Renal Calculi NCLEX style questions

A client who has been diagnosed with renal calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time? a. Report hematuria to the physician. b. Strain the urine carefully. c. Administer meperidine (Demerol) every 3 hours. d. Apply warm compresses to the flank area.

B Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessened.

The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones? a. Calcium oxalate b. Uric acid c. Struvite d. Cystine

C Rationale: Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect that results in decreased renal absorption of the amino acid cystine.

The client with urolithiasis has a history of chronic urinary tract infections. The nurse plans teaching the client to avoid which of the following? a. Long-term use of antibiotics. b. Wearing synthetic underwear and pantyhose. c. High--phosphate foods, such as dairy products. d. Foods that make the urine more acidic, such as cranberries.

B Rationale: Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on prevention of infections and ingesting foods to make the urine more acidic. The client should wear cotton (not synthetic) underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection.

The nurse instructs a patient seen in the outpatient clinic with symptoms of renal calculi to strain all urine and to a. report the pain level when the stone passed. b. collect the stone and bring it to the clinic. c. record the time that the stone passed. d. save a urine specimen to check for blood.

B Rationale: The patient should save the stone for analysis of the stone composition, which will help in determining treatment. Reporting the pain level and recording the time the stone passed are not essential. Hematuria is common with urinary calculi, so it is not necessary to test the urine for blood.

A nurse is evaluating discharge instructions to a client admitted for urolithiasis. Which of the following statements made by the client indicates to the nurse a need for further instructions? a. "I will report any changes in the amount or character of urine to my physician." b. "If I have any pain during urination, I will inform my physician." c. "I will drink at least 2000 mL of fluid per day." d. "I will report any blood in my urine."

C Rationale: Measures to prevent further urolithiasis include increasing fluid intake to 2500 to 3500 mL per day. The client is also instructed to report any changes in the amount or character of urine. Dysuria, frequency, urgency, and cloudy urine are symptoms of a urinary tract infection, often associated with urolithiasis. Hematuria is often associated with calculi and with procedures used to remove stones.

A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors? a. Antibodies b. Type of infection c. Composition of calculus d. Size and number of calculi

C The calculus should be analyzed for composition to determine appropriate interventions such as dietary restrictions. Calculi don't result in infections. The size and number of calculi aren't relevant, and they don't contain antibodies.

Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. limit oral fluid intake for 1 to 2 weeks. b. report the presence of fine, sandlike particles through the nephrostomy tube. c. notify the physician about cloudy or foul-smelling urine. d. report bright pink urine within 24 hours after the procedure.

C The client should report the presence of foul-smelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal due to residual stone products. Hematuria is common after lithotripsy.

To prevent the recurrence of renal calculi, the nurse teaches the patient to a. avoid all sources of dietary calcium. b. drink diuretic fluids such as coffee. c. drink 2000 to 3000 ml of fluid a day. d. use a filter to strain all urine.

C Rationale: A fluid intake of 2000 to 3000 ml daily is recommended help flush out minerals before stones can form. Patients are not advised to avoid all calcium-containing foods and a high calcium intake may decrease the incidence of some types of stones. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.

A nurse is caring for a client with renal calculi. Which drug does the nurse expect the physician to order? a. Opioids analgesics b. Nonsteroidal anti-inflammatory drugs c. Muscle relaxants d. Salicylates

A Opioid analgesics are usually needed to relieve the severe pain of renal calculi. NSAIDs and Salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain. Muscle relaxants are typically used to treat skeletal muscle spasms.

A patient with a history of renal calculi is hospitalized with gross hematuria and severe colicky left flank pain that radiates to his left testicle. In planning care for the patient, the nurse gives the highest priority to the nursing diagnosis of a. acute pain related to irritation by the stone. b. deficient fluid volume related to inadequate intake. c. risk for infection related to urinary system damage. d. risk for nausea related to pain and renal colic.

A Rationale: Although all the diagnoses are appropriate, the initial nursing actions should focus on relief of the acute pain.

A patient with a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock-wave lithotripsy. Which information is most important for the nurse to collect after lithotripsy? a. Urine output b. Pain level c. Appearance of the site d. Patient temperature

A Rationale: Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to monitor the urine output. The patient may have pain as the stones pass and bruising at the site, but these are not unexpected. Extracorporeal shock wave lithotripsy (ESWL) is not associated with a risk for infection.

