A nurse is providing care to several clients. The nurse reviews each client's diagnostic and assessment findings. Which result would warrant the nurse to investigate further?
A 78-year-old client's stomach pH is increased.
A 71-year-old client's echocardiogram reveals slight left ventricular hypertrophy.
A 78-year-old client has recently developed urinary incontinence
An 81-year-old client's glomerular filtration rate (GFR) is decreased.
The Correct Answer is D
A. A 78-year-old client's stomach pH is increased.
An increased stomach pH could indicate a disruption in gastric acidity levels, which may be associated with various gastrointestinal conditions or medications. While it could be a normal variation in some cases, especially considering age-related changes, an increased stomach pH might also suggest underlying issues such as hypochlorhydria or certain medications' effects. Further investigation may be warranted to determine the cause and potential implications of this finding, especially if it's persistent or associated with symptoms.
B. A 71-year-old client's echocardiogram reveals slight left ventricular hypertrophy.
Left ventricular hypertrophy (LVH) is a common finding, particularly in older adults with hypertension or other cardiovascular risk factors. While slight LVH might not always be clinically significant, it could indicate underlying cardiac abnormalities or increased cardiovascular risk. However, it's important to note that echocardiographic findings need to be interpreted in conjunction with the patient's clinical history and other cardiac assessments to determine the significance of the finding and the need for further investigation.
C. A 78-year-old client has recently developed urinary incontinence.
Urinary incontinence is a common problem in older adults and can have various causes, including urinary tract infections, neurological disorders, medication side effects, or pelvic floor dysfunction. While it is important to assess and address urinary incontinence, particularly considering its impact on quality of life, it may not always warrant immediate further investigation unless it's associated with other concerning symptoms or complications that require assessment or treatment.
D. An 81-year-old client's glomerular filtration rate (GFR) is decreased.
A decreased glomerular filtration rate (GFR) is indicative of impaired kidney function and may suggest underlying kidney disease or other systemic conditions affecting renal function. This finding warrants further investigation to determine the cause and severity of kidney dysfunction, assess for associated complications, and guide appropriate management. Further evaluation may include additional renal function tests, imaging studies, or referral to a nephrologist for specialized care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Ensure that medical treatments comply with cultural expectations:
- This choice suggests the importance of aligning medical treatments with the cultural expectations of patients. While it's crucial to consider cultural factors when providing healthcare, the primary goal is not just to comply with cultural expectations, but rather to ensure that care is effective, respectful, and aligned with the individual's values and preferences within their cultural context.
B. Increase compliance among minority clients:
- This choice implies a focus on increasing adherence or compliance with medical recommendations among minority clients. While improving compliance is an important aspect of healthcare delivery, it should not be the sole focus when considering cultural factors. Instead, understanding culture should aim to provide culturally competent care that respects the beliefs, values, and preferences of minority clients, thereby fostering trust, engagement, and better health outcomes.
C. Provide individualized and culturally sensitive care:
- This choice accurately reflects the essence of understanding culture in healthcare. Providing individualized and culturally sensitive care involves recognizing and respecting the unique cultural backgrounds, beliefs, values, and preferences of each patient. It emphasizes the importance of tailoring care to meet the specific needs and preferences of diverse older adults within their cultural context, thereby promoting effective communication, engagement, and trust in the healthcare provider.
D. Ensure that clients get the respect customary in their own ethnic group:
- While ensuring respect for clients is indeed important, focusing solely on the respect customary in their own ethnic group may overlook the diversity of cultural backgrounds and preferences within that group. Understanding culture in healthcare goes beyond adherence to specific customs or norms and involves recognizing and respecting the individuality and diversity of each patient's cultural background and preferences. Therefore, while respect is important, the broader goal is to provide individualized and culturally sensitive care that respects the unique cultural perspectives and preferences of each patient.
Correct Answer is A
Explanation
A. Educator:
In this role, the nurse imparts knowledge and teaches the client about their health condition, including its causes, symptoms, management strategies, and preventive measures. The nurse provides information in a clear and understandable manner, tailoring the education to the client's individual needs and preferences. In the context of stress incontinence, the nurse may teach the client about pelvic floor exercises, bladder training, lifestyle modifications, and other techniques to manage the condition effectively.
B. Caregiver:
In the role of a caregiver, the nurse provides direct physical care and assistance to the client, such as helping with activities of daily living, administering medications, and providing emotional support. While caring for a client with stress incontinence may involve assisting with hygiene and addressing related concerns, such as skin care, the primary focus of the nurse in this scenario is on educating the client about managing the condition rather than providing hands-on care.
C. Advocate:
As an advocate, the nurse acts on behalf of the client to ensure their rights, preferences, and needs are respected and addressed within the healthcare system. This may involve advocating for appropriate treatment options, facilitating communication between the client and healthcare providers, and helping the client make informed decisions about their care. While advocacy is an important aspect of nursing practice, it may not be the primary role in this scenario, where the focus is on educating the client about managing stress incontinence.
D. Innovator:
The role of an innovator involves implementing new ideas, approaches, or technologies to improve patient care and outcomes. While nurses may engage in innovative practices to address various healthcare challenges, such as developing new treatment protocols or implementing evidence-based interventions, the act of educating a client about managing stress incontinence does not necessarily involve innovation in this context. Instead, it primarily involves applying established knowledge and best practices to meet the client's needs.
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