UTI and Kidney Stones

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? a. "I should increase my fluid intake, especially in warm weather." b. "I should eat foods containing cocoa and chocolate." c. "I will walk about a mile every week and not exercise often." d. "I should take one vitamin a day with extra calcium."

a An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stone forming salts from becoming concentrated enough to precipitate.

A female patient has a UTI and kidney stones. The nurse knows that they are most likely which type of stone? a. cystine b. struvite c. uric acid d. calcium phosphate

b Struvite stones are most common in women and always occur with UTIs. They are usually large staghorn type.

A nurse in a Women's Health clinic is caring for a client who reports urinary urgency and disurea. Which of the following additional findings should the nurse identify as an indication of a urinary tract infection? a. bagenal discharge b. pyuria c. glucosuria d. elevated creatine kinase MB

b The nurse should identify pyuria, or white blood cells in the urine as a common manifestation of a UTI.

Which classification of UTI is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI b. Lower UTI c. Complicated UTI d. Uncomplicated UTI

a An upper UTI affects the renal parenchyma, renal pelvis, and ureters. A lower UTI is an infection of the bladder and/or urethra. A complicated UTI exists in the presence of coexisting obstruction, stones, catheters, or preexisting diseases. An uncomplicated UTI occurs in an otherwise normal urinary tract.

Besides being mixed with struvite or oxalate stones, what characteristics is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective GI and kidney absorption

a Calcium phosphate stones are typically mixed with struvite or oxalate stones and related to alkaline urine. Cystine stones are associated with a genetic autosomal recessive defect and defective GI and kidney absorption of cystine. Struvite stones are 3 to 4 times more common in women than in men.

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first? a. A midstream urine for culture. b. A sonogram of the kidney. c. An intravenous pyelogram for renal calculi. d. A CT scan of the kidneys.

a Fever, chills, and costovertebral pain are clinical manifestations of a urinary tract infection (acute pyelonephritis), which requires a urine culture first to confirm the diagnosis.

The client diagnosed with renal calculi is schedule for a 24-hour urine specimen collection. Which interventions should the RN implement? SATA a. Check for the ordered diet and medication modifications. b. Instruct the client to urinate, and discard this urine when starting a collection. c. Collect all urine for 24 hours and place it in the appropriate specimen container. d. Insert an indwelling catheter in the client after having the client empty the bladder. e. Instruct the UAP to notify the nurse when the client urinates.

a, b, c The HCP may order certain foods and medications when obtaining a 24-hr urine collection to evaluate for calcium oxalate or uric acid. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. All urine for 24-hrs should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result.

Following electrohydraulic lithotripsy for treatment of kidney stones, the patient has a nursing diagnosis of risk for infection. What is the most appropriate nursing intervention for this patient? a. monitor for hematuria b. encourage fluid intake of 3 L/day c. apply moist heat to the flank area d. strain all urine through gauze or a special strainer

b A high fluid intake maintains dilute urine, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals. Moist heat to the flank may be helpful to relieve muscle spasms during renal colic. All urine should be strained in patients with renal stones to collect and identify stone composition, but these are not related to infection. Interprofessional care usually will include antibiotics to reduce infection risk.

During assessment of the patient who had an open nephrectomy, what should the nurse expect to find? a. Shallow, slow respirations b. Clear breath sounds in all lung fields c. Decreased breath sounds in the lower left lobe d. Decreased breath sounds in the right and left lower lobes

b A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breath deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? a. Monitor the client's urinary output. b. Assess the client's pain and rule out complications. c. Increase the client's oral fluid intake. d. Use a safety gait belt when ambulating the client.

b Assessment is the first part of the nursing process and is a priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope.

What should the nurse include in the teaching plan for a female patient with a UTI? a. Empty the bladder at least 4 times a day. b. Drink at least 2 quarts of water every day. c. Wait to urinate until the urge is very intense. d. Clean the urinary meatus with an anti infective agent after voiding.

b Fluid intake should be increased to about 2000 mL/day without caffeine, alcohol, citrus juices, and chocolate drinks, because they are potential bladder irritants. The bladder should be emptied at least every 3 to 4 hours, not waiting until an intense urge. Cleaning the urinary meatus with an anti infective agent after voiding will irritate the meatus, but the perineal area should be wiped from front to back after urination and defecation to prevent fecal contamination of the meatus.

A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient immediately after the procedure, what is the most appropriate nursing action? a. Milk or strip the catheter every 2 hrs b. Measure ureteral urinary drainage every 1 to 2 hr c. Encourage ambulation to promote urinary peristaltic action d. Irrigate the catheter with a 30-mL sterile saline every 4 hr

b Output from urethral catheters must be monitored every 1 to 2 hours because an obstruction will cause over distention of the renal pelvis and renal damage. The renal pelvis has a capacity of only 3 to 5 mL, and if irrigation is ordered, no more than 5 mL of sterile saline is used. The patient with a ureteral catheter is usually kept on bed rest until specific orders for ambulation are given. Suprapubic tubes may be milked to prevent obstruction of the catheter by sediment and clots.

