The nurse provides care for a client who has a history of renal calculi. Which type of renal calculi is most common in clients with gout?

Choice A reason: A sacculated aneurysm in the circle of Willis is not the most likely cause of a left-sided embolic stroke. A sacculated aneurysm is a bulging of a weak spot in the wall of an artery, which may occur in the circle of Willis, a network of arteries at the base of the brain. A sacculated aneurysm may cause a hemorrhagic stroke, which is a bleeding into the brain, not an embolic stroke, which is a blockage of a blood vessel by a clot.

Choice B reason: Rupture of small cerebral blood vessels is not the most likely cause of a left-sided embolic stroke. Rupture of small cerebral blood vessels may occur due to hypertension, diabetes, or aging, which may damage the integrity of the blood vessel walls. Rupture of small cerebral blood vessels may cause a hemorrhagic stroke, which is a bleeding into the brain, not an embolic stroke, which is a blockage of a blood vessel by a clot.

Choice C reason: Diffuse inflammation of the small diameter blood vessels is not the most likely cause of a left-sided embolic stroke. Diffuse inflammation of the small diameter blood vessels may occur due to vasculitis, which is an autoimmune disorder that causes inflammation and narrowing of the blood vessels. Diffuse inflammation of the small diameter blood vessels may cause a thrombotic stroke, which is a formation of a clot within the blood vessel, not an embolic stroke, which is a blockage of a blood vessel by a clot that travels from another site.

Choice D reason: Migration of a clot from the left atrium of the heart is the best explanation for the most likely cause of a left-sided embolic stroke. An embolic stroke is a type of ischemic stroke, which is a lack of blood flow to the brain due to a blockage of a blood vessel by a clot. A clot may form in the left atrium of the heart due to conditions such as atrial fibrillation, which is an irregular heartbeat that causes blood to pool and clot in the heart. A clot may then break off and travel through the bloodstream until it reaches a smaller blood vessel in the brain, where it causes an embolic stroke.

Choice A reason: Fewer numbers of parietal cells in the gastric mucosa is not the best explanation because it is a condition that affects the production of gastric acid, not the development of duodenal ulcers. Parietal cells are the cells that secrete hydrochloric acid and intrinsic factor in the stomach. Hydrochloric acid helps to digest food and kill bacteria, while intrinsic factor helps to absorb vitamin B12. Fewer numbers of parietal cells can cause hypochlorhydria, which is a low level of gastric acid, or pernicious anemia, which is a deficiency of vitamin B12. Hypochlorhydria can increase the risk of bacterial overgrowth and infections, while pernicious anemia can cause symptoms such as fatigue, weakness, and neurological problems.

Choice B reason: Helicobacter pylori infection is the best explanation because it is the most common cause of duodenal ulcers, which are sores that form in the lining of the first part of the small intestine, called the duodenum. Helicobacter pylori is a type of bacteria that can survive in the acidic environment of the stomach and the duodenum. It can damage the protective layer of mucus that covers the lining of the digestive tract, exposing it to the gastric acid and causing inflammation and ulceration. Helicobacter pylori infection can also increase the production of gastrin, which is a hormone that stimulates the secretion of gastric acid, and decrease the production of somatostatin, which is a hormone that inhibits the secretion of gastric acid.

Choice C reason: Slowed gastric emptying is not the best explanation because it is a condition that affects the movement of food from the stomach to the small intestine, not the development of duodenal ulcers. Gastric emptying is the process of passing the food that has been partially digested in the stomach to the duodenum, where it is further broken down and absorbed. Slowed gastric emptying can be caused by various factors, such as diabetes, medications, or nerve damage, and can result in symptoms such as nausea, vomiting, bloating, or fullness.

Choice D reason: Frequent use of acetaminophen is not the best explanation because it is a factor that affects the development of gastric ulcers, not duodenal ulcers. Acetaminophen is a type of medication that is used to relieve pain and fever. It can cause gastric ulcers by inhibiting the synthesis of prostaglandins, which are substances that protect the lining of the stomach from the gastric acid and promote healing. Acetaminophen can also cause liver damage if taken in high doses or for a long time.