Renal Calculi and Management Practice Questions
20 free Renal Calculi and Management practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
In a patient presenting with sudden, severe flank pain radiating to the groin, hematuria, and nausea, what is the likely diagnosis based on nursing assessment?
- A Acute lower urinary tract infection
- B Kidney stone causing ureteral obstruction
- C Acute bacterial bladder infection
- D Musculoskeletal lower back pain
Correct answer: Kidney stone causing ureteral obstruction
Sharp flank pain radiating to the groin and hematuria strongly suggest ureteral obstruction from a renal calculus (stone) causing renal colic.
In a patient with a history of calcium oxalate stones, which dietary advice is most appropriate for prevention?
- A Avoid all calcium-rich foods
- B Drink 2 to 3 quarts of water daily
- C Increase sodium and animal protein intake
- D Restrict fluid intake
Correct answer: Drink 2 to 3 quarts of water daily
High fluid intake dilutes urine, reduces supersaturation of stone-forming salts; guidelines for prevention of renal calculi recommend this.
In the case of a 5 mm ureteral stone diagnosis, what might the nurse anticipate as part of 'medical expulsive therapy'?
- A Immediate surgical stone removal
- B Alpha-adrenergic blocker to aid stone passage
- C No therapy other than observation
- D IV fluids alone without any medication
Correct answer: Alpha-adrenergic blocker to aid stone passage
For certain ureteral stones, medical expulsive therapy (MET) with an alpha‐blocker helps facilitate passage according to current management guidelines.
What is the most important nursing intervention post-extracorporeal shock wave lithotripsy (ESWL)?
- A Encourage strict bed rest for several days
- B Limit oral fluid intake after the procedure
- C Strain urine and encourage fluid intake
- D Administer prophylactic anticoagulants
Correct answer: Strain urine and encourage fluid intake
After ESWL, patients pass fragmented stones in urine; fluid intake and urine-straining facilitate passage and collection of fragments for analysis.
For a patient with a large renal calculus >20 mm in the lower pole of the kidney, current guidelines recommend which procedure as most appropriate?
- A Observation only
- B ESWL as first-line
- C PCNL as first-line
- D Dietary management alone
Correct answer: PCNL as first-line
Guidelines recommend PCNL as first-line for renal calculi >20 mm for improved stone-free rates.
Which statement is correct regarding nursing priority when caring for a patient in renal colic?
- A Pain relief is a low priority
- B Encourage immediate heavy exercise
- C Focus on pain control and monitoring
- D Restrict fluids to 500 mL/day
Correct answer: Focus on pain control and monitoring
Renal stones cause intense pain; managing pain and watching for obstruction or infection are nursing priorities.
For a patient with uric acid stones, which dietary recommendation is correct for prevention?
- A Increase intake of purine-rich foods
- B Decrease animal protein and purine intake
- C No dietary modifications are needed
- D Increase dietary sodium intake markedly
Correct answer: Decrease animal protein and purine intake
Uric acid stones are associated with purine metabolism; reducing animal protein/purines and alkalinizing urine help prevent recurrence.
In a patient diagnosed with struvite stones (infection stones), what is the most relevant nursing teaching point?
- A Recurrent infections have no impact on these stones
- B Preventing recurrent UTIs is crucial to control them
- C A high-oxalate diet is the main cause of these stones
- D Surgical intervention is never required for them
Correct answer: Preventing recurrent UTIs is crucial to control them
Struvite stones are commonly infection-related; infection control and elimination are essential.
When reviewing lab results post-stone episode, which 24-hour urine result would prompt further evaluation?
- A Low urine volume and high calcium concentration
- B High urine volume with low solute excretion
- C Normal urine volume and calcium excretion
- D Low urine output with negligible solute excretion
Correct answer: Low urine volume and high calcium concentration
Low output and high urine calcium promote supersaturation and stone formation; 24-hour urine analysis guides prevention.
When teaching a patient with a calcium-oxalate stone, which statement is accurate regarding calcium intake?
- A Avoid all dietary calcium entirely
- B Maintain a normal calcium intake
- C High calcium intake prevents stones
- D Calcium intake makes no difference
Correct answer: Maintain a normal calcium intake
Adequate dietary calcium reduces oxalate absorption; guidelines recommend ~1000-1200 mg/day while lowering sodium and oxalate for prevention.
