A client is diagnosed with chronic kidney disease, stage 5. The nurse knows at this stage the client will have to include which of the following in their treatment that has not been needed in previous stages?

Choice a reason: Maintaining IV fluids and encouraging oral fluids is important for patients with renal colic to ensure hydration and facilitate the passage of kidney stones. However, it is not the most immediate action to take for managing the patient's current condition, which includes severe pain and hematuria.
Choice b reason: Promoting assisted ambulation as tolerated can help in the movement and passage of kidney stones. Nevertheless, it is not the priority action to take initially when the patient is experiencing severe pain and there is a need to identify the cause of the hematuria.
Choice c reason: Straining urinary output and observing for stones is the most appropriate initial action. This allows the nurse to collect any stones that pass, which can then be analyzed to determine their composition. Understanding the type of stone can help in planning further treatment and preventive measures. Identifying and collecting the stones is crucial for proper diagnosis and management of renal colic.
Choice d reason: Administering prescribed narcotic medication is essential for managing severe pain associated with renal colic. Pain management is a critical component of care. However, while it is necessary, it should be accompanied by straining the urine to detect any stones and understand the underlying cause of the symptoms.

Choice a reason: Frequent urination is a common sign and symptom of a urinary tract infection (UTI). UTIs cause inflammation and irritation in the urinary tract, leading to an increased urge to urinate frequently. Patients with UTIs often experience this symptom along with a burning sensation during urination and an urgent need to urinate, even if little urine is produced. This symptom is a direct result of the infection affecting the bladder and urethra.
Choice b reason: Joint stiffness is not associated with urinary tract infections. Joint stiffness is typically a symptom of musculoskeletal or rheumatologic conditions such as arthritis or injury. While it can be uncomfortable, it is unrelated to the urinary system and does not indicate the presence of a UTI.
Choice c reason: Chest pain is not a symptom of urinary tract infections. Chest pain can be a sign of cardiovascular issues, respiratory conditions, or musculoskeletal problems. It is important to assess chest pain seriously, but it is not related to UTIs, which primarily affect the urinary tract.
Choice d reason: Fever can be a symptom of a more severe urinary tract infection, particularly if it has spread to the kidneys (pyelonephritis). However, fever alone is not the most common symptom of a UTI. It usually occurs along with other symptoms such as frequent urination, pain, and discomfort. Fever indicates the body's systemic response to the infection, suggesting that the infection may be more widespread.