A patient is being seen for complaints of severe flank pain lasting for 2 days. The emergency department physician suspects that the patient has renal calculi. Which of the following tests would the nurse expect the health care provider to order?

Choice A reason: Limiting activity can worsen constipation by reducing bowel motility. Physical activity stimulates peristalsis via abdominal muscle movement and increased blood flow, so advising reduced activity is counterproductive and not recommended for managing constipation.

Choice B reason: While hydration is important, four to five glasses of water daily may be insufficient for older adults, who often need 6-8 glasses (1.5-2 liters) to soften stool and promote bowel movements. This instruction is suboptimal compared to dietary fiber.

Choice C reason: Raw vegetables are high in insoluble fiber, which adds bulk to stool and stimulates peristalsis, easing constipation. This dietary change directly addresses the issue by promoting regular bowel movements, making it a key teaching point for older adults.

Choice D reason: Bearing down hard (Valsalva maneuver) can strain pelvic muscles and increase risks like hemorrhoids or cardiovascular stress, especially in older adults. Gentle defecation with proper positioning is safer, making this instruction inappropriate.

Choice A reason: Endoscopy visualizes the gastrointestinal or urinary tract but is not the primary test for renal calculi. It may be used for ureteral stones but is invasive and less effective than imaging for initial diagnosis.

Choice B reason: Ultrasound can detect renal calculi, especially in pregnant patients or those avoiding radiation, but it is less sensitive than CT for small stones or precise location. It is not the preferred initial test in most cases.

Choice C reason: Chest radiography is irrelevant for renal calculi, as it images the thoracic cavity, not the kidneys or ureters. Flank pain from stones is unrelated to chest pathology, making this test inappropriate.

Choice D reason: Intravenous pyelogram (IVP) or CT scans are gold standards for diagnosing renal calculi. CT provides detailed images of stone size, location, and obstruction, while IVP assesses urinary tract function, making them the expected tests.