Kidney Stones (Urinary Calculi)

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

A 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.

Which would be the most appropriate measure for preventing the development of a paralytic ileus in a client who has undergone renal surgery? A. Encourage the client to ambulate every 2 to 4 hours B. Offer 3 to 4 oz of a carbonated beverage periodically C. Encourage use of a stood softner D. Continue IV fluid therapy

A Ambulation stimulates peristalsis. A client with paralytic ileus is kept on NPO status until peristalsis returns.

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

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

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 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 contribution 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.

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 caused by the calculi scraping against the ureter lining." B. "Pain is the result of excess fluid pushing on the ureter." C. "Pain is caused by the acidic urine associated with renal calculi." D. "Pain is never associated with renal calculi. This is just a general discussion given to every client."

A Pain is the result of the calculi crystals scraping the ureter lining.

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. Teaching the client to retrieve stones by straining all urine B. Teaching the client the importance of fluid restriction C. Ordering appropriate pain medication if indicated D. Requesting an order for bed rest because the client has been taking frequent walks

A The client or the nurse must retrieve stones by straining all urine.

The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which medication teaching should the nurse discuss with the client? A. Inform the client to report chills, fever,and muscle aches to the HCP B. Instruct the client to avoid driving or other activities that require alertness C. Tell the client that the medication must be taken on an empty stomach D. Explain the importance of not eating breads, cereals, and fruits

A The client should notify the HCP if a skin rash or influenza symptoms develop because these signs and symptoms may indicate hypersensitivity.

The client diagnosed with renal calculi is being scheduled for surgery. The client is having epidural anesthesia. Which intervention should the circulating nurse implement? A. Have the client lie on the side in the fetal position B. Determine if the client has an advance directive C. Assess the client's gag and swallowing reflex D. Ensure that the head of the client's stretcher is elevated 30 degrees

A This is the correct position for the client when an epidural anesthesia is being inserted.

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) A. Check for the ordered diet and medication modifications B. Instruct the client to urinate, and discard this urine when starting collection C. Collect all urine during 24 hours and place in appropriate specimen container D. Insert an indwelling catheter in client after having the client empty the bladder E. Instruct the UAP to notify the nurse when the client urinates.

A,B,C -The HCP may order certain foods and medications when obtaining a 24 hour urine collection to evaluate for calcium oxalate or uric acid. -When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. -All urine for 24 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 a inaccurate test result.

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? (Select all that apply) A. Limit intake of food high in animal protein B. Reduce sodium intake C. Strain urine for 48 hr D. Report burning with urination to the provider E. Increase fluid intake to 3 L/day

A,B,D,E -The client should limit the intake of food high in animal protein, which contains calcium phosphate. -The client should limit intake of sodium, which affects the precipitation of calcium phosphate in the urine. -The client should report burning with urination to the provider because this can indicate a urinary tract infection. -The client should increase fluid intake to 2 to 3 L/day. A decrease in fluid intake can cause dehydration, which increases the risk of calculi formation.

A client has been prescribed allopurinol for renal calculi that are caused by high uric acid levels. Which symptoms indicate the client is experiencing adverse effects 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 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.

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

A,B,E Following lithotripsy, the nurse strains all 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 client's pain level and administers analgesics as needed.

The client is admitted to the surgical department diagnosed with renal calculi. The HCP prescribes a morphine patient-controlled analgesia (PCA). Which interventions should the nurse implement? (Select all that apply) A. Instruct the client to push the control button as often as needed B. Explain the medication will ensure the client has no pain C. Discuss that medication effectiveness is evaluated on a pain scale of 1-10 D. Inform the client to obtain assistance when getting out of the bed E. Instruct the unlicensed assistive personnel to strain all the client's urine

A,C,D,E -The PCA pump automatically administers a specific amount and has a lockout interval time in which the PCA pump cannot administer any morphine. The client can push the control button as often as needed and will not receive an overdose of pain medications. -Adult clients use the 1-10 pain scale, with 0 being no pain and 10 being the worst pain. -The client receiving PCA morphine should be instructed not to ambulate without assistance due to the chance of falls. -All the client's urine should be strained by all staff members.

