The nurse is caring for an elderly female client who has an indwelling catheter. Which data in the assessment warrants notification of the health care provider?

Change in mental status

Vital signs: T-98, P- 90, RR- 20, BP-142/88.

Client states, "No discomfort or pain."

Urine is cloudy with sediment

Answer and Explanation

The Correct Answer is A

A.   This is a significant finding that warrants immediate notification. Changes in mental status in elderly patients can indicate a variety of issues, including infection (such as a urinary tract infection), dehydration, or other acute illnesses. Given that elderly patients are at higher risk for delirium and other cognitive changes, this finding should be taken seriously.
B.   These vital signs are largely within normal limits for an elderly patient. While the blood pressure is on the higher side, the heart rate and respiratory rate are within acceptable ranges. Therefore, this does not warrant immediate notification unless other symptoms are present.
C.   This statement is reassuring and suggests that the client is not experiencing complications related to the indwelling catheter, such as infection or obstruction. It does not indicate any need for immediate notification of the provider.
D.   Cloudy urine with sediment can be indicative of a urinary tract infection (UTI) or other complications related to the indwelling catheter. While this finding is concerning and may require further evaluation, it is not as urgent as a change in mental status. It should still be reported to the healthcare provider but may not necessitate immediate action.

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Correct Answer is A

Explanation

A. Renal cancer can often present with a palpable flank mass due to tumor growth. Hematuria (blood in the urine) is also a common finding in patients with kidney tumors and can result from bleeding within the renal system. Flank pain, especially in the context of renal cancer, often accompanies these findings.
B. Dark, tarry stools (melena) suggest gastrointestinal bleeding, which is not directly associated with renal cancer. Mental status changes could indicate various issues, such as metabolic imbalances or anemia, but they are not specific findings for renal cancer.
C. While patients with advanced cancer may experience shortness of breath due to metastasis to the lungs or other complications, chest pain is not a direct finding associated with renal cancer. These symptoms could indicate other issues, such as cardiac or pulmonary problems.
D. While urinary frequency can occur due to various urinary tract issues, it is not a classic symptom of renal cancer. Hypotension is also not a typical finding associated with renal cancer unless there is significant blood loss or other complications.

A. Utilizing hormone replacement therapy B. Yearly colposcopy testing C. Utilizing safer sex methods D. Vaginal ultrasound every 2 years

Correct Answer is C

Explanation

A. This choice is not relevant to reducing the risk of cervical cancer. Hormone replacement therapy (HRT) is primarily used to manage symptoms of menopause and does not have a protective effect against cervical cancer.
B. While colposcopy is a diagnostic procedure used to evaluate abnormal cervical findings, it is not a routine screening method. The primary screening method for cervical cancer is the Pap test (Papanicolaou test) combined with HPV (human papillomavirus) testing. Colposcopy is usually performed after an abnormal Pap test result, not on a yearly basis for general screening.
C. Utilizing safer sex methods, such as consistent use of condoms and reducing the number of sexual partners, can help decrease the risk of acquiring HPV, which is the primary cause of cervical cancer. Promoting safe sexual practices is a key component of cervical cancer prevention.
D. This choice is not effective for reducing the risk of cervical cancer. While vaginal ultrasounds may be used for various gynecological assessments, they are not a screening tool for cervical cancer and do not reduce the risk of developing the disease.

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The nurse is caring for an elderly female client who has an indwelling catheter. Which data in the assessment warrants notification of the health care provider?

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Naxlex Comprehensive Predictor Exams

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