Kidney Stones and Urinary Retention Practice Questions

25 multiple-choice questions on Kidney stones and urinary retention for paramedic and EMT students, from Chapter 22 (Genitourinary and Renal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A patient with a 4-mm ureteral stone was prescribed tamsulosin. This drug helps by:

   1. A. Relaxing the ureter so the stone passes
   2. B. Dissolving calcium in the stone
   3. C. Making the kidney produce less urine
   4. D. Treating an infection trapped behind the stone
   Show answer

   Answer: A. Relaxing the ureter so the stone passes

   Tamsulosin is an alpha-blocker that relaxes smooth muscle in the distal ureter and may help larger distal stones pass. It does not dissolve stones or treat infection, and it can cause dizziness from low blood pressure.

2. A patient has classic renal colic, but a dipstick shows no blood in the urine. This finding:

   1. A. Proves the pain is not urologic
   2. B. Means the stone has passed
   3. C. Means the patient is faking
   4. D. Does not rule out a stone
   Show answer

   Answer: D. Does not rule out a stone

   About 10 to 15% of patients with confirmed stones have no hematuria, especially if the stone completely blocks the ureter. Absence of blood lowers but does not exclude the likelihood of a stone, and you must still consider other causes.

3. Kidney stone pain is caused mainly by:

   1. A. Infection of the bladder wall
   2. B. Bleeding into the kidney
   3. C. Inflammation of the peritoneum
   4. D. Ureter spasm and stretching
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   Answer: D. Ureter spasm and stretching

   A stone blocks urine flow, stretching the ureter and renal capsule. The ureter contracts strongly to push the stone forward.

4. Which finding commonly accompanies a kidney stone?

   1. A. A rigid, boardlike abdomen
   2. B. Pain eased by lying still
   3. C. Blood in the urine
   4. D. Diarrhea with mucus
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   Answer: C. Blood in the urine

   Most patients with stones have microscopic or visible hematuria from the stone scraping the urinary tract lining. Stone patients writhe rather than lie still, the abdomen stays soft, and mucus-filled diarrhea suggests a bowel cause.

5. Which risk factor most increases the chance of kidney stones?

   1. A. High daily water intake
   2. B. Chronic dehydration
   3. C. Low-protein diet
   4. D. Regular exercise
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   Answer: B. Chronic dehydration

   Concentrated urine lets minerals crystallize. Hot climates, gout, prior stones, and family history also raise risk.

6. A kidney stone patient with fever and chills is concerning because:

   1. A. Infected, blocked kidneys cause sepsis
   2. B. Fever is expected with all stones
   3. C. Fever means the stone has passed
   4. D. Fever only occurs after ureter rupture
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   Answer: A. Infected, blocked kidneys cause sepsis

   Infection behind an obstruction cannot drain and can progress rapidly to septic shock. It needs urgent drainage.

7. A portable bladder scan shows 900 mL in a man who has not voided in 10 hours. This means:

   1. A. Urinary retention needing drainage
   2. B. A normal amount for an adult
   3. C. Kidney failure with no urine
   4. D. The scanner is likely broken or wrong
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   Answer: A. Urinary retention needing drainage

   Normal bladder capacity is about 400 to 600 mL, so 900 mL with no voiding is acute retention and needs catheter drainage. Kidney failure would leave the bladder nearly empty, not full.

8. Most kidney stones smaller than 5 mm:

   1. A. Need emergency surgery
   2. B. Pass on their own
   3. C. Cause acute kidney failure
   4. D. Are passed without pain
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   Answer: B. Pass on their own

   Small stones usually pass within days to weeks with fluids and pain control. Larger stones may need procedures.

9. Prehospital pain management for renal colic per protocol may include:

   1. A. Sublingual nitroglycerin
   2. B. IM epinephrine
   3. C. IV atropine
   4. D. Opioids or ketorolac
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   Answer: D. Opioids or ketorolac

   NSAIDs like ketorolac reduce ureteral spasm and inflammation and are effective for colic. Avoid NSAIDs if kidney function is poor.

10. For a patient with a kidney stone, giving large volumes of IV fluid to 'flush it out':

    1. A. Doubles the chance of passage
    2. B. Is the main treatment of colic
    3. C. Does not help the stone pass
    4. D. Should be given before pain relief
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    Answer: C. Does not help the stone pass

    Studies show that forced IV hydration does not improve stone passage or pain. Fluids are given for dehydration or vomiting, while analgesia and antiemetics are the mainstays of care.

11. Acute urinary retention is:

    1. A. Frequent passage of small amounts
    2. B. Sudden inability to void
    3. C. Leakage of urine with coughing
    4. D. Blood clots in the ureter
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    Answer: B. Sudden inability to void

    The bladder fills but cannot empty. It causes severe suprapubic pain and is common in older men.

12. A 72-year-old man with an enlarged prostate took an over-the-counter cold remedy and now cannot urinate. Which ingredient most likely caused this?

    1. A. Pseudoephedrine
    2. B. Acetaminophen
    3. C. Dextromethorphan
    4. D. Guaifenesin
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    Answer: A. Pseudoephedrine

    Decongestants such as pseudoephedrine stimulate alpha receptors that tighten the bladder neck, which can tip a man with BPH into acute retention. Acetaminophen, guaifenesin, and dextromethorphan rarely do.

