Nur570||FINAL EXAMINATION (2025-2026).
COMMON DIAGNOSIS AND MANAGEMENT IN
ACUTE CARE PRACTICUM. || Questions and
Answers||.
1.What is nephrolithiasis?
• Renal calculi (kidney stones)
2. How does Renal calculi form?
• Formed d/t elevated levels of minerals in the body
3. What minerals in excess can cause renal calculi?
• Calcium oxalate (most common),
phosphate
uric acid
struvite
cystine
4. Urolithiasis?
• Stone in the bladder
5. Ureterolithiasis
• Condition of stones in the ureter
6. Risk Factor & complications of renal calculi
• -Male, 20-50yo, previous stones, obesity, HTN, diabetes, low fluid intake.
-complications of stones: obstructions, pyelonephritis (kidney infection), CKD
7. Classic Kidney stone presentation
• Acute onset of severe, colicky flank pain that wax and wane in intensity.
Severe pain is associated with the movement of the stone and can cause n/v.
pt may seem anxious and unable to sit still
8. History and physical for nephrolithiasis (kidney stones)
• Irritative Bladder symptoms -dysuria (painful or difficulty urinating), urgency, &
frequency
• Vague flank pain or acute colicky pain with increasing intensity
Radiation of pain into the groin
Costovertebral angle (CVA) tenderness
Hematuria
Diaphoretic, tachycardic, appear extremely uncomfortable
9. CVA tenderness tell you the stone is located where?
• Caused by passing of the stone through the ureter with obstruction & spasm1
,10. Where is the stone located if the patient has pain in the groin region?
• Pain that radiates downward into the groin indicates the stone has passed into the lower
third of the ureter
11. Vague flank pain or acute colicky pain with increasing intensity means the stone is located where?
• Stones in renal pelvis
12. Differential Diagnosis for abdominal pain and/or flank pain:
• Nephrolithiasis (kidney stones)
Pyelonephritis (kidney infection)
Ectopic pregnancy
Ovarian or testicular torsion
Appendicitis
Bowel obstruction
Diverticulitis
Rupture of aortic aneurysm1
13. Right lower abdominal tenderness with a +Blumberg sign. What should be suspected?
• Blumberg sign: Rebound tenderness in the RLQ, caused by acute peritonitis.
*Appendicitis
14. What labs do we run to diagnose a kidney stone?
• UA dipstick, urine microscopy and urine C&S
Serum blood urea nitrogen (BUN) and creatinine (Cr) to assess renal function.
15. What radiology methods are preferred for outpatient treatment and why
• Inexpensive, easily accessible. in combo its more practical
-KUB xray
-Renal Ultrasound
16. What stones can be seen on a KUB?
What stone can you not see on a KUB?
• CAN see: Calcium oxalate - most common type of stone
CANNOT see: uric acid stones (radio translucent)
17. What is a Renal Ultrasound used for when testing for kidney stones?
• Good for assessing for hydronephrosis (excess fluid in the kidney d/t back up of urine
that can be caused by an obstruction). Bad for identifying a stone.
18. What is the GOLD STANDARD for diagnosing a kidney stone?
• Non-contrast CT scan.
19. Goal of renal calculi treatment
• focused on symptomatic relief
pain medications -NSAID or narcs
antiemetics -n/v
facilitate stone passage-Thiazide diuretics, alpha-blockers or calcium channel blockers to
help facilitate the passage of a stone. Terazosin -alpha blockers used for BPH.
20. <5 mm renal calculi can
• Be passed through the urine. may only require NSAIDs for management.
, 21. >5 mm renal calculi require what?
• Urology consult.
this may cause an obstruction or kidney failure.
this type of stone may need surgical intervention to be removed.
22. When is a Urology Referral indicated?
• Stone > 5mm
Recurrent stones
23. When is a hospital admission appropriates for a patient with nephrolithiasis?
• Hospital admission is indicated when:
-Inability to control pain
-Impaired renal function with an obstructing stone
-Infection (pyelonephritis or sepsis)
-Intractable n/v
24. What does a 24-hour urine collection analyze?
• -total volume
-urine pH
-calcium oxalate
-uric acid
-citrate
-sodium
-potassium
-creatinine
25. Factor Regarding hospital DC for nephrolithiasis
• -Pain is reasonably controlled
-n/v controlled
• Treatment depends on:
-Stone type
-Location of the stone
-Extent of obstruction
-Kidney function
-Progress of stone passage.
26. When should a patient with a kidney stone seek emergency treatment
• Inability to void
Severe pain
Fever
Intractable nausea and vomiting
27. Patient ed for nephrolithiasis regarding fluid intake?
• Increase fluid intake to 2-3 L per day to help with the passage of the stone
28. Stone prevention is based on what?
• Stone analysis-urine straining
24-hour urine collection result
COMMON DIAGNOSIS AND MANAGEMENT IN
ACUTE CARE PRACTICUM. || Questions and
Answers||.
