Question

The nurse is evaluating a client for a UT1. To correctly assess for costovertebral angle tenderness, the nurse would a. use fist percussion performed bilaterally on the posterior chest below the rib cage. b. have the client contract pelvic floor muscles for 10 seconds, then relax them for 10 seconds. c. apply pressure over symphysis pubis. d. have the client contract abdominal muscles and hold his or her breath while straining.

Short answer

a. The correct method to assess for costovertebral angle tenderness is to use fist percussion performed bilaterally on the posterior chest below the rib cage.

Step-by-step solution

Understanding the assessment for costovertebral angle tenderness

Costovertebral angle tenderness is assessed to check for inflammation of the kidneys, which is often a sign of a UTI (urinary tract infection). To test for this tenderness, the nurse would perform an indirect percussion at the angle formed by the vertebral column and the costal margin (the rib cage).

Identifying the correct method of assessment

The correct method to assess for costovertebral angle tenderness involves the use of fist percussion. This is done by the healthcare professional using the side of a closed fist to gently strike the area of the back where the ribs meet the spine at the costovertebral angle.

Eliminating incorrect options

The other options provided do not correctly describe the assessment of costovertebral angle tenderness. Option (b) describes a technique to evaluate pelvic floor muscle function, option (c) is a different assessment that palpates the bladder area, and option (d) is not related to kidney evaluation but rather assesses for abdominal related issues.

Key concepts

NCLEX-RN Examination

The NCLEX-RN (National Council Licensure Examination for Registered Nurses) is a critical test that potential nurses must pass to obtain their license to practice nursing. The exam encompasses a wide range of topics, including the fundamentals of patient care, pharmacology, nursing practice standards, and more.

A key aspect of the NCLEX-RN is its focus on assessing a nurse's ability to make sound clinical judgments and understand how to perform various nursing procedures, such as assessing for costovertebral angle tenderness. This procedure would fall under the physiologic integrity category, which covers skills necessary for the physical assessment and intervention of patients.

Test preparation for nursing students includes familiarizing themselves with different types of physical assessments and what clinical findings suggest about a patient's health status. A firm grasp of how to assess for signs of a urinary tract infection, like costovertebral angle tenderness, is essential for both the exam and nursing practice.

Urinary Tract Infection Assessment

Assessing for a urinary tract infection (UTI) is a common nursing responsibility that requires a thorough understanding of the associated signs and symptoms. UTIs are infections that can affect any part of the urinary system, including kidneys, ureters, bladder, and urethra.

For a nurse to accurately assess a UTI, he or she must be skilled in performing a focused physical examination. This may include assessing for costovertebral angle tenderness, which is an indication of pyelonephritis — an upper urinary tract infection that has potentially reached the kidneys. The assessment is traditionally performed by gently striking the area with a fist (option a) to elicit pain or discomfort that would signify tenderness in that region.

Other potential signs of a UTI might include frequency and urgency of urination, hematuria, fever, and suprapubic tenderness (option c). Thus, understanding the proper assessment techniques and recognizing the clinical indicators of a UTI is vital for accurate diagnosis and effective patient care.

Nursing Clinical Skills

Nursing clinical skills encompass a broad spectrum of competencies that nurses must acquire to provide safe and effective patient care. One of these skills includes the ability to perform accurate physical assessments, such as evaluating for costovertebral angle tenderness. This particular clinical skill assists in identifying issues with the kidneys, commonly associated with urinary tract infections.

Proper execution of the fist percussion technique (option a) requires the nurse to use the side of their closed fist to tap gently on the patient's back, precisely at the costovertebral angle. Mastery of this skill not only aids in UTI assessment but also demonstrates the nurse's proficiency in performing targeted physical exams.

Hands-on practice and in-depth understanding of the anatomy involved in such examinations are pillars of nursing education. These competencies are critical because they lay the foundation for nurses to make accurate clinical diagnoses and provide appropriate interventions, ensuring high-quality patient care.