13. A 74-year-old man has not urinated in 12 hours and has a firm suprapubic mass. He recently started a cold medicine. The likely cause is:

    1. A. Acute kidney failure
    2. B. Bladder rupture
    3. C. Drug-induced retention
    4. D. Simple dehydration
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    Answer: C. Drug-induced retention

    Decongestants such as pseudoephedrine tighten the bladder neck. In a man with BPH, this can cause complete retention.

14. A man with heavy blood in his urine now cannot void and has lower abdominal pain. The most likely cause is:

    1. A. A kidney stone
    2. B. Normal hematuria
    3. C. Overflow from a full bowel
    4. D. Clots blocking the outlet
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    Answer: D. Clots blocking the outlet

    Clot retention occurs when blood clots from bladder or prostate bleeding block the urethra. It is painful and needs catheter irrigation in the hospital. Kidney stones do not block the bladder outlet.

15. Which finding with urinary retention should raise concern for cauda equina syndrome?

    1. A. Groin and buttock numbness
    2. B. Mild suprapubic fullness
    3. C. History of an enlarged prostate
    4. D. Recent use of antihistamines
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    Answer: A. Groin and buttock numbness

    Saddle anesthesia with retention and back pain suggests nerve compression in the lower spine.

16. Postobstructive diuresis after a bladder is drained can cause:

    1. A. Immediate kidney stone formation
    2. B. Large urine output and dehydration
    3. C. Severe hypertension
    4. D. Uncontrolled bleeding from the bladder
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    Answer: B. Large urine output and dehydration

    After obstruction is relieved, the kidneys may produce large volumes of urine, causing fluid and electrolyte loss.

17. Hematuria in an older adult without pain or infection is concerning for:

    1. A. Normal aging of the bladder
    2. B. Mild dehydration
    3. C. Recent heavy exercise
    4. D. Bladder or kidney cancer
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    Answer: D. Bladder or kidney cancer

    Painless hematuria is a classic warning sign of urinary tract cancer and needs follow-up.

18. Which patient with a kidney stone may need urgent hospital treatment?

    1. A. A patient with mild pain at home
    2. B. A patient who passed the stone
    3. C. A patient with a solitary kidney
    4. D. A patient drinking fluids well
    Show answer

    Answer: C. A patient with a solitary kidney

    A stone blocking a solitary kidney stops all urine output and can cause rapid kidney failure, so it needs urgent treatment. A patient with mild pain at home, a patient who already passed the stone, and a patient drinking fluids well are lower risk and may not need urgent care. Fever, intractable vomiting, and uncontrolled pain are other red flags.

19. Which positioning is usually best for a patient with renal colic?

    1. A. Flat and still on the cot
    2. B. Position of comfort
    3. C. Trendelenburg position
    4. D. Prone
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    Answer: B. Position of comfort

    These patients are restless and move often. Let them find a comfortable position.

20. Gout increases the risk of which type of kidney stone?

    1. A. Uric acid stones
    2. B. Struvite stones
    3. C. Cystine stones
    4. D. Calcium phosphate stones
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    Answer: A. Uric acid stones

    High uric acid levels in gout can crystallize in the urinary tract.

21. Large, branching (staghorn) stones are most often associated with:

    1. A. Vitamin C supplements
    2. B. A high-calcium dairy diet
    3. C. Recurrent UTIs
    4. D. Regular exercise
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    Answer: C. Recurrent UTIs

    Struvite stones form in infected, alkaline urine and can fill the renal pelvis. High-dose vitamin C can add oxalate but does not form staghorn stones, and dietary calcium and exercise do not cause them.

22. A patient with renal colic suddenly reports that his pain has nearly stopped. This most often means:

    1. A. The kidney has stopped working
    2. B. He needs more pain medicine
    3. C. The stone has become infected
    4. D. The stone has moved or passed
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    Answer: D. The stone has moved or passed

    Colic eases when the stone moves out of a narrow area, often into the bladder. Infection is suggested by fever, not sudden relief. Continue to reassess, because pain can return.

23. Patients with renal colic often vomit mainly because:

    1. A. The kidney and gut share nerve pathways
    2. B. Toxins build up behind the blocked kidney
    3. C. Pain medicine is given too early
    4. D. The stone irritates the peritoneum
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    Answer: A. The kidney and gut share nerve pathways

    Afferent pain fibers from the kidney and ureter share pathways with GI nerves (through the celiac plexus), so renal colic commonly causes nausea and vomiting. One blocked kidney does not cause a toxin buildup, because the other kidney keeps filtering, and the ureter lies behind the peritoneum rather than irritating it.

24. Pain from a stone in the lower ureter near the bladder may cause:

    1. A. Numbness of the inner thigh
    2. B. Urgency and frequency
    3. C. Pain radiating to the shoulder
    4. D. Cloudy urine, no pain
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    Answer: B. Urgency and frequency

    Stones near the bladder irritate it, causing urgency and frequency, and pain may radiate to the genitals. Referred stone pain is felt in the groin, not as numbness, the shoulder is not involved, and painless cloudy urine does not fit a moving stone.

25. Acute urinary retention in a young woman is uncommon. It should prompt a search for:

    1. A. An enlarged prostate
    2. B. Too much fluid intake
    3. C. Normal effects of hard exercise
    4. D. A neurologic or pelvic cause
    Show answer

    Answer: D. A neurologic or pelvic cause

    Women do not have a prostate, so retention points to causes such as spinal cord or cauda equina problems, multiple sclerosis, pelvic masses, drugs, or infection. High fluid intake does not cause retention.