A client has a history of urolithiasis related to hyperuricemia. To prevent the formation of future stones, the nurse instructs the client to avoid certain foods, including: a. liver b. carrots c. skim milk d. white rice

A Rationale: Because the client has a high level of uric acid in the blood and a history of kidney stones from crystallized uric acid in the renal pelvis, the nurse instructs the client to avoid foods that contain high amounts of purines, because these foods contain a high concentration of uric acid. This includes limiting or avoiding organ meats, such as liver, brain, heart, and kidney. Other foods to avoid include sweetbreads, herring, sardines, anchovies, meat extracts, consommés, and gravies. Foods that are low in purines include all fruits, many vegetables, milk, cheese, eggs, refined cereals, coffee, tea, chocolate, and carbonated beverages.

A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which intervention is important? a. Strain all urine b. Limit fluid intake c. Enforce strict bed rest. d. Encourage a high-calcium diet

A Rationale: Urine should be strained for calculi and sent to the laboratory for analysis. Fluid intake of 3 to 4 qt. 3 to 4 L/day is encouraged to flush the urinary tract and prevent further calculi formation. Ambulation is encouraged to help pass the calculi through gravity. A low-calcium formation of calcium calculi.

A client has been prescribed allopurinol (Zyloprim) for renal calculi that are caused by high uric acid levels. Which of the following indicate the client is experiencing adverse effect( s) of this drug? Select all that apply. a. Nausea. b. Rash. c. Constipation. d. Flushed skin. e. Bone marrow depression.

A, B, E Common adverse effects of allopurinol (Zyloprim) include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.

The client is experiencing urolithiasis composed of Struvite. The nurse would teach the client that the cause of these stones is: a. calcium. b. uric acid. c. cystine. d. bacteria.

D Rationale: Most kidney stones are composed of calcium, others are from uric acid. Cystine stones are from a genetic defect whereas struvite stones originate from bacteria.

Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? a. Milk, apples, tomatoes, and corn. b. Eggs, spinach, dried peas, and gravy. c. Salmon, chicken, caviar, and asparagus. d. Grapes, corn, cereals, and liver.

A Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline-ash diet is also advocated because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Foods allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.

After an intravenous pyelogram (IVP), the nurse should anticipate incorporating which of the following measures into the client's plan of care? a. Maintaining bed rest. b. Encouraging adequate fluid intake. c. Assessing for hematuria. d. Administering a laxative.

B After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria.

Allopurinol (Zyloprim), 200 mg/ day, is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which of the following adverse effects of this medication? a. Retinopathy. b. Maculopapular rash. c. Nasal congestion. d. Dizziness.

B Allopurinol (Zyloprim) is used to treat renal calculi composed of uric acid. Adverse effects of allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report rashes and unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not adverse effects of allopurinol.

In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. The nurse should assess the client further for signs of: a. Nephritis. b. Referred pain. c. Urine retention. d. Additional stone formation.

B The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and to the testicles in male clients. Nausea, vomiting, abdominal cramping, and diarrhea may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of pain described in this situation is unlikely to be caused by additional stone formation.

A nurse is instructing a client with renal calculi about recommended daily fluid consumption. The nurse would be most helpful by telling the client to drink approximately: a. 4 cups per day b. 8 cups per day c. 12 cups per day d. 16 cups per day

C A client with renal calculi should drink 3L (12 cups) of fluid per day.

A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6 ° F (38.1 ° C). Which of the following would be a priority outcome for this client? a. Prevention of urinary tract complications. b. Alleviation of nausea. c. Alleviation of pain. d. Maintenance of fluid and electrolyte balance.

C The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate throughout the client's hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte imbalance.

The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. To prepare the client for this procedure, the nurse should explain to the client that: a. Fluid and food will be withheld the morning of the examination. b. A tranquilizer will be given before the examination. c. An enema will be given before the examination. d. No special preparation is required for the examination.

D A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances.

A client has renal colic due to renal lithiasis. What is the nurse's first priority in managing care for this client? a. Do not allow the client to ingest fluids. b. Encourage the client to drink at least 500 mL of water each hour. c. Request the central supply department to send supplies for straining urine. d. Administer an opioid analgesic as prescribed.

D If infection or blockage caused by calculi is present, a client can experience sudden severe pain in the flank area, known as renal colic. Pain from a kidney stone is considered an emergency situation and requires analgesic intervention. Withholding fluids will make urine more concentrated and stones more difficult to pass naturally. Forcing large quantities of fluid may cause hydronephrosis if urine is prevented from flowing past calculi. Straining urine for small stones is important, but does not take priority over pain management.

During a health history, which statement by a client indicates a risk of renal calculi? a. "I've been drinking a lot of cola soft drinks lately." b. "I've been jogging more than usual." c. "I've had more stress since we adopted a child last year." d. "I'm a vegetarian and eat cheese two or three times each day."

