1820: 42-year-old male endorsing right-sided flank pain, nausea, vomiting, dysuria, increased urinary frequency, and hematuria. The symptoms started twelve hours ago and have worsened. The client reports the pain as a '9' (0-no pain; 10-extreme pain). He states the pain is further exacerbated with urination, described as 'sharp and throbbing.' He says he recently ran out of prescribed medications because he lost his job. He has a medical history of major depressive disorder, gout, hypertension, and hyperlipidemia.
- Oral temperature 98° F (36.7° C)
- Heart rate 113/minute
- Respirations 22/minute
- Blood pressure 139/89 mm Hg
- Pulse oximetry 96% on room air
- Ketorolac 30 mg intramuscular (IM) x 1 dose now
- Computed tomography (CT) scan of the abdomen and pelvis without contrast
- Urine analysis
- One liter 0.9% saline bolus over one hour
- Ondansetron 4 mg Disintegrating Tablet x 1 dose now
2030: The client reports no pain, nausea, or vomiting. Stating, 'I feel so much better.' CT scan results showed a 2 mm stone in the right kidney. Dr. T. Smith gave a verbal order to discharge the client home and follow up with the primary healthcare provider (PHCP) within one week. Discharge teaching provided.
The nurse reviews the nursing note entry from 2030
The nurse performs teaching
➢ Which statement, if made by the client, indicates that the teaching has been effective or not effective?
Nephrolithiasis is when stones form in the kidney
➢ Risk factors include dehydration, metabolic conditions such as gout, male gender, and previous urinary stone
➢ Treatment depends on the size of the stone, as most stones < 5 mm pass with minimal medical intervention
➢ Treatment goals include saturating the urine with water to facilitate passage and other prescriptive treatments such as tamsulosin to dilate the urinary tract
➢ Pain control is a priority and is accomplished with NSAIDs such as ketorolac or naproxen
➢ The client should be educated to prevent recurrence by increasing fluid intake and modifying their diet
- A. I should report any fevers or chills to my doctor.
- B. I will decrease my water intake to prevent more stones.
- C. I will strain all my urine until the stone passes.
- D. I should call the doctor if I stop making any urine at all.
- E. I will increase my coffee intake to help flush my system.
- F. I must save the stone so the doctor can test it.
Sign in to reveal the correct answer & rationale
A free account unlocks answers for the preview questions in every exam. A pass unlocks all of them.