Chapter 50: Kidney Stones

Question 1

Which of the following factors increases the risk of developing urinary tract calculi? (Select all that apply)

A. Family history of kidney stones
B. Living in the Southern United States
C. Low fluid intake
D. High dietary calcium intake
E. Older age

Answer 1

A. Family history of kidney stones
B. Living in the Southern United States
C. Low fluid intake
E. Older age

Rationale: A family history of kidney stones, living in hot climates (such as the Southern United States), low fluid intake, and older age all increase the risk of developing urinary tract calculi.

Question 2

In which of the following populations is the incidence of urinary tract calculi the highest?

A. Middle-aged African American women
B. Older Hispanic men
C. Middle-aged White and Asian adults
D. Young Black men

Answer 2

C. Middle-aged White and Asian adults

Rationale: The incidence of kidney stones is highest in middle-aged White and Asian adults.

Question 3

Which of the following is a major environmental factor that may contribute to an increased risk of developing kidney stones?

A. Cold climate
B. Excessive exercise
C. Hot climate and dehydration
D. High salt intake

Answer 3

C. Hot climate and dehydration

Rationale: Kidney stone formation is more common in hot climates, particularly in the South and Southwest of the United States, where dehydration is a contributing factor.

Question 4

Which of the following factors is associated with a higher incidence of urinary tract calculi formation?

A. Increased intake of fluids
B. High dietary calcium intake
C. Decreased body temperature
D. Living in a cool, humid climate

Answer 4

B. High dietary calcium intake

Rationale: High dietary calcium intake can increase the risk of kidney stone formation, especially in individuals with certain types of stones such as calcium oxalate stones.

Question 5

Which of the following factors is MOST likely to contribute to the formation of calcium and phosphate stones?

A. Low urinary pH
B. High urinary pH
C. High intake of vitamin C
D. High intake of sodium

Answer 5

B. High urinary pH

Rationale: Calcium and phosphate stones are less soluble in a higher (alkaline) urinary pH, increasing the likelihood of stone formation.

Question 6

Which of the following conditions is associated with the formation of struvite stones?

A. UTI with urea-splitting bacteria
B. Chronic dehydration
C. Hypercalcemia
D. High purine intake

Answer 6

A. UTI with urea-splitting bacteria

Rationale: Struvite stones form in the presence of urea-splitting bacteria (e.g., Proteus, Klebsiella, Pseudomonas), which alkalinize the urine and contribute to stone formation.

Question 7

Which of the following is a key factor that reduces the risk of recurrent kidney stone formation?

A. Increasing the solute load in the urine
B. Keeping urine dilute and free-flowing
C. Decreasing urinary pH
D. Decreasing fluid intake

Answer 7

B. Keeping urine dilute and free-flowing

Rationale: Keeping the urine dilute and free-flowing reduces the risk of crystal precipitation and stone formation.

Question 8

Which of the following is TRUE regarding the pathophysiology of kidney stone formation?

A. Urinary pH has no effect on stone formation.
B. Crystals can precipitate when in a supersaturated concentration.
C. The higher the pH, the more soluble uric acid becomes.
D. Only genetic factors contribute to stone formation.

Answer 8

B. Crystals can precipitate when in a supersaturated concentration.

Rationale: When crystals reach a supersaturated concentration in the urine, they are more likely to precipitate and form stones.

Question 9

Which of the following urine characteristics increases the risk of uric acid stone formation?

A. Alkaline pH
B. High solute load
C. Acidic pH
D. Increased inhibitor levels

Answer 9

C. Acidic pH

Rationale: Uric acid is less soluble in acidic urine, increasing the likelihood of stone formation in patients with low urinary pH.

Question 10

What is the most likely result of obstruction and urinary stasis caused by kidney stones?

A. Hydronephrosis and kidney dysfunction
B. Decreased risk of infection
C. Increased urine production
D. Improved stone passage

Answer 10

A. Hydronephrosis and kidney dysfunction

Rationale: Obstruction and urinary stasis can lead to hydronephrosis (swelling of the kidney due to urine buildup) and impaired kidney function.

Question 11

Which of the following dietary factors is MOST likely to contribute to the formation of kidney stones?

A. High intake of low-fat dairy
B. Excessive consumption of tea or fruit juices
C. Increased intake of fiber-rich foods
D. Reduced sodium intake

Answer 11

B. Excessive consumption of tea or fruit juices

Rationale: Excessive consumption of tea or fruit juices can increase urinary oxalate levels, contributing to stone formation.

Question 12

A patient with a family history of kidney stones, gout, and renal acidosis is at increased risk for kidney stone formation due to which of the following factors?

A. Dietary factors
B. Lifestyle factors
C. Metabolic factors
D. Genetic factors

Answer 12

D. Genetic factors

Rationale: Genetic factors, such as a family history of kidney stones, gout, and renal acidosis, increase the risk of kidney stone formation.

