A nurse is admitting a client to the emergency department after a gunshot wound to the abdomen. Which of the following actions should the nurse take to help prevent the onset of acute kidney failure?

A. Fluid overload: While NG tubes can be used for enteral feeding, they are often associated with fluid losses from suctioning or drainage rather than overload. Clients with NG tubes are more prone to dehydration and electrolyte imbalances.

B. Metabolic acidosis: NG tube suctioning primarily removes gastric contents, which are rich in hydrochloric acid. This can lead to metabolic alkalosis rather than acidosis due to excessive loss of acidic gastric secretions.

C. Hyponatremia: Prolonged NG tube suctioning or drainage can lead to the loss of sodium-rich gastric secretions, resulting in hyponatremia. Monitoring electrolyte levels and replacing lost fluids appropriately is essential to prevent imbalances.

D. Constipation: NG tubes are more commonly associated with diarrhea due to enteral feeding formulas rather than constipation. However, reduced oral intake and immobility could contribute to constipation in some cases.

The nurse should first address the client's chest pain followed by the client's irregular heart rate.

Rationale:

Chest pain is the priority concern as it indicates an acute coronary event (ST-elevation myocardial infarction, STEMI). Immediate interventions such as oxygen, nitroglycerin, and pain management are required to reduce myocardial oxygen demand and prevent further cardiac damage.

Irregular heart rate must be addressed next, as tachycardia and arrhythmias can increase myocardial workload and worsen ischemia. Monitoring and possible antiarrhythmic interventions may be required to stabilize cardiac function.

Incorrect:

Troponin levels: Elevated troponin confirms myocardial injury but does not require immediate intervention; managing the ongoing ischemia is the priority.

Oxygen saturation: The client's oxygen saturation is 93% on room air, which is adequate. Oxygen therapy is not the first priority unless levels drop further.

Hyperlipidemia: While a cardiovascular risk factor, it is not an acute concern during an MI. Long-term management is necessary but not the immediate priority.

C-reactive protein: Elevated CRP indicates inflammation but does not require urgent intervention in the acute phase of MI.