Renal Calculi (10 Questions)

1. M. Sylvain Côté, a 45-year-old male, arrives at the Emergency Department triage wincing in pain and clutching his right flank. He rates the pain as 10/10, describing it as "stabbing" and intermittent. He is pale, diaphoretic, and has vomited twice in the waiting room. His vital signs are: BP 150/92 mmHg, HR 118 bpm, RR 24 breaths/min, Temp 37.0°C.

The physician writes the following STAT orders:
*Hydromorphone (Dilaudid) 2 mg IV stat.
*Ondansetron (Zofran) 4 mg IV stat.
*Normal Saline 0.9% 1000 mL bolus.
*KUB (Kidney, Ureter, Bladder) X-ray.

Question:
Aside from maintaining a patent airway and breathing, what is the nurse’s priority intervention for M. Côté? *

Encourage the patient to ambulate in the hallway to help move the stone.

Administer hydromorphone (Dilaudid) 2 mg IV.

Initiate aggressive IV fluid resuscitation (Bolus 1L).

Obtain a 24-hour urine collection history.

2. Mme Isabelle Roy, 38 years old, is admitted for a confirmed 6mm ureteral stone. The physician orders an Intravenous Pyelogram (IVP) to locate the obstruction.

The pre-procedure orders include:
*NPO after midnight.
*Bowel preparation (laxative) this evening.
*Start IV Normal Saline at 100 mL/hr.

Question:
Before sending Mme Roy for this procedure, which specific assessment finding is critical for the nurse to report to the radiologist? *

The patient reported a mild allergy to shellfish (shrimp) in childhood.

The patient has a history of claustrophobia.

The patient ate breakfast 6 hours ago.

The patient complains of hematuria (blood in urine).

3. M. Marc-André Tremblay, 52 years old, is managed conservatively on the medical unit for a 4mm kidney stone.

The physician’s orders are:
*Encourage PO fluids to 3L/day.
*Strain all urine.
*Ketorolac (Toradol) 30 mg IV q6h PRN for pain.

M. Tremblay asks the nurse, "Why do I have to pee through this filter every time? It's annoying."

Question:
What is the nurse’s best response? *

"It helps us measure your urine output exactly to ensure your kidneys are working."

"We need to check if there is any blood in your urine."

"If we catch the stone, the lab can analyze it to prevent you from getting another one."

"It prevents the stone from clogging the hospital plumbing system."

4. Mme Claudine Lapointe, 60 years old, returns to the day surgery unit following Extracorporeal Shock Wave Lithotripsy (ESWL).

The post-procedure orders read:
*Monitor vital signs q15min x 1 hour.
*Encourage PO fluids.
*Strain all urine.

The nurse assesses the flank area and notes a large ecchymosis (bruise) on the treated side. Mme Lapointe's first voided urine is bright red.

Question:
How should the nurse interpret these findings? *

Call the physician immediately; these are signs of internal hemorrhage.

Document the findings as expected post-procedure responses.

Prepare the patient for a return to the operating room.

Irrigate the bladder manually to prevent clots.

5. M. Étienne Fortin, 30 years old, has recurrent kidney stones. Laboratory analysis of a previous stone revealed it was composed of Calcium Oxalate.

He is being discharged with the following order:
*Dietary consultation for renal stone prevention.

Question:
Which dietary instruction is most appropriate for this specific type of stone? *

"Stop eating all dairy products to reduce calcium intake."

"Eat a diet rich in purines, such as liver and sardines."

"Take a Vitamin C supplement daily to acidify your urine."

"Avoid foods high in oxalates, such as spinach, rhubarb, chocolate, and nuts."

6. M. Roger Bouchard, 65 years old, presents with severe flank pain. He has a history of Gout. The physician diagnoses a Uric Acid stone and writes the following discharge prescriptions:
*Allopurinol (Zyloprim) 300 mg PO daily.
*Low-purine diet.

Question:
Which specific food group should the nurse teach M. Bouchard to limit based on these orders? *

Citrus fruits like lemons and oranges.

Organ meats (liver), sardines, and shellfish.

Leafy green vegetables.

Dairy products like milk and cheese.

7. Mme Valérie Morin, 44 years old, was admitted yesterday for a ureteral stone.

Her orders include:
*IV Normal Saline at 150 mL/hr.
*Monitor Intake and Output (I&O).

During the last 4 hours, the nurse notes that Mme Morin’s urine output has dropped to 15 mL total, and she complains of dull, increasing pressure in her flank.

Question:
What is the nurse’s priority interpretation of this situation? *

The patient is dehydrated and needs the IV rate increased.

The patient is experiencing a side effect of opioid medication.

The stone has passed into the bladder.

The stone has completely obstructed the ureter, causing hydronephrosis.

8. M. Guillaume Pelletier, 29 years old, is being discharged. The physician emphasizes fluid intake in the discharge summary:
*Maintain urine output > 2L/day.

M. Pelletier asks, "So, how much water do I actually need to drink to do that?"

Question:
What is the best standard recommendation for the nurse to provide? *

"Drink 3 liters of fluid per day to ensure a urine output of at least 2 liters."

"Drink only when you feel thirsty to avoid overworking your kidneys."

"Drink mostly cranberry juice to acidify the urine."

"Restrict fluids in the evening so you can sleep."

9. Mme Francine Dubé, 55 years old, has a nephrostomy tube following a procedure for a staghorn calculus.

The standing orders for tube care are:
*Monitor drainage q2h.
*Report sudden cessation of drainage.
*Irrigate with 5mL sterile saline PRN ONLY if ordered.

The nurse observes the tube is draining bright red urine, and then suddenly stops draining entirely. Mme Dubé reports pressure in her back.

Question:
What is the nurse’s initial action? *

Irrigate the tube immediately with 10 mL saline.

Assess the tubing for kinks or compression and ensure the bag is below waist level.

Clamp the tube to prevent hemorrhage.

Administer a diuretic to stimulate urine production.

10. M. Jean-Luc Gagnon, 50 years old, has recurrent calcium phosphate stones. The physician adds a new medication to his regimen:
*Hydrochlorothiazide 25 mg PO daily.

M. Gagnon asks, "I thought this was a water pill for blood pressure. Won't peeing more dry me out and cause more stones?"

Question:
What is the nurse’s best explanation of why this medication is prescribed? *

"It increases the flow of urine to mechanically flush small stones out."

"It dissolves the calcium stones that are already in your kidney."

"It treats the urinary tract infections that are causing your stones."

"It helps your kidneys reabsorb calcium into the blood so it doesn't build up in your urine."