Urinary Calculi Review
rationale
A client with renal calculi is at risk of developing a urinary tract infection. Cloudy urine would be an indicator of infection. Nausea and vomiting often occur with renal calculi but do not indicate infection. An oral temperature of 99.1degrees°F does not indicate infection, but it is an indicator of possible dehydration. Right flank pain is a common clinical manifestation of renal calculi and does not indicate infection. Next Question
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A clinical finding of microscopic hematuria indicates that there is blood in the urine. The hemoglobin and hematocrit will be monitored as part of the treatment. BUN and creatinine are monitored with a diagnosis of acute hydronephrosis to determine the extent of kidney damage. The evaluation of kidney function will be monitored for a client with chronic hydronephrosis. Serum calcium, phosphorus, and uric acid levels are obtained to help identify factors contributing to calculus formation.
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A decreased respiratory rate with low blood oxygen levels are side effects of IV morphine. Nausea is a side effect of morphine but is not a priority. Hyperventilation and frequent loose stools do not normally occur as side effects of morphine.
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A high blood level of calcium can result in the formation of calcium phosphate kidney stones. Exercise promotes the retention of calcium in the bones. If the client's blood level of calcium is high, weight-bearing exercise is an intervention that can help return the calcium to the bones. Calcium is not excreted from the body through exercise. Weight is not a contributing factor to kidney stones.
Which follow-up care should the nurse implement for a child previously treated for urolithiasis?
A 24-hour urine sample B.Urinalysis C.Urine calcium level D.Urine uric acid level ans A
A client is experiencing acute hydronephrosis. Which prescribed clinical therapy should the nurse expect will be initiated? (Select all that apply.)
A. IV therapy B.Oral hydration C. Thiazide diuretic D.Calcium-binding agents ans A C
The nurse is caring for a client with renal calculi. Which treatment is considered supportive? (Select all that apply.)
A. Increasing fluid intake B.Increasing dietary fat intake C.Maintaining the client on bedrest D.Avoiding excess calcium-containing foods E.Administering ordered medications to help prevent the formation of future stones ans: ADE
Which information should the nurse provide for an older adult with gout, to prevent uric acid stones?
A. Limit meat intake." B.Decrease sodium intake." C.Limit dairy products." D. Increase acidic foods."
The nurse is caring for a client who has been diagnosed with urinary calculi. The client reports a pain level of 0 on a 0dash-10 scale, 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. Teaching the client the importance of fluid restriction B.Ordering appropriate pain medication if indicated C.Teaching the client to retrieve stones by straining all urine D.Requesting an order for bedrest because the client has been taking frequent walks ans : C
The nurse is admitting a client who is bent over and guarding the left lower side of the back. The client appears pale and has cool and clammy skin. Which is the nurse's priority intervention?
A.Assess the client's vital signs. B.Assist the client into a supine position. C.Initiate IV therapy. D.Obtain a urine sample. ans :A
A client has been diagnosed with a calcium phosphate kidney stone. Which contributing factor should the nurse assess?
A.Consumption of foods high in acid B.Consumption of foods high in calcium C.Consumption of foods high in phosphate D.Consumption of foods high in purine ans C
Which activity should the nurse instruct a client with a genetic defect of the urinary tract to perform?
A.Decrease dietary purine. B.Increase exercise. C.Limit foods high in oxalate. D.Restrict dietary sodium. Ans: D
The nurse is obtaining a prenatal intake for a pregnant client with a history of kidney stones. Which measure should the nurse instruct the client to take to prevent further kidney stones from forming?
A.Empty the bladder frequently." B Collect and strain all urine." C Increase fluid intake to 2500-3500 mL per day." D Decrease dietary calcium intake." ans C
The nurse is caring for a client diagnosed with struvite urinary calculi (staghorn stones). Which condition should the nurse consider as the cause?