Question 13

Which lifestyle factor is MOST likely to contribute to kidney stone formation in patients who are immobilized for extended periods?

A. Increased fluid intake
B. Sedentary occupation
C. Increased weight-bearing activity
D. Immobility leading to increased calcium excretion

Answer 13

D. Immobility leading to increased calcium excretion

Rationale: Immobility leads to increased calcium excretion in the urine, which can contribute to stone formation.

Question 14

Which of the following metabolic abnormalities is MOST likely to contribute to kidney stone formation?

A. High citrate levels in the urine
B. Low calcium levels in the urine
C. High levels of uric acid, calcium, or oxalate in the urine
D. Low uric acid levels in the urine

Answer 14

C. High levels of uric acid, calcium, or oxalate in the urine

Rationale: Abnormalities that result in increased levels of uric acid, calcium, or oxalate in the urine contribute to the formation of kidney stones.

Question 15

A patient with a history of obesity and sedentary occupation is at increased risk for kidney stones due to which of the following factors?

A. Low urinary volume
B. Increased fluid intake
C. High levels of citrate in the urine
D. Increased calcium excretion in the urine

Answer 15

A. Low urinary volume

Rationale: Obesity and a sedentary lifestyle contribute to low urinary volume and increased solute concentration, both of which increase the risk of kidney stone formation.

Question 16

Which dietary habit is MOST likely to increase the risk of uric acid kidney stones?

A. High intake of fruits and vegetables
B. High intake of animal protein
C. Low intake of salt
D. Increased calcium-rich foods

Answer 16

B. High intake of animal protein

Rationale: High intake of animal protein increases uric acid excretion, contributing to the formation of uric acid stones.

Question 17

Which of the following statements about the risk of kidney stones is MOST accurate?

A. Low fluid intake results in high urine volume, which reduces the risk of stone formation.

B. High calcium intake is always a risk factor for kidney stone formation.

C. A family history of cystinuria can increase the likelihood of developing kidney stones.

D. Low protein intake is a major risk factor for stone formation.

Answer 17

C. A family history of cystinuria can increase the likelihood of developing kidney stones.

Rationale: A family history of cystinuria, a genetic disorder that increases cystine excretion in urine, can increase the likelihood of developing kidney stones.

Question 18

Which of the following is the BEST prevention strategy for a patient at risk for kidney stones related to low urine volume?

A. Decrease fluid intake to reduce kidney workload.
B. Maintain a high-protein diet to increase urine output.
C. Increase fluid intake to dilute the urine and prevent crystal formation.
D. Limit sodium intake to decrease urinary calcium excretion.

Answer 18

C. Increase fluid intake to dilute the urine and prevent crystal formation.

Rationale: Increasing fluid intake helps dilute the urine, reducing the concentration of stone-forming substances and preventing stone formation.

Question 19

Which type of urinary stone is the MOST common among patients with nephrolithiasis?

A. Calcium oxalate
B. Calcium phosphate
C. Uric acid
D. Struvite

Answer 19

A. Calcium oxalate

Rationale: Calcium oxalate stones are the most common type of urinary stones found in patients with nephrolithiasis.

Question 20

Which of the following types of urinary stones is most commonly associated with urinary tract infections caused by urea-splitting bacteria?

A. Calcium oxalate stones
B. Cystine stones
C. Struvite stones
D. Uric acid stones

Answer 20

C. Struvite stones

Rationale: Struvite stones (magnesium ammonium phosphate) are commonly associated with urinary tract infections caused by urea-splitting bacteria, such as Proteus or Klebsiella.

Question 21

Which of the following characteristics is MOST likely to be found in a patient with uric acid stones?

A. Urine pH is typically alkaline.
B. The stones are radiopaque on imaging.
C. The stones are often associated with gout.
D. The stones form more frequently in females than in males.

Answer 21

C. The stones are often associated with gout.

Rationale: Uric acid stones are often associated with gout, and they tend to form in acidic urine. They are radiolucent and not visible on standard x-rays.

Question 22

Which of the following types of stones may form as a result of an inherited disorder, such as cystinuria?

A. Uric acid stones
B. Struvite stones
C. Cystine stones
D. Calcium phosphate stones

Answer 22

C. Cystine stones

Rationale: Cystine stones are often a result of cystinuria, an inherited disorder that causes excess excretion of cystine in the urine.

Question 23

Which of the following symptoms is most commonly associated with the passage of a kidney stone through the ureter?

A. Radiating flank pain
B. Abdominal distention
C. Chronic low-grade fever
D. Severe renal colic

Answer 23

D. Severe renal colic

Rationale: Renal colic is the most common symptom when a kidney stone is passing through the ureter. It is described as sharp, severe pain that radiates, often to the genital region, and is due to obstruction and ureteral spasm.

