Question 1

A client is complaining of dull flank pain.List the order of the steps the nurse should take in conducting the physical assessment for this client.
1.Instruct the client.
2.Assess the general appearance.
3.Position the client.
4.Inspect the abdomen for color,contour,symmetry,and distention

Accepted Answer

The answer of A client is complaining of dull flank...

Question 2

A client with urinary calculi is admitted to the hospital.When planning care for this client,which goal is most appropriate?

Accepted Answer

The most appropriate goal for a client with urinary calculi is to manage their pain. The client may experience significant discomfort and pain with this condition, and managing their pain is a significant aspect of their care. The other goals listed (losing weight, ambulating, and showering independently) may be important for overall health, but they are not specific to managing the symptoms of urinary calculi.

Question 3

A novice nurse is providing care to clients on a urology unit.When providing care to a group of clients,which client does the novice nurse identify as being at the greatest risk for developing urinary stones?

Accepted Answer

A 35-year-old woman with quadriplegia from an auto accident is at the greatest risk for developing urinary stones due to immobility, catheterization, and dehydration. Immobility can lead to stasis of urine, allowing for crystal formation, and catheterization increases the risk of infection and stone development. Dehydration can also contribute to the formation of urinary stones. The other clients are not identified as having risk factors for developing urinary stones.

Question 4

The nurse is caring for a client with a history of kidney stones.The stones have been analyzed and are all composed of calcium phosphate.Based on this data,which foods should the nurse teach the client to avoid?

Accepted Answer

A) Flour, milk, and milk products such as ice cream have high calcium levels and, therefore, are recommended to be reduced to decrease the risk of further episodes of calcium-containing calculi. Organ meats, sardines, seafood, tomatoes, fruits, nuts, chicken, beef, and ham products are not high in calcium and do not need to be restricted for this client.
B) Flour, milk, and milk products such as ice cream have high calcium levels and, therefore, are recommended to be reduced to decrease the risk of further episodes of calcium-containing calculi. Organ meats, sardines, seafood, tomatoes, fruits, nuts, chicken, beef, and ham products are not high in calcium and do not need to be restricted for this client.
C) Flour, milk, and milk products such as ice cream have high calcium levels and, therefore, are recommended to be reduced to decrease the risk of further episodes of calcium-containing calculi. Organ meats, sardines, seafood, tomatoes, fruits, nuts, chicken, beef, and ham products are not high in calcium and do not need to be restricted for this client.
D) Flour, milk, and milk products such as ice cream have high calcium levels and, therefore, are recommended to be reduced to decrease the risk of further episodes of calcium-containing calculi. Organ meats, sardines, seafood, tomatoes, fruits, nuts, chicken, beef, and ham products are not high in calcium and do not need to be restricted for this client.

Question 5

The nurse is preparing to discharge a client who underwent lithotripsy for the treatment of a kidney stone.What should the nurse teach the client to prevent further complications of urinary calculi after discharge?

Accepted Answer

A)The client with stones may develop a UTI when formed stones obstruct urinary flow. These symptoms should be reported as early as possible to the primary care provider. By discharge, the stones should have passed and there would be no need for pain medication. Fluid intake per day should be 2.5-3.0 L. Foods high in purines, such as organ meats, are to be avoided.
B)The client with stones may develop a UTI when formed stones obstruct urinary flow. These symptoms should be reported as early as possible to the primary care provider. By discharge, the stones should have passed and there would be no need for pain medication. Fluid intake per day should be 2.5-3.0 L. Foods high in purines, such as organ meats, are to be avoided.
C)The client with stones may develop a UTI when formed stones obstruct urinary flow. These symptoms should be reported as early as possible to the primary care provider. By discharge, the stones should have passed and there would be no need for pain medication. Fluid intake per day should be 2.5-3.0 L. Foods high in purines, such as organ meats, are to be avoided.
D)The client with stones may develop a UTI when formed stones obstruct urinary flow. These symptoms should be reported as early as possible to the primary care provider. By discharge, the stones should have passed and there would be no need for pain medication. Fluid intake per day should be 2.5-3.0 L. Foods high in purines, such as organ meats, are to be avoided.

Question 6

The nurse is providing care to a client whose medication therapy for the treatment of renal calculi has failed.Based on this data,which treatment option does the nurse anticipate for this client?

