Kidney Stones

1. You're providing an in-service to a group of nurses about the different types of kidney stones. You explain to the attendees that the most common type of kidney stone is made up of:
A. Cholesterol
B. Calcium and oxalate
C. Calcium and phosphate
D. Uric acid

1. You're providing an in-service to a group of nurses about the different types of kidney stones. You explain to the attendees that the most common type of kidney stone is made up of:
A. Cholesterol
B. Calcium and oxalate
C. Calcium and phosphate
D. Uric acid

B. Calcium and oxalate

2. Which patient below is at MOST risk for developing uric acid type kidney stones?
A. A 53 year old female with recurrent urinary tract infections.
B. A 6 year old male with cystinuria.
C. A 63 year male with gout.
D. A 25 year old female that follows a vegan diet and report eating high amounts of spinach and strawberries on a regular basis.

C. A 63 year male with gout.

Patients with gout experience high uric acid levels which can lead to the development of uric acid kidney stones. In option A, the patient is at risk for struvite kidney stones. In option B, the patient is at risk for cystine kidney stones, and in option C, the patient is at a small risk for calcium oxalate stones due to the high consumption of foods with oxalates.

3. A patient is scheduled for an intravenous pyelogram (IVP) to assess for kidneys stones. Which finding below requires the nurse to contact the physician?
A. Patient reports flank pain that radiates downward
B. Patient has hematuria
C. Patient is allergic to shellfish
D. Patient has cloudy urine

C. Patient is allergic to shellfish

4. The physician orders a 24-hour urine collection on a patient with recurrent kidney stones. As the nurse you know that the specimen should be?
A. Kept at room temperature
B. Kept on ice or refrigerated
C. Sent to the lab every four hours
D. Kept at a temperature between 98.6 'F to 99.3'F

B. Kept on ice or refrigerated

24-hour urine collection specimens should be kept refrigerated or on ice (ice bath). If specimen is not kept cold it can alter the test results.

5. You're providing care to a patient with a uric acid kidney stone that is 2 mm in size per diagnostic imaging. The patient is having severe pain and rates their pain 10 on 1-10 scale. The physician has ordered a treatment plan to assist the patient in passing the kidney stone. What nursing intervention is PRIORITY for this patient based on the scenario?
A. Administer pain medication
B. Encourage fluid intake of 2-4 liters per day
C. Massage the costovertebral area
D. Implement a high protein diet

A. Administer pain medication

Controlling the patient's pain is priority. Option B is another important part of the patient's plan of care to help assist the passage of the kidney stone, but it is not priority at the moment until the patient's pain is controlled. Option C and D are not recommended for the treatment of uric acid kidney stones. You would never massage the costovertebral area, and a high protein diet will further increase uric acid levels, therefore, should be avoided.

6. A patient with a kidney stone explains that the pain he is experiencing is intense, sharp, and wavelike that radiates to the scrotum. In addition, he explains it feels like he has to void but a small amount of urine is passed. Based on the patient's signs and symptoms, where may the kidney stone be located?
A. Renal Calyx
B. Renal Papilla
C. Ureter
D. Urethra

C. Ureter

The patient's description of the pain is known as ureteral colic. The kidney stone may be in the ureter. On the other hand, another type of pain that can be reported is renal colic. This is a dull, deep aching in the flank/costovertebral area and the kidney stone may be in the renal pelvis.

7. You're developing a nursing care plan for a patient with a kidney stone. Which of the following nursing interventions will you include in the patient's plan of care?
A. Restrict calcium intake
B. Strain urine with every void
C. Keep patient in supine position to alleviate pain
D. Maintain fluid restriction of 1-2 Liter per day

B. Strain urine with every void

It is vital the nurse strains every void and assesses the urine very closely for stones. This is crucial so it can be determined what type of kidney stone is causing the problem, therefore, appropriate treatment can be ordered. Restricting calcium intake is no longer recommended unless the patient has a metabolic or renal tubule problem. It is important to avoid placing the patient in the supine position for long periods because this impedes the flow of urine and the patient's ability to pass the stone. Fluid should not be restricted (unless the patient has a condition that requires it like heart failure etc.) because this concentrates the urine...hence increases the chances of another stone developing.

8. You're providing discharge teaching to a patient who was hospitalized for the treatment of a kidney stone. The type of kidney stone the patient experienced was a uric acid type stone. What type of foods will you educate the patient to avoid?
A. Cabbage, spinach, tomatoes, strawberries
B. Ice cream, milk, pork, cheese
C. Beans, potatoes, corn, peas
D. Liver, scallops, anchovies, sardines, pork

D. Liver, scallops, anchovies, sardines, pork

The patient should avoid foods high in purine and foods high in animal proteins. Foods that are high in purine or animal proteins breakdown into uric acid. Foods high in purine are any type of organ meats (liver), most seafood (scallops, anchovies, sardines), pork, red meats, beer etc.

9. Your patient arrives back to their room after having extracoporeal shock wave lithotripsy (ESWL) for treatment of a kidney stone. What will be included in the patient's plan of care? SELECT-ALL-THAT-APPLY:
A. Keep the patient in bed
B. Encourage fluid intake of 3-4 liters per day
C. Maintain nephrostomy tube
D. Strain urine
E. Keep dressing dry and intact

B. Encourage fluid intake of 3-4 liters per day
D. Strain urine

Extracoporeal shock wave lithotripsy (ESWL) is NONINVASIVE (no incisions...no dressings or nephrostomy tubes are placed). Shockwaves are created to penetrate though the skin and body tissue. Shockwaves will hit the stone and break it down into grain of sand like particles which will be passed out by the patient. Option A is wrong because the patient should be kept mobile (as tolerated) to assist the passage of the kidney stone fragment.

10. You are providing pre-op teaching to a patient scheduled for a percutaneous nephrolithotomy. Which statement by the patient demonstrates the patient understood the pre-op teaching?
A. "During the procedure the surgeon will move the stone down the ureter, so I can pass the stone in the urine.
B. "I may have a nephrostomy tube after the procedure."
C. "A scope is inserted through the urinary system from the urethra to the kidneys to assess the kidney stone."
D. "This procedure is noninvasive and no incision is required."

B. "I may have a nephrostomy tube after the procedure."

A percutaneous nephrolithotomy is an INVASIVE procedure that can be used to remove large kidney stones. An incision is made on the back where the kidney is located. A nephroscope is then insert through the incision and used to remove the stone. Generally, the surgeon is able to remove the stone or break it up, therefore, the patient doesn't have to pass it naturally as with other procedures. A nephrostomy tube is sometimes placed after the procedure to drain urine and fragments of the stone out of the kidney.