# A nurse is caring for a client with acute pyelonephritis. Which nursing intervention should be the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541459  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention should be the priority?

A 28-year-old female client is admitted to the medical unit with acute pyelonephritis. She presents with flank pain, fever of 101.8°F (38.8°C), chills, nausea, and dysuria. Laboratory results show elevated white blood cell count and bacteria in the urine. The physician has ordered IV antibiotics, analgesics, and increased fluid intake.

## 보기

1. Administer prescribed analgesics for pain relief
2. Monitor vital signs and assess for signs of sepsis **✔ 정답**
3. Encourage increased fluid intake to flush bacteria
4. Provide patient education about medication compliance

**정답: 2**

## 해설

Monitoring vital signs and assessing for sepsis is the priority because acute pyelonephritis can rapidly progress to life-threatening sepsis. Other interventions like pain management and education are important but secondary to preventing hemodynamic instability.

## 심화 해설

Clinical Scenario Analysis

The client presents with classic manifestations of acute pyelonephritis: flank pain, fever (101.8°F / 38.8°C), chills, nausea, and dysuria. Laboratory findings of leukocytosis and bacteriuria confirm an active upper urinary tract infection. This infection carries a significant risk of progressing to urosepsis, a systemic and potentially life-threatening response to infection.

Priority Intervention: Early Detection of Sepsis

The correct answer is **Option 2**. While all listed interventions are important components of care for acute pyelonephritis, the nurse's immediate priority is to monitor for and detect early signs of systemic decompensation. The rationale is rooted in the concept of early risk stratification and the time-critical nature of sepsis intervention.

Research on acute pyelonephritis has validated the use of structured assessment tools to predict clinical deterioration. A prospective study comparing scoring systems in non-emphysematous acute pyelonephritis found that tools like the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score 2 (NEWS2) are relevant for guiding ICU admission and anticipating in-hospital mortality in this specific urological infection [2]. By systematically monitoring vital signs and mental status, the nurse can calculate these scores and identify a patient who is transitioning from a localized infection to a systemic illness with organ dysfunction.

The assessment of vital signs and signs of sepsis directly informs the most critical clinical decisions. A change in respiratory rate, a drop in blood pressure, or an altered level of consciousness are early indicators of systemic involvement that necessitate immediate escalation of care. A multicenter cohort study on acute pyelonephritis management highlights that even in monitored settings, the focus remains on tracking the severity of illness (SOI) and risk of mortality (ROM) to prevent pyelonephritis-related complications [1]. The nurse's ongoing assessment at the bedside is the primary mechanism for capturing this data in real time.

The other options, while valid, are secondary to this initial and continuous safety assessment. Administering analgesics (Option 1) addresses comfort, encouraging fluids (Option 3) supports the medical plan to flush bacteria, and providing education (Option 4) promotes long-term adherence. However, none of these actions will detect a life-threatening deterioration. A patient who is becoming septic cannot be effectively treated if the warning signs are missed because the nurse was prioritizing a non-urgent task. The foundational nursing process step of assessment must come first to ensure the safety and appropriateness of all subsequent interventions.

References (research sources)

- [1]Patient Characteristics and Clinical Outcomes of Acute Pyelonephritis Treated in Mayo Clinic's Hospital-at-Home Program.Research articleGomez-Cabello CA, Dumic I, Maniaci MJ, Paulson MR, Shiari A, Webster LW, McGrew J, Genovese A, Collaco B, Trabilsy M, Forte AJ, Bosch W. (2026) · DOI: 10.1093/ofid/ofaf748

- [2]Dual-score framework: National Early Warning Score 2 and quick Sequential Organ Failure Assessment scores in acute pyelonephritis.Research articleJain PR, Aravind S, K PR, Shekar M, Palaniyandi V, Sekar H, Krishnamoorthy S. (2026) · DOI: 10.5527/wjn.v15.i1.114165

## 임상 시나리오

Early Sepsis Detection in PyelonephritisPrioritizing Assessment to Prevent Urosepsis
For a patient with acute pyelonephritis, the nursing priority is monitoring vital signs and assessing for signs of sepsis. This infection can rapidly progress to urosepsis, a life-threatening condition.

Utilize structured assessment tools like qSOFA (altered mentation, systolic BP ≤100 mmHg, respiratory rate ≥22/min) or NEWS2 to identify early clinical deterioration and the need for escalation of care.

CautionInterventions like administering analgesics or encouraging fluid intake are secondary. Do not delay a focused assessment for systemic decompensation, as early recognition is critical to reducing mortality.

## 핵심 개념

- **Urosepsis** — A systemic, life-threatening infection originating from the urinary tract that can lead to organ dysfunction and septic shock.
- **qSOFA** — Quick Sequential Organ Failure Assessment; a bedside tool using altered mentation, systolic BP ≤100 mmHg, and respiratory rate ≥22/min to identify high-risk patients.
- **Acute Pyelonephritis** — A bacterial infection of the renal pelvis and kidney parenchyma, commonly presenting with flank pain, fever, chills, and dysuria.

## 같은 주제 문제

- [A nurse is assessing a 45-year-old female client who presents to the emergency department …](https://mymerci.kr/pages/nclex_q.php?qn_id=541456)
- [A 45-year-old female patient is admitted to the medical unit with suspected acute pyelonep…](https://mymerci.kr/pages/nclex_q.php?qn_id=541457)
- [A nurse is caring for a client diagnosed with acute pyelonephritis. Which nursing interven…](https://mymerci.kr/pages/nclex_q.php?qn_id=541458)
- [A nurse is caring for a client diagnosed with acute pyelonephritis. Which nursing interven…](https://mymerci.kr/pages/nclex_q.php?qn_id=541460)
- [A nurse is caring for a client with acute pyelonephritis. Which assessment finding require…](https://mymerci.kr/pages/nclex_q.php?qn_id=541461)
- [A nurse is caring for a 65-year-old male client admitted with acute pyelonephritis. He pre…](https://mymerci.kr/pages/nclex_q.php?qn_id=541462)
- [A nurse is caring for a client with acute pyelonephritis. Which nursing intervention shoul…](https://mymerci.kr/pages/nclex_q.php?qn_id=541463)
- [A pregnant client at 28 weeks gestation is admitted to the hospital with suspected pyelone…](https://mymerci.kr/pages/nclex_q.php?qn_id=542953)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._