A nurse is caring for a client who has an admited diagnosis of renal calculi and a medical history of hypertension and gout. The client works 6 days a week outside in temperatures between 32.2°C to 37.8°C (90°F to 100°F). Which of the following should the nurse tell the client to prevent a recurrence of renal calculi?

The correct answer is Choice A

Choice A rationale: Headache and restlessness can be signs of a seizure or neurological disturbance, which phenytoin is used to treat. Phenytoin is an anticonvulsant medication that helps control seizures by stabilizing neuronal membranes and reducing excitability.

Choice B rationale: Decreased blood pressure and rapid pulse are not indications for phenytoin administration. These symptoms may suggest hypotension or cardiovascular issues, which require different interventions such as fluid resuscitation or vasopressors.

Choice C rationale: Muscle cramps and chest heaviness are not treated with phenytoin. These symptoms could indicate electrolyte imbalances or cardiac issues, which need specific treatments like electrolyte replacement or cardiac monitoring.

Choice D rationale: Pain and tingling at the access site are not indications for phenytoin administration. These symptoms may suggest local irritation or infection at the dialysis access site, requiring appropriate wound care or antibiotics.

Choice A reason: A diet high in calcium oxalate-rich foods should be avoided as it can contribute to the formation of calcium oxalate stones.

Choice B reason: Continuing prescribed gout medication is important, but it does not directly prevent the formation of renal calculi unless the medication is specifically for reducing uric acid levels.

Choice C reason: Drinking plenty of fluids, especially water, is one of the most effective ways to prevent the recurrence of renal calculi by diluting the urine and reducing the concentration of stone-forming minerals.

Choice D reason: A diet high in purine-rich foods can increase the risk of uric acid stones and should be avoided, especially in patients with gout and a history of renal calculi.