Before weaning a client from a ventilator, which assessment parameter(s) is most important for the nurse to assess?

Choice A reason: In DKA, hyperglycemia and ketoacidosis cause fruity breath and Kussmaul respirations (rapid, deep breathing) as the body compensates for acidosis. IV insulin halts ketone production, corrects hyperglycemia, and reverses acidosis, addressing the primary metabolic disturbance. This is the priority intervention to stabilize the client and prevent further acid-base imbalance.

Choice B reason: Oral glucose administration is contraindicated in DKA, as it worsens hyperglycemia. Fruity breath and Kussmaul respirations indicate severe metabolic acidosis from ketone accumulation. Insulin is needed to lower blood glucose and stop ketogenesis, making glucose administration harmful and inappropriate for managing this life-threatening condition.

Choice C reason: IV sodium bicarbonate may correct severe acidosis (pH <7.0) in DKA but is not the first-line intervention. Insulin therapy addresses the root cause by reducing hyperglycemia and ketone production, naturally correcting pH. Fruity breath and respirations indicate ongoing acidosis, making insulin the priority over bicarbonate in initial management.

Choice D reason: Restricting fluid intake is contraindicated in DKA, which causes dehydration from osmotic diuresis. Fruity breath and Kussmaul respirations reflect acidosis and compensatory hyperventilation. IV fluids and insulin are needed to restore volume and correct metabolic imbalances, making fluid restriction harmful and inappropriate for this critical condition.

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.