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The nurse is preparing a patient with a decreased glomerular filtration rate for an intravenous pyelogram (IVP). Which of the following actions should be included in the plan of care?
- A. Monitor the urine output after the procedure.
- B. Assist with monitored anesthesia care (MAC).
- C. Give oral contrast solution before the procedure.
- D. Insert a large size urinary catheter before the IVP.
Correct Answer: A
Rationale: Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient's urine output. MAC sedation and retention catheterization are not required for the procedure. The contrast medium is given intravenously, not orally.
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The nurse is caring for a patient following an intravenous pyelogram (IVP) and obtains all of the following assessment data. Which of the following findings require immediate action by the nurse?
- A. The heart rate is 58 beats/minute.
- B. The respiratory rate is 38 breaths/minute.
- C. The patient complains of a dry mouth.
- D. The urine output is 400 mL in the first 2 hours.
Correct Answer: B
Rationale: The increased respiratory rate indicates that the patient may be experiencing an allergic reaction (anaphylactic reaction) to the contrast medium used during the procedure. The nurse should immediately assess the patient's oxygen saturation and breath sounds. The other data are not unusual findings following an IVP.
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.
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.
A patient's urine dipstick indicates a small amount of protein in the urine. Which of the following actions should the nurse take next?
- A. Check which medications the patient is currently taking.
- B. Obtain a clean-catch urine specimen for culture and sensitivity testing.
- C. Ask the patient about any family history of persistent renal failure.
- D. Send a urine specimen to the laboratory to test for ketones and glucose.
Correct Answer: A
Rationale: Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings. The other actions by the nurse may be appropriate, but checking for medications that may affect the dipstick accuracy should be done first.