Nightingale BSN 315 Pharmacology II: Edward Carter (Kidney
Stone & Back Pain) – Exam Preparation Q&A
1. You are preparing to assess Edward Carter, a 65‑year‑old African American male admitted with flank
pain, hematuria, and increased urinary frequency. What is the most appropriate initial question to begin
your patient interview?
A) “Do you have any allergies?”
B) “What brought you to the hospital today?”
C) “Can you rate your pain on a scale of 0 to 10?”
D) “Have you fallen recently?”
Correct Answer: B – “What brought you to the hospital today?” an open‑ended question that allows the
patient to describe his primary concern without bias. Asking about allergies, pain rating, or falls would
be appropriate later, but the initial question should establish the chief complaint in the patient’s own
words.
2. Edward Carter’s chief complaints upon admission are:
A) Chest pain and shortness of breath
B) Back pain, blood in urine, and increased urinary frequency
C) Abdominal pain and nausea
D) Headache and visual changes
Correct Answer: B – The scenario states that the patient is a 65‑year‑old African American man who has
been admitted to Shadow General Hospital for back pain, blood in his urine, and increased urinary
frequency.
3. When you ask Edward Carter about the onset of his symptoms, he reports that his pain began:
A) 1 week ago
B) 3 days ago
C) 1 month ago
D) Suddenly this morning
Correct Answer: B – In the subjective data collection, Edward Carter reports that his pain began 3 days
ago.
,4. Edward Carter describes the location of his pain as:
A) Mid‑back, radiating to both legs
B) Right upper quadrant
C) Left side of the body and lower back
D) Generalized chest tightness
Correct Answer: C – Nursing notes indicate: “Left side of body and lower back. Does not radiate
anywhere”.
5. The nurse documents that Edward Carter’s pain is “sharp, shooting.” This description is most
consistent with:
A) Musculoskeletal strain
B) Renal colic from a kidney stone
C) Neuropathic pain from diabetes
D) Cardiac ischemia
Correct Answer: B – Renal colic (pain from a kidney stone) is often described as sharp, stabbing, or
shooting and is typically located in the flank or lower back. The presence of hematuria and increased
urinary frequency further supports the suspicion of a kidney stone.
6. Edward Carter reports that he had an episode of severe pain this morning and that the pain has been
getting progressively worse. This pattern suggests:
A) An intermittent, self‑limiting condition
B) An acute process that may require urgent intervention
C) Chronic, stable osteoarthritis pain
D) A psychosomatic complaint
Correct Answer: B – A progressive worsening of acute‑onset pain, especially when accompanied by
hematuria and urinary frequency, indicates an evolving acute condition such as a ureteral stone. Prompt
assessment and intervention are necessary to prevent complications such as hydronephrosis or
infection.
7. Edward Carter states that his pain before receiving medication was 9 on a 0–10 pain scale. Which
action should the nurse take first?
,A) Administer another dose of morphine immediately
B) Document the pain level and continue monitoring
C) Ask about the quality and location of the pain
D) Notify the provider of severe pain
Correct Answer: C – In the nursing process, assessment always precedes intervention. The nurse must
first complete a comprehensive pain assessment (quality, location, aggravating/relieving factors,
duration) before notifying the provider or administering medication.
8. After receiving hydromorphone at 10:05 am, Edward Carter reports his current pain as 2/10. This
finding indicates that:
A) The pain medication was ineffective
B) The pain is now well‑controlled
C) The patient requires a higher dose of opioid
D) The pain has shifted to a different location
Correct Answer: B – On a standard 0–10 pain scale, a rating of 2 indicates mild, well‑controlled pain.
Combined with the patient’s statement that the pain before medication was 9/10, this demonstrates
effective analgesia.
9. Edward Carter reports that he has never had kidney stones before. What is the significance of this
finding?
