Calculi Test 4

c

A client being discharged after lithotripsy for removal of a kidney stone. Which statement by the client indicates an understanding of the nurses instructions? a. i will need to strain my urine in the morning b. i will need to save all my urine c. I will be careful to strain my urine and save the stone d. i wont need to strain my urine now that the procedure is complete

a

Which of the following is a classic manifestation of glomerulonephritis? a hypertension b. lassitude c. fatigue d vomiting and diarrhea

b (Intermittent pain that is less colicky indicates the stone 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. Analgesics should be administered when the pt needs them, not routinely. moist heat to the flank is helpful but is less necessary when pain is lessened)

A client has been diagnosed with renal calculi and reports that the pain is intermittent and less colicky. Which nursing action is MOST important at this time? a. report hematuria to the HCP b. strain the urine carefully c. administer meperidine every 3 hours d. apply warm compresses to the flank area

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.)

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

a (Rationale Urinary calculi can be caused by a genetic predisposition to the accumulation of certain mineral substances in the urine. Calculi may also be caused by a congenital lack of protective factors. )

The nurse is assigned to care for a client admitted last night with urinary calculi. The client asks the nurse what causes the development of urinary calculi. What is the best response of the​ nurse? a ​"You probably inherited a genetic tendency to develop​ calculi." ​b "It is just something that happens. There is no specific​ cause." ​c "It is probably because of​ anxiety." d ​"Urinary calculi are caused by inflammation of the urinary​ bladder."

b,d,e (Rationale: Risk factors for developing renal calculi include excess dietary intake of calcium, oxalate, or proteins, dehydration with resultant increase in urine concentration, and immobility. Fruits and vegetables do not help the formation of kidney stones.)

The nurse, assessing a client diagnosed with kidney stones, suspects the development of calculi may be related to: (Select all that apply.) a The client's intake of three bananas daily. b The client's intake of a liter of milk every day. c The client's intake of large quantities of tomatoes. d Dehydration following recent gastroenteritis. e Immobility and sedentary lifestyle.

b (during episode of renal colic, the pain is excruciating It is necessary to control the pain. meperdine is Demerol. The other measures are important interventions but not the MOST )

Which 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 c. encouraging high fluid intake d. maintaining complete bed rest

a (a high fluid intake is essential for all clients with risk for stone formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the component of the stone, the client may have dietary measures aimed at specific condition. )

A client with a history of renal stones is being discharged after surgery to remove the stone. What instruction should the nurse include in the clients discharge teaching plan? a. increase fluid to 2 to 3 L at least b. strain urine at home regularly c. eliminate dairy from diet d. follow measures to alkinilize urine

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

The client with urolithiasis has a history of chronic urinary tract infections. The nurse 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

b (The decrease in urine output may reflect inadequate renal perfusion and should be reported immed. Urine output of 30 mL/hr or greater is considered acceptable. A slight elevation in temp is expected after surgery. Peristalsis returns gradually, the 2nd or 3rd day after surgery. Bowel sounds will be absent until then. A small amt of serosanguineous drainage is to be expected)

The nurse is conducting a post op assess of a client on the first day after renal surgery. The nurse should report which finding to the HCP? a. temp 99.8 F (37.7 C) b. urine output 20 mL/hr c. absence of bowel sounds d. a 2x2" area of serosanguineous drainage on the flank dressing

a

When assessing the output of a client who has had extracorporeal lithotripsy the nurse can expect to find: a. cherry red urine that gradually becomes clearer b. orange tinged urine containing particles of calculi c. dark red urine that becomes cloudy in appearance d. dark,smoky colored urine with a high specific gravity

a (The nurse should give priority to IV fluids. Increasing the intake to 3000 mL/day will help prevent the obstruction of urine flow by increasing the frequency and volume of urinary output. Answer c is important but has no effect on preventing or alleviating the obstruction of urine flow from the kidney.)