A.Excess dietary intake of calcium B.Excess of uric acid C.Genetic defect D.Bacterium associated with a UTI ans D
The nurse is conducting a health history for a client with manifestations of urinary calculi. Which data should the nurse collect? SATA
A.Immobility B.Dehydration C.Excess dietary oxalate D.Dietary potassium deficiency E.Familial history of urinary calculi ans: ABCE
A client with microscopic hematuria is diagnosed with urinary calculi. Which laboratory assessment should the nurse monitor?
A.Kidney function studies B.BUN and creatinine C.Serum calcium, phosphorus, and uric acid levels D.Hemoglobin and hematocrit ans D
The nurse is caring for a client diagnosed with a ureteral stone. Which assessment finding should the nurse anticipate?
A.Microscopic hematuria B.Fever C.Colicky pain D.Renal colic ans D
A client experiencing an acute episode of renal colic rates the pain at a 9 on a scale of 0dash-10. Which prescribed treatment should the nurse anticipate? (Select all that apply.)
A.Morphine B.Indomethacin C.Thiazide diuretic D.Potassium citrate ans: A, B
A client is diagnosed with a calculus in the ureter. Which term should the nurse use to describe the client's condition?
A.Nephrolithiasis B.Calcium stone C.Urolithiasis D. Cystine ans C
Which symptom indicates to the nurse that the client may still have an infection related to renal calculi?
A.Oral temperature of 99.1 °F B.Nausea and vomiting C.Cloudy urine D.Right flank pain ans C
The nurse is assessing a client who is receiving morphine sulfate IV for pain from urinary calculi. Which assessment finding is a priority to communicate to the healthcare provider?
A.The client has respirations of 8 breaths per min and oxygen saturation of 90%. B.The client is hyperventilating. C.The client has nausea. D.The client has frequent loose stools. ans : A
Which nursing goal is appropriate for a client who is admitted to the hospital with urinary calculi?
A.The client will rate the pain at 5 on a 0 -10 scale in 20 minutes after receiving IV morphine. B.The client will receive 80% of fluids while hospitalized. C.The client will consume at least 30% of the prescribed diet while hospitalized. D.The client will maintain urine output of 2500 mL/24 hours while hospitalized. ans : D
The nurse is admitting a client with suspected urinary calculi. Which collaborative activity should the nurse anticipate as part of diagnosing urinary calculi and/or the possible complications associated with this diagnosis? (Select all that apply.)
A.Urinalysis B.Chest x-ray C.Renal ultrasound D.Intravenous pyelography (IVP) E.Computed tomography (CT) scan of the kidney ans: ACDE
A client with a history of kidney stones formed from calcium phosphate asks the nurse, "Why are you recommending exercise to prevent another kidney stone?" Which response by the nurse is accurate?
A."Exercise will help you decrease your weight, which is a contributing factor to kidney stones." B.Exercise will help move the calcium back into your bones." C."Exercise will help excrete the calcium from your body." D."Exercise promotes the retention of calcium in the bones." ans: B
rationale
Acute hydronephrosis is caused by the development of a sudden obstruction of urine flow. Prescribed clinical treatment includes IV therapy. A thiazide diuretic and calcium-binding agent are only administered if the stone is caused by excess calcium. Oral hydration is implemented in chronic hydronephrosis caused by gradual development of obstruction of urine flow.
rationale
Acute severe flank pain and pale, cool, and clammy skin are clinical manifestations of a ureteral stone. The nurse will obtain the client's vital signs and then assist the client into a supine position for further physical assessment. Initiation of IV therapy and obtaining a urine sample can be done after the client's initial assessment.
rationale
Consumption of foods high in calcium can be a contributing factor to the formation of calcium phosphate kidney stones. Management includes limiting foods high in calcium and increasing foods that acidify the urine. Foods high in purine contribute to the formation of uric acid stones. Phosphates bind with calcium to decrease the blood level of calcium.
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Contributing factors to calculus formation include dehydration, immobility, excess dietary oxalate, and a familial history of urinary calculi. A dietary potassium deficiency does not contribute to the formation of calculus.
