A nurse is caring for a client who has progressing chronic kidney disease (CKD). Which of the following laboratory results would the nurse expect to find in the client's electronic health record?

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 reason: In acute kidney injury (AKI), the blood urea nitrogen (BUN) level is expected to be elevated due to the kidneys' impaired ability to excrete urea, which is a waste product of protein metabolism. Normal BUN levels range from approximately 7 to 20 mg/dL.

Choice B reason: Hypercalcemia is not commonly associated with AKI. Instead, patients with AKI may experience hypocalcemia due to the kidneys' reduced ability to convert vitamin D to its active form, which is necessary for calcium absorption.

Choice C reason: Metabolic alkalosis is not a typical finding in AKI. More commonly, patients with AKI experience metabolic acidosis because the kidneys are unable to excrete acid effectively, leading to an accumulation of acid in the body.

Choice D reason: Hypokalemia is generally not expected in AKI. The condition is more often associated with hyperkalemia, as the impaired kidney function leads to a reduced excretion of potassium, which can accumulate to dangerous levels.