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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.
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The nurse is reviewing the result of a patient's creatinine clearance test which is 60 mL/minute. Which of the following values is the patient's glomerular filtration rate (GFR) in mL/minute?
- A. 30
- B. 60
- C. 120
- D. 240
Correct Answer: B
Rationale: The creatinine clearance approximates the GFR. The other responses are not accurate.
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.
Which of the following explanations should the nurse provide to a patient who asks, 'What is a cystoscopy?'
- A. Your health care provider will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney.
- B. Your health care provider will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys.
- C. Your health care provider will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked.
- D. Your health care provider will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray.
Correct Answer: D
Rationale: With a cystoscopy, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken. The response beginning, 'Your health care provider will place a catheter' describes a renal arteriogram procedure. The response beginning, 'Your health care provider will inject a radioactive solution' describes a nuclear scan. The response beginning, 'Your health care provider will insert a lighted tube into the bladder, and little catheters will be inserted' describes a retrograde pyelogram.
A patient who had a cystoscopy the previous day calls the urology clinic and gives the nurse all the following information. Which of the following patient statements should be reported immediately to the health care provider?
- A. My urine still looks pink.
- B. My IV site is still bruised.
- C. I have a temperature of 38.3°C (100.9°F).
- D. I did not sleep well last night.
Correct Answer: C
Rationale: The patient's elevated temperature may indicate a bladder infection, a possible complication of cystoscopy. The health care provider should be notified so that antibiotic therapy can be started. Pink-tinged urine is expected after a cystoscopy. The insomnia and bruising should be discussed further with the patient but do not indicate a need to notify the health care provider.
The nurse is preparing a patient for an intravenous pyelogram (IVP) and obtains the following information. Which information has the most immediate implications for the patient's care?
- A. The patient describes allergies to shellfish and penicillin.
- B. The patient has not had anything to eat or drink for 8 hours.
- C. The patient complains of costovertebral angle (CVA) tenderness.
- D. The patient used a bisacodyl tablet the previous night.
Correct Answer: A
Rationale: Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started. The other information also is important to note and document but does not have immediate implications for the patient's care during the procedures.