urinary calculi practice questions
Which information should the nurse provide for an older adult with gout, to prevent uric acid stones? A."Increase acidic foods." B."Limit meat intake." C."Decrease sodium intake." D."Limit dairy products."
B."Limit meat intake." 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.
A patient with a kidney stone explains that the pain he is experiencing is intense, sharp, and wavelike that radiates to the scrotum. In addition, he explains it feels like he has to void but a small amount of urine is passed. Based on the patient's signs and symptoms, where may the kidney stone be located? A. Renal Calyx B. Renal Papilla C. Ureter D. Urethra
C. Ureter The answer is C. The patient's description of the pain is known as ureteral colic. The kidney stone may be in the ureter. On the other hand, another type of pain that can be reported is renal colic. This is a dull, deep aching in the flank/costovertebral area and the kidney stone may be in the renal pelvis.
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.Obtain a urine sample. D.Initiate IV therapy.
A.Assess the client's vital signs. -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.
You're providing an in-service to a group of nurses about the different types of kidney stones. You explain to the attendees that the most common type of kidney stone is made up of: A. Cholesterol B. Calcium and oxalate C. Calcium and phosphate D. Uric acid
B. Calcium and oxalate The answer is B. The most common type of kidney stone composite is calcium and oxalate.
Which nursing goal is appropriate for a client who is admitted to the hospital with urinary calculi? A.The client will consume at least 30% of the prescribed diet while hospitalized. B.The client will maintain urine output of 2500 mL/24 hours while hospitalized. C.The client will receive 80% of fluids while hospitalized. D.The client will rate the pain at 5 on a 0dash10 scale in 20 minutes after receiving IV morphine.
B.The client will maintain urine output of 2500 mL/24 hours while hospitalized. -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 0dash10 scale 20 minutes after receiving IV morphine.
A patient is scheduled for an intravenous pyelogram (IVP) to assess for kidneys stones. Which finding below requires the nurse to contact the physician? A. Patient reports flank pain that radiates downward B. Patient has hematuria C. Patient is allergic to shellfish D. Patient has cloudy urine
C. Patient is allergic to shellfish The answer is C. During an IVP a special dye, which is iodine based, will be given through an IV. Then x-ray images will be taken to assess the kidneys, bladder, ureters, and urethra. It is very important to make sure the patient isn't allergic to iodine or shellfish, pregnant, nursing, has impaired renal function, or is taking Metformin. All the other options are typical signs and symptoms that can occur with a kidney stone.
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.Cystine C.Calcium stone D.Urolithiasis
D.Urolithiasis -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.
A client experiencing an acute episode of renal colic rates the pain at a 9 on a scale of 0dash10. Which prescribed treatment should the nurse anticipate? (Select all that apply.) A.Morphine B.Indomethacin C.Thiazide diuretic D.Potassium citrate
A,B A.Morphine B.Indomethacin -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).
The nurse is conducting a health history for a client with manifestations of urinary calculi. Which data should the nurse collect? (Select all that apply.) A.Immobility B.Dehydration C.Excess dietary oxalate D.Dietary potassium deficiency E.Familial history of urinary calculi
A,B,C,E A.Immobility B.Dehydration C.Excess dietary oxalate E.Familial history of urinary calculi -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.
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
A,C A.IV therapy C.Thiazide diuretic -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.
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
A,C,D,E A.Urinalysis C.Renal ultrasound D.Intravenous pyelography (IVP) E.Computed tomography (CT) scan of the kidney -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.
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
A,D,E A.Increasing fluid intake D.Avoiding excess calcium-containing foods E.Administering ordered medications to help prevent the formation of future stones -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.
You're providing care to a patient with a uric acid kidney stone that is 2 mm in size per diagnostic imaging. The patient is having severe pain and rates their pain 10 on 1-10 scale. The physician has ordered a treatment plan to assist the patient in passing the kidney stone. What nursing intervention is PRIORITY for this patient based on the scenario? A. Administer pain medication B. Encourage fluid intake of 2-4 liters per day C. Massage the costovertebral area D. Implement a high protein diet
A. Administer pain medication The answer is A. Controlling the patient's pain is priority. Option B is another important part of the patient's plan of care to help assist the passage of the kidney stone, but it is not priority at the moment until the patient's pain is controlled. Option C and D are not recommended for the treatment of uric acid kidney stones. You would never massage the costovertebral area, and a high protein diet will further increase uric acid levels, therefore, should be avoided.
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."Increase fluid intake to 2500dash3500 mL per day." B."Empty the bladder frequently." C."Decrease dietary calcium intake." D."Collect and strain all urine."
A."Increase fluid intake to 2500dash3500 mL per day." -Measures to prevent further kidney stones include increasing fluid intake to 2500dash3500 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.
You are providing pre-op teaching to a patient scheduled for a percutaneous nephrolithotomy. Which statement by the patient demonstrates the patient understood the pre-op teaching? A. "During the procedure the surgeon will move the stone down the ureter, so I can pass the stone in the urine. B. "I may have a nephrostomy tube after the procedure." C. "A scope is inserted through the urinary system from the urethra to the kidneys to assess the kidney stone." D. "This procedure is noninvasive and no incision is required."
