A client who has low back pain reports that they are unable to void. The nurse notices a distended bladder on assessment. Which of the following is the likely cause of this client's low back pain?

The correct answer is D. Urine output 75 mL in 1 hr.

Adequate urine output (at least 30 mL/hr) indicates effective hydration, showing that the kidneys are functioning properly and fluid balance is improving. A urine output of 75 mL in 1 hour suggests sufficient fluid replacement.

Here’s why the other options are incorrect:

• A. Urine specific gravity 1.005 to 1.030 – This range covers both normal and abnormal values. In dehydration, urine specific gravity is usually high (>1.030) due to concentrated urine. Effective treatment should lead to lower urine specific gravity, but the full range does not confirm improvement.

• B. Decreased pulse pressure – Pulse pressure is the difference between systolic and diastolic blood pressure. Dehydration typically causes a narrowed pulse pressure, so improvement should lead to a normal or increased pulse pressure rather than a decrease.

• C. Lightheadedness – Dizziness and lightheadedness are signs of dehydration-related hypotension. Effective hydration should resolve these symptoms, not maintain them.

Choice A rationale: Cantaloupe is high in potassium. Clients with acute kidney injury (AKI) have impaired potassium excretion, and consuming high-potassium foods increases the risk of hyperkalemia, which can lead to cardiac arrhythmias.

Choice B rationale: Baked potatoes contain significant potassium, especially in the skin. In AKI, potassium retention is dangerous, so this choice reflects poor understanding of dietary restrictions for renal safety.

Choice C rationale: Yogurt is rich in potassium and phosphorus. In AKI, both electrolytes may accumulate due to reduced renal clearance, making yogurt an inappropriate choice without close monitoring.

Choice D rationale: Pecans are low in potassium, making them a safer snack for clients with AKI. Choosing low-potassium foods demonstrates appropriate understanding of renal dietary management.