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: Testing the urine sample with a reagent strip is not a standard procedure for a 24-hour urine collection. This method is used for spot urine tests to assess parameters like glucose or protein but does not ensure accurate measurement of total urine output or analytes over 24 hours. It introduces potential contamination and is irrelevant to the collection process, which focuses on volume and composition over time.

Choice B reason: Withholding all patient medications is unnecessary and potentially harmful for a 24-hour urine collection. Medications may influence urine composition, but the collection aims to reflect the patient’s normal physiological state, including medication effects. Disrupting medication schedules could alter metabolic or renal function, skewing results and compromising patient health.

Choice C reason: Asking the patient to void and discard the initial urine marks the start of the 24-hour collection period. This ensures all subsequent urine reflects the exact 24-hour timeframe, providing accurate data on volume, electrolytes, and other analytes. This step establishes a clear baseline, preventing inclusion of urine from an undefined prior period.

Choice D reason: Irrigating the sample with sterile solution is inappropriate for a 24-hour urine collection. Adding any solution would dilute the sample, altering its concentration and volume, thus invalidating results for tests like creatinine clearance or protein excretion. The collection requires untouched urine to maintain analytical integrity.

Choice A reason: Offering narcotics immediately without assessing pain details or considering nonpharmacological options is not therapeutic. Pain management requires a tailored approach, evaluating pain characteristics and patient preferences, as narcotics carry risks like respiratory depression, especially post-surgery, necessitating cautious use.

Choice B reason: Dismissing pain based on stable vitals is not therapeutic. Pain is subjective, and normal vitals (e.g., 110/60 mmHg, 60 bpm) don’t negate severe pain. This response invalidates the patient’s experience, potentially eroding trust and delaying effective pain management.

Choice C reason: Stating the patient doesn’t look in pain is dismissive and non-therapeutic. Pain is subjective, and external appearance may not reflect internal experience, especially in stoic patients. This response risks undermining patient trust and delaying appropriate pain relief interventions.

Choice D reason: Asking what the patient wants to try is therapeutic, promoting patient-centered care. It validates the patient’s pain, encourages shared decision-making, and considers both pharmacological and nonpharmacological options, optimizing pain relief while respecting patient autonomy and preferences post-surgery.