A client with a history of chronic renal failure receives hemodialysis treatment three times per week through an arteriovenous (AV) fistula in the left arm. Which priority intervention should the nurse include in the care plan?

Choice A reason: HIPAA requires client consent to disclose protected health information, like psychological evaluations, to third parties such as employers. This response upholds confidentiality laws, ensuring the client’s privacy is protected while clearly communicating the legal process for information release, making it the most appropriate and compliant action.

Choice B reason: Forwarding the call to the doctor delays the response and does not directly address the confidentiality requirement. While the doctor may handle consent, the nurse can directly inform the employer about the need for signed consent, maintaining clarity and legal compliance in protecting patient privacy.

Choice C reason: Refusing to confirm or deny the client’s presence is overly restrictive and not necessary for an employer’s request. It avoids addressing the consent process, which is the legal requirement for releasing information, making it less direct and potentially confusing in this context.

Choice D reason: Stating that information cannot be given is accurate but incomplete, as it does not explain the consent process. Providing a clear path (obtaining signed consent) ensures compliance with confidentiality laws while addressing the employer’s request, making this response less precise than option a).

Choice A reason: Hypocalcemia may occur in AKI due to impaired vitamin D activation, but it is not a primary concern in the diuresis phase, where kidneys produce large urine volumes. Calcium imbalances are less immediate than fluid losses, which can rapidly destabilize hemodynamics during this phase.

Choice B reason: In the diuresis phase of AKI, kidneys regain function, producing excessive urine, which can lead to hypovolemia. Fluid loss depletes intravascular volume, causing hypotension, tachycardia, and organ hypoperfusion. Monitoring is critical to prevent dehydration and ensure adequate fluid replacement to maintain hemodynamic stability during recovery.

Choice C reason: Increased blood pressure is more common in the oliguric phase of AKI due to fluid overload. In the diuresis phase, excessive urine output reduces volume, potentially lowering blood pressure. Hypertension is not a typical complication during this phase, making it an incorrect focus for monitoring.

Choice D reason: Hyperkalemia is a concern in the oliguric phase of AKI due to reduced potassium excretion. In the diuresis phase, increased urine output facilitates potassium clearance, reducing hyperkalemia risk. Hypovolemia from excessive fluid loss is a more immediate concern during this phase of AKI recovery.