Nephrolithiasis (urolithiasis) is the formation of crystalline mineral deposits within the renal collecting system. Stones may remain asymptomatic in the kidney or cause severe obstructive uropathy as they migrate through the ureter. A completely obstructing ureteral stone is a urological emergency — bilateral obstruction or obstruction of a solitary kidney causes acute obstructive uropathy progressing to renal failure within hours to days. Obstruction combined with infection (pyonephrosis) is immediately life-threatening and requires emergency urological decompression. Top 3 nursing priorities: 1. Pain control — renal colic is among the most severe acute pain syndromes; ketorolac ± opioid IV/IM within 30 minutes of presentation 2. Strain ALL urine through a fine mesh filter — stone collection enables composition analysis and guides dietary/pharmacologic prevention 3. Recognize signs of infection or obstruction requiring emergent escalation: fever >38.5°C, rigors, WBC >15 × 10⁹/L, creatinine rising, bilateral hydronephrosis Common NCLEX trap: Students focus on pain management and miss the instruction to strain urine — stone retrieval is essential for composition analysis and secondary prevention planning. On the exam, writers often pair stable-sounding options with unstable data—notice...