A client with acute renal failure requires close monitoring. The nurse should be particularly alert for which complication?

• A. Drug toxicity
• B. Hyperglycemia
• C. Excessive thirst
• D. Hypertension as the sole concern

Answer: (A)

In acute renal failure, the kidneys lose their ability to excrete waste and many drugs or their metabolites. When drug clearance drops, levels in the blood rise, making toxicity much more likely. Medications that depend heavily on renal elimination or have narrow therapeutic ranges can quickly become toxic if dosing isn’t adjusted for the reduced kidney function. That’s why close monitoring for signs of drug toxicity is a primary nursing priority in this situation, along with adjusting doses based on renal function and using therapeutic drug monitoring when available.

Hyperglycemia, excessive thirst, and hypertension can occur with kidney problems, but they are not the immediate safety risk tied to impaired drug elimination. The most pressing concern in acute renal failure regarding medication safety is the potential for drug accumulation and toxicity.