The nurse is assessing four clients at the neighborhood clinic.
Which of these clients should the nurse identify to be at risk for the development of pernicious anemia?

Choice A rationale

A low sodium, high-calorie diet does not directly address severe pain caused by renal colic. Dietary interventions are long-term strategies for kidney health but are not immediate priorities for acute pain relief. Renal colic pain requires prompt management with pharmacological interventions to alleviate severe discomfort. Adjusting dietary intake may support prevention but would not resolve the acute symptoms, emphasizing that this is not the first-line measure for this clinical situation.

Choice B rationale

Increasing fluid intake to 3–4 L/day is beneficial for flushing out kidney stones and preventing further stone formation. However, this intervention does not directly alleviate severe pain experienced during an episode of renal colic. While adequate hydration is crucial for long-term management, acute pain demands immediate pharmacological relief. Therefore, fluid intake implementation is secondary when compared to pain management priorities.

Choice C rationale

Tamsulosin (Flomax) is an alpha-blocker that promotes the passage of kidney stones by relaxing the smooth muscles of the ureter. Although effective in expediting stone passage, it does not provide immediate pain relief for severe renal colic. Its role is valuable for the resolution of the obstruction but does not address acute symptoms. Administering pain medication remains a priority to manage distress caused by colic episodes.

Choice D rationale

Morphine sulfate is an opioid analgesic that directly targets severe pain associated with renal colic. It binds to mu-opioid receptors in the central nervous system, producing analgesia and a calming effect. Its rapid onset and effectiveness in severe pain management make it the first prescription to implement. Pain relief improves the client's comfort and allows for addressing underlying causes of colic after stabilizing acute distress.

Choice A rationale

Delaying follow-up without immediate intervention may result in the client's blood pressure remaining uncontrolled, increasing the risk of complications like cardiovascular events. Reevaluation in one month without assessing adherence neglects the urgent need for optimizing management.

Choice B rationale

Assessing adherence to both lifestyle modifications and medication therapy is crucial as noncompliance may explain the suboptimal blood pressure control. Ensuring adherence and addressing any barriers are necessary steps in evaluating the effectiveness of treatment.

Choice C rationale

Increasing medication dosage without first assessing the client's adherence to current prescriptions or lifestyle modifications may be premature. Nonadherence to therapy could render dosage adjustments ineffective, leading to unnecessary changes to the regimen.

Choice D rationale

Adding a calcium-channel blocker without assessing adherence disregards the importance of compliance. Treatment should be optimized based on existing therapy before considering additional pharmacological interventions. .