Author Question: Rodney is a nurse who works for a medical unit in the hospital. He is admitting Harry, a 76-year-old ... (Read 54 times)

Alygatorr01285 · **on:** Jul 22, 2018

Rodney is a nurse who works for a medical unit in the hospital. He is admitting Harry, a 76-year-old patient from a nursing home. Harry's health care provider has admitted him with a UTI.

During his assessment, Rodney notes that Harry complains of right flank pain. To assess for tenderness, Rodney should gently: A. auscultate the costovertebral angle.
B. palpate the tenth intercostal space.
C. percuss the costovertebral angle.
D. touch the area above the ischial spine.

Question 2

A nursing student who is doing a clinical rotation at an orthopedic unit is caring for a 67-year-old patient who has undergone a knee replacement. The patient is complaining of pain at the IV site.

The nursing student assesses the site and finds that the site is cool and pale. He stops the IV and reports the situation to his nurse. What does the nursing student suspect? A. Phlebitis
B. Infiltration
C. Thrombophlebitis
D. Deep vein thrombosis

Brummell1998 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

C
If the kidneys become infected or inflamed, flank pain typically develops. You assess for ten-derness early in the disease by gently percussing the costovertebral angle (the angle formed by the spine and twelfth rib). Inflammation of the kidney results in pain on percussion.

Answer to Question 2

B
An infiltration occurs when IV fluids seep into the subcutaneous tissue around the venipuncture site. Infiltration causes swelling (from increased tissue fluid) and possible pallor and coolness (caused by decreased circulation) around the venipuncture site. Early warning of infiltration is an IV infusing at a decreased rate or one that stops flowing. Pain is also present, usually resulting from tissue edema.