Question 24

A patient with a kidney stone reports severe flank pain and difficulty staying still, often moving from walking to sitting and lying down. This pattern is most commonly referred to as:

A. Renal colic dance
B. Kidney stone waltz
C. Ureteral spasms
D. Kidney stone dance

Answer 24

D. Kidney stone dance

Rationale: The pattern of moving between walking, sitting, and lying down due to the severe pain of kidney stones is referred to as the “kidney stone dance.”

Question 25

Which of the following is the most likely cause of the nausea and vomiting in a patient with kidney stones?

A. Renal obstruction causing increased creatinine levels
B. Pain associated with renal colic
C. Urinary tract infection (UTI) due to stone obstruction
D. Systemic sepsis from a stone-related infection

Answer 25

B. Pain associated with renal colic

Rationale: Nausea and vomiting in kidney stone patients typically occur due to the severe pain associated with renal colic, which can affect the gastrointestinal system.

Question 26

Which of the following clinical manifestations would be most concerning in a patient with kidney stones and may indicate a secondary urinary tract infection?

A. Fever and chills
B. Sharp flank pain
C. Increased urinary frequency
D. Pain radiating to the groin

Answer 26

A. Fever and chills

Rationale: Fever and chills in a patient with kidney stones could indicate a secondary urinary tract infection (UTI) due to obstruction, which may lead to infection and requires prompt intervention.

Question 27

In a patient with a kidney stone, which of the following findings is typically observed during renal colic?

A. Persistent low-grade fever
B. Decreased heart rate
C. Cool, moist skin
D. Stable blood pressure

Answer 27

C. Cool, moist skin

Rationale: Patients with renal colic may experience shock-like symptoms, including cool, moist skin, due to the pain and stress response from the kidney stone.

Question 28

Which symptom would suggest that a kidney stone has obstructed the urinary flow at the level of the renal pelvis or ureteropelvic junction (UPJ)?

A. Pain radiating to the testicle or labia
B. Costovertebral flank pain
C. Pain relieved by movement
D. Mild abdominal discomfort

Answer 28

B. Costovertebral flank pain

Rationale: Costovertebral flank pain is a common manifestation when a kidney stone obstructs at the renal pelvis or UPJ.

Question 29

A patient with kidney stones is exhibiting intense colicky pain that radiates to the genital region. This pain pattern is most likely due to:

A. Passage of the stone through the ureter
B. A stone obstructing the renal pelvis
C. Infection from a urinary tract obstruction
D. The stone being trapped in the bladder

Answer 29

A. Passage of the stone through the ureter

Rationale: Intense, colicky pain radiating to the genital region is most commonly associated with the passage of a kidney stone through the ureter, causing spasm and stretching.

Question 30

Which of the following is a characteristic symptom of kidney stones when the stone is nearing the ureterovesical junction (UVJ)?

A. Severe flank pain without radiation
B. Pain radiating to the lower abdomen and groin
C. No pain or discomfort
D. Pain that decreases as the stone moves into the bladder

Answer 30

B. Pain radiating to the lower abdomen and groin

Rationale: As a stone nears the UVJ, pain typically radiates toward the lower abdomen and groin, and men may experience testicular pain, while women may experience labial pain.

Question 31

A 45-year-old male is being evaluated for recurrent kidney stones. A noncontrast CT scan was performed, and the patient’s urinalysis revealed hematuria and crystalluria. The healthcare provider suspects that the patient may have struvite stones. Which of the following lab findings would be most indicative of struvite stones?

A) Increased serum calcium
B) Alkaline urine pH
C) Decreased BUN levels
D) High creatinine levels

Answer 31

B) Alkaline urine pH

Rationale: Struvite stones tend to form in alkaline urine. An alkaline pH is a key indicator for struvite stones, which are often associated with urinary tract infections. Serum calcium, BUN, and creatinine levels are not typically diagnostic for struvite stones, though they may be altered in some cases of renal dysfunction.

Question 32

A patient is being treated for recurrent kidney stones. A 24-hour urinary collection is ordered to assess the patient’s urine composition. Which of the following substances is MOST likely to be measured in this test for a patient with a history of uric acid stones?

A) Oxalate
B) Citrate
C) Calcium
D) Uric acid

Answer 32

D) Uric acid

Rationale: Uric acid stones are associated with elevated levels of uric acid in the urine. A 24-hour urinary collection helps measure various substances, including uric acid, which plays a key role in the formation of uric acid stones. Oxalate, citrate, and calcium are more relevant to other types of stones.

Question 33

A nurse is reviewing the lab results of a patient with suspected urinary stones. The results show elevated serum creatinine and BUN levels, which suggest renal impairment. Which diagnostic study is MOST appropriate to confirm the diagnosis of a urinary stone?

