A nurse is caring for a client with a history of recurrent kidney stones. Which of the following instructions should the nurse include in the client's discharge teaching to help prevent stone formation?

A. Fever and chills are more commonly associated with a urinary tract infection, which can sometimes be a complication of kidney stones. However, the severe pain described is more likely related to the presence of the stone itself.

B. This is the correct answer. Blood in the urine, also known as hematuria, is a common symptom of kidney stones. As the stone moves through the urinary tract, it may cause irritation and small blood vessels may be damaged, resulting in blood in the urine.

C. Difficulty starting the urine stream is not a specific symptom of kidney stones. It may be seen in other urinary conditions but is not typically associated with stones.

D. The frequent urge to urinate may be experienced if the stone causes irritation in the bladder, but it is not the most common symptom associated with kidney stones.

A. Limiting fluid intake to 1 liter per day is not recommended to prevent kidney stone formation. Adequate hydration is essential to

help prevent stone formation, as it helps dilute the urine and reduce the concentration of minerals that can lead to stone formation.

B. Decreasing dietary fiber intake is not a preventive measure for kidney stones. In fact, increasing dietary fiber intake can be beneficial for overall health.

C. Reducing calcium intake from all sources is not recommended to prevent kidney stones. In some cases, reducing dietary calcium intake can actually increase the risk of certain types of kidney stones.

D. This is the correct answer. Increasing citric acid intake can help prevent certain types of kidney stones, such as calcium oxalate stones. Citric acid helps to bind calcium in the urine, reducing the risk of stone formation. Citric acid can be found in citrus fruits and juices, and the nurse may advise the client to include more of these foods in their diet.