Which client is at greatest risk of acute intra-renal kidney injury?

Choice A reason: Ecchymosis, or bruising, may occur with a fracture due to soft tissue injury and bleeding but is not specific to fractures. It results from ruptured blood vessels in the skin, not bone disruption, and can occur in many trauma scenarios, making it less definitive than crepitus for fracture assessment.

Choice B reason: Crepitus, the grating sound or sensation from bone fragments rubbing together, is a hallmark of fractures. It occurs due to disrupted bone continuity, detectable during physical examination. This clinical manifestation is highly specific to fractures, making it the most accurate choice for a nurse’s assessment focus.

Choice C reason: Shock can occur with severe fractures due to blood loss or pain but is not a direct manifestation of the fracture itself. It reflects systemic response to trauma, not the localized bone injury, making it less specific than crepitus for identifying a fracture during assessment.

Choice D reason: Deformity is a common fracture sign due to bone misalignment but is not always present, especially in hairline or non-displaced fractures. Crepitus is more consistently detectable in physical exams, as it directly results from bone fragment movement, making it a more reliable clinical manifestation.

Choice A reason: Humulin R (regular insulin) has an onset of 30-60 minutes and peaks at 2-3 hours. Taking a snack at 0900-0930, immediately after injection, is too early, as insulin action is minimal, and glucose from the meal may cause hyperglycemia before insulin peaks, making this timing inappropriate.

Choice B reason: Humulin R peaks at 2-3 hours (1100-1200 for a 0900 dose), when hypoglycemia risk is highest due to maximum glucose uptake. A snack or meal at 1100-1130 provides glucose to counter insulin’s peak effect, preventing low blood sugar, making this the most appropriate timing.

Choice C reason: By 1400-1430, Humulin R’s effect (duration 5-8 hours) is waning, reducing hypoglycemia risk. A snack at this time is less critical, as insulin’s glucose-lowering action is declining. This timing is less effective for preventing hypoglycemia compared to the peak action period at 1100-1130.

Choice D reason: At 1700-1730, Humulin R’s effect is nearly gone (duration 5-8 hours), making hypoglycemia unlikely from the 0900 dose. A snack this late is irrelevant to the insulin’s action, as glucose levels are stabilized, making this timing inappropriate for preventing hypoglycemia.