A nurse is caring for four clients on the urology unit. Which of the following clients should the nurse plan to teach about kidney stone prevention?

The client admitted to the hospital who has clinical findings of severe flank pain, nausea, and vomiting.

The client admitted to the hospital who has clinical findings of polyuria, nocturia, proteinuria, and a palpable kidney mass.

The client admitted to the hospital who has clinical findings of urinary urgency, weak urine stream, and dysuria.

The client admitted to the hospital who has clinical findings of periorbital edema, dark frothy urine, and elevated blood pressure.

Answer and Explanation

The Correct Answer is A

A. The client admitted to the hospital who has clinical findings of severe flank pain, nausea, and vomiting: These are hallmark signs of a current or recent episode of kidney stones. Once the acute symptoms are managed, this client would benefit the most from kidney stone prevention education, including dietary modifications and increased fluid intake, to reduce recurrence risk.
B. The client admitted to the hospital who has clinical findings of polyuria, nocturia, proteinuria, and a palpable kidney mass: These signs suggest a chronic kidney condition such as polycystic kidney disease or another form of kidney pathology rather than nephrolithiasis. Kidney stone prevention is not the primary teaching focus for this client.
C. The client admitted to the hospital who has clinical findings of urinary urgency, weak urine stream, and dysuria: These symptoms are more consistent with a lower urinary tract condition such as benign prostatic hyperplasia (BPH) or a urinary tract infection, rather than kidney stones. Prevention teaching should be focused on the underlying cause.
D. The client admitted to the hospital who has clinical findings of periorbital edema, dark frothy urine, and elevated blood pressure: These symptoms point to nephrotic syndrome or glomerulonephritis, which involve protein loss and renal inflammation. The pathophysiology here differs from that of kidney stone formation, and stone prevention would not be the priority.

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Correct Answer is B

Explanation

A. The liver releases glucagon to regulate blood glucose levels: The liver does release glucagon, but glucagon's role is to stimulate the liver to release glucose into the bloodstream, not to regulate blood glucose directly. Glucagon is released in response to low blood glucose levels to raise them, but the adrenal glands play a larger role in regulating glucose in the short term.
B. The adrenal glands release epinephrine and norepinephrine to respond to low blood glucose: When blood glucose levels drop, the adrenal glands release epinephrine (adrenaline) and norepinephrine. These hormones stimulate glucose release from the liver and promote glucose production to help increase blood sugar levels. This is the correct response to hypoglycemia, as these hormones help combat low blood sugar quickly.
C. Glycogenesis occurs in the pancreas when blood glucose levels fall: Glycogenesis refers to the process of glucose being stored as glycogen, primarily in the liver and muscles, and not the pancreas. When blood glucose levels fall, glycogenolysis (the breakdown of glycogen into glucose) occurs, not glycogenesis, to raise glucose levels. The pancreas releases insulin and glucagon, but not for storing glucose.
D. The brain uses protein for energy if glucose levels fall too low: While the brain primarily uses glucose for energy, when glucose levels are critically low, it will use ketones, not protein, for energy. Protein breakdown for energy is typically a later response, and the body generally tries to prevent using protein for energy as long as possible due to its importance in cellular functions.

A. Hyperventilate the client. B. Decrease sedation. C. Lower blood pressure. D. Reduce the temperature in the room.

Correct Answer is A

Explanation

A. Hyperventilate the client: Controlled hyperventilation reduces carbon dioxide levels, leading to cerebral vasoconstriction and decreased intracranial pressure, making it a temporary emergency measure in brain herniation.
B. Decrease sedation: Sedation is often maintained to reduce metabolic demand and intracranial pressure. Decreasing it could cause agitation and increase ICP.
C. Lower blood pressure: Lowering blood pressure could reduce cerebral perfusion, worsening ischemia. In brain herniation, maintaining adequate perfusion pressure is essential.
D. Reduce the temperature in the room: Mild hypothermia may be therapeutic, but adjusting room temperature is not an effective or immediate treatment for brain herniation.

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A nurse is caring for four clients on the urology unit. Which of the following clients should the nurse plan to teach about kidney stone prevention?

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