The nurse is reviewing risk factors for cholelithiasis in a client’s history. Which factor most significantly increases the client’s risk for developing gallstones?

Choice A reason: Solar radiation delivers approximately 99.97% of Earth's climate system energy. The sun emits electromagnetic waves, primarily in visible and infrared spectra, absorbed by Earth's surface and atmosphere. This energy fuels atmospheric circulation, ocean currents, and the hydrological cycle, establishing temperature gradients that drive global weather and climate patterns. Sunspot cycles cause minor variations but affirm solar dominance.

Choice B reason: Geothermal heat, from radioactive decay in Earth's core and mantle plus residual formation heat, contributes only about 0.025% to the climate energy budget. It powers volcanic activity and tectonic processes, with localized effects like geothermal springs, but its role in atmospheric or oceanic circulation is negligible compared to solar radiation’s extensive influence.

Choice C reason: Tidal forces, driven by gravitational interactions between Earth, the moon, and the sun, produce oceanic tides, contributing less than 0.001% to the climate system’s energy. Tides influence coastal mixing but lack the magnitude to drive atmospheric circulation or global climate, making them insignificant compared to solar radiation’s vast energy input.

Choice D reason: Human activities, such as fossil fuel burning and deforestation, release greenhouse gases, altering climate by trapping solar heat. These are secondary effects, not primary energy sources, with negligible direct energy contribution. They modify solar radiation absorption, acting as feedback mechanisms, not independent drivers like the sun’s direct energy.

Choice A reason: Hepatorenal failure involves liver and kidney dysfunction, typically from chronic liver disease or shock. Elevated amylase and lipase, with pain and vomiting, point to pancreatic inflammation, not hepatorenal issues. Pancreatitis is more consistent with the client’s post-cholecystectomy presentation and lab findings.

Choice B reason: Biliary duct obstruction causes jaundice and elevated bilirubin, not amylase or lipase. Pain may radiate, but vomiting and fever with high pancreatic enzymes suggest pancreatitis, a known post-cholecystectomy complication, rather than a blocked bile duct, which lacks pancreatic enzyme elevation.

Choice C reason: Surgical site infection causes localized pain, erythema, and fever but not elevated amylase or lipase. Radiating pain and vomiting align with pancreatitis, not wound infection. Pancreatic enzyme elevation is specific to pancreatic inflammation, making infection less likely than pancreatitis in this scenario.

Choice D reason: Acute pancreatitis is characterized by elevated amylase and lipase, epigastric pain radiating to the back, vomiting, and fever. Post-cholecystectomy, bile duct manipulation or gallstone migration can trigger pancreatitis. These findings align perfectly with the client’s symptoms and lab results, making it the correct condition.