A) Urine pH measurement
B) Noncontrast CT scan
C) Serum calcium level
D) 24-hour urinary calcium measurement

Answer 33

B) Noncontrast CT scan

Rationale: A noncontrast CT scan is the most effective imaging technique to diagnose urinary stones. Elevated serum creatinine and BUN levels suggest possible renal impairment, which warrants further investigation using diagnostic imaging. Urine pH, serum calcium, and 24-hour urine collection are useful in assessing stone types or recurrent formation, but a CT scan is the definitive test for diagnosing stones.

Question 34

A patient presents with renal colic pain due to a 3-mm kidney stone. The healthcare provider orders NSAIDs for pain relief. What is the most important assessment the nurse should make before administering NSAIDs to this patient?

A) Patient’s blood pressure
B) Patient’s medication adherence
C) Patient’s renal function
D) Patient’s fluid intake

Answer 34

C) Patient’s renal function

Rationale: NSAIDs can negatively affect renal function, particularly in patients with existing renal issues. Before administering NSAIDs, the nurse must assess the patient’s renal function to avoid potential complications. Blood pressure, medication adherence, and fluid intake are also important considerations but do not directly relate to the risk of renal impairment with NSAID use.

Question 35

A nurse is educating a patient about the use of α-adrenergic blockers, such as tamsulosin (Flomax), to help with the passage of a kidney stone. Which of the following statements made by the patient indicates a need for further teaching?

A) “This medication will help relax the smooth muscle in my ureter.”

B) “I should expect some relief from urinary symptoms related to BPH if I have it.”

C) “This medication will increase the size of my stone so it can pass more easily.”

D) “I may need to take this medication for several weeks to pass the stone.”

Answer 35

C) “This medication will increase the size of my stone so it can pass more easily.”

Rationale: α-Adrenergic blockers, like tamsulosin, relax the smooth muscle in the ureter to facilitate the passage of the stone. They do not increase the size of the stone. Statements A, B, and D are correct, as the medication aids in stone passage, may alleviate BPH symptoms, and can take time for the stone to pass.

Question 36

A patient with a history of recurrent kidney stones is undergoing a comprehensive management approach for stone prevention. Which of the following interventions would be most effective in reducing the formation of new stones in this patient?

A) Increasing fluid intake
B) Administering opioids for pain control
C) Encouraging a sedentary lifestyle
D) Prescribing antibiotics for all patients with kidney stones

Answer 36

A) Increasing fluid intake

Rationale: Adequate hydration is one of the most effective methods for preventing the formation of new kidney stones by diluting the urine and preventing crystallization. While opioids may be used for pain control during an acute episode, and antibiotics may be indicated for certain conditions like struvite stones, fluid intake is the primary preventive measure. A sedentary lifestyle may contribute to stone formation.

Question 37

A patient with struvite stones is not a candidate for surgery. The healthcare provider prescribes chronic antibiotic therapy. What is the primary purpose of this therapy?

A) To prevent future kidney infections
B) To treat the underlying cause of stone formation
C) To prevent the recurrence of struvite stones
D) To promote the passage of existing stones

Answer 37

C) To prevent the recurrence of struvite stones

Rationale: Chronic antibiotic therapy in patients with struvite stones is primarily aimed at preventing the recurrence of infections caused by urea-splitting bacteria, which contribute to the formation of struvite stones. This therapy is not meant to treat the underlying cause directly or promote the passage of existing stones.

Question 38

A 60-year-old male with benign prostatic hyperplasia (BPH) is being treated with tamsulosin (Flomax) for kidney stone passage. The nurse is aware that this medication may also help alleviate symptoms of BPH. Which of the following is a common side effect of tamsulosin?

A) Diarrhea
B) Orthostatic hypotension
C) Insomnia
D) Constipation

Answer 38

B) Orthostatic hypotension

Rationale: Tamsulosin is an α-adrenergic blocker that can cause orthostatic hypotension as a side effect. This occurs due to the medication’s effect on smooth muscle relaxation, not only in the ureter but also in the blood vessels. Diarrhea, insomnia, and constipation are not common side effects.

Question 39

A nurse is caring for a patient with a large kidney stone that is causing obstructive symptoms and renal dysfunction. The healthcare provider decides to perform a percutaneous nephrolithotomy. Which of the following is the primary goal of this intervention?

A) To remove the stone and relieve obstruction
B) To treat the underlying infection
C) To alter urine pH and prevent future stone formation
D) To reduce the size of the stone for spontaneous passage

Answer 39

A) To remove the stone and relieve obstruction

Rationale: A percutaneous nephrolithotomy is a surgical intervention aimed at removing large stones that cannot pass spontaneously, especially when causing obstruction, renal dysfunction, or severe symptoms. It is not primarily focused on treating infection, altering urine pH, or reducing the size for passage.