A) It rules out a kidney stone as the cause of his symptoms
B) It suggests that the current episode is not serious
C) It is a key part of the history but does not exclude a first stone
D) It indicates that the patient will not require imaging
Correct Answer: C – Many patients present with a first‑time kidney stone. A negative history does not
rule out the diagnosis. The clinical presentation (flank pain, hematuria, urinary frequency) remains
highly suggestive, and diagnostic imaging (e.g., non‑contrast CT) is still indicated.
10. The presence of blood in Edward Carter’s urine (hematuria) is most concerning for:
A) Urinary tract infection
B) Renal calculus (kidney stone)
C) Benign prostatic hyperplasia
, D) Dehydration
Correct Answer: B – Hematuria is a classic presenting symptom of a ureteral stone. While UTIs, BPH, and
dehydration can cause hematuria, the combination of acute flank pain, hematuria, and increased urinary
frequency makes a kidney stone the most likely diagnosis.
11. Edward Carter’s urine is described as “pinkish” in color. The nurse should document this finding as:
A) Gross hematuria
B) Microhematuria
C) Pyuria
D) Proteinuria
Correct Answer: A – Hematuria that is visible to the naked eye is termed gross hematuria. Pink or red
discoloration of urine indicates visible blood. Microhematuria refers to blood that is only detectable on
microscopic examination.
12. Which diagnostic imaging study is most commonly used to confirm a kidney stone in the emergency
setting?
A) Abdominal X‑ray (KUB)
B) Renal ultrasound
C) Non‑contrast CT of the abdomen and pelvis
D) Intravenous pyelogram (IVP)
Correct Answer: C – Non‑contrast helical CT is the gold‑standard imaging modality for detecting renal
calculi. It has high sensitivity and specificity and can also identify other causes of abdominal or flank
pain. KUB may miss radiolucent stones, and ultrasound is less sensitive for small stones.
13. Edward Carter’s pain is described as sharp, located on the left side of the lower back, and does not
radiate. This location is most consistent with:
A) Appendicitis
B) Renal colic from a left‑sided ureteral stone
C) Diverticulitis
D) Lumbar radiculopathy
Stone & Back Pain) – Exam Preparation Q&A
1. You are preparing to assess Edward Carter, a 65‑year‑old African American male admitted with flank
pain, hematuria, and increased urinary frequency. What is the most appropriate initial question to begin
your patient interview?
A) “Do you have any allergies?”
B) “What brought you to the hospital today?”
C) “Can you rate your pain on a scale of 0 to 10?”
D) “Have you fallen recently?”
Correct Answer: B – “What brought you to the hospital today?” an open‑ended question that allows the
patient to describe his primary concern without bias. Asking about allergies, pain rating, or falls would
be appropriate later, but the initial question should establish the chief complaint in the patient’s own
words.
2. Edward Carter’s chief complaints upon admission are:
A) Chest pain and shortness of breath
B) Back pain, blood in urine, and increased urinary frequency
C) Abdominal pain and nausea
D) Headache and visual changes
Correct Answer: B – The scenario states that the patient is a 65‑year‑old African American man who has
been admitted to Shadow General Hospital for back pain, blood in his urine, and increased urinary
frequency.
3. When you ask Edward Carter about the onset of his symptoms, he reports that his pain began:
A) 1 week ago
B) 3 days ago
C) 1 month ago
D) Suddenly this morning
Correct Answer: B – In the subjective data collection, Edward Carter reports that his pain began 3 days
ago.
,4. Edward Carter describes the location of his pain as:
A) Mid‑back, radiating to both legs
B) Right upper quadrant
C) Left side of the body and lower back
D) Generalized chest tightness
Correct Answer: C – Nursing notes indicate: “Left side of body and lower back. Does not radiate
anywhere”.
5. The nurse documents that Edward Carter’s pain is “sharp, shooting.” This description is most
consistent with:
A) Musculoskeletal strain
B) Renal colic from a kidney stone
C) Neuropathic pain from diabetes
D) Cardiac ischemia
Correct Answer: B – Renal colic (pain from a kidney stone) is often described as sharp, stabbing, or
shooting and is typically located in the flank or lower back. The presence of hematuria and increased
urinary frequency further supports the suspicion of a kidney stone.
