A nurse is caring for older adult clients at a long-term care facility. Which of the following assessments should the nurse consider when monitoring clients for urinary retention? (Select all that apply.)

Choice A reason: A distended bladder can cause low back pain due to the pressure and stretching of the bladder wall, which is often related to a urinary disorder such as urinary retention or obstruction.

Choice B reason: A stress fracture is less likely to be the cause of low back pain associated with an inability to void and a distended bladder.

Choice C reason: Nerve root pain typically presents with radiating pain down the leg rather than low back pain associated with urinary symptoms.

Choice D reason: Renal cancer could potentially cause low back pain, but it would not typically cause an inability to void or a distended bladder without other significant symptoms.

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.