A patient is admitted to the intensive care unit after a motor vehicle accident. On the second day of hospital admission, the patient develops acute renal failure. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patient's hypervolemia and hyperkalemia. Which of the following therapies will the patient's hemodynamic status best tolerate?

Choice A reason: Starting an IV infusion of lactated Ringer’s supports fluid status and may be needed for anticoagulation administration in pulmonary embolism. However, it does not address the immediate hypoxemia caused by the embolism’s ventilation-perfusion mismatch. Oxygen therapy is the priority to correct low oxygen levels and prevent tissue hypoxia.

Choice B reason: Morphine IV may relieve pain and anxiety in pulmonary embolism, reducing oxygen demand. However, it does not directly address hypoxemia, the primary life-threatening issue. The ABCDE approach prioritizes breathing, making oxygen therapy the first intervention to stabilize the patient before pain management is considered.

Choice C reason: Pulmonary embolism causes a ventilation-perfusion mismatch, reducing oxygen delivery to the blood, leading to hypoxemia. Administering oxygen therapy immediately increases alveolar oxygen, improving arterial PaO2 and preventing tissue hypoxia. In the ABCDE approach, breathing is prioritized, making oxygen therapy the first intervention to stabilize the client.

Choice D reason: Cardiac monitoring assesses for arrhythmias or right heart strain in pulmonary embolism, which is important for ongoing management. However, it does not correct the immediate threat of hypoxemia. Oxygen therapy addresses the critical reduction in oxygen saturation, taking precedence in the ABCDE approach over monitoring in acute management.

Choice A reason: Low blood glucose (hypoglycemia) can cause cool, moist skin and tachycardia due to sympathetic activation, but falling blood pressure is less typical unless severe. Femur fractures are associated with significant blood loss, and the symptoms align more closely with hypovolemic shock from hemorrhage than metabolic disturbances like hypoglycemia.

Choice B reason: High blood glucose (hyperglycemia) may cause tachycardia and diaphoresis in severe cases (e.g., diabetic ketoacidosis), but cool, moist skin and falling blood pressure are not primary features. These symptoms are more indicative of hypovolemia from blood loss, as femur fractures can cause significant internal bleeding, making hyperglycemia unlikely.

Choice C reason: Hemorrhage from a femur fracture causes hypovolemic shock, characterized by cool, moist skin (due to vasoconstriction), increased heart rate (compensatory tachycardia), and falling blood pressure (due to volume loss). This is a life-threatening condition requiring urgent fluid resuscitation and hemorrhage control, aligning with the symptoms described and the injury’s severity.

Choice D reason: Fluid volume excess typically presents with edema, hypertension, and bounding pulses, not cool, moist skin or falling blood pressure. A femur fracture is unlikely to cause fluid overload acutely. The symptoms suggest hypovolemia from blood loss, not excess fluid, making this an incorrect diagnosis for the client’s presentation.