(2) Nephrolithiasis

Which clinical manifestations should 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. The client will be asymptomatic.

"2 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: Options ""1"" and ""3"" both have assessment data indicating bleeding. The test taker can usually eliminate these as possible answers or eliminate the other two options not addressing blood. Renal stones are painful; therefore, option ""4"" could be eliminated as a possible answer"

"The client diagnosed with renal calculi is admitted to the medical unit. Which intervention 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 ambulating the client"

"2 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 priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting 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 four (4) 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 if the client is not in distress."

A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter is to: 1.Irrigate the catheter with 30 mL of normal saline every 8 hours. 2.Ensure that the catheter is draining freely. 3.Clamp the catheter every 2 hours for 30 minutes. 4.Ensure that the catheter drains at least 30 mL/h.

"2 The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client's total urine output (ureteral catheter plus voiding or indwelling urinary catheter output) should be at least 30 mL/h."

A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to: 1. Irrigate the catheter with 30 mL of normal saline every 8 hours. 2. Ensure that the catheter is draining freely. 3. Clamp the catheter every 2 hours for 30 minutes. 4. Ensure that the catheter drains at least 30 mL/ hour.

"2. The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client's total urine output (ureteral catheter plus voiding or indwelling urinary catheter output) should be 30 mL/ hour."

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).

"3 1. This is appropriate for the client who has uric acid stones. 2. The nurse should recommend drinking one (1) to two (2) 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: The test taker should remember to read the question carefully. The question asks for a ""discharge teaching"" intervention. This rules out option ""4,"""

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? 1. Prevention of urinary tract complications. 2. Alleviation of nausea. 3. Alleviation of pain. 4. Maintenance of fluid and electrolyte balance.

"3. 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."

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? 1.Prevention of urinary tract complications. 2.Alleviation of nausea. 3.Alleviation of pain. 4.Maintenance of fluid and electrolyte balance.

"3. 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 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? 1.Decreased urine alkaline phosphatase level. 2.Increased urine calcium excretion. 3.Increased serum calcium level. 4.Decreased serum uric acid level.

"4 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 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? 1. Decreased urine alkaline phosphatase level. 2. Increased urine calcium excretion. 3. Increased serum calcium level. 4. Decreased serum uric acid level.

"4. 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."

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."

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 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."

"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 admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and postobstructive diuresis is occurring. Which of the following interventions should be done? A. Take vital signs every 8 hours B. Weigh the client every other day C. Assess for urine output every shift D. Monitor the client's electrolyte levels"

"D. Monitor the client's fluid and electrolyte levels Postobstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The client's weight should be taken daily to assess fluid status more closely."

"Which statement indicates 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 containing cocoa and chocolate."" 3. ""I will walk about a mile every week and not exercise often."" 4. ""I should take one (1) vitamin a day with extra calcium"""

1 1. An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stoneforming 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; therefore, 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 addressing fluid, and there is only one option addressing oral intake.

"A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan? 1.Increase daily fluid intake to at least 2 to 3 L. 2.Strain urine at home regularly. 3.Eliminate dairy products from the diet. 4.Follow measures to alkalinize the urine."

1 A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly

Which of the following interventions would be the most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery? 1.Encourage the client to ambulate every 2 to 4 hours. 2.Offer 3 to 4 oz (90 to 120 mL) of a carbonated beverage periodically. 3.Encourage use of a stool softener. 4.Continue IV fluid therapy.

1 Ambulation stimulates peristalsis. A client with paralytic ileus is kept on nothing-by-mouth status until peristalsis returns. Carbonated beverages will increase gas and distention but will not stimulate peristalsis. A stool softener will not stimulate peristalsis. IV fluid infusion is a routine postoperative prescription that does not have any effect on preventing paralytic ileus

"Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline-ash diet was prescribed. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? 1.Milk, apples, tomatoes, and corn. 2.Eggs, spinach, dried peas, and gravy. 3.Salmon, chicken, caviar, and asparagus. 4.Grapes, corn, cereals, and liver."

1 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.

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. 1. Nausea. 2. Rash. 3. Constipation. 4. Flushed skin. 5. Bone marrow depression.

1, 2, 5. 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.

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. 1.Nausea. 2.Rash. 3.Constipation. 4.Flushed skin. 5.Bone marrow depression.

1, 2, 5. 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 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 an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to

1,2,3 1. The health-care provider may order certain foods and medications when obtaining a 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 this urine. The test is started after the bladder is empty. 3. All urine for 24 hours 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. 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. The nurse can delegate placing the urine output in the proper container to the UAP; therefore, the UAP does not need to notify the nurse when the client urinates. TEST-TAKING HINT: This is an alternate-type question that has more than one correct answer. The test taker must be knowledgeable of specific laboratory tests.

Which of the following interventions would be the most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery? 1. Encourage the client to ambulate every 2 to 4 hours. 2. Offer 3 to 4 oz of a carbonated beverage periodically. 3. Encourage use of a stool softener. 4. Continue I.V. fluid therapy.

1. Ambulation stimulates peristalsis. A client with paralytic ileus is kept on nothing-by-mouth status until peristalsis returns. Carbonated beverages will increase gas and distention but will not stimulate peristalsis. A stool softener will not stimulate peristalsis. I.V. fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus.

"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? 1. Milk, apples, tomatoes, and corn. 2. Eggs, spinach, dried peas, and gravy. 3. Salmon, chicken, caviar, and asparagus. 4. Grapes, corn, cereals, and liver."