D Renal calculi are commonly composed of calcium. Diets high in calcium may predispose a person to renal calculi. Milk and milk products are high in calcium. Cola soft drinks don't contain ingredients that would increase the risk of renal calculi. Jogging and increased stress aren't considered risk factors for renal calculi formation.

A nurse is instructing a client with oxalate renal calculi. What foods should the nurse urge the client to eliminate from his diet? a. Citrus fruits, molasses, and dried apricots b. Milk, cheese, and ice cream c. Sardines, liver and kidney d. Spinach rhubarb and asparagus

D To reduce the formation of oxalate calculi, urge the client to avoid foods high in oxalate, such as spinach, rhubarb, and asparagus. Other oxalate- rich foods to avoid include tomatoes, beets, chocolate, cocoa, celery, and parsley. Citrus fruits, molasses, dried apricots, milk, cheese, ice cream, sardines and organ meats do NOT produce oxalate and do NOT need to be omitted from the client's diet.

A client is being admitted to the hospital with a diagnosis of urolithiasis and ureteral colic. The nurse assesses the client for pain that is: a. dull and aching in the costovetebal area b. aching and camplike thoughout the abdomen c. sharp and radiating posteriorly to the spinal column d. excruciating, wavelike, and radiating toward the genitalia

D excruciating, wavelike, and radiating toward the genitalia

Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? a. Applying moist heat to the flank area. b. Administering meperidine (Demerol). c. Encouraging high fluid intake. d. Maintaining complete bed rest.

B During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.

The nurse is reviewing laboratory reports for a client who is taking allopurinol (Zyloprim). Which of the following indicate that the drug has had a therapeutic effect? a. Decreased urine alkaline phosphatase level. b. Increased urine calcium excretion. c. Increased serum calcium level. d. Decreased serum uric acid level.

D By inhibiting uric acid synthesis, allopurinol (Zyloprim) decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, nor does it affect urine calcium excretion or the serum calcium level.

The composition of a patient's renal calculus is identified as uric acid. To prevent recurrence of stones, the nurse teaches the patient to avoid a. spinach, chocolate, and tomatoes. b. organ meats and fish with fine bones. c. milk and dairy products. d. legumes and dried fruits.

B Rationale: Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.

The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which of the following measures would be most important for the nurse to include in pretest preparation? a. Ensuring adequate fluid intake on the day of the test. b. Preparing the client for the possibility of bladder spasms during the test. c. Checking the client's history for allergy to iodine. d. Determining when the client last had a bowel movement.

C A client scheduled for an IVP should be assessed for allergies to iodine and shellfish. Clients with such allergies may be allergic to the IVP dye and be at risk for an anaphylactic reaction. Adequate fluid intake is important after the examination. Bladder spasms are not common during an IVP. Bowel preparation is important before an IVP to allow visualization of the ureters and bladder, but checking for allergies is most important.

The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include on the client's postoperative care? a. Sterile irrigation of the Penrose drain b. Frequent dressing changes around the Penrose drain c. Weighing the dressings d. Maintaining the client's position on the affected side

B Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. A Penrose drain is not irrigated. Weighing the dressings is not necessary. Placing the client on the affected side will prevent a free flow of urine through the drain.

The client who has a history of gout also is diagnosed with urolithiasis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: a. Milk b. Liver c. Apples d. Carrots

B Rationale: The client with uric acid stones should avoid foods containing high amounts of purines. This includes limiting or avoiding organ meats such as liver, brain, heart, kidney, and sweetbreads. Other foods to avoid include herring, sardines, anchovies, meat extracts, consommés, and gravies. Foods that are low in purines include all fruits, many vegetables, milk, cheese, eggs, refined cereals, sugars and sweets, coffee, tea, chocolate, and carbonated beverages.

The nurse is receiving in transfer from the postanesthesia care unit a client who has had a percutaneous ultrasonic lithrotripsy for calculuses in the renal pelvis. The nurse anticipates that the client's care will involve monitoring which of the following? a. Suprapubic tube b. Urethral stent c. Nephrostomy tube d. Jackson-Pratt drain

C A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculus fragments.

The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions? a. Increase intake of meat, fish, plums, and cranberries b. Avoid citrus fruits and citrus juices c. Avoid green, leafy vegetables such as spinach. d. Increase intake of dairy products.

C Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

A client with urolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL). The nurse assesses to ensure that which of the following items are in place or maintained before sending the client for the procedure? a. IV line and a foley catheter b. NPO status and a foley catheter c. signed informed consent, NPO status, and an IV line d. signed informed consent and clear liquid restriction preprocedure

C Rationale: ESWL is done with conscious sedation or general anesthesia. The client must sign an informed consent form for the procedure and must be NPO for the procedure. The client needs an IV line for the procedure as well. A Foley catheter is not needed.