1.What is nephrolithiasis?
• Renal calculi (kidney stones)
2. How does Renal calculi form?
• Formed d/t elevated levels of minerals in the body
3. What minerals in excess can cause renal calculi?
• Calcium oxalate (most common),
phosphate
uric acid
struvite
cystine
4. Urolithiasis?
• Stone in the bladder
5. Ureterolithiasis
• Condition of stones in the ureter
6. Risk Factor & complications of renal calculi
• -Male, 20-50yo, previous stones, obesity, HTN, diabetes, low fluid intake.
-complications of stones: obstructions, pyelonephritis (kidney infection), CKD
7. Classic Kidney stone presentation
• Acute onset of severe, colicky flank pain that wax and wane in intensity.
Severe pain is associated with the movement of the stone and can cause n/v.
pt may seem anxious and unable to sit still
8. History and physical for nephrolithiasis (kidney stones)
• Irritative Bladder symptoms -dysuria (painful or difficulty urinating), urgency, &
frequency
• Vague flank pain or acute colicky pain with increasing intensity
Radiation of pain into the groin
Costovertebral angle (CVA) tenderness
Hematuria
Diaphoretic, tachycardic, appear extremely uncomfortable
9. CVA tenderness tell you the stone is located where?
• Caused by passing of the stone through the ureter with obstruction & spasm1
,10. Where is the stone located if the patient has pain in the groin region?
• Pain that radiates downward into the groin indicates the stone has passed into the lower
third of the ureter
11. Vague flank pain or acute colicky pain with increasing intensity means the stone is located where?
• Stones in renal pelvis
12. Differential Diagnosis for abdominal pain and/or flank pain:
• Nephrolithiasis (kidney stones)
Pyelonephritis (kidney infection)
Ectopic pregnancy
Ovarian or testicular torsion
Appendicitis
Bowel obstruction
Diverticulitis
Rupture of aortic aneurysm1
13. Right lower abdominal tenderness with a +Blumberg sign. What should be suspected?
• Blumberg sign: Rebound tenderness in the RLQ, caused by acute peritonitis.
*Appendicitis
14. What labs do we run to diagnose a kidney stone?
• UA dipstick, urine microscopy and urine C&S
Serum blood urea nitrogen (BUN) and creatinine (Cr) to assess renal function.
15. What radiology methods are preferred for outpatient treatment and why
• Inexpensive, easily accessible. in combo its more practical
-KUB xray
-Renal Ultrasound
16. What stones can be seen on a KUB?
What stone can you not see on a KUB?
• CAN see: Calcium oxalate - most common type of stone
CANNOT see: uric acid stones (radio translucent)
17. What is a Renal Ultrasound used for when testing for kidney stones?
• Good for assessing for hydronephrosis (excess fluid in the kidney d/t back up of urine
that can be caused by an obstruction). Bad for identifying a stone.
18. What is the GOLD STANDARD for diagnosing a kidney stone?
• Non-contrast CT scan.
19. Goal of renal calculi treatment
• focused on symptomatic relief
pain medications -NSAID or narcs
antiemetics -n/v
facilitate stone passage-Thiazide diuretics, alpha-blockers or calcium channel blockers to
help facilitate the passage of a stone. Terazosin -alpha blockers used for BPH.
20. <5 mm renal calculi can
• Be passed through the urine. may only require NSAIDs for management.
, 21. >5 mm renal calculi require what?
• Urology consult.
this may cause an obstruction or kidney failure.
this type of stone may need surgical intervention to be removed.
22. When is a Urology Referral indicated?
• Stone > 5mm
Recurrent stones
23. When is a hospital admission appropriates for a patient with nephrolithiasis?
• Hospital admission is indicated when:
-Inability to control pain
-Impaired renal function with an obstructing stone
-Infection (pyelonephritis or sepsis)
-Intractable n/v
24. What does a 24-hour urine collection analyze?
• -total volume
-urine pH
-calcium oxalate
-uric acid
-citrate
-sodium
-potassium
-creatinine
25. Factor Regarding hospital DC for nephrolithiasis
• -Pain is reasonably controlled
-n/v controlled
• Treatment depends on:
-Stone type
-Location of the stone
-Extent of obstruction
-Kidney function
-Progress of stone passage.
26. When should a patient with a kidney stone seek emergency treatment
• Inability to void
Severe pain
Fever
Intractable nausea and vomiting
27. Patient ed for nephrolithiasis regarding fluid intake?
• Increase fluid intake to 2-3 L per day to help with the passage of the stone
28. Stone prevention is based on what?
• Stone analysis-urine straining
24-hour urine collection result
