The nurse is providing care for a patient admitted with severe flank pain identified as renal colic. Urinalysis is positive for microscopic hematuria. Which action should the nurse take?

Choice a reason: Specific gravity measures the concentration of solutes in the urine. In glomerulonephritis, urine may be more dilute due to the kidneys' inability to concentrate urine properly, leading to a decrease rather than an increase in specific gravity.
Choice b reason: Creatinine clearance is a measure of the rate at which creatinine is cleared from the blood by the kidneys. In glomerulonephritis, kidney function is impaired, resulting in decreased creatinine clearance. Therefore, an increase in creatinine clearance is not expected in this condition.
Choice c reason: BUN (blood urea nitrogen) and serum creatinine are waste products filtered out of the blood by the kidneys. In glomerulonephritis, the kidneys' filtering capability is compromised, leading to the accumulation of these waste products in the blood. Hence, an increase in BUN and serum creatinine levels is expected in clients with glomerulonephritis, indicating reduced kidney function.
Choice d reason: RBC (red blood cell) count in the blood is not typically affected by glomerulonephritis. However, microscopic hematuria (the presence of red blood cells in urine) is a common finding in glomerulonephritis, indicating damage to the glomeruli. The RBC count in the blood itself is not expected to increase as a result of glomerulonephritis.

Choice a reason: Discarding the first voiding when beginning a 24-hour urine collection is a crucial step in accurately measuring the components of urine over 24 hours. This step ensures that the test starts with an empty bladder and provides a precise beginning point. This action prevents the inclusion of residual urine from previous hours, which could affect the accuracy of the test results. The nurse collects all subsequent urine voids in a designated container throughout the test. By discarding the initial void, the measurement captures exactly 24 hours of urine production, crucial for diagnosing and monitoring various medical conditions.
Choice b reason: Storing collected urine at room temperature is incorrect. Urine collected for a 24-hour urine test must be stored in a cool environment, ideally refrigerated, to prevent bacterial growth and the breakdown of urine components. This ensures the urine sample remains stable and accurate for analysis. Storing at room temperature can compromise test accuracy and lead to false results.
Choice c reason: Documenting any missed urine collection is a good practice, but it doesn't directly impact the initial test process. The primary goal is to ensure all urine is collected accurately within the 24-hour window. Missed collections should be minimized to maintain the test's integrity. While documenting is important for transparency and understanding test discrepancies, it is not the immediate action the nurse should take when starting the test.
Choice d reason: Posting a notice on the client's door helps remind healthcare team members about the ongoing 24-hour urine collection. This prevents disruptions and ensures all urine output is collected accurately. However, this action, while important, supports the process rather than directly initiating the test. The nurse can post the notice to ensure everyone involved is aware, but it is not the first step in beginning the urine collection.