B. "I may have a nephrostomy tube after the procedure." The answer is B. A percutaneous nephrolithotomy is an INVASIVE procedure that can be used to remove large kidney stones. An incision is made on the back where the kidney is located. A nephroscope is then insert through the incision and used to remove the stone. Generally, the surgeon is able to remove the stone or break it up, therefore, the patient doesn't have to pass it naturally as with other procedures. A nephrostomy tube is sometimes placed after the procedure to drain urine and fragments of the stone out of the kidney.
Your patient arrives back to their room after having extracoporeal shock wave lithotripsy (ESWL) for treatment of a kidney stone. What will be included in the patient's plan of care? SELECT-ALL-THAT-APPLY: A. Keep the patient in bed B. Encourage fluid intake of 3-4 liters per day C. Maintain nephrostomy tube D. Strain urine E. Keep dressing dry and intact
B. Encourage fluid intake of 3-4 liters per day D. Strain urine The answers are B and C. Extracoporeal shock wave lithotripsy (ESWL) is NONINVASIVE (no incisions...no dressings or nephrostomy tubes are placed). Shockwaves are created to penetrate though the skin and body tissue. Shockwaves will hit the stone and break it down into grain of sand like particles which will be passed out by the patient. Option A is wrong because the patient should be kept mobile (as tolerated) to assist the passage of the kidney stone fragment.
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
B. Kept on ice or refrigerated The answer is 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.
You're developing a nursing care plan for a patient with a kidney stone. Which of the following nursing interventions will you include in the patient's plan of care? A. Restrict calcium intake B. Strain urine with every void C. Keep patient in supine position to alleviate pain D. Maintain fluid restriction of 1-2 Liter per day
B. Strain urine with every void The answer is B. It is vital the nurse strains every void and assesses the urine very closely for stones. This is crucial so it can be determined what type of kidney stone is causing the problem, therefore, appropriate treatment can be ordered. Restricting calcium intake is no longer recommended unless the patient has a metabolic or renal tubule problem. It is important to avoid placing the patient in the supine position for long periods because this impedes the flow of urine and the patient's ability to pass the stone. Fluid should not be restricted (unless the patient has a condition that requires it like heart failure etc.) because this concentrates the urine...hence increases the chances of another stone developing.
Which follow-up care should the nurse implement for a child previously treated for urolithiasis? A.Urine uric acid level B.24-hour urine sample C.Urine calcium level D.Urinalysis
B.24-hour urine sample -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.
A client with microscopic hematuria is diagnosed with urinary calculi. Which laboratory assessment should the nurse monitor? A.BUN and creatinine B.Hemoglobin and hematocrit C.Kidney function studies D.Serum calcium, phosphorus, and uric acid levels
B.Hemoglobin and hematocrit -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.
The nurse is caring for a client diagnosed with a ureteral stone. Which assessment finding should the nurse anticipate? A.Colicky pain B.Renal colic C.Microscopic hematuria D.Fever
B.Renal colic -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.
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 is hyperventilating. B.The client has respirations of 8 breaths per min and oxygen saturation of 90%. C.The client has nausea. D.The client has frequent loose stools.
B.The client has respirations of 8 breaths per min and oxygen saturation of 90%. -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.
Which patient below is at MOST risk for developing uric acid type kidney stones? A. A 53 year old female with recurrent urinary tract infections. B. A 6 year old male with cystinuria. C. A 63 year male with gout. D. A 25 year old female that follows a vegan diet and report eating high amounts of spinach and strawberries on a regular basis.
C. A 63 year male with gout. The answer is C. Patients with gout experience high uric acid levels which can lead to the development of uric acid kidney stones. In option A, the patient is at risk for struvite kidney stones. In option B, the patient is at risk for cystine kidney stones, and in option C, the patient is at a small risk for calcium oxalate stones due to the high consumption of foods with oxalates.
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 of uric acid B.Excess dietary intake of calcium C.Bacterium associated with a UTI D.Genetic defect
C.Bacterium associated with a UTI -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.
Which activity should the nurse instruct a client with a genetic defect of the urinary tract to perform? A.Limit foods high in oxalate. B.Increase exercise. C.Restrict dietary sodium. D.Decrease dietary purine.
C.Restrict dietary sodium -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.
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. Liver, scallops, anchovies, sardines, pork The answer is 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.
Which symptom indicates to the nurse that the client may still have an infection related to renal calculi? A.Nausea and vomiting B.Oral temperature of 99.1degreesF C.Right flank pain D.Cloudy urine
D. cloudy urine -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 99.1degreesF 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.
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 excrete the calcium from your body." C."Exercise promotes the retention of calcium in the bones." D."Exercise will help move the calcium back into your bones."
D."Exercise will help move the calcium back into your bones." -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.
A client has been diagnosed with a calcium phosphate kidney stone. Which contributing factor should the nurse assess? A.Consumption of foods high in purine B.Consumption of foods high in acid C.Consumption of foods high in phosphate D.Consumption of foods high in calcium
D.Consumption of foods high in calcium -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.
The nurse is caring for a client who has been diagnosed with urinary calculi. The client reports a pain level of 0 on a 0dash10 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.Requesting an order for bedrest because the client has been taking frequent walks C.Ordering appropriate pain medication if indicated D.Teaching the client to retrieve stones by straining all urine
D.Teaching the client to retrieve stones by straining all urine -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.