Med-Surg Book Renal Calculi

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement?
1. Encourage the client to eat a low-purine diet and limit foods such as organ meats.
2. Explain the importance of not drinking water two (2) hours before bedtime.
3. Discuss the importance of limiting vitamin D-enriched foods.
4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).
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The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement?
1. Encourage the client to eat a low-purine diet and limit foods such as organ meats.
2. Explain the importance of not drinking water two (2) hours before bedtime.
3. Discuss the importance of limiting vitamin D-enriched foods.
4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).
3
Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract
The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first?
1. Monitor the client's urinary output.
2. Assess the client's pain and rule out complications.
3. Increase the client's oral fluid intake.
4. Use a safety gait belt when ambulating the client.
2
Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope.
The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure?
1. Ask if the client is allergic to shellfish or iodine.
2. Keep the client NPO eight (8) hours prior to the ultrasound.
3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.
4
No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied, which produces sound waves, resulting in a picture.
Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone?
1. Dull, aching flank pain and microscopic hematuria.
2. Nausea; vomiting; pallor; and cool, clammy skin.
3. Gross hematuria and dull suprapubic pain with voiding.
4. The client will be asymptomatic.
2
The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin.
The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply.
1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection.
3. Collect all urine during 24 hours and place in appropriate specimen container.
4. Insert an indwelling catheter in client after having the client empty the bladder.
5. Instruct the UAP to notify the nurse when the client urinates.
1,2,3
1. The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid.
2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty.
3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result
The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client?
1. Fluid volume loss.
2. Knowledge deficit.
3. Impaired urinary elimination. 4. Alteration in comfort.
4
Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.
The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP?
1. Monitor the amount, color, and consistency of urine output.
2. Teach the client about care of the indwelling Foley catheter.
3. Assist the client to the car when being discharged home. 4. Take the client's postprocedural vital signs
3
The UAP could assist the client to the car once the discharge has been completed.
Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation?
1. "I should increase my fluid intake, especially in warm weather."
2. "I should eat foods containing cocoa and chocolate."
3. "I will walk about a mile every week and not exercise often."
4. "I should take one (1) vitamin a day with extra calcium."
1
An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stoneforming salts from becoming concentrated enough to precipitate.
Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi?
1. Assess the client's neurological status every two (2) hours.
2. Strain all urine and send any sediment to the laboratory.
3. Monitor the client's creatinine and BUN levels.
4. Take a 24-hour dietary recall during the client interview.
2
The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client?
1. Increase water intake for the next 24 hours.
2. Take two (2) Tylenol to help decrease the temperature.
3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine.
3
A urinalysis can assess for hematuria, the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI.
The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000/mm3 .4 The white blood cell count is elevated; normal is 5,000 to 10,000/mm3.The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.3 Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.