A client is admitted with a diagnoses of renal calculi, the nurse should give priority to: a. initiating an IV infusion b. encouraging oral fluids c. administering pain medications d. straining the urine

b (the cath should drain freely without bleeding at the site. The cath is rarely irrigated and any irrigation would be done by the HCP. The cath is NEVER clamped. The clients total urine output should be AT LEAST 30 mL/hr)

A client has a ureteral cath in place after renal surgery. A priority nursing action for care of the uretral cath is to: a. irrigate the cath with 30 mL of NS q8h b. ensure the cath is draining freely c. clamp the cath every 2 hours for 30 mins d. ensure the cath drains at least 30 mL/hr

b (Rationale: The renal medulla is composed of structures called pyramids and calyces. The calyces collect urine and transport it into the renal pelvis, which is the funnel-shaped superior end of the ureter. Removal of lymph, filtration of blood, and clearance of toxins are not affected by stones.)

A client has been diagnosed with a kidney stone, lodged within the medulla of the right kidney. Which of the following will this stone most affect? a The filtration of blood b The collection of urine c The clearance of toxins d The removal of lymph

d (If infection or blockage 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 concentrate urine and stones more difficult to pass. 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 mngmt.)

A client has renal colic due to renal lithiasis. What is the nurses first priority in managing care of 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 dept. to send supplies for straining urine d. administer the opoid analgesic as prescribed.

c (the priority nursing goal for this client is to alleviate pain which could be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate thruought the clients hospitalization, but the relief of 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 temp is 100.6 F (38.1 C) Which outcome is the priority for this client? a. prevention of urinary tract complications b. alleviation of nausea c. alleviation of pain d. maintenance of fluid and electrolyte blance

d (Rationale Intravenous pyelography is one of the tests that is used to diagnose urinary calculi. Other diagnostic tests that may also be used include a urinalysis and​ kidneys, ureters, and bladder​ x-ray (KUB). A​ CBC, chemistry​ panel, and blood cultures will not diagnose calculi.)

A client presents to the emergency department with symptoms of right​ lower-quadrant pain,​ fatigue, nausea, and vomiting. Laboratory work is completed that indicates that the client has urinary calculi. The client asks the nurse​ "How are urinary calculi​ diagnosed? What should the​ nurse's response​ include? a Blood cultures b CBC c Chemistry panel d Intravenous pyelography

1 (When patients with urolithiasis pass stones, they can be in excruciating pain for up to 24 to 36 hours. All of the other nursing diagnoses for this patient are accurate; however, at this time, pain is the most urgent concern for the patient. Focus: Prioritization)

A patient has urolithiasis and is passing the stones into the lower urinary tract. What is the priority nursing diagnosis for the patient at this time? 1. Acute Pain 2. Risk for Infection 3. Risk for Injury 4. Anxiety related to the risk for recurrent stones

a (Rationale: The location of the renal calculus in the left ureter places the client at risk for obstruction and impaired urinary elimination. These must be prevented or reversed in order to prevent permanent damage to the nephrons in the kidney. The client may also have a knowledge deficit, which is important to address, but is lower in priority than impaired urinary elimination. The right kidney will function normally, unless there is a preexisting condition that is not indicated by the question, so there should be no reason for the client to have excess fluid volume or imbalanced potassium levels.)

The nurse admits a client diagnosed with a renal calculus located in the left ureter. Other than pain, what is the priority nursing diagnosis for this client? a Impaired Urinary Elimination b Knowledge Deficit c Alteration in Fluid Volume: Excess d Electrolyte Imbalance: Potassium

a,c,d,e (Rationale Urinalysis is used to assess for​ hematuria, WBCs, and crystal fragments. A renal ultrasound can detect stones and hydronephrosis. A CT scan of the kidney can show calculi and obstruction. IVP can visualize the​ kidneys, ureters, and​ bladder, and will demonstrate clear evidence of calculi. A chest​ x-ray will not be ordered.)

