Nokea
A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.)
- A. Clear drainage
- B. Cloudy drainage at site
- C. Client reports headache
- D. Foul-smelling drainage
- E. Urine draining from site
Correct Answer: B,D,E
Rationale: Cloudy or foul-smelling drainage and urine leaking from the nephrostomy site suggest infection or obstruction, requiring urgent provider notification. Clear drainage is normal, and a headache is unrelated unless accompanied by other concerning symptoms.
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A nurse cares for a client who has pyelonephritis. The client states, 'I am embarrassed to talk about my symptoms and I don't want to talk to my nurse.' How should the nurse respond?
- A. I am a professional. Your symptoms will be kept in confidence.
- B. I understand. Elimination is a private topic and shouldn't be discussed.
- C. Take your time. It is okay to use words that are familiar to you.
- D. You seem anxious. Would you like a nurse of the same gender to care for you?
Correct Answer: C
Rationale: Encouraging the client to use familiar language helps facilitate discussion about sensitive genitourinary symptoms. Promising absolute confidentiality may not be feasible, dismissing the topic is inappropriate, and changing nurses does not address the client's discomfort with communication.
A nurse provides health screening for a community health center with a large population of African American clients. Which priority assessment should the nurse include when working with this population?
- A. Measure height and weight.
- B. Assess blood pressure.
- C. Measure blood pressure and pulse.
- D. Ask about medications.
Correct Answer: B
Rationale: African Americans have a high prevalence of hypertension, which is a leading cause of end-stage renal disease. Assessing blood pressure is a priority to monitor and manage this risk. While other assessments are important, blood pressure screening is critical for this population.
The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypertension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypertension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Which action should the nurse take first?
- A. Reposition the client to promote comfort.
- B. Measure the specific gravity of the client's urine.
- C. Administer intravenous pain medications.
- D. Assess the rate and quality of the client's pulse.
Correct Answer: D
Rationale: Assessing the rate and quality of the client's pulse is critical to evaluate for signs of volume depletion or shock, which are potential complications post-nephrectomy due to hemorrhage or adrenal insufficiency. This assessment provides essential data before notifying the provider. Repositioning, measuring urine specific gravity, or administering pain medication do not address the immediate risk of these complications.
A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma. Which statement should the nurse include in this client's teaching?
- A. Since you only have one kidney, a salt and fluid restriction is required.
- B. Your therapy will include hemodialysis while you recover.
- C. Medications will be prescribed to control your high blood pressure.
- D. You need to avoid participating in contact sports like football.
Correct Answer: D
Rationale: Clients with one kidney should avoid contact sports to prevent injury to the remaining kidney. Salt and fluid restriction, dialysis, or new hypertension medications are not typically required post-nephrectomy unless other complications arise.
A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?
- A. Test your urine daily for the presence of ketone bodies and proteins.
- B. Use tampons rather than sanitary napkins during your menstrual period.
- C. Drink more water and empty your bladder more frequently during the day.
- D. Keep your hemoglobin A1C under 9% by keeping your blood sugar controlled.
Correct Answer: C
Rationale: Increasing fluid intake (especially water) and frequent voiding help flush bacteria from the urinary tract, reducing the risk of pyelonephritis. Chronically elevated blood glucose in diabetes can promote bacterial growth, but frequent voiding is the most direct preventive measure. Testing urine for ketones/proteins, using tampons, or controlling hemoglobin A1C are not as directly related to preventing urinary tract infections.