Which intervention is most important for the nurse to implement for the client diagnosed with possible renal calculi? a. Assess the client's neurological status every 2 hours. b. Strain all urine and send any sediment to the lab. c. Monitor the client's creatinine and BUN levels. d. Take a 24-hr dietary recall during the client interview.

b Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the lab to determine what caused the stone.

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? a. Dull, aching flank pain, and microscopic hematuria. b. Nausea; vomiting; pallor; and cool, clammy skin. c. Gross hematuria and dull suprapubic pain with voiding. d. The client will be asymptomatic.

b The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin.

A patient with a history of gout has been diagnosed with renal calculi (kidney stones). Which treatment will be used with this patient. SATA. a. Reduce dietary oxalate b. Administer allopurinol c. Administer alpha-penicillamine d. Administer thiazide diuretics e. Reduce animal protein intake f. Reduce intake of milk products

b, e This patient is most likely to have uric acid stones. Gout is a predisposing factor. The treatment will include allopurinol and reducing animal protein intake to reduce purine, as uric acid is a waste product from purine metabolism. Reducing oxalate and using thiazide diuretics help treat calcium oxalate stones. Giving alpha-penicillamine and tiopronin prevents cystine crystallization for cystine stones. Reducing intake of milk products to decrease calcium intake of milk products to decrease calcium intake may be indicated for patients with calcium stones.

On assessment of the patient with a kidney stone passing down the ureter, what should the nurse expect the patient to report? a. A history of chronic UTIs b. Dull, costovertebral flank pain c. Severe, colicky back pain radiating to the groin d. A feeling of bladder fullness with urgency and frequency

c A classic sign of the passage of a stone down the ureter is intense, colicky back pain that may radiate into the testicles, labia, or groin and may be accompanied by mild shock with cool, moist skin. Many patients with renal stones do not have a history of chronic UTIs. Stones obstructing a calyx or at the ureteropelvic junction may produce dull costovertebral flank pain, and large bladder stones may cause bladder fullness and lower obstructive symptoms.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? a. Increase water intake for the next 24 hours. b. Take two acetaminophen to help decrease the temperature. c. Come to the clinical and provide a urine specimen for urinalysis. d. Use a sterile 4 x 4 gauze to strain the client's urine.

c A urinalysis can assess for hematuria, the presence of WBCs, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying clinical manifestations of UTI.

33. What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients? a. Measuring urine output every 1 to 2 hr to ensure patency b. Turning the patient frequently from side to side to promote drainage c. Using strict sterile technique during irrigation and obtaining culture specimens d. Daily cleaning of the catheter insertion site with soap and water and application of lotion

c All urinary catheters in hospitalized patients pose a very high risk for infection, especially antibiotic-resistant, health care-associated infections, and scrupulous aseptic technique is essential in the insertion and maintenance of all catheters. Routine irrigations are not performed. Turning the patient to promote drainage is recommended only for suprapubic catheters. Cleaning the insertion site with soap and water should be performed for urethral and suprapubic catheters, but lotion or powder should be avoided. Site care for the catheters may require special interventions.

What can patients at risk for kidney stones do to prevent them in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

c Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is by drinking adequate fluids to keep the urine dilute and flowing (e.g., an output of about 2 L of urine a day). Sedentary lifestyle is a risk factor for renal stones, but exercise also causes fluid loss and a need for additional fluids. Protein foods high in purine should be restricted only for the small percentage of patients with uric acid stones. Although UTIs contribute to stone formation, prophylactic antibiotics are not indicated.

Which type of urinary tract stones are the most common and often obstruct the ureter? a. cystine b. uric acid c. calcium oxalate d. calcium phosphate

c Calcium oxalate stones are most common (35% to 40%) and small enough to get trapped in the ureter. Cystine stones incidence is 1% to 2%; uric acid incidence is 5% to 8%; calcium phosphate incidence is 8% to 10%.

The lab data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? a. Encourage the client to eat a low-purine diet and limit foods such as organ meats. b. Explain the importance of not drinking water 2 hours before bedtime. c. Discuss the importance of limiting vitamin D-enriched foods. d. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

c Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the GI tract.

The client diagnosed with renal calculi is scheduled for a lithotripsy. Which post procedure nursing task is the most appropriate to delegate to the UAP? a. Monitor the amount, color, and consistency of urine output. b. Teach the client about the care of the indwelling Foley catheter. c. Assist the client to the car when being discharged home. d. Take the client's postprocedural vital signs.

c The UAP could assist the client to the car once the discharge has been completed.

