The nurse is caring for a client who has been diagnosed with renal calculi. Which pathophysiologic change occurs as renal calculi move through the urinary tract?

Choice A reason: The epigastric region, located midline above the umbilicus, encompasses the stomach, where the orange-sized mass was identified on imaging and palpation. GI bleeding and a stomach mass align with this location, making it the correct area for documentation, per standard anatomical landmarks used in clinical assessment.

Choice B reason: The hypochondriac regions are lateral to the epigastrium, covering parts of the liver and spleen, not the stomach. A stomach mass causing GI bleeding is located in the epigastric region. This choice is incorrect, as it does not correspond to the anatomical location of the stomach.

Choice C reason: The periumbilical area surrounds the umbilicus, covering small intestines, not the stomach. A stomach mass is in the epigastric region, as confirmed by imaging and palpation. This area is incorrect for documenting a stomach-related finding associated with GI bleeding, per anatomical standards.

Choice D reason: The costovertebral angle is posterior, near the kidneys, unrelated to the stomach. A stomach mass causing GI bleeding is in the epigastric region. This choice is incorrect, as it does not align with the stomach’s anatomical location or the clinical findings of a palpable mass.

Choice A reason: Polyuria, excessive urination, is not caused by renal calculi movement. Stones obstruct the ureter, reducing urine flow and causing pain, not increased output. Polyuria is associated with conditions like diabetes, making this incorrect for the pathophysiological change linked to calculi movement in the urinary tract.

Choice B reason: Uric acid increases may contribute to stone formation but are not a change caused by calculi movement. Movement triggers pain and obstruction, not serum uric acid changes. Renal colic is the direct result of stones moving, making this choice incorrect for the pathophysiological effect.

Choice C reason: Cystitis, bladder inflammation, may occur secondary to stones but is not the primary change from calculi movement. Stones moving through the ureter cause renal colic due to obstruction and spasm. Cystitis is a complication, not the direct pathophysiological change, making this incorrect.

Choice D reason: Renal colic, severe pain from ureteral obstruction and smooth muscle spasm, occurs as renal calculi move through the urinary tract. Stones irritate and block the ureter, triggering intense, colicky pain. This is the primary pathophysiological change, aligning with urological evidence for stone movement effects.