Accepted Answer

A)When medication fails to dissolve stones, the preferred method of treatment is lithotripsy, which is using sound waves to crush the stones so they can be passed out of the urinary system. Depending on the location of the stones, surgery may be the next step in the treatment process. Diet and fluids are used to prevent further stone formation.
B)When medication fails to dissolve stones, the preferred method of treatment is lithotripsy, which is using sound waves to crush the stones so they can be passed out of the urinary system. Depending on the location of the stones, surgery may be the next step in the treatment process. Diet and fluids are used to prevent further stone formation.
C)When medication fails to dissolve stones, the preferred method of treatment is lithotripsy, which is using sound waves to crush the stones so they can be passed out of the urinary system. Depending on the location of the stones, surgery may be the next step in the treatment process. Diet and fluids are used to prevent further stone formation.
D)When medication fails to dissolve stones, the preferred method of treatment is lithotripsy, which is using sound waves to crush the stones so they can be passed out of the urinary system. Depending on the location of the stones, surgery may be the next step in the treatment process. Diet and fluids are used to prevent further stone formation.

Question 7

The nurse on the medical unit is admitting an older adult client whose primary symptoms include fatigue,pruritus,and pain in the right flank area.When conducting this client's assessment,which technique is the least appropriate?

Accepted Answer

A)Blunt percussion in a frail older individual is contraindicated. Instead, palpation of the costovertebral angles and flanks can be used to reveal any pain or tenderness. All other assessments are appropriate.
B)Blunt percussion in a frail older individual is contraindicated. Instead, palpation of the costovertebral angles and flanks can be used to reveal any pain or tenderness. All other assessments are appropriate.
C)Blunt percussion in a frail older individual is contraindicated. Instead, palpation of the costovertebral angles and flanks can be used to reveal any pain or tenderness. All other assessments are appropriate.
D)Blunt percussion in a frail older individual is contraindicated. Instead, palpation of the costovertebral angles and flanks can be used to reveal any pain or tenderness. All other assessments are appropriate.

Question 8

The nurse educator is speaking with a group of students about renal disorders.Which statement is appropriate for the educator to include regarding renal stones?

Accepted Answer

Young- or middle-adult men are at an increased risk for renal stones, particularly those who have a family history of stones, are overweight or obese, consume a high-protein diet, or have certain medical conditions such as hyperparathyroidism or Crohn's disease. Other risk factors include dehydration, low urine volume, and certain medications.

Question 9

A client admitted to the hospital with a diagnosis of gout has also been diagnosed with uric acid renal calculi.When planning meals for this client,which diet will the nurse anticipate?

Accepted Answer

A low-purine diet is the most appropriate choice for a client with gout and uric acid renal calculi. Purines are broken down into uric acid in the body, so reducing purine intake can lead to lower levels of uric acid and decreased risk of developing more kidney stones. A low-sodium diet may also be helpful, but it is not as directly related to the management of gout and uric acid renal calculi. A diet high in calcium can actually increase the risk of kidney stones in some cases, so it would not be the most appropriate choice. A diet low in calcium is also not recommended for the prevention of kidney stones, as calcium can actually bind to oxalates in the gut and prevent them from being absorbed and excreted in the urine.

Question 10

A client is admitted to the emergency department and diagnosed with renal colic after experiencing symptoms for 1 week,including those associated with the body's sympathetic response to severe pain.When planning care for this client,which nursing diagnosis is the most appropriate?

Accepted Answer

A)The client with renal colic of lengthy duration is at risk for imbalanced nutrition from the resulting nausea. Activity intolerance, risk for constipation, and risk for disuse syndrome are not as appropriate because the symptoms of urinary calculi do not lead to these diagnoses.
B)The client with renal colic of lengthy duration is at risk for imbalanced nutrition from the resulting nausea. Activity intolerance, risk for constipation, and risk for disuse syndrome are not as appropriate because the symptoms of urinary calculi do not lead to these diagnoses.
C)The client with renal colic of lengthy duration is at risk for imbalanced nutrition from the resulting nausea. Activity intolerance, risk for constipation, and risk for disuse syndrome are not as appropriate because the symptoms of urinary calculi do not lead to these diagnoses.
D)The client with renal colic of lengthy duration is at risk for imbalanced nutrition from the resulting nausea. Activity intolerance, risk for constipation, and risk for disuse syndrome are not as appropriate because the symptoms of urinary calculi do not lead to these diagnoses.

