Nokea
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.
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For which of the following purposes does the nurse use auscultation during assessment of the urinary system?
- A. Check for ureteral peristalsis.
- B. Assess for bladder distension.
- C. Identify renal artery or aortic bruits.
- D. Determine the position of the kidneys.
Correct Answer: C
Rationale: The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract information.
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.
The nurse is caring for a patient with an elevated blood urea nitrogen (BUN) and serum creatinine who is scheduled for a renal arteriogram. Which of the following bowel preparation prescriptions should the nurse question?
- A. Fleet enema
- B. Tap-water enema
- C. Bisacodyl tablets
- D. Castor oil
Correct Answer: A
Rationale: High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure. The other medications for bowel evacuation are more appropriate.
The nurse is caring for a patient with diabetic nephropathy who is scheduled for a right renal biopsy. Immediately after the biopsy, which of the following actions is essential?
- A. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function.
- B. Check blood glucose to assess for hyperglycemia or hypoglycemia.
- C. Insert a straight catheter to check for gross or microscopic hematuria.
- D. Apply a pressure dressing and keep the patient prone for 30-60 minutes.
Correct Answer: D
Rationale: After the procedure, a pressure dressing is applied, and the patient is kept prone for 30-60 minutes. Usually bed rest is prescribed for 24 hours. The blood glucose and BUN/creatinine will not be affected by the biopsy. Although monitoring for hematuria is needed, there is no need for catheterization.
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.