When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

Choice A reason: Assessing for orthostatic hypotension before administering the dose is not necessary, as labetalol does not cause orthostatic hypotension. Orthostatic hypotension is a condition where the blood pressure drops significantly when changing positions from lying to sitting or standing. Labetalol is a beta-blocker that lowers blood pressure by reducing the heart rate and cardiac output.

Choice B reason: Administering the dose and monitoring the client's B/P regularly is not appropriate, as labetalol may cause further bradycardia (slow heart rate) in this client. The client's heart rate is already below normal (48 beats/minute), which may indicate that labetalol is overdosed or contraindicated. Bradycardia can lead to decreased perfusion, dizziness, fatigue, and fainting.

Choice C reason: Applying a telemetry monitor before administering the dose is not sufficient, as labetalol may cause serious cardiac arrhythmias (irregular heart rhythms) in this client. The client's heart rate is already below normal (48 beats/minute), which may indicate that labetalol is affecting the electrical conduction system of the heart. Arrhythmias can cause palpitations, chest pain, shortness of breath, and cardiac arrest.

Choice D reason: Withholding the scheduled dose and notifying the healthcare provider is the best action for the nurse to take in this situation. The client's heart rate is already below normal (48 beats/minute), which may indicate that labetalol is causing adverse effects or interactions with other medications. The healthcare provider should be informed of the client's vital signs and medication history, and decide whether to adjust or discontinue labetalol.

Choice A reason: This is the correct action to include in the client's plan of care, as sucralfate should be given on an empty stomach, at least one hour before meals and at bedtime. Sucralfate is a mucosal protectant that forms a protective barrier over the ulcer and prevents further damage from acid and pepsin. It requires an acidic environment to work, so it should not be taken with food or antacids.

Choice B reason: This is not a relevant action to include in the client's plan of care, as sucralfate does not cause or increase the risk of secondary Candida infection. Candida infection is a fungal infection that can affect the mouth, throat, esophagus, or vagina. It is more common in clients who use antibiotics, corticosteroids, or immunosuppressants, but not sucralfate.

Choice C reason: This is not an accurate action to include in the client's plan of care, as sucralfate should be administered four times a day, not once a day. Sucralfate has a short duration of action, so it needs to be taken frequently to maintain its protective effect on the ulcer.

Choice D reason: This is not a necessary action to include in the client's plan of care, as sucralfate does not cause or affect electrolyte imbalance. Electrolyte imbalance is an abnormality in the levels of sodium, potassium, calcium, magnesium, or other minerals in the blood. It can be caused by dehydration, vomiting, diarrhea, kidney disease, or other conditions, but not sucralfate.