Nokea
During assessment of a patient with decreased renal function, which of the following medications taken by the patient at home is of most concern to the nurse?
- A. Ibuprofen
- B. Warfarin
- C. Folic acid
- D. Penicillin
Correct Answer: A
Rationale: The nonsteroidal anti-inflammatory drugs (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function. The nurse also should ask about reasons the patient is taking the other medications, but the medication of most concern is the ibuprofen.
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The nurse is reviewing the results of a patient's urinalysis. Which of the following information indicates that the nurse should notify the health care provider?
- A. pH 6.2
- B. Trace protein
- C. WBC: 20-26/hpf
- D. Specific gravity: 1.021
Correct Answer: C
Rationale: The increased number of white blood cells (WBCs) indicates the presence of urinary tract infection or inflammation. Normal WBC result in a urinalysis report is 0-5/hpf. The other findings are normal.
Which of the following actions should the nurse plan to take first when admitting a patient who has a history of neurogenic bladder as a result of a spinal cord injury?
- A. Ask about the usual urinary pattern and any measures used for bladder control.
- B. Assist the patient to the toilet at scheduled times to help ensure bladder emptying.
- C. Check the patient for urinary incontinence every 2 hours to maintain skin integrity.
- D. Use intermittent catheterization on a regular schedule to avoid the risk of infection.
Correct Answer: A
Rationale: Before planning any interventions, the nurse should complete the assessment and determine the patient's normal bladder pattern and the usual measures used by the patient at home. All the other responses may be appropriate, but until the assessment is complete, an individualized plan for the patient cannot be developed.
The nurse is assessing a patient's urinary system and is unable to palpate either kidney. Which of the following actions should the nurse take next?
- A. Obtain a urine specimen to check for hematuria
- B. Document the information on the assessment form.
- C. Ask the patient about any history of recent sore throat.
- D. Ask the health care provider about scheduling a renal ultrasound.
Correct Answer: B
Rationale: The kidneys are protected by the abdominal organs, ribs, and muscles of the back and may not be palpable under normal circumstances, so no action except to document the assessment information is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound may be appropriate when assessing for renal problems for some patients, but there is nothing in the question stem to indicate that they are appropriate for this patient.
Which of the following techniques should the nurse use to assess the flank area of a patient with pyelonephritis for tenderness?
- A. Push gently into the two lowest intercostal spaces.
- B. Palpate along both sides of the lumbar vertebral column.
- C. Position one hand flat at the costovertebral angle (CVA) and strike it with the other fist.
- D. Use two fingers to percuss the area between the iliac crest and ribs along the midaxillary line.
Correct Answer: C
Rationale: Checking for flank pain is best performed by percussion of the CVA and asking about pain. The other techniques would not assess for flank pain.
A creatinine clearance test is ordered for a hospitalized patient with possible renal insufficiency. Which of the following equipment will the nurse need to obtain?
- A. Sterile specimen cup
- B. Large container for urine
- C. Foley catheter and drainage bag
- D. Towelettes for perineal cleaning
Correct Answer: B
Rationale: Since creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.