Question 40

A patient with a history of recurrent kidney stones is undergoing a comprehensive treatment plan. The nurse is teaching the patient about dietary changes to prevent stone formation. Which of the following foods should the patient avoid to reduce the risk of forming calcium oxalate stones?

A) Spinach
B) Apples
C) Bananas
D) Rice

Answer 40

A) Spinach

Rationale: Spinach is high in oxalate, a substance that can contribute to the formation of calcium oxalate stones. While apples, bananas, and rice are not high in oxalate, patients are typically advised to avoid or limit oxalate-rich foods like spinach in order to reduce the risk of stone formation.

Question 41

A nurse is caring for a patient who underwent lithotripsy for kidney stone removal. What is the most important post-procedure care the nurse should prioritize?

A) Encouraging fluid intake to flush out stone fragments
B) Administering opioids for pain control
C) Limiting ambulation to prevent injury
D) Monitoring for signs of infection

Answer 41

A) Encouraging fluid intake to flush out stone fragments

Rationale: After lithotripsy, the patient is encouraged to drink plenty of fluids to help flush out any remaining stone fragments from the urinary tract. While pain management and infection prevention are important, the most critical post-procedure care involves ensuring that the patient can effectively eliminate the fragmented stones.

Question 42

A 55-year-old patient with recurrent kidney stones is being assessed for potential underlying causes of stone formation. Which of the following factors is most likely to contribute to the development of kidney stones?

A) Prolonged immobilization
B) Excessive fluid intake
C) Active exercise routine
D) Low vitamin D intake

Answer 42

A) Prolonged immobilization

Rationale: Prolonged immobilization can lead to an increased risk of kidney stone formation due to the release of calcium from bones into the bloodstream, which may then be excreted in the urine and form stones. While excessive fluid intake and regular exercise help prevent stone formation, immobilization and low vitamin D intake are risk factors for stone development.

Question 43

A nurse is caring for a patient who underwent cystoscopic lithotripsy to remove a bladder stone. Which of the following is the most important post-procedure nursing intervention?

A) Restricting fluid intake to prevent bladder irritation
B) Monitoring for signs of hemorrhage and infection
C) Encouraging early ambulation to promote healing
D) Administering opioid pain medication to manage pain

Answer 43

B) Monitoring for signs of hemorrhage and infection

Rationale: Following cystoscopic lithotripsy, the most important nursing intervention is to monitor for complications such as hemorrhage and infection, which are common after the procedure. Although pain management, fluid intake, and early ambulation are also essential, preventing and identifying hemorrhage and infection are critical to patient safety.

Question 44

A patient undergoes a percutaneous nephrolithotomy to remove kidney stones. The nurse notes that the patient has a percutaneous nephrostomy tube in place. What is the primary purpose of this tube?

A) To prevent bleeding
B) To allow for irrigation of the kidney
C) To maintain ureteral patency and prevent obstruction
D) To drain excess fluid from the bladder

Answer 44

C) To maintain ureteral patency and prevent obstruction

Rationale: A percutaneous nephrostomy tube is placed after percutaneous nephrolithotomy to maintain ureteral patency and prevent obstruction, allowing the kidney to drain properly. It does not primarily address bleeding, irrigation, or bladder drainage.

Question 45

A patient who had a transurethral cystolitholapaxy for a large bladder stone is at risk for certain complications. Which of the following complications is most commonly associated with this procedure?

A) Retained stone fragments
B) Acute renal failure
C) Pneumonia
D) Bowel perforation

Answer 45

A) Retained stone fragments

Rationale: Retained stone fragments are a common complication following a transurethral cystolitholapaxy because some small fragments may remain in the bladder after the stone is crushed. While acute renal failure, pneumonia, and bowel perforation are possible complications of some procedures, they are not as directly associated with cystolitholapaxy.

Question 46

The nurse is preparing a patient for a flexible ureteroscopy to remove a stone from the renal pelvis. Which of the following statements by the patient indicates an understanding of the procedure?

A) “I will be awake during the procedure and may feel some discomfort.”
B) “The surgeon will break up the stone into smaller pieces using ultrasound energy.”
C) “This procedure will remove the stone by making a large incision in my abdomen.”
D) “I will need a catheter for several weeks after the procedure.”

Answer 46

B) “The surgeon will break up the stone into smaller pieces using ultrasound energy.”

Rationale: Flexible ureteroscopy uses ultrasound or laser energy to break up stones in the renal pelvis and upper urinary tract. The patient may be awake, depending on the anesthesia used, and discomfort can occur, but large incisions are not made, and the procedure does not require a long-term catheter.

Question 47

A patient is undergoing cystoscopic lithotripsy for a large bladder stone. Which of the following complications is the nurse most likely to monitor for after the procedure?

