N300 Exam 2: Renal Calculi
Which clinical manifestations would the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. No symptoms.
1. Dull flank pain and microscopic hematuria are manifestations of a renal stone in the kidney. ***2. 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. 3. Gross hematuria and suprapubic pain when voiding are manifestations of a stone in the bladder. 4. Kidney stones and bladder stones may produce no signs/symptoms, but a ureteral stone always causes pain on the affected side because a ureteral spasm occurs when the stone obstructs the ureter. TEST-TAKING HINT: Note that options "1" and "3" both have assessment data that indicate bleeding. The test taker can usually eliminate these as possible answers or eliminate the other two options that do not address blood. Renal stones are painful; therefore "4" could be eliminated as a possible answer.
The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shell fish or iodine. 2. Keep the client NPO eight (8) hours prior to the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.
1. An ultrasound does not require administration of contrast dye. 2. Food, fluids, and ordered medication are not restricted prior to this test. 3. This is not an invasive procedure so a signed consent is not required. ***4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied that produces sound waves that produce a picture. TEST-TAKING HINT: The nurse must be aware of pre-procedure and post-procedure teaching and care. The test taker must know the invasive and noninvasive diagnostic tests in general. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are a few of the noninvasive diagnostic tests.
Which intervention is most important for the nurse to implement for the client diagnosed with rule out renal calculi? 1. Assess the client's neurological status every 2 hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.
1. Assessment is important but the neurological system is not priority for a client with a urinary problem. ***2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgi- cal procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone. 3. These are laboratory studies that evaluate kidney function, but they are not pertinent when passing a renal stone. These values do not elevate until at least half the kidney function is lost. 4. A dietary recall can be done to determine what types of foods the client is eating that may contribute to the stone formation, but it is not the most important intervention. TEST-TAKING HINT: Remember if the question asks for "most important," more than one of the options could be appropriate but only one is most important. Assessment is always priority, but make sure it is appropriate for the situation.
The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.
1. Beer and colas are foods high in oxalate, which can cause calcium oxalate stones. 2. Asparagus and cabbage are foods high in oxalate, which can cause calcium oxalate stones. ***3. Venison, sardines, goose, organ meats, and herrings are high purine foods, which should be eliminated from the diet to help prevent uric acid stones. 4. Cheese and eggs are foods that help acidify the urine and do not cause the development of uric acid stones. TEST-TAKING HINT: The nurse has to be knowledgeable of foods included in specific diets. This is memorizing, but the reader must have this knowledge to answer questions evaluating types of diets for specific diseases and disorders.
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? 1. Increase water intake for the next 24 hours. 2. Take two Tylenol to help decrease the temperature. 3. Come to the clinic and give a urinalysis specimen. 4. Use a sterile 4 4 gauze to strain the client's urine.
1. The client needs to be evaluated for a possible urinary tract infection, which may accompany renal calculi. Therefore, the clinic nurse should not give advice without knowing what is wrong with the client. 2. The nurse should not prescribe medication (even Tylenol) unless the nurse is absolutely sure what is wrong with the client. ***3. A urinalysis can assess for hematuria (red blood cells in the urine), the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI. 4. The client would need to strain the urine if there is a possibility of renal calculi, which these signs/symptoms do not support. Further diagnostic testing is needed to determine the presence of renal calculi. TEST-TAKING HINT: Fever, chills, and burning on urination require some type of assessment. Therefore the test taker should select an option that helps determine what is wrong with the client and "3" is the only option.
The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Pain.
1. The client's fluid volume is increased and there is usually not a fluid volume loss. 2. Knowledge deficit is important to help prevent future renal calculi, but this is not priority when the client is in pain, which will occur with an acute episode. 3. Impaired urinary elimination may occur, but it is not priority for the client with an acute episode of calculi. ***4. Pain is priority. The pain can be so severe that a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin. TEST-TAKING HINT: Remember Maslow's Hierarchy of Needs: airway and pain are priority. No option mentions possible airway problems, so pain is priority.
The client diagnosed with renal calculi is admitted to the medical unit. Which inter- vention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when walking the client.