Why is ambulation recommended for a patient with a small renal stone waiting to pass it?
- A No effect on stone passage
- B Facilitates stone fragment passage
- C Increases pain and should be avoided
- D Bed rest only recommended
Correct answer: Facilitates stone fragment passage
Mobility helps the stone move along the urinary tract, aiding passage and reducing obstruction risk.
What is the most critical nursing assessment post-percutaneous nephrolithotomy (PCNL)?
- A Monitor for signs of heart failure
- B Check for bleeding and infection
- C Strictly restrict oral fluid intake
- D Stop all analgesic medications
Correct answer: Check for bleeding and infection
PCNL is an invasive procedure; bleeding, drainage issues, infection and output must be closely monitored post-procedure.
If a patient asks about the importance of high fluid intake to prevent stones, what is the most accurate explanation?
- A It simply washes the kidneys for prevention
- B Dilutes urine and reduces stone formation
- C It prevents every type of stone equally
- D It is only required for uric acid stones
Correct answer: Dilutes urine and reduces stone formation
Adequate hydration keeps urine dilute, reduces concentration of salts that crystallize into stones, and promotes flow to flush particles.
How does management differ between stones <10 mm and >20 mm in size?
- A Spontaneous passage likely for <10 mm; diet only for >20 mm
- B Spontaneous passage possible for <10 mm; PCNL for >20 mm
- C All stones are treated the same regardless of size
- D Only dietary management is used for stones >20 mm
Correct answer: Spontaneous passage possible for <10 mm; PCNL for >20 mm
Size influences treatment; stones ≤10 mm may be managed conservatively or with ESWL/URS; >20 mm often require PCNL.
In a patient with a fluid restriction due to heart failure developing a kidney stone, what is the best nursing response?
- A Explain that stone prevention does not apply here
- B Balance fluid management to keep urine dilute
- C Stop the fluid restriction immediately for now
- D Disregard fluid intake given the heart failure
Correct answer: Balance fluid management to keep urine dilute
In patients with comorbidities like heart failure, fluid management must be individualized to balance both restrictions and stone prevention.
Which guideline for pain management in renal colic is correct?
- A NSAIDs ineffective; opioids first choice
- B NSAIDs effective and often superior
- C Pharmacologic management never needed
- D Use only non-pharmacologic methods
Correct answer: NSAIDs effective and often superior
NSAIDs reduce ureteral spasm and are considered very effective in renal colic management.
For a patient with a recurrent calcium phosphate stone, which factor is most likely to be addressed in prevention?
- A Increasing urine citrate by reducing intake
- B Reducing dietary sodium intake
- C Adding high-dose vitamin D supplementation
- D Eliminating dietary calcium intake
Correct answer: Reducing dietary sodium intake
High sodium increases urinary calcium excretion; reducing sodium while maintaining normal calcium intake helps prevent calcium-based stones.
When is a urologic stent typically placed in stone management?
- A Routinely for any patient discomfort
- B Only after a failed PCNL procedure
- C To maintain drainage in ureteral obstruction
- D For every small, passable stone
Correct answer: To maintain drainage in ureteral obstruction
Ureteral stents are used to maintain drainage when obstruction risk exists or post-procedure to facilitate fragment passage.
To reduce kidney stone recurrence, what evidence-based response should be provided to the patient?
- A Recurrence is unlikely once a stone has passed
- B Maintain hydration and make dietary modifications
- C Recurrence is largely a matter of chance
- D Restrict dietary calcium intake substantially
Correct answer: Maintain hydration and make dietary modifications
Recurrence risk is high; hydration, dietary modifications, and specific risk factors management help prevent recurrence.
In caring for a patient with a nephrostomy tube after stone removal, what is the nurse's key responsibility?
- A Keep the tube clamped between drainages
- B Maintain patency and monitor drainage
- C Remove the tube once voiding resumes
- D Allow output changes without intervention
Correct answer: Maintain patency and monitor drainage
Nephrostomy tubes require monitoring of output, integrity, infection signs, and ensuring patency post stone removal.