A college student comes to the school's health clinic troubled by urinary frequency and burning with right lower back pain. Which intervention should the nurse implement first?
Palpate the right flank for tenderness.
Evaluate the urine for a strong odor.
Test the urine for the presence of hematuria.
Measure the temperature and pulse rate.
The Correct Answer is D
D. In a client presenting with urinary symptoms and lower back pain, measuring the temperature and pulse rate is essential for assessing for signs of systemic infection, such as fever (elevated temperature) and tachycardia (elevated pulse rate). These vital signs can help determine the urgency of the situation and guide further assessment and management.
A. Palpating the right flank for tenderness may be appropriate to assess for signs of kidney involvement, such as in pyelonephritis. However, this intervention is not the first priority. Assessing for systemic signs of infection, such as fever, is more urgent.
B. Evaluating the urine for a strong odor may provide additional information about the student's symptoms, but it is not the first intervention priority.
C. Testing the urine for the presence of hematuria (blood in the urine) is an important diagnostic step in evaluating urinary symptoms, but it is not the first intervention priority. Hematuria may be present in various conditions, including UTIs, kidney stones, or other urinary tract disorders.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
While getting an influenza vaccine annually is important for individuals with diabetes to prevent complications from influenza, it is not specific to diabetes self-management.
Using salt, herbs, and spices to enhance the flavor of foods can help reduce the reliance on added sugars and unhealthy fats for flavoring, which is beneficial for individuals with diabetes in managing blood sugar levels and overall health.
Alcohol use interferes with glycemic control. Diabetic clients should stop taking alcohol completely to reduce the risk of complications
Eating a protein snack before exercise may be helpful for some individuals to provide sustained energy and maintain blood sugar levels during physical activity. However, it is not a universal recommendation for all individuals with type 2 diabetes.
Correct Answer is B
Explanation
B. Hematuria can indicate renal involvement, which is a serious complication of SLE. Lupus nephritis, inflammation of the kidneys caused by SLE, can lead to hematuria, proteinuria, and impaired kidney function. Monitoring for renal complications is essential in managing SLE exacerbations, and hematuria warrants immediate attention to assess the extent of renal involvement and adjust treatment as necessary.
A. Joint pain is a common symptom of systemic lupus erythematosus (SLE), an autoimmune disease that can affect multiple organs and tissues, including the joints. While joint pain can be distressing for the patient, it is not necessarily an urgent or life-threatening complication requiring immediate intervention.
C. Muscle atrophy, or the wasting away of muscle tissue, can occur in individuals with systemic lupus erythematosus (SLE), particularly if they are experiencing prolonged periods of inactivity due to joint pain, fatigue, or other symptoms. While muscle atrophy can contribute to functional impairment and decreased quality of life, it is not typically considered an urgent or life-threatening complication requiring immediate intervention.
D. Low-grade fever is a common symptom in systemic lupus erythematosus (SLE), often occurring during disease flares or exacerbations. Monitoring the patient's temperature and assessing for other signs of infection or disease activity is important, but low-grade fever alone may not warrant urgent intervention.

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