A nurse notices that an older adult client has not urinated all day, despite drinking three liters of water. Which physiological change is the most likely cause for this issue?
1. Reduction in plasma protein levels
2. Increased glomerular filtration rate
3. Increase in body fat
4. Renal function impairment
Correct Answer: 4
Rationale 1: A reduction in plasma protein levels occurs as liver function declines. This will not affect urine output.
Rationale 2: Urine output will be affected when glomerular filtration rate is decreased, not increased. Glomerular filtration rate will be decreased in the elderly, not increased.
Rationale 3: Changes in body fat are not related to urine output.
Rationale 4: A decline in renal function, especially if acute, would best explain why the client has not urinated.
Global Rationale: A decline in renal function, especially if acute, would best explain why the client has not urinated. A reduction in plasma protein levels occurs as liver function declines. This will not affect urine output. Urine output will be affected when glomerular filtration rate is decreased, not increased. Glomerular filtration rate will be decreased in the elderly, not increased. Changes in body fat are not related to urine output.
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