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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.
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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.
The health care provider orders a clean-catch urine specimen for culture and sensitivity testing for a patient with a suspected urinary tract infection (UTI). Which of the following actions should the nurse implement to obtain the specimen?
- A. Teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup.
- B. Have the patient empty the bladder completely, and then obtain the next urine specimen that the patient is able to void.
- C. Insert a short, small 'mini' catheter attached to a collecting container into the urethra and bladder to obtain the specimen.
- D. Clean the area around the meatus with a povidone-iodine swab, and then have the patient void into a sterile container.
Correct Answer: A
Rationale: Teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup best describes the technique for obtaining a clean-catch specimen. The answer beginning, 'insert a short, small, 'mini' catheter attached to a collecting container' describes a technique that would result in a sterile specimen, but a health care provider's order for a catheterized specimen would be required. Using povidone-iodine before obtaining the specimen is not necessary and might result in suppressing the growth of some bacteria. And the technique described in the answer beginning 'have the patient empty the bladder completely' would not result in a sterile specimen.
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.
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.
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.