A nurse is performing discharge teaching with a client who was admited for pyelonephritis. Which of the following instructions related to the prevention of pyelonephritis should the nurse include in the teaching? (Select all that apply.)

Choice A reason: Flank pain is a common symptom of PKD due to the enlargement of cysts within the kidneys.

Choice B reason: Confusion is not a direct symptom of PKD but could be related to complications such as severe hypertension or toxins in the blood due to decreased kidney function.

Choice C reason: Hypotension is not typically associated with PKD; in fact, hypertension is a more common finding due to the disease's impact on kidney function.

Choice D reason: Urinary retention is not a typical finding in PKD. Instead, symptoms like hematuria (blood in the urine) and increased urinary frequency may occur.

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.