A) Urinary retention
B) Renal colic
C) Hemorrhage
D) Hydronephrosis

Answer 47

C) Hemorrhage

Rationale: Hemorrhage is a common complication after cystoscopic lithotripsy due to the manipulation and breaking up of stones in the bladder. While urinary retention, renal colic, and hydronephrosis may occur in some patients with kidney stones, they are not the most common complications after this procedure.

Question 48

A patient with a large renal stone undergoes percutaneous nephrolithotomy. The healthcare provider uses a nephroscope to remove the stone. Which of the following is a potential complication of this procedure?

A) Infection
B) Elevated blood pressure
C) Hypothermia
D) Dehydration

Answer 48

A) Infection

Rationale: Infection is a common complication of percutaneous nephrolithotomy, especially with the insertion of a nephroscope and the creation of a track through the skin. The procedure involves direct access to the kidney, which can introduce bacteria. Although elevated blood pressure, hypothermia, and dehydration are possible issues for other conditions, infection is the most relevant complication in this case.

Question 49

A nurse is educating a patient who is scheduled for percutaneous nephrolithotomy about the procedure. Which of the following instructions should the nurse include in the teaching plan?

A) “You will need to stay in the hospital for several weeks after the procedure.”
B) “You may need a tube inserted through your skin to help drain urine after the procedure.”
C) “This procedure involves breaking the stone into smaller pieces and passing them naturally.”
D) “You will have a large incision made in your abdomen to remove the stone.”

Answer 49

B) “You may need a tube inserted through your skin to help drain urine after the procedure.”

Rationale: A percutaneous nephrolithotomy typically involves inserting a nephrostomy tube through the skin to ensure the kidney remains drained and unobstructed. The patient does not need to stay in the hospital for several weeks, and there is no large abdominal incision. The procedure does not involve passing stones naturally after fragmentation.

Question 50

A patient is undergoing extracorporeal shock-wave lithotripsy (ESWL) to break up a kidney stone. Which of the following complications is most commonly associated with this procedure?

A) Infection
B) Incomplete breakup of the stone
C) Hemorrhage
D) Hypertension

Answer 50

B) Incomplete breakup of the stone

Rationale: Incomplete breakup of the stone is a common complication of ESWL. If the stone is not completely fragmented, it can lead to possible obstruction, kidney damage, or decreased renal function. While infection and hemorrhage are possible, they are less common. Elevated BP can occur as a result of other factors, but it is not a typical complication of ESWL.

Question 51

A nurse is preparing a patient for laser lithotripsy. Which of the following statements by the patient indicates an understanding of the procedure?

A) “The laser will be used to break up the stone, and I will be awake during the procedure.”

B) “I will be given a local anesthetic, and the procedure will take a few hours.”

C) “A small fiber will be inserted into the ureter to target the stone, and I will be under general anesthesia.”

D) “The procedure will require an incision, and I will be in the hospital for several days.”

Answer 51

C) “A small fiber will be inserted into the ureter to target the stone, and I will be under general anesthesia.”

Rationale: Laser lithotripsy involves inserting a small fiber through a ureteroscope to deliver laser energy directly to the stone. This procedure typically requires general anesthesia. Local anesthesia and lengthy hospital stays are not required for this minimally invasive treatment.

Question 52

After extracorporeal shock-wave lithotripsy (ESWL), a patient complains of pain and reports bright red urine. Which of the following is the most appropriate nursing intervention?

A) Encourage increased fluid intake and reassure the patient that hematuria is common
B) Administer a blood transfusion to correct the bleeding
C) Apply ice to the flank to reduce pain
D) Notify the healthcare provider immediately about the hematuria

Answer 52

A) Encourage increased fluid intake and reassure the patient that hematuria is common

Rationale: Hematuria is common after lithotripsy procedures like ESWL, especially in the first few voids. It is usually transient and resolves as the bleeding subsides. Increasing fluid intake can help flush out the fragments and reduce the discomfort associated with passing them. Blood transfusion, ice application, and immediate notification are not necessary unless complications arise.

Question 53

A patient who underwent ultrasonic lithotripsy is scheduled for discharge. Which of the following instructions should the nurse provide to the patient to help with recovery?

A) “You should rest in bed for the next 48 hours to avoid complications.”

B) “Expect to pass stone fragments in your urine over the next few weeks.”

C) “You can resume strenuous exercise in 1 week to help with healing.”

D) “You may not drink fluids for the next 24 hours to avoid bladder irritation.”

Answer 53

B) “Expect to pass stone fragments in your urine over the next few weeks.”

Rationale: After ultrasonic lithotripsy, it is common for patients to pass small fragments of the stone in their urine. These fragments may pass for several days to weeks. Resting in bed and avoiding fluid intake are not necessary, and patients can resume most normal activities after a short recovery period.

Question 54

A patient undergoing electrohydraulic lithotripsy for a large stone asks how the procedure will be performed. Which of the following is the most accurate explanation of the process?