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Cystine stones are the most common type of stone formation in clients with genetic defects. Restriction of dietary sodium and increased hydration are recommended to prevent further stone formation. Increased exercise is beneficial to all clients, but not specifically to clients at risk for cysteine stones. Decreased dietary purine decreases the risk of uric acid stone formation. Limiting foods high in oxalate will help prevent the formation of calcium oxalate stones.
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Gout and increased purine intake predispose the client to uric acid stones. The client will be instructed to limit meat intake. Meat is high in purine, which contributes to the formation of uric acid stones. Increasing acidic foods is encouraged for clients with calcium phosphate or oxalate stones. Dietary sodium restriction is implemented in the plan of care for a client with a history of cysteine stones.
rationale
In an acute episode of renal colic, morphine is prescribed. Morphine is a narcotic analgesic given intravenously to relieve pain and reduce ureteral spasms. Indomethacin is an NSAID, given as a suppository that may reduce the amount of narcotic analgesic required for acute renal colic. A thiazide diuretic is frequently prescribed for calcium calculi, acts to reduce urinary calcium excretion, and is very effective in preventing further stones. Potassium citrate alkalinizes urine (raises the pH) and is often prescribed to prevent stones that tend to form in acidic urine (uric acid, cystine, and some forms of calcium stones). Next Question
rationale
Measures to prevent further kidney stones include increasing fluid intake to 2500dash-3500 mL per day. Collecting and straining urine is only necessary if the client is diagnosed with a kidney stone. Emptying the bladder frequently prevents urine stasis, which is a contributing factor for UTIs. Dietary calcium intake is important for fetal growth, and the type of stone should be identified prior to recommending dietary changes.
rationale
Stone or calculus formation in urinary structures other than the kidney is termed urolithiasis. Cystine is a substance that contributes to stone formation. A calcium stone indicates that the stone is made of calcium. Stones or calculi formed in the kidney are termed nephrolithiasis.
Rationale:
Struvite urinary calculi are associated with the bacterium Proteus that is the cause of certain UTIs. Calcium oxalate and calcium phosphate stones are associated with excess dietary intake of calcium. Uric acid stones and stones comprised of calcium are associated with a genetic defect. Uric acid stones are associated with excess uric acid.
rationale
The client admitted to the hospital with urinary calculi will maintain urinary output of 2500 mL/24 hours while hospitalized. The client should receive 100% of fluids and consume at least 50% of the prescribed diet while hospitalized. The client's pain should be no more than a 3 on a 0dash-10 scale 20 minutes after receiving IV morphine.
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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 bedrest.
Rationale
The nurse caring for the client diagnosed with a ureteral stone can anticipate renal colic. Renal colic is an acute, severe flank pain on the affected side. Fever, colicky pain, and microscopic hematuria are not clinical manifestations of a ureteral stone.
rationale
The recommended follow-up care for the child previously treated for urolithiasis is diligent screening for risk factors by collection of a 24-hour urine sample to evaluate the presence of hypercalciuria, hyperuricosuria, hypomagnesuria, hyperoxaluria, and hypocitraturia, to prevent renal insufficiency. A urinalysis is an assessment for a UTI. Urine calcium and uric acid levels are included in the 24-hour urine sample.
rationale
Thiazide diuretics, allopurinol, and antibiotics may help prevent the formation of future calculi. Increasing fluid intake will prevent future stones from occurring and also prevent side effects of the medications used to treat the renal calculi. Adequate fluid intake will also assist in urine formation to help pass the stones. Excess dietary intake of calcium, oxalate, or proteins can contribute to the formation of urinary calculi. Dietary fat does not usually contribute to, or prevent formation of, urinary calculi. It is important for the client to avoid immobility because it contributes to the formation of urinary calculi.
rationale
Urinalysis is used to assess for hematuria, WBCs, and crystal fragments. A chest x-ray would not be routinely ordered. 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 it will demonstrate clear evidence of calculi.