What is the priority nursing action for a client with suspected acute kidney injury and urine output of 15 mL/hr?

• A. Assess hemodynamics and notify provider.
• B. Administer diuretics as prescribed.
• C. Initiate fluid restriction immediately.
• D. Obtain a renal ultrasound.

Answer: (A)

When urine output is this low, the priority is to assess the patient’s perfusion and notify the provider. A urine output of 15 mL/hour suggests oliguria and potential acute kidney injury, often related to reduced renal perfusion. By checking vital signs, pulse quality, blood pressure, mental status, capillary refill, and overall fluid status (and reviewing baseline labs), you can determine if the kidneys are being under-perfused due to dehydration, bleeding, sepsis, or shock. This assessment guides urgent actions to restore perfusion, such as appropriate fluid resuscitation or other interventions ordered by the provider, and helps prevent progression of kidney injury. Administering diuretics without knowing the cause can worsen fluid and electrolyte imbalances, so it isn’t the first step. Fluid restriction isn’t the immediate move unless there’s fluid overload, and obtaining a renal ultrasound is important for obstruction but isn’t the immediate priority when perfusion status and stability need rapid assessment.