Percutaneous Nephrostomy (10 Questions)

1. M. Roger Tremblay, 64 years old, has had a right-sided percutaneous nephrostomy tube for 2 weeks due to a ureteral stone. Today, the urologist wants to test if the ureter is patent (open) enough to remove the tube.

Assessment:
*1 hour after clamping the tube, M. Tremblay calls the nurse.
*He is grimacing, diaphoresis is present.
*He reports: "I have a severe, sharp pain in my right side and I feel sick to my stomach." (Pain 8/10).

Medical Orders:
*Clamp nephrostomy tube at 08:00 to test ureteral patency.
*Unclamp if severe pain or fever occurs.
*Acetaminophen 650 mg PO q4h PRN for mild pain.
*Morphine 2 mg SC q4h PRN for severe pain.

Question:
What is the nurse’s priority action? *
2. Mme. Ginette Roy, 82 years old, has a left nephrostomy tube. She is confused and agitated due to a UTI. The nurse enters the room and finds the nephrostomy tube lying on the bedsheets, completely removed from the flank. There is urine leaking from the insertion site.

Medical Orders:
*Nephrostomy tube to straight drainage.
*Ciprofloxacin 500 mg PO BID.
*Notify MD immediately if tube is dislodged.

Question:
What is the priority nursing action? *
4. Mme. Denise Fortin, 67 years old, had a nephrostomy inserted 3 days ago.

Assessment:
*Urine output: Decreased amount, appearance is cloudy and foul-smelling.
*Patient reports chills.
*Vital Signs: Temp 38.9°C, HR 102, BP 110/70.
*Flank site: Redness noted around the tube.

Medical Orders:
*Nephrostomy to gravity drainage.
*Notify MD for signs of infection (Fever > 38.0°C, flank pain, purulent drainage).
*Urine Culture & Sensitivity (C&S) PRN.

Question:
What is the nurse’s priority action? *
5. M. Jean-Paul Cote, 60 years old, returns to the unit 2 hours after a PCN insertion.

Assessment:
*Nephrostomy Bag: 150 mL of bright red urine with large clots.
*Vital Signs: BP 90/60, HR 115.
*Patient is pale and complains of dizziness.

Medical Orders:
*Vital signs q15min x 4, then q4h.
*Monitor site for bleeding.
*Notify MD if heavy bleeding or hemodynamic instability occurs.

Question:
How should the nurse interpret these findings and act? *
6. M. Sylvain Bouchard, 50 years old, is being discharged with a permanent nephrostomy tube. The nurse is observing him demonstrate bag management. M. Bouchard clips the drainage bag to his belt, at the level of his waist, while standing.

Medical Orders:
*Discharge home with Nephrostomy care teaching.
*Follow up in 2 weeks.

Question:
What teaching must the nurse provide? *
7. Mme. Louise Lapointe, 70 years old, complains of burning skin around her nephrostomy site.

Assessment:
*The dressing is saturated with urine.
*The skin surrounding the insertion site is macerated, red, and excoriated.
*The tube appears patent and is draining urine.

Medical Orders:
*Change dressing q3 days and PRN.
*Apply skin barrier cream PRN.

Question:
What is the most appropriate nursing intervention? *
8. M. Michel Desjardins, 58 years old, has a right PCN. He reports "pain" to the nurse.

Assessment:
*Pain is located in the bladder/suprapubic area, not the flank.
*He feels a strong urge to void naturally.
*Nephrostomy is draining clear yellow urine.

Medical Orders:
*Nephrostomy to gravity.
*Acetaminophen 650 mg PO q4h PRN.

Question:
What is the most likely cause of this pain? *
9. Mme. Solange Turcotte, 65 years old, has bilateral nephrostomy tubes (Right and Left) placed for obstruction due to cancer.

Assessment at 14:00:
*Right bag: 200 mL clear yellow urine.
*Left bag: 15 mL dark amber urine (has not increased in 4 hours).

Medical Orders:
*Monitor Output q4h.
*Notify MD if output < 30 mL/hr per catheter.
*Irrigate gently PRN.

Question:
What is the nurse’s interpretation and action? *
10. M. Guy Lambert, 59 years old, is 1 day post-PCN insertion. He wants to walk to the nursing station.

Medical Orders:
*Activity as tolerated.
*Nephrostomy to leg bag drainage.

Question:
Which safety measure is the most critical for the nurse to verify before M. Lambert walks? *