6. Edward Carter reports that he had an episode of severe pain this morning and that the pain has been
getting progressively worse. This pattern suggests:
A) An intermittent, self‑limiting condition
B) An acute process that may require urgent intervention
C) Chronic, stable osteoarthritis pain
D) A psychosomatic complaint
Correct Answer: B – A progressive worsening of acute‑onset pain, especially when accompanied by
hematuria and urinary frequency, indicates an evolving acute condition such as a ureteral stone. Prompt
assessment and intervention are necessary to prevent complications such as hydronephrosis or
infection.
7. Edward Carter states that his pain before receiving medication was 9 on a 0–10 pain scale. Which
action should the nurse take first?
,A) Administer another dose of morphine immediately
B) Document the pain level and continue monitoring
C) Ask about the quality and location of the pain
D) Notify the provider of severe pain
Correct Answer: C – In the nursing process, assessment always precedes intervention. The nurse must
first complete a comprehensive pain assessment (quality, location, aggravating/relieving factors,
duration) before notifying the provider or administering medication.
8. After receiving hydromorphone at 10:05 am, Edward Carter reports his current pain as 2/10. This
finding indicates that:
A) The pain medication was ineffective
B) The pain is now well‑controlled
C) The patient requires a higher dose of opioid
D) The pain has shifted to a different location
Correct Answer: B – On a standard 0–10 pain scale, a rating of 2 indicates mild, well‑controlled pain.
Combined with the patient’s statement that the pain before medication was 9/10, this demonstrates
effective analgesia.
9. Edward Carter reports that he has never had kidney stones before. What is the significance of this
finding?
A) It rules out a kidney stone as the cause of his symptoms
B) It suggests that the current episode is not serious
C) It is a key part of the history but does not exclude a first stone
D) It indicates that the patient will not require imaging
Correct Answer: C – Many patients present with a first‑time kidney stone. A negative history does not
rule out the diagnosis. The clinical presentation (flank pain, hematuria, urinary frequency) remains
highly suggestive, and diagnostic imaging (e.g., non‑contrast CT) is still indicated.
10. The presence of blood in Edward Carter’s urine (hematuria) is most concerning for:
A) Urinary tract infection
B) Renal calculus (kidney stone)
C) Benign prostatic hyperplasia
, D) Dehydration
Correct Answer: B – Hematuria is a classic presenting symptom of a ureteral stone. While UTIs, BPH, and
dehydration can cause hematuria, the combination of acute flank pain, hematuria, and increased urinary
frequency makes a kidney stone the most likely diagnosis.
11. Edward Carter’s urine is described as “pinkish” in color. The nurse should document this finding as:
A) Gross hematuria
B) Microhematuria
C) Pyuria
D) Proteinuria
Correct Answer: A – Hematuria that is visible to the naked eye is termed gross hematuria. Pink or red
discoloration of urine indicates visible blood. Microhematuria refers to blood that is only detectable on
microscopic examination.
12. Which diagnostic imaging study is most commonly used to confirm a kidney stone in the emergency
setting?
A) Abdominal X‑ray (KUB)
B) Renal ultrasound
C) Non‑contrast CT of the abdomen and pelvis
D) Intravenous pyelogram (IVP)
Correct Answer: C – Non‑contrast helical CT is the gold‑standard imaging modality for detecting renal
calculi. It has high sensitivity and specificity and can also identify other causes of abdominal or flank
pain. KUB may miss radiolucent stones, and ultrasound is less sensitive for small stones.
13. Edward Carter’s pain is described as sharp, located on the left side of the lower back, and does not
radiate. This location is most consistent with:
A) Appendicitis
B) Renal colic from a left‑sided ureteral stone
C) Diverticulitis
D) Lumbar radiculopathy