Question 11

A client admitted to the hospital with a diagnosis of inflammatory bowel disease has also been diagnosed with calcium phosphate renal calculi.When planning care for this client,which type of medication does the nurse anticipate based on the data?

Accepted Answer

Thiazide diuretics can decrease urinary calcium excretion and prevent the formation of calcium phosphate renal calculi. Antibiotics, allopurinol, and NSAIDs would not address the formation of renal calculi.

Question 12

In which of the following ways do calcium phosphate stones differ from uric acid and cystine stones?

Accepted Answer

Calcium phosphate stones are formed in alkaline urine while uric acid and cystine stones are formed in acidic urine.

Question 13

The nurse is providing care for a client with renal calculi.Which expected outcomes will the nurse include in this client's plan of care? Select all that apply.

Accepted Answer

A)While straining of the client's urine may indicate that the stone has passed, it is important to assess the client for possible complications. Client outcomes should include the client's rating pain at 3 or less on a 0-10 scale and being comfortable enough to perform own ADLs, the client demonstrating an adequate fluid intake of 2-3 liters a day, the client's choosing the appropriate diet to prevent the reoccurrence of renal calculi, and the client's remaining free of signs and symptoms of infection.
B)While straining of the client's urine may indicate that the stone has passed, it is important to assess the client for possible complications. Client outcomes should include the client's rating pain at 3 or less on a 0-10 scale and being comfortable enough to perform own ADLs, the client demonstrating an adequate fluid intake of 2-3 liters a day, the client's choosing the appropriate diet to prevent the reoccurrence of renal calculi, and the client's remaining free of signs and symptoms of infection.
C)While straining of the client's urine may indicate that the stone has passed, it is important to assess the client for possible complications. Client outcomes should include the client's rating pain at 3 or less on a 0-10 scale and being comfortable enough to perform own ADLs, the client demonstrating an adequate fluid intake of 2-3 liters a day, the client's choosing the appropriate diet to prevent the reoccurrence of renal calculi, and the client's remaining free of signs and symptoms of infection.
D)While straining of the client's urine may indicate that the stone has passed, it is important to assess the client for possible complications. Client outcomes should include the client's rating pain at 3 or less on a 0-10 scale and being comfortable enough to perform own ADLs, the client demonstrating an adequate fluid intake of 2-3 liters a day, the client's choosing the appropriate diet to prevent the reoccurrence of renal calculi, and the client's remaining free of signs and symptoms of infection.
E)While straining of the client's urine may indicate that the stone has passed, it is important to assess the client for possible complications. Client outcomes should include the client's rating pain at 3 or less on a 0-10 scale and being comfortable enough to perform own ADLs, the client demonstrating an adequate fluid intake of 2-3 liters a day, the client's choosing the appropriate diet to prevent the reoccurrence of renal calculi, and the client's remaining free of signs and symptoms of infection.

Question 14

A nurse is caring for four clients with renal calculi.Of these clients,which one should the nurse identify as having the highest likelihood of requiring surgery to remove the calculi?

Accepted Answer

Struvite stones are also called infection stones and are commonly found in older adults with chronic urinary tract infections. These stones can grow rapidly and cause significant obstruction, increasing the likelihood of surgical intervention. Calcium phosphate and uric acid stones are often managed with conservative measures such as increased fluid intake and medication, while calcium oxalate stones may require dietary modifications and possibly lithotripsy. The fact that the client in option B has struvite stones and is older increases the likelihood of requiring surgery.

Question 15

A client with a history of urinary calculi presents with frequency,urgency,and dysuria.A urinalysis reveals formation of crystals in the urine,known as nucleation.Based on this finding,which statement is true about the composition of the client's urine?

Accepted Answer

The presence of nucleation in the urine indicates a high concentration of insoluble salt, which can lead to the formation of urinary calculi. Choices A and B are unlikely because a high concentration of citrate and glycoproteins would hinder stone formation, and a pH of 7.0 is considered neutral and not associated with crystal formation. Choice C is not relevant to the presence of nucleation.

Quiz 5: Elimination

A client is complaining of dull flank pain.List the order of the steps the nurse should take in conducting the physical assessment for this client. 1.Instruct the client. 2.Assess the general appearance. 3.Position the client. 4.Inspect the abdomen for color,contour,symmetry,and distention