A nurse is teaching a group of clients about the risk factors for developing cholelithiasis. Which client is at the highest risk for developing gallstones?

Rationale: A. While chronic alcohol use and smoking are associated with liver disease, pancreatitis, and cardiovascular risk, they are not primary contributors to gallstone formation. Men generally have a lower risk for cholelithiasis than women, and without additional risk factors like obesity or hormonal influences, his overall risk remains moderate. B. This client demonstrates protective factors against gallstone formation. Regular physical activity helps maintain healthy body weight and promotes bile flow, while a low-fat diet reduces cholesterol saturation in bile, decreasing the likelihood of stone formation. His age and sex also place him at relatively low risk. C. Oral contraceptives containing estrogen can slightly increase the risk of gallstones because estrogen increases cholesterol secretion into bile and may impair gallbladder emptying. However, this client’s young age and absence of obesity or other risk factors reduce her overall risk. A high-protein diet has minimal direct effect on gallstone formation. D. This client exhibits multiple major risk factors for cholelithiasis. Female sex is a well-known risk factor because estrogen promotes cholesterol saturation in bile and reduces gallbladder motility. Obesity increases cholesterol levels in bile, further predisposing to stone formation. A history of multiple pregnancies (multiparity) exposes the gallbladder to repeated high estrogen levels, increasing the likelihood of gallstones. Age over 40 adds an additional risk. The combination of these factors makes her the highest-risk individual among the options.