The clinic nurse is obtaining information from a client who presents for her annual wellness exam.
Which of the following statements should be used when taking a sexual health history?

Choice A rationale

Limiting fluid intake to 1500 mL/day is contraindicated for a client with renal stones. Adequate hydration, generally 2000 to 3000 mL/day, is essential to promote diuresis and the flushing of the renal calculi through the urinary system. Insufficient fluid volume increases urine concentration, which fosters the crystallization and aggregation of stone-forming solutes, thereby worsening the condition and risk of obstruction.

Choice B rationale

Straining the urine, even with a catheter in place, is a critical intervention to capture and retrieve any passed renal calculi fragments. These fragments must be sent to the laboratory for chemical composition analysis, which guides targeted preventive dietary and pharmacological therapy. Identifying the stone type (e.g., calcium, struvite, uric acid) is fundamental for effective secondary prevention of recurrence.

Choice C rationale

Clamping the urinary catheter periodically is a technique used to promote bladder muscle tone retraining, which is not indicated for a client with acute renal stones. Furthermore, clamping the catheter increases the risk of urinary stasis, promoting bacterial proliferation and reflux of urine back into the kidneys, significantly elevating the risk of pyelonephritis and sepsis.

Choice D rationale

Maintaining a client with renal stones on bed rest is not generally recommended and can be detrimental. Ambulation and mobility are encouraged as they promote the peristaltic movement of the ureters, which assists in the gravitational passage of the stone fragments. Prolonged immobility also increases the risk of bone demineralization, potentially contributing to calcium-based stone formation. 80mm.5pt.

Choice A rationale

Hydrochlorothiazide is a thiazide diuretic that works by inhibiting sodium and chloride reabsorption in the distal convoluted tubule. This mechanism causes increased excretion of both water and potassium, making the client susceptible to hypokalemia (serum potassium <3.5 mEq/L), not hyperkalemia, thereby requiring regular electrolyte monitoring.

Choice B rationale

Furosemide is a potent loop diuretic that acts on the ascending limb of the loop of Henle, blocking the reabsorption of sodium, chloride, and potassium. Its high efficacy in causing diuresis leads to significant renal loss of potassium, which places the client at a high risk for developing hypokalemia (serum potassium <3.5 mEq/L), not the elevated levels of hyperkalemia.

Choice C rationale

Mannitol is an osmotic diuretic that acts primarily by increasing the osmotic pressure of the glomerular filtrate, which inhibits the reabsorption of water. It is predominantly used for reducing cerebral edema and intraocular pressure; it does not significantly interfere with the renal tubular handling of potassium, so it poses little risk for hyperkalemia.

Choice D rationale

Spironolactone is a potassium-sparing diuretic that functions as an aldosterone receptor antagonist in the distal nephron. By blocking aldosterone's effects, it promotes sodium and water excretion while retaining potassium, which, especially in clients with impaired kidney function, significantly elevates the risk for life-threatening hyperkalemia (serum potassium >5.0 mEq/L). 80mm.5pt.