The nurse is admitting a client with suspected urinary calculi. Which diagnostic tests will the nurse anticipate being ordered to diagnose urinary calculi​ and/or the possible complications associated with this​ diagnosis? ​(Select all that​ apply.) a Intravenous pyelogram​ (IVP) b Chest​ x-ray c Computed tomography​ (CT) scan of the kidney d Urinalysis e Renal ultrasound

c (Rationale The client or the nurse must retrieve stones by straining all urine. The nurse cannot order medication. Fluids need to be​ increased, not decreased. Ambulation assists​ urination; therefore the client should not be put on bed rest.)

The nurse is caring for a client who has been diagnosed with urinary calculi. The client reports a pain level of 0 out of​ 10; is drinking an adequate amount of​ fluids; and has been taking frequent walks in the hallway. The nurse is responsible for which intervention at this​ time? a Requesting an order for bed rest because the client has been taking frequent walks. b Ordering appropriate pain medication if indicated. c Teaching the client to retrieve stones by straining all urine. d Teaching the client the importance of fluid restriction.

c (Rationale Pain is the result of the calculi crystals scraping the ureter lining. The other answers are not correct. Although pain management should be discussed with each​ client, pain is typically associated with renal calculi.)

The nurse is instructing a client with renal calculi about the importance of pain management. The client asks what causes the pain associated with renal calculi. How should the nurse​ respond? ​a "Pain is the result of excess fluid pushing on the​ ureter." ​b "Pain is caused by the acidic urine associated with renal​ calculi." c ​"Pain is caused by the calculi scraping against the ureter​ lining." ​d "Pain is never associated with renal calculi. This is just a general discussion given to every​ client."

b (24-hour urine collection specimens should be kept refrigerated or on ice (ice bath). If specimen is not kept cold it can alter the test results.)

The physician orders a 24-hour urine collection on a patient with recurrent kidney stones. As the nurse you know that the specimen should be?* A. Kept at room temperature B. Kept on ice or refrigerated C. Sent to the lab every four hours D. Kept at a temperature between 98.6 'F to 99.3'F

a (Rationale: The best indicator of kidney function is a normal BUN and creatinine. The healthy kidney can adequately compensate for a damaged kidney, maintaining normal fluid and electrolyte balance, so urine output and electrolyte levels do not assure lack of damage to one kidney. Temperature elevation, while mild, could be a normal finding or could indicate the beginning of an infection. An elevated temperature would require further monitoring but would not contribute to assessment of kidney function. )

Which of the following would the nurse evaluate as the best indicator of a positive outcome regarding kidney function for a client diagnosed with urinary calculi? a Client's BUN and creatinine are within normal limits. b Client's urine output is within normal range for age. c Client temperature is only mildly elevated following passage of renal calculi. d Client's electrolytes are within normal limits.

d (The patient should avoid foods high in purine and foods high in animal proteins. Foods that are high in purine or animal proteins breakdown into uric acid. Foods high in purine are any type of organ meats (liver), most seafood (scallops, anchovies, sardines), pork, red meats, beer etc.)

You're providing discharge teaching to a patient who was hospitalized for the treatment of a kidney stone. The type of kidney stone the patient experienced was a uric acid type stone. What type of foods will you educate the patient to avoid? A. Cabbage, spinach, tomatoes, strawberries B. Ice cream, milk, pork, cheese C. Beans, potatoes, corn, peas D. Liver, scallops, anchovies, sardines, pork

d (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.)

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 level

b

A client is admitted with kidney disease, which type of IV fluid is likely to be ordered for this client? a. hypertonic b. isotonic c. colloid d. hypotonic

a,b,c,d,e

A focused nursing assessment of the urinary system includes SELECT ALL THAT APPLY a. skin​ assessment, b. abdominal​ assessment, c. a urinary meatus​ assessment, d. kidney​ assessment, e. bladder assessment.​ f. Dietary, g. perianal, h. inguinal area

c (the greatest risk to client is damage to the kidney resulting from obstruction of urine flow. PRIORITY anuria)