Which interventions should the nurse discuss with the client who has calcium/oxalate renal calculi and has been prescribed a thiazide diurectic? (Select all that apply) A. Tell the client to increase the intake of fluids B. Discuss possible kidney stones caused by this diutetic C. Explain the need to check the potassium level daily D. Inform the client to check the blood pressure daily E. Instruct the client to take the diuretic in the morning

A,E -The client should drink adequate fluids or increase fluids when taking a thiazide diuretic and to help prevent formation of renal calculi. -Diuretics should be take in the morning so that the client is not up all night urinating. Thiazide diuretics are prescribed because they decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in the bone. Most kidney stones are calcium stones, composed of calcium.

After an intravenous pyelogram (IVP), the nurse should include which measure in the client's plan of care? A. Maintain bed rest B. Encourage adequate fluid intake C. Assess for hematuria D. Administer a laxative

B After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent.

Allopurinol, 200 mg/day, is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which adverse effect of this medication? A. Retinopathy B. Maculopapular rash C. Nasal congestion D. Dizziness

B Allopurinol 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.

The client diagnosed with renal calculi is receiving pain medication via morphine patient-controlled analgesia (PCA). The client is still voicing excruciating pain and is requesting something else. Which intervention should the nurse implement first? A. Administer the rescue dose of morphine intravenous push B. Check the client's urine for color, sediment, and output C. Determine the last time the client received PCA morphine D. Demonstrate how to perform guided imagery with the client

B Assessing the client and ruling out any complications is the nurse's first intervention.

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

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

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

B Diaphoresis is a manifestation associated with a client who has renal calculi.

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

B During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics to control the pain.

A client who has been diagnosed with renal calculi 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.

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.

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? A. Assess the client's neurological status every two hours B. Strain all urine and send any sediment to the laboratory C. Monitor the client's creatinine and BUN levels D. Take a 24-hour dietary recall during the client interview

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

The client passes a kidney stone, ant 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. Increase consumption of wheat bran B. Avoid eating spinach and other green leafy vegetables C. Limit fluid intake to 1 liter per day D. Avoid fruit juices

B Spinach and other green leafy vegetables are high in oxalate and should be avoided.

The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the HCP? A. Temperature, 99.8 B. Urine output, 20 mL/hr C. Absence of bowel sounds D. A 2x2 area of serosanguineous drainage on the flank dressing

B The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine output of 30 mL/hr or greater is considered acceptable.

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.

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

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

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

B The ureteral catheter should drain freely without bleeding at the site.

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. "It is probably because of anxiety." B. "You probably inherited a genetic tendency to develop calculi." C. "Urinary calculi are cased by inflammation of the urinary bladder." D. "It is just something that happens. There is no specific cause."

B Urinary calculi can be caused by a genetic predisposition to the accumulation of certain mineral substances in the urine.

The client diagnosed with rule-out renal calculi is scheduled for an intravenous dye pyelogram (IVP). Which interventions should the nurse implement? (Select all that apply) A. Keep the client NPO B. Check the serum creatinine level C. Assess for an iodine allergy D. Obtain informed consent E. Insert an 18-guage angiocatheter

B,C,D -The client should not have this diagnostic test if the kidneys are not working properly. The intravenous dye could damage the kidneys if normal functioning is not present. -The nurse would assess for iodine allergy. The nurse should ask if the client is allergic to Betadine or shellfish. -This is an invasive procedure; therefore, he client must give informed consent.

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. Chest x-ray B. Urinalysis C. Computed tomography (CT) scan of the kidney D. Renal ultrasound E. Intravenous pyelogram (IVP)

B,C,D,E Urinalysis is used to assess for hematuria, WBCs, and crystal fragments. A renal ultrasound can detect stones and hydroephrosis. 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 nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the change of recurrence, the nurse should instruct the client to avoid which of the following food? (Select all that apply) A. Red meat B. Black tea C. Cheese D. Whole grains E. Spinach

B,E -A client who has renal calculi composed of calcium composed of calcium oxalate should avoid intake of black tea because it is a source of oxalate. -A client who has renal calculi composed of calcium oxalate should avoid intake of spinach because it is a source of oxalate.

