Medical Surgical Kidney stones #1

Question

A client comes to the emergency department (ED) in severe pain from renal colic due to nephrolithiasis. Which nursing action will be performed first?

Answers

  1. Encourage the client to drink 800 mL of fluids every hour.
    • Rationale:

      This answer is not correct since while increasing oral intake is important to flush the stone from the urinary tract, this is not the first action the nurse should implement. The nurse must address the client’s pain first.

  2. Administer an opioid analgesic as soon as possible.
    • Rationale:

      This answer is correct because it is essential to address the client’s pain prior to providing education regarding increased fluid intake and straining the urine for stones. The client will not be able to retain any teaching until the pain is manageable. Acute pain is a nursing diagnosis related to nephrolithiasis and is a priority.

  3. Instruct the client to avoid drinking fluids.
    • Rationale:

      This answer is not correct because increasing fluids is required to flush the kidney stone from the urinary tract. This can be accomplished by oral intake, as well as intravenously.

  4. Teach the client to strain all urine.
    • Rationale:

      This answer is not correct because although it is important to strain the urine for stones, it is not the priority at the present and pain is of primary concern. Straining the first urine specimen of the morning is advised since the stone may pass into the bladder during the night. A stone can look like a grain of sand or a small piece of gravel.

Overview

Renal colic is a type of pain you get when urinary stones block part of your urinary tract. It is a very painful condition, therefore, addressing the client’s pain is the first priority.

Explanation

Learning Outcomes

The client is experiencing severe flank pain related to renal colic. This type of pain requires analgesic intervention as soon as possible. Administer an opioid analgesic or other pain medication as prescribed by the ED healthcare provider. Increasing fluids is required to flush the kidney stone from the urinary tract. This can be accomplished by oral intake, as well as intravenously if in the hospital. Straining the urine for stones will be encouraged to make sure the stone has passed. Straining the first urine specimen of the morning is advised since the stone may pass into the bladder during the night. A stone can look like a grain of sand or a small piece of gravel. Any stone found should be kept dry.

Test Taking Tip

First indicates that while more than one choice may be appropriate, only one is the priority.

Video Rationale