A patient with extensive electrical bum injuries is admitted to the emergency department. Which of these prescribed interventions would the nurse implement first?

A. Explain ROM therapy: Educating the patient about the purpose and benefits of range-of-motion (ROM) therapy is important for cooperation and understanding. However, patient education alone does not address the immediate barrier of pain, which can prevent participation and limit the effectiveness of therapy.

B. Delay therapy until pain improves: Postponing therapy may reduce immediate discomfort but can lead to joint stiffness, contractures, and decreased functional outcomes. Burn rehabilitation requires timely, consistent ROM exercises to maintain mobility, so delaying therapy is not ideal.

C. Manage pain prior to therapy: Administering analgesics before ROM exercises allows the patient to participate more comfortably and effectively. Preemptive pain control reduces muscle guarding, facilitates full joint movement, and improves compliance, directly supporting the goal of preserving function and preventing contractures.

D. Stop therapy permanently: Discontinuing ROM therapy permanently would result in progressive joint contractures, decreased mobility, and long-term functional deficits. Pain management strategies should be used to enable continued participation rather than abandoning therapy altogether.

A. Administer IV potassium to correct hypokalemia: During the failure stage of acute kidney injury (AKI), hyperkalemia is more common than hypokalemia due to impaired renal excretion. Administering IV potassium without careful monitoring can precipitate life-threatening cardiac arrhythmias. Electrolyte management must be guided by laboratory values.

B. Prepare for hemodialysis to manage fluid and electrolyte imbalances: The failure stage of AKI is characterized by severe reduction in glomerular filtration rate, oliguria or anuria, and accumulation of toxins, electrolytes, and fluid. Hemodialysis provides rapid removal of excess potassium, urea, and fluid, which is critical to preventing complications such as pulmonary edema, hyperkalemia-induced arrhythmias, and severe acidosis.

C. Begin fluid restriction to prevent overload: Fluid restriction may be indicated, especially in oliguric or anuric patients, but it is not sufficient as the primary intervention in the failure stage. Restricting fluid alone does not correct severe electrolyte disturbances or remove accumulated toxins. It is supportive, whereas renal replacement therapy addresses the derangements.

D. Encourage oral intake and high protein to support kidney function: High-protein intake may worsen azotemia in AKI because protein metabolism generates nitrogenous waste that the failing kidneys cannot excrete efficiently. Oral intake is encouraged only if not contraindicated, but promoting protein-heavy intake is not a priority in the failure stage.