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A 32-Year-Old Woman Comes to the Emergency Department Due to Right

question 214

Multiple Choice

A 32-year-old woman comes to the emergency department due to right flank pain for the last 12 hours. The patient describes severe, intermittent pain lasting 20-30 minutes at a time. She has also had nausea and several episodes of vomiting but no fever, chills, dysuria, or diarrhea. The patient had similar symptoms 2 years ago and was found to have a renal calculus. The stone passed spontaneously and no analysis was performed. She has no other medical conditions and takes no medications.
Temperature is 36.8 C (98.2 F) , blood pressure is 132/74 mm Hg, pulse is 90/min, and respirations are 16/min. BMI is 32 kg/m². Physical examination shows dry mucous membranes. There is mild right flank tenderness without guarding or rebound tenderness.
Blood cell counts are within normal limits, serum creatinine is 1.4 mg/dL, and blood urea nitrogen is 33 mg/dL. Urinalysis shows moderate blood with numerous erythrocytes and a pH of 6.5. Urine pregnancy test is negative. Noncontrast abdominal CT scan reveals a high-density, 15-mm calculus in the proximal right ureter without hydronephrosis.
Intravenous analgesics, antiemetics, and fluids are administered. Which of the following is the most appropriate next step in management of this patient?

Definitions:

Seatbelt

A safety device in vehicles designed to secure the occupant against harmful movement that may result during a collision or a sudden stop.

Uterus

The female reproductive organ where a fertilized egg implants and develops into a fetus during pregnancy.

Shoulder Strap

A part of clothing or accessories that goes over the shoulder to support the garment or item being carried.

Preeclampsia

A condition during pregnancy marked by elevated blood pressure and evidence of harm to another organ system, typically the liver and kidneys.