A patient is suspected to have pyelonephritis.
How will the nurse assess for flank tenderness?
Palpate along both sides of the lumbar vertebral column.
Strike a flat hand covering the costovertebral angle (CVA).
Push fingers upward into the two lowest intercostal spaces.
Percuss between the iliac crest and ribs at the midaxillary line.
The Correct Answer is B
Choice A rationale
Palpating along the lumbar vertebral column primarily assesses for spinal tenderness or musculoskeletal issues, not specifically kidney inflammation. The kidneys are retroperitoneal organs, and direct palpation of the lumbar area might not elicit specific tenderness related to pyelonephritis, which involves renal parenchymal inflammation.
Choice B rationale
Striking a flat hand covering the costovertebral angle (CVA) elicits pain if the kidney capsule is inflamed, a classic sign of pyelonephritis. This maneuver, known as CVA tenderness, directly assesses for inflammation of the renal parenchyma or surrounding structures, which become sensitive to percussion with infection.
Choice C rationale
Pushing fingers upward into the two lowest intercostal spaces would primarily assess for liver or spleen enlargement, or tenderness related to the lower ribs, not directly for kidney tenderness. The kidneys are situated more posteriorly and superiorly, making this approach less effective for assessing pyelonephritis.
Choice D rationale
Percussing between the iliac crest and ribs at the midaxillary line targets the flank area but is not the most precise method for assessing kidney tenderness. While it's in the general vicinity, the CVA percussion directly overlies the kidney and is a more specific and sensitive maneuver for pyelonephritis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Stopping topical fluorouracil when the skin appears worse is incorrect. The medication often causes an inflammatory reaction, including erythema, crusting, and erosion, which indicates the drug is working by causing cellular necrosis of abnormal cells. Premature discontinuation compromises treatment efficacy and may lead to inadequate destruction of cancerous cells, necessitating prolonged or alternative therapies.
Choice B rationale
Avoiding sun exposure while using topical fluorouracil is crucial due to the medication's photosensitizing properties. Fluorouracil enhances the skin's sensitivity to ultraviolet radiation, increasing the risk of severe sunburn, erythema, and blistering. This phototoxicity can exacerbate local inflammatory reactions and compromise treatment outcomes, necessitating strict photoprotection.
Choice C rationale
Applying topical fluorouracil only to affected areas is essential to minimize systemic absorption and reduce adverse effects on healthy skin. Fluorouracil is a cytotoxic agent that nonspecifically inhibits DNA and RNA synthesis, leading to cell death. Accidental application to unaffected skin can cause unnecessary irritation, inflammation, and discomfort without therapeutic benefit.
Choice D rationale
Washing hands before and after applying topical fluorouracil is a fundamental infection control and safety measure. Handwashing before application prevents the introduction of microbes to the treatment site, reducing infection risk. Post-application handwashing removes residual medication, preventing accidental transfer to other body parts or individuals, minimizing systemic exposure.
Correct Answer is B
Explanation
Choice A rationale
While deficits in mobility can indirectly impact urinary habits, leading to issues like delayed toileting, they are not a primary physiological cause of the specific symptoms of frequency, retention, and dribbling in an elderly male. These symptoms often stem from underlying anatomical or functional changes within the genitourinary system itself.
Choice B rationale
Prostate enlargement, specifically benign prostatic hyperplasia (BPH), is a very common condition in elderly males. The enlarged prostate gland compresses the urethra, leading to increased urinary frequency due to bladder irritation, urinary retention due to outflow obstruction, and dribbling as a result of incomplete bladder emptying. This is a direct physiological cause.
Choice C rationale
While some changes in urinary patterns can occur with aging, urinary retention and dribbling are not considered "normal" symptoms. They indicate a potential underlying pathology requiring investigation, not just an expected part of the aging process. Normal aging might involve slight increases in frequency but not significant retention.
Choice D rationale
Coughing or sneezing can sometimes lead to stress incontinence in individuals with weakened pelvic floor muscles, resulting in involuntary urine leakage. However, this differs from the symptoms of urinary retention and dribbling, which are more indicative of an obstructive process within the urinary tract.
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