A nurse is reviewing the health histories of a group of clients. Which of the following findings should the nurse identify as an indication that a client is at an increased risk for urinary tract infections (UTIs)?

Rationale:
A. A pearly, waxy nodule: This is the classic presentation of basal cell carcinoma. These lesions often appear as small, shiny, flesh-colored or pink nodules with a translucent or pearly surface and may have visible blood vessels. They are slow-growing and rarely metastasize.

B. An irregular border on a variegated-colored lesion: This description is more indicative of malignant melanoma, which often appears as an asymmetric lesion with uneven borders and multiple colors, including black, brown, red, or white.

C. A firm, nodular, crusty, or ulcerated lesion: These characteristics are more commonly associated with squamous cell carcinoma, which tends to be more aggressive and can metastasize if untreated.

D. A weeping vesicle: This finding is consistent with inflammatory skin conditions such as contact dermatitis or eczema, not basal cell carcinoma. These vesicles are usually associated with allergic or irritant reactions.

Rationale:

• Hepatic encephalopathy: This is caused by the buildup of neurotoxins, particularly ammonia, due to impaired liver function. The client’s elevated ammonia level and history of chronic alcohol use and jaundice support this diagnosis. Early signs may include confusion and lethargy, progressing to coma if untreated.
• Uremic encephalopathy: This condition is caused by accumulation of urea and toxins due to kidney failure. There is no evidence in the case of renal impairment, such as elevated BUN or creatinine levels, making this diagnosis unlikely in the current context.
• Hypoglycemia: Low blood glucose can cause confusion or altered mental status, but this client’s symptoms and labs do not indicate hypoglycemia. There is no mention of a low glucose level, and the focus of concern is more aligned with liver failure than endocrine causes.

• Abdominal pain: Although abdominal pain is a relevant symptom in liver disease, it is nonspecific and not directly responsible for hepatic encephalopathy. It reflects general liver inflammation or ascites but does not cause neurologic symptoms on its own.
• Albumin 3.0 g/dL: Low albumin indicates reduced liver synthetic function and contributes to fluid shifts like ascites, but it is not neurotoxic. It does not directly cause hepatic encephalopathy or altered mental status.
• Ammonia 150 mcg/dL: This is a critically elevated value, more than double the normal upper limit. High ammonia levels are the most direct biochemical cause of hepatic encephalopathy and require immediate treatment to prevent worsening neurological decline.
• Total Bilirubin 2.0 mg/dL: While elevated bilirubin suggests cholestasis and impaired liver clearance, it leads to jaundice rather than mental status changes. It reflects liver dysfunction but is not the key factor in encephalopathy development.