Which finding by the nurse will be most helpful in determining whether a 67- yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (pyelonephritis)?
Costovertebral tenderness
Foul-smelling urine
Bladder distention
Suprapubic discomfort
The Correct Answer is A
The most helpful finding by the nurse in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (pyelonephritis) would be
**costovertebral tenderness**⁴. This is because costovertebral tenderness is a common symptom of pyelonephritis⁵. Pyelonephritis is an infection of the upper urinary tract that can cause fever, chills, flank pain, nausea, vomiting, and costovertebral tenderness⁵. Foul-smelling urine and bladder distention are not specific symptoms of pyelonephritis⁵. Suprapubic discomfort can be a symptom of lower urinary tract infection⁵.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This is because the persistent dysuria suggests that the initial treatment was not effective, and there may be a possibility of a resistant organism. Obtaining a midstream urine specimen for culture and sensitivity testing will help identify the specific microorganism causing the infection and determine the most effective antibiotic to use. The nurse should also instruct the patient to continue to drink plenty of fluids, as this will help flush out the bacteria and relieve symptoms. The nurse may suggest the use of acetaminophen (Tylenol) to relieve discomfort, but this should not be the only action taken, as treating the underlying infection is crucial. The nurse should not tell the patient to take trimethoprim and sulfamethoxazole for an additional three days, as the initial treatment was not effective, and a different course of treatment may be required based on the results of the urine culture and sensitivity testing.

Correct Answer is C
Explanation
The patient's vital signs suggest that she is experiencing hypotension, tachycardia, and possibly dehydration due to acute adrenal insufficiency. The highest priority nursing intervention for this patient is to provide isotonic fluids to restore intravascular volume and blood pressure. This will also help to correct any electrolyte imbalances that may be present. Administering furosemide (Lasix) or replacing potassium losses may be necessary interventions, but they are not the highest priority at this time. Restricting sodium would be contraindicated in this situation as the patient is hypotensive and needs fluids to increase intravascular volume.

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