A nurse is caring for a client who has a left renal calculus and an indwelling urinary cath. Which of the following assessment findings is the PRIORITY for the nurse to report to the provider? a. Flank pain that radiates to the lower abdomen b. Client reports nausea c. Absent urine output for 1 hr d. Serum WBC 15000/mm

b,e (a: client with stone from calcium phosphate struvite, uric acid or cysteine should limit animal protein, c: stone from calcium phosphate or struvite should limit dairy. d: stone from struvite should limit whole grains BLACK TEA AND SPINACH IS OXALATE)

A nurse is completing discharge instruction with a client who has spontaneously passed a calcium oxalate calculus. To decrease the chance of recurrence the nurse should instruct the client to avoid which of the following foods?(SELECT ALL THAT APPLY) a. red meat b. black tea c. cheese d. whole grains e spinach

b (oliguria not nocturia is a manifestation of renal calculi, as well as tachypnea and tachycardia)

A nurse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect? a. bradycardia b. diaphoresis c. nocturia d. bradypnea

a,b,d,e (client does not need to strain once stone passed) (sodium will affect the precipitation of calcium phosphate in urine)

A nurse is reviewing discharge instructions with a client who had spontaneous passage of a calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? a. limit intake of food high in animal protein b. reduce sodium intake c. strain urine for 48 hours d. report burning with urination to provider e. increase fluids intake to 3L/ day

3, 4 (Both these patients will need frequent assessments and medications. The patient receiving chemotherapy and the patient who has just undergone surgery should not be exposed to any patient with infection. Focus: Assignment)

As charge nurse, you must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roommates? 1. 58-year-old with urothelial cancer receiving multiagent chemotherapy 2. 63-year-old with kidney stones who has just undergone open ureterolithotomy 3. 24-year-old with acute pyelonephritis and severe flank pain 4. 76-year-old with urge incontinence and a UTI _____, _____

c (Rationale: When enlargement occurs, the kidneys may be palpable. Otherwise they are rarely palpable. Kidneys are not palpable.)

During the assessment of a client's kidneys, the nurse is unable to palpate the organs from the back of the client. What does this finding suggest to the nurse? a The client's kidneys are misshapen. b The client's kidneys are misplaced. c Nothing, as it is a normal finding. d The client's kidneys have atrophied.

b (the pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and testicles in male clients. N/V, abdominal cramping, and diarrhea may 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 the cause of stone formation)

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

7-20

Normal BUN is _____-_____ mg/dL

0.5-1.2

Normal creatinine_____-_____ mg/dL

4.5-8

Normal urine pH is ____-_____

1.003-1.030

Normal urine specific gravity ranges from ______-______.

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. Sand-like debris is normal due to residual stone products. Hematuria is common after lithotripsy.)

Nurse Harry 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, sand-like particles through the nephrostomy tube. C notify the physician about cloudy or foul-smelling urine. D report bright pink urine within 24 hours after the procedure

c (Rationale: Increasing fluid intake to 3,000 mL per day will produce enough urine to prevent stone-forming salts from concentrating sufficiently to precipitate. Calcium supplements will not prevent stones, and may contribute to their formation. Monitoring pH of urine or maintaining an indwelling catheter will not prevent stone formation.)

Recognizing the risk for urolithiasis in the immobilized client, the nurse appropriately plans to: a administer a calcium supplement. b regularly monitor urine pH. c increase fluid intake to 3000 mL per day. d maintain an indwelling urinary catheter.

d

The Dr has ordered increased oral rehydration for a client with renal calculi. Unless contraindicated, the recommended oral intake for helping with the removal of renal calculi is: a 75 mL/hr b 100 mL/hr c. 150 mL/hr d. 200 mL/hr

d (a KUB radiograph exam requires no preparation. It is usually done while the client lays supine and does not involve radiopaque substances. It is not necessary to withhold fluids, the client will not need a tranquilizer and enema is not include in prep)

The client is scheduled to have a KUB radiograph. To prepare the client for the procedure the nurse should explain to the client that: a. fluid and food will be withheld the morning of the exam b. a tranquilizer will be given before the exam c. an enema will be given before the exam d. no special preparation is required for the exam

c (place on unaffected side)

