ch 45 Renal Calculi

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of this analysis, which option should the nurse specifically include in the dietary instructions? 1. Increase intake of dairy products. 2. Avoid citrus fruits and citrus juices. 3. Avoid green, leafy vegetables such as spinach. 4. Increase intake of meat, fish, plums, and cranberries.

3. Avoid green, leafy vegetables such as spinach. (oxalate is found in dark green foods such as spinach) NCLEX

A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings requires immediate intervention by the nurse? A. Flank pain that radiates to the lower abdomen B. Client report of nausea C. Absent urine output for 1 hr D. Serum WBC count 15,000/mm³

C. Absent urine output for 1 hr (greatest risk to the pt is damage to the kidney resulting from obstruction of urine flow by the renal calculus) ATI MS

A nurse is completing teaching for a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements made 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. "Straining my urine following the procedure is important." (to verify that the calculi have passed) ATI MS

Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective gastrointestinal (GI) and kidney absorption

a. Associated with alkaline urine MS workbook

The male patient is Jewish, has a history of gout, and has been diagnosed with renal calculi. Which treatment will be used with this patient (select all that apply)? a. Reduce dietary oxalate b. Administer allopurinol c. Administer α-penicillamine d. Administer thiazide diuretics e. Reduce animal protein intake f. Reduce intake of milk products

b. Administer allopurinol e. Reduce animal protein intake (pt is most likely to have uric acid calculi, which have a high incidence in Jewish men, and gout is a predisposing factor. The treatment will include allopurinol and reducing animal protein intake to reduce purine) MS workbook

Which type of urinary tract calculi are the most common and frequently obstruct the ureter? a. Cystine b. Uric acid c. Calcium oxalate d. Calcium phosphate

c. Calcium oxalate (most common and small enough to get trapped in the ureter) MS workbook

Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks? a. Milk and milk products b. Dried beans and dried fruits c. Liver, kidney, and sweetbreads d. Spinach, cabbage, and tomatoes

d. Spinach, cabbage, and tomatoes MS workbook

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1. Steak 2. Shrimp 3. Chicken liver 4. Cottage cheese

4. Cottage cheese (With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet.) NCLEX

The female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone? a. Cystine b. Struvite c. Uric acid d. Calcium phosphate

b. Struvite (most common in women and always occur with UTIs) MS workbook

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 (other symptoms include tachycardia and tachypnea, nocturia is not associated with renal calculi) ATI MS

On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report? a. A history of chronic UTIs b. Dull, costovertebral flank pain c. Severe, colicky back pain radiating to the groin d. A feeling of bladder fullness with urgency and frequency

c. Severe, colicky back pain radiating to the groin MS workbook

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. Limit intake of food high in animal protein. B. Reduce sodium intake. D. Report burning with urination to the provider. E. Increase fluid intake to 3 L/day. ATI MS

A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate stone. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.) A. Red meat B. Black tea C. Cheese D. Whole grains E. Spinach

B. Black tea E. Spinach (black tea and spinach have oxalate) ATI MS

Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria. b. Encourage fluid intake of 3 L/day. c. Apply moist heat to the flank area. d. Strain all urine through gauze or a special strainer.

b. Encourage fluid intake of 3 L/day. (A high fluid intake maintains dilute urine, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy) MS workbook

What can patients at risk for renal lithiasis do to prevent the stones in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

c. Drink enough fluids to produce dilute urine MS workbook

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1. Fish 2. Plum juice 3. Fruit juice 4. Cranberries

1. Fish (pts who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted) NCLEX

A nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that the client has properly understood the information presented when the client chooses which selections from a diet menu? 1. Spinach salad, milk, and a banana 2. Chicken, potatoes, and cranberries 3. Peanut butter sandwich, milk, and prunes 4. Linguini with shrimp, tossed salad, and a plum

1. Spinach salad, milk, and a banana NCLEX

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1. Breads 2. Poultry 3. Chocolate 4. Prune juice

3. Chocolate (Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter.) NCLEX