A) “The procedure involves the use of sound waves to break the stone into sand-like particles.”

B) “The procedure uses high-energy shock waves from outside your body to shatter the stone.”

C) “The procedure involves inserting a small fiber into the stone and breaking it up with a laser.”

D) “The procedure uses electrical shock waves to break the stone into smaller fragments.”

Answer 54

D) “The procedure uses electrical shock waves to break the stone into smaller fragments.”

Rationale: Electrohydraulic lithotripsy uses electrical shock waves to break a stone into smaller fragments. It is similar to other lithotripsy techniques, but instead of sound or laser energy, electrical energy is used to shatter the stone.

Question 55

A nurse is caring for a patient who underwent lithotripsy. The patient reports moderate pain after the procedure and is passing stone fragments in their urine. Which of the following is the most appropriate action by the nurse?

A) Encourage fluids to help flush out stone fragments and manage pain with NSAIDs.

B) Administer opioids for pain and advise the patient to limit fluid intake.

C) Limit the patient’s activity and administer antibiotics for the pain.

D) Monitor for signs of infection and administer IV fluids only if the patient is dehydrated.

Answer 55

A) Encourage fluids to help flush out stone fragments and manage pain with NSAIDs.

Rationale: Encouraging fluid intake helps dilute the urine and facilitates the passage of stone fragments. Managing pain with NSAIDs is appropriate, as these medications are effective for mild to moderate pain. Opioids are typically reserved for more severe pain. Limiting fluid intake or activity is not recommended in this case.

Question 56

A nurse is explaining the potential complications of lithotripsy to a patient. Which of the following is the most common complication after the procedure?

A) Hemorrhage
B) Infection
C) Obstruction
D) Hematuria

Answer 56

D) Hematuria

Rationale: Hematuria is the most common complication after lithotripsy and is usually temporary. It typically resolves within a few days to weeks as the stone fragments are passed. While hemorrhage, infection, and obstruction can occur, they are less common than hematuria.

Question 57

A patient undergoing an open cystotomy for bladder stones is at risk for which of the following complications?

A) Hemorrhage and infection
B) Renal failure and dehydration
C) Urinary retention and oliguria
D) Paralytic ileus and nausea

Answer 57

A) Hemorrhage and infection

Rationale: The most common complications after open cystotomy for bladder stones are hemorrhage and infection. The procedure involves making an incision into the bladder, which increases the risk of bleeding and infection. Other complications listed are not specific to this procedure.

Question 58

After undergoing a pyelolithotomy to remove a stone from the renal pelvis, which of the following complications should the nurse monitor for in the immediate postoperative period?

A) Increased renal function
B) Bleeding and infection
C) Dehydration and electrolyte imbalances
D) Decreased urination and hypotension

Answer 58

B) Bleeding and infection

Rationale: The most common complications after any surgery for stone removal, including pyelolithotomy, are bleeding and infection. The nurse should monitor for these issues in the immediate postoperative period. Other complications listed are less specific to this surgical procedure.

Question 59

A patient with a stone in the ureter is scheduled for a ureterolithotomy. The nurse explains the procedure and mentions that a flank incision will be made. Which of the following is the primary reason for this approach?

A) To provide access to the renal pelvis for stone removal
B) To allow the surgeon to access the bladder directly
C) To remove stones from the kidney through a side incision
D) To facilitate access to the ureter for stone removal

Answer 59

D) To facilitate access to the ureter for stone removal

Rationale: A ureterolithotomy involves a flank incision to access the ureter and remove the stone. This approach is necessary because the stone is located in the ureter. The other options describe procedures related to different locations of stone removal, such as in the kidney or bladder.

Question 60

A patient is scheduled for a nephrolithotomy to remove a kidney stone. Which of the following is the primary reason for choosing this surgical intervention?

A) The stone is causing pain, infection, or obstruction.
B) The stone is located in the bladder.
C) The patient has a history of renal calculi and no symptoms.
D) The stone is smaller than 5 mm and can pass spontaneously.

Answer 60

A) The stone is causing pain, infection, or obstruction.

Rationale: Nephrolithotomy is indicated when a stone causes significant pain, infection, or obstruction in the kidney. It is a surgical intervention used for stones located in the kidney. Other options are incorrect because they do not align with the indications for nephrolithotomy, such as stone location or the absence of complications.

Question 61

A nurse is educating a patient with a history of urinary stones about lifestyle changes to prevent recurrence. The nurse should emphasize the importance of which of the following recommendations?

A) Limit fluid intake to 1.5 L/day
B) Increase fluid intake to 3 to 4 L/day for a moderately active person
C) Limit physical activity to reduce strain on the kidneys
D) Avoid consuming dietary calcium

Answer 61

B) Increase fluid intake to 3 to 4 L/day for a moderately active person

Rationale: Adequate fluid intake is crucial to prevent urinary stone formation. For a moderately active person, the recommended fluid intake is 3 to 4 L/day. Decreasing fluid intake or avoiding dietary calcium is not recommended, as these are not proven methods for preventing stone recurrence. Limiting physical activity is also not advised, as moderate activity is beneficial for overall health.

