Practice Question
A nurse is educating a client on risk factors for renal calculi (kidney stones). Which Of the following modifiable factors increase the client's risk of developing renal calculi? (Select all that apply.)
Answer Choices:
Correct Answer:
Elevated acid levels
Rationale:
🪨 A. Elevated acid levels (uric acid) — MODIFIABLE
📌Hyperuricosuria and low urine pH promote uric acid stones and can nucleate calcium oxalate stones.
📌Management: reduce purine-rich foods (organ meats, certain fish), increase citrate (alkalinizes urine), and consider potassium citrate or allopurinol if indicated.
📌Aim for urine pH ~6–6.5 for uric-acid stone prevention.
📌Weight control and insulin sensitivity also help normalize acid-base balance in urine.
🪨 C. Diet high in animal protein — MODIFIABLE
📌High animal protein increases uric acid, calciuria, and reduces citrate (a natural stone inhibitor), raising risk for uric acid and calcium oxalate stones.
📌Counsel on moderation of animal protein, more plant proteins, and balanced meals with calcium + oxalate timing.
📌Excess sodium (often paired with protein diets) further increases urinary calcium—limit sodium to <2 g/day when possible.
📌Emphasize portion control rather than total elimination.
🪨 D. Frequent UTIs — MODIFIABLE
📌Recurrent infections with urease-producing bacteria (e.g., Proteus, Klebsiella) create alkaline urine and struvite (magnesium ammonium phosphate) stones.
📌Strategy: prompt diagnosis and treatment, consider urology for source control, and ensure complete stone removal to stop the infection-stone cycle.
📌Hydration and voiding habits support prevention; sometimes prophylaxis is considered.
📌Educate on recognizing early UTI symptoms and completing antibiotics.
🪨 E. Excessive intake of calcium-based antacids — MODIFIABLE
📌High-dose calcium carbonate supplements/antacids can increase urinary calcium, predisposing to calcium stones.
📌Nuance: Adequate dietary calcium (with meals) helps bind oxalate in the gut and reduce stone risk, but excess supplemental calcium is problematic.
📌Prefer dietary calcium over large, frequent supplements; if supplements are needed, take with meals and under guidance.
📌Avoid indiscriminate antacid use; review for GERD alternatives or other therapies.
🪨 F. Inadequate fluid intake — MODIFIABLE (strongest factor)
📌Low urine volume leads to supersaturation of stone-forming salts.
📌Target urine output > 2–2.5 L/day (usually needs ~2.5–3 L fluid/day, more with heat/exertion).
📌Include citrate-containing beverages (e.g., lemon/lime) to increase urinary citrate; limit sugary sodas (especially colas with phosphoric acid).
📌Teach distributed intake throughout the day and extra fluids with exercise or hot weather.
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This question is from RN NUR 195 EXAM 2 Summer 25 Deroit C which contains 42 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: Examplify Exam(s)
- Domain: Medical-Surgical
- Answer Choices: 5