You are caring for a client who has suffered a severe crush injury yesterday and now has decreasing urine output. The urine is now a dark cola color. You suspect the client is developing acute kidney injury as a direct result of

A. Cardiac monitor shows a pulse rate of 204: A markedly elevated heart rate is expected during the early burn-shock phase due to pain, stress, and circulating catecholamines. Although it indicates a hypermetabolic and hypovolemic state, it is not as specific for inadequate fluid resuscitation as reduced urine output, so it is not the most urgent finding.

B. Serous exudate is leaking from the burns: Plasma leakage from damaged capillaries is normal in the first 24–48 hours after a major burn. While this contributes to hypovolemia, its presence alone does not indicate a worsening condition and does not require immediate provider notification compared with signs of renal hypoperfusion.

C. Urine output is 20 mL for the past 2 hours: This extremely low output is a key indicator of inadequate renal perfusion during the resuscitation period. Clients with major burns should maintain 30–50 mL/hr to ensure the kidneys are receiving adequate circulation, making this the most critical finding to report promptly.

D. Blood pressure is 94/50 per arterial line: Borderline hypotension commonly occurs during early burn shock because of fluid shifts into the interstitial space. Although concerning, it is less reliable than urine output for assessing end-organ perfusion.

A. Lactulose: Lactulose is used to reduce ammonia levels in hepatic encephalopathy by promoting bowel excretion of nitrogen, but it does not control bleeding. It addresses neurologic complications rather than hemorrhage.

B. Vasopressin: Vasopressin is a potent vasoconstrictor that reduces portal venous pressure, helping control active bleeding from esophageal varices. It is commonly administered in acute variceal hemorrhage to achieve hemostasis and stabilize the client.

C. Propranolol: Propranolol, a nonselective beta-blocker, is used prophylactically to reduce portal hypertension and prevent variceal bleeding. It is not effective in stopping active hemorrhage.

D. Neomycin sulfate: Neomycin is an antibiotic used to reduce intestinal bacteria and lower ammonia levels in hepatic encephalopathy. It has no role in controlling acute variceal bleeding.