A nurse is preparing a client for a kidney biopsy. Which of the following client conditions should the nurse identify as a contraindication for this diagnostic test?

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: A BUN level of 8 mg/dL and a creatinine level of 0.7 mg/dL are within normal ranges for healthy individuals. In CKD, BUN and creatinine levels are typically elevated due to decreased kidney function.

Choice B reason: A BUN level of 45 mg/dL is elevated, which could be expected in CKD, but a creatinine level of 8 ng/dL is not correctly expressed. Creatinine is measured in mg/dL, and in CKD, it would be higher than normal, not lower.

Choice C reason: A BUN level of 10 mg/dL and a creatinine level of 0.3 mg/dL are both lower than what would typically be expected in a patient with CKD. CKD usually results in higher levels due to reduced kidney function.

Choice D reason: A BUN level of 23 mg/dL and a creatinine level of 1.0 mg/dL are more aligned with what might be expected in CKD. Normal BUN levels range from 7 to 20 mg/dL, and normal creatinine levels can vary based on age, sex, and body size. In CKD, both levels tend to be higher as the kidneys' ability to filter blood decreases.