carefully calculated and administered slowly, usually via infusion pump, after lab values and ECG findings are reviewed.