A patient is admitted with a diagnosis of acute pyelonephritis. Which of the following assessment findings would the nurse most expect to see?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

Acute pyelonephritis is an infection of the kidney parenchyma and renal pelvis (upper urinary tract).
The infection triggers a systemic inflammatory response, unlike a lower UTI (cystitis).
The classic triad of symptoms includes fever, chills (rigors), and costovertebral angle (CVA) tenderness, also known as flank pain.
These systemic symptoms distinguish it from a localized bladder infection.

Option A: Hematuria (blood in urine) and suprapubic pain (pain over the bladder) are the hallmark signs of cystitis, an infection of the lower urinary tract (bladder), not the upper tract (kidney).
Option C: Urinary retention and bladder distention point towards a urinary outflow obstruction (e.g., benign prostatic hyperplasia, urethral stricture) or a neurogenic bladder, not an infection itself.
Option D: Polyuria (excessive urination) and polydipsia (excessive thirst) are classic symptoms of hyperglycemia, commonly seen in uncontrolled Diabetes Mellitus, or Diabetes Insipidus.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of acute pyelonephritis to guide bedside assessment, documentation, and the next nursing action.
Recognizing the difference between upper and lower UTI symptoms is critical for nurses. Pyelonephritis is a more serious condition that can lead to sepsis, kidney scarring, and renal failure if not treated promptly and aggressively, often with intravenous antibiotics.
A key nursing assessment is checking for CVA tenderness. This is done by placing one hand flat over the CVA and gently tapping it with the fist of the other hand. Pain upon percussion is a positive sign.
What if the patient is elderly and presents with confusion, malaise, and a low-grade fever, but denies flank pain? In the elderly, classic signs of pyelonephritis may be absent. New-onset confusion (delirium) can be the primary manifestation of a severe infection like pyelonephritis, and a high index of suspicion is required.

How to Approach the Question

First, identify the core diagnosis provided in the question: acute pyelonephritis.
Recall the location and nature of this condition. Pyelonephritis is an infection of the kidneys, which are part of the upper urinary tract.
Differentiate the signs of an upper UTI from a lower UTI. Upper UTIs (kidneys) cause systemic symptoms (fever, chills) and flank pain. Lower UTIs (bladder) cause localized symptoms (suprapubic pain, dysuria).
Evaluate each option based on this differentiation.
Option B (Fever, chills, CVA tenderness) directly matches the classic presentation of a systemic infection involving the kidneys.
Options A, C, and D describe symptoms characteristic of other conditions: lower UTI/cystitis, urinary obstruction, and diabetes, respectively.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 450-452

E6 Medicine Harrison 22e Part 1 p. 1130-1132

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 507-509

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