The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which action would be most important for the nurse to include in 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 client's history for allergy to iodine D. Determine 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.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? A. Increase water intake for the next 24 hours B. Take two Tylenol to help decrease the temperature C. Come to the clinic and provide a urinalysis specimen D. Use a sterile 4x4 gauze to strain the client's urine

C 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.

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

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

The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid calculi. Which statement warrants intervention by the nurse? A. "I had to take two Tylenol because of my headache." B. "I drink at least eight glasses of water a day." C. "My joints ache so I take a couple of aspirins." D. "I do not drink wine or any type of alcoholic drinks."

C Salicylic acid (aspirin) increases the acidity of the urine, and the urine should be alkaline; therefore this statement warrants intervention by the nurse.

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

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

A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. 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 report of nausea C. Absent urine output for 1 hour D. Serum WBC count 15,000

C The greatest risk to this client is damage to the kidney resulting from obstruction of urine flow by the renal calculus. Therefore, the priority finding for the nurse to report to the provider is anuria.

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. Which outcome is a priority 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.

The client with calcium renal calculi is prescribed cellulose sodium phosphate (Calcibind). The client asks the nurse, "How will this medication help prevent my stones from coming back?" Which statement is the nurse's best response? A. "Calcibind reduces the uric acid level in your bloodstream and the uric acid excreted in your urine." B. "This medication will decrease calcium levels in the bloodstream by increasing calcium excretion in the urine." C. "It binds calcium from food in the intestines, reducing the amount absorbed in the circulation." D. "The medication will help alkalinize the urine, which reduces the amount of cystine in the urine."

C This is the scientific rationale for administering Calcibind to reduce the formation of calcium renal calculi.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? A. Beer and colas B. Asparagus and cabbage C. Venison and sardines D. Cheese and eggs

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

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 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 doctor." D. "Straining my urine following the procedure is important."

D A client is instructed to strain urine following lithotripsy to verify that the calculi have passed.

The nurse is reviewing laboratory reports that a client who is taking allopurinol. Which finding indicates 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 decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration.

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.

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. CBC B. Chemistry panel C. Blood cultures D. Intravenous pyelography

D Intravenous pyelography is one of the tests that is used to diagnose urinary calculi.

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? A. Ask if the client is allergic to shellfish or iodine B. Keep the client NPO eight hours prior to the ultrasound C. Ensure the client has a signed informed consent form D. Explain the test is noninvasive and there is no discomfort

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

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? A. Fluid volume loss B. Knowledge deficit C. Impaired urinary elimination D. Alteration in comfort

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

The client diagnosed with renal calculi has just had an intravenous pyelogram (IVP). Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? A. Hang a new bag of intravenous fluid B. Discontinue the client's intravenous catheter C. Assist the client outside to smoke a cigaretter D. Maintain the client's intake and output

D The UAP can document the client's oral intake and urinary output, but the UAP cannot evaluate if the urine output is adequate and appropriate for the IVP procedure.

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? A. A serum potassium level of 3,8 B. A urinalysis shows microscopic hematuria C. A creatinine level of 0.8 D. A white blood cell count of 14,000

D The white blood cell count is elevated; normal is 5,000 to 10,000.

The male client diagnosed with renal calculi is receiving pain medication via a morphine patient-controlled analgesia (PCA) pump. The health-care provider prescribed the nonsteroidal anti-inflammatory drug (NSAID) indomethacin (Indocin) in a rectal suppository. Which intervention should the nurse implement? A. Question and clarify the prescription with the health-care provider B. Give the suppository to the client and allow the client to insert it into the rectum C. Administer a Fleet's enema to clear the bowel prior to administering the suppository D. Have the client lie on the side and insert the rectal suppository with nonsterile gloves

D This medication is prescribed because it may reduce the amount of narcotic analgesia required for acute renal colic.