A client who has broken his femur presents to the emergency department with the following signs and symptoms: cool, moist skin, increased heart rate, and falling blood pressure. The nurse suspects the client is experiencing:

Choice A reason: Hemodialysis rapidly removes fluid and solutes, which can cause significant hemodynamic shifts, including hypotension, in unstable patients. It involves high blood flow rates and ultrafiltration, stressing the cardiovascular system. For a hemodynamically unstable patient with acute renal failure, hemodialysis is less suitable due to its potential to exacerbate hypotension and circulatory collapse.

Choice B reason: Peritoneal dialysis uses the peritoneal membrane for slow fluid and solute exchange, which is gentler on hemodynamics. However, it is less efficient for rapid correction of hypervolemia and hyperkalemia in acute renal failure. It also carries risks of peritonitis and is impractical in critically ill patients with abdominal trauma or instability.

Choice C reason: Continuous venovenous hemodialysis (CVVHD) is ideal for hemodynamically unstable patients. It provides slow, continuous fluid and solute removal, minimizing cardiovascular stress. CVVHD effectively manages hypervolemia and hyperkalemia in acute renal failure by maintaining steady-state clearance, reducing the risk of hypotension compared to intermittent hemodialysis, making it the best choice.

Choice D reason: Plasmapheresis removes plasma components, not fluid or electrolytes like potassium, and is used for conditions like autoimmune disorders, not acute renal failure. It does not address hypervolemia or hyperkalemia and can cause hemodynamic instability due to rapid plasma exchange, making it inappropriate for this patient’s needs.

Choice A reason: Blood pressure of 110/70 mm Hg is within normal range and does not indicate hypovolemic shock, which typically presents with hypotension (e.g., <90/60 mm Hg). Early shock may have normal blood pressure, but tachycardia (heart rate 120 beats/min) is a more sensitive indicator of compensatory response to volume loss.

Choice B reason: Heart rate of 120 beats/min indicates tachycardia, a hallmark of hypovolemic shock. In trauma, blood loss reduces circulating volume, triggering sympathetic activation to increase heart rate, compensating for decreased cardiac output. This is the most indicative finding, as it appears early and reflects the body’s response to hypovolemia.

Choice C reason: Warm, dry skin is not typical of hypovolemic shock, which causes cool, clammy skin due to vasoconstriction from sympathetic activation. Warm skin may occur in distributive shock (e.g., sepsis). Tachycardia is a more specific indicator of hypovolemia, making this finding incorrect for the suspected condition.

Choice D reason: Urine output of 40 mL/hr is within normal range (30-50 mL/hr) and does not indicate hypovolemic shock, which typically reduces output (<30 mL/hr) due to decreased renal perfusion. Tachycardia (120 beats/min) is a more immediate and sensitive sign of hypovolemia, making urine output less indicative in early shock.