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Renal function is reestablished: Renal function is not reestablished during the oliguric phase. This phase is characterized by reduced kidney function, with impaired filtration and accumulation of waste products in the blood. Recovery occurs later in the diuretic and recovery phases.

The glomerular filtration rate (GFR) recovers: The GFR does not recover in the oliguric phase. Instead, it remains severely reduced, which is the reason urine output declines. Recovery of GFR is expected in the later phases as renal tissue begins to heal.

BUN and creatinine levels decrease: During the oliguric phase, BUN and creatinine levels increase because of reduced clearance of metabolic wastes. The accumulation of these substances contributes to uremia, which often necessitates careful monitoring and sometimes dialysis.

Collect a urine specimen for culture and sensitivity: This intervention is indicated when infection is suspected, in cases of fever, dysuria, or cloudy urine. The lab values here suggest hemoconcentration rather than infection, so a culture would not address the client’s fluid balance problem.

Continue routine care because the results are within the expected reference range: The results are not all within the expected range. The BUN of 32 mg/dL is elevated, and the hematocrit of 50% is high, both pointing toward dehydration.

Decrease the IV fluid infusion rate and limit oral fluid intake: Reducing fluid intake would be inappropriate in this case, since the client shows signs of fluid volume deficit. Decreasing fluids would worsen dehydration, elevate lab abnormalities further, and compromise perfusion.

Apply absorbent adult incontinence diapers and pads over the bed linens: Absorbent products may help keep the skin dry, but it does not address the patient’s continence needs or promote independence. Prolonged use also increases risk of skin breakdown and infection.

Restrict fluids between meals and after the evening meal: Fluid restriction is not appropriate in dehydration, as the patient needs fluid replacement to restore balance. Limiting fluids could worsen confusion, impair perfusion, and further elevate the risk of complications

Insert an indwelling catheter until the symptoms have resolved: Indwelling catheters increase the risk of urinary tract infections, especially in older adults. Catheterization should be avoided unless absolutely necessary for close monitoring of urine output or in cases of urinary obstruction.

Reflex incontinence: Reflex incontinence occurs when the bladder empties without the sensation of the need to void, often related to neurologic impairment such as spinal cord injury. It is not associated with a distended bladder or continuous small leakage of urine.

Urge incontinence: Urge incontinence involves a sudden, strong need to urinate followed by involuntary bladder emptying. It is caused by detrusor overactivity and is not characterized by a consistently distended bladder or constant small leakage.

Stress incontinence: Stress incontinence is the leakage of urine with activities that increase intra-abdominal pressure, such as coughing, sneezing, or lifting. It does not usually involve bladder distension or continuous dribbling of urine.

"I should consume most of the fluid during the evening": Concentrating fluid intake in the evening increases the risk of nocturia, sleep disruption, and fluid overload at night. Clients with acute kidney disease should distribute fluid intake evenly throughout the day.

"I will put beverages in large containers to give the appearance of drinking a lot.": Using large containers encourages excess fluid intake rather than control. Clients are better supported by using smaller cups or pre-measured amounts to help monitor and limit total daily fluid intake.

"I will not add ice cream to the amount of fluid intake.": Ice cream, gelatin, sherbet, and other liquid-based foods must be counted toward the daily fluid allowance because they melt into liquid at room temperature. Excluding these from the total can result in unintentional fluid overload.

Decreased blood pressure: Nephrotic syndrome is typically associated with fluid retention rather than fluid deficit. Most clients present with normal or elevated blood pressure due to sodium and water retention, making decreased blood pressure an unlikely finding.

Poor skin turgor: Poor skin turgor is generally a sign of dehydration. In nephrotic syndrome, the problem is not dehydration but rather fluid shifting into interstitial spaces, leading to edema rather than loss of skin elasticity from fluid deficit.

Elevated urine ketones: Elevated urine ketones are typically seen in uncontrolled diabetes mellitus or starvation, not nephrotic syndrome. In nephrotic syndrome, urinalysis usually reveals proteinuria, lipiduria, and the presence of casts rather than ketones.

Decreased pH: A lower urine pH can result from diet, such as high-protein intake, or metabolic conditions like acidosis. While it is important to note, a mildly acidic urine pH is not usually urgent and does not require immediate notification of the healthcare provider.

Increased WBC: An elevated white blood cell count in urine suggests infection, such as a urinary tract infection. While important, this requires follow-up with a urine culture and treatment but is not as urgent as proteinuria, which may indicate progressive renal damage.

Increased specific gravity: A higher specific gravity usually reflects concentrated urine from dehydration or reduced fluid intake. This finding is generally reversible with hydration and does not necessarily indicate a pathologic renal condition requiring immediate provider notification.

BUN 23 mg/dL and creatinine 1.0 mg/dL: These values are within or near normal range for an older adult and do not reflect the impaired renal clearance expected in chronic kidney disease. Mild elevation of BUN alone without creatinine elevation is more consistent with dehydration than CKD.

BUN 8 mg/dL and creatinine 0.7 mg/dL: These values fall below or within the normal range and do not suggest chronic kidney disease. They reflect adequate kidney filtration and nitrogen waste clearance rather than impaired renal function.

BUN 10 mg/dL and creatinine 0.3 mg/dL: These levels are lower than expected, which can be seen in conditions such as low muscle mass or malnutrition, but not in chronic kidney disease. CKD typically presents with elevated values, not reduced ones.