The nurse is discharging a client diagnosed with a catheter-associated urinary tract infection (CAUTI). Which information should the nurse include in the discharge teaching? a. Liimit fluid intake so the urinary tract can heal. b. Collect a routine urine specimen for culture. c. Take all the antibiotics as prescribed. d. Tell the client to void every 5 to 6 hours.

c The client should be taught to take all the prescribed medication anytime a prescription is written for antibiotics.

While caring for a 77 y/o woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient likely to experience? a. Cloudy urine and fever b. Urethral burning and bloody urine c. Vague abdominal discomfort and disorientation d. Suprapubic pain and slight decline in body temperature

c The usual classic manifestations of UTI are often absent in older adults, who tend to have non localized abdominal discomfort and cognitive impairment characterized by confusion or decreased level of consciousness rather than dysuria and suprapubic pain.

The nurse is examining a 15 y/o female client reporting pain, frequency, and urgency when urinating. After asking the parent to leave the room, which question should the nurse ask the client? a. "When was your last menstrual cycle?" b. "Have you noticed any change in the color of the urine?" c. "Are you sexually active?" d. "What have you taken for the pain?"

c These are clinical manifestations of cystitis, a bladder infection, which may be caused by sexual intercourse as a result of the introduction of bacteria into the urethra during the physical act. A teenager may not want to divulge this information in front of the parent.

A woman with no history of UTI who has no urgency, frequency, a no dysuria comes to the clinic. A dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity. b. No treatment with medication unless she develops fever, chills, and flank pain. c. Empirical treatment with trimethoprim-sulfamethoxazole (Bactrim) for 3 days. d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests.

c Unless a patient has a history of recurrent UTIs or a complicated UTI, trimethoprim-sulfamethoxazole or nitrofurantoin is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment, but symptomatic UTIs should always be treated.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? a. Beer and cola b. Asparagus and cabbage c. Venison and sardines d. Cheese and eggs

c Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.

A nurse is caring for a client who is schedule for an intravenous urography. Which of the following interventions is the nurse's priority? a. Tell the client to increase fluid intake following the procedure. b. Place the informed consent document in the clients medical record. c. Inform the client that a warm sensation can occur when the contrast dye is injected. d. Determine if the client has an allergy to iodine or shellfish.

d

The female client in an outpatient clinic is being sent home with a diagnosis of UTI. Which instruction should the nurse teach to prevent a recurrence of a UTI? a. Clean the perineum from back to front after a bowel movement. b. Take warm tub baths instead of hot showers daily. c. Void immediately preceding sexual intercourse. d. Avoid coffee, tea, colas, and alcoholic beverages.

d Coffee, tea, cola, and alcoholic beverages are urinary tract irritants.

The client diagnosed with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement first? a. Ask if the client is allergic to shellfish or iodine. b. Keep the client NPO 8 hours before the ultrasound. c. Ensure the client has a signed informed consent form. d. Explain the test is noninvasive, and there is no discomfort

d No special preparation is needed for this noninvasive, non painful test. A conductive gel is applied to the back or flank and then a transducer is applied, which produces sound waves, resulting in a picture.

Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks? a. milk and milk products b. dried beans and dried fruits c. liver, kidney, and sweetbreads d. spinach, cabbage, and tomatoes

d Oxalate-rich foods should be limited to reduce oxalate excretion. Foods high in oxalate include spinach, rhubarb, asparagus, cabbage, and tomatoes, chocolate, coffee, and cocoa. Encourage increased intake of calcium, fruits, and vegetables. Milk, milk products, dried beans, and dried fruits are sources of high levels of calcium. Organ meats are high in purine, which contributes to uric acid stones.

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is the priority when caring for this client? a. Fluid volume loss b. Knowledge deficit c. Impaired urinary elimination d. Alteration in comfort

d Pain is the priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.

A nurse is caring for a client following extracorporeal shock wave lithotripsy for the treatment of calcium kidney stones. Which of the following actions should the nurse take? a. Monitor the client's urine for ketones. b. Provide the client with an increased animal protein diet. c. Limit the client's fluid intak to 1.5 L day d. Strain all of the client's urine

d The nurse should strain all of the client's urine following ESWL to monitor for stone fragments that have left the client's body.

The client had surgery to remove a kidney stone. Which lab assessment data warrant immediate intervention by the nurse? a. A serum potassium level of 3.8. b. A urinalysis shows microscopic hematuria. c. A creatinine level of 0.8. d. A white blood cell count of 14x10

d The white blood cell count is elevated; normal is 4.5 to 11.1.

The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first? a. Start an IV with a 20-gauge catheter. b. Initiate antibiotic therapy IVPB. c. Collect a urine specimen for culture. d. Change the indwelling catheter.

d Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis.