The nurse on a urology unit is caring for a client diagnosed with calcium oxalate renal calculi.
When planning this client's health education, what nutritional guidelines should the nurse provide?

Hypercalcemia is a condition in which the calcium level in the blood is above normal.

This can cause various symptoms, such as confusion, constipation, and bradycardia (slow heart rate).

These are the clinical manifestations that the nurse would expect to observe in a client with hypercalcemia.

Choice A is wrong because muscle spasms are not a common symptom of hypercalcemia.

In fact, hypercalcemia can cause muscle weakness and pain.

Choice E is wrong because polyuria (excessive urination) is not a direct symptom of hypercalcemia, but rather a result of kidney problems caused by hypercalcemia.

Hypercalcemia can make the kidneys work harder to filter the excess calcium, leading to dehydration and thirst.

However, this does not necessarily mean that the client will have polyuria.

Normal ranges for calcium levels in the blood are 8.5 to 10.2 mg/dL (milligrams per deciliter) or 2.1 to 2.6 mmol/L (millimoles per liter).

Choice A reason: This hypotonic saline solution is often used after initial resuscitation, especially when the patient’s serum sodium is normal or elevated. It helps replace intracellular fluid losses and provides ongoing hydration without excessively increasing sodium levels. It is typically administered once the initial intravascular volume is restored with isotonic fluids.

Choice B reason: This isotonic saline solution is the first-line intravenous fluid used in DKA. It helps expand intravascular volume quickly, restore tissue perfusion, and correct hypovolemia caused by osmotic diuresis. It is given initially as a bolus, followed by continuous infusion until the patient is stabilized.

Choice C reason: This dextrose-containing solution is introduced once blood glucose falls to approximately 200–250 mg/dL. At this point, insulin therapy must continue to clear ketones and correct acidosis, but dextrose is added to prevent hypoglycemia. It is usually combined with saline (e.g., D5 0.45% NS) to balance hydration and glucose support.

Choice D reason: This balanced electrolyte solution is not typically the preferred fluid in DKA management because the lactate component may complicate interpretation of acid–base status. Although it can expand volume, it is generally avoided in favor of saline solutions that more directly address dehydration and electrolyte imbalance in DKA.

Choice E reason: This form of insulin is the only type used intravenously in DKA. A continuous infusion of regular insulin is essential to reduce blood glucose, suppress ketone production, and correct metabolic acidosis. It is carefully titrated with close monitoring of electrolytes, especially potassium, since insulin drives potassium into cells and can cause hypokalemia.