The nurse is caring for a client post right nephrolithotomy. post operatively the client should be positioned: a. on the right side b. supine c. on the left side d. prone

a,b,c,i,j (foods high in oxylate include: asparagus, beets, celery, cabbage, fruits, tomatoes, green beans, chocolate and nuts. Beer cola and tea are also high in oxylate. )

The nurse is providing dietary teaching to a client with recurring urinary calculi. To prevent the recurrence of oxylate stones, the client should be told to limit the intake of which foods? a. almonds b. chocolate c. beets d. cheese e. whole grains f cranberries g. rhubarb h. eggs i. cabbage j. nuts

d (straining is important to verify calculi have passed. The client is NOT fully awake, moderately sedated, bruising is expected)

A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements by the client indicates understanding of the teaching? a. I will be fully awake during the procedure b. lithotripsy will reduce my chances of having stones in the future c. I will report any bruising that occurs to my Dr. d. Straining my urine following the procedure is important

c (allergies most important. adequate fluid intake is important AFTER the exam. Bladder spasms are not common during the IVP. Bowel prep is done prior to IVP to allow for visualization of the ureters and bladder.)

The client is scheduled for an IVP to determine the location of the stone. Which action would be most important for the nurse to include in the pretest preparation? a. ensure adequate fluid intake on the day of the test b. prepare the client for the possibility of bladder spasms during the test c. check the clients history for allergy to iodine d. determine when the client last had a bowel movement

a (a high purine diet contributes to 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 acidic urine. )

Because a clients stone was found to be uric acid composition, a low purine alkaline-ash diet was prescribed. Incorporation of which food items into the home diet would indicate the client understands the necessary diet indications? 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

b (pain increases blood pressure usually)

A client hospitalized with renal calculi complains of severe pain in the right flank. In addition to complaints of pain, the nurse can expect to see changes in the clients vital signs that include: a. decreased pulse rate b. increased blood pressure c. decreased respiratory rate d. increased temperature

d ( the client prescribed alkaline ash diet should consume rhubarb, legumes, milk and milk products, and green vegetables. a,b,c are found on acid ash diet and should be limited)

The physician orders an alkaline ash diet for a pt with recurrent cysteine kidney stones. Which of the following should be included in the pt's diet? a. cranberries b. grapes c. plums d. rhubarb

a (Rationale: These are manifestations of renal colic and possible ureteral obstruction. Prompt diagnosis and treatment is vital to prevent hydroureter and hydronephrosis should the ureter be completely obstructed. Although pain management and collection of the stone are important, prevention of hydronephrosis is of highest priority. Residual urine is not expected in this scenario. )

A client admitted with possible kidney stones develops sudden complaints of acute crampy pain on the left side that radiates into the groin. The client is nauseated and vomits clear fluid. On voiding, his urine is pink. The nurse should: a notify the physician. b obtain a bladder scan to assess for residual urine. c administer the prescribed narcotic analgesic. d strain all urine.

a (The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.)

A male client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnosed renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? A Kidney B Ureter C Bladder D Urethra

D ( The nurse should explain to the client that a KUB can identify renal calculi, strictures, calcium deposits and obstructions of the urinary system)

A nurse is teaching a client who will have a x-ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching? A. You will receive contrast dye during the procedure B. An enema is necessary before the procedure C. You will need to lie in a prone position during the procedure D. The procedure determines whether you have a kidney stone

c (Rationale: When larger amounts of urine are present, the bladder becomes distended and rises above the symphysis pubis. Kidney stones cannot be palpated. While a tumor and stool can be palpated in the abdomen, they are not palpated in the symphysis pubis. Only a portion of the abdomen is distended with tumors or constipation. A full bladder will distend the whole abdomen.)

During the abdominal assessment of a male client, the nurse palpates a large round mass in the hypogastric region. Which of the following could explain what this nurse has palpated? a The client has a tumor in his small intestines. b The client is constipated. c The client has a distended or full bladder. d The client has kidney stones.

