Answer to Question 1
Most dietary strategies and drug treatments for calcium oxalate stones aim to reduce urinary calcium and oxalate levels. Dietary measures may include adjustments in calcium, oxalate, protein, and sodium intakes. Patients should consume adequate calcium from food sources (about 800 to 1200 milligrams per day) because dietary calcium combines with oxalate in the intestines, reducing oxalate absorption and helping to control hyperoxaluria. Conversely, low-calcium diets promote oxalate absorption and higher urinary oxalate levels. Some individuals with hyperoxaluria may benefit from dietary oxalate restriction. Vitamin C intakes should not exceed the RDA (90 and 75 milligrams for men and women, respectively) because vitamin C degrades to oxalate. High intakes of protein (especially from meat, fish, poultry, or eggs) and sodium increase urinary calcium excretion, so moderate protein consumption (0.8 to 1.0 gram per kilogram of body weight per day) and a controlled sodium intake (no more than about 2000 to 3000 milligrams daily) are also advised. Patients with hypocitraturia are usually advised to reduce intakes of animal proteins and increase intakes of fruits and vegetables.
Answer to Question 2
D
Indirect Fist Percussion of Left Kidney
The DASH diet, rich in whole grains, fruits, vegetables, and low-fat dairy foods
Measuring the client’s weight with a standard platform scale
Testing the client’s ability to feel vibrations, the knee
Client positioned and draped
The client is positioned for the examination