Question 62

A patient on bed rest for an extended period is at risk for developing urinary stones. Which of the following is the best nursing intervention to help prevent stone formation in this patient?

A) Encourage frequent ambulation to increase fluid flow
B) Administer analgesics regularly to control pain
C) Maintain adequate fluid intake and turn the patient every few hours
D) Limit the patient’s fluid intake to reduce strain on the kidneys

Answer 62

C) Maintain adequate fluid intake and turn the patient every few hours

Rationale: For patients on bed rest or prolonged immobility, maintaining adequate fluid intake and turning the patient regularly to promote urinary flow are essential interventions. Ambulation is not possible for patients on bed rest, and limiting fluid intake would increase the risk of stone formation.

Question 63

When teaching a patient with a history of uric acid stones about dietary changes, the nurse should include which of the following recommendations?

A) Increase intake of foods high in purines, such as organ meats
B) Avoid foods high in calcium
C) Restrict intake of purines to help prevent uric acid stone formation
D) Consume large amounts of high-sodium foods to aid in stone prevention

Answer 63

C) Restrict intake of purines to help prevent uric acid stone formation

Rationale: Uric acid stones are associated with high levels of purines in the diet. Restricting purine intake, found in foods like organ meats, shellfish, and certain fish, is recommended to help prevent the formation of uric acid stones. Calcium and sodium intake do not need to be restricted for uric acid stone prevention.

Question 64

A patient is experiencing renal colic due to an obstructing stone. The nurse is teaching the patient about pain management strategies. Which of the following interventions is a priority for the nurse to implement?

A) Administer opioid analgesics as prescribed
B) Encourage ambulation to promote stone movement
C) Instruct the patient to limit fluid intake to reduce discomfort
D) Apply heat to the lower abdomen to relieve pain

Answer 64

A) Administer opioid analgesics as prescribed

Rationale: Pain management is a priority in patients with obstructing stones and renal colic. Opioid analgesics are commonly prescribed to manage this severe pain. While ambulation can help move the stone, it is not the priority intervention in the acute pain phase. Limiting fluid intake and applying heat are not standard interventions for pain relief in this context.

Question 65

A nurse is caring for a patient with renal colic who is receiving opioid analgesics. Which of the following is the most important safety consideration when ambulating this patient?

A) Monitor blood pressure and heart rate before ambulation
B) Ensure the patient asks for assistance when moving to avoid falls
C) Instruct the patient to use a walker during ambulation
D) Allow the patient to ambulate independently as long as they are pain-free

Answer 65

B) Ensure the patient asks for assistance when moving to avoid falls

Rationale: Patients receiving opioid analgesics are at an increased risk for falls due to the sedative effects of the medication. It is crucial to ensure that the patient asks for assistance when ambulating, especially during acute episodes of renal colic, when they may be unsteady. Monitoring vital signs and providing walking aids are important, but preventing falls is the top priority.

Question 66

A patient has had recurrent uric acid kidney stones. Which diet items would the nurse recommend that the patient avoid or limit?

a. Milk and cheese

b. Sardines and liver

c. Spinach and chocolate

d. Legumes and dried fruit

Answer 66

b. Sardines and liver

Rationale: Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.

Question 67

Which topic would the nurse include when teaching the patient ways to prevent the recurrence of kidney stones?

a. Using a filter to strain all urine

b. Drinking 3000 mL of fluid each day

c. Avoiding dietary sources of calcium

d. Choosing diuretic fluids such as coffee

Answer 67

b. Drinking 3000 mL of fluid each day

Rationale: A fluid intake of 2000 to 3000 mL/day is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with kidney stones. Coffee tends to increase stone recurrence. Straining all urine routinely after a stone has passed will not prevent stones.

Question 68

Which nursing action is of highest priority for a patient with kidney stones who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?

a. Administer prescribed analgesics.

b. Monitor temperature every 4 hours.

c. Encourage increased oral fluid intake.

d. Give antiemetics as needed for nausea.

Answer 68

a. Administer prescribed analgesics.

Rationale: Although all the nursing actions may be used for patients with kidney stones, the patient‘s presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.

Question 69

A patient has been diagnosed with urinary tract stones that are high in uric acid. Which foods will the nurse teach the patient to avoid or limit? (Select all that apply.)

a. Milk
b. Liver
c. Spinach
d. Chicken
e. Cabbage
f. Chocolate

Answer 69

b. Liver
d. Chicken

Rationale: Meats contain purines, which are metabolized to uric acid. The other foods might be restricted in patients who have calcium or oxalate stones.