1. 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? 1.Maintaining bed rest. 2.Encouraging adequate fluid intake. 3.Assessing for hematuria. 4.Administering a laxative."

2 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? 1.Retinopathy. 2.Maculopapular rash. 3.Nasal congestion. 4.Dizziness.

2 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.

Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? 1.Applying moist heat to the flank area. 2.Administering meperidine (Demerol). 3.Encouraging high fluid intake. 4.Maintaining complete bed rest

2 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.

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? 1.Report hematuria to the physician. 2.Strain the urine carefully. 3.Administer meperidine (Demerol) every 3 hours. 4.Apply warm compresses to the flank area.

2 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 nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician? 1.Temperature, 99.8°F (37.7°C). 2.Urine output, 20 mL/h. 3.Absence of bowel sounds. 4.A 2″ × 2″ area of serosanguineous drainage on the flank dressing.

2 The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine output of 30 mL/h or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serosanguineous drainage is to be expected.

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: 1.Nephritis. 2.Referred pain. 3.Urine retention. 4.Additional stone formation.

2 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.

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? 1. Retinopathy. 2. Maculopapular rash. 3. Nasal congestion. 4. Dizziness.

2. 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.

Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? 1. Applying moist heat to the flank area. 2. Administering meperidine (Demerol). 3. Encouraging high fluid intake. 4. Maintaining complete bed rest.

2. 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.

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? 1. Report hematuria to the physician. 2. Strain the urine carefully. 3. Administer meperidine (Demerol) every 3 hours. 4. Apply warm compresses to the flank area.

2. 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 nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician? 1. Temperature, 99.8 ° F (37.7 ° C). 2. Urine output, 20 mL/ hour. 3. Absence of bowel sounds. 4. A 2″ × 2″ area of serosanguineous drainage on the flank dressing.

2. The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine output of 30 mL/ hour or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serosanguineous drainage is to be expected.

The client is diagnosed with a uric acid (purine) 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.

3 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 herring 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 test taker must have this knowledge to answer questions evaluating types of diets for specific diseases and disorders.

"The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP? 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 postprocedural vital signs"

3 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 a UAP. 2. Teaching cannot be delegated to a UAP. The nurse should teach and evaluate the effectiveness of the teaching. 3. The UAP 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 postprocedure. TEST-TAKING HINT: There are some basic rules about delegation: the nurse cannot delegate assessment, teaching, evaluation, or any task requiring judgment.

"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? 1.Ensuring adequate fluid intake on the day of the test. 2.Preparing the client for the possibility of bladder spasms during the test. 3.Checking the client's history for allergy to iodine. 4.Determining when the client last had a bowel movement."

3 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 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? 1. Ensuring adequate fluid intake on the day of the test. 2. Preparing the client for the possibility of bladder spasms during the test. 3. Checking the client's history for allergy to iodine. 4. Determining when the client last had a bowel movement."

3. 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 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 shellfish 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

4 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, which produces sound waves, resulting in a picture. TEST-TAKING HINT: The nurse must be aware of preprocedure and postprocedure 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

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000/mm3 .

4 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. The white blood cell count is elevated; normal is 5,000 to 10,000/mm3. 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 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: 1.Fluid and food will be withheld the morning of the examination. 2.A tranquilizer will be given before the examination. 3.An enema will be given before the examination. 4.No special preparation is required for the examination.

4 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? 1.Do not allow the client to ingest fluids. 2.Encourage the client to drink at least 500 mL of water each hour. 3.Request the central supply department to send supplies for straining urine. 4.Administer an opioid analgesic as prescribed."

4 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

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: 1. Fluid and food will be withheld the morning of the examination. 2. A tranquilizer will be given before the examination. 3. An enema will be given before the examination. 4. No special preparation is required for the examination.

4. 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? 1. Do not allow the client to ingest fluids. 2. Encourage the client to drink at least 500 mL of water each hour. 3. Request the central supply department to send supplies for straining urine. 4. Administer an opioid analgesic as prescribed."

4. 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.

"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.

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.

"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.

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 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.

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 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 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 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.

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.

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.

"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 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.

A client who has been diagnosed with 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. Strain the urine carefully 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 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.

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.

"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.

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 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.

"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.

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.

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 b

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.

"The nurse is receiving in transfer from the postanesthesia care unit a client who has had a percutaneous ultrasonic lithotripsy 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. Nephrostomy Tube 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 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.

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.

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. Alteration in comfort.

"4 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 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"

"A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan? 1. Increase daily fluid intake to at least 2 to 3 L. 2. Strain urine at home regularly. 3. Eliminate dairy products from the diet. 4. Follow measures to alkalinize the urine."

1. A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly.

"After an intravenous pyelogram (IVP), the nurse should anticipate incorporating which of the following measures into the client's plan of care? 1. Maintaining bed rest. 2. Encouraging adequate fluid intake. 3. Assessing for hematuria. 4. Administering a laxative."

2. 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.

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: 1. Nephritis. 2. Referred pain. 3. Urine retention. 4. Additional stone formation.

2. 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.

"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 two (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"

"2 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 surgical 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 evaluating 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 priority if the client is not in distress, but the test taker should make sure it is appropriate for the situation

"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 (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine"

"3 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 recommend any medication (even Tylenol) unless the nurse is absolutely sure what is wrong with the client. 3. A urinalysis can assess for hematuria, 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 needs 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 th

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