A nurse is caring for a client admitted for renal calculus. Which of the following assessment findings should the nurse associate with renal calculi?
(Select All that Apply.)
Incontinence
Gastrointestinal upset
Urinary urgency
Fever
Flank pain
Correct Answer : B,C,D,E
A. Incontinence: Incontinence is not a typical symptom of renal calculi. Pain, urgency, and difficulty urinating are more common.
B. Gastrointestinal upset: Nausea, vomiting, and gastrointestinal upset can occur as a result of renal colic due to the proximity of the kidneys to the gastrointestinal system.
C. Urinary urgency: Clients with renal calculi may experience urinary urgency due to irritation of the urinary tract.
D. Fever: Fever may indicate an infection related to the obstruction caused by the stone, such as pyelonephritis.
E. Flank pain: Flank pain, often severe and radiating to the lower abdomen or groin, is a classic symptom of renal calculi as the stone moves through the urinary tract.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Elevate the head of the bed to 90 degrees: While elevating the head of the bed may help ease breathing, it does not address the potential issue of NG tube misplacement.
B. Administer a bronchodilator as prescribed: This would only be appropriate if the patient’s respiratory distress were related to bronchospasm or asthma, not NG tube displacement.
C. Check the placement of the NG tube to ensure it has not dislodged into the lungs. When a patient with an NG tube experiences respiratory distress, the tube may have dislodged and entered the respiratory tract, which could obstruct breathing. Verifying the placement of the NG tube is critical to preventing aspiration or further complications.
D. Increase the flow rate of the patient’s oxygen therapy: This may provide temporary relief but does not resolve the underlying cause of the distress if the NG tube has entered the respiratory tract.
Correct Answer is D
Explanation
A. Apply a heating pad to the abdomen: This is incorrect and potentially harmful, as applying heat to the abdomen can increase blood flow and worsen inflammation or risk rupture of the appendix.
B. Administer a cleansing enema: Enemas should not be administered for suspected appendicitis as they may cause irritation and increase the risk of perforation.
C. Administer oral analgesics as needed: Oral analgesics are contraindicated since the patient should be NPO, and strong pain relief might mask the symptoms of a ruptured appendix.
D. Place the patient on NPO status: The highest priority preoperative intervention is to place the patient on NPO (nothing by mouth) status to prevent aspiration during anesthesia, a standard preoperative practice, especially for abdominal surgeries.
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