61. 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.

TEST-TAKING HINT: The test taker should remember to read the question carefully. The question asks for a "discharge teach- ing" intervention. This rules out option "4," which is a treatment, as a potential answer.

62. 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

TEST-TAKING HINT: Remember, if the question asks which intervention is first, all four (4) options may be appropriate for the client's diagnosis but only one has priority. Assessment is the first part of the nursing process and it is the first intervention a nurse should implement if the client is not in distress.

63.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.

TEST-TAKING HINT: The nurse must be aware of pre-procedure and post-procedure teach- ing and care. The test taker must know the invasive and noninvasive diagnostic tests in general. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are a few of the noninvasive diagnostic tests.

64. 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

TEST-TAKING HINT: Options "1" and "3" both have assessment data indicating bleeding. The test taker can usually eliminate these as possible answers or eliminate the other two options not addressing blood. Renal stones are painful; therefore, option "4" could be eliminated as a possible answer.

65.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 a collection.

3. Collect all urine during 24 hours and place it in an appropriate specimen container.

4. Insert an indwelling catheter in the client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

1. The health-care provider may order certain foods and medications when obtain- ing 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.

66.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

TEST-TAKING HINT: Remember Maslow's hierarchy of needs: airway and pain are priority. No option mentions possible airway problems, so pain is priority.

67.The client diagnosed with renal calculi is scheduled for lithotripsy. Which post-procedure 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 the care of the indwelling Foley catheter.

3. Assist the client in the car when being discharged home.

4. Take the client's post procedural vital signs.

3. The UAP could assist the client to the car once the discharge has been completed

TEST-TAKING HINT: There are some basic rules about delegation: the nurse cannot delegate assessment, teaching, evaluation, or any task requiring judgment.

68. 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 stone- forming salts from becoming concentrated enough to precipitate

TEST-TAKING HINT: This is a urinary problem and fluid is priority. Therefore, the test taker should select an option addressing fluid, and there is only one option addressing oral intake.

69. 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.Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and stone, if found, should be sent to the laboratory to determine what caused the stone

TEST-TAKING HINT: Remember, if the question asks for "most important," more than one of the options could be appropriate but only one is most important. Assessment is a priority if the client is not in distress, but the test taker should make sure it is appropriate for the situation.

70.The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and 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.

TEST-TAKING HINT: Fever, chills, and burn- ing on urination require some type of assessment. Therefore, the test taker should select an option that helps determine what is wrong with the client and "3" is the only such option.

71.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

TEST-TAKING HINT: The nurse must know normal laboratory data and be able to apply the normal and abnormal results to specific diseases and disorders.

72. 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

TEST-TAKING HINT: The nurse has to be knowledgeable of foods included in specific diets. This is memorizing, but the test taker must have this knowledge to answer questions evaluating types of diets for specific diseases and disorders.