Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is to initiate hemodialysis. The patient's symptoms and lab results strongly suggest acute renal failure, which requires immediate intervention to correct life-threatening electrolyte imbalances and fluid overload. Hemodialysis is the most effective way to rapidly remove excess fluid, correct electrolyte abnormalities (especially hyperkalemia), and address metabolic acidosis in acute renal failure.

While fluid resuscitation is often important in many emergency situations, it would be contraindicated in this case due to the patient's apparent fluid overload (swollen legs). Administering insulin and glucose is a temporary measure for hyperkalemia but does not address the underlying renal failure. Antibiotics are not indicated without clear signs of infection, and they would not address the immediate life-threatening electrolyte and acid-base disturbances.