The nurse has taught nutrition management for a client diagnosed with oxalate kidney stones.
Which of the following food choices by the client would indicate that the client requires more teaching?

Choice A rationale

Malaise is more associated with systemic conditions, such as upper urinary tract infections or generalized illness, rather than isolated lower urinary tract infections. Lower UTIs tend to present with localized urinary symptoms rather than systemic effects.

Choice B rationale

Chills suggest systemic involvement and are characteristic of pyelonephritis or upper urinary tract infections. Lower UTIs typically do not produce systemic signs like chills, as the infection is confined to the bladder and urethra.

Choice C rationale

Dysuria is a classic symptom of lower UTIs. It results from inflammation of the bladder mucosa due to the presence of pathogenic organisms. The irritation of the urinary tract leads to painful or difficult urination, confirming the diagnosis of lower UTI.

Choice D rationale

High fever, like chills, is indicative of upper urinary tract infections, such as pyelonephritis. Lower UTIs are generally afebrile, presenting more with localized urinary symptoms rather than systemic manifestations.

Choice E rationale

Urinary frequency is another hallmark symptom of lower UTIs, caused by bladder irritation. The infection leads to an increased urge to urinate, even when little urine is produced. This symptom is specific to lower UTIs and supports the diagnosis when present.

Choice A rationale

Edema of the lower extremities suggests right-sided heart failure, not left ventricular failure. Fluid backs up into systemic circulation in right-sided failure, while left-sided failure primarily affects pulmonary circulation. Differentiating between these conditions is essential for targeted management.

Choice B rationale

Pulmonary crackles result from fluid accumulation in alveoli due to left ventricular failure, where decreased cardiac output causes blood to back up into pulmonary vasculature. Crackles indicate pulmonary congestion or edema. Prompt identification aids in early intervention. Normal respiratory assessment excludes crackles.

Choice C rationale

Ascites is more indicative of chronic right-sided heart failure or liver disease, not acute left ventricular failure. Ascites results from systemic venous congestion, which is less common in isolated left-sided heart failure. Differentiating causes helps refine diagnostic focus.

Choice D rationale

Jugular vein distention is associated with elevated central venous pressure, typical of right-sided heart failure or combined heart failure. It does not specifically characterize left ventricular failure. Accurate recognition of findings ensures precise diagnosis and management.