1, 2, 4, 6 (Administering oral medications is appropriate to the scope of practice for an LPN/LVN or RN. Assessing breath sounds requires additional education and skill development and is most appropriately within the scope of practice of an RN, but it may be part of the observations of an experienced and competent LPN/LVN. All other actions are within the educational preparation and scope of practice of an experienced UAP. Focus: Delegation, supervision)

. You are providing nursing care for a patient with acute kidney failure for whom a nursing diagnosis of Excess Fluid Volume related to compromised regulatory mechanisms has been identified. Which actions should you delegate to an experienced UAP? (Select all that apply.) 1. Measuring and recording vital sign values every 4 hours 2. Weighing the patient every morning using a standing scale 3. Administering furosemide (Lasix) 40 mg orally twice a day 4. Reminding the patient to save all urine for intake and output measurement 5. Assessing breath sounds every 4 hours 6. Ensuring that the patient's urinal is within reach

a,b,e (following lithotripsy the nurse strains urine to collect and identify stone composition. Providing heat to the flank area may be helpful to relieve muscle spasms when renal colic is present. the nurse assesses the clients pain level and administers analgesics as needed. Hematuria is common after lithotripsy, and it is not necessary to notify the HCP. The nurse should promote fluid intake of at least 2000 mL a day to flush stones and clots thru the urinary tract)

A client had a lithotripsy to treat renal calculi. The client is having ureteral spasms and hematuria. What should the nurse do? Select all that apply: a. strain all urine b. apply a heating pad to the lower back area c. contact the HCP to report hematuria d. encourage fluid intake of 1000 mL/day e. assess pain level

d (Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn't be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only after assessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.)

A client had a transurethral prostatectomy for benign prostatic hypertrophy. He's currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first? A Administer an oral analgesic B Stop the irrigation and call the physician C Administer a belladonna and opium suppository as ordered by the physician D Check for the presence of clots, and make sure the catheter is draining properly

1 (The patient with cystitis who is taking oral antibiotics is in stable condition with predictable outcomes, and caring for this patient is therefore appropriate to the scope of practice of an LPN/LVN under the supervision of an RN. The patient with a new order for lithotripsy will need teaching about the procedure, which should be accomplished by the RN. The patient in need of bladder training will need the RN to plan this intervention. The patient with flank pain needs careful and skilled assessment by the RN. Focus: Assignment)

As charge nurse, you would assign the nursing care of which patient to an LPN/LVN, working under the supervision of an RN? 1. 48-year-old with cystitis who is taking oral antibiotics 2. 64-year-old with kidney stones who has a new order for lithotripsy 3. 72-year-old with urinary incontinence who needs bladder training 4. 52-year-old with pyelonephritis who has severe acute flank pain

c (Rationale Spinach and other green leafy vegetables are high in oxalate and should be avoided. Wheat bran is high in oxalate and should be​ decreased, not increased. Fluid intake should be​ increased, not limited. Fruit juices do not need to be avoided as they have been shown in clinical trials to decrease calcium oxalate levels.)

The client passes a kidney​ stone, and it is sent to the lab for analysis. The results indicate it was a calcium oxalate stone. Which dietary instructions should be included for this client at ​discharge? a Limit fluid intake to 1 liter per day b Increase consumption of wheat bran c Avoid eating spinach and other green leafy vegetables d Avoid fruit juices

3 (Bruising is to be expected after lithotripsy. It may be quite extensive and take several weeks to resolve. All of the other statements are accurate for a patient after lithotripsy. Focus: Prioritization)

You are supervising a nurse on orientation to the unit who is discharging a patient admitted with kidney stones who underwent lithotripsy. Which statement by the nurse to the patient requires that you intervene? 1. "You should finish all of your antibiotics to make sure that you don't get a UTI." 2. "Remember to drink at least 3 L of fluids every day to prevent another stone from forming." 3. "Report any signs of bruising to your physician immediately, since this indicates bleeding." 4. "You can return to work in 2 days to 6 weeks, depending on what your physician prescribes."