A nurse is caring for a client with acute pyelonephritis. Which area should the nurse percuss to assess for pain related to pyelonephritis?
McBurney's point on the abdomen
Psoas sign at the knee
Rovsing's Sign on the abdomen
costovertebral angle (CVA) on the back
The Correct Answer is D
A. McBurney's point on the abdomen: McBurney's point is a location in the right lower quadrant of the abdomen that is significant in the assessment for appendicitis. It is not relevant to the assessment of pyelonephritis, which is a kidney infection.
B. Psoas sign at the knee: The psoas sign is a test for appendicitis, not pyelonephritis. It involves the patient lying on their back and lifting their right leg against resistance. If this movement causes pain in the lower right abdomen, it could indicate irritation of the psoas muscle due to an inflamed appendix.
C. Rovsing's Sign on the abdomen: Rovsing's sign is also a test for appendicitis. It involves palpating the left lower quadrant of the abdomen and observing if it causes pain in the right lower quadrant. The presence of pain in the right lower quadrant during palpation of the left lower quadrant can indicate appendicitis. This sign is not specific to pyelonephritis.
D. Costovertebral angle (CVA) on the back: The CVA is located on the back at the angle formed by the 12th rib and the spine. Percussion of the CVA is a common technique used to assess for kidney tenderness. In the case of acute pyelonephritis, infection and inflammation of the kidneys can cause tenderness and pain in the CVA area. Therefore, this area is assessed for pain related to kidney infections like pyelonephritis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["438"]
Explanation
To calculate the high-end dosage for a 125 kg patient, you can multiply the weight in kilograms (125 kg) by the high-end dosage range (3.5 mg/kg):
High-end dosage = 125 kg * 3.5 mg/kg = 437.5 mg
Rounded to whole number give 438mg.
Correct Answer is B
Explanation
A. "I will need to drink apple cider vinegar each day."
This statement is incorrect. Drinking apple cider vinegar is not a proven method to prevent urinary tract infections (UTIs). The client does not need to consume apple cider vinegar as a preventive measure for UTIs.
B. “I will need to wipe my perineal area from back to front after urination."
This statement is incorrect and indicates a need for further teaching. Proper hygiene is essential in preventing UTIs, and wiping from back to front can introduce bacteria from the anal area to the urethra, increasing the risk of UTIs. The correct technique is to wipe from front to back after urination to prevent the spread of bacteria.
C. “I need to drink 8 cups of liquid each day."
This statement is correct. Staying well-hydrated by drinking an adequate amount of fluids, such as 8 cups of liquid each day, can help flush out bacteria from the urinary tract and reduce the risk of UTIs. Proper hydration is a good preventive measure.
D. "I will need to empty my bladder regularly and completely.”
This statement is correct. Emptying the bladder regularly and completely helps prevent the accumulation of bacteria in the urinary tract. Incomplete emptying of the bladder can allow bacteria to multiply, increasing the risk of UTIs. Regular and thorough emptying of the bladder is an important preventive measure against UTIs.
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