nur 116 - Davis Advantage / Edge - Kidney Stones

A nurse is providing instructions to a patient who is prescribed antibiotics and phenazopyridine for a urinary tract infection. Which statement made by the patient indicates effective learning? "I should reduce my fluid intake." "I should report if my urine turns orange." "I should administer phenazopyridine for only 3 days." "I should stop using antibiotics if my symptoms disappear."

"I should administer phenazopyridine for only 3 days." Rationale: The administration of phenazopyridine beyond 3 days can mask symptoms of dysuria and frequency and urgency. Therefore, this statement indicates an effective understanding. Test Taking Tips: Phenazopyridine can mask symptoms of the disease.

When planning care, which nursing diagnoses should the nurse include? Select all that apply. Acute pain Risk for infection Altered elimination Fluid volume deficit Decreased cardiac output

Acute pain Risk for infection Altered elimination CORRECT. Nursing diagnoses that you should include in this patient's plan of care include acute pain related to inflammation and obstruction of kidney, risk for infection related to obstruction, and altered elimination related to obstruction. The other choices are not relevant.

A patient is diagnosed with urolithiasis. Which treatment strategies are most likely to aid in the removal or prevention of small stones passing during urination? Select all that apply. Ureteroscopy Alpha-adrenergic blockers Narcotics and antiemetics Percutaneous nephrolithotomy Extracorporeal shock wave lithotripsy

Alpha-adrenergic blockers Rationale: Alpha-adrenergic blockers such as tamsulosin relax the musculature of the lower ureter. This aids in the stone passing through the urine during micturition. Rationale: Extracorporeal shock wave lithotripsy uses shock waves to break down kidney stones. This allows the patient to pass stone fragments during urination. Test Taking Tips: Know treatment options.

A 52-year-old female patient is diagnosed with metastatic bladder cancer, which has spread to her ovaries and fallopian tubes. Which treatment option is most likely to benefit the patient? Fulguration Anterior exenteration Intravesical chemotherapy Colporrhaphy

Anterior exenteration Rationale: Anterior exenteration involves the removal of the ovaries and fallopian tubes. This procedure is performed if the cancerous cells have spread to these organs. Test Taking Tips: Understand treatment recommendations based on invasiveness.

The nurse is preparing a client for extracorporeal shock wave lithotripsy. Which assessment finding should be reported to the healthcare provider immediately? Negative urine human chorionic gonadotropin test Client reports taking blood thinner medication daily History of previous stones Creatinine level 0.9 mg/dL

Client reports taking blood thinner medication daily

Which description of pain most likely causes the nurse to suspect a client is suffering from kidney stones? Moderate lower back tightness on one side Mild cramping in lower abdominal area Colicky pain with nausea and vomiting Constant dull pain in bilateral flank areas

Colicky pain with nausea and vomiting

A nurse is assessing the vital signs of a patient diagnosed with stones in his or her ureters. Which vital sign change is most likely to be observed? Decreased heart rate Decreased temperature Decreased blood pressure Decreased respiratory rate

Decreased blood pressure Rationale: A patient with urolithiasis will have decreased blood pressure because of infection and sepsis, dehydration, and complication of untreated stones. Test Taking Tips: Understand assessment findings.

The nurse is caring for Samantha, a 30-year-old female who presents to the emergency department with symptoms associated with urolithiasis. Which of Samantha's symptoms supports a diagnosis of urolithiasis? Select all that apply. Polyuria Diarrhea Flank pain Nausea and vomiting Abdominal distention Check Answer

Flank pain Nausea and vomiting CORRECT. Urolithiasis, commonly referred to as a kidney stone, often manifests with nausea, vomiting, and flank pain. Decreased urine output, not polyuria, is a clinical manifestation associated with this diagnosis. Diarrhea is not typically associated with urolithiasis. Although there may be distention within the urinary system, there is not abdominal distention.

A 45-year-old male patient has undergone surgery for invasive bladder cancer. Which nursing intervention is most appropriate to clear blood clots from the bladder postsurgery? Perform intravesical immunotherapy . Perform continuous bladder irrigation. Record accurate bladder intake and output. Administer intravesical chemotherapy medications.

Perform continuous bladder irrigation. Rationale: A radial cystoprostatectomy is a surgical treatment for bladder cancer. Continuous bladder irrigation is used after a tumor excision or biopsy to clear blood and blood clots from the bladder and prevent urine obstruction. Test Taking Tips: Understand treatments.

