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

Pregnant women may experience increased iron demands due to expanded blood volume and fetal requirements. However, prescribed prenatal vitamins typically contain sufficient iron to prevent deficiency. Compliance with supplementation reduces the risk for anemia, and pregnancy itself is not an independent factor without nutritional inadequacy. Other physiological conditions, such as menorrhagia or dietary restrictions, can significantly elevate risk factors for iron deficiency anemia.

Choice B rationale

Hypertension does not inherently increase the risk of iron deficiency anemia. Exercise three times a week is unlikely to create significant hematological challenges unless combined with conditions like poor dietary intake or chronic illness. Physical activity does not deplete iron stores unless excessive or accompanied by inappropriate nutrition. This client does not exhibit risk factors as critical as menorrhagia or dietary restrictions for anemia development.

Choice C rationale

Working long hours and consuming a high-carbohydrate diet might affect overall health, but these factors do not directly relate to iron absorption or blood loss. While poor nutritional habits can lead to deficiencies, high carbohydrate intake does not necessarily deplete iron reserves. A vegetarian or restrictive diet lacking iron-rich foods poses a greater risk for developing anemia than carbohydrate consumption alone.

Choice D rationale

Menorrhagia results in excessive blood loss during menstruation, which can deplete iron stores and lead to anemia. A strict vegetarian diet often lacks heme iron, which is more readily absorbed compared to non-heme iron from plant sources. Together, these factors create a dual risk of iron deficiency, emphasizing why this client is the most likely among the options to develop anemia. Nutritional counseling and supplementation are key preventive measures.

Choice A rationale

Ureteral stones cause severe, colicky pain that radiates to the groin or genital area. The ureter’s narrow anatomy can trap stones, causing obstruction. This obstruction triggers increased intrarenal pressure and ureteral spasms, producing waves of intense pain. Hematuria and urinary urgency with minimal voiding are common due to mucosal irritation or obstruction.

Choice B rationale

While small stones may pass spontaneously, predicting exact timelines is speculative. Passage depends on factors like stone size, location, and hydration. For stones larger than 5 mm, spontaneous passage rates decrease, often requiring intervention. Therefore, giving definite timeframes may misinform patients and delay appropriate care.

Choice C rationale

Bladder stones typically cause suprapubic pain, urinary frequency, and hematuria rather than radiating pain to the thigh or genital area. Bladder irritation may lead to dysuria or cloudy urine, but the described symptoms are more consistent with ureteral obstruction rather than bladder involvement.

Choice D rationale

Some stones do require procedural removal, especially those causing recurrent infections or obstruction. However, initial management includes conservative measures like hydration and pain control, reserving procedures for unresolvable cases. Early procedural focus may unnecessarily alarm the client or overlook noninvasive options.