Which pair of procedures are modern stone management options, and what is a relevant nursing consideration post-procedure?

• A. Open surgery and ESWL; nursing considerations include wound care
• B. ESWL and ureteroscopy with laser lithotripsy; nursing considerations include pain control, monitor bleeding and infection, urine color/output, stent care if placed
• C. Ureteral dilation and lithotripsy; nursing considerations include hydration
• D. Percutaneous nephrolithotomy and ESWL; nursing considerations include patient education on recurrence

Answer: (B)

The key idea is that modern stone management relies on minimally invasive approaches rather than open surgery. Extracorporeal shock wave lithotripsy uses external waves to fragment stones, while ureteroscopy with laser lithotripsy involves threading a scope through the urinary tract to reach stones and break them with a laser. Together, these two options represent current, less invasive methods for treating kidney and ureteral stones.

After these procedures, nursing focus centers on comfort and safety: provide effective pain control as fragments move and ureteral irritation occurs; monitor for bleeding and signs of infection; track urine color and urine output to detect ongoing bleeding or obstruction; and manage a ureteral stent if one was placed, including patient education on stent symptoms and when to seek care. Adequate hydration helps fragment passage and reduces stone recurrence risk, and patients should be instructed on activity and follow-up for stent removal if applicable.

The other pairings involve more invasive or less commonly used approaches or mix modalities that don’t reflect the typical modern options, so they don’t fit as well with current practice.