16 terms

Nclex Review: Renal Calculi

A client has renal colic due to renal lithiasis. What is the nurse's first priority in managing care for this client?
1. Do not allow the client to ingest fluids.
2. Encourage the client to drink at least 500 mL of water each hour.
3. Request the central supply department to send supplies for straining urine.
4. Administer an opioid analgesic as prescribed.
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. Withholding fluids will make urine more concentrated and stones more difficult to pass naturally. Forcing large quantities of fluid may cause hydronephrosis if urine is prevented from flowing past calculi. Straining urine for small stones is important, but does not take priority over pain management.
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 ° F (38.1 ° C). Which of the following would be a priority outcome for this client?
1. Prevention of urinary tract complications.
2. Alleviation of nausea.
3. Alleviation of pain.
4. Maintenance of fluid and electrolyte balance.
The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate throughout the client's hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte imbalance.
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:
1. Fluid and food will be withheld the morning of the examination.
2. A tranquilizer will be given before the examination.
3. An enema will be given before the examination.
4. No special preparation is required for the examination.
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.
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:
1. Nephritis.
2. Referred pain.
3. Urine retention.
4. Additional stone formation.
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. Nausea, vomiting, abdominal cramping, and diarrhea may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of pain described in this situation is unlikely to be caused by additional stone formation.
Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic?
1. Applying moist heat to the flank area.
2. Administering meperidine (Demerol).
3. Encouraging high fluid intake.
4. Maintaining complete bed rest.
During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.
A client who has been diagnosed with renal calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time?
1. Report hematuria to the physician.
2. Strain the urine carefully.
3. Administer meperidine (Demerol) every 3 hours.
4. Apply warm compresses to the flank area.
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. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessened.
The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which of the following measures would be most important for the nurse to include in pretest preparation?
1. Ensuring adequate fluid intake on the day of the test.
2. Preparing the client for the possibility of bladder spasms during the test.
3. Checking the client's history for allergy to iodine.
4. Determining when the client last had a bowel movement.
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. Adequate fluid intake is important after the examination. Bladder spasms are not common during an IVP. Bowel preparation is important before an IVP to allow visualization of the ureters and bladder, but checking for allergies is most important.
After an intravenous pyelogram (IVP), the nurse should anticipate incorporating which of the following measures into the client's plan of care?
1. Maintaining bed rest.
2. Encouraging adequate fluid intake.
3. Assessing for hematuria.
4. Administering a laxative.
After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria.
A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to:
1. Irrigate the catheter with 30 mL of normal saline every 8 hours.
2. Ensure that the catheter is draining freely.
3. Clamp the catheter every 2 hours for 30 minutes.
4. Ensure that the catheter drains at least 30 mL/ hour.
The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client's total urine output (ureteral catheter plus voiding or indwelling urinary catheter output) should be 30 mL/ hour.
Which of the following interventions would be the most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
1. Encourage the client to ambulate every 2 to 4 hours.
2. Offer 3 to 4 oz of a carbonated beverage periodically.
3. Encourage use of a stool softener.
4. Continue I.V. fluid therapy.
Ambulation stimulates peristalsis. A client with paralytic ileus is kept on nothing-by-mouth status until peristalsis returns. Carbonated beverages will increase gas and distention but will not stimulate peristalsis. A stool softener will not stimulate peristalsis. I.V. fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus.
The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician?
1. Temperature, 99.8 ° F (37.7 ° C).
2. Urine output, 20 mL/ hour.
3. Absence of bowel sounds.
4. A 2″ × 2″ area of serosanguineous drainage on the flank dressing.
The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine output of 30 mL/ hour or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serosanguineous drainage is to be expected.
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan?
1. Increase daily fluid intake to at least 2 to 3 L.
2. Strain urine at home regularly.
3. Eliminate dairy products from the diet.
4. Follow measures to alkalinize the urine.
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. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly.
Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications?
1. Milk, apples, tomatoes, and corn.
2. Eggs, spinach, dried peas, and gravy.
3. Salmon, chicken, caviar, and asparagus.
4. Grapes, corn, cereals, and liver.
Because a high-purine diet contributes 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. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Foods allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.
Allopurinol (Zyloprim), 200 mg/ day, is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which of the following adverse effects of this medication?
1. Retinopathy.
2. Maculopapular rash.
3. Nasal congestion.
4. Dizziness.
Allopurinol (Zyloprim) 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. Clients should be instructed to report rashes and unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not adverse effects of allopurinol.
A client has been prescribed allopurinol (Zyloprim) for renal calculi that are caused by high uric acid levels. Which of the following indicate the client is experiencing adverse effect( s) of this drug? Select all that apply.
1. Nausea.
2. Rash.
3. Constipation.
4. Flushed skin.
5. Bone marrow depression.
1, 2, 5.
Common adverse effects of allopurinol (Zyloprim) 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. Constipation and flushed skin are not associated with this drug.
The nurse is reviewing laboratory reports for a client who is taking allopurinol (Zyloprim). Which of the following indicate that the drug has had a therapeutic effect?
1. Decreased urine alkaline phosphatase level.
2. Increased urine calcium excretion.
3. Increased serum calcium level.
4. Decreased serum uric acid level.
By inhibiting uric acid synthesis, allopurinol (Zyloprim) decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, nor does it affect urine calcium excretion or the serum calcium level.