Which medication is used to decrease discomfort in a patient with a urinary tract infection (UTI)? Doxazosin Ciprofloxacin Phenazopyridium Trimethoprim-sulfamethoxazole

Phenazopyridium Rationale: Phenazopyridium is a bladder analgesic that can be used to decrease dysuria, frequency, and urgency in a patient with a UTI. Test Taking Tips: Chose the medication for discomfort.

Which action should the nurse teach Samantha to perform in order to determine if the kidney stone has passed? Straining the urine Measuring urine output Documenting daily urine pH Monitoring the urine for ketones

Straining the urine CORRECT. You should teach the patient to strain urine to collect the stone so it can be analyzed. Stone analysis will help dictate patient education and prevention of future stones. If the patient requires strict monitoring of input and output, hospital admission would be required along with placement of a Foley catheter. Urine pH may be monitored during the ED visit to determine the presence of acidic urine, which would support the diagnosis of uric acid stones. Urine is monitored for ketones for patients diagnosed with diabetes mellitus, not urolithiasis.

The nurse is providing discharge education to Samantha. Which clinical manifestations might necessitate the need for surgical intervention? Select all that apply. The development of renal colic Pain and burning during urination Pain controlled by narcotics A stone that does not pass in 2 to 3 weeks The decreased incidence of nausea and vomiting

The development of renal colic Pain and burning during urination CORRECT. A patient may need surgery if he or she is experiencing renal colic with pain and burning on urination, as these symptoms indicate a urinary tract infection. Pain that is not controlled by narcotics is also an indication for surgical intervention. A stone that does not pass after 4 to 6 weeks and development of nausea and vomiting, not a decreased incidence of these findings, would indicate the need for surgical intervention.

Samantha is diagnosed with a urolithiasis smaller than 5 mm in diameter. She is in minimal pain and urinalysis does not indicate infection. What is the first line of treatment? Trial passage Ureteroscopy Percutaneous nephrolithotomy Extracorporeal shock wave lithotripsy Check Answer

Trial Passage CORRECT. Fifty percent of stones less than 5 mm in size will pass spontaneously. For patients with minimal pain and no hydronephrosis or infection, the first line of treatment is an opportunity to pass the stone without intervention. Surgery is the treatment of choice for a patient who presents with a stone larger than 10 mm. Surgical choices are varied and dependent on stone size, location, and urgency of treatment. Ureteroscopy, percutaneous nephrolithotomy, and extracorporeal shock wave lithotripsy are common surgical procedures for the management of stones.

A pregnant female is assessed for suspected kidney stones. The nurse should prepare the client for which diagnostic test? Computed tomography scan Magnetic resonance imaging Kidneys-ureters-bladder plain film Ultrasound

Ultrasound

A pregnant patient with calculi in the lower ureter is prescribed tamsulosin for 6 weeks. During a follow-up visit, the patient reports severe intermittent genital pain and vomiting. The laboratory reports reveal that the pain is related to the stones. Which intervention is most likely to benefit the patient? Ureteroscopy Narcotics and antiemetics Other alpha-adrenergic blockers Extracorporeal shock wave lithotripsy

Ureteroscopy Rationale: Surgical management via ureteroscopy is indicated when medical interventions fail. This includes failure to remove stones even after 4 to 6 weeks of medical therapy. Test Taking Tips: Know safe treatment options.

A client is diagnosed with a 3-mm right kidney stone. The nurse should plan to include which teaching with the client? Select all that apply. Use of kidney stone strainers Side effects of analgesics Restricting amount of oral fluid intake Changing positions slowly when taking alpha blockers Increasing the number of dairy products in diet

Use of kidney stone strainers Side effects of analgesics

A patient is diagnosed with stage T2 bladder cancer. The tumor has not metastasized. Which part of the urinary tract is infected according to the tumor, node, metastasis (TNM) staging system? Kidney Urothelium Renal artery Detrusor muscle

Detrusor muscle Rationale: Stage T2 indicates that the tumor is an invasive cancer that has extended into the detrusor muscle. Test Taking Tips: T2 staging is indicative of an invasive bladder cancer.

