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

Answer and Explanation

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.

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Correct Answer is C

Explanation

A. Performing range of motion:
Explanation: Range of motion exercises are important for preventing joint stiffness and muscle atrophy, especially in clients with casts. However, this is not the first priority. Ensuring adequate circulation and perfusion is crucial before initiating any exercises or movements, as compromised circulation could lead to serious complications.

B. Managing pain:
Explanation: Pain management is important for the client's comfort, but it is not the first priority in this context. Assessing circulation and ensuring there are no signs of compromised perfusion takes precedence. Pain management can follow once circulation has been confirmed as adequate.

C. Checking capillary refill:
Explanation: Checking capillary refill is the first priority when assessing a client with a cast. Capillary refill assesses peripheral circulation by pressing on the nail bed and observing how quickly color returns. Delayed capillary refill could indicate compromised blood flow, which is a serious concern and requires immediate intervention.

D. Discussing cast care:
Explanation: Educating the client about cast care is important, but it is not the first priority. Ensuring proper circulation and ruling out any signs of impaired perfusion must be addressed before discussing cast care instructions.

A. "Pyelonephritis increases a person's risk for kidney damage." B. "Pyelonephritis is an infection of the lower urinary tract." C. "Pyelonephritis often causes no symptoms in affected clients." D. "Pyelonephritis is most often caused by Staphylococcus saprophyticus."

Correct Answer is A

Explanation

A. "Pyelonephritis increases a person's risk for kidney damage." - Pyelonephritis is a bacterial infection of the renal parenchyma and renal pelvis, typically caused by the ascent of bacteria from the lower urinary tract into the kidneys. If left untreated, it can lead to kidney damage, including scarring of the renal tissue and impaired kidney function.

B. "Pyelonephritis is an infection of the lower urinary tract." - This statement is incorrect. Pyelonephritis specifically involves the upper urinary tract, affecting the kidneys. In contrast, infections of the lower urinary tract (such as cystitis) affect the bladder and urethra.

C. "Pyelonephritis often causes no symptoms in affected clients." - This statement is incorrect. Pyelonephritis typically presents with symptoms such as fever, chills, flank pain, painful urination (dysuria), and frequent urination. Clients with pyelonephritis usually experience noticeable symptoms.

D. "Pyelonephritis is most often caused by Staphylococcus saprophyticus." - This statement is incorrect. While Staphylococcus saprophyticus is a common cause of urinary tract infections, pyelonephritis is more commonly caused by gram-negative bacteria, such as Escherichia coli, which often ascend from the lower urinary tract into the kidneys.

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A nurse is caring for a client with acute pyelonephritis. Which area should the nurse percuss to assess for pain related to pyelonephritis?

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