1. The client's urinary output should be monitored, but it is not the first nursing intervention. ***2. Assessment is the first part of the nursing process and is always priority. The intensity of the renal colic pain can be so intense it can cause a vasovagal response, with result- ing hypotension and syncope. 3. Increased fluid increases urinary output, which will facilitate movement of the renal stone through the ureter and help decrease pain, but it is not the first intervention. 4. Ambulation will help facilitate movement of the renal stone through the ureter and safety is important, but it is not the first intervention. TEST-TAKING HINT: Remember if the question asks which intervention is first, all 4 (four) options may be appropriate for the client's diagnosis but only one has priority. Assessment is the first part of the nursing process and it is the first intervention a nurse should implement.
The client diagnosed with renal calculi is scheduled for lithotripsy. Which post- procedure nursing task would be most appropriate to delegate to the unlicensed nurs- ing assistant (NA)? 1. Monitor the amount, color, and consistency of urine output. 2. Teach the client about care of the indwelling Foley catheter. 3. Assist the client to the car when being discharged home. 4. Take the client's post-procedural vital signs.
1. The urine must be assessed for bleeding and cloudiness. Initially the urine is bright red, but the color soon diminishes and cloudiness may indicate an infection. This assessment should not be delegated to an NA. 2. Teaching cannot be delegated to an NA. The nurse should teach and evaluate the effective- ness of the teaching. ***3. The NA could assist the client to the car once the discharge has been completed. 4. The kidney is highly vascular. Hemorrhaging and resulting shock are potential complications of lithotripsy, so the nurse should not delegate vital signs post-procedure. TEST-TAKING HINT: There are some basic rules about delegation; the nurse should never delegate assessment, teaching, or any task that requires judgment.
The client had surgery to remove a kidney stone. Which laboratory assessment data would warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis that shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000 mm/dL.
1. This potassium level is within normal limits, 3.5 to 5.5 mEq/L. 2. Hematuria is not uncommon after removal of a kidney stone. 3. A normal creatinine level is 0.8 to 1.2 mg/100 mL. ***4. This white blood cell count is elevated; normal is 5,000-10,000 mm. TEST-TAKING HINT: The nurse must know normal laboratory data and be able to apply the normal and abnormal results to specific diseases and disorders.
The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).
1. This would be appropriate for the client who has uric acid stones. 2. The nurse should recommend drinking one to two glasses of water at night to prevent concentration of urine during sleep. ***3. 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 gastrointestinal tract. 4. This is a treatment for an existing renal stone, not a discharge teaching intervention for a client who has successfully passed a renal calculus. TEST-TAKING HINT: Remember to read the question carefully. The question asks for a "discharge teaching" intervention. This would rule out "4," which is a treatment, as a potential answer.
Which statement indicates that the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods that contain cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one vitamin a day that has extra calcium."
***1. An increased fluid intake that ensures 2-3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate. 2. Cocoa and chocolate are high in calcium and should be avoided or the amount should be decreased to help prevent formation of calcium phosphate renal stones. 3. Physical activity prevents bone absorption and possible hypercalciuria; therefore, the nurse should instruct the client to walk daily to help retain calcium in bone. 4. The renal calculi are caused by calcium; there- fore, the client should not increase calcium intake. TEST-TAKING HINT: This is a urinary problem and fluid is priority. Therefore the test taker should select an option that addresses fluid, and there is only one option that addresses oral intake.
The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert a Foley catheter in client after having the client empty the bladder. 5. Post notices on the client's door to save all urine output.
***1. The health-care provider may order certain foods and medications when obtaining 24- hour urine collection to evaluate for calcium oxalate or uric acid. ***2. When the collection begins, the client should completely empty the bladder and discard that urine. ***3. All urine for 24 hours should be saved and put in a container with preservative, refrig- erated, or put on ice as indicated. Not following specific instructions will result in an inaccurate test result. 4. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized. ***5. Posting signs will help ensure that all the urine is saved during the 24-hour period. If any urine is discarded, the test may result in inaccurate information or the need to start the test over. TEST-TAKING HINT: This is an alternate-type question that may have more than one correct answer. The test taker must be knowledgeable of specific laboratory tests.