An older male adult with a history of kidney stones presents to the emergency department with a family member. Which finding in the assessment would most likely alert the nurse to the possibility of a urinary tract infection while waiting on urinalysis results? Family member states client is confused History of benign prostatic hypertrophy Takes alpha-adrenergic blocker daily Voids 100 mL straw-colored urine

Family member states client is confused

Which clinical manifestation is observed in a patient with upper ureteral stones? Flank pain Genital pain Urinary urgency Urinary frequency

Flank pain Rationale: Flank pain indicates the presence of upper ureteral stones. Test Taking Tips: Know symptoms of stones.

A male client diagnosed with kidney stones is unable to void. What procedure should the nurse anticipate next? Nephrostomy tube placement Percutaneous nephrolithotomy Foley catheter insertion Renal ultrasound imaging

Foley catheter insertion

Which assessment finding is priority for the nurse to address after administering an alpha blocker prescribed for a client with kidney stones? Nausea and vomiting Pain verbalized as 6/10 Decreased urinary output Hypotension

Hypotension

Which topics should the nurse include in the teaching session to decrease the risk for Samantha developing urolithiasis in the future? Select all that apply. Increasing fluid intake Decreasing citrate intake Increasing sodium intake Decreasing oxalate intake Increasing fatty acid intake

Increasing fluid intake Decreasing oxalate intake CORRECT. Patients who have had a kidney stone should increase fluid intake (1 to 2 L/day) and decrease oxalate intake (rhubarb, chocolate, tea, coffee, and nuts). The patient should be taught to increase, not decrease, citrate intake (lemons and lemonade). Decreasing oxalate and increase citrate intake are both effective in decreasing the risk of stone formation. The patient should be taught to decrease sodium intake, as a low-sodium diet can prevent stones by decreasing the risk for dehydration. Fatty acids are not linked to the formation of kidney stones.

The nurse should include which risk factors when teaching about kidney stone prevention? Select all that apply. Living in a warm climate Family history Low salt intake Low protein intake Previous stones

Living in a warm climate Family history Previous stones

Which medication classifications should you include in Samantha's plan of care based on the current data? Select all that apply. Narcotics Antibiotics Antiemetics Alpha-adrenergic blockers Nonsteroidal anti-inflammatory drugs (NSAIDs)

Narcotics Antiemetics Alpha-adrenergic blockers Nonsteroidal anti-inflammatory drugs (NSAIDs) CORRECT. Narcotics and/or nonsteroidal anti-inflammatory medicine along with antiemetics are utilized during the trial of passage. Alpha-adrenergic blockers such as tamsulosin (Flomax), doxazosin (Cardura), and terazosin (Hytrin) can be used to relax the musculature of the lower ureter and aid in stone passage. Although antibiotics may be required if symptoms of infection are present, the patient is not currently exhibiting symptoms that indicate a need for antibiotic therapy.

A patient reports severe colicky pain in the abdomen and difficulty urinating. An ultrasound reveals the presence of 11-mm stones in the ureter. This procedure is recommended for the patient. What is it called? Open surgery removal Nephrolithotomy Ureteroscopy Extracorporeal shock wave lithotripsy

Nephrolithotomy Rationale: A nephrolithotomy is a surgical intervention performed on patients with stones greater than 10 mm. Test Taking Tips: Understand options.

Which diagnostic test is Samantha likely to have prescribed? Ultrasound Non-contrast CT scan Kidney ureter bladder (KUB) x-ray Magnetic resonance imagery (MRI)

Non-contrast CT scan CORRECT. A non-contrast CT scan is the diagnostic modality of choice to diagnose urolithiasis. In addition to identifying calculi, CT can assess for obstructive uropathy such as hydronephrosis (swelling of the kidneys that occurs when urine flow is blocked). An MRI is not a diagnostic modality used for the diagnosis of urolithiasis. A KUB x-ray is quick and inexpensive, but does not detect radiolucent uric acid stones. Ultrasound is recommended in children and pregnant females who should avoid radiation exposure.

A client is diagnosed with hydronephrosis due to obstructive kidney stones. The nurse should assess for which electrolyte imbalance that might lead to cardiac dysrhythmia? Potassium Calcium Magnesium Sodium

Potassium

What is the priority teaching point when the nurse is discussing narcotic analgesic side effects with a client diagnosed with kidney stones? Lightheadedness Nausea